Category: Illegal Drugs

— Frequent use of energy drinks is associated with binge drinking, alcohol-related social problems and misuse of prescription drugs among musicians, according to researchers at the University at Buffalo's Research Institute on Addictions.

In survey results published in the Journal of Caffeine Research this spring, UB research scientists Kathleen E. Miller and Brian M. Quigley examined substance use by 226 Western New York professional and amateur musicians aged 18-45. In the sample, 94 percent were caffeine users and 57 percent reported use of energy drinks specifically.

Sixty-eight percent of the musicians surveyed reported heavy binge drinking at least once or twice a year and 74 percent reported experiencing at least one alcohol-related social problem, such as hangovers, arguing with others about their drinking, or doing something while drinking that they later regretted. Most of those surveyed also reported recreational drug use, including prescription drugs (23 percent), marijuana (52 percent), psychedelic drugs (25 percent), or cocaine (21 percent).

Musicians who used energy drinks reported significantly more misuse of legal substances than those who did not use energy drinks. For example, 31 percent of energy drink users misused prescription drugs (compared to 13 percent of nonusers) and 76 percent reported binge drinking (compared to 59 percent of nonusers).

Consistent with previous studies of athletes and college students, this study suggests that the unique relationships between energy drink consumption and other substance use represent more than merely a repackaging of the U.S. public's longstanding love affairs with coffee and soft drinks. "No question, we've got quite a caffeine habit," observes Miller. "But energy drinks bring something more to the equation."

Manufacturers of popular energy drink brands appear to target actual or aspiring musicians as a niche market for their products, evoking music in their names, sponsoring music tours, and incorporating music-related logos.

Edgy energy drink marketers consistently use brand naming, packaging, and advertising messages to tie the products to themes of rebellion, risk taking, and even illegal drug use, Miller points out. This may help to explain the unique associations between substance misuse and energy drinks but not other caffeinated beverages, she suggests. It may also give energy drinks a special appeal for musicians, who tend to score high on the personality trait of sensation-seeking.

Given the unconventional lifestyles often associated with paid musicianship — such as late or irregular hours and periodic sleep deprivation — it is likely, Miller says, that professional musicians constitute an especially fertile demographic for energy drinks, which derive their pharmacological impact primarily from caffeine.

Caffeine in low or moderate doses is a common feature of most U.S. diets. However, because they are classed as dietary supplements and therefore not subject to FDA regulation like other caffeine products, energy drinks constitute a greater than average risk for caffeine intoxication, a recognized clinical syndrome associated with higher than average doses. High levels of caffeine use have been linked to adverse health effects ranging from anxiety, irritability and insomnia to high blood pressure, cardiac arrhythmias, seizures and even death, in rare cases.

In the current study, most participants were male (60 percent) and non-Hispanic white (72 percent), with an average age of 28. Approximately one-fourth had a high school diploma or less, one-fourth had attended some college, 22 percent had a bachelors or postgraduate degree and the remaining 29 percent were currently in school. Thirty-six percent were employed full-time or part-time as professional musicians.

In addition to her research position at RIA, Miller is an adjunct research assistant professor in the UB Department of Sociology.

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Journal Reference:

1. Kathleen E. Miller, Brian M. Quigley. Energy Drink Use and Substance Use Among Musicians. Journal of Caffeine Research, 2011; 1 (1): 67-73 DOI: 10.1089/jcr.2011.0003

— While alcohol has a wide range of pharmacological effects on the body, the brain is a primary target. However, the molecular mechanisms by which alcohol alters neuronal activity in the brain are poorly understood. Participants in a symposium at the June 2010 annual meeting of the Research Society on Alcoholism in San Antonio, Texas addressed recent findings concerning the interactions of alcohol with prototype brain proteins thought to underlie alcohol actions in the brain.

Proceedings will be published in the September 2011 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

"Alcohol is the most common drug in the world, has been used by diverse human communities longer than recorded history, yet our understanding of its effects on the brain is limited when compared to other drugs," said Rebecca J. Howard, a postdoctoral fellow at The University of Texas at Austin Waggoner Center for Alcohol & Addiction Research and corresponding author for this study.

Howard explained that neuroscientists have discovered how marijuana, cocaine, and heroin each bind to a special type of protein on the surface of brain cells, fitting like a key into a lock to change that protein's normal function. Yet alcohol has special properties that make it difficult to characterize its lock-and-key binding in detail, for example, alcohol is much smaller than other drugs, and appears to interact with several different types of proteins.

