The Blog of ALAN TRACHTENBERG, MD, MPH, Adj. Assoc. Professor of Community Medicine, George Washington University School of Public Health and Health Services; TOPICS course in "Substance Abuse, Prevention, Intervention & Public Health." Also To Create: General Preventive Medicine & Public Health, Health Policy, Alternative & Complementary Health Practices (ACHP/CAM), Substance Abuse, Chronic Pain, Community Oriented Primary Care (COPC), Epidemiology & Research Methods.
For your information, two data-related reports pertaining to American Indians, Alaska Natives and Native Americans produced under contract for ASPE’s Office of Human Services Policy are now available on the ASPE website:
Data on Health and Well-being of American Indians, Alaska Natives, and Other Native Americans. Data Catalog This data catalog is a compilation of existing data sources pertaining to American Indian/Alaska Native/Native American (AI/AN/NA) populations. The Catalog includes sources of socioeconomic and health data using national and some state-level surveys. Information on 68 data sources including their characteristics and limitations is included in the catalog. This data catalog is a valuable reference for researchers, analysts and policymakers interested in AI/AN/NA issues. It can be found at:http://aspe.hhs.gov/hsp/06/Catalog-AI-AN-NA
Gaps and Strategies for Improving AI/AN/NA Data - Final Report This report identifies gaps in AI/AN/NA data on health and well-being, strategies for improving AI/AN/NA data availability and quality, and some current initiatives underway within HHS and other federal agencies that are intended to improve these data. It is located at:http://aspe.hhs.gov/hsp/07/AI-AN-NA-data-gaps
Psychedelic substances present in nature have been used by humans across hundreds of years to produce mind-altering changes in thought, mood, and perception - changes we do not experience otherwise except rarely in dreams, religious exaltation, or psychosis. U.S. scientists were studying the practical and therapeutic uses for hallucinogens, including LSD and mescaline, in the 1950s and 1960s supplied by large manufacturers including Sandoz. But the government took steps to ban all human consumption of hallucinogens, and thus the research. By 1970s, all human testing was stopped. Medical concerns were not the issue, the ban was moved by social concerns, not the least of which were created by legendary researcher Timothy Leary, a psychologist who advocated free use of hallucinogens by all who desired. Nationwide, however, a cadre of scholars and researchers has persisted in pushing the federal government to again allow human testing. And the moratorium has been lifted. The FDA has begun approving hallucinogenic research using human subjects. In these groundbreaking volumes, top researchers explain the testing and research underway to use - under the guidance of a trained provider - psychedelic substances for better physical and mental health.
“These books are a comprehensive and scholarly review of the current status of the therapeutic potential of hallucinogens. The contributors represent an outstanding group of scientists, scholars and clinicians, most of whom have had direct experience using and administering these drugs in either therapeutic or religious contexts. The result is an impressive collection. The authors provide scholarly historical reviews of the use of these drugs, as well as detailed instructions and advice for the clinician on how to administer these drugs safely and effectively in a therapeutic context. The authors provide a balanced view and acknowledge the many risks and pitfalls of improper use of these drugs. Likely to be of interest to scientists, clergy, mental health professionals, and anyone interested in the mind. It provides an up to date review of the status of h allucinogens in modern medicine, as well as a historical review of their status in the past. It is highly recommended.” --Harriet de Wit, PhD Professor, Department of Psychiatry The University of Chicago
“Until they were caught up in the cultural revolution of the 1960s, hallucinogens were being seriously examined by top researchers for their potential to alleviate many human ills. The contributors to this volume make a persuasive case that science should now do more to pursue these questions.” --Professor Jonathan D. Moreno, University of Pennsylvania Center for Bioethics
“Roberts and Winkelman have assembled one of the most impressive and comprehensive collection of writings in the field of psychedelic medicine. The chapters, written by first-rate academic scholars, are rigorous and clear. The topics range from neuroscience to the legal, spiritual, medicinal, and ethical implications of using this novel class of agents. This book is an invaluable resource for educators, clinicians, and policy makers who are interested in rejuvenating the field of psychedelic research.” -- Stephen Ross, M.D. Assistant Clinical Professor, Psychiatry, NYU School of Medicine Director, Division of Alcoholism and Drug Abuse, Bellevue Hospital Associate Director, Addiction Psychiatry Fellowship, NYU School of Medicine
“These volumes present fresh ideas for using psychedelic drugs as therapeutic agents to treat some of the most intractable of psychological ailments. As the authors make clear, the ability of these substances to facilitate direct experiential access to our deepest thoughts, feelings, and spirituality makes them uniquely suited for this purpose. Undoubtedly, their amazing healing potential has yet to be fully realized. Thanks to these forward-thinking educators, researchers, and clinicians, we now have new paths to explore in the cure for old diseases.” -- Nicholas V. Cozzi, Ph.D. Department of Pharmacology University of Wisconsin School of Medicine and Public Health
Psychedelic Medicines: New Evidence for Hallucinogenic Substances as Treatments
Winkelman, Michael, & Roberts, Thomas B. (editors) (2007).
