Now there is  a  study published in Biological Psychiatry in  May 2018,  conducted by researchers at the IRCCS Santa Lucia Foundation and University of Rome “La Sapienza,” Italy, that  focuses on the traumatic roots of substance use disorders and identifies a specific way in which   high levels of childhood stress   increase an individual’s sensitivity to psychoactive substances.

First a word about ACES:  Adverse Childhood Events

We’ve known for some time that adverse events that occur in childhood increase the likelihood of physical and mental disorders later in life. A study conducted by the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente  and published in 1998 demonstrated that toxic  childhood stress leads to a myriad of  dramatic and highly destructive outcomes in adults, including a number  of life-threatening health conditions such as  obesity, heart disease, alcoholism, and drug use.  Subsequent research has reinforced these findings. Adverse childhood events  can include emotional abuse, physical abuse, sexual abuse, neglect, exposure to domestic violence, mental illness in the household and other highly stressful experiences. They may be acute events that occur between birth and age 18 or they may occur over a sustained period of time. While adverse events  can happen to anyone, they are far more frequent among children who live in poverty.

The American Pediatric Society observed in 2014 that  “ACEs may become toxic when there is “strong, frequent, or prolonged activation of the body’s stress response systems in the absence of the buffering protection of a supportive, adult relationship”  and affirmed that these impacts can last a lifetime.  The current study illuminates one of the ways in which  toxic stress  can permanently transform key biological processes  and predispose affected children to later problems with psychoactive substances. This interesting and important discovery concerns the impact of toxic stress on the immune system. The researchers used both animal and human subjects to demonstrate “that exposure to social stress at an early age permanently sensitizes… peripheral and brain immune responses to cocaine in mice”.

First, the authors explained that, because the human immune system is not fully developed at birth, it can change in significant ways during childhood, so that people have a greater response when they experience psychological and immune challenges later in life.  Then, they posed three questions:

1. Does child maltreatment (CM) cause individuals to develop greater immune responses to cocaine?
2. What are the acute effects of early stress on the immune system in the brain?
3. Do these effects cause long-lasting susceptibility to cocaine?

Then, they  performed a series of  experiments in mice and humans in an attempt to answer these questions.

The animal studies showed that mice who were exposed to psychosocial stress (an intimidating adult mouse)   produced permanent changes in the peripheral and central immune system, rendering them more sensitive to a potent tumor promoter as well as  cocaine in adulthood.

Next, the researchers recruited individuals with a diagnosis of  cocaine use disorders who were currently abstinent and undergoing treatment for their disorders.  They assessed these subjects for exposure to childhood and/or adolescent maltreatment and used blood tests to evaluate whether genes that are mediators of innate immunity (and which were  significantly modulated in the experimental mice) were also altered in the human subjects.

The researchers observed significantly higher messenger RNA expression levels of these three genes in all cocaine-addicted individuals when they compared them with control subjects who did not have cocaine use disorders, “suggesting that chronic cocaine use has persistent inflammatory effects”. Most importantly though, when  the cocaine-dependent population was further  categorized by level of their  exposure to childhood maltreatment, differences in gene expression were driven  primarily by the group that reported exposure to severe maltreatment at an early age. The authors observed that, “These findings corroborate and expand earlier data on altered immune system in individuals who experience CM, demonstrating that an early life stress experience permanently changes the responsiveness of the peripheral immune system to a substance of abuse, such as cocaine. Moreover, if immune activation during early life stress was blocked using antibiotics, affected mice did not demonstrate cellular change or drug-seeking behavior.

According to senior researcher Valeria Carola, PhD:

 “Our work emphasizes once again the importance of the emotional environment where our children are raised and how much a serene and stimulating environment can provide them with an extra ‘weapon’ against the development of psychopathologies,”

The results of this study speak to the  important matter of heritability in alcohol use disorders.   Recent research indicates that 50 to 60 percent of the risk for alcoholism is determined by an individual’s genetic make-up.  But what particular risk factors are passed along in  families where alcohol use disorders (AUDs) are prevalent? Answering this question could lead to more effective strategies for both pharmacological and psychological interventions aimed at prevention and treatment of these destructive and often deadly maladies.