"The adverse effects of alcohol abuse are devastating on a personal level and on a societal level," added Gregg Homanics, a professor of anesthesiology and pharmacology & chemical biology at the University of Pittsburgh. "Alcohol abuse costs our society more than the costs of all illegal drug abuse combined. For many years, most investigators thought that alcohol exerted nonspecific effects on the brain and simply perturbed neuronal function by dissolving in the membranes of nerve cells. However, our understanding of alcohol action has dramatically shifted in the last 10 to 15 years or so. There is now solid experimental evidence that alcohol binds in a very specific manner to key protein targets in the brain to cause the drug's well known behavioral effects. This review summarizes some of the most recent research."

Some of the key points were:

• Combining X-ray crystallography, structural modeling, and site-directed mutagenesis may be better suited to studying alcohol's low-affinity interactions than traditional techniques such as radioligand binding or spectroscopy.

  "One major problem in studying alcohol binding to brain proteins is that the alcohol key does not fit very tightly into any particular protein lock," said Howard. "That is, alcohol has a 'low affinity' for proteins, compared to how other drugs interact with their own protein targets. We think this is one reason it takes such a large quantity of alcohol to affect the brain: whereas users of cocaine or heroin may consume just a few milligrams at a time, a person drinking a shot of strong liquor consumes about 1,000 times that much alcohol (several grams). The low affinity of alcohol for its protein targets [also] makes it difficult to study by traditional methods that rely on detecting stable drug-protein complexes over a long period of time."

• Some common themes are beginning to emerge from a review of diverse proteins such as inwardly rectifying potassium, transient receptor potential, and neurotransmitter-gated ion channels, as well as protein kinase C epsilon.

  "It is now very clear that hydrophobic pockets exist in the structure of various brain proteins and alcohols can enter those pockets," said Homanics. "Alcohols interact with specific amino acids that line those pockets in a very specific manner."

• In particular, evidence is emerging that supports characteristic, discrete alcohol binding sites on protein targets.

"Different drugs bind to different types of proteins on the surface of brain cells, each fitting like a key, or drug, into a lock, or binding site, on a protein to change its normal function," explained Howard. "Understanding the exact shape of that lock and key helps us to understand how individuals with special mutations may be affected differently by drugs, and can help scientists design new medicines to help people with drug abuse or other problems."

"I feel that there is now overwhelming evidence that specific alcohol binding sites exist on a variety of brain protein targets," added Homanics. "This is significant because we can now focus on defining these sites in greater detail, ultimately at the level of each atom involved. This will allow for, one, a more complete understanding of the molecular pharmacology of alcohol action, two, the discovery of similar sites on other important brain proteins, and three, the rational design of drugs that can selectively target these binding sites."

"Our review summarizes very recent advances in understanding the molecular details of alcohol binding sites, which now include human brain targets, not just metabolic enzymes and receptors from other species," said Howard. "This information will give researchers new opportunities to characterize human mutations and design new medicines. Furthermore, common themes emerging about alcohol binding sites may help scientists identify important binding sites in other important brain proteins."

"In other words," said Homanics, "alcohol exerts its effects via binding sites on target molecules just like all other drugs we know about. There is now solid evidence from several different putative alcohol targets using several different techniques that alcohol interacts with specific brain targets in a highly selective manner. This is particularly important for more senior clinicians and researchers that were trained years ago when the predominant theory of alcohol action was via nonspecific effects on the nervous system." Both Howard and Homanics are hopeful that this research will aid the development of therapies and treatments for individuals with alcohol problems.

"Great progress is being made in understanding how alcohol exerts its effects on the brain at the molecular level," noted Homanics. "Understanding how alcohol affects brain proteins on a molecular level is essential if we are to effectively develop rational treatments to combat alcohol use disorders."

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Journal Reference:

1. Rebecca J. Howard, Paul A. Slesinger, Daryl L. Davies, Joydip Das, James R. Trudell, R. Adron Harris. Alcohol-Binding Sites in Distinct Brain Proteins: The Quest for Atomic Level Resolution. Alcoholism: Clinical and Experimental Research, 2011; DOI: 10.1111/j.1530-0277.2011.01502.

