Archive for February, 2016

Marijuana smokers more likely to develop an alcohol problem

Adults who use marijuana are five times more likely to develop an alcohol use disorder (AUD) –alcohol abuse or dependence– compared with adults who do not use the drug. And adults who already have an alcohol use disorder and use marijuana are more likely to see the problem persist.

Results of a study by researchers at Columbia University’s Mailman School of Public Health and the City University of New York appear online in the journal Drug and Alcohol Dependence.

Increased Risk of Alcohol Problems

“Our results suggest that cannabis use appears to be associated with an increased vulnerability to developing an alcohol use disorder, even among those without any history of this,” said Renee Goodwin, PhD, associate professor of Epidemiology at the Mailman School of Public Health. “Marijuana use also appears to increase the likelihood that an existing alcohol use disorder will continue over time.”

The researchers analyzed data from 27,461 adults enrolled in the National Epidemiologic Survey on Alcohol and Related Conditions who first used marijuana at a time when they had no lifetime history of alcohol use disorders.

The population was assessed at two time points. Adults who had used marijuana at the first assessment and again over the following three years (23 percent) were five times more likely to develop an alcohol use problem, compared with those who had not used marijuana (5 percent).

Marijuana Smokers Delay Alcohol Treatment

Adult problem drinkers who did not use cannabis were significantly more likely to be in recovery from alcohol use disorders three years later.

“From a public health standpoint we recommend that further research be conducted to understand the pathways underlying these relationships as well as the degree to which various potentially vulnerable population subgroups — youth, for example — are at increased risk,” noted Goodwin. “If future research confirms these findings, investigating whether preventing or delaying first use of marijuana might reduce the risk of developing alcohol use disorders among some segments of the population may be worthwhile.”

February 26th, 2016  in Substance Abuse No Comments »

Early Binge Drinking Can Cause Hypertension

Having an occasional drink is fine, but “binge” drinking is a known health hazard and now high blood pressure may need to be added to the list of possible consequences.

Young adults in their twenties who regularly binge drink have higher blood pressure which may increase the risk of developing hypertension, concludes a study conducted by researchers at the University of Montreal Hospital Research Centre (CRCHUM).

Binge drinking (i.e. consuming five or more alcoholic beverages in less than two hours), is quite prevalent: previous studies in Canada and the U.S. have shown that about four in ten young adults aged 18 to 24 are frequent binge drinkers.

Binge Drinking Affects Blood Pressure

Now researchers have demonstrated, for the first time, that binge drinking may have an effect on blood pressure, which can increase the risk of developing hypertension and chronic diseases related to hypertension.

“We found that the blood pressure of young adults aged 20 to 24 who binge drink was 2 to 4 millimetres of mercury higher than non-binge drinkers,” says Jennifer O’Loughlin, senior author of a study published today in the Journal of Adolescent Health.

Data on alcohol consumption at age 20 were collected from 756 participants in the Nicotine Dependence in Teens study, which has followed 1294 young people from diverse social backgrounds in Montreal, Canada since 1999. Data were collected again at age 24, at which time participants’ systolic blood pressure was also taken.

One in Four Affected, Study Shows

Systolic blood pressure measures the pressure in the arteries when the heart beats (i.e., when the heart muscle contracts), and it should be below 140 millimetres of mercury. A blood pressure reading of more than 140 over 90 indicates high blood pressure. The latter number, diastolic blood pressure, measures the pressure in the arteries between heartbeats (i.e., when the heart muscle is resting between beats and refilling with blood).

“Our findings show that more than one in four young adults who binge drink meet the criterion for pre-hypertension (i.e., a systolic blood pressure between 120 and 139 millimetres of mercury). This is worrisome because this condition can progress to hypertension, which in turn can cause heart disease and premature death,” says O’Loughlin, a researcher at the CRCHUM and professor in the School of Public Health, University of Montreal.

Risk of Chronic Diseases

Health professionals and others may need to adopt a preventive approach, recommends O’Loughlin: “Poor diet, salt intake, and obesity are predictors of high blood pressure.

Since we know there is a link between higher blood pressure and the risk of developing chronic diseases, clinicians should ask young people about their alcohol consumption. A slight and continuous increase in systolic blood pressure may be an important warning sign.”

The study also revealed that 85% of young adults who drink heavily at age 20 maintain this behaviour at age 24. But unlike our genetic make-up, risky behaviour can be changed.

When to Intervene?

The researchers will now investigate whether this trend toward high blood pressure will continue when binge drinkers turn 30. With work and family obligations, binge drinking may become less frequent. Other questions that arise include: will the short-term effects of binge drinking disappear when binge drinking declines?

Is there a critical time period in which to intervene to prevent hypertension? While awaiting for answers to these questions, the old adage “moderation is always in good taste” may apply.

