substance abuse

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Rat Study Suggests Teen Binge Drinking Could Cause Lasting Brain Effects

sixpacks

(racineur via Compfight)

Remember the neuroscience study this spring that seemed to indicate that even casual marijuana use could cause lasting changes in teen brains? It was, shall we say, a bit controversial — to the point that the Knight Science Journalism Tracker, a leading arbiter of science coverage, questioned both what the study’s authors said and how the media handled it, here: Don’t bogart that joint: Casual marijuana use linked to brain changes?

Now, a new study on rats out of the University of Massachusetts at Amherst and Louisiana State suggests that binge drinking in adolescence can cause long-lasting damage to brain pathways still developing in the young. The press release quotes neuroscience researcher Heather Richardson of UMass:

“Adverse effects of this physical damage can persist long after adolescent drinking ends. We found that the effects of alcohol are enduring.” She adds, “The brains of adolescent rats appear to be sensitive to episodic alcohol exposure. These early experiences with alcohol can physically alter brain structure, which may ultimately lead to impairments in brain function in adulthood.”

She and her colleagues believe their study is the first to show that voluntary alcohol drinking has these effects on the physical development of neural pathways in the prefrontal cortex, one of the last brain regions to mature.

In humans, early onset of alcohol use in young teenagers has been linked to memory problems, impulsivity and an increased risk of alcoholism in adulthood. Because adolescence is a period when the prefrontal cortex matures, Richardson adds, it is possible that alcohol exposure might alter the course of brain development. Rodent models used in this study are documented to have clinical relevance to alcohol use disorder in humans.

Of particular concern: I think of the prefrontal cortex as, well, where I think, the seat of rationality and control, the highest of the higher brain functions. Not a good place to damage — not that there’s any good place in the brain to damage.

On the lasting effects: Continue reading

Even At Mass. General, Medical Training On Addiction Deemed Lousy

Massachusetts General Hospital is one of the highest paid in the state. (Steven Senne/AP)

Massachusetts General Hospital. (Steven Senne/AP)

Even at the lofty institution that bears the nickname Man’s Greatest Hospital, most medical residents think they’re not taught well enough about addiction and substance abuse, a 2012 survey found.

The hospital itself, Massachusetts General Hospital, sent over word of the study today, and says it has since increased addiction training for medical residents, who estimate that one-quarter of the inpatients they see have a substance abuse problem. From its press release:

BOSTON – A 2012 survey of internal medicine residents at Massachusetts General Hospital (MGH) – one of the nation’s leading teaching hospitals – found that more than half rated the training they had received in addiction and other substance use disorders as fair or poor.

Significant numbers felt unprepared to diagnose or treat such disorders, results similar to surveys of practicing physicians. In response to the findings, published online in the journal Substance Abuse, the MGH has increased residents’ training in addiction medicine.

“Our residents estimated that one in four hospital inpatients has a substance use disorder, which matches what other studies have found and represents a disease prevalence similar to that of diabetes,” says Sarah Wakeman, MD, chief medical resident at MGH and lead author of the report. “Finding that the majority of residents feel unprepared to treat addiction and rate the quality of their education so low represents a tremendous disparity between the burden of disease and the success of our current model of training.”

The study’s authors note that residents provide most direct medical care in teaching hospitals and often find caring for patients with addictions to be troublesome – possibly due to a lack of training and faculty role models – which can lead to a lack of trust between patients and physicians. Continue reading

Report: Inpatient Detox Costs Patients Ever More Out Of Pocket

Source: Health Care Cost Institute

Source: Health Care Cost Institute

Here’s some valuable national context for a hot local struggle over inpatient detox beds.

The local news, from the Boston Globe yesterday:

Brigham and Women’s Faulkner Hospital is modifying its plan for closing an inpatient drug and alcohol detoxification unit, after the proposal drew heavy criticism from patients, hospital staff, and mental health advocates who said the state has too few such specialized facilities and the change could harm patients.

“Sure,” I thought when I saw that. “Those attempted cuts fit with all you hear about mental health care as the neglected stepchild of other medical care, and substance abuse as the even more neglected stepchild of mental health care.”