Westport, CT: Praeger/Greenwood Publishers
Volume I: Psychedelic Medicine: Social, Clinical and Legal Perspectives
Preface-Warning. Thomas B. Roberts
Editor’s Overview of Psychedelic Medicines Volume 1. Michael Winkelman
Section I: The Social and Clinical Context
Chapter 1: Therapeutic Bases of Psychedelic Medicines: Psychointegrative Effects. Michael Winkelman
Chapter 2: The Healing Vine: Ayahuasca as Medicine in the 21st Century. Dennis McKenna
Chapter 3: Contemporary Psychedelic Therapy: An Overview. Torsten Passie
Chapter 4: Therapeutic Guidelines: Dangers and Contra-Indications in Therapeutic Applications of Hallucinogens. Ede
Frecska
Section II: Medical Applications
Chapter 5: Response of Cluster Headaches to Psilocybin and LSD. Andrew Sewell & John H. Halpern
Chapter 6: Psilocybin Treatment of Obsessive- Compulsive Disorder. F. A. Moreno & P. L. Delgado
Chapter 7: Therapeutic Uses of MDMA. George Greer & Requa Tolbert
Chapter 8: MDMA-Assisted Psychotherapy for the Treatment of Posttraumatic Stress Disorder. Michael Mithoefer
Chapter 9: Psychedelic Drugs for the Treatment of Depression. Michael Montagne
Chapter 10: Marijuana and AIDS. Donald Abrams
Chapter 11:The Use of Psilocybin in Patients with Advanced Cancer and Existential Anxiety. C. Grob
Section III: Legal Aspects of the Medical Use
Chapter 12: Psychedelic Medicine and the Law. Richard Boire
Chapter 13: The Legal Bases for Religious Peyote Use. Kevin Feeney
Chapter 14: The Supreme Court’s Psychedelic Case. Alberto Groisman & Marlene de Rios
Chapter 15: Conclusions. Michael Winkelman & Thomas B. Roberts
Volume II: Psychedelic Medicine: Addictions Medicine and Transpersonal Healing
Preface- Lancet Editorial
Chapter 1: Introduction — The Adventure Continues. Thomas B. Roberts
Section I: Treating Substance Abuse
Chapter 2: Hallucinogens in the Treatment of Alcoholism and Other Addictions. J. H. Halpern
Chapter 3: Addiction, Despair, and the Soul: Psychedelic Psychotherapy. R. Yensen & D. Dryer
Chapter 4: The Therapeutic Use of Peyote in the Native American Church. Joseph Calabrese
Chapter 5:Ibogaine and Substance Abuse Rehabilitation. Kenneth R. Alper & Howard Lotsof
Chapter 6:Ketamine Psychedelic Psychotherapy. Evgeny Krupitsky & Eli Kolp
Chapter 7: Ayahuasca Treatment of Cocaine-Paste Addiction. Jacques Mabit
Section II: Guidelines for Psychotherapeutic Applications
Chapter 8: The Ten Lessons of Psychedelic Psychotherapy… Rediscovered. Neal Goldsmith
Chapter 9: Therapeutic Guidelines from Shamanic Traditions. Michael Winkelman
Chapter 10: Common Processes in Psychospiritual Change. Sean House
Chapter 11: Preliminary Remarks on Interpreting Resistance to Psychedelic Insights. Dan Merkur
Section III: Transpersonal Dimension of Healing with Psychedelic Medicines
Chapter 12: Psychedelics in Psychological Health and Growth. Roger Walsh & Charles Grob
Chapter 13: Psilocybin Can Occasion Mystical-type Experiences Having Substantial and Sustained Personal Meaning and Spiritual Significance. R. Griffiths, W. Richards, U. McCann & R. Jesse.