The  scientists conducting the present study found that subjects with a family history of alcohol use disorders (family history-positive or FHN) exhibited a  different physiological response to the expectation of drinking an alcoholic beverage than subjects whose families did not have this history (family history-negative or FHN). Specifically,  the FHP subjects appeared to produce more of the neurotransmitter dopamine when presented with an opportunity to drink than the other participants in the study, including those already diagnosed with an alcohol use disorder.

The brain’s dopamine system is a  key  reward pathway in the brain. and the way in which we experience physiological rewards is essential to our ability to learn new things. Receiving a reward teaches us teach us to repeat the behaviors that earned us the reward.  As  Dr. Martha Burns of Northwestern University explained, dopamine is the  “save button” in the brain:   “When dopamine is present during an event or experience, we remember it; when it is absent, nothing seems to stick.” All psychoactive substances raise levels of dopamine in the brain. This is why the mesolimbic dopamine system is considered essential to the development and progression of compulsive drug and alcohol use.

The strategy  in this study was to examine the release of dopamine in 3 groups of subjects who consumed both alcohol and a placebo beverage that smelled like alcohol.   One group of subjects consisted of people diagnosed with an alcohol use disorder and  the other two groups consisted of healthy subjects (moderate drinkers who would be able to tolerate the alcohol introduced in the experiment)  with family histories that were either positive or negative for a family history of alcohol.  Positron Emission Tomography imaging was used to trace the release of dopamine in the brains of study subjects, and each subject received 2 PET scans at least 2 weeks apart. Participants who received the placebo drink during their initial scan received the alcoholic beverage during the subsequent scan and vice-versa. Participants were told this was to be the procedure and all participants were able to identify which beverage they received after consuming it.

The PET scans found, as expected, “a highly significant (dopamine)-releasing effect of alcohol compared with placebo across all participants”, particularly in the ventral striatum, a region of the brain that plays a critical role in acquiring and developing reward-based behaviors. However, participants with a family history of alcohol use disorders exhibited signs of greater dopamine release prior to drinking  the alcoholic beverage when they had received a placebo drink during their first experimental session.  Remember, all participants were able to identify which beverage they had consumed, so everyone knew, prior to the second session, whether or not they would be consuming an alcoholic drink. So heightened dopamine activity in the FHP subjects before receiving the second drink is an indication that they were anticipating the reward to come, and their brains were significantly more activated by this expectation than the brains of other study subjects. Even participants already diagnosed with alcohol use disorders were not as activated as the FHP subjects.  The researchers speculated that this powerful response to the expectation of consuming alcohol could represent an important risk factor for the development of a substance disorder in the future.

This is important information for people who grow up in families where substance use disorders are prevalent and who are considering their own risk for developing a serious problem.  It is also an important finding to think about if you find yourself judging the character or motives of people in your life whose drug and alcohol-related behaviors have hurt you. People with these disorders cause real pain to their families and friends     and of course their destructive acts feel personal, but I think   the words of Dr. Michael Miller, the past president of the American Society of Addiction Medicine  are  helpful to consider:

At its core, addiction isn’t just a social problem or a moral problem or a criminal problem. It’s a brain problem whose behaviors manifest in all these other areas. Many behaviors driven by addiction are real problems and sometimes criminal acts. But the disease is about brains, not drugs. It’s about underlying neurology, not outward actions (emphasis mine)“

For more about the  neurobiology of substance use disorders, please read Where Is That Pink Cloud When You Need It?  elsewhere on my blog. If you would like to read more about the impact of substance use disorders on the family, try Nurse Jackie Takes Us to Hell and Back: Was This Relapse Necessary?

Dr. Wood is the author of  Raising Healthy Children in an Alcoholic Home and Children of Alcoholism: The Struggle for Self and Intimacy in Adult Life.

A new study indicates that adolescent boys who use marijuana on a weekly basis may be at heightened risk for   subclinical  symptoms of psychosis. (The term subclinical typically refers to the early stages or mild form  of an illness.)  Alarmingly, these symptoms appear to persist, even after a year of abstinence from the drug.

