'Alcohol worse for female brains'

Women are far more vulnerable to alcohol-induced brain damage than men, scans have shown.

CT pictures of the brains of more than 150 volunteers revealed how women come to more harm and quicker than men when they drink heavily.

Scientists have suspected for some time that men might be more resilient to booze than women. The German research gives visible evidence of this.

The University of Heidelberg team published their findings in Alcoholism.

Women may be more vulnerable to chronic alcohol consumption Study author Professor Karl Mann

In the study, around half of the volunteers were alcoholics. All of the volunteers had brain scans at the start and end of the six week study.

Those who were alcoholic were helped to "dry out" during the six weeks.

When the researchers analysed the brain scan results they found obvious evidence of brain damage among the heavy drinkers.

The drinkers had smaller brains, due to loss or atrophy, than the controls.

Brain loss

Women who were heavy drinkers lost the same amount of brain volume as the drinking men, but over a much shorter period of alcohol dependence.

Lead author Professor Karl Mann said although men generally drink more alcohol, women probably develop alcohol dependence and adverse consequences more readily.

Other alcohol-related disorders, such as heart problems, depression and liver disease, also occurred earlier in women than men, he said.

"Women typically start drinking later in life, consume less...and one could reason that women are less affected by alcohol.

"But there is evidence for a faster progress of the events leading to dependence among female alcoholics and an earlier onset of adverse consequences of alcoholism.

"This suggests that women may be more vulnerable to chronic alcohol consumption."

For these reasons, he said it was even more important to spot and treat alcohol abuse early in women.

A spokesman from the Institute of Alcohol Studies said: "This study supports previous findings that women experience many alcohol-related harms before men at the same level of drinking.

"These results are particularly concerning given the rising alcohol consumption in UK women, and the increased risk of alcohol dependence that goes with it.

"This worryingly suggests that alcohol-related damage experienced by women in the UK is set to increase rapidly in the coming years."

Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/4541281.stm

Published: 2005/05/15 23:02:41 GMT

© BBC MMVII

Contributor: Peggy Seo Oba

Press Release - Pioneering researcher Dr. Kenneth Lyons Jones receives genetics award from March of Dimes









Public release date: 16-Mar-2007

Contact: Elizabeth Lynch
elynch@marchofdimes.com
914-997-4286
March of Dimes Foundation

WHITE PLAINS, N.Y., MARCH 16, 2007 -- Kenneth Lyons Jones, M.D., the renowned pediatrician and birth defects researcher who was one of two doctors who identified fetal alcohol syndrome (FAS), will receive the 2007 March of Dimes/Colonel Harland Sanders Award for lifetime achievement in the field of genetic sciences.

The award will be presented to Dr. Jones on March 23 at the Annual Clinical Genetics Meeting of the American College of Medical Genetics in Nashville, Tennessee. Michael Katz, M.D., senior vice president for Research and Global Programs of the March of Dimes, will preside over the ceremony.

Dr. Jones is Chief of the Division of Dysmorphology/Teratology in the Department of Pediatrics at the University of California, San Diego (UCSD). He has been active in research, teaching, clinical work, and public service for nearly 40 years. Dr. Jones was also awarded a March of Dimes grant for organizing an annual seminar in clinical teratology.

Dr. Jones’ research has focused on dysmorphology, the study of birth defects, particularly those affecting the anatomy of the individual; identifying the mechanisms of normal and abnormal fetal development; and the recognition of new human teratogens (birth defects-causing agents). He is the author of more than 400 publications in scientific journals, as well as several books. His book, “Smith’s Recognizable Patterns of Human Malformation,’’ is the reference used by health care professions to assist in the diagnosis and management of individuals with birth defects and genetic conditions.

Among Dr. Jones’ many accomplishments, the most famous by now is his coining of the term “fetal alcohol syndrome,” along with David W. Smith, M.D., to define the distinct cluster of birth defects seen exclusively in the babies of women who used alcohol during pregnancy. In 1973, the two published their finding that alcohol was a teratogen in the British journal Lancet*.

Dr. Jones and his colleagues who identified FAS were part of a March of Dimes-supported group focusing on diagnosis and treatment of birth defects. Another major accomplishment by Dr. Jones was the establishment of the California Teratogen Information Service (CTIS) in 1979. The goals of CTIS are two-fold: to provide information to pregnant women and their physicians about the potential teratogenic risk of drugs, chemicals and environmental agents to the developing fetus and to gain new information about the effects of agents for which little or no information is available. Many in the medical and scientific communities worldwide embraced the concept of providing a service while conducting research. CTIS is now well known as the model for Teratology Information Services in not only the United States and Canada, but South America, Europe, and Australia as well.

Dr. Jones is past president of the Western Society for Pediatric Research and the Teratology Society. He was co-chair of the Scientific Working Group on Diagnostic Guidelines for Fetal Alcohol Syndrome Disorder, convened by the National Center for Birth Defects & Developmental Disabilities at the Centers for Disease Control & Prevention.

###

Wasting the Best and Brightest

The National Center on Addiction and Substance Abuse at Columbia University.

Contacts: Lauren R. Duran, 212-841-5260, lduran@casacolumbia.org

Sulaiman Beg, 212-841-5213, sbeg@casacolumbia.org

NEW CASA* REPORT FINDS HALF OF

COLLEGE STUDENTS BINGE DRINK,

ABUSE PRESCRIPTION AND ILLEGAL DRUGS

NEARLY ONE IN FOUR MEET MEDICAL CRITERIA FOR ALCOHOL, DRUG ABUSE AND DEPENDENCE

WASHINGTON, D. C., March 15, 2007 – Forty-nine percent (3.8 million) of full time college students binge drink and/or abuse prescription and illegal drugs, according to Wasting the Best and the Brightest: Substance Abuse at America’s Colleges and Universities, a new report by The National Center on Addiction and Substance Abuse at Columbia University.