Chapter 14: Remarkable Healing During Psychedelic Psychotherapy. Stanislav Grof
Chapter 15: Transpersonal Healing with Hallucinogens. Roger Marsden & David Lukoff
Chapter 16: Conclusions and Future Recommendations: The Wider Contexts. Thomas B. Roberts
Author biographies
Index
List Price: $200.00 0-275-99023-0/978-0-275-99023-7 Pages:Publication: 6/30/2007
Public Health - A Social Institution, A Discipline, and a Practice (World Health Organization)
"Organized efforts of society to protect, promote, and restore people's health. It is the combination of science, skills, and beliefs that is directed to the maintenance and improvement of the health of all the people through collective or social actions. The programs, services and institutions involved emphasize the prevention of disease and the health needs of the population as a whole. Public health activities change with variations in technology and social values but the goals remain the same: to reduce the amount of disease, premature death, and disease-produced discomfort and disability in the population. Public health is thus a social institution, a discipline, and a practice." Public Health (Institute of Medicine, Public Health and Prevention) Public health practice is what "...we as a society do collectively to assure the conditions in which people can be healthy." Institute of Medicine, 1988 & 2003 Reports (http://www.iom.edu/topic.asp?id=3735) To improve population health status, IOM recommends communities focus on several areas of strategic action:
·adopting a focus on population health that includes multiple determinants of health
·strengthening the public health infrastructure
·building partnerships
·developing systems of accountability
·emphasizing evidence
·improving communication Population Health (World Health Organization) "Organized efforts focused on the health of defined populations in order to promote and maintain or restore health, to reduce the amount of disease, premature death and disease-produced discomfort and disability. Programs, services and institutions here emphasize the prevention of disease and the health needs of the population as a whole. Among a broad scope of disciplines, various knowledge and skills are utilized such as bio-statistics, epidemiology, planning, organization, management, financing and evaluation of health programs, environmental health, application of social and behavioral factors in health and disease, health promotion, health education and nutrition." Prevention (World Health Organization) "The goals of medicine are to promote health, to preserve health, to restore health when it is impaired, and to minimize suffering and distress. These goals are embodied in the word prevention, which is easiest to define in the context of levels, customarily called primary, secondary and tertiary prevention:
Primary prevention refers to the protection of health by personal and community wide effects, such as preserving good nutritional status, physical fitness, and emotional well-being, immunizing against infectious diseases, and making the environment safe.
Secondary prevention can be defined as the measures available to individuals and populations for the early detection and prompt and effective intervention to correct departures from good health.
Tertiary prevention consists of the measures available to reduce or eliminate long-term impairments and disabilities, minimize suffering caused by existing departures from good health, and to promote the patient's adjustment to irremediable conditions. This extends the concept of prevention into the field of rehabilitation. There are no precise boundaries between these levels."
Despite fears that using psychostimulants to treat patients with ADHD and co-occurring SUDs (especially those with a history of stimulant use disorders) would exacerbate their SUDs, the evidence suggests that they are safe and effective in reducing core ADHD symptoms as well as possibly decreasing substance abuse (1,2). Furthermore, they may serve as a protective factor to decrease the longitudinal risk of developing a SUD in patients with ADHD as the index disorder (3).
1. Wilson JJ, Levin FR. Attention-Deficit/Hyperactivity Disorder and Early-Onset Substance Use Disorders. Journal of Child and Adolescent Psychopharmacology. 2005;15(5):751-763. 2. Levin FR, Evans SM, McDowell D, Kleber HD. Methylphenidate treatment for cocaine abusers with adult attention-deficit/hyperactivity disorder: A pilot study. J Clin Psychiatry. 1998;59:300-305. 3. Wilens TE, Faraone S, Biederman J, et al. Does stimulant therapy of ADHD beget later substance abuse: a meta-analytic review of the literature. Pediatrics. 2003;11(1):179-185.
Steve
Stephen Ross MD Assistant Professor of Psychiatry Director, Division of Alcoholism and Drug Abuse, Bellevue Hospital Associate Director for Education NYU School of Medicine (212) 562-4097; fax (212) 562-2041
Effects of chronic oral methylphenidate on cocaine self-administration and striatal dopamine D2 receptors in rodents
Panayotis K. Thanos, Michael Michaelides, Helene Benveniste, Gene Jack Wang and Nora D. Volkow
Abstract
Background
Methylphenidate (MP) and amphetamine, which are the mainstay for the treatment of ADHD, have raised concerns because of their reinforcing effects and the fear that their chronic use during childhood or adolescence could induce changes in the brain that could facilitate drug abuse in adulthood.
