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Addiction

Addiction, In the News, Public Health, Public Safety

Can the “24/7 sobriety” model reduce drunken disorderly conduct and violence in London?

beer_london_pubIn an article published yesterday in the Telegraph, Stanford addiction expert Keith Humphreys, PhD, discusses how public officials in London are turning to the United States’ “24/7 sobriety” model in an effort to reduce repeat offenders convicted of alcohol-related crimes. The program, which combines mandatory sobriety and daily breathalyser tests, was created under Humphreys’ guidance. He writes:

Research by the RAND Corporation – a US-based non-profit global policy think tank – found that 24/7 sobriety dropped repeat drink driving arrests by 12 per cent. The same study also yielded a pleasant surprise: domestic violence arrests dropped by 9 per cent, despite not being a focus of the programme. Removing alcohol from the lives of criminals can apparently have radiating benefits beyond those directly related to their most recent offence.

In light of its positive results, judges across the U.S. have been adopting the 24/7 sobriety approach. This week, under the leadership of Mayor Johnson and his team, a pilot of the programme will be launched in South London. Leaping the pond will come with some challenges, particularly around delivering sanctions swiftly within the constraints of British law, but local tailoring of innovations is always an essential part of making them spread.

In any event, with over one million alcohol-related assaults occurring nationally each year and many London boroughs being regularly marred by violence and disorder on weekend evenings, the time for new approaches to binge drinking criminal offenders has clearly arrived. The judges and probation officers who are undertaking this pilot should be applauded for refusing to accept the status quo.

Previously: Text messages after ER visit could reduce young adults’ binge drinking by more than 50 percent, Study shows legal drinking age of 21 saves lives and reduces health risks for young adults, Alcoholism: Not just a man’s problem and Stopping criminal men from drinking reduces domestic violence
Photo by Paul Downey

Addiction, Emergency Medicine, Public Health, Research, Technology

Text messages after ER visit could reduce young adults’ binge drinking by more than 50 percent

Text messages after ER visit could reduce young adults' binge drinking by more than 50 percent

Bar_texting_0701414Researchers have demonstrated that text message programs can, among other things, help diabetes patients better manage their condition, assist smokers in kicking their nicotine habit, and encourage expecting mothers to get flu shots.

Now new findings published in the Annals of Emergency Medicine show that text messages can also be an effective tool for reducing binge drinking among young adults whose hazardous alcohol use has resulted in an emergency room visit. During a 12-week study, 765 patients who were treated in the emergency room and screened positive for a history of hazardous drinking were divided into three groups. The first group received text messages prompting them to respond to drinking-related queries and received text messages in return offering feedback aimed at either strengthening their low-risk drinking plan or promoting reflection on their drinking plan or decision not to set a low-risk goal. Another group received only text queries about their drinking, and the remaining individuals received no text messages.

A story published today on PsychCentral reports on the researchers’ results:

The group receiving both text message queries and feedback decreased their self-reported binge drinking days by 51 percent and decreased the number of self-reported drinks per day by 31 percent.

The groups that received only text messages or no text messages increased the number of binge drinking days.

“Illicit drugs and opiates grab all the headlines, but alcohol remains the fourth leading cause of preventable death in the U.S.,” said [Brian Suffoletto, MD, assistant professor in the Department of Emergency Medicine at the University of Pittsburgh School of Medicine].

“If we can intervene in a meaningful way in the health and habits of people when they are young, we could make a real dent in that tragic statistic. Alcohol may bring them to the ER, but we can do our part to keep them from becoming repeat visitors,” [he added].

Previously: CDC explores potential of using smartphones to collect public health data, Could better alcohol screening during doctor visits reduce underage drinking?, Personality-based approach can reduce teen drinking and The costs of college binge drinking
Photo by Anders Adermark

Addiction, FDA, Health Policy, otolaryngology, Public Health

How e-cigarettes are sparking a new wave of tobacco marketing

e-cig tip - smallFollowing the FDA’s announcement earlier this spring that it would regulate the sale – but not marketing – of electronic cigarettes, debate has continued on the safety of using e-cigarettes and the ethics of advertising them.

