Bipolar disorder preceded by substance abuse: A different phenotype with not so poor outcome?

World Journal of Biological Psychiatry, Volume 10, Issue 3 August 2009 , pages 209 - 216

The co-occurrence of bipolar disorder and substance use is frequent. The question whether substance use precedes, induces or follows bipolar disorder is still unresolved. Substance use has been typically represented as a negative prognostic factor for the clinical course of bipolar illness and it has been associated with decreased compliance and treatment resistance.

To extend these previous findings we examined the clinical course and outcome of patients with bipolar disorder I or II whose bipolar onset was preceded by substance/alcohol use.

Bipolar disorder preceded by substance misuse may represent a clinically milder subtype of bipolar illness. This subtype would be less “primary” and might be more early targeted by primary prevention with programmes focused on substance misuse.

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Request Reprint E-Mail: isabella.pacchiarotti@uniroma1.it

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Risk Factors of Transition from Normal Cognition to Mild Cognitive Disorder: The PATH through Life Study

Dement Geriatr Cogn Disord 2009;28:47-55

The aim of this study was to identify physical and mental health and lifestyle predictors of transition from normal cognition to mild cognitive disorder (MCD).

The main predictors of conversion to MCI and to other mild cognitive disorders were past alcohol intake, current anxiety and depression medication, increased systolic blood pressure, and past smoking.

Participants with a history of smoking or harmful alcohol consumption, hypertension, or who took medication for anxiety or depression were at increased risk of transitioning to MCI or any MCD. Strategies targeted at managing the above risk factors may have benefits in preventing mild cognitive decline in relatively healthy middle-aged individuals living in the community.

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Request Reprint E-Mail: nicolas.cherbuin@anu.edu.au

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No association of alcohol dependence with SLC6A5 and SLC6A9 glycine transporter polymorphisms

Addiction Biology Early View Published Online: 24 Jul 2009

To determine whether glycine transporter polymorphisms are associated with alcoholism, three genetic variants of SLC6A5 and two polymorphisms of SLC6A9 were genotyped in 463 German non-alcoholic controls and 644 German alcohol-dependent subjects.

There was a significant association between the SLC6A5 polymorphism (rs1443547) and alcohol dependence as alcoholic individuals had a lower rate of AG-allele (χ2 = 6.048, P = 0.049, d.f. = 2), which did not remain significant after correction for multiple testing.

There was no association between SLC6A9 glycine transporter polymorphisms and alcohol dependence, and also none in haplotype analysis.

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Request Reprint E-Mail: gabi.koller@med.uni-muenchen.de

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Dental care and oral disease in alcohol-dependent persons
Journal of Substance Abuse Treatment Volume 37, Issue 2, September 2009, Pages 214-218

Dental/Oral health of alcohol-dependent persons and substance abusers is often neglected. It is not clear that alcohol dependence has effects on oral health beyond those expected in nonalcoholic persons of similar socioeconomic status (SES). Study objectives were to examine the personal dental care habits, ability to access professional dental care, and the types of services received and to examine their effect on the oral health of alcohol-dependent persons and substance abusers.

Access to professional dental care was inversely associated with periodontitis in the alcohol-dependent group (p < .05). Alcohol dependence may increase plaque levels above that seen in race, gender, age, and SES-matched controls, but professional dental care can limit the subsequent development of periodontal disease in these people.

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Request Reprint E-Mail: akhocht@temple.edu
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Journal of Studies on Alcohol and Drugs Supplement Number 16, July 2009 College Drinking: New Research From the National Institute on Alcohol Abuse and Alcoholism’s Rapid Response to College Drinking Problems Initiative

Special Editors: William DeJong, Ph.D., Mary E. Larimer, Ph.D., Mark D. Wood, Ph.D.