A new study indicates high rates of injection drug use in urban Canadian Aboriginal youth, particularly in women, and points to the need for culturally specific prevention programs, states an article in CMAJ (Canadian Medical Association Journal).

Aboriginal leadership is alarmed at the levels of substance abuse in their young people, especially injection drug use, which is associated with HIV and hepatitis C virus infections. Injection drug use accounts for 70%-80% of all hepatitis C virus and almost 60% of HIV infections in Aboriginal youth under age 24 in Canada. The history of colonization, including the effect of residential schooling on several generations and the child welfare system, has had significant negative effects on Aboriginal communities. Many children and youth have experienced physical, sexual and emotional abuses as well as exposure to familial violence and drug dependence.

The Cedar Project is a prospective study of 605 Aboriginal youth in Vancouver and Prince George, British Columbia, conducted from 2003 to 2007 that sought to understand use of illicit drugs, particularly relating to infection with HIV. Participants were between the ages of 14 and 30 years and had smoked or injected illicit drugs, other than marijuana, in the month before enrolment. The median age was 23, and 292 (48.3%) were women.

At the start of the study, 335 (55.4%) of participants reported a history of injection drug use. Injection drug users were more likely to be women, to be older, to identify as gay, lesbian, bisexual or two-spirited, to have experienced sexual abuse, to have a parent who attended a residential school and to have other risk factors. In participants who had no history of injection drug use and who attended at least one follow-up visit (197 out of 270), 39 people (18 men, 21 women) began to inject drugs.

Young Aboriginal women were twice as likely to inject drugs as men.

"In our study population, about 11 participants per 100 person-years will transition to injection drug use — a rate that is almost twice as high as that found in the only other available longitudinal study done in Canada investigating transition to injection drug use among young people (6.8 per 100 person-years in Montréal, Quebec)," states Dr. Patricia Spittal, School of Population and Public Health, University of British Columbia, with coauthors. "Transition to injection drug use at a young age not only increases the risk of contracting an infectious disease, it also further entrenches the young person in an increasingly dangerous street life that often involves sex work, violence, predation and life-long addiction."

The study was conducted by researchers from the School of Population and Public Health, University of British Columbia; Simon Fraser University; the Centre for Health Evaluation and Outcome Sciences at Providence Health Care; the Wuikinuxv Nation, Port Hardy, BC; and the Splats'in/Secwepemc Nation, Enderby, BC.

"This study documents an unacceptable number of young, at-risk Aboriginal people transitioning to injection drug use every year; however, there are no prevention programs tailored specifically to this population," states Chief Wayne Christian and coauthors. "Support for community-based programs that address the potential for drug dependence within the context of sexual trauma should be prioritized to respond to the dual epidemics of injection drug use and blood-borne infection among Aboriginal people," they conclude.

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Journal Reference:

1. Cari L. Miller, Margo E. Pearce, Akm Moniruzzaman, Vicky Thomas, Chief Wayne Christian, Martin T. Schechter, and Patricia M. Spittal. The Cedar Project: risk factors for transition to injection drug use among young, urban Aboriginal people. Canadian Medical Association Journal, 2011; DOI: 10.1503/cmaj.101257

 Definitive proof of an adverse effect of chronic marijuana use revealed at SNM's 58th Annual Meeting could lead to potential drug treatments and aid other research involved in cannabinoid receptors, a neurotransmission system receiving a lot of attention. Scientists used molecular imaging to visualize changes in the brains of heavy marijuana smokers versus non-smokers and found that abuse of the drug led to a decreased number of cannabinoid CB1 receptors, which are involved in not just pleasure, appetite and pain tolerance but a host of other psychological and physiological functions of the body.

"Addictions are a major medical and socioeconomic problem," says Jussi Hirvonen, MD, PhD, lead author of the collaborative study between the National Institute of Mental Health and National Institute on Drug Abuse, Bethesda, Md. "Unfortunately, we do not fully understand the neurobiological mechanisms involved in addiction. With this study, we were able to show for the first time that people who abuse cannabis have abnormalities of the cannabinoid receptors in the brain. This information may prove critical for the development of novel treatments for cannabis abuse. Furthermore, this research shows that the decreased receptors in people who abuse cannabis return to normal when they stop smoking the drug."