In case you missed it, today’s New York Times delves into the issue and highlights how Big Tobacco is now rolling into the world of e-cigarettes, which writer Matt Richtel calls an “overnight sensation.” A subsidiary of Reynolds American plans to begin distributing its Vuse e-cigarette line nationwide on June 23 with a campaign that includes television ads (forbidden for cigarettes) in major markets, and other tobacco companies have similar entries in the works. Questions about the potentially far-reaching effects advertising of e-cigarettes, including promoting smoking tobacco and reaching child audiences, concern public-health advocates and other critics – and a U.S. Senate hearing is planned for Wednesday.

From the article:

Matthew L. Myers, [JD,] president of the Campaign for Tobacco-Free Kids, who is scheduled to testify at the Senate hearing, said the fact that the F.D.A. did not limit marketing allowed tobacco companies to return to the airwaves with ads that make e-cigarettes sexy, rebellious, glamorous — “exactly the same themes we saw work with kids in the U.S. for decades with cigarettes.”

In the absence of marketing regulation, “they will set the agenda,” Mr. Myers said of the tobacco companies. “They will drive the evolution of the product in a way that serves their interests and not public health, and that’s exactly what’s happening.”

Robert Jackler, MD, chair of otolaryngology at Stanford Medicine, is an expert on tobacco marketing who studies it through his center, the Stanford Research Into the Impact of Tobacco Advertising. Like Myers, he has vocalized his concerns about e-cigarettes and tobacco companies’ aggressive marketing tactics – especially those targeted toward teens – and you can hear more about his views and research in this recent podcast.

Previously: E-cigarettes and the FDA: A conversation with a tobacco-marketing researcherE-Cigarettes: The explosion of vaping is about to be regulatedStanford chair of otolaryngology discusses federal court’s ruling on graphic cigarette labels and What’s being done about the way tobacco companies market and manufacture products
Photo by Li Tsin Soon

Addiction, In the News, Medicine and Society, Research, Stanford News

As AA approaches 79, a look at its effectiveness for sobriety

As AA approaches 79, a look at its effectiveness for sobriety

stairsAlcoholics Anonymous, a nonprofessional, international fellowship for people who have had a drinking problem, is approaching 79 years of existence. This morning, Keith Humphreys, PhD, a Stanford addiction expert, writes in Washington Post‘s Wonkblog about how medical experts have viewed the organization during its tenure and what can be made of results from studies measuring AA’s effectiveness.

From the piece:

For most of the 12-step fellowship’s existence, professionals in the addiction field held widely varying opinions of its value. Some praised AA as an extremely valuable resource for people seeking recovery, but others viewed it as unsophisticated folk medicine and even a bit cultish. Other tensions emerged from turf issues: Medical professionals can be dismissive of – at times even hostile to – those they consider well-intentioned amateurs. Just as some obstetricians resent midwives, some addiction treatment professionals looked down on the non-professional AA members in their midst.

Humphreys notes that results from Project MATCH, the largest study of alcohol-dependence treatment, and a subsequent randomized clinical trial have changed some skeptics’ minds. More from the piece:

Studies such as these dramatically reduced the ranks of AA critics among scientists. AA’s value is still questioned in a few quarters, but as Harvard Professor of Psychiatry John Kelly [PhD] notes, this is becoming less true as the years go by: “The stronger scientific evidence supporting the effectiveness of AA is relatively new. It takes time for evidence to disseminate into clinical practice as well as into broader society.”

Previously: What’s the best way to handle the chronically intoxicated?, Examining how addiction in the U.S. has changed over the last decade and A discussion of the history and effectiveness of Alcoholics Anonymous
Photo by Kristin Charles-Scaringi

Addiction, Public Health, Research

Text message program helps smokers “stay focused on quitting”

text_to_quit_3A growing body of scientific evidence shows that text-messaging programs are an effective and affordable way to provide motivation and support for smokers to kick their nicotine habit. Now new research shows that one such mobile health program doubles the chances that smokers will quit.