The study also finds that 1.8 million full-time college students (22.9 percent) meet the medical criteria for substance abuse and dependence,[i] two and one half times the 8.5 percent of the general population who meet these same criteria.

The comprehensive 231-page report, the result of more than four years of research, surveys, interviews and focus groups is the most extensive examination ever undertaken of the substance abuse situation on the nation’s college campuses.

“It’s time to get the ‘high’ out of higher education,” said Joseph A. Califano, Jr., CASA’s chairman and president and former U.S. Secretary of Health, Education, and Welfare. “Under any circumstances acceptance by administrators, trustees, professors and parents of this college culture of alcohol and other drug abuse is inexcusable. In this world of fierce global competition, we are losing thousands of our nation’s best and brightest to alcohol and drugs, and in the process robbing them and our nation of their promising futures.”

The report finds that from 1993 to 2005 there has been no real decline in the proportion of students who drink (70 to 68 percent) and binge drink (40 to 40 percent). However, the intensity of excessive drinking and rates of drug abuse have jumped sharply:

· Between 1993 and 2001 the proportion of students who binge drink frequently[ii] is up 16 percent; who drink on 10 or more occasions in a month, up 25 percent; who get drunk at least three times a month, up 26 percent; and who drink to get drunk, up 21 percent.

· Between 1993 and 2005 the proportion of students abusing prescription drugs increased:

• 343 percent for opioids like Percocet, Vicodin and OxyContin;
• 93 percent for abuse of stimulants like Ritalin and Adderall;
• 450 percent for tranquilizers like Xanax and Valium;
• 225 percent for sedatives like Nembutal and Seconal.

· Between 1993 and 2005, the proportion of students who:

o Use marijuana daily more than doubled to 310,000.

o Use cocaine, heroin, and other illegal drugs (except marijuana), is up 52 percent to 636,000.

Consequences of Abuse

Consequences of substance abuse on college campuses include:

· 1, 717 deaths from unintentional alcohol-related injuries in 2001, up six percent from 1998;

· A 38 percent increase from 1993 to 2001 in the proportion of students injured as a result of their own drinking;

· A 21 percent increase from 2001 to 2005 in the average number of alcohol-related arrests per campus. In 2005, alcohol-related arrests constituted 83 percent of campus arrests;

· 97,000 students were victims of alcohol-related rape or sexual assaults in 2001;

· 696,000 students were assaulted by a student who had been binge drinking in 2001.

These statistics come from a variety of analyses using the best and most recent data available.

What’s the Problem?

Nearly 38 percent of college administrators say the major barrier to more effective prevention is the public perception that substance abuse by college students is a normal rite of passage.

“College presidents are reluctant to take on issues they feel they cannot change and this growing public health crisis reflects today’s society where students are socialized to consider substance abuse a harmless rite of passage and to medicate every ill,” said Reverend Edward A. Malloy, CSC, Chair, The CASA Commission on Substance Abuse at Colleges and Universities II and President Emeritus, University of Notre Dame. “To change this culture, college and university presidents need help from parents, alumni, students, Greek and athletic organizations, state and federal governments. Substance abuse on college campuses is not just an issue of public health; it is one of self-interest. Failure to act in the face of foreseeable harm places schools at risk for damaging their academic reputations and liability lawsuits in the millions of dollars.”

Other key findings:

· Rates of daily smoking among college students dropped from 15 percent in 1993 to 12 percent in 2005 and of daily heavy smoking (half a pack or more a day) from nine percent in 1993 to seven percent in 2005. More than 1.8 million full-time college students are current smokers.

· Fraternity and sorority members are likelier than non-members to drink (88 vs. 67 percent), binge drink (64 vs. 37 percent), drink and drive (33 vs. 21 percent), use marijuana (21 vs. 16 percent) or cocaine (3 vs. 1.5 percent), smoke (26 vs. 21 percent).

· 37 percent of college students fear social stigma attached to substance abuse, which keeps them from seeking help. Only 6 percent of students who meet medical criteria for alcohol or drug abuse or dependence seek help.

· 78 percent of college students who use illicit drugs have sexual intercourse compared to 44 percent of those who never use drugs.

“College presidents, deans and trustees have facilitated a college culture of alcohol and drug abuse that is linked to poor student academic performance, depression, anxiety, suicide, property damage, vandalism, fights and a host of medical problems,” noted Califano. “By failing to become part of the solution, these Pontius Pilate presidents and parents, deans, trustees and alumni have become part of the problem. Their acceptance of a status quo of rampant alcohol and other drug abuse puts the best and the brightest--and the nation’s future--in harm’s way.”

More than a decade ago, CASA convened its landmark Commission on Substance Abuse at Colleges and Universities to understand better the issues surrounding substance abuse at our nation’s colleges and universities. The Commission issued two reports: The Smoke-Free Campus: A Report by the Commission on Substance Abuse at Colleges and Universities (1993) and Rethinking Rites of Passage: Substance Abuse on America’s Campuses 1994) which drew attention to the widespread problems of student smoking and drinking, and highlighted the growing problem of dangerous drinking among women. In 2002, CASA reconvened and expanded the Commission on Substance Abuse at Colleges and Universities II, to examine what progress, if any, had been made in the intervening years.