Methods
Here we measured the effects of chronic treatment (8 months) with oral MP (1 or 2 mg/kg), which was initiated in periadolescent rats (postnatal day 30). Following this treatment, rats were tested on cocaine self-administration. In addition at 2 and 8 months of treatment we measured dopamine D2 receptor (D2R) availability in the striatum using [11C]raclopride microPET (μPET) imaging.
Results
Animals treated for 8 months with 2 mg/kg of MP showed significantly reduced rates of cocaine self-administration at adulthood than vehicle treated rats. D2R availability in the striatum was significantly lower in rats after 2 months of treatment with MP (1 and 2 mg/kg) but significantly higher after 8 months of MP treatment than in the vehicle treated rats. In vehicle treated rats D2R availability decreased with age whereas it increased in rats treated with MP. Because low D2R levels in the striatum are associated with a propensity for self-administration of drugs both in laboratory animals and in humans, this effect could underlie the lower rates of cocaine self-administration observed in the rats given 8 months of treatment with MP.
Conclusions
Eight month treatment with oral MP beginning in adolescence decreased cocaine-self administration (1 mg/kg) during adulthood which could reflect the increases in D2R availability observed at this life stage since D2R increases are associated with reduced propensity for cocaine self administration.
In contrast, two month treatment with MP started also at adolescence decreased D2R availability, which could raise concern that at this life stage short treatments could possibly increase vulnerability to drug abuse during adulthood.
These findings indicate that MP effects on D2R expression in the striatum are sensitive not only to length of treatment but also to the developmental stage at which treatment is given.
Future studies evaluating the effects of different lengths of treatment on drug self-administration are required to assess optimal duration of treatment regimes to minimize adverse effects on the propensity for drug self administration.
About 4 Percent of Pain Patients Abuse Meds, Study Estimates August 7, 2007
A new study finds that 3.8 percent of chronic-pain patients misuse prescription medications like OxyContin and Percocet, a rate about four times higher than among the general population, Reuters reported Aug. 3. Researcher Michael F. Fleming of the University of Wisconsin at Madison and colleagues also found that patients who had addiction problems tended to exhibit "aberrant" behavior, such as requesting early refills, raising dosage without authorization, intentionally oversedating themselves, or using opioids for reasons other than treating pain. However, the authors said, "considering the potential benefit to improving the lives of patients with chronic pain, a 3.8-percent rate of opioid addiction is a small risk compared with the alternative of continuous pain and suffering." The study included 801 patients with an average age of 49 and who, on average, had had pain problems for 16 years. The findings were reported in the July 2007 issue of the Journal of Pain.
Reference: Fleming, M.F., Balousek, S.L., Klessig, C.L., Mundt, M.P., Brown, D.D. (2007) Substance Use Disorders in a Primary Care Sample Receiving Daily Opioid Therapy. The Journal of Pain, 8(7): 573-582.
Implants that deliver time-released doses of the anti-addiction medication naltrexone have been touted for preventing drug overdoses, but Australian researchers have found at least five fatal overdoses among implant patients, The Age reported Feb. 5.
Researchers at the University of New South Wales' Drug and Alcohol Research Center said that four men and a woman died from overdoses between 2002 and 2004 despite the implants. The users were suspected of taking large doses of heroin to overcome the blocking effect of the naltrexone.
"The big thing that has been claimed is if you are actively in treatment with naltrexone implants you can't overdose, and the fact of the matter is these people did," said study co-author Louisa Degenhardt.
Another expert said that the patients may have overdosed after the naltrexone wore off. "The problem is when you stop using [naltrexone] you become sensitive to the effects of heroin, so that even much smaller doses of heroin than you used to use could be potentially lethal," said Nick Lintzeris of the addiction-treatment program Turning Point.
Antismoking Ads Backfire, Study Concludes July 23, 2007
Research Summary
Middle-school students who were exposed to the greatest number of antismoking ads were also the most likely to smoke, according to researchers who concluded that such ads can backfire unless constructed carefully.