Previous research  linked regular marijuana use to earlier onset of psychosis, but it’s not clear whether such  use leads to the expression of psychotic symptoms or whether people are more likely to turn to marijuana because it relieves their distressing psychiatric symptoms.  The present study, which was conducted by  Bechtold, et al and published online by The American Journal of Psychiatry in May 2016 sought  to clarify this question.

A research team from The University of Texas found that adolescents who begin using marijuana prior to age 16, and those who begin using the drug after that age, suffer different kinds of neurological harms with regular use. They also discovered that the  amount of marijuana ingested over time affects the extent of neurological change that occurs. The Texas study was published in Developmental Cognitive Neuroscience  and is described online in an article posted by ScienceDaily in February 2016.

To understand the importance of this finding, it is helpful to understand some things about the process of cortical “pruning” that occurs as a normal part of brain development. Pruning refers to a process in which unnecessary synaptic connections are eliminated and white matter (myelin) is wrapped around the remaining ones, stabilizing and strengthening them. The pruning process serves to consolidate learning.

An interesting article on pbs.org likens the process of pruning connections between brain cells, which occurs in early childhood and again in adolescence, to the pruning of a tree. That is, “By cutting back weak branches, others flourish.” The first period of pruning, which begins when children are about three, occurs because the brains of babies grow by over-producing connections. Scientists now know that there is a second burst of synaptic formation that occurs in the frontal cortex just before puberty and that this is also followed by a round of pruning during adolescence. Frontline producer Sarah Spinks explains in the article on  the PBS website that this second round of growth and pruning is considered to be a very critical period of development for the brain because the cortex is associated with a variety of important cognitive and emotional processes. These include problem solving, memory, language, judgment, sexual behavior and emotional expression. In fact, the pre-frontal cortex is often called the “chief executive officer of the brain.”

Ms. Spinks cites the work of Dr. Jay Giedd of the National Institute Mental Health, who observes  that what teens do, and do not do during the period of synaptic growth and pruning in adolescence can affect them for the rest of their lives. He calls this the “use it or lose it principle,” and he said on  Frontline’s documentary entitled  “Inside the Teenage Brain”, that, “If a teen is doing music or sports or academics, those are the cells and connections that will be hardwired. If they’re lying on the couch or playing video games or MTV, those are the cells and connections that are going to survive.”

Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA) recently spoke to Medscape Medical News and she, too, highlighted the vulnerability of adolescent brains to the toxic effects of psychoactive substances. Like Dr. Giedd, Dr. Volkow stressed that adolescence is a period in which the brain undergoes a great deal  of “brain programming,” so that adolescent activities have enormous impact on the architecture and connectivity of the adult brain. Dr. Volkow explained that all psychoactive drugs “directly interfere with the process of neural pruning and interregional connectivity”. Dr. Volkow said, in her interview with Mescape, “Young brains and drugs shouldn’t mix”.Period.”

As the ScienceDaily article points out, The University of Texas team knew that successful pruning during adolescence results in “reduced cortical thickness and greater gray and white matter contrast…(and also leads to) increased gyrification, which is the addition of wrinkles or folds on the brain’s surface”. So they used magnetic resonance imaging (MRI) technology to examine the brains of 42 heavy marijuana users. Twenty of their subjects were “early onset users”, who began marijuana use, on average, between the ages of 13-14. The other 22 were “late onset”, and began using, on average, at 16 years 9 months of age. The subjects, who ranged in age betweeen 21-50, all reported beginning marijuana use during adolescence and said that they continued using the substance throughout adulthood, at least one time a week.

MRI results from the Texas study showed that “the more marijuana early onset users consumed, the greater their cortical thickness, the less gray and white matter contrast, and the less intricate the gyrification, as compared to late onset users.” On the other hand, “those who began using marijuana after age 16 showed brain change that would normally manifest later in life: thinner cortical thickness (and) stronger gray and white matter contrast.

The Texas researchers stressed that,

“In the early onset group, we found that how many times an individual uses and the amount of marijuana used strongly relates to the degree to which brain development does not follow the normal pruning pattern. The effects observed were above and beyond effects related to alcohol use and age. These findings are in line with the current literature that suggest that cannabis use during adolescence can have long-term consequences.”