CASA is the only national organization that brings together under one roof all the professional disciplines needed to study and combat all types of substance abuse as they affect all aspects of society. CASA has issued 63 reports and white papers, published one book, conducted demonstration projects focused on children, families and schools at 161 sites in 67 cities and counties in 29 states plus Washington, DC and a Native American tribal reservation, and has been evaluating the effectiveness of drug and alcohol treatment in a variety of programs and drug courts. CASA is the creator of the nationwide initiative Family Day – A Day to Eat Dinner with Your Children^t-- the fourth Monday in September – the 24^t in 2007 -- that promotes parental engagement as a simple and effective way to reduce children’s risk of smoking, drinking and using illegal drugs. For more information visit www.casacolumbia.org.

###

Wasting the Best and the Brightest: Substance Abuse at America’s Colleges and Universities (PDF)

Response of the HPA-axis to alcohol and stress as a function of alcohol dependence and family history of alcoholism Psychoneuroendocrinology
Article in Press, Corrected Proof

Xing Dai^a, ,

Joseph Thavundayil^a, ,

Sandra Santella^a, and

Christina Gianoulakis<sup>, a, E-mail:christina.gianoulakis@mcgill.ca

a</sup>Douglas Hospital Research Centre and Department of Psychiatry, McGill University, Montreal, Que., Canada

Received 14 July 2006; revised 10 November 2006; accepted 9 January 2007. Available online 8 March 2007.

Summary

Dysfunction of the hypothalamic–pituitary–adrenal (HPA)-axis has been observed in chronic alcoholics and in non-alcoholic sons of alcoholic parents, while genetic and environmental factors, such as stress, may play a significant role in the development of alcoholism. The present study was designed to investigate the response of the HPA-axis to alcohol and stress as a function of family history of alcoholism and chronic alcohol abuse.

We determined changes in plasma adrenal corticotrophin (ACTH) and cortisol concentrations in response to a placebo or an alcohol (0.50 g ethanol/kg body wt) drink and to a stress task performed 30 min following ingestion of either the placebo or the alcohol drink in social and heavy drinkers with [high risk (HR)] and without [low risk (LR)] a family history of alcoholism. Thus, four groups of healthy male individuals, low risk with no alcohol-dependence diagnosis (LRNAD), high risk with no alcohol-dependence diagnosis (HRNAD), low-risk alcohol dependent (LRAD) and high-risk alcohol dependent (HRAD), participated in the four experimental sessions given in random order.

Basal plasma ACTH levels of LRNAD participants were higher from those of the other three groups of participants. Basal plasma cortisol levels of HRAD participants were higher from those of LRNAD and HRNAD but not of LRAD participants. The stress-induced increases of plasma ACTH and cortisol concentrations were more pronounced in LRNAD participants. The alcohol drink prevented the stress-induced increases in plasma ACTH and cortisol of all groups of participants. The self-ratings of anxiety were attenuated in LRNAD and LRAD participants in the alcohol only session and in HRNAD and HRAD participants in the alcohol plus stress session.

In conclusion, there are differences in the activity of the HPA-axis as a function of family history and alcohol dependence, while the effect of an alcohol drink on the self-rating of anxiety may be influenced by both family history and stress.

Corresponding author. Tel.: +1 514 761 6131x5929; fax: +1 514 762 3034.

TV REVIEW - Addiction

HBO's latest will keep you glued to the TV

David Wiegand, Chronicle Staff Writer

Wednesday, March 14, 2007

Addiction: Documentary. Nine segments by individual directors. 9 p.m. Thursday, HBO. Repeat broadcasts through March 27 on HBO and HBO2. For information and resources on addiction, visit www.hbo.com.

---

The first segment of HBO's anchor documentary, "Addiction," reminds you of those films they used to show you in high school. You are in an emergency room in Dallas and doctors are working on someone whose arm has been sliced open. The gore is supposed to scare you, and, for a second, it's just like "CSI," realistic but, still, not real.

On Thursday, HBO launches an extraordinary multimedia project on addiction with the 90-minute film. Yes, it targets addiction for what it does to the lives of those who can't help themselves and for what it does to the lives who can't help loving them. But part of what makes the project so important and compelling is that the nine films that make up "Addiction" collectively target the various mythologies of addiction that perpetuate and exacerbate the problem.

The facts of America's addiction problems are shocking, yet we've heard many of the numbers before, or ones like them: One-tenth of all Americans older than 12 have substance abuse problems; alcohol and drug abuse costs the American economy $366 billion annually; 1 out of 4 Americans has a family member struggling with addiction.

Those numbers are sprinkled among the nine films by directors such as Barbara Kopple ("Harlan County, USA"), Albert Maysles ("Grey Gardens") and D.A. Pennebaker and Chris Hegedus ("The War Room"). But the individual short films tell even more indelible stories beyond the numbers. We watch a guy die in the Dallas ER, the victim of a drunken-motorcycling accident, while a doctor tells us that about half of all trauma cases relate to substance abuse.

After the man dies, his body disappears beneath a mound of bloodied towels and he's wheeled away like a pile of laundry while the doctor offers another probability: that the guy left his house in the morning and set out on his activities, not even considering the remotest possibility that the day would be his last.

In "A Mother's Desperation," by Maysles and Susan Froemke, a woman makes the painful choice to have her 23-year-old daughter arrested. The daughter turns herself in, saying it was just too hard trying to get high every day. Her mom drives her home from the police station and talks about wanting to "make a contract" with her. Somehow, we're not sure it's going to take. And it's with that doubt that we're next led into "The Science of Relapse," by Froemke and Eugene Jarecki, which, in combination with "Brain Imaging," by Rory Kennedy and Liz Garbus, explains the physiological reasons for addiction and why even the best of intentions cannot always protect a recovering addict from relapse.