According to the National Institute on Drug Abuse, marijuana is the number-one illicit drug of choice in America. The psychoactive chemical in marijuana, or cannabis, is delta-9-tetrahydrocannabinol (THC), which binds to numerous cannabinoid receptors in the brain and throughout the body when smoked or ingested, producing a distinctive high. Cannabinoid receptors in the brain influence a range of mental states and actions, including pleasure, concentration, perception of time and memory, sensory perception, and coordination of movement. There are also cannabinoid receptors throughout the body involved in a wide range of functions of the digestive, cardiovascular, respiratory and other systems of the body. Currently two subtypes of cannabinoid receptors are known, CB1 and CB2, the former being involved mostly in functions of the central nervous system and the latter more in functions of the immune system and in stem cells of the circulatory system.

For this study, researchers recruited 30 chronic daily cannabis smokers who were then monitored at a closed inpatient facility for approximately four weeks. The subjects were imaged using positron emission tomography (PET), which provides information about physiological processes in the body. Subjects were injected with a radioligand, 18F-FMPEP-d2, which is a combination of a radioactive fluorine isotope and a neurotransmitter analog that binds with CB1 brain receptors.

Results of the study show that receptor number was decreased about 20 percent in brains of cannabis smokers when compared to healthy control subjects with limited exposure to cannabis during their lifetime. These changes were found to have a correlation with the number of years subjects had smoked. Of the original 30 cannabis smokers, 14 of the subjects underwent a second PET scan after about a month of abstinence. There was a marked increase in receptor activity in those areas that had been decreased at the outset of the study, an indication that while chronic cannabis smoking causes downregulation of CB1 receptors, the damage is reversible with abstinence.

Information gleaned from this and future studies may help other research exploring the role of PET imaging of CB1 receptors — not just for drug use, but also for a range of human diseases, including metabolic disease and cancer.

Aboriginal-youth living off-reserve in Canada use tobacco, alcohol and drugs significantly more than non-Aboriginal youth and have higher health risks, according to an article in CMAJ (Canadian Medical Association Journal).

Despite the high prevalence of smoking among Aboriginal youth in Canada, there is a lack of information on their patterns of tobacco use, especially among people living off-reserve. Most Aboriginals in Canada live off-reserve, and those 15 years of age and older are more likely than non-Aboriginals to have chronic health conditions, to drink heavily and to smoke. Aboriginal youth also have higher rates of marijuana use.

Researchers compared smoking habits, use of other tobacco products, alcohol and drugs as well as second-hand smoke exposure in 2620 off-reserve Aboriginal youth and 26 223 non-Aboriginal youth. All youth were in grades 9-12 and had participated in the 2008-2009 Youth Smoking Survey.

In the study, 24.9% of the Aboriginal respondents reported they were current smokers, 2.6% were previous smokers, and 72.4% were nonsmokers. In the non-Aboriginal youth, 10.4% were current smokers, 1.5% former smokers and 88.0% nonsmokers.

Exposure to second-hand smoke was more common for Aboriginal respondents than non-Aboriginal respondents.

Most of the respondents reported having tried alcohol (88.5% of Aboriginal and 84.2% of non-Aboriginal youth). The average age at which they first tried alcohol was considerably lower among Aboriginal youth. Among those who had tried alcohol, Aboriginal youth were more likely to engage in binge drinking (91.9% compared to 85.2% of non-Aboriginals). Aboriginal youth also used marijuana (62.0%) and other illicit drugs (34.8%) more frequently compared with non-Aboriginal youth (41.0% and 20.6% respectively).

"The high prevalence of smoking and use of other substances among Aboriginal youth living off-reserve highlights the need for culturally appropriate smoking cessation and substance prevention programs that target Aboriginal youth," writes Dr. Tara Elton-Marshall, Propel Centre for Population Health Impact, University of Waterloo, with coauthors.

Aboriginal females had higher rates of smoking, marijuana and other illicit drug use than male aboriginals.

"Most of the Aboriginal youth who identified themselves as current smokers, particularly females, reported that they had tried to quit at least once previously," wrote the authors. "This finding suggests that Aboriginal youth are interested in quitting but have not been successful and that they may require additional support to stop smoking."

"Our findings highlight the need for culturally appropriate prevention and cessation policies and programs for this at-risk population," conclude the authors.

