Monthly Archives: February 2017

Are women increasingly at risk of addiction?

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Last year, American novelist Joyce Maynard faced a harsh realization: Her habit of reaching for a glass of wine whenever she felt stressed had crossed the line into an addiction.

“It kind of crept up on me,” said Maynard, 63, whose novel about a single mother with a wine dependence, “Under the Influence,” came out in paperback in November. “The way I was drinking is the way a lot of women drink and don’t see it as any kind of problem. And for a lot of them, it may not be a problem. It wasn’t the quantity; it was the space wine occupied in my life. I could tell it was occupying an unhealthy one. I was using it increasingly as a comfort and a reliever of stress. I would say, ‘I’m not going to drink,’ and then I would.”

Maynard is part of an increasing cohort of women who have been drinking (or abusing) alcohol more than women did only a few decades ago, and in patterns increasingly similar to men’s. Health officials are watching the situation with concern, and some addiction specialists are making comparisons to other dependencies to which women may be more vulnerable, such as food addictions.

Recent research makes the pattern with women and alcohol clear. Analyzing 68 alcohol-use studies from around the world dating to the mid-1900s, Australian researchers found a remarkably steady “gender convergence.” Their review and analysis, published in October, showed that men born in the early 20th century were more than twice as likely as women to drink and three times as likely to have an alcohol problem – but for those born closer to the end of the century, those ratios were 1.1 and 1.2 to 1, respectively. In other words, the difference between male and female drinking had all but disappeared.

The study reinforced earlier, smaller studies, including one in September 2015 that used data from the National Survey on Drug Use and Health to demonstrate how the U.S. gender gap in drinking had narrowed from 2002 to 2012.

The authors of these studies don’t explain why this is happening. But clinicians and other professionals have opinions.

“It’s presumably [caused by] all the factors associated with women having a different culture than they did 100 years ago,” George Koob, the director of the National Institute on Alcohol Abuse and Alcoholism, said in an interview. “Instead of being at home, they’re in society, and drinking is part of business and social gatherings. Another issue that’s relevant, there has been a decline in underage drinking in men that is not happening with women.”

He added that “women report depression and anxiety twice as much as men, and . . . depression and anxiety are often comorbid with addictions.” Furthermore, among women who drink, “alcohol use tends to escalate more quickly than with men” – what doctors call a “telescoping effect.”

The main problem with women drinking like men is that they don’t have the same physiology as men. Women are more susceptible to alcohol’s effects, largely because they have lower body mass, and in particular less water to disperse the alcohol through their bodies. “Therefore, a woman’s brain and other organs are exposed to more alcohol and to more of the toxic byproducts that result when the body breaks down and eliminates alcohol,” notes the NIAAA, part of the National Institutes of Health.

In the short term, alcohol is quicker to affect women’s ability to function. Long term, women who drink are more likely than men who drink to develop breast cancer, alcoholic hepatitis and certain heart problems.

Food addiction, in contrast, can lead to weight gain and its well-documented health effects, including higher risks of diabetes and heart disease. Food addiction is still an emerging field of research, but the relatively few studies so far that sort data by gender show that women appear to be more vulnerable here, too. Of the 652 adults who participated in a 2013 Canadian study, more than twice as many women as men met the Yale Food Addiction Scale criteria for food addiction. And a 2016 U.S. study designed to test an update of the Yale Scale found that “gender was significantly associated with addictive-like eating symptoms with women, on average, reporting a higher number of symptoms” than men.

Ashley Gearhardt, the lead developer of the Yale Food Addiction Scale, noted that women might be more vulnerable to addictive eating patterns because of “so many pressures” in their lives – “pressures in the workplace, pressures regarding child care.”

And there are other social pressures. “Women, more than men, are held to unattainable beauty ideals against the backdrop of a toxic food environment,” she said. “This can increase the likelihood that women will bounce back and forth between the extremes of intense dietary restriction and binge eating.”

No matter where stresses come from, experts agree that they can push a merely unhealthy food or drinking habit into an addiction. But how does one tell when a fondness for a snack or nightly cocktail starts becoming an issue?

“It stops being about how much you like it,” Gearhardt said. “People say, ‘I don’t even like it anymore. I want it or crave it.’ You start to feel you can’t control it. Some people say that they’re ‘addicted to chocolate.’ You can like chocolate or look forward to it or have it as a special treat. That’s not an indication of a concern, normally – but it is when you experience such intense cravings that you feel you can’t manage, when it impacts your life.”