Relapse, as one doctor puts it, is "not a failure of the treatment but a part of the disorder." Simply put, the human brain has "stop" and "go" functions. For an addict, the go function kicks in before the stop mechanism can react. That's one of the reasons addiction should not be viewed as a moral issue. Every time we condemn as morally weak someone with substance problems, it's the same thing as ignoring someone who is drowning.

It's probably not a surprise that 95 percent of adults who abuse alcohol started drinking before they were 21. The layperson probably thinks that drugs and alcohol are just part of a youthful rite of passage. "The Adolescent Addict," by Kate Davis and David Heilbroner, confirms that teenagers have a higher risk of drug or alcohol dependency and that society does a bad job of identifying the problem early on. Often, we chalk the problem up to typical teenage behavior and dupe ourselves with the traditional dismissal that he or she will "grow out of it."

But while the kids themselves say they turned to booze and pills because they were bored, medical experts interviewed by Davis and Heilbroner point to something more insidious and pervasive: For many kids, drugs and alcohol are the only coping mechanism they have. They haven't yet learned the better mechanisms that come with adulthood and experience on the planet.

Many films about addiction and substance abuse seem to fall into one of two categories: They are either entirely cautionary, like those films we were subjected to in high school, or they show us how the sun can shine over a clean and sober life. By constructing a single film from nine works by individual directors, Froemke and her co-producer, John Hoffman, reflect the multiplicity of problems, viewpoints and, yes, mythologies surrounding addiction.

We get a warm feeling of hope watching a mom congratulate her teenage son as he graduates from a treatment program. A few minutes later, when a 42-year-old man, who's just seen brain-imaging evidence of what his meth addiction is doing to his body, tells Dr. Nora Volkow that he'll quit "in a year or so," we know he's doomed. A young couple try to get themselves off opiates. He's been using for four years and figures he'll have to give up the new drug Seboxone and switch to methadone for financial reasons.

For someone who's been using for a longer period of time, insurance and managed care programs can be a formidable obstacle. Justin can't afford the $150 he would have to shell out for Seboxone, but his story doesn't begin to compare with the tragedies related by a group of Pennsylvania parents who have lost their children because they couldn't get proper care for them.

Testifying before a Pennsylvania state legislative committee, one mom holds up a picture of her daughter, Ashley, who was released after seven days in a treatment center because her insurance wouldn't fund a longer stay -- despite the center's professional determination that a 28-day initial stay was warranted. A few days later, her mother found Ashley in her room, her fingernails blue, the TV remote still clutched in her hand.

As an adjunct to the film, HBO has created a supplementary series of 13 films meant to focus more specifically on individual aspects of a massive and massively complex problem. The supplementary series will be shown on HBO2 digital cable, beginning Friday. In addition, a four DVD-set, including the 14-film series, will be available in stores beginning Tuesday. A companion book, "Addiction: Why Can't They Just Stop," published by Rodale Press, is already available in stores. And HBO has set up a comprehensive adjunct to its Web site with resource information.

It's a lot, but after watching the opening documentary, you can't help wondering if it's anywhere near enough.

E-mail David Wiegand at dwiegand@sfchronicle.com.

TV Review | 'Addiction'

When the Cravings Won’t Quit, Turn On the Camera

By VIRGINIA HEFFERNAN

Published: March 15, 2007

This just in from pseudoscience: Addiction documentaries contain an element that excites dopamine receptors, shuts down the frontal lobe and causes intense cravings.

HBO

A scene from “Montana Meth,” one of the documentaries that make up HBO’s 14-part “Addiction” series.

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Pseudoscientists don’t know yet whether drug-documentary addicts are hooked by the gruesomely thrilling scenes of tourniquets and needles, the photos of pre-Vicodin fifth graders or the promise of redemption through higher powers. But something definitely sets the brain reeling with manic questions: How could they fall so far? How could so many of us? Whom will addiction strike next, and will the culprit be the demon rum or the demon OxyContin?

The American addiction story, as refined by Alcoholics Anonymous, tells of good folks turned bad — of men taking drinks and drinks taking men. No wonder we crave this story: It’s the master narrative of innocence and fall, complete with the possibility of deliverance. Nor is it any wonder that HBO has embraced the genre with its current authoritarian gusto. That channel’s “Addiction,” an anthology of short films by famous documentary filmmakers, has its premiere tonight.

The blunt title holds promise. As a story, addiction to drugs and alcohol has a chilling and ritualistic arc. Typically, the variable is the drug. Some viewers go for the methamphetamine documentaries, with their slightly high-handed attitude toward the Midwest, their contested statistics and their focus on dental issues. Other viewers prefer the shadowy, stylish heroin ones, with the sexy, skinny kids and “Requiem for a Dream” fashion.

When it comes to drug-addiction TV, I’m a garbagehead: I watch it all. But to my amazement, “Addiction” doesn’t quite hit the spot. Someone at HBO seems to have instructed the esteemed filmmakers — auteurs like Albert Maysles and D. A. Pennebaker, even — to deny ravenous viewers what they want. The film is bereft of feel-good scenes and drug-movie clichés. As such, the shorts can build a cumulative sense of deprivation.

Don’t expect needles here, in other words, or ravaged street kids turning tricks, or spectacular scenes of delirium tremens. No one even gets high in “Addiction”; no fervid expression gives way to one of stoned beatitude. It’s enough to make you kind of mad: “Addiction” is holding out on us. And, surely, this is the point.

