Substance Abuse News

Men and women with a history of alcohol abuse may not see long-term negative effects on their memory and thinking, but female smokers do, a new study suggests.

In a study of 287 men and women ages 31 to 60, researchers found that those with past alcohol-use disorders performed similarly on standard tests of cognitive function as those with no past drinking problems.

The findings were not as positive when it came to tobacco, however.

Cognitive Function Impaired

In general, women who had ever been addicted to smoking had lower scores on certain cognitive tests than their nonsmoking counterparts. The same pattern was not true of men, however, the researchers report in the Journal of Studies on Alcohol and Drugs.

The reasons for the disparate findings on alcohol and smoking are not fully clear. Nor do they necessarily mean that serious alcohol problems would not affect long-term memory and other cognitive abilities; most study participants who had ever had drinking problems met the criteria for alcohol abuse rather than the more serious diagnosis of dependence.

Alcohol abuse was diagnosed when people reported one symptom of problem drinking — drinking and driving, for instance, or failing to meet work or school obligations as a result of drinking. Dependence, on the other hand, required people to have at least three symptoms — such as needing to drink more and more to achieve the same effects and experiencing physical withdrawal symptoms when they did not drink.

Alcoholics Not ‘Doomed’

If more study participants had been alcohol dependent, the findings on cognition might have been different, says lead researcher Dr. Kristin Caspers, an assistant research scientist in the department of psychiatry at the University of Iowa in Iowa City.

But the bottom line, she says, is that people with a history of alcohol abuse appear not to be “doomed” to suffer cognitive effects when current levels of drinking are in the light to moderate range.

The findings are based on assessments of 115 men and 169 women with an average age of 43. Overall, 45 percent of men and 37 percent of women met the criteria for lifetime alcohol abuse, and 13 percent and nearly 4 percent, respectively, had a lifetime history of alcohol dependence. One quarter of women and 18 percent of men had a history of tobacco dependence.

Overall, women who reported having ever smoked 20 or more cigarettes a day scored lower than nonsmokers on tests of executive function — that is, “higher-order” brain functions that include the ability to reason, plan and organize. The scores were, however, all within normal range.

Estrogen a Factor?

As for why smoking was related to cognitive scores only among women, it’s possible that there is a role for estrogen, according to Caspers.

Animal research suggests that nicotine lowers blood estrogen levels and may inhibit the positive effects of the hormone on brain cells. Sixty percent of the women in the current study were between the ages of 40 and 54, when menopause usually occurs. In theory, nicotine may exacerbate any brain-cell effects of fluctuating estrogen levels in women as they age, the researchers speculate.

In a study published in the journal Addiction, researchers in the United States have discovered that accidental overdose deaths involving cocaine rise when the average weekly ambient temperature passes 24 degrees Celsius (75 degrees Fahrenheit). Using mortality data from New York City’s Office of the Chief Medical Examiner for 1990 through 2006, and temperature data from the National Oceanic and Atmospheric Association, researchers found that accidental overdose deaths that were wholly or partly attributable to cocaine use rose significantly as the weekly ambient temperature passed 24 degrees Celsius. The number of cocaine-related overdose deaths continued to rise as temperatures continued to climb.

Cocaine Increases Body Temperature

Cocaine-related overdose deaths increase as the ambient temperature rises because cocaine increases the core body temperature, impairs the cardiovascular system’s ability to cool the body, and decreases the sense of heat-related discomfort that ordinarily motivates people to avoid becoming overheated. Cocaine users who become overheated (hyperthermic) can overdose on lower amounts of cocaine because their bodies are under more stress.

The study’s findings correct previous research that associated an increase in cocaine-related mortality with much higher temperatures (31.1 degrees Celsius, or 87.9 degrees Fahrenheit). Because cocaine-related overdose fatalities begin to rise at lower ambient temperatures than was previously thought, it is now apparent that cocaine users are at risk for longer periods of each year. Between 1990 and 2006, the average weekly temperature in New York City rose above 24 degrees Celsius for about seven weeks per year.

Deaths Linked to Temperature Rise

The study showed no difference in the number of drug overdoses in New York City among those weeks where the average temperature was between -10 and 24 degrees Celsius. Above 24 degrees Celsius, however, there were 0.25 more drug overdoses per 1,000,000 residents per week for every two degrees increase in weekly average temperature. Given that over 8.2 million people live in New York City, the study’s findings predict that at least two more people per week will die of a drug overdose in the city for each two degree rise in temperature above 24 degrees Celsius, compared to weeks with average temperatures of 24 degrees and below.

