Substance Abuse News

Heavy smoking in midlife is associated with a 157 percent increased risk of developing Alzheimer’s disease and a 172 percent increased risk of developing vascular dementia, according to a Kaiser Permanente study published in the Archives of Internal Medicine.

This is the first study to look at the long-term consequences of heavy smoking on dementia.

Increased Risk Among Smokers

Researchers followed an ethnically diverse population of 21,123 men and women from midlife onward for an average of 23 years. Compared with non-smokers, those who had smoked more than two packs of cigarettes a day had more than a 157 percent increased in risk of Alzheimer’s disease and 172 percent increased risk of vascular dementia during the mean follow-up period of 23 years. Vascular dementia, the second most common form of dementia after Alzheimer’s disease, is a group of dementia syndromes caused by conditions affecting the blood supply to the brain.

“This study shows that the brain is not immune to the long-term consequences of heavy smoking,” said the study’s principal investigator, Rachel A. Whitmer, Ph.D., a research scientist with the Kaiser Permanente Division of Research in Oakland, Calif. “We know smoking compromises the vascular system by affecting blood pressure and elevates blood clotting factors, and we know vascular health plays a role in risk of Alzheimer’s disease.”

Researchers analyzed prospective data from of 21,123 Kaiser Permanente Northern California members who participated in a survey between 1978 and 1985. Diagnoses of dementia, Alzheimer’s disease and vascular dementia made in internal medicine, neurology, and neuropsychology were collected from 1994 to 2008. The researchers adjusted for age, sex, education, race, marital status, hypertension, hyperlipidemia, body mass index, diabetes, heart disease, stroke, and alcohol use.

Brain Vessels Affected

“While we don’t know for sure, we think the mechanisms between smoking and Alzheimer’s and vascular dementia are complex, including possible deleterious effects to brain blood vessels as well as brain cells,” said study co-author Minna Rusanen, MD, of the University of Eastern Finland and Kuopio University Hospital in Finland.

This study is the latest in a series of published Kaiser Permanente research to better understand the modifiable risk factors for dementia. This ongoing body of research adds to evidence base that what is good for the heart is good for the brain, and that midlife is not too soon to begin preventing dementia with good health. The other studies led by Whitmer found that a large abdomen in midlife increases risk of late-life dementia, elevated cholesterol levels in midlife increase risk of Alzheimer’s disease and vascular dementia, and low blood-sugar events in elderly patients with type 2 diabetes increase dementia risk. Another Kaiser Permanente study led by Valerie Crooks of Kaiser Permanente in Southern California found that having a strong social network of friends and family appears to decrease risk for dementia.

Researchers may have pinpointed a reason many smokers struggle to quit. According to new research published in the journal Addiction, smokers with a history of anxiety disorders are less likely to quit smoking. The study, conducted by the University of Wisconsin Center for Tobacco Research and Intervention (UW-CTRI), offered free coaching and medications to smokers in Madison and Milwaukee.

While overall quit rates for the study were high, participants with anxiety diagnoses were much less likely to quit smoking.

Anxiety Diagnosis Is Common

Study results also showed that anxiety diagnoses were very common among participants — more than a third of them met criteria for at least one anxiety diagnosis in their lifetime. Out of all 1,504 study participants, 455 had had a panic attack in the past, 199 social anxiety disorder, and 99 generalized anxiety disorder (some reported having more than one diagnoses). Other research has shown that up to 25 percent of the more than 50 million smokers in the U.S. had at least one anxiety disorder in their lifetime. And yet, very little research has addressed smoking in this population.

Lead author Megan Piper says it surprised her that the nicotine lozenge and patch — alone or in combination — failed to help patients with an anxiety history to quit smoking. In the general population, the lozenge and patch — especially when combined — have been very effective in helping patients quit smoking. Bupropion (Zyban) alone, or in combination with the nicotine lozenge, also did not increase cessation rates among patients with a history of anxiety disorders.

“Further research is needed to identify better counseling and medication treatments to help patients with anxiety disorders to quit smoking,” Piper says.

Anxiety and Nicotine Dependence

Smokers in the study with anxiety disorders also reported higher levels of nicotine dependence and withdrawal symptoms prior to quitting. Smokers often experience craving, negative feelings and difficulty concentrating in the minutes or hours after finishing a cigarette, and those feelings can be heightened simply because the smokers know they’re about to attempt to quit. In addition, participants with a history of panic attacks or social-anxiety disorder experienced more negative feelings on their quit day than did smokers in the study without this history.

These findings suggest that clinicians should assess anxiety-disorder status when helping patients quit smoking. While anxiety medications alone haven’t boosted cessation rates, Piper is planning further research to test other quit-smoking counseling interventions and medications with patients who have had an anxiety diagnosis.

In the meantime, all smokers can call the national tobacco quit line at 1-800-QUIT-NOW for free, confidential coaching and support to quit smoking.

After a major review of scientific information, six leading tobacco research and policy experts have concluded that a nicotine reduction strategy should be an urgent research priority because of its potential to profoundly reduce the death and disease from tobacco use. Their findings were published today in the journal Tobacco Control.