Contents

Dejong, W., Larimer, M.E., Wood, M.D., and Hartman, R.NIAAA’s Rapid Response to College Drinking Problems Initiative: Reinforcing the Use of Evidence-Based Approaches in College Alcohol Prevention Page 5

Hingson, R.W., Zha, W., and Weitzman, E.R.Magnitude of and Trends in Alcohol-Related Mortality and Morbidity Among U.S. College Students Ages 18-24, 1998-2005 Page 12

Saltz, R.F., Welker, L.R., Paschall, M.J., Feeney, M.A., and Fabiano, P.M.Evaluating
Comprehensive Campus–Community Prevention Intervention to Reduce Alcohol-Related Problems in a College Population Page 21

Faden, V.B., Corey, K., and Baskin, M.An Evaluation of College Online Alcohol-Policy Information: 2007 Compared With 2002 Page 28

Schaus, J.F., Sole, M.L., McCoy, T.P., Mullett, N., Bolden, J., Sivasithamparam, J., and O’Brien, M.C.Screening for High-Risk Drinking in a College Student Health Center: Characterizing Students Based on Quantity, Frequency, and Harms Page 34

Amaro, H., Ahl, M., Matsumoto, A., Prado, G., Mulé, C., Kemmemer, A., Larimer, M.E., Masi, D., and Mantella, P.Trial of the University Assistance Program for Alcohol Use Among Mandated Students Page 45

Cimini, M.D., Martens, M.P., Larimer, M.E., Kilmer, J.R., Neighbors, C., and Monserrat, J.M.Assessing the Effectiveness of Peer-Facilitated Interventions Addressing High-Risk Drinking Among Judicially Mandated College Students Continued Page 57

Ichiyama, M.A., Fairlie, A.M., Wood, M.D., Turrisi, R., Francis, D.P., Ray, A.E., and Stanger, L.A.A Randomized Trial of a Parent-Based Intervention on Drinking Behavior Among Incoming College Freshmen Page 67

Labrie, J.W., Huchting, K.K., Lac, A., Tawalbeh, S., Thompson, A.D., and Larimer, M.E.Preventing Risky Drinking in First-Year College Women: Further Validation of a Female-Specifi c Motivational-Enhancement Group Intervention Page 77

Cranford, J.A., McCabe, S.E., Boyd, C.J., Lange, J.E., Reed, M.B., and Scott, M.S.Effects of Residential Learning Communities on Drinking Trajectories During the First Two Years of College Page 86

Wood, M.D., Dejong, W., Fairlie, A.M., Lawson, D., Lavigne, A.M., and Cohen, F.Common Ground: An Investigation of Environmental Management Alcohol Prevention Initiatives in a College Community Page 96

Kaysen, D.L., Lee, C.M., Labrie, J.W., and Tollison, S.J.Readiness to Change Drinking Behavior in Female College Students Page 106

Larimer, M.E., Kaysen, D.L., Lee, C.M., Kilmer, J.R., Lewis, M.A., Dillworth, T., Montoya, H.D., and Neighbors, C.Evaluating Level of Specificity of Normative Referents in Relation to Personal Drinking Behavior Page 115

Oster-Aaland, L., Lewis, M.A., Neighbors, C., Vangsness, J., and Larimer, M.E.Alcohol Poisoning Among College Students Turning 21: Do They Recognize the Symptoms and How Do They Help? Page 122

Schaus, J.F., Sole, M.L., McCoy, T.P., Mullett, N., and O’Brien, M.C.Alcohol Screening and Brief Intervention in a College Student Health Center: A Randomized Controlled Trial Page 131

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Gender specific trends in alcohol use: cross-cultural comparisons from 1998 to 2006 in 24 countries and regions

International Journal of Public Health Online First 21 July 2009

To examine trends in the prevalence of monthly alcohol use and lifetime drunkenness among 15 year olds in 20 European countries, the Russian Federation, Israel, the United States of America, and Canada.