The Atlanta Journal-Constitution reported July 19 that researchers at the University of Georgia and the University of Wisconsin at Madison said that the survey of 1,700 middle-school students found that ads that warn about the dangers of smoking may unintentionally encourage the rebelliousness of youth.
"They don't want to hear what they should do or not do," said study co-author Hye-Jin Paek. Instead, ads should try to convince young teens that their peers are rejecting smoking so they should, too.
"Rather than saying, 'don't smoke,' it is better to say, 'your friends are listening to this message and not smoking,'" she said. "It doesn't really matter what their peers are actually doing."
"To fathom Hell or soar angelic, just take a pinch of psychedelic." -Humphry Osmond
"There are two major products that come out of Berkley: LSD and UNIX. We don't believe this to be a coincidence." -Jeremy S. Anderson
"Drugs have taught an entire generation of American kids the metric system." -P.J. O'Rourke
"All drugs of any interest to any moderately intelligent person in America are now illegal." -Thomas Szasz
"If addiction is judged by how long a dumb animal will sit pressing a lever to get a 'fix' of something, to its own detriment, then I would conclude that netnews is far more addictive than cocaine." -Rob Stampfli
"Don't do drugs because if you do drugs you'll go to prison, and drugs are really expensive in prison." -John Hardwick
"If God dropped acid, would he see people?" -Steven Wright
"Anyway, no drug, not even alcohol, causes the fundamental ills of society. If we're looking for the source of our troubles, we shouldn't test people for drugs, we should test them for stupidity, ignorance, greed and love of power." -P.J. O'Rourke
"I tried sniffing Coke once, but the ice cubes got stuck in my nose." -Author Unknown
"Did you know America ranks the lowest in education but the highest in drug use? It's nice to be number one, but we can fix that. All we need to do is start the war on education. If it's anywhere near as successful as our war on drugs, in no time we'll all be hooked on phonics." -Leighann Lord
"Avoid all needle drugs - the only dope worth shooting is Richard Nixon." -Abbie Hoffman
"Reality is a crutch for people who can't cope with drugs." -Lily Tomlin
"Drugs may be the road to nowhere, but at least they're the scenic route." -Author Unknown
"Half the modern drugs could well be thrown out the window except that the birds might eat them." -Martin H. Fischer, Fischerisms
"A miracle drug is any drug that will do what the label says it will do." -Eric Hodgins
"I've never had a problem with drugs. I've had problems with the police." -Keith Richards
"It is difficult to live without opium after having known it because it is difficult, after knowing opium, to take earth seriously. And unless one is a saint, it is difficult to live without taking earth seriously." -Jean Cocteau
"I'm in favor of it as long as it's multiple choice." -Kurt Rambis, on drug testing
"It is easy to get a thousand prescriptions but hard to get one single remedy." -Chinese Proverb
"In the 1960s, people took acid to make the world weird. Now the world is weird, and people take Prozac to make it normal." -Author Unknown
"God made pot. Man made beer. Who do you trust?" -Graffiti
"Thou hast the keys of Paradise, oh, just, subtle, and mighty opium!" -Thomas De Quincey, Confessions of an English Opium-Eater, Part II
"I will lift mine eyes unto the pills. Almost everyone takes them, from the humble aspirin to the multi-coloured, king-sized three deckers, which put you to sleep, wake you up, stimulate and soothe you all in one. It is an age of pills. -Malcolm Muggeridge, 1962
"Pharmaceutical companies will soon rule the world if we keep letting them believe we are a happy, functional society so long as all the women are on Prozac, all children on Ritalin, and all men on Viagra." -The Quote Garden
"Cocaine is God's way of saying you're making too much money." -Robin Williams
"I will lift up mine eyes unto the pills. Almost everyone takes them, from the humble aspirin to the multi-coloured, king-sized three deckers, which put you to sleep, wake you up, stimulate and soothe you all in one. It is an age of pills." -Malcolm Muggeridge
"Drugs are very much a part of professional sports today, but when you think about it, golf is the only sport where the players aren't penalized for being on grass." -Bob Hope
"He does not need opium. He has the gift of reverie." -Anais Nin