February 26th, 2016  in Alcohol No Comments »

Chronic alcohol use helps bacteria harm the liver

End-stage liver disease or liver cirrhosis is the tenth leading cause of death in the United States, and approximately half of these cases are related to alcohol consumption. There’s no refuting that alcohol itself harms the liver, but new research in mice and humans published February 10 in Cell Host & Microbe reveals that chronic drinking also promotes the growth of gut bacteria that can travel to the liver and exacerbate liver disease.

Gastroenterologist Bernd Schnabl of the University of California, San Diego School of Medicine and his colleagues found that chronic alcohol consumption suppresses the mouse antibacterial defense system in the intestine. It does so by blocking intestinal cells’ ability to produce natural antibiotic proteins (called REG3B and REG3G).

Gut Bacteria Reaching the Liver

“Intestinal bacteria can now not only proliferate, but also slowly migrate through the intestinal wall,” says Schnabl. “Since the liver encounters all the blood coming from the intestine, not only important nutrients but also bacteria can now reach the liver. The direct damage that is caused by alcohol to the liver is augmented by the arrival of these gut bacteria, through mechanisms that are currently unknown.”

The team also found that mice genetically engineered to lack REG3G had more of these bacteria after consuming alcohol, and they developed more severe alcoholic liver disease than their littermates. However, restoring REG3G to the intestine reduced the levels of bacteria that traveled to the liver and protected against alcohol-induced liver damage.

Finally, the researchers found that humans with alcohol dependency had elevated levels of bacteria in their small intestines. The team’s previous research showed that they also had lower levels of REG3G.

Probiotic Bacteria Needed

While it may be best for patients at risk of liver disease to stop drinking altogether, Schnabl notes that it can be difficult for some to do so. These latest findings indicate that it may be possible to help patients with alcoholic liver disease by boosting their intestinal defense against certain bacteria, for example by encouraging the growth of good (probiotic) bacteria or by stimulating the production of intestinal antibiotics such as REG3G.

The National Institute on Alcohol Abuse and Alcoholism states that “low-risk” drinking levels for men are no more than 4 drinks on any single day and no more than 14 drinks per week. For women, “low-risk” drinking levels are no more than three drinks on any single day and no more than 7 drinks per week.

February 13th, 2016  in Alcohol No Comments »

Gambling by teens linked to other risk-taking behaviors

Gambling among young teens may be associated with increased use of alcohol, cigarettes, or marijuana according to a study that surveyed sixth- to eighth-graders in Italian schools. The research is reported in the February issue of the Journal of Developmental & Behavioral Pediatrics, the official journal of the Society for Developmental and Behavioral Pediatrics. The journal is published by Wolters Kluwer.

The high prevalence of gambling and its association with substance use “provides further evidence of the need for a greater awareness of gambling behavior in early adolescence,” according to the new research by Dr. Alessandra Buja of University of Padova, Italy, and colleagues.

Gambling Associated with ‘Risk-Taking Behavior’ in Young Teens

The study included 1,325 sixth- to eighth-graders from Italian schools participating in a program for the prevention of underage substance abuse. In surveys, the students answered questions about their experience with certain types of gambling: video poker, online betting, and “scratch-and-win” cards (such as lottery tickets).

The students were also asked about their use of alcohol, cigarettes, marijuana, and energy drinks. (Use of energy drinks, which contain stimulants, has been linked to substance use and other risk-taking behaviors.) Associations between gambling and substance use were evaluated, including adjustment for a wide range of other factors.

The results suggested a high rate of gambling in this group of children and young teens. Among eighth-graders, about 46 percent of boys and 35 percent of girls said they had engaged in at least one sort of gambling. Scratch cards were the most common type of gambling.

Gambling Linked to Substance Abuse

Children who had experience with gambling were also more likely to report substance use. Gambling was reported by 60 percent of children who smoked cigarettes, 73 percent of those who used alcohol, and 63 percent of those who used marijuana.

Gambling remained significantly associated with substance use and other risk-taking behaviors, after adjustment for demographic, family, peer, personality, and behavioral characteristics previously linked to substance abuse in young people

Previous studies in older adolescents have linked gambling to substance use disorders. Dr. Buja and coauthors note, “Today’s youth are the first generation for whom gambling opportunities are as close as the neighborhood corner store and as easily accessible as the Internet.”

Parents Think It’s Harmless

The new findings are consistent with previous reports suggesting that many adolescents and even younger children are involved in gambling, despite legal age limits. Parents may see gambling as a harmless activity–rather than restricting or warning against it, they may even initiate their children into betting and gambling.

“Our data show that a history of gambling is associated with risk-taking behavior relating to the use of other substances in very young adolescents,” Dr. Buja and coauthors write. However, they note that the direction of the relationship remains open to debate: “Impulsiveness may be an important common denominator linking gambling with substance abuse in adolescence.”