Average monthly alcohol use across all countries declined from 45.3% to 43.6% and drunkenness declined from 37.2% to 34.8. There was substantial variability across countries, with decreases in some countries and increases or no change in use or drunkenness in others. The overall decline was greater among boys, from 41.2% to 36.7% than among girls, 33.3% to 31.9%. In most of the countries where drinking or drunkenness increased, it was due mainly to increases among girls.

Trends in alcohol use and drunkenness varied by country. Drinking and drunkenness remained higher among boys than girls, but the gap between boys and girls declined and girls appear to be catching up with boys in some countries

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Request Reprint E-Mail: mortonb@exchange.nih.gov

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Cognitive impairment in dual diagnosis inpatients with schizophrenia and alcohol use disorder

Schizophrenia Research Article in Press 22 June 2009

Cognitive impairment has been found independently among individuals with schizophrenia and individuals with alcohol use disorders. Less is known about the nature and severity of cognitive impairment in patients with a dual diagnosis, though the co-occurrence of these disorders may further exacerbate cognitive impairment. The study investigates the possible additive effect of alcohol use disorder and schizophrenia on cognitive impairment among patients diagnosed with

Dual diagnosis patients were significantly more impaired than schizophrenia patients on delayed verbal memory, and executive functioning, primarily set-shifting, working memory, and planning, and had higher psychiatric morbidity scores. The findings provide support for an additive effect of the two disorders on cognitive impairment.

These cognitive deficits may affect capacity to engage in treatment, increase risk of relapse, and adversely affect treatment outcomes. An understanding of the cognitive profile of people with dual diagnosis may help to tailor treatment delivery to meet their specific needs, enhance cognitive strengths, accommodate deficits and improve treatment outcomes.

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Request Reprint E-Mail: v.manning@iop.kcl.ac.uk

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Chronic Ethanol Intake Alters Circadian Phase Shifting and Free-Running Period in Mice

Journal of Biological Rhythms, Vol. 24, No. 4, 304-312 (2009)

Chronic alcohol intake is associated with widespread disruptions in sleep and circadian rhythms in both human alcoholics and in experimental animals. Recent studies have demonstrated that chronic and acute ethanol treatments alter fundamental properties of the circadian pacemaker—including free-running period and responsiveness to photic and nonphotic phase-shifting stimuli—in rats and hamsters.

In the present work, the authors extend these observations to the C57BL/6J mouse, an inbred strain characterized by very high levels of voluntary ethanol intake and by reliable and stable free-running circadian activity rhythms.

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Request Reprint E-Mail: alanr@maine.edu

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Social norms interventions to reduce alcohol misuse in University or College students

Cochrane Database of Systematic Reviews, Issue 3, 2009

To determine whether social norms feedback reduces alcohol misuse in university or college students.

Alcohol related problems: Significant reduction with Web/computer feedback (WF) (SMD -0.31 95% Cl -0.59 to -0.02), three studies, 278 participants. No significant effect of mailed feedback (MF), individual face-to-face feedback (IFF) or group face-to-face feedback (GFF).

WF and IFF are probably effective in reducing alcohol misuse. No direct comparisons of WF against IFF were found, but WF impacted across a broader set of outcomes and is less costly so therefore might be preferred. Significant effects were more apparent for short-term outcomes (up to three months). For mailed and group feedback, and social norms marketing campaigns, the results are on the whole not significant and therefore cannot be recommended.

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Request Reprint E-Mail: m.teresa.moreira@googlemail.com

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Smoking, drinking and drug use among young people in England in 2008 full report

This report contains results from an annual survey of secondary school pupils in years 7 to 11 (mostly aged 11 to 15). 7,798 pupils in 264 schools in England completed questionnaires in the autumn term of 2008.

Approximately a third (32 per cent) of pupils have tried smoking at least once and 6 per cent of pupils smoke regularly (at least once a week). 52 per cent of pupils have tried alcohol at least once and 18 per cent drank alcohol in the last week. 22 per cent of pupils had ever tried drugs and 8 per cent had taken drugs in the last month.