The program is part of a solemn project, something that Sheila Nevins, the enterprising president of HBO Documentary Films, has called “didactic television.” It is also devised to be more accessible than past HBO projects, with some cable systems, including RCN in the New York City area, showing it free during its first four-day run.

Intended to do more than entertain or alarm, then, “Addiction” is meant to sober people up. To that end, its message is this: Drug and alcohol addiction are diseases of the brain, and they can be treated, at least partly, with medicine.

This straightforward message is remarkable for at least two reasons. First, it’s intrinsically controversial, since A.A. for a long time expected its participants to refrain entirely from drug use, even prescription pills. The model of addiction presented here — addiction as a brain disease — is somewhat at odds with the cognitive model used in classic 12-step programs.

Second, it’s remarkable that so many top-notch filmmakers have consented to push someone else’s point so hard. It’s almost ominous. The sameness of the films in “Addiction” might aid its effectiveness as propaganda, but as art it’s monotone; it’s hard to believe it’s the collaborative work of so many otherwise individualistic artists.

Evidently, filmmakers submitted film to HBO, which took over postproduction. As a result, each installment mixes vérité and to-the-camera interviews in precisely the same proportions; employs explanatory title cards and interviews with experts; showily defers to the experts, most of them M.D.’s and Ph.D.’s; refrains from using graphics, humor or archival photographs; and keeps sound bites short.

An exception here is Barbara Kopple. Her short film “Steamfitters Local Union 638” is crisp tonic with lime. Unlike the other filmmakers, she has stuck to her interests and her aesthetic, making a film about a labor union that now actively supports its members who want treatment for addictions. The faces and voices of the union members, many of whom have been installing heating, ventilation and air-conditioning systems for decades, are like nobody else’s in “Addiction,” and indeed like those of few other people’s on television.

“We were the hardest-working,” says one union lifer, remembering the ’60s, when he was drinking daily on the job. “We were the biggest drinkers.” He recalls how the members used to enable one another as drinkers, helping them lie to their wives and families and still be paid.

Now the union uses the same infrastructure of loyalty to help people into detox and rehabilitation. Steamfitters like them — with mustaches and paunches like theirs — join them in meetings; there’s no interference from management or doctors. As rendered, this is an extremely effective, and good-natured, program.

By presenting both addiction and recovery as community affairs, only “Steamfitters Local Union 638” has added something beyond the brain-scan science to these drug and alcohol stories. Still, as I detoxed from the sensationalism I had gotten from other films and had been hoping for in “Addiction,” I also came to appreciate other parts of the program. One was the short by Chris Hegedus and Mr. Pennebaker. In their story of two young addicts who try a new Methadone-like drug to treat their cravings for prescription pills, the melancholy Amanda caught my eye. She’s kind of a lazy oracle.

As she’s driving to the clinic for the first time, contemplating the new drug that she’s hoping will relieve her dopesickness, she seems to speak for every kind of addict, as well as about the paradox of treating drug addiction with drugs.

As Amanda says, “I hope it works as good as everybody says it does, so I don’t have to worry about feeling like this anymore.”

ADDICTION

HBO, tonight at 9, Eastern and Pacific times; 8, Central time.

Produced by John Hoffman and Susan Froemke; Sheila Nevins, executive producer.

HBO - ADDICTION

Television

Facing ‘Things That Destroy Your Life’

Photographs from HBO

Some of the people addicted to drugs or alcohol whose lives are examined in the documentary series “Addiction,” with Scott Farnum, an administrator for substance abuse services at Acadia Hospital in Maine, in the lower left corner.

By ELIZABETH JENSEN

Published: March 11, 2007

ADDICTION, whether to drugs or alcohol, doesn’t lack for TV exposure. The likes of “Entertainment Tonight” and “Access Hollywood” seem to exist these days to chronicle various stars’ spins in and out of rehabilitation facilities.

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But real-life addiction is distinctly unglamorous, and the goal of HBO’s new “Addiction” project, which makes its debut on Thursday, is to help everyday victims and their friends and families. One of the series’s defining premises is that, celebrities aside, addiction comes with such stigma attached that open conversation about treating it is difficult and even doctors don’t want to deal with some addicted patients.

The centerpiece and first installment of the project is a 90-minute film that is essentially a primer on the state of the medicine, science and treatment options available today. Produced in partnership with the Robert Wood Johnson Foundation, the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, the film and supplemental materials argue that addiction is a chronic brain disease and one that is treatable, with an ever-increasing array of medicines in addition to the more widely known therapy-based 12-step programs.

“If all we do is succeed in letting people know there are medical treatments for alcoholism, we will have done our job,” said John Hoffman, who produced the series over nearly three years with Susan Froemke.

Dr. Nora D. Volkow, director of the National Institute on Drug Abuse and one of the project’s featured scientists, said at an HBO-sponsored luncheon in February that she saw the film in an even broader context: “How do you generate a culture that has empathy for a person who is addicted?”

The main film, with nine segments contributed by many of the top names in vérité filmmaking, will be shown on HBO and its digital channels; it will also be streamed on HBO.com. Some topics are expanded upon in another 13 extended pieces, which include interviews with top scientists working on addiction and profiles of successful treatment programs, like a South Boston drug court.

The supplemental series, and four independent addiction-theme films, will be shown Thursday through Sunday on HBO2, with repeats over the following weeks on all of HBO’s digital channels and HBO on Demand, as well as online. Although HBO is a pay-cable channel, some cable systems, including RCN in the New York City area, will offer the project free during its first four-day run.