Recently, scientists have been fine-tuning the diagnostic tools for what constitutes a substance-use problem, making it easier for people to recognize when their ritual becomes risk.

Notably, when the American Psychiatric Association updated the Diagnostic and Statistical Manual of Mental Disorders in 2013, it changed the way it categorized drug and alcohol issues: Instead of dividing them into two categories – abuse and dependence – the new DSM-5 established a spectrum of “substance use disorders,” based on 11 questions about symptoms. The questions emphasize psychological issues, such as a new question about cravings: “In the past year, have you wanted a drink so badly you couldn’t think of anything else?” (The list can be found online, including at the NIAAA’s website, niaaa.nih.gov.)

According to the manual, the presence of at least two of the 11 symptoms indicates a substance or alcohol disorder, and six or more symptoms mean it’s severe.

As in the DSM-5, cravings were added to the Yale Scale – “I had such strong urges to eat certain foods that I couldn’t think of anything else.” Gearhardt, who directs the Food and Addiction Science and Treatment Lab at the University of Michigan, said these cravings go well beyond most people’s everyday hunger – like having to get up and leave a business meeting to satisfy a desire for a specific treat.

“Other things we’ve seen clinically, someone may go from grocery store to grocery store to buy food to binge,” Gearhardt said. “They don’t go to just one place to buy it, because of the shame and embarrassment. Or they may have a social engagement but they lose control and cancel so they can stay home and binge. People lose control and really feel not well as a result.”

A few bouts of excessive drinking or eating may not indicate a severe problem: A Centers for Disease Control and Prevention fact sheet notes that “approximately 12 percent of adult women report binge drinking three times a month” but goes on to say that “most (90 percent) people who binge drink are not alcoholics or alcohol dependent.”

But both Koob and Gearhardt stressed that when a substance negatively affects someone’s life, or they answer positively to criteria on the DSM or Yale Scale, they should seek further help.

“One of the really good things about the DSM-5,” Koob said, “is that it emphasizes that you don’t have to be what we used to call an ‘alcoholic’ to have a problem. Now you can try to seek out a counselor, seek out a family physician, seek out a religious person in your community so that problems with alcohol can be stopped before they progress. It may make it a little clearer that a problem with alcohol is a spectrum of intensity, and is not always the guy you see out on the street. And the guy on the street is often the exception. Alcohol use disorders pervade our society.”

Gearhardt said, regarding food addiction, “We’ve treated people clinically who tried to manage for 20 years on their own, trying any diet they could get their hands on, but they didn’t see a therapist or psychologist, and they ran out of options.”

In Maynard’s case, her longtime enjoyment of wine kicked into high gear after her late husband, Jim, was diagnosed with pancreatic cancer in November 2014. During the worst of his illness, she says, she drank every night, sometimes half a bottle. After several failed attempts to quit in 2015, she decided she had to quit cold turkey in January 2016. A month later, she wrote a widely read online essay about her case.

Since then, she said, women have reached out to her about their addictions.

“So many women experience this,” she said. “We live with an enormous amount of stress. Reaching for a bottle of wine is one of the easiest, quickest ways to take the edge off.”

Today, Maynard is back to drinking, but in moderation; she says she always intended to drink again when she believed she could manage it. However, she has new rules: She will not drink every night, and never alone. She rarely has more than one drink. She attends Al-Anon meetings, organized for families of problem drinkers, as her late father was an alcoholic.

“I love to cook. I love wine with good food,” Maynard said. “There are times I wish that I could have more and know I cannot.”

She added: “I would say I had an addiction” – then, correcting herself – “I have an addiction that I’m always aware of. There may be people who will hear this or read this and say: ‘She’s kidding herself. She’s an alcoholic. She needs to not drink.’

“If I get to the point where I can’t maintain it, it will tell me the problem is too severe.”

Retrieved from: http://www.cortezjournal.com/article/20170227/AP/302279861/Are-women-increasingly-at-risk-of-addiction

Epigenetics studies of fetal alcohol spectrum disorder: where are we now?

The study of epigenetic mechanisms is fast on its way to becoming an important method for understanding and potentially diagnosing fetal alcohol spectrum disorder (FASD).

“Epigenetics studies of fetal alcohol spectrum disorder,” a recent review published in Future Medicine by a team of Kids Brain Health Network researchers found that several epigenetic mechanisms are affected by alcohol, which could explain many of the neurobiological deficits and abnormalities associated with prenatal alcohol exposure.