For the first time, the 2008 survey explored the relationship between pupils' home context and whether they drank alcohol. Pupils are more than three times as likely to drink if they live with other people who do. The percentage who drank alcohol in the last week also increased with the number of other drinkers at home; for example, the percentage of pupils who have drunk alcohol in the last week increased from 5 per cent of those who live in non-drinking households to 31 per cent of those who live with three or more people who drank alcohol.

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Fetal Alcohol Spectrum Disorders and Their Persisting Sequelae in Adult Life

Dtsch Arztebl Int 2008; 105(41): 693-8

The present review describes the different variants of Fetal Alcohol Spectrum Disorders (FASD) as a consequence of maternal alcohol abuse during pregnancy. According to international findings, some 3 000 to 4 000 affected newborns may be expected annually in Germany. Detection of these individuals in clinical practise is insufficient.

Pathogenesis of FASD is not sufficiently clear and there is no causal treatment. Thus, besides prevention and information, early diagnosis, installation of fostering or adoption, and intensive psychosocial care including selection of appropriate schooling, occupational counselling and supportive care in adulthood are mandatory.

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Personality Disorders in Alcohol-Dependent Individuals: Relationship with Alcohol Dependence Severity

Eur Addict Res 2009;15:188-195

The rate of axis II disorders in alcohol-dependent individuals is suggested to be high. The aim of this investigation is to assess the rate of DSM-IV axis II diagnoses in alcohol-dependent inpatients and their correlation with clinical characteristics of alcohol dependence (AD).

The majority of alcohol-dependent individuals had one or more comorbid axis II disorders. Univariate and multivariate analyses indicate that different PDs are related to age at first dinking and alcoholism severity.

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Request Reprint E-Mail: ulrich.preuss@medizin.uni-halle.de

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Alcohol in moderation, premorbid intelligence and cognition In Older Adults: results from the Psychiatric Morbidity Survey

J Neurol Neurosurg Psychiatry. Published Online First: 19 July 2009

To test the hypothesis that the association previously reported between moderate alcohol use and better cognition, is an artefact of confounding by (a) higher premorbid education and socioeconomic status; (b) a lifestyle of moderation (using smoking as a risk marker); and (c) decreased alcohol consumption in people with physical illnesses.

In people who were not problem drinkers, higher alcohol intake was not associated with improved current cognition after controlling for premorbid intelligence and physical health. Our findings suggest that, despite previous suggestions, moderate alcohol consumption does not protect older people from cognitive decline.

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Request Reprint E-Mail: ccooper@doctors.org.uk

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Comparing methods of detecting alcohol-related emergency department presentations

Emergency Medicine Journal 2009;26:596-600

Not all patients with an alcohol-related ED presentation usually drink at risky levels, nor do all risky drinkers present to the ED for an alcohol-related reason. The use of routinely recorded nursing triage text detects over a third of alcohol-related ED presentations with no additional burden on busy clinicians. As these data are potentially readily accessible, further research is needed to evaluate their validity for the detection of alcohol-related ED presentations.

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Request Reprint E-Mail: devon.indig@justicehealth.nsw.gov.au

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Perceived coercion in substance abuse treatment: The eye of the beholder?

Journal of Substance Use 22 July 2009

To examine potential differences in subjective perceptions of coercion between substance abuse professionals and clients in how they view events that trigger entry to treatment. Such differences may influence both the clinician's approach and the client's response to treatment.

Discrepant perceptions of treatment entry triggers may impact the development of a working alliance and the use of motivational strategies intended to enhance readiness to change. Further investigation into these divergent perceptions is needed to untangle the relationships among client and clinician assumptions, readiness for change, and treatment outcome

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Request Reprint E-Mail: mackains@uncw.edu

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Pilot Alcoholism-Treatment Program Targets Gays

New York Magazine July 20, 2009 Issue

What gay man doesn't like a cocktail? Certainly, there are enough gay men who seem to drink too much. But 40 years after Stonewall — the birth of the gay liberation movement took place at a bar, let’s remember — Columbia University researchers have been trying to figure out if gay men can avoid giving up the nightlife just because they have a drinking problem.