The word addiction is used loosely in today’s culture, where overspending, overeating and compulsive sexual activities all have their own self-help groups. HBO chose to stick with drug and alcohol abuse. The federal Substance Abuse and Mental Health Services Administration estimated that 23.2 million Americans needed treatment for an illicit drug or alcohol problem in 2005, but that just 10 percent were receiving it.

“We tried to limit it to things that destroy your life,” said Sheila Nevins, HBO’s president of documentary and family programming and the project’s executive producer. “A cigarette smoker can have a life. This was a show about people who were losing their lives to addiction.”

Interspersed with the science are personal stories: a mother who had her heroin-addicted daughter arrested; a young couple who attempt to break longtime opiate addictions with a replacement drug. The segments were produced and directed by filmmakers who have worked closely with HBO, among them Alan and Susan Raymond (“An American Family”), Albert Maysles (“Grey Gardens”), Jon Alpert (“Baghdad ER”), Eugene Jarecki (“Why We Fight”), Liz Garbus (“The Farm: Angola, U.S.A.”) and Rory Kennedy (“Ghosts of Abu Ghraib”).

Despite its ubiquity, addiction is often misunderstood, as some of the film’s subjects lament. Parents are blamed for a child’s addiction; managed care companies restrict treatment; relapse is seen as a moral failure, rather than a normal stage on the road to recovery from a disease in which the addictive substances themselves distort the brain’s reactions.

Ms. Nevins said the filmmakers had been recruited to bring an emotional element to an essentially educational project. “People who make didactic television often don’t make vérité documentaries,” she said, calling the marriage of the two forms experimental.

The filmmakers were given what Ms. Froemke called a crash course in the science of addiction and assigned to specific topics but mostly found their own characters. It was an unusual process for filmmakers used to marinating for months, even years in their subjects’ lives, to build trust and let events dictate a story line.

Mr. Alpert said he was happy to adapt. “I’ve made four HBO documentaries that were really only about the problems of drug addiction,” he said. “This was a chance to do something that had a good positive back end on it.”

Ms. Froemke, a filmmaker herself, even sent Mr. Alpert a list of questions she wanted answered by the piece he filmed in a Dallas emergency room. “I have a feeling those questions never made it down to Dallas with him,” she said with a laugh.

But Mr. Alpert said he did take the questions with him and worked them in while filming in the chaos of the emergency room. “They were well-researched and thoughtful questions,” he said, but he did not want to do a formal interview with the doctor. “I don’t know how to light. I haven’t used it in 30 years.”

Most filmmakers had just days or weeks to find people willing to go public with their addiction issues.

Barbara Kopple, who won Academy Awards for her films “Harlan County, U.S.A.” and “American Dream,” both about labor unions, was assigned to chronicle the innovative and unusually successful hands-on approach that Steamfitters Local Union 638 of Long Island City, Queens, takes to dealing with members who are addicted. By pushing “a tiny bit” and talking about her past work, she said, she was able to persuade some members to let her team film inside the union-run post-rehab weekly therapy groups.

The counselors initially didn’t want the cameras, she said, but eventually “some people decided it was O.K. to expose themselves and their lives.”

After submitting half-hour director’s cuts to HBO, the filmmakers gave up control over how their work was used, as the films were cut down, occasionally chopped up and re-edited to fit the themes HBO wanted to explore.

“It was like joining the U.N.,” said D. A. Pennebaker, who with Chris Hegedus (his co-director on “The War Room” and other films) profiled a model treatment facility in Bangor, Me., where replacement therapy drugs help addicts with opiate addiction.

Ms. Nevins said she was nervous about showing off the final film. She called the filmmakers “good sports” for allowing their work to be manipulated at will.

Ms. Kopple, for one, said she had no qualms about handing over her material. “I just wanted it to work,” she said of the HBO project. “You just can’t hang on to everything.”

Press Release - NIH Partners with HBO on Groundbreaking Documentary on Addiction

FOR IMMEDIATE RELEASE March 7, 2007

NIDA Contacts: Dorie Hightower or Sara Rosario Wilson 301-443-6245 media@nida.nih.gov en Espanol: 301-594-6145 NIAAA Contact: Ann Bradley, 301-443-3860 abradley@mail.nih.gov en Espanol: 301-443-3860

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The National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA), components of the National Institutes of Health, have collaborated with HBO to create an eye-opening documentary, ADDICTION, to air on Thursday, March 15 (9:00-10:30 p.m. ET/PT). The documentary, developed with funding support from the Robert Wood Johnson Foundation, seeks to help Americans understand addiction as a chronic yet treatable brain disease, and spotlights promising scientific advancements.

With nearly one in ten Americans over the age of 12 classified with substance abuse or dependence, addiction takes an emotional, psychological, and social toll on the country. The economic costs of substance abuse and addiction alone are estimated to exceed a half trillion dollars annually in the United States due to health care expenditures, lost productivity, and crime.

“The National Institutes of Health is proud to be part of this effort to educate Americans about the nature of addiction and its devastating consequences,” said NIH Director Dr. Elias A. Zerhouni. “We especially appreciate the opportunity to inform the public about the scientific research that is transforming our understanding and treatment of addictive disorders.”

Addiction is now understood to be a brain disease because scientific research has shown that alcohol and other drugs can change brain structure and function. Advances in brain imaging science make it possible to see inside the brain of an addicted person and pinpoint the parts of the brain affected by drugs of abuse—providing knowledge that will enable the development of new approaches to prevention and treatment.