The study involved more than 500 smokers recruited via the web. Researchers randomized the participants to either receive a text-messaging program called Text2Quit or self-help material. The interactive text messages offered advice and allowed individuals to request more help, reset their quit date or play a game to help distract them until a craving subsided. After six months, individuals completed a survey to determine how many in each group had successfully quit smoking. According to a release:

More than 11 percent of smokers who used a text- messaging program to help them quit did so and remained smoke free at the end of a six- month study as compared to just 5 percent of controls, according to a new report by researchers at Milken Institute School of Public Health at the George Washington University (Milken Institute SPH.)

“Text messages seem to give smokers the constant reminders they need to stay focused on quitting,” says Lorien C. Abroms, ScD, MA, an associate professor of prevention and community health at Milken Institute SPH and the lead author of the study. “However, additional studies must be done to confirm this result and to look at how these programs work when coupled with other established anti-smoking therapies.”

In their conclusion, researchers noted that future studies should look at less-Internet-savvy populations as well as compare Text2Quit with similar programs.

Previously: Craving a cigarette but trying to quit? A supportive text message might help, National Cancer Institute introduces free text message cessation service for teens and Can daily texts help smokers kick their nicotine addiction?
Photo by William Atkins/George Washington University

Addiction, Health Policy, In the News

Increasing access to an anti-overdose drug

In the past decade, the U.S. has experienced a surge of fatal opioid overdoses, driven partly by increased heroin use but mostly by the greatly expanded availability of prescription medications (e.g. Oxycontin). One important tool in combating this epidemic is naloxone, a drug that rapidly reverses the respiration-suppressing effects of opioids.  Expanding its use has been a goal of President Obama’s drug policy from the first days of the administration, and an increasing number of community members, health and social care workers and police have been trained how to administer it.  Some New York police officers give a powerful account of their experiences with the rescue drug in the video above.

However, with the increased demand for naloxone has come an increase in its price. It’s an off-patient medication, so in absolute terms costs are low (up to $40 for the nasal administered naloxone kits that police tend to carry and much less for the injected version distributed by many non-profit service organizations). But even low costs can be a barrier particularly if a drug is provided to cover an entire population (most of whom will never need it) rather than employed to treat an identified individual in need.

That’s why it’s encouraging that The Clinton Foundation has announced that it will attempt to lower the cost and increase the accessibility of naloxone, presumably using the same strategies that were employed successfully to achieve the same goals with HIV-related medications. Another potentially important effort, under consideration in the California legislature, is to allow naloxone to be distributed by pharmacists rather than requiring an individual prescription for everyone to whom it is provided.  Although the impact of this policy on public health can’t be known in advance, naloxone does not appear to have serious or common side-effects to weigh against it potentially life-saving benefits, which makes it more reasonable to have it be available over the counter.

Addiction expert Keith Humphreys, PhD, is a professor of psychiatry and behavioral sciences at Stanford and a career research scientist at the Palo Alto VA. He recently completed a one-year stint as a senior advisor in the Office of National Drug Control Policy in Washington. He can be followed on Twitter at @KeithNHumphreys.

Previously: How police officers are tackling drug overdose, Do opium and opioids increase mortality risk? and Prescription drug addiction: How the epidemic is shaking up the policy world

Addiction, FDA, Health Policy, In the News, Podcasts

E-cigarettes and the FDA: A conversation with a tobacco-marketing researcher

E-cigarettes and the FDA: A conversation with a tobacco-marketing researcher

The FDA announced today its plans to regulate e-cigarettes. The news comes as little surprise to many, including Robert Jackler, MD, chair of otolaryngology at Stanford Medicine, who studies the effects of tobacco advertising, marketing, and promotion through his center, the Stanford Research Into the Impact of Tobacco Advertising. I asked Jackler this morning what he thought of the FDA’s plan, and he had this to say:

While I welcome the FDA proposal to deem electronic cigarettes as tobacco products under their regulatory authority, I’m disappointed with the narrow scope of their proposal and the snail’s pace of the process. Given its importance, I’m particularly troubled by the FDA’s failure to address the the widespread mixing of nicotine with youth-oriented flavorings (e.g. gummy bears, cotton candy, chocolate, honey, peach schnapps) in electronic cigarettes products.  Overwhelming evidence implicates such flavors as a gateway to teen nicotine addiction [which] led the FDA to ban flavors (except for menthol – which is presently under review) for cigarettes in 2009.  Give the lethargic pace of adopting new regulations, a generation of American teens is being placed at risk of suffering the ravages of nicotine addiction.

In a podcast last month, Jackler spoke in-depth about the rise of, and problems with, e-cigarettes. If you haven’t yet listened, now is a great time to.

Previously: E-Cigarettes: The explosion of vaping is about to be regulated, Stanford chair of otolaryngology discusses federal court’s ruling on graphic cigarette labels and What’s being done about the way tobacco companies market and manufacture products

Addiction, Behavioral Science, In the News, Mental Health, Research

Knitting as ritual – with potential health benefits?

Knitting as ritual - with potential health benefits?

knittingDuring finals, one of my college roommates would ritualistically sit in silence and knit an entire hat before she could begin studying. The steady, repetitive action calmed her down and cleared her mind. (Before less stressful exams, she baked.)

I thought of her when coming across a recent post on The Checkup that points to evidence, including previous research in seniors with mild cognitive impairment, that the health benefits experienced by people who engage in activities such as knitting and crocheting might be more than anecdotal. More from the piece:

In one study, 38 women hospitalized for anorexia were given a questionnaire about their psychological state after being taught to knit.

After an average of one hour and 20 minutes of knitting a day for an average of three weeks, 74 percent of them reported less fear and preoccupation with their eating disorder, the same percentage reported that knitting had a calming effect, and just over half said knitting gave them a sense of pride, satisfaction and accomplishment.

The rhythmic movements of knitting offer many of the same kinds of benefits as meditation, says Carrie Barron, [MD,] an assistant clinical professor of psychiatry at Columbia University in New York and co-author of the book “The Creativity Cure: How to Build Happiness With Your Own Two Hands.” In addition, she says, seeing a project take shape provides a deep sense of satisfaction.

That might have been why Pee-wee Herman found the unsolved mystery of his stolen bike so unnerving: “It’s like you’re unraveling a big cable-knit sweater that someone keeps knitting and knitting and knitting…” he said in the 1985 film Pee Wee’s Big Adventure.

Previously: Image of the Week: Personalized brain activity scarves, Image of the Week: aKNITomy, Study shows meditation may alter areas of the brain associated with psychiatric disorders and Ommmmm… Mindfulness therapy appears to help prevent depression relapse
Photo by Merete Veian

Addiction, Health Disparities, In the News, Public Health

Menthol cigarettes: How they’re being used by and marketed towards African Americans

Menthol pic - smallHere’s a scary statistic, included in a recently published Newsweek article: “Each year, smoking-related illnesses kill more black Americans than AIDS, car crashes, murders and drug and alcohol abuse combined, according to the Centers for Disease Control and Prevention (CDC).” And then there’s this: “More than four in five black smokers choose menthol cigarettes, a far higher proportion than for other groups… By mitigating the harshness of cigarettes and numbing the throat, menthol makes smoking more palatable, easier to start – and harder to quit.”

The article discusses advocates’ call for a ban on menthol cigarettes (all other flavored cigarettes were banned in 2009) before going on to describe the history of African Americans and menthol-cigarette use, and tobacco companies’ aggressive marketing tactics. (“The tobacco industry… positioned itself as an ally of the very community it was seducing,” writes Abigail Jones.) It also quotes Stanford’s Robert Jackler, MD, founder of Stanford Research into the Impact of Tobacco Advertising, who expresses his concerns with ads that appear in a prominent African-American publication:

…[Jackler] has analyzed Ebony magazines since the 1940s and discovered it ran 59 cigarette ads in 1990, 10 in 2011 and 19 last year.