According to this new report, reducing the amount of nicotine in cigarettes to non-addictive levels could have a significant public health impact on prevention and smoking cessation. Over time, the move could dramatically reduce the number of annual deaths related to cigarette smoking by decreasing adolescent experimentation with cigarettes preventing a progression to addiction, and by reducing dependence on tobacco among currently addicted smokers of all ages.

Reducing Nicotine to Non-Addictive Levels

Dorothy Hatsukami, Ph.D., University of Minnesota Medical School, and Mitch Zeller, J.D., Pinney Associates in Bethesda, MD, led the overall effort as co-chairs of the National Cancer Institute’s Tobacco Harm Reduction Network. They convened several meetings of researchers, policy makers, tobacco control advocates and government representatives that explored the science base for a nicotine reduction strategy.

Currently, about 44 million (or 20 percent) of adults in the United States smoke cigarettes. Other research cited by the authors had found that reducing nicotine to non-addictive levels could potentially reduce smoking prevalence to about 5 percent.

“Nicotine addiction sustains tobacco use. Quitting tobacco can be as difficult to overcome as heroin or cocaine addiction,” said Hatsukami, director of the University of Minnesota’s Tobacco Use Research Center and the Masonic Cancer Center’s Cancer Control and Prevention Research Program “Reducing the nicotine in cigarettes to a level that is non-addicting could have a profound impact on reducing death and disability related to cigarettes and improving overall public health.”

Hatsukami adds that studies to date have found that substantial reduction in nicotine in cigarettes does not lead to smokers smoking more lower-nicotine cigarettes because it is harder to compensate for very low nicotine intake.

“In addition, studies have shown a significantly lower number of cigarettes are smoked when low-nicotine cigarettes are used, resulting in eventual abstinence in a considerable number of smokers,” she said.

Preventing Youthful Addiction

“Imagine a world where the only cigarettes that kids could experiment with would neither create nor sustain addiction,” Zeller said. “The public health impact of this would be enormous if we can prevent youthful experimentation from progressing to regular smoking, addiction, and the resulting premature disease and death later. Reducing the nicotine content in cigarettes may be a very effective way to accomplish this major impact,” he added.

Hatsukami, Zeller, and their colleagues recommend engaging scientific, research and government agencies to conduct the necessary research and set priorities and goals as the next step toward determining the feasibility of a nicotine reduction approach.

Hispanic middle school students may be more likely to smoke, drink or use marijuana than their peers of other races and ethnicities, whereas Asian students seem to have the lowest risk, according to new research in the September issue of the Journal of Studies on Alcohol and Drugs.

The study, of 5,500 seventh- and eighth-graders at 16 California schools, found that young Hispanic adolescents were more likely than other students to have ever used alcohol, cigarettes or marijuana. Asian students, meanwhile, had the lowest rates of substance use compared with Hispanic, white and African American students.

Race a Factor in Substance Abuse?

Moreover, the study found that some of the factors that seemed to influence kids’ odds of substance use also varied by race and ethnicity.

Among Hispanic youth, it was personal factors that were linked to the risk of substance use — including their confidence in their ability to “say no” and whether they believed drinking, smoking and drug use had more negative consequences.

In contrast, a wider range of factors was linked to Asian teens’ relatively low rates of substance use — not only those same personal-level factors but also respect for their parents and lower rates of substance use among their older siblings and peers.

The findings point to some important issues that could be addressed in substance-use prevention programs for middle school students, according to Regina A. Shih, Ph.D., and colleagues at the research organization RAND Corporation.

Culturally Appropriate Interventions

“Most interventions haven’t really been tailored to be culturally appropriate,” Shih explained. For example, “skills training,” where kids learn how to resist pressure to smoke, drink or use drugs, could help address one of the personal factors that was connected to Hispanic students’ higher rates of substance use.

Similarly, interventions that encourage positive parent-child communication and boost kids’ sense of responsibility to their parents might help maintain lower rates of substance use — and could be particularly effective for young Asian teens.

Shih said, however, that the researchers are not suggesting that such targeted efforts only be offered to students of certain ethnicities — but that they could be widely applied in prevention programs to help the broadest range of kids possible. Many existing interventions target these types of personal factors and address adolescent and parent communication. “It is important for parents to be aware that many youth initiate substance use during the middle school years, and parents can help their teen make healthier choices by monitoring their activities and talking with them about these issues,” Shih said.

Of all students in the study, 22 percent said they had ever used alcohol, 10 percent admitted to smoking at some point, and 7 percent reported marijuana use. In general, the odds of substance use were highest among Hispanic students, lowest among Asians and not statistically different between white and African American students.

Hispanic Students at Greater Risk

When it came to drinking, for example, 26 percent of Hispanic students said they had ever tried alcohol, versus 21 percent of black students, 18 percent of whites and just below 10 percent of Asians.

When the researchers accounted for several other factors — including gender and students’ family structures — Hispanic middle schoolers still had a higher probability, and Asian students still had a lower probability, of ever using cigarettes, alcohol or marijuana, compared with white students.

Using this large longitudinal sample, Shih’s team will be able to continue to follow young adolescents over time to see which personal, family and school factors seem to predict the initiation or worsening of teens’ smoking, drinking or drug use.

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.