The authors of this study point out the need for public health interventions in warm weather, such as delivering health-related warnings to high-risk groups. Prevention efforts could also include making air conditioning available in locations where cocaine use is common such as urban areas with a known high prevalence of cocaine use, and within those urban areas, particular neighbourhoods with elevated numbers of cocaine-related deaths or arrests. As lead author Dr. Amy Bohnert explains, “Cocaine users are at a high risk for a number of negative health outcomes and need public health attention, particularly when the weather is warm.”

Of the 2.3 million inmates crowding our nations prisons and jails, 1.5 million meet the DSM IV medical criteria for substance abuse or addiction, and another 458,000, while not meeting the strict DSM IV criteria, had histories of substance abuse; were under the influence of alcohol or other drugs at the time of their crime; committed their offense to get money to buy drugs; were incarcerated for an alcohol or drug law violation; or shared some combination of these characteristics, according to Behind Bars II: Substance Abuse and America’s Prison Population. Combined these two groups constitute 85 percent of the U.S. prison population.

The new 144-page report released today by The National Center on Addiction and Substance Abuse (CASA) at Columbia University also reveals that alcohol and other drugs are significant factors in all crime. In 2006, alcohol and other drugs were involved in these inmate offenses:

• 78 percent of violent crimes;
• 83 percent of property crimes; and
• 77 percent of public order, immigration or weapon offenses; and probation/parole violations.

The CASA report found that only 11 percent of all inmates with substance abuse and addiction disorders receive any treatment during their incarceration. The report found that if all inmates who needed treatment and aftercare received such services, the nation would break even in a year if just over 10 percent remained substance and crime free and employed. Thereafter, for each inmate who remained sober, employed and crime free the nation would reap an economic benefit of $90,953 per year.

“States complain mightily about their rising prison costs; yet they continue to hemorrhage public funds that could be saved if they provided treatment to inmates with alcohol and other drug problems and stepped up use of drug courts and prosecutorial drug treatment alternative programs,” said Susan E. Foster, CASA’s Vice President and Director of Policy Research and Analysis.

Joseph A. Califano, Jr., CASA’s Chairman and President and former U.S. Secretary of Health, Education, and Welfare, called the nation’s current prison policies, “Inane and inhuman. Between 1996 and 2006, the U.S. population grew by 12 percent. Over that same period, the number of adults incarcerated grew by 33 percent to 2.3 million inmates and the number of inmates who either met the DSM IV medical criteria for alcohol or other drug abuse and addiction or were otherwise substance involved shot up by 43 percent to 1.9 million inmates. The tragedy is that we know how to sharply reduce the costs of incarceration and the crimes committed by substance-involved offenders.”

The report also noted that in 2005, federal, state and local governments spent $74 billion on incarceration, court proceedings, probation and parole for substance-involved adult and juvenile offenders and less than one percent of that amount–$632 million–on prevention and treatment for them.*

Twelve years ago, CASA released Behind Bars: Substance Abuse and America’s Prison Population. CASA prepared this report to see if any progress had been made in reducing the number of substance-involved offenders behind bars and to examine and identify promising practices for cost-effective investments. To conduct this study, CASA researchers analyzed data on inmates from 11 federal sources, reviewed more than 650 articles and other publications, examined best practices in prevention and treatment for substance-involved offenders, reviewed accreditation standards and analyzed costs and benefits of treatment.

“Despite increased recognition of the problem and its potential solutions, we have made no progress in reducing the number of substance-involved inmates crowding our prisons and jails. The United States has less than five percent of the world’s population and we consume two-thirds of the world’s illegal drugs and incarcerate almost a quarter of the world’s prisoners, more than eight of ten of whom have some substance involvement,” said Califano.

The CASA report also found that compared to non-substance involved inmates, substance-involved inmates are not only likelier to be re-incarcerated, begin their criminal careers at an early age, and have more contacts with the criminal justice system, but they are also:

• Four times likelier to receive income through illegal activity;
• Twice as likely to have had at least one parent who abused alcohol or other drugs when they were children;
• 41 percent likelier to have some family criminal history;
• 29 percent less likely to have completed at least high school; and
• 20 percent likelier to be unemployed a month before incarceration.

