Substance Abuse News

Standard therapeutic techniques decrease cravings of cigarette smokers by regulating activity in two separate but related areas of the brain, a new study led by a Yale University researcher shows.

Smokers who are taught cognitive strategies, such as thinking about the long-term consequences of smoking, show increased activity in the prefrontal cortex, an area of the brain associated with cognitive control and rational thought. They also show decreased activity in areas of the striatum, an area of the brain associated with drug craving and reward-seeking behavior, according to the paper published online Aug. 2 in the Proceedings of the National Academy of Sciences.

“This shows that smokers can indeed control their cravings, they just need to be told how to do it,” said Hedy Kober, assistant professor of psychiatry at the Yale School of Medicine and lead author of the paper.

Cravings Trigger Relapse

Cravings are the triggers that often lead to relapse in a host of addictions, which carry a staggering economic and social cost. Cigarette smoking alone is responsible for over 400,000 deaths per year in the U.S. (more than all illicit drugs and alcohol combined). Some experts predict that substance abusers should show impairments in areas of the prefrontal cortex, which among other functions helps control emotion. But in smokers at least, this does not appear to be the case. This area of the brain showed increased activity—and smokers reported less intense cravings—when using cognitive strategies.

Cognitive behavioral therapy has been shown to be an effective tool in treating a variety of mental health disorders, including substance use disorders. The new study shows why this approach is effective, Kober said.

“We do not see any impairment in the prefrontal cortex, which suggests the brain is able, when prompted, to recruit control regions to reduce cravings,” Kober said.

In the largest study of its kind, researchers at the Southwest Foundation for Biomedical Research (SFBR) have found that exposure to cigarette smoke can alter gene expression — the process by which a gene’s information is converted into the structures and functions of a cell. These alterations in response to smoking appear to have a wide-ranging negative influence on the immune system, and a strong involvement in processes related to cancer, cell death and metabolism.

Smoking Influences Genes

The scientists indentified 323 unique genes whose expression levels were significantly correlated with smoking behavior in their study of 1,240 people. The changes were detected by studying the activity of genes within white blood cells of study participants.

“Our results indicate that not only individual genes but entire networks of gene interaction are influenced by cigarette smoking,” wrote lead author Jac Charlesworth, Ph.D., in the July 15 issue of the open access journal BMC Medical Genomics. Charlesworth, formerly at SFBR, is now a research fellow at the Menzies Research Institute at the University of Tasmania in Australia.

The study was funded by the National Institutes of Health and the Azar and Shepperd families of San Antonio, ChemGenex Pharmaceuticals and the AT&T Foundation. The study is part of SFBR’s San Antonio Family Heart Study (SAFHS) which includes 40 families in the Mexican American community.

Smoking and Transcriptomics

“Previous studies of gene expression as influenced by smoking have been seriously limited in size with the largest of the in vivo studies including only 42 smokers and 43 non-smokers. We studied 1,240 individuals, including 297 current smokers” Charlesworth said. “Never before has such a clear link between smoking and transcriptomics been revealed, and the scale at which exposure to cigarette smoke appears to influence the expression levels of our genes is sobering”.

“Our results indicate that not only individual genes but entire networks of gene interaction are influenced by cigarette smoking. It is likely that this observed effect of smoking on transcription has larger implications for human disease risk, especially in relation to the increased risk of a wide variety of cancers throughout the body as a result of cigarette smoke exposure,” Charlesworth said.

Newborns of non-smoking moms exposed to secondhand smoke during pregnancy have genetic mutations that may affect long-term health, according to a University of Pittsburgh Graduate School of Public Health study published online in the Open Pediatric Medicine Journal. The abnormalities, which were indistinguishable from those found in newborns of mothers who were active smokers, may affect survival, birth weight and lifelong susceptibility to diseases like cancer.

Secondhand Smoke Dangers

The study confirms previous research in which study author Stephen G. Grant, Ph.D., associate professor of environmental and occupational health at Pitt’s Graduate School of Public Health, discovered evidence of abnormalities in the HPRT gene located on the X chromosome in cord blood from newborns of non-smokers exposed to environmental tobacco smoke.