“This area of research holds more promise than ever,” says Dr. Joanne Weinberg, co-author of the review.

Fetal alcohol syndrome was coined nearly 40 years ago, and is the most severe end of the FASD spectrum, characterized by distinctive facial features and extreme cognitive delays. However, the spectrum is quite broad and depends on many factors including the level of alcohol exposure and genetic background. At the milder end of the spectrum, symptoms can be as inconspicuous as minor cognitive delays.

The exact cellular mechanisms behind FASD remain unknown, but scientists suspect epigenetics is one of the key mechanisms underlying the effects of this disorder.

“Epigenetics provides an attractive mechanism to study FASD because it’s a very robust system that regulates cell types and functions, but is also sensitive to environmental influences,” says co-author Alexandre Lussier, a Kids Brain Health PhD student. “It’s that balance between plasticity and stability over time that makes it interesting when looking at fetal programing by alcohol, and it’s not quite as deterministic as genetics.”

Several studies have determined that epigenetic changes in DNA methylation patterns, chromatin states, and non-coding RNA expressions levels occur as a result of prenatal alcohol exposure, and could potentially provide targets for future biomarkers.

“Biomarkers are becoming more important in screening and particularly in identifying the kids who don’t have the facial features of FASD, and epigenetics may become one of those biomarkers, or at least used in conjunction with other markers,” says Dr. Weinberg.

Identification of these biomarkers could aid in the diagnosis of FASD. Current diagnostic practices rely heavily on schemes and protocols, meaning a lot of FASD cases go undiagnosed.

“There are a lot of diagnostic guidelines that have been established but it doesn’t get diagnosed so easily in the general pediatrician’s office,” says Dr. Weinberg. “The big issue in the field is if the child doesn’t have the facial features and doesn’t have the maternal history, we can’t know if they were exposed to alcohol.”

Identifying biomarkers could be critical not only for diagnostic purposes, but for developing targeted interventions and therapies as well. There is still much work to be done before epigenetic tools for FASD can be used in a clinical setting, however researchers are optimistic.

“It took 10 years and billions of dollars to analyze the first human genome and now it takes three weeks and a thousand dollars—that’s the type of progress you can get,” she says. “Epigenetics is now primarily a research tool but we’re getting these profiles that may become clinically important. Identifying biomarkers is one of the ways that epigenetics could go from the bench to the bedside.”

The hope for the future is that children with FASD will get screened and diagnosed early on so they can receive proper medical care throughout their life. There has also been a conscious effort in the field to remove the stigma surrounding this disorder, in order to quickly diagnose and apply interventions.

Epigenetics is one way the field of FASD is advancing, but Lussier says more long-term research is needed, with a focus on human populations and assessing prenatal alcohol exposure impacts based on gender. He says the future of diagnosing and treating FASD will likely rely on several methods.

“Epigenetics is just one part of looking at FASD, and I think at the end of the day we will have to integrate multiple approaches,” he says. “I don’t think there will be one silver bullet for it.”

Story by Vanessa Hrvatin

Retrieved from: http://www.neurodevnet.ca/news/epigenetics-studies-fetal-alcohol-spectrum-disorder-where-are-we-now

Reconciliation the theme of national FASD conference at U of R

 

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Rachel Tambour was seven weeks along before realizing she was pregnant with her son.

She would “whoop it up” on weekends, and had “excessively” consumed alcohol.

On the birth control pill, she never suspected she was pregnant.

“I didn’t know what to do. Should I abort this child, or should I just take my chances?” Tambour said Wednesday at the University of Regina.

When he was diagnosed years later with fetal alcohol effects, Tambour was floored by “the damage that I did to my son,” learning he might never read past a Grade 3 level or obtain a driver’s license.

Tambour, who lives in Yellowknife, told her story at the National Symposium on fetal alcohol spectrum disorder (FASD).

The two-day conference was organized with justice and reconciliation in mind. Two of the Truth and Reconciliation Commission’s calls to action are focused on FASD.

 

“FASD, and reconciliation itself, really requires a comprehensive approach,” said Michelle Stewart, a justice studies professor who helped organize the event.

FASD is “an epidemic back home, amongst our aboriginal people,” said Tambour. “There’s no education on FASD. It keeps getting pushed under the rug.”

There is also stigma that prevents women from talking about it.

imgresLisa Lawley has witnessed this in her community of Terrace in northern B.C. — and experienced it firsthand.