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Journal Reference:

1. Tara Elton-Marshall, Scott T. Leatherdale, and Robin Burkhalter. Tobacco, alcohol and illicit drug use among Aboriginal youth living off-reserve: results from the Youth Smoking Survey. Can. Med. Assoc. J., May 2011 DOI: 10.1503/cmaj.101913

 Vanderbilt researchers are studying heavy users of marijuana to help understand what exercise does for the brain, contributing to a field of research that uses exercise as a modality for prevention and treatment.

Participants saw a significant decrease in their cravings and daily use after just a few sessions of running on the treadmill, according to a Vanderbilt study published in the journal PLoS ONE. It is the first study to demonstrate that exercise can reduce cannabis use in persons who don't want to stop.

Twelve study participants — eight female and four male — were selected because they met the criteria for being 'cannabis-dependent' and did not want treatment to help them stop smoking pot.

During the study their craving for and use of cannabis was cut by more than 50 percent after exercising on a treadmill for 10 30-minute sessions over a two-week period.

"This is 10 sessions but it actually went down after the first five. The maximum reduction was already there within the first week," said co-author Peter Martin, M.D., director of the Vanderbilt Addiction Center.

"There is no way currently to treat cannabis dependence with medication, so this is big considering the magnitude of the cannabis problem in the U.S. And this is the first time it has ever been demonstrated that exercise can reduce cannabis use in people who don't want to stop."

Cannabis abuse or dependence and complications have increased in all age groups in the past decade in the United States.

In 2009, approximately 16.7 million Americans age 12 or older reported cannabis use in the previous month and 6.1 million used the drug on 20 or more days per month, the authors wrote.

Treatment admissions for cannabis dependence have risen from 7 percent of total addiction treatment admissions in 1998 to 16 percent by 2009.

Co-author Mac Buchowski, Ph.D., director of the Vanderbilt Energy Balance Laboratory, said the importance of this study and future studies will only continue to grow with the new knowledge of the role of physical activity in health and disease.

"It opens up exercise as a modality in prevention and treatment of, at least, marijuana abuse. And it becomes a huge issue with medical marijuana now available in some states," he said. "What looks like an innocent, recreational habit could become a disease that has to be treated."

Martin sees the study results as the beginning of an important area of research to better understand brain mechanisms of exercise in addiction.

"It shows that exercise can really change the way the brain works and the way the brain responds to the world around us," he said. "And this is vital to health and has implications for all of medicine."

Study participants, who reported they smoke on average 5.9 joints per day, came to Vanderbilt five times a week for two weeks to run on the treadmill. Buchowski and his co-workers measured the amount of exercise needed for each individual to achieve 60-70 percent of maximum heart rate, creating a personalized exercise treadmill program for each participant.

Participants were shown pictures of a cannabis-use related stimuli before and after each exercise session and then asked to rank their cravings according to the cannabis craving scale. They also documented cannabis use, which reduced to an average of 2.8 joints per day during the exercise portion of the study.

Martin said it is important to repeat the findings in a much larger study, in a randomized and controlled manner. The study results also should prompt further research into understanding what exercise does for the brain, he added. "Mental and physical health in general could be improved. Unfortunately, young people who smoke cannabis often develop panic attacks, and may develop to psychosis or mood disorders," Martin said.

"Back in the 1960s and 70s people used to say that cannabis is not particularly unhealthy. Well, there have been data coming out over the last five years that have demonstrated pretty conclusively that cannabis smoking may be a predisposing factor for developing psychosis."

Vanderbilt co-investigators for this study are Evonne Charboneau, M.D., research assistant professor of Psychiatry; Sohee Park, Ph.D., professor of Psychology; Mary Dietrich, Ph.D., research associate professor of Psychiatry and Nursing; Ronald Cowan, M.D., Ph.D., associate professor of Psychiatry; and Natalie Meade, study coordinator.

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Journal Reference:

1. Maciej S. Buchowski, Natalie N. Meade, Evonne Charboneau, Sohee Park, Mary S. Dietrich, Ronald L. Cowan, Peter R. Martin. Aerobic Exercise Training Reduces Cannabis Craving and Use in Non-Treatment Seeking Cannabis-Dependent Adults. PLoS ONE, 2011; 6 (3): e17465 DOI: 10.1371/journal.pone.0017465

Few primary care physicians pay adequate attention to patients taking prescription opioid drugs — despite the potential for abuse, addiction and overdose, according to a new study by researchers at Albert Einstein College of Medicine of Yeshiva University.