In the current study, Dr. Grant confirmed smoke-induced mutation in another gene called glycophorin A, or GPA, that is representative of oncogenes – genes that transform normal cells into cancer cells and cause solid tumors. The GPA mutation was the same level and type in newborns of mothers who were active smokers and of non-smoking mothers exposed to tobacco smoke. Likewise, the mutations were discernable in newborns of women who had stopped smoking during their pregnancies, but who did not actively avoid secondhand smoke.

Permanent Genetic Damage

“These findings back up our previous conclusion that passive, or secondary, smoke causes permanent genetic damage in newborns that is very similar to the damage caused by active smoking,” said Dr. Grant. “By using a different assay, we were able to pick up a completely distinct yet equally important type of genetic mutation that is likely to persist throughout a child’s lifetime. Pregnant women should not only stop smoking, but be aware of their exposure to tobacco smoke from other family members, work and social situations.”

Second hand smoke exposure is associated with psychological distress and risk of future psychiatric illness, according to new UCL research that suggests the harmful affects of passive smoking go beyond physical health.

The new research, published in the Archives of General Psychiatry, examined the associations between mental health and second hand smoke (SHS) exposure – known as passive smoking – by measuring the circulating biochemical marker cotinine, which is found in saliva and can be used to measure levels of exposure to tobacco smoke. The study found that SHS exposure is associated with psychological distress and risk of future psychiatric illness in healthy adults.

Secondhand Smoke and Distress

A representative sample of 5,560 non-smoking adults and 2,689 smokers without history of mental illness were drawn from the 1998 and 2003 Scottish Health Surveys. A score greater than 3 on the 12-item General Health Questionnaire was employed as an indicator of psychological distress. Incident psychiatric hospital admissions over 6 years follow up were also recorded.

Psychological distress was apparent in 14.5% of the sample. In an analysis of the data, after adjustments for a range of potential confounding factors such as social status, high SHS exposure among non-smokers (cotinine levels between 0.70 and 15 micrograms per litre) was associated with 50% higher odds of reporting psychological distress in comparison with participants with cotinine levels below the limit of detection. Active smokers were also more likely to report psychological distress. The risk of future psychiatric illness was also related to high SHS exposure and active smoking.

Lead author Dr Mark Hamer, UCL Epidemiology & Public Health, said: “SHS exposure at home is growing in relative importance as restrictions on smoking in workplaces and public places spread. A growing body of literature has demonstrated the harmful physical effects of second hand smoke exposure, but there has been limited research about the affects on mental health.

Nicotine and Mental Health

“Animal data have suggested that tobacco may induce a negative mood, and some human studies have also identified a potential association between smoking and depression. Our data is therefore consistent with other emerging evidence to suggest a causal role of nicotine exposure in mental health. Importantly, this study advances previous research because we obtained an accurate assessment of SHS exposure using a valid biochemical indicator.

“Mental ill health accounts for almost 20% of the burden of disease in the European Region and can affect one in four people at some time in their life. Our findings emphasise the importance of reducing SHS exposure at a population level, not only for the benefit of our physical health but for our mental health as well.”

A novel study by German researchers reported that alcohol consumption and cigarette smoking were associated with increased migraines and tension-type headaches (TTH) in high school students. Coffee drinking and physical inactivity were associated specifically with migraines. Results of this study, the first to investigate modifiable risk factors for different types of headaches in a youth population, appear online early in Headache, a journal of the American Headache Society.

Prior studies have indicated that headache is one of the most frequently reported health complaints in adolescents with 5%-15% of this age group suffering from migraine and 15%-25% with TTH. Modifiable risk factors, such as alcohol use, cigarette smoking and coffee drinking which have been associated with headache in adults, have not been fully explored in a youth population.