This is your brain on loveWhen you're attracted to someone, is your gray matter talking sense -- or just hooked? Scientists take a rational look. By Susan BrinkLos Angeles Times Staff WriterJuly 30, 2007 Her front brain is telling her he's trouble. Look at the facts, it says. He's never made a commitment, he drinks too much, he can't hold down a job. But her middle brain won't listen. Man, it swoons, he looks great in those jeans, his black hair curls onto his forehead so adorably, and when he drags on a cigarette, he's so bad he's good. His front brain is lecturing, too: She's flirting with every guy in the place, and she can drink even you under the table, it says. His mid-brain is unresponsive, distracted by her legs, her blouse and her come-hither stare. "What could you be thinking?" their front brains demand. Their middle brains, each on a quest for reward, pay no heed. Alas, when it comes to choosing mates, smart neurons can make dumb choices. Sure, if the brain's owner is in her 40s and has been around the block a few times, she might grab her bag and scram. If the guy has reached seasoned middle age, he might think twice about that cleavage-baring temptress. Wisdom -- at least a little -- does come with experience. But if the objects of desire are in their 20s, all bets are off. A lot will depend on the influence of Mom and Dad's marriage, the gossip and urgings of friends, and whether life experience has convinced these two brains that what they're looking at is attractive. She just might sidle over to Mr. Wrong and bat her eyes. And he could well give in to temptation. And so the dance of attraction, infatuation and ultimately love begins. It's a dance that holds many mysteries, to psychologists as well as to the willing participants. Science is just beginning to parse the inner workings of the brain in love, examining the blissful or ruinous fall from a medley of perspectives: neural systems, chemical messengers and the biology of reward. It was only in 2000 that two London scientists selected 70 people, all in the early sizzle of love, and rolled them into the giant cylinder of a functional magnetic resonance imaging scanner, or fMRI. The images they got are thought to be science's first pictures of the brain in love. The pictures were a revelation, and others have followed, showing that romantic love is a lot like addiction to alcohol or drugs. The brain is playing a trick, necessary for evolution, by associating something that just happened with pleasure and attributing the feeling to that magnificent specimen right before your eyes. All animals mate: The most primitive system in the brain, one that even reptiles have, knows it needs to reproduce. Turtles do it but then lay their eggs in the sand and head back to sea, never seeing their mate again. Human brains are considerably more complicated, with additional neural systems that seek romance, others that want comfort and companionship, and others that are just out for a roll in the hay. Yet the chemistry between two people isn't just a matter of molecules careening around the brain, dictating feelings like some game of neuro-billiards. Attraction also involves personal history. "Our parents have an effect on us," says Helen Fisher, evolutionary anthropologist at Rutgers University who studies human attraction. "So does the school system, television, timing, mystery." Every book ever read, and every movie ever wept through, starts charting a course toward the chosen one. The love dance"Love," that one small word, stands for a hodgepodge of feelings and drives: lust, romance, passion, attachment, commitment and contentment. Studying this brew is made harder because the pathways aren't totally distinct. Lust and romance, for example, have some overlapping biology, even though they are not the same thing. Similarly, the dance that leads, if we're lucky, to a stable commitment moves through several key steps. First comes initial attraction, the spark. If someone's going to pick one person out of the billions of opposite-sex humans out there, it's this step that starts things rolling. Next comes the wild, dizzying infatuation of romance -- a unique magic between two people who can't stop thinking about each other. The brain uses its chemical arsenal to focus our attention on one person, forsaking all others. "Everyone knows what that feels like. This is one of the great mysteries. It's the love potion No. 9, the click factor, interpersonal chemistry," says Gian Gonzaga, senior research scientist at eHarmony Labs. The passion lasts at least for a few months, two to four years tops, says relationship researcher Arthur Aron, psychologist at the State University of New York at Stony Brook. As it fades, something more stable takes over: the steady pair-bonding of what's called companionate love. It's a heartier variety, characterized by tenderness, affection and stability over the long haul. Far less is known about the brains of people celebrating their silver anniversaries or more, but researchers are beginning to recruit such couples to find out. When Kelly and Robert Iblings of Calabasas had their first face-to-face meeting after a month of corresponding online, all signs of a spark were there. Kelly, 30, recalls thinking "Wow!" Robert, 33, thought Kelly was beautiful. "I love his height," Kelly says of Robert's 6-foot-4 frame. "And those eyes. He's quite handsome. I mean, look at him. He's cute. He's hot." "She's very cute," Robert says. "And I like the way she laughs." Their brains' signals were in sync, and it was good. It probably didn't hurt that they were a little bit nervous about meeting each other. For years, scientists have known that attraction is more likely to happen when people are aroused, be it through laughter, anxiety or fear. Aron tested that theory in 1974 on the gorgeous but spine-chilling heights of the Capilano Canyon Suspension Bridge in Vancouver, British Columbia -- a 5-foot wide, 450-foot, wobbly, swaying length of wooden slats and wire cable suspended 