Francesca Filbey, the lead investigator for the Texas study said that future research is planned in order to determine what cognitive and behavioral phenomena may be associated with  brain changes that the researchers observed. Dr. Volkow, in her discussion with the Medscape interviewers said that we already know that when adolescents use psychoactive drugs, the way in which substances interfere with brain development  negatively affects their academic performance . Dr. Volkow stated that, with respect to cannabis , “There is both preclinical and clinical evidence supporting the view (that its use by adolescents is associated with an) ‘amotivational’ state,” characterized by both apathy and poor concentration.  The Medscape article pointed out that any  drug use that begins in adolescence and continues into adulthood “can impair behavioral adaptability, mental health, and life trajectories“.

Click here to read more about the impact of marijuana and other drugs on the brain.

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Many thanks to addictionblog.org for including Raising Healthy Children in an Alcoholic Home to their list of must reads for individuals and families in recovery!

A list of 18 books for you to read in recovery. Whether someone you love or yourself are a recovering addict, we have outlined suggestions about self-help

Source: Books to read in addiction recovery (18 MUST HAVES!) | Addiction Blog

• bowel cancer
• breast cancer
• liver cancer
• mount cancer
• oesophagus cancer
• throat cancer

2. Heart problems – Drinking regularly damages the heart. The condition is called cardiomyopathy or heart muscle damage and can lead to decreased efficiency in pumping blood through the organism. Heart and circulatory system risks, include:

• arrhythmia
• constricted blood vessels
• coronary heart disease
• heart attack
• high blood pressure
• stroke

3. Liver damage – It takes about one (1) hour for the liver to break down one (1) unit of alcohol. Overloading the liver by drinking a lot of alcohol can lead to developing a range of alcoholic liver diseases, such as:

• alcohol-induced cirrhosis
• fatty liver disease
• hepatitis

Negative alcohol effects on the body

Of course, there are many other health implication and physical well-being impairments that are the result of continuous alcohol misuse. Check out our infographic to learn more and ask your questions in the comments section below. We also appreciate your feedback and encourage you to Share the infographic.

Learn More at Addictionblog.org

Yesterday I posted the results of a study that found an increased risk of accidental and intentional death among women and young people with alcohol use disorders.  Now there is a brand new study, published online by the journal Alcoholism: Clinical and Experimental Research (September 2015) that indicates that over the last decade, women have begun to drink much more similarly to men.

Data from the National Survey on Drug Use and Health were used to “assess the prevalence and trends for females and males aged 12 and over in lifetime abstinence, age of onset, current drinking, binge drinking, drinking and driving, reaching DSM-IV criteria for an alcohol use disorder, combining alcohol with other drugs such as marijuana, and other variables.”

The study found that,  between the years between 2002 and 2012,  more females became current drinkers, having at least 1 drink per month, while the numbers for males remained relatively stable.  This led  to convergence in the percentage of males and females in the United States who consume alcohol. The number of drinking days per month also increased for females but decreased for males, making this pattern more similar as well.  Finally, there was  an overall increase in the prevalence of binge drinking occurred for females but not for males.   The increases in drinking and binge drinking were observed for women across a range of groups.  Women who were married, never married, full-time employed, part-time employed, and not in the labor force all drank at higher rates.  Moreover,  increases were observed even after controlling for education level, pregnancy, and race/ethnicity. Once again, since women are more vulnerable to the toxic and intoxicating effects of alcohol, this is alarming news. In addition to the higher risks of accidental death and suicide that women face, a special cause of concern is the direct link that appears to exist between the amount of alcohol women drink and their likelihood of developing breast cancer. Compared to women who don’t drink at all, women who have three alcoholic drinks per week have a 15% higher risk of breast cancer. As I noted in a previous post, “Experts estimate that the risk of breast cancer goes up another 10% for each additional drink women regularly have each day. Breast cancer is the most common cause of alcohol-attributable cancer deaths in women, accounting for approximately 6,000 deaths annually, or about 15 percent of all breast cancer deaths.” And as I observed in yesterday’s post, it is very important that educators and medical and mental health providers work to raise women’s consciousness of these risks.