Why? “It’s too socially debilitating to cut a gay man off from the bar and club scene,” said Jon Morgenstern, a clinical psychologist at Columbia University who is vice-president of the school’s National Center on Addiction and Substance Abuse and the director of the trial. “Gay men,” continued Dr. Morgenstern, a Dos Equis–swigging heterosexual, “have the minds of college students and teenagers when it comes to alcohol. It’s crucial to their socialization.” (Morgenstern makes it clear that the same conditions exist for other groups that tend to socialize around alcohol.) Unlike most accepted methods of managing alcoholism, the double-blind clinical trial does not demand abstinence; instead, alcoholics are taught to manage their addiction and moderate their drinking. . . . . . .

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Alcohol Alert

Issue 2 Summer 2009

On the cover of this issue
“Supermarkets exhibiting the morality of a crack dealer” Select Committee told

Also in this issue:
Leading Health Charities call for ban on advertising alcohol price promotions

Institute of Alcohol Studies comment

Southampton study highlights risks of daily drinking

A quarter of adults in England are hazardous drinkers

Drink a day increases cancer risk

8 to 14 weekly units of alcohol boosts overall tally of days spent in hospital

Scots alcohol related deaths double what previously thought - one alcohol death every three hours

Scotland out of step with European levels of alcohol related harm

UK doctors back calls for minimum price of alcohol

Chris Huhne acts on minimum pricing

Drunks - to treat or to punish?

NOFAS UK

The Phoney War on Drugs - Kathy Gyngell

Alcohol in Britain: young men are bingedrinking less, but women are binge-drinking more

Book Reviews:
‘Nightlife and crime: Social order and governance in international perspective’ by Phil Hadfield Reviewed by Geoff Munro

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Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis

Policymakers and other stakeholders can use cost-benefit analysis as an informative tool for decisionmaking for substance abuse prevention. This report reveals the importance of supporting effective prevention programs as part of a comprehensive substance abuse prevention strategy. The following patterns of use, their attendant costs, and the potential cost savings are analyzed:

• Extent of substance abuse among youth


• Costs of substance abuse to the Nation and to States


• Cost savings that could be gained if effective prevention policies, programs, and services were implemented nationwide
  
• Programs and policies that are most cost beneficial
  
  The cost of substance abuse could be offset by a nationwide implementation of effective prevention policies and programs. SAMHSA’s Strategic Prevention Framework should include a planning step that considers cost-benefit ratios. Communities should consider a comprehensive prevention strategy based on their unique needs and characteristics and use cost-benefit ratios to help guide their decisions. Model programs should include data on costs and estimated cost-benefit ratios to help guide prevention planning.
  

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Growth in alcohol use in at-risk adolescent boys: Two-part random effects prediction models

Drug and Alcohol Dependence Article in Press 21 July 2009

Alcohol use frequently onsets and shows rapid growth during the adolescent years, but few studies have examined growth in two indicators, namely in use and in volume given use, with prediction from key risk factors measured across the adolescent years.

Findings indicated that alcohol use by both parents and peers were associated with initial levels of alcohol use and volume, but increases in peer use predicted growth in these indicators. Parental monitoring showed a protective effect on growth in volume in high school.

Alcohol use by members of the adolescent's social network is critical to initiation of use, and peer use is critical to growth. With these predictors specific to alcohol use in the model, none of the general risk factors for antisocial behavior were significant.

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Request Reprint E-Mail: deborahc@oslc.org

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Manipulation of GABAergic steroids: sex differences in the effects on alcohol drinking- and withdrawal-related behaviors
Hormones and Behavior Article in Press, 15 July 2009

Alcoholism is a complex disorder that represents an important contributor to health problems worldwide and that is difficult to encompass with a single preclinical model. Additionally, alcohol (ethanol) influences the function of many neurotransmitter systems, with the interaction at γ-aminobutyric acidA (GABAA) receptors being integral for ethanol's reinforcing and several withdrawal-related effects.