Four of Lawley’s six children have alcohol-related neurodevelopmental disorder.

The possibility of their FASD only occurred to her about 15 years ago.

“I went OK, what was I doing when I was pregnant?” Lawley said. “We were young, we worked in a mine. The weekend we had off, we were out at the lake with our friends and our family, having drinks. So I never thought about that. We played baseball — baseball, connected to alcohol. Curling, connected to alcohol.”

Her children’s diagnoses brought her “devastation, shame and guilt,” said Lawley.

“Service providers have used words like brain damage, alcoholic mothers … There was no hope. At least that is what I felt. There was no support for mothers.”

When people see a drunk pregnant woman, they are quick to judge, Lawley added. They don’t think ‘how can I help?’ or ‘why is she self-medicating?’

She was so frustrated, she decided to speak out.

Along with four other aboriginal women, Lawley has pushed for better FASD supports in Terrace, B.C., where she works at the Kermode Friendship Society.

Now people can get FASD diagnoses in the community, instead of travelling 1,350 kilometres to Vancouver.

But, Lawley and Tambour agreed, there are still issues with government ministries, in terms of adults with FASD having custody of their own children, and people with FASD receiving funding and housing supports they require.

“We hear a lot of stigma, shame and blame,” Tambour said.

Tambour’s son, now 25, is seeking a pardon for an assault conviction he received at age 18.

The symposium continues Thursday, beginning with a discussion on the law and FASD.

Research shows that 10 per cent of people in Canadian correctional institutions are diagnosed with FASD, while another 18 per cent are suspected of having FASD.

The Royal University Hospital’s forensic outpatient clinic, which cares for patients from the Regina and Saskatoon correctional centres, reported a 56-per-cent FASD diagnosis among its patients.

Youth with FASD are 10 to 19 times more likely to be incarcerated than youth without FASD.

Retrieved from: http://leaderpost.com/news/local-news/reconciliation-the-theme-of-national-fasd-conference-at-u-of-r

amartin@postmedia.com

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CanFASD is looking for volunteers! We want to hear from adults with FASD about their successes at work

Edmonton and area Fetal Alcohol Network Society

CanFASD is doing a study with the University of Alberta to look at employment successes of adults with FASD.

There are two parts to the study:

  1. A short survey. This can be completed on the phone, online, or on paper.
  2. A video. We will be taking short clips of people talking about their successes at work. This part of the study is optional.

Are you coming to the International Conference on FASD in Vancouver this March? 

CanFASD and he U of A are hoping to find volunteers to complete the study at the conference. They welcome service providers, caregivers, and adults with FASD to visit Dr. Jacqueline Pei or Dr. Katy Flannigan at the CanFASD conference booth for more information. You can also contact Katy (katy.flannigan@canfasd.ca) any time if you have questions before the conference. Hope to see you there!

Another post will be up soon with information about how to do the study if you…

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New UBC study reaffirms link between genes and addiction

New UBC study reaffirms link between genes and addiction

Researchers from the Faculty of Medicine have genetically engineered mice that resisted the lure of cocaine

By Farrah Merali, CBC News Posted: Feb 13, 2017 

The study involved injecting mice with cocaine in a chamber so that it would associate the area with the pleasure of the drug.

The study involved injecting mice with cocaine in a chamber so that it would associate the area with the pleasure of the drug. (UBC)

Canadian researchers have genetically-engineered a mouse that had unexpected resistance to the lure of cocaine, offering new insight on addiction at a molecular level in the brain.

The study was published today in the peer-reviewed journal Nature Neuroscience, led by scientists at the University of B.C. and University of Calgary.

Based on previous studies involving gene mutation, the team focused on a type of protein that helps binds cells together, known as cadherins, which are believed to be important for learning and addiction.

Bamji’s team genetically engineered mice that had higher levels of cadherin and conducted an experiment using the drug cocaine.

A group of mice was injected with cocaine in a specific chamber of a cage, the goal being: the mice would associate the drug with being in that area. Their behaviour was observed over a number of days.

What the team found: the normal mice almost always gravitated to the chamber where they were injected with cocaine, while the mice with the extra cadherin spent only half as much time there.

Cadherin Synapse

A diagram that shows the difference between a mouse with the extra protein cadherin and a regular mouse. (UBC)

Bamji said her team believes the extra cahderin prevented the transmission between neurons and the pleasurable memory of the drug didn’t stick.