But that’s just my lazy, impressionistic thinking. The quants with hearts over at the Health Care Cost Institute have just used their monumentally huge data sets of tens of millions of insurance claims to pin down what’s been happening lately with inpatient substance abuse payments. And I’d say they, too, found a certain stepchild factor, at least in terms of what patients must pay out of pocket.

Their new report says, according to the press release:

In 2011, out-of-pocket payments for mental health admissions more closely aligned with payments for medical/surgical admissions. However, the amount spent out-of-pocket on substance use admissions remained higher than payments for medical/surgical admissions. Out-of-pocket payments for substance use hospital admissions grew at twice the rate of out-of-pocket payments for mental health or medical/surgical admissions between 2010 and 2011.

The report also found that rates of inpatient detox had taken a major jump after the federal “parity” law, requiring health insurers to cover mental health similarly to physical health, kicked in: Continue reading

Overdose Antidote: What The Government Doesn't Do, And What You Can

naloxone

(PunchingJudy/Flickr Creative Commons)

You hear a lot these days about the national epidemic of painkiller overdoses. What you don’t hear so much about is what you can do to respond to those overdoses when they happen, much as we learn about CPR or defibrillators for heart attacks.

In an opinion piece just out in the Journal of the American Medical Association, Northeastern University assistant professor of law and health sciences Leo Beletsky and his co-authors argue that the government should do far more to enable the public to fight overdoses. Why doesn’t it? And what can each of us do? He explains here.

By Leo Beletsky
Guest contributor

Now a true national crisis, overdose from opioid drugs like Oxycontin and heroin kills about 16,000 Americans every year. Outranking car accidents, it is now the leading cause of accidental death in many states, including Massachusetts.

Rural and poor communities are particularly hard-hit, but contrary to popular belief, this epidemic does not discriminate: Overdose victims come from all classes, races, and age groups. Deaths afflict both legitimate and illicit users of prescription medications as well as those using street drugs like heroin.

Many of these deaths could be averted. Long-term prevention efforts are needed, but in the meantime, there are some straightforward things we can all do immediately to stop overdoses from turning fatal.

First: From the onset of the telltale signs of overdose, such as shallow breathing and slow pulse, it typically takes 30 to 90 minutes for the victim to die. This provides a precious window of opportunity to save a life. The tragic reality is that people often don’t recognize the overdose in time and thus don’t quickly call 911.

Second: Most people do not realize that once an ambulance has been called, they can help save the victim’s life. The key is to determine if the person is breathing; if not, rescue breathing and CPR should be performed. And ideally, the drug naloxone should be given to the victim.

Leo Beletsky

Northeastern University’s Leo Beletsky (Courtesy of Northeastern)

What is naloxone? Known by the brand name Narcan, it is an overdose antidote, a drug whose only effect is to reverse an overdose from opioid drugs like Oxycontin, Vicodin or heroin. Given via injection or nasal spray, it blocks the opioid receptors in the brain, typically working within about four minutes to revive the victim.

It seems like a no-brainer, doesn’t it? Shouldn’t anyone who takes opioids, or who is close to someone who does, know what to do in the event of an overdose, and keep this potentially lifesaving drug available?

In fact, however, it is much harder than it should be to get and fill a prescription for naloxone, even though it’s extremely safe and has no potential for abuse.

Why? Continue reading

Not Just One But 101 Reasons To Exercise Today

We’ve been giving you sips of exercise motivation with one reason a day, but if you want The Big Gulp, check out this ultra-inspiring poster from www.healthylearning.com. They’ve got an appealing online catalog of all kinds of exercise-related materials, and when they offered to send me a free copy of the “101 Reasons to Exercise” poster, I shamelessly agreed. Just wanted you to know. We’ll continue pulling exercise inspiration from all different sources, including  more local experts, but it will be nice to have such a powerful concentration up on the office wall…

In case you can’t find your magnifying glass, here are a few of the entries from above:

1. Helps you to more effectively manage stress.

26, Helps to overcome jet lag.

49: Reduces the risk of developing prostate cancer.

50, Helps to combat substance abuse.

78. Reduces your likelihood of developing low-back problems.