Given that some steroid derivatives exert rapid membrane actions as potent positive modulators of GABAA receptors and exhibit a similar pharmacological profile to that of ethanol, studies in the laboratory manipulated GABAergic steroid levels and determined the impact on ethanol's rewarding- and withdrawal-related effects. Manipulations focused on the progesterone metabolite allopregnanolone (ALLO), since it is the most potent endogenous GABAergic steroid identified.

The underlying hypothesis is that fluctuations in GABAergic steroid levels (and the resultant change in GABAergic inhibitory tone) alter sensitivity to ethanol, leading to changes in the positive motivational or withdrawal-related effects of ethanol.

This review describes results that emphasize sex differences in the effects of ALLO and the manipulation of its biosynthesis on alcohol reward- versus withdrawal-related behaviors, with females being less sensitive to the modulatory effects of ALLO on ethanol-drinking behaviors but more sensitive to some steroid manipulations on withdrawal-related behaviors.

These findings imply the existence of sex differences in the sensitivity of GABAA receptors to GABAergic steroids within circuits relevant to alcohol reward versus withdrawal. Thus, sex differences in the modulation of GABAergic neurosteroids may be an important consideration in understanding and developing therapeutic interventions in alcoholics.

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Request Reprint E-Mail: finnd@ohsu.edu
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Relation Between Modifiable Lifestyle Factors and Lifetime Risk of Heart Failure
JAMA. 2009;302(4):394-400.

The lifetime risk of heart failure at age 40 years is approximately 1 in 5 in the general population; however, little is known about the association between modifiable lifestyle factors and the remaining lifetime risk of heart failure.

To examine the association between modifiable lifestyle factors and the lifetime risk of heart failure in a large cohort of men.

During a mean follow-up of 22.4 years, 1200 men developed heart failure. Overall, the lifetime risk of heart failure was 13.8% (95% confidence interval [CI], 12.9%-14.7%) at age 40 years. Lifetime risk remained constant in men who survived free of heart failure through age 70 years and reached 10.6% (95% CI, 9.4%-11.7%) at age 80 years. Lifetime risk of heart failure was higher in men with hypertension than in those without hypertension. Healthy lifestyle habits (normal body weight, not smoking, regular exercise, moderate alcohol intake, consumption of breakfast cereals, and consumption of fruits and vegetables) were individually and jointly associated with a lower lifetime risk of heart failure, with the highest risk in men adhering to none of the 6 lifestyle factors (21.2%; 95% CI, 16.8%-25.6%) and the lowest risk in men adhering to 4 or more desirable factors (10.1%; 95% CI, 7.9%-12.3%).

In this cohort of apparently healthy men, adherence to healthy lifestyle factors is associated with a lower lifetime risk of heart failure.

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Request Reprint E-Mail: ldjousse@rics.bwh.harvard.edu
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American Indian and Alaska Native Mental Health Research

Volume 16, issue 2

This issue includes three articles:

• “First Nation Communities and Tobacco Taxation: A Commentary,”


• “Intimate Partner Violence and Alcohol, Drug, and Mental Disorders among American Indian Women in Primary Care,” and


• “The Effect of Near-miss Rate and Card Control when American Indians and Non-Indians Gamble in a Laboratory Situation: The Influence of Alcohol.”

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Fluctuations in male ischaemic heart disease mortality in Russia 1959–1998: Assessing the importance of alcohol

Drug and Alcohol Review Volume 28 Issue 4, Pages 390 - 395

The decline in cardiovascular mortality in Russia following the Soviet anti-alcohol campaign of 1985–1988 and the subsequent increase when these extreme alcohol controls were repealed suggested that alcohol consumption is responsible for a substantial number of ischaemic heart disease (IHD) deaths in Russia. To examine whether a similar conclusion can be drawn on the basis of a time-series analysis covering a longer time period, namely 1959–1998.