Headaches and Alcohol, Smoking

Astrid Milde-Busch, Ph.D. and colleagues at the Ludwig-Maximilians-University in Munich, Germany invited 1,260 students in grades 10 and 11 (aged 14-20) from eleven area public schools to participate in the study. The students were asked to fill out a questionnaire on headache and associated lifestyle factors. Students were asked: ‘Did you have headache during the last seven days/three months/six months?’ and were classified as headache sufferers if the response was positive. Furthermore, migraine and TTH were differentiated by questions regarding headache characteristics and symptoms. The questionnaire also inquired about diet and lifestyle (e.g. ‘Do you daily have breakfast before you go to school?’; ‘How much beer, wine and cocktails do you normally drink?’; ‘How much coffee do you normally drink?’; ‘Do you smoke?’).

Research results show 83.1% of students reported headache at least once during the previous six months with 10.2% reporting migraine; 48.7% citing TTH; and 19.8% having combined migraine plus TTH. For diet, 28.4% of students never had breakfast; 16.5% did not eat a daily break meal (snack); and only 24.0% had a daily warm lunch. Researchers found that 22.3% of students consumed less than 1 liter (4.23 8 ounce cups) of non-alcoholic drinks per day. Alcohol consumption, however, was widespread among students in the study with 38.5%, 18.6%, and 25.3% drinking beer, wine, and cocktails at least once per week, respectively. Results also showed that 73.3% of participants reported never smoking and 43.4% students noted that they did not drink coffee.

Coffee Drinking and Migraine

The authors found that a high consumption of alcoholic drinks and coffee, smoking, and lack of physical activity were significantly associated with migraine plus TTH episodes. There was a significant association of coffee drinking and physical inactivity with migraine. “Our study confirms, adolescents with any type of headache might benefit from regular physical activity and low consumption of alcoholic drinks,” commented Dr. Milde-Busch. “In teens suffering from migraine a low coffee consumption should also be suggested.” Skipping meals or insufficient fluid intake was not associated with any type of headache.

According to the Centers for Disease Control and Prevention (CDC), 75% of high school students in the U.S. have had one or more alcoholic drinks during their lifetime (2007). A 2004 report by the World Health Organization (WHO) notes that alcohol consumption by those under 20 varies by country and “a trend of increased drinking to intoxication.” Cigarette smoking is another modifiable risk factor in which youths engage and a 2002 WHO report estimated about 1 in every 5 teens worldwide (aged 13

A nationwide smoking ban would save more than $90 million and significantly reduce hospitalizations for heart attack, according to a Henry Ford Hospital study.

After analyzing data from the 13 states that don’t have a law banning smoking in public places, researchers concluded that more than 18,596 fewer hospitalizations for heart attack could be realized from a smoking ban in all 50 states after the first year of implementation, resulting in more than $92 million in savings in hospitals costs for caring for those patients.

The study, funded by the hospital, will be presented Thursday at the American Heart Association’s annual Quality of Care and Outcomes Research conference in Washington.

Smokers Harming Themselves

“Even if you just save one heart attack, it is something significant,” says Mouaz Al-Mallah, M.D., Henry Ford’s co-director of Cardiac Imaging Reearch and lead author of the study. “When people smoke, they are not only harming themselves, they’re harming those around them who are exposed to secondhand smoke.”

A similar study conducted in 2008 by Dr. Al-Mallah found that a smoking ban in Michigan could lead to a 12 percent drop in heart attack admissions after the first year of implementation. On May 1, Michigan became the 38th state to ban smoking in public places.

Prior research involving risk reduction from smoking bans has shown that heart attack rates can be reduced by 11 percent after a comprehensive smoking ban.

Henry Ford obtained 2007 data on the number of heart attack discharges, length of stay and hospital charges from the 13 states currently without a public smoking ban. Researchers found 169,043 hospitalizations for heart attack were reported in the states with a comprehensive smoking ban. When the same 11 percent risk reduction was applied to the non-smoking states, researchers concluded it would led to 18,596 fewer heart attack admissions.