230 feet above rocks and shallow rapids. His research team waited as unsuspecting men, between ages 18 and 35 and unaccompanied by women, crossed over. About halfway across the bridge, each man ran into an attractive young woman claiming to be doing research on beautiful places. She asked him a few questions and gave him her phone number in case he had follow-up questions. The experiment was repeated upriver on a bridge that was wide and sturdy and only 10 feet above a small rivulet. The same attractive coed met the men, brandishing the same questionnaire. The result? Men crossing the scary bridge rated the woman on the Capilano bridge more attractive. And about half the men who met her called her afterward. Only two of 16 men on the stable bridge called. Fear got their attention and aroused emotional centers in the brain. "People are more likely to feel aroused in a scary setting," Aron says. "It's pretty simple. You're feeling physiologically aroused, and it's ambiguous why. Then you see an attractive person, and you think, 'Oh, that's why.' " In a laboratory, Aron tested his arousal theory further by having people run in place for 10 minutes, and compared them with people who didn't run. Those who had exercised were more attracted to good-looking people in photographs than those who had been sedentary. Any kind of physiological arousal would probably do the trick, Aron concludes from his studies. Couples who ride roller coasters, laugh at a really funny comedian or escape a burning building together get an emotional jolt and could attribute the feeling to the attractiveness of the other. The forces of attraction are in many ways mysterious, but scientists know certain things. Studies have shown that women prefer men with symmetrical faces and that men like a certain waist-to-hip ratio in their mates. One study even found that women, when they sniffed men's T-shirts, were attracted to certain kinds of body odors. That initial spark can flash and fade. Or it can become a flame and then a fire, a rush of exhilaration, yearning, hunger and sense of complete union that scientists know as passionate love. Key to this state of seeing a person as a soul mate instead of a one-night stand is the limbic system, nestled deep within the brain between the neocortex (the region responsible for reason and intellect) and the reptilian brain (responsible for primitive instincts). Altered levels of dopamine, norepinephrine and serotonin -- neurotransmitters also associated with arousal -- wield their influence. But passionate love is something far stronger than that first sizzle of chemistry. "It's a drive to win life's greatest prize, the right mating partner," Fisher says. It is also, she adds, an addiction. People in the early throes of passionate love, she says, can think of little else. They describe sleeplessness, loss of appetite, feelings of euphoria, and they're willing to take exceptional risks for the loved one. Brain areas governing reward, craving, obsession, recklessness and habit all play their part in the trickery. In an experiment published as a chapter in a 2006 book, "Evolutionary Cognitive Neuroscience," Fisher found 17 people who were in relationships for an average of seven months. She knew they were in love from their answers to what researchers call the Passionate Love Scale. They all said they'd feel deep despair if their lover left, and they yearned to know all there was to know about the loved one. She put these lovesick, enraptured people in an fMRI to see what areas of their brains got active when they saw a photograph of their beloved ones. "We found some remarkable things," she said. "We saw activity in the ventral tegmental area and other regions of the brain's reward system associated with motivation, elation and focused attention." It's the same part of the brain that presumably is active when a smoker reaches for a cigarette or when gamblers think they're going to win the lottery. No wonder it's as hard to say no to the feeling of romantic arousal as it would be to say no to a windfall in the millions. The brain has seen what it wants, and it's going to get it. "At that point, you really wouldn't notice if he had three heads," Fisher says. "Or you'd notice, but you'd choose to overlook it." Other studies also suggest that the brain in the first throes of love is much like a brain on drugs. Lucy Brown, professor of neuroscience at the Albert Einstein College of Medicine, has also taken fMRI images of people in the early days of a new love. In a study reported in the July 2005, Journal of Neurophysiology, she too found key activity in the ventral tegmental area. "That's the area that's also active when a cocaine addict gets an IV injection of cocaine," Brown says. "It's not a craving. It's a high." You see someone, you click, and you're euphoric. And in response, your ventral tegmental area uses chemical messengers such as dopamine, serotonin and oxytocin to send signals racing to a part of the brain called the nucleus accumbens with the good news, telling it to start craving. "The other person becomes a goal in your life," Brown says. He or she becomes a goal you might die without and would pack up and move across the country for. That one person begins to stand out