Other Key Findings

In 2006, an estimated one million substance-involved inmates were parents to more than 2.2 million minor children. Three quarters of these children were age 12 or younger.
Alcohol is implicated in the incarceration of more than half of all inmates in America; illicit drugs are implicated in three quarters of incarcerations.
Contrary to public perception, only two percent of all inmates are incarcerated for marijuana possession as their controlling or only offense.

A Call for Action

To reduce the number of substance-involved inmates crowding our prisons, improve the health of inmates and reduce crime, the CASA report offers specific recommendations in its call for action by the nation’s criminal justice systems and federal, state, and local governments including these:

• Use trained health care professionals to screen, assess and treat substance-involved offenders and provide care for co-occurring physical and mental health problems.
• Provide comprehensive pre-release planning and aftercare to continue treatment services for inmates with substance use disorders.
• Require addiction treatment for inmates to be medically managed.
• Expand the use of treatment-based alternatives to jail and prison.
• Require accreditation for prison- and jail-based treatment programs and providers.

“This report lays out the steps we need to take to address the treatment needs of offenders while holding them accountable for their crimes,” noted Foster. “We do not as a nation refuse to provide treatment for other chronic ailments like heart disease or diabetes. We should do so for addictive disorders, especially when the added benefits of treatment for offenders include significant reductions in crime and its costs to society.”

A novel technology for delivering nicotine to the lungs may soon give smokers a new way to kick the habit.

When compared to the nicotine vapor delivery system used in the Nicotrol/Nicorette inhaler, the new technology proved more effective at delivering nicotine to the blood stream. As a result, it provides immediate relief of withdrawal symptoms, according to Duke University Medical Center researchers. Users also reported the new nicotine delivery method was more tolerable than the current inhaler because it caused less throat irritation.

Smoking Without Danger?

“We wanted to replicate the experience of smoking without incurring the dangers associated with cigarettes, and we wanted to do so more effectively than the nicotine replacement therapies currently on the market,” said Jed Rose, Ph.D., director of the Duke Center for Nicotine and Smoking Cessation Research where the technology is being developed. He presented the data today at the Society for Nicotine and Tobacco Research (SRNT) in Baltimore, MD.

The Nicotrol inhaler is a smoking cessation therapy that delivers nicotine vapor to the mouth and upper airways, but little of it reaches the lungs.

Duke’s new technology employs a unique method to deliver nicotine to the lungs. In today’s presentation, the researchers show the new lung delivery technology results in rapid absorption of nicotine that provides immediate relief of withdrawal symptoms and also re-creates some of the familiar sensations that are pleasurable to smokers.

Current methods that deliver medicine to the lungs — metered dose sprays, dry powder inhalers or nebulizers that create a fine mist – do not replicate the natural inhalation used by smokers when drawing on a cigarette. And, because medication residue often deposits in the mouth and throat, doses aren’t always high enough to ensure the appropriate amount reaches the lungs.

Combining Two Vapors

Duke’s new technology combines the vapor phase of pyruvic acid, which occurs naturally in the body, and nicotine. “When the two vapors combine, they form a salt called nicotine pyruvate,” explains Rose. “This reaction transforms invisible gas vapors into a cloud of microscopic particles which is inhaled, just like a smoker inhales from a cigarette.”

In a study of the new Duke technology, nine healthy smokers inhaled 10 puffs of nicotine pyruvate in increasing doses, 10 puffs from a Nicotrol/Nicorette inhaler cartridge, and 10 puffs of room air (placebo). Blood was drawn before and after each set of inhalations. When the results were analyzed, the Duke researchers noted rapid increases in plasma nicotine concentrations following the nicotine pyruvate inhalations and less complaints of harshness/irritation when compared to the Nicotrol/Nicorette control cartridge. The smokers also said their cravings for cigarettes were substantially alleviated following the nicotine pyruvate inhalations.

“Compared to the current nicotine vapor inhaler, we are able to give smokers more nicotine, although still less than a cigarette, with less irritation, resulting in reduced cravings,” said Rose. “Thus we are able to achieve a therapeutic effect with greater tolerability.”

More research is needed to examine the safety and effectiveness of prolonged use of the inhalation system, and to assess its role in helping people quit smoking. But, Rose says if all goes well, he anticipates the product could become commercially available within three to five years.

He also says the novel inhalation system may one day prove useful for delivery of other medications. Duke has filed patent applications on the new technology, which was invented by Rose and his colleagues, including his brother, Seth D. Rose, Ph.D., Duke colleague, Thangaraju Murugesan, Ph.D., and James E. Turner, an inventor of the Nicotrol/Nicorette inhaler.