As fewer people puff on cigarettes, a new smoking trend may be gaining popularity among North American youth. A study published in the journal Pediatrics has found that almost one-quarter of young adults in Montreal had used waterpipes (also known as shishas or hookahs) in the past year.

“The popularity of waterpipes may be due in part to perceptions that they are safer than cigarettes. However, waterpipe smoke contains nicotine, carbon monoxide, carcinogens and may contain greater amounts of tar and heavy metals than cigarette smoke,” warns senior investigator Jennifer O’Loughlin, a professor at the University of Montreal Department Of Social and Preventive Medicine and a scientist at the University of Montreal Hospital Research Center.

Hookahs Popular Among Males

As part of a longitudinal cohort investigation (NDIT Study), 871 youth aged 18 to 24 completed questionnaires on their smoking habits. The research team, which included scientists from the University of Montreal, the National Institute of Public Health of Quebec and McGill University, found that 23 percent of respondents had used a waterpipe within the last 12 months and that 5 percent had used waterpipes one or more times in the past month.

The study found waterpipes to be particularly popular among young, English-speaking males who lived on their own and had a higher household income. In addition, the research team found that waterpipe users were more likely to use other psychoactive substances such as cigarettes, marijuana, illicit drugs and alcohol.

It is well-known that maternal smoking during pregnancy can have long-term effects on the physical health of the child, including increased risk for respiratory disease, ear infections and asthma. New research shows that prenatal smoking also can lead to psychiatric problems and increase the need for psychotropic medications in childhood and young adulthood.

Smoking and Psychiatric Problems

Finnish researchers found that adolescents who had been exposed to prenatal smoking were at increased risk for use of all psychiatric drugs especially those uses to treat depression, attention-deficit/hyperactivity disorder (ADHD) and addiction compared to non-exposed youths. The study will be presented Tuesday, May 4 at the Pediatric Academic Societies (PAS) annual meeting in Vancouver, British Columbia, Canada.

“Recent studies show that maternal smoking during pregnancy may interfere with brain development of the growing fetus,” said Mikael Ekblad, lead author of the study and a pediatric researcher at Turku University Hospital in Finland. “By avoiding smoking during pregnancy, all the later psychiatric problems caused by smoking exposure could be prevented.”

Smoking and Birthweight

Ekblad and his colleagues collected information from the Finnish Medical Birth Register on maternal smoking, gestational age, birthweight and 5-minute Apgar scores for all children born in Finland from 1987 through 1989. They also analyzed records on mothers’ psychiatric inpatient care from 1969-1989 and children’s use of psychiatric drugs.

Results showed that 12.3 percent of the young adults had used psychiatric drugs, and of these, 19.2 percent had been exposed to prenatal smoking.

The rate of psychotropic medication use was highest in young adults whose mothers smoked more than 10 cigarettes a day while pregnant (16.9 percent), followed by youths whose mothers smoked fewer than 10 cigarettes a day (14.7 percent) and unexposed youths (11.7 percent).

Smoking Affects Unborn Child

The risk for medication use was similar in males and females, and remained after adjusting for risk factors at birth, such as Apgar scores and birthweight, and the mother’s previous inpatient care for mental disorders.

Smoking exposure increased the risk for use of all psychotropic drugs, especially stimulants used to treat ADHD (unexposed: 0.2 percent; less than 10 cigarettes/day: 0.4 percent; and more than 10 cigarettes/day: 0.6 percent) and drugs for addiction. An increased risk for use of drugs to treat depression also was seen (unexposed: 6 percent; less than 10 cigarettes/day: 8.6 percent; and more than 10 cigarettes/day: 10.3 percent).

“Smoking during pregnancy is still quite common even though the knowledge of its harmful effects has risen in recent years,” Ekblad concluded. “Recent studies have shown that smoking during pregnancy has negative long-term effects on the health of the child. Therefore, women should avoid smoking during their pregnancy.”

Kids who have just started smoking, but not on a daily basis, don’t seem to recognize the early symptoms of dependence, according to a new study.