The study, published in the March 2 online edition of the Journal of General Internal Medicine, found lax monitoring even of patients at high risk for opioid misuse, such as those with a history of drug abuse or dependence. The findings are especially concerning considering that prescription drug abuse now ranks second (after marijuana) among illicitly used drugs, with approximately 2.2 million Americans using pain relievers nonmedically for the first time in 2009, according to the National Institute on Drug Abuse (NIDA).

"Our study highlights a missed opportunity for identifying and reducing misuse of prescribed opioids in primary care settings," said lead author Joanna Starrels, M.D., M.S. , assistant professor of medicine at Einstein. "The finding that physicians did not increase precautions for patients at highest risk for opioid misuse should be a call for a standardized approach to monitoring."

The researchers studied administrative and medical records of more than 1,600 primary care patients for an average of two years while they received regular prescription opioids for chronic, non-cancer pain. They looked at whether patients received urine drug testing, were seen regularly in the office, or received multiple early opioid refills.

Only a small minority (8 percent) of patients were found to have undergone any urine drug testing. While such testing was more common in patients at higher risk for opioid misuse, the rate of testing among those high-risk patients was still low (24 percent). Only half of patients were seen regularly in the office, and patients at higher risk of opioid misuse were not seen more frequently than patients at lower risk. Although fewer than one-quarter (23 percent) of all patients received two or more early opioid refills, patients at greater risk for opioid misuse were more likely to receive multiple early refills.

"We were disturbed to find that patients with a drug use disorder were seen less frequently in the office and were prescribed more early refills than patients without these disorders," said Dr. Starrels. "We hope that these findings will call attention to this important safety concern."

Prescription drug misuse is a major public health problem. In a 2004 NIDA report , it was estimated that 48 million people over the age of 12 have taken prescription drugs for nonmedical uses in their lifetime — which represents approximately 20 percent of the U.S. population. Opioids, central nervous system depressants and stimulants were the drugs most commonly abused.

"Most primary care physicians are attuned to these problems," said Dr. Starrels, "but they haven't put sufficient strategies in place to help reduce risks." She and her co-authors recommend that physicians adopt the following risk-reduction strategies: standardize a plan of care for all patients on long-term opioids, which includes urine drug testing; schedule regular face-to-face office visits to evaluate patients' response to opioids and evidence of misuse; and stick to a previously agreed-upon refill schedule.

The paper, "Low Use of Opioid Risk Reduction Strategies in Primary Care Even for High Risk Patients with Chronic Pain," was published March 2, 2011 in the online edition of the Journal of General Internal Medicine. Co-authors include William C. Becker, M.D., of Yale University School of Medicine, New Haven, CT; Mark G. Weiner, M.D., of the University of Pennsylvania School of Medicine, Philadelphia, PA; Xuan Li, M.S., and Moonseong Heo, Ph.D., of Einstein; and Barbara J. Turner, M.D., M.S.Ed., of the University of Texas Health Science Center and University Health System, San Antonio,

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Journal Reference:

1. Joanna L. Starrels, William C. Becker, Mark G. Weiner, Xuan Li, Moonseong Heo, Barbara J. Turner. Low Use of Opioid Risk Reduction Strategies in Primary Care Even for High Risk Patients with Chronic Pain. Journal of General Internal Medicine, 2011; DOI: 10.1007/s11606-011-1648-2

The federal anti-drug campaign "Above the Influence" appears to have effectively reduced marijuana use by teenagers, new research shows.

A study of more than 3,000 students in 20 communities nationwide found that by the end of 8th grade, 12 percent of those who had not reported having seen the campaign took up marijuana use compared to only 8 percent among students who had reported familiarity with the campaign.

The researchers said they believe this is the first independent study to find evidence for the effectiveness of the "Above the Influence" campaign, which was initially funded at nearly $200 million a year when it began in 2005.

Evidence for the success of "Above the Influence" is especially heartening because the primary independent evaluation of its predecessor campaign, "My Anti-Drug," showed no evidence for success, said Michael Slater, principal investigator of the new study and professor of communication at Ohio State University.

"The 'Above the Influence' campaign appears to be successful because it taps into the desire by teenagers to be independent and self-sufficient," Slater said.

For example, one television ad in the campaign ends with the line "Getting messed up is just another way of leaving yourself behind."

Campaigns that only emphasize the risk of drug use may not be effective with many teens.