“Addiction is a disease—a treatable disease—and it needs to be understood,” said Dr. Nora Volkow, Director of the National Institute on Drug Abuse, whose work is featured in the documentary. “Our goal is for HBO’s ADDICTION project to educate the public about this disease and thereby help to eliminate the stigma associated with it.”

Currently, addiction affects 23.2 million Americans—of whom only about 10 percent are receiving the treatment they need. “HBO’s Addiction Project offers us the opportunity to directly acquaint viewers with available evidence-based medical and behavioral treatments,” said NIAAA Director Dr. Ting-Kai Li. “This is especially important for disorders that for many years were treated outside the medical mainstream.”

Consisting of nine segments, the film presents an encouraging look at addiction as a treatable brain disease and the major scientific advances that have helped us better understand and treat it. From emergency rooms to living rooms to research laboratories, the documentary follows the trail of an illness that affects one in four families in the United States.

One segment, “The Adolescent Addict,” explains that the adolescent brain differs from the adult brain because it is not yet fully developed. According to NIDA’s Dr. Nora Volkow, adolescent brains may be more susceptible to drug abuse and addiction than adult brains. However, because it is still developing, the adolescent brain may also offer an opportunity for greater resilience. Although treatment can yield positive results, many families are unwilling to look outside the home for help due to concerns about stigma.

Medications for use in treating alcoholism also are a focus of the program, including a segment on topiramate, under study by NIH-supported researchers at a clinic in Charlottesville, Virginia. At present, there are three FDA-approved medications available to treat alcohol dependence: the older aversive agent disulfiram, and two newer anti-relapse medications. Naltrexone, available by tablet or monthly injections, interferes with drinking reward and reinforcement, and acamprosate works on multiple brain systems to reduce craving, especially in early sobriety. According to NIAAA’s Dr. Mark Willenbring, who is featured in the film, these medications are not addictive and can be helpful adjuncts to treatment.

NIDA and NIAAA have released these new publications to coincide with the launch of ADDICTION.

Drugs Brains and Behavior, the Science of Addiction http://www.nida.nih.gov/scienceofaddiction/

Helping Patients Who Drink Too Much: A Clinician’s Guide http://www.niaaa.nih.gov/guide. Downloadable patient education handouts include Strategies for Cutting Down, U.S. Adult Drinking Patterns, and What’s a Standard Drink?

ADDICTION is directed by an HBO-assembled team of filmmakers including Jon Alpert, Susan Froemke, Eugene Jarecki, Liz Garbus, Barbara Kopple, Albert Maysles and D.A. Pennebaker among others. The documentary is part of a broader HBO Addiction Project that includes a supplementary series of 13 additional short films featuring extended expert interviews and focusing on such subjects as family treatment and drug courts. All films will be offered March 15-18 at no charge by participating cable systems and available on numerous digital platforms including multiplex channels, podcasts, and web streams at www.HBO.com. The Project is being promoted by HBO and the Robert Wood Johnson Foundation in collaboration with national groups committed to addiction and recovery support, including Community Anti-Drug Coalitions of America, Faces and Voices of Recovery, and Join Together. More information can be found at http://www.addictionaction.org/.

Daily Register Exclusive: Trysh Travis comments on HBO's Addiction project

Advance press for HBO’s Addiction has been referring to it as a “film,” but if you look at the website you’ll have the strange sensation of not being sure what to call the programming event that begins on HBO on March 15th.

There is a “Film”—it’s the last drop-down menu on the right, and you encounter it only after your eyes travel over five other drop-downs labeled (in fine Public Service Announcement-style) “Understanding Addiction,” “Adolescent Addiction,” “Treatment,” “Aftercare,” and “Stigma and Discrimination.” These appear over the site’s central image—an arresting close-up of a blonde, blue-eyed, young woman, over which is super-imposed the legend “I need help for….”

Push past the informative and interactive features of the site to click on “The Film,” and you’ll find that the generic and formal entity you were expecting doesn’t really exist. There’s a “centerpiece documentary” titled Addiction—but it’s bundled with a “supplementary series” of thirteen additional short films, as well as four additional feature-length documentaries that “capture the personal, family and community struggles caused by addiction.”

If you’re worried (as I am) that all this content is going to crash your DVR capacity, you’ll be relieved to know that a DVD version will be available in stores next week. There is also a “companion book” from Rodale Press, titled Addiction: Why Can't They Just Stop? Rather than duplicating programming content, however, the book offers “a comprehensive consumer guide to navigating the world of addiction treatment.” And finally, lest poring over all this addiction-related material alone in your house start to make you feel a little weird, you can meet some other people who have been sucked into the Addiction vortex, thanks to the 30-city outreach program of “town hall meetings, house parties, briefings and other community-wide events” that piggy-back on the HBO-generated materials.

All this is just to say that you shouldn’t be fooled by the fact that much of the advance press on Addiction has been written by the television critics of your local papers. As the saying goes, “It’s not TV—it’s HBO.” Rather than a program, Addiction is sheer content: crafted with the explicit goal of what the website calls “multiplatform” delivery, it’s a high-quality realization of what media studies scholars call “post-network” TV.

Addiction’s formal aspects should be of interest to readers of the ADHS Daily Register because it looks like its content will be fairly familiar. The website reiterates the classic formulations of the disease concept, emphasizes the need for professional treatment, and stresses that recovery is a life-long project. Save for the expansive language of “alcohol-and-other-drugs,” much of the site content could have been lifted straight from the writings of Marty Mann, Harold Hughes, or some other mid-20th-century Alcoholism Movement activist.