The high rate of gambling and its association with substance use highlights the need for effective strategies to prevent gambling in early adolescence, according to Dr. Buja and colleagues. They conclude, “It is important for healthcare professionals, teachers, and parents to recognize this problem and take it seriously.”

February 9th, 2016  in Substance Abuse No Comments »

Phone counseling insufficient to help teen smokers

In a 14-year study involving more than 2,000 teen smokers in 50 Washington state high schools, a team of cancer prevention researchers at Fred Hutchinson Cancer Research Center has found that one year of telephone counseling using motivational interviewing and skills training delivered during the senior year of high school is insufficient to help the smokers quit and stay quit up to six years into young adulthood.

The finding is significant because previous results from the same study had indicated that the intervention did have a beneficial effect in helping smokers quit earlier, at one year after high school. This earlier finding was a research breakthrough: It was the first-ever demonstration of effectiveness of a smoking-cessation intervention in a population-based sample of teens.

But today the researchers report that, by the time the teens became young adults, the earlier effectiveness had completely faded. Two-thirds of the teen smokers who had quit earlier had gone back to smoking. These findings, by principal investigator Dr. Arthur V. Peterson Jr., database manager Patrick Marek, and colleagues in the Public Health Sciences Division at Fred Hutch, are reported in a paper published Feb. 1 in the peer-reviewed, open-access journal PLOS ONE.

Extended Interventions Needed

This new finding means that to help teen smokers quit and stay quit after high school and beyond, new extended interventions are needed: ones that stick with them longer than just one year, and that continue into young adulthood.

Telephone counseling was used because of its special appeal to teens. It provided private, confidential, one-to-one counseling and allowed the counselors to explore and focus on issues specific to the individual smoker. Telephone counseling also gave teens control over the timing and length of the counseling sessions.

The motivational interviewing approach, first described in the early ’80s by Dr. William R. Miller, seeks to learn from each client their thoughts, attitudes, and practices about smoking and non-smoking. This approach aims to explore and resolve the participants’ ambivalence about smoking and quitting, and to mobilize their inner resources to trigger a decision to quit.

Motivational Interviewing

“Motivational interviewing is very caring, nonjudgmental and respectful,” explained Kathleen Kealey, co-investigator and intervention manager of the study. “It is non-confrontational. A counselor would never say, ‘I want you to quit smoking.’ Instead the counselor would ask what the behavior means to the participant. What do they like about it? What don’t they like about it? In the end, it is the smoker’s own reasons and desire to quit that motivate the quit attempt.”

The deferential approach of motivational interviewing is especially appropriate for high school students, because teens in particular don’t want to be told what to do. Motivational interviewing puts them in the driver’s seat.

In the beginning, this approach worked. Smokers responded in large numbers to invitations from the telephone counselors to participate in the conversations. In the experimental telephone counseling group, 65 percent of the smokers agreed, with their parents’ permission, to participate during their senior year of high school. “To get this large amount of participation by teen smokers was a terrific vote of confidence in telephone counseling that uses the motivational interviewing approach,” said Peterson, lead author of the paper.

Worked in the Short Term

The findings were based on data from the Hutchinson Study of High School Smoking, the largest and longest randomized trial of teen smoking cessation ever conducted. “This study showed that most teens are interested in sharing their views and practices about smoking. The field has encountered great obstacles in recruiting teens to smoking-cessation programs. And so, the large participation rates accomplished in this study were a big breakthrough.”

There were good reasons to think that an expanded multi-year version of telephone counseling based on motivational interviewing might work to help teen smokers quit and stay quit for the long term. First of all, this study has shown that teens like the deferential approach of motivational interviewing. Indeed, two-thirds of smokers in the study were happy to accept the study’s invitation and participate in telephone conversations.

Also, the motivational interviewing approach worked in the short term: at one year post high school it led to increased six-month abstinences, a strict measure of quitting smoking. “But it is well known that individual motivations, and pressures to smoke, change substantially in the critical period after high school,” Peterson said. “So, a sustained intervention that sticks with them during this period of change, aimed at helping them address their changing motivations and new situations to help them avoid relapse to smoking, makes good sense.”

High Level of Interest in Quitting

Fifty high schools in Washington state collaborated with Peterson and colleagues on this long-term, randomized trial. Half of the schools were randomly assigned to the experimental intervention; teens in these schools were, with their parents’ permission, proactively contacted and invited to take part in confidential, personalized telephone counseling designed to help motivate them to quit. The remaining 25 schools served as a comparison group; teen smokers from these schools did not participate in the telephone intervention.

“It was only because of the tremendous cooperation from students, parents, teachers and administrators that this study was able to rigorously address the important question of how to help interested teen smokers to quit,” Peterson said. “Without such a high level of interest and cooperation this study could not have been done.”

February 1st, 2016  in Tobacco No Comments »