The results provide additional empirical evidence supporting alcohol's conceivable negative effects on IHD in Russia and the idea that binge drinking could be the mechanism through which this effect is mediated. There were no signs of any protective effects from alcohol among Russian men.

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Request Reprint E-Mail: mats.ramstedt@sorad.su.se

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A healthy dose of scepticism: Four good reasons to think again about protective effects of alcohol on coronary heart disease

Drug and Alcohol Review Volume 28 Issue 4, Pages 441 - 444

Alcohol has been implicated in both the popular press and scientific literature as having a protective effect for at least a dozen conditions including coronary heart disease (CHD). Approach. Epidemiological evidence for an apparent protective effect of alcohol on CHD is now being challenged on a number of fronts. This paper is a synopsis of those various challenges as they currently stand.

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Request Reprint E-Mail: t.n.chikritzhs@curtin.edu.au

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AERC Alcohol Academy launch event - summary and slides

The launch of the AERC Alcohol Academy took place last month in London with a one day event of workshops and presentations. The event was set up to pilot and deliver the academy’s objectives of facilitating networking and developing skills and learning for alcohol coordinators and strategic leads. . . . . . .

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An interaction between DAT1 and having an alcoholic father predicts serious alcohol problems in a sample of males

Drug and Alcohol Dependence Volume 104, Issues 1-2, 1 September 2009, Pages 17-22

The current study examines whether the dopamine transporter (DAT1) VNTR polymorphism and paternal alcoholism are related to serious alcohol problems.

These analyses suggest that additive and interactive effects of DAT1 and paternal alcoholism may operate differently across genders and races.

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Request Reprint E-Mail: vaskeje@email.uc.edu

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Unforeseen Benefits: Addiction Treatment Reduces Health Care Costs

Addiction is a pervasive yet treatable chronic health condition. Often it occurs alongside other chronic diseases. If untreated, the addicted person's medical care becomes more costly due to secondary health conditions. When treated, addiction leads to better health care outcomes.

This paper demonstrates how addiction treatment will contribute to containing costs in reforming America's health system. Studies show that addiction treatment significantly reduces emergency room, inpatient and total health care costs.

While the overall cost savings have not been documented, there are clear signs of the potential for savings. For example:

• One out of every 14 hospital stays - 2.3 million stays - was related to substance disorders in 2004, a federal study found.


• Total medical costs were reduced 26 percent among one group of patients that received addiction treatment.


• A group of at-risk alcohol users who received brief counseling recorded 20 percent fewer emergency department visits and 37 percent fewer days of hospitalization.

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A Commentary on "Consumer"
Language, Stigma, and Recovery Representation

This brief essay describes why this "consumer" terminology is counterproductive and suggests other ways to describe the critical role that people seeking or in long-term recovery, their families, and friends play in the design, delivery, and evaluation of addiction treatment and recovery support services.

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The glutamate homeostasis hypothesis of addiction

Nature Reviews Neuroscience 10, 561-572 (August 2009)

Addiction is associated with neuroplasticity in the corticostriatal brain circuitry that is important for guiding adaptive behaviour. The hierarchy of corticostriatal information processing that normally permits the prefrontal cortex to regulate reinforcement-seeking behaviours is impaired by chronic drug use.

A failure of the prefrontal cortex to control drug-seeking behaviours can be linked to an enduring imbalance between synaptic and non-synaptic glutamate, termed glutamate homeostasis. The imbalance in glutamate homeostasis engenders changes in neuroplasticity that impair communication between the prefrontal cortex and the nucleus accumbens.

Some of these pathological changes are amenable to new glutamate- and neuroplasticity-based pharmacotherapies for treating addiction.

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Request Reprint E-Mail: kalivasp@musc.edu

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