As Addiction unspools over the next couple of weeks, it will be interesting to see whether the various film-makers, clinicians, and educators involved pay any attention to the questions that have compelled the attention of ADHS members and other scholars in recent years—issues like the social construction of vice and disease, the political economy that lies back of addiction (captured so well on that other HBO gem, David Simon’s The Wire), and the cultural politics of the recovery movement, to name just a few. Addiction’s ambition suggests it could encompass such complexities. If it doesn’t, and all we’re getting for the price of premium cable is the old wine of the disease concept packaged in some spiffy new bottles, it will be important to try and figure out why.

Trysh Travis
Assistant Professor of Women's Studies
University of Florida

Source: Matthew McKean Alcohol and Drugs History Society March 15, 2007

Alcohol Use, Abuse, and Dependence

Ting-Kai Li, MD


Supercourse is a global repository of lectures on public health and prevention targeting educators across the world. Supercourse has a network of over 41300 scientists in 171 countries who are sharing for free a library of over 3162 lectures in 26 languages. The concept of the Supercourse and its lecture style has been described as the Global Health Network University and the Hypertext Comic Books.

In November 2006 a lecture entitled "Alcohol Use, Abuse, and Dependence" by Dr. Li was added to the Supercourse, a free, online library of 3000 lectures written by experts such as Nobel Prize winner Leland Hartwell and NIH Director Elias Zerhouni. Dr. Li's lecture includes information about NIAAA and its research priorities, as well an overview of alcohol use around the world and its relationship to health problems, including abuse and addiction. The lecture also includes information about the new Clinician's Guide, as well as updates on current pharmacological and behavioral treatments of alcohol use disorders. The lecture can be downloaded at http://www.pitt.edu/~super1/lecture/lec25521/index.htm

NIAAA Ting-Kai Li, MD
Director's Report on Institute Activities to the 114th Meeting of the National Advisory Council on Alcohol Abuse and Alcoholism - February 8, 2007

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CONTENTS

A. Reauthorization Legislation and Budget
B. Director's Activities
C. NIAAA Staff and Organization
D. NIAAA Research Programs
E. Scientific Meetings
F. Outreach
G. Multi-Media Products from NIAAA

The War Within
Lou Dobbs - Tonight
CNN

March 12, 2007






(transcript)
DOBBS: Tonight, "The War Within," our special report on the war against drugs and alcohol abuse and addiction. Approximately 40 percent of patients who go to emergency rooms are there because of an alcohol-related injury. But as Kitty Pilgrim reports, in many states doctors simply will not even test those patients for alcohol because insurance companies will not reimburse those claims.

(BEGIN VIDEOTAPE) KITTY PILGRIM, CNN CORRESPONDENT (voice over): A horrific accident. The driver injured. At the emergency room, doctors don't test for drugs or alcohol because they want to get paid.

DR. LARRY GENTILELLO, UNIVERSITY OF TEXAS MEDICAL CENTER: Once you go to the ER, you're almost sure not to have your blood alcohol level tested because of this law. And so, as a result, many patients cause property damage or severe bodily injuries to other people as a result of alcohol-related crashes. And by going to the ER, they don't get tested and they get away with it all.

PILGRIM: These exclusion clauses, officially called UPPL laws, were passed way back in 1947 to allow insurance companies to avoid paying for alcohol-related accidents. Thirty-four states still have laws allowing insurers to walk away without paying, and 10 other states leave it up to the discretion of the insurers.

Major healthcare organizations and advocacy groups like MADD want UPPL laws repealed. They say alcohol-related accidents are epidemic.

Statistics prove that to be the case. The National Highway Traffic Safety Administration says three in 10 Americans will be involved in an alcohol-related crash at some time in their lives. Thirty-eight percent of all fatal car crashes are alcohol related.

DR. MARK WILLENBRING, NATIONAL INST. ALCOHOL ABUSE: Eighteen thousand young people a year who are dying because of alcohol-related motor vehicle crashes, that's a tremendous loss of life and opportunity, and we really do need to start paying more attention to it.

PILGRIM: Those numbers are likely even higher. The don't ask, don't test policy in emergency rooms gives doctors a financial interest in not reporting alcohol-related accidents. The approach actually generates more accidents because people are never treated for alcohol abuse.

(END VIDEOTAPE)

PILGRIM: Now, advocates for repealing the law say doctors are often very well intentioned because insurers won't pay for the alcohol related injuries and doctors are trying to protect their patients from having to pay the high medical bills on their own. The problem is, Lou, with alcohol abuse, there are more than one victim. This -- if this continues, other people are also injured if they don't...

DOBBS: Well, they're perpetrators and victims alike, and the insurance companies are actually standing between -- 38 percent of all of these are alcohol related based on the current statistics. We have no idea what the real number is, but it has to be substantially higher.

PILGRIM: It's much, much higher. The industry says the -- the insurance industry says the law should be repealed, but then they do nothing to actually advance this. And 34 states still have these laws on their books. DOBBS: Plus 10 others that leave it to the discretion of the insurer.

PILGRIM: That's right.

DOBBS: And I can imagine which way that discretion goes.

PILGRIM: Yes, well...

DOBBS: All right.

It's incredible. The deeper we dig into this issue of alcohol and drug abuse and addiction in this country, it -- I mean, this is really very serious. And one would hope that some would join -- you said the Mothers Against Drunk Driving and other groups.

PILGRIM: There's 30 organizations, major organizations, that want these laws overturned.

DOBBS: Well, why not get it done?

All right. Kitty Pilgrim, thank you very much.

Unless you want to upset an insurance company and avoid that. Or whatever. I can't imagine that being the case.

Thanks.

Source: David Anderson Ensuring Solutions to Alcohol Problems