"We know that many teenagers are not risk avoidant, and consider the risks of marijuana to be modest. A campaign that merely emphasizes already-familiar risks of marijuana probably won't reach the teens who are most likely to experiment with drugs," he said.

The study appears in the March 2011 issue of the journal Prevention Science.

Slater said this study was not originally designed to study the effectiveness of the "Above the Influence" campaign, which is sponsored by the federal Office of National Drug Control Policy (ONDCP).

Instead, the study was going to examine the effectiveness of a very similar, but more localized anti-drug campaign called "Be Under Your Own Influence." This theme was developed years before the "Above the Influence" campaign by study co-author Kathleen Kelly, professor of marketing at Colorado State University.

It involved in-school media and promotional materials combined with community-based efforts. Like the "Above the Influence" campaign, it emphasized that drug use undermines the ability of teens to achieve their goals and act independently.

Slater said that members of his research team presented preliminary results supporting the effectiveness of "Be Under Your Own Influence" to the ONDCP and to Partnership for Drug Free America, which oversees creative efforts for the national campaign, in 2003, about two years before "Above the Influence" was launched. However, the researchers did not have any direct input into the development of the "Above the Influence" campaign.

Slater said the approaches are very similar.

"'Above the Influence' uses the same approach — focusing on the inconsistency of substance use with teens' aspirations and autonomy — that we developed," he said.

A study published in 2006 of "Be Under Your Own Influence" showed that it reduced by about half the number of students who began using marijuana and alcohol during the two years of the project, compared to students in communities without the program.

This new study was designed to replicate and extend the previous research, Slater said. In the 20 communities involved in the study, schools received some combination of some, all or none of the "Be Under Your Own Influence" materials.

The researchers surveyed 3,236 students who were about 12 years old when the study began in 2005. They were surveyed four times beginning in 7th grade and ending about a year and a half later.

The researchers didn't know that the ONDCP would be launching its "Above the Influence" campaign about the same time this new study began. As a result, though, the researchers asked students about their exposure to the national campaign during the second through fourth surveys.

The results of this study showed that the ONDCP campaign appeared to be very successful at reaching students: up to 79 percent of students surveyed said they had seen the ads.

"There was wide exposure to the national campaign, and it really swamped the effects of our local effort," Slater said. "It took over, and we didn't see any independent effects for the 'Be Under Your Own Influence' campaign."

But it was really the message of "Above the Influence" that mattered in reducing marijuana use — not the fact that it was a national campaign, he said. In their previous study, the researchers found that "Be Under Your Own Influence" showed strong local anti-drug effects, even though the national "My Anti-Drug" campaign was going on.

"'Above the Influence' has succeeded more than its predecessor attempt to influence teens," Slater said.

The effectiveness of the ONDCP campaign can be seen in the way it appeared to influence attitudes of teens who viewed the ads.

Results showed that teens who had seen the "Above the Influence" ads were more likely than others to say that marijuana use was inconsistent with being autonomous and independent and that it would interfere with their goals and aspirations.

"The teens seemed to pick up on the messages that the campaign promoted," Slater said.

"The campaign really works to honor teens' interest in becoming autonomous and achieving goals and stays away from messages that don't really reach the teens who are most likely to use marijuana."

Slater says study limitations include the fact that findings regarding the ONDCP campaign were based on survey results and not a randomized, experimental design in which some youth saw the ONDCP campaign and others did not. Another limitation was that the study, while taking place in 20 communities around the U.S., did not use a random sample of U.S. youth.

Other co-authors of the study were Frank Lawrence of Penn State University; Linda Stanley of Colorado State University; and Maria Leonora G. Comello of the University of North Carolina.

The research was supported by a grant from the National Institute on Drug Abuse.

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Journal Reference:

1. Michael D. Slater, Kathleen J. Kelly, Frank R. Lawrence, Linda R. Stanley, Maria Leonora G. Comello. Assessing Media Campaigns Linking Marijuana Non-Use with Autonomy and Aspirations: 'Be Under Your Own Influence' and ONDCP’s 'Above the Influence'. Prevention Science, 2011; 12 (1): 12 DOI: 10.1007/s11121-010-0194-1

While smoking and alcohol use remained relatively stable over a 13-year study period, street drug use among stroke patients rose more than nine-fold, according to new research from the University of Cincinnati (UC).