Ebony published 21 articles about breast cancer and 11 about prostate cancer between 1999 and 2013 but did not publish a single full-length story on lung cancer in that 15-year period. “Tobacco advertising is a huge revenue stream,” says Jackler. “Ebony professes itself to be the so-called ‘heart and soul and voice of the African-American community,’ and it completely neglects smoking.”

Previously: E-Cigarettes: The explosion of vaping is about to be regulated, What’s being done about the way tobacco companies market and manufacture products, Menthol “sweetens the poison,” attracts more young smokers, Menthol cigarette marketing aimed at young African Americans and NPR’s Picture Show highlights Stanford collection of cigarette ads
Photo by Classic Film

Addiction, Public Health, Research

What the experience of Swedish snuff can teach us about e-cigarettes

snusA new study in JAMA Internal Medicine suggests that e-cigarettes don’t help tobacco smokers quit.  This study will no doubt attract enormous attention because it relates to the hottest debate in tobacco control: Whether e-cigarettes are a boon or bane to public health. E-cigarette proponents see them as a way for cigarette smokers to transition to a less damaging way of consuming tobacco; opponents worry that e-cigarettes will entice non-smokers into using a product that will ultimately be a gateway to cigarette smoking. Until more definitive data are gathered on e-cigarettes, participants in this debate would do well to examine the experience of Swedish snuff (also known as “snus”).

Snus is a smokeless tobacco that is mainly used in Scandinavia. Its use is damaging to health, but because it is not smoked and contains a low level of cancer-causing nitrosamines, the damage to users and those around them from snus is less than that of tobacco cigarettes. The fundamental question at play in the current e-cigarette debate was also raised regarding snus: Would it be a net harm or a net benefit to public health?

A study of 15,000 Swedish males examined snus use and smoking among a younger (age 16-44) and older (age 45-84) cohort. About 18 percent of tobacco smokers had previously been snus users. This gateway effect from snus to cigarettes was more common for older than younger individuals.  However, in both cohorts, the reverse pattern was far more common, leading to an overall drop in tobacco smoking. Among the younger cohort, snus accounted for six smoking quitters for each smoking starter.  In the older cohort, the benefit was less: About two smoking quitters per starter. Given the size of these effects and the prevalence of snus use, it is entirely credible to argue that snus has contributed to the declining lung cancer rate in the Swedish population.

The Swedish results would seem to make a conclusive case for the public health benefits of snus. However, a subsequent study of 1151 Finnish men had starkly different results. Only 22 participants in the study had replaced tobacco smoking with snus use. The norm in this population was to use snus to supplement rather than replace cigarette smoking, tending to increase the physical dependence of tobacco users. Although not able to draw a definitive conclusion, the authors noted that “it is likely that snus use complicates the attempts to quit smoking”.

The science on snus is thus unsatisfying for those desiring a simple answer regarding the public health value of putatively less harmful forms of tobacco. In one context, snus was enormously beneficial. In another, it appears to have made things worse. The effect of snus also varied across historical time periods as younger and older people used it in distinct ways.

The experience of e-cigarettes may very well follow the same pattern – or perhaps it is better said – the same lack of a pattern. An empirically grounded, universally valid judgment on the impact of e-cigarettes may be difficult to attain. Whether they are a net positive or negative for public health will depend on the context in which they are used, the degree to which different generations adopt them, and the regulations society sets regarding them.

Addiction expert Keith Humphreys, PhD, is a professor of psychiatry and behavioral sciences at Stanford and a career research scientist at the Palo Alto VA. He recently completed a one-year stint as a senior advisor in the Office of National Drug Control Policy in Washington. He can be followed on Twitter at @KeithNHumphreys.

Previously: E-Cigarettes: The explosion of vaping is about to be regulated
Photo by Ole C Eid

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