Recent research indicates that women and young people may experience an elevated risk of death as a result of alcohol use disorders. 

A study published online by the  journal Alcoholism: Clinical and Experimental Research (Volume 39,  Issue 7, looked at the extent to which AUDs increased the risk of death by “external causes” among 18-64 year olds  treated at public outpatient treatment centers in Spain. The authors observed  that though the overall death rate among patients with AUD is higher among adult men, there have been studies suggesting that young people and women may have a higher risk of premature death compared to their peers.  However,  relatively few  AUD studies have analyzed differences in mortality and the causes of AUD-related deaths according to gender and age,  and this group of investigators hoped to fill this gap.  The research was longitudinal in nature and the study was large. Investigators examined the records  of 7, 012 patients who began treatment for AUD’s between 1997 and 2007.  These patients were followed until the end of 2008 and   death due to “external cause” was defined as death that occurred on account of intentional or unintentional injuries.  The study   also gauged how much time, on average, elapsed from the initiation of treatment to death of a patient due to his or her AUD.

Investigators  recorded 114 deaths due to external causes. Unintentional injury was the most common cause of death (n= 65), and acute poisoning (n = 25; 38.5%) and traffic accidents (n = 15; 23.1%) accounted for most of these. Suicide accounted for most of the deaths that resulted from intentional injuries. “The excess of mortality between the AUD group and the general population was 9.5 higher than in the general population.”

The results of this study  indicated  that “there are important gender differences in premature mortality due to external causes among patients with AUD, with more than 20 times excess mortality among women than in the general population versus to 6 times excess mortality among men.” Moreover, the investigators found that, “Among women under 35 years with AUD, excess mortality was 31 times higher than among their peers.”  They noted that   “excess mortality due to suicide was remarkably high in both sexes and age groups”.   AUD patients seem particularly vulnerable in the early years of treatment, especially with respect to suicide.

The results of this study are in line with what is known about women’s heightened vulnerability to the toxic and intoxicating effects of alcohol as compared to men, as well as the greater susceptibility of the developing brain to the impact of alcohol and other drugs. The authors of this study advocate for increased attention to  screening and treatment of women and young people and note that, “it is essential to explore all opportunities offered by social and health services to detect, assess, and refer or treat individuals with AUD, either through emergency departments, or primary or specialized care…(and)  a systematic assessment is recommended for all the patients who initiate treatment for AUD to check for the presence of concomitant mental disorders such as depression or suicidal behaviors and to provide the required treatment”.  They also recommend  “drink-driving counter measures, and large-scale preventive actions through taxation, advertising regulation, and reducing availability”, since these policies  have proved effective in reducing the mortality associated with alcohol consumption.  Psychoeducation is, in my opinion, also very important–not just for the affected populations, but for mental health and medical providers who serve these groups.  I have found that many trainees and senior clinicians for example, are unaware of the special risks that women face with respect to alcohol consumption.

Rick Nauert reports on PsychCentral about a study by investigators from Northwestern University concerning  the adverse impact of teens’ daily marijuana smoking on the shape and function of the hippocampus, a brain structure that plays a key role in the preservation of long-term memories.

The study was published in the journal Hippocampus and 97 subjects participated. Healthy control subjects were matched with individuals who had a marijuana use disorder, schizophrenic subjects with no history of a substance use disorder, and schizophrenic subjects with a marijuana use disorder. Subjects with marijuana use disorders started using the drug between the ages of 16 and 17 and used it daily for about three years. They did not abuse other drugs and, at  the time of the study,   had been marijuana free for approximately two years.

Structural MRIs of the participants’ brains revealed that that subjects with a history of daily marijuana smoking had abnormally shaped hippocampi, despite the two years of abstinence from the drug. The longer these subjects had engaged in heavy use of marijuana,  the more abnormal the shape of their hippocampus, according to the researchers.  These subjects also  “performed about 18 percent worse on long-term memory tests than young adults who never abused cannabis”.

Nauert correctly reports that, “In the U.S., marijuana is the most commonly used illicit drug, and young adults have the highest — and growing — prevalence of use.”