The findings are being presented on February 9, in Los Angeles at International Stroke Conference (ISC) 2011, the annual meeting of the American Stroke Association, by Felipe De los Rios, MD, of the UC Department of Neurology and the UC Neuroscience Institute. De los Rios is a fourth-year resident in the neurology department.

The research is part of the Greater Cincinnati/Northern Kentucky Stroke Study, begun in 1993 at the UC College of Medicine, which is funded by the National Institutes of Health (NIH) and identifies all hospitalized and autopsied cases of stroke and transient ischemic attack (TIA) in a five-county region. The NIH also funded the study led by De los Rios.

"We know that stroke incidence in younger age groups has increased over time in our region," says De los Rios, referring to UC research presented at last year's International Stroke Conference. "With street drug use more prevalent at younger ages, this could help explain that phenomenon."

Researchers examined three one-year periods: July 1993 to June 1994, 1999 and 2005, the latest year for which complete statistics are available. While current smoking (rising from 21 percent to 24 percent) and heavy alcohol use (dropping from 6 percent to 5 percent) remained relatively stable, street drug use including marijuana and cocaine/crack, among others, rose from 0.5 percent in 1993-94 to 4.6 percent in 2005. (It was 1.5 percent in 1999.)

Street drug use information came from patients' charts or positive urine/blood tests. Current smoking was defined as present within the past three months; heavy alcohol use constituted three or more servings per day.

"The number of stroke subjects with street drug use is not trivial," says de los Rios, adding that the heaviest usage (21 percent) among stroke patients in 2005 was in the under-35 age group.

Data presented by UC researchers at ISC 2010 in San Antonio, also using information from the Greater Cincinnati/Northern Kentucky Stroke Study, showed the proportion of all strokes under age 45 in the area was up to 7.3 percent in 2005 from 4.5 percent in 1993-94 and 5.5 percent in 1999.

The growing numbers of new cases of substance abuse disorders are perplexing. After all, the course of drug addiction so often ends badly. The negative consequences of drug abuse appear regularly on TV, from stories of celebrities behaving in socially inappropriate and self-destructive ways while intoxicated to dramatization of the rigors of drug withdrawal on "Intervention" and other reality shows.

Schools now educate students about the risks of addiction. While having a keen awareness of the negative long-term repercussions of substance use protects some people from developing addictions, others remain vulnerable.

One reason that education alone cannot prevent substance abuse is that people who are vulnerable to developing substance abuse disorders tend to exhibit a trait called "delay discounting," which is the tendency to devalue rewards and punishments that occur in the future. Delay discounting may be paralleled by "reward myopia," a tendency to opt for immediately rewarding stimuli, like drugs.

Thus, people vulnerable to addiction who know that drugs are harmful in the long run tend to devalue this information and to instead be drawn to the immediately rewarding effects of drugs.

Delay discounting is a cognitive function that involves circuits including the frontal cortex. It builds upon working memory, the brain's "scratchpad," i.e., a system for temporarily storing and managing information reasoning to guide behavior.

In a new article in Biological Psychiatry that studied this process, Warren Bickel and colleagues used an approach borrowed from the rehabilitation of individuals who have suffered a stroke or a traumatic brain injury. They had stimulant abusers repeatedly perform a working memory task, "exercising" their brains in a way that promoted the functional enhancement of the underlying cognitive circuits.

They found that this type of training improved working memory and also reduced their discounting of delayed rewards.

"The legal punishments and medical damages associated with the consumption of drugs of abuse may be meaningless to the addict in the moment when they have to choose whether or not to take their drug. Their mind is filled with the imagination of the pleasure to follow," commented Dr. John Krystal, Editor of Biological Psychiatry. "We now see evidence that this myopic view of immediate pleasures and delayed punishments is not a fixed feature of addiction. Perhaps cognitive training is one tool that clinicians may employ to end the hijacking of imagination by drugs of abuse."

Dr. Bickel agrees, adding that "although this research will need to be replicated and extended, we hope that it will provide a new target for treatment and a new method to intervene on the problem of addiction."

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Journal Reference:

1. Warren K. Bickel, Richard Yi, Reid D. Landes, Paul F. Hill, Carole Baxter. Remember the Future: Working Memory Training Decreases Delay Discounting Among Stimulant Addicts. Biological Psychiatry, 2011; 69 (3): 260 DOI: 10.1016/j.biopsych.2010.08.017