“What happens when we have too much cadherin — or glue — is that it really holds on to the old type of receptor and prevents the new one from from getting to that right spot.”

“So basically what happens is: no synapse strengthening, no learning no addiction,” said Bamji.

The findings show that people with genetic mutations associated with cadherin may be more prone to substance use problems.

No ‘magic’ pill to curing addiction

Bamji said while the study doesn’t show how researchers can help people afflicted by addiction right now, it does reaffirm the thinking that addiction is more complicated than just a series of bad choices.

“It wasn’t that long ago where we just kind of thought of people who had addiction disorders as just being weak and that’s certainly not the case,” said Bamji.

“There’s accumulating evidence — and ours is just one of them — suggesting that addiction is really a biochemical disorder.”

Bamji said while there’s no “magic pill” to make people less addicted or less vulnerable, the hope is that research like her team’s can lead to greater confidence in predicting who is more vulnerable to drug abuse.

“In this day of genetics when we [can better] understand genes and which mutations what might cause this predisposition to addiction, we might have a better idea about the underlying cause of somebody’s addiction,” said Bamji.

As the province grapples with the opioid crisis, Bamji said it’s essential to understand addiction in a scientific way.

“It’s very important that these studies come out to continually remind the public that addiction is a matter of biochemistry,” said Bamji

“If we look at it that particular way … the way we design our policies and the way we deal with these people is going to be very different.”

Retrieved from: http://www.cbc.ca/news/canada/british-columbia/new-ubc-study-reaffirms-link-between-genes-and-addiction-1.3980476

 

Suit against Wisconsin’s ‘cocaine mom’ law could go to trial this year

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A lawsuit challenging a Wisconsin law that allows the state to detain pregnant women suspected of drug or alcohol abuse is scheduled for trial in May.

The suit, filed in 2014 in U.S. District Court in Madison by former Wisconsin resident Tammy Loertscher, claims the 1998 law is unconstitutional. It is sometimes called the “cocaine mom” law because concern about “crack babies” was paramount at the time.

Loertscher was living in Medford in 2014 when she sought a pregnancy test and help for depression and a thyroid problem, according to the suit. At Mayo Clinic in Eau Claire, she told a doctor she had used methamphetamine and marijuana but stopped taking them when she thought she was pregnant.

Tests showed Loertscher was 14 weeks pregnant and had traces of the drugs in her body, the suit says. A Taylor County judge ordered her into inpatient drug treatment. When she refused, she was taken to the county jail for 18 days, including 36 hours in solitary confinement, until she agreed to urinalysis throughout her pregnancy.

Between 2005 and 2014, the state made claims of abuse of fetuses against 467 women based on the law, said Nancy Rosenbloom, director of legal advocacy for National Advocates for Pregnant Women, which is representing Loertscher. In at least 152 cases, authorities removed children from their parents after birth, Rosenbloom said.

A handful of states — including Minnesota, Oklahoma and South Dakota — have similar laws, Rosenbloom said. Wisconsin’s law is unique in allowing for the provision of attorneys for the fetus but not the pregnant woman being detained, and for handling the cases in juvenile court where records are confidential, she said.

Some doctors say the law harms women and children because it discourages pregnant women struggling with addiction from seeking prenatal care or being open about drug use.

“The law increases the stigma of addiction and decreases the willingness of pregnant women who struggle with substance use to seek prenatal care and addiction treatments,” Dr. Aleksandra Zgierska, president of the Wisconsin chapter of the American Society of Addiction Medicine, and Dr. Kathy Hartke, chair of the Wisconsin section of the American Congress of Obstetricians and Gynecologists, wrote in a Wisconsin State Journal opinion column in December.

Written by:

  • DAVID WAHLBERG dwahlberg@madison.com
Retrieved from: http://www.wiscnews.com/news/local/health-med-fit/article_054e9acd-cd11-58e7-9141-cc717c73de77.html

CanFASD is hosting a new blog!

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Hello readers –

CanFASD is hosting a new blog called CanFASD Connect at canfasdblog.wordpress.com and they will no longer be updating at FASDintervention. The intervention blog will remain online so you can continue to access earlier posts, but all new postings will be at CanFASD Connect. Please join us there for weekly posts on FASD prevention, intervention, diagnosis, social justice, child welfare, and family collaboration. They will be sharing newly published FASD research, book reviews, researcher profiles, program highlights, and more.

The CanFASD researchers will also continue to post at fasdprevention.wordpress.com and fasdresearchproject.com.

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