as the one and only. Biologically, the cravings and pleasure unleashed are as strong as any drug. Surely such a goal is worth taking risks for, and other alterations in the brain help ensure that the lovelorn will do just that. Certain regions, scientists have found, are being deactivated, such as within the amygdala, associated with fear. "That's why you can do such insane things when you're in love," Fisher says. "You would never otherwise dream of driving across the country in 13 hours, but for love, you would." Sooner or later, excited brain messages reach the caudate nucleus, a dopamine-rich area where unconscious habits and skills, such as the ability to ride a bike, are stored. The attraction signal turns the love object into a habit, and then an obsession. According to a 1999 study in the journal Psychological Medicine, people newly in love have serotonin levels 40% lower than normal people do -- just like people with obsessive-compulsive disorders. Experiments in other mammals add to the human chemical findings. Female prairie voles, for example, develop a distinct preference for a specific male after mating, and the preference is associated with a 50% increase in dopamine in the nucleus accumbens. But when the monogamous vole is injected with a dopamine antagonist, blocking the activity of the chemical, she'll readily dump her partner for another. Using their headsKelly and Robert Iblings, now married for nine months, are fascinated by all this talk of nucleus accumbens, addiction and primitive mating instincts. Sure, they admit, they found each other attractive. But they were also making use of their front brains' sharp thinking skills. They were remembering painful past lessons and looking for signs of compatibility. They had each survived an earlier, failed engagement, and they knew what they were looking for this time around. They were listening to their front brains as they told them to look for compatibility, stability, shared values and commitment. From their first e-mail exchanges through eHarmony, an Internet dating service, the Iblings each felt they had found a unique mate. She liked to travel. So did he. They both love books and learning, have similar religious beliefs and come from loving, intact families. She no sooner sent an e-mail telling him about an exhibit she saw on a business trip to New York than he sent a message back telling her he knew of the exhibit because he had bought a book on it the day before. Coincidence, or soul mate? The front brain certainly gets involved as it ponders all of life's experiences and past mistakes, researchers say -- but not just the front brain. The nucleus accumbens, virtual swamp of dopamine that it is, is also holder of memories. Its quest for reward is influenced by childhood experiences, friends, previous failed engagements or the jerk who cheated on you. The sum of those experiences make some people attracted to a prince or a frog, a princess or a shrew. And, as it happens, practical matters such as whether a couple both like piña coladas and getting caught in the rain do matter in igniting passionate love. A research project headed by eHarmony Labs' Gonzaga interviewed 1,200 dating and newlywed couples. The results, reported in the July issue of the Journal of Personality and Social Psychology, found that those who reported similar interests and feelings were more satisfied. "Those who reported chemistry said they felt at ease, relaxed, connected. They knew they had some things in common," he says. "Chemistry is more than just being hot or handsome." Clearly, in the matters of love, the stars were aligned for the Iblings. When they met, they were ready for each other. But they were also attracted to each other. The chemistry was there. Most relationship researchers think it has to be. They had what it took to kick-start the relationship with an undeniable urgency, allowing two people to give up the candy store of other choices and commit to each other. Odds are that in two to four years, this urgency will fade -- and the couple will, if all goes well, settle in for the long haul with companionate love. Such peoples' lives are entwined, as are their property and bank accounts, and they begin to answer questionnaires differently. The rush and the urgency is gone, but they feel committed, emotionally close and stable. It is the state that many desire, yet it is the least studied. There's a reason for that. Most studies of couples are of college students and young newlyweds. Brown, however, has recently recruited volunteers for a study of people 40 to 65 who have been together for many years. She'll put them in fMRIs to see where love resides after the urgency fades. "It's unknown, the extent to which these original brain motivations are still active," she says. "Or whether companionate love has turned more cortical, more conscious thinking, more evaluative." Her first volunteers had their brains scanned this month. The free fall of love's first rush can happen at any age, whether people are 20 or 70, says Elaine Hatfield, psychology professor at the University of Hawaii and relationship researcher. What differs is that the older people get, the more memories they harbor of joy and trust, rejection and disappointment