Published in the latest issue of Pediatrics by Chyke Doubeni, MD, MPH of the University of Massachusetts, the study found that among kids who have started smoking, “an urge to smoke or being irritable because they are not able to smoke is a sign of early dependence. But they don’t seem to recognize that symptoms such as irritability are harbingers of addiction.”

“Previous studies have already shown that there is a strong correlation between symptoms of nicotine dependence and nicotine addiction. This study shows that adolescents who start smoking, don’t appear to recognize the early signs of dependence,” Doubeni said. Other signs of early dependence that go unnoticed include experiencing a desire to smoke or craving for a cigarette.

Early Signs of Nicotine Dependence

The study concluded that nondaily use of tobacco can trigger any of these early signs of dependence. Early dependence promotes increased smoking. That in turn accelerates additional signs of dependence, which leads to even higher frequencies of smoking. Eventually, it leads to addiction.

The conclusions are based on a study that surveyed adolescent smokers every three to four months, over a four-year period from 2002-2006. The study found that over those four years, of the 370 subjects who had inhaled from a cigarette, 62% smoked at least once per month, 52% experienced dependence symptoms, and 40% went on to become daily smokers.

The study, “Early Course of Nicotine Dependence in Adolescent Smokers,” provides additional evidence supporting the Food and Drug Administration’s (FDA) recent rules placing restrictions on tobacco marketing to youth. Tobacco companies are challenging some of the FDA’s rules in court.

Using CT scans to measure blood flow in the lungs of people who smoke may offer a way to identify which smokers are most at risk of emphysema before the disease damages and eventually destroys areas of the lungs, according to a University of Iowa study.

The study found that smokers who have very subtle signs of emphysema, but still have normal lung function, have very different blood flow patterns in their lungs compared to non-smokers and smokers without signs of emphysema.

Smokers and Emphysema

This difference could be used to identify smokers at increased risk of emphysema and allow for early intervention. The findings appear this week in the Early Edition of the Proceedings of the National Academy of Sciences.

“We have developed a new tool to detect early emphysema-related changes that occur in smokers who are susceptible to the disease,” said lead study author Eric Hoffman, Ph.D., UI professor of radiology, internal medicine and biomedical engineering. “Our discovery may also help researchers understand the underlying causes of this disease and help distinguish this type of emphysema from other forms of chronic obstructive pulmonary disease. This type of CT scan could even be a tool to test the effectiveness of new therapies by looking at the changes in lung blood flow.”

Targeting COPD

As many as 24 million Americans have chronic obstructive pulmonary disease (COPD) — a group of serious lung diseases that includes emphysema — and COPD is the fourth leading cause of death nationwide. Because COPD is a group of different diseases, identifying more effective treatments may hinge on distinguishing between these diseases and targeting them separately.

The team used multi-detector row CT imaging to measure blood flow patterns in the lungs of 41 study participants — 17 non-smokers and 24 smokers. All the participants had normal lung function, but 12 of the smokers had very subtle signs of emphysema. The CT scans showed that these 12 individuals had the most disrupted patterns of blood flow compared to the other participants.

The findings also support the idea that abnormal blood flow occurs before emphysema develops.

“Although the underlying causes of emphysema are not well understood, smoking increases the risk of developing the disease,” Hoffman said. “Our study suggests that some smokers have an abnormal response to inflammation in their lungs; instead of sending more blood to the inflamed areas to help repair the damage, blood flow is turned off and the inflamed areas deteriorate.”

Repairing the Damage

The cellular pathway that turns off blood flow is helpful when an area of the lung has become permanently blocked and cannot be rescued. In that case, the lung “optimizes gas exchange” and stops supplying the area with blood. However, lung inflammation caused by smoking can be resolved and resultant damage repaired by increased blood flow, which brings oxygen and helpful cellular components to the site of injury.

This study suggests that the ability to distinguish when to turn off or when to ramp up blood flow is defective in some people — probably due to genetic differences. If this genetic difference is coupled with smoking, which increases lung inflammation, that could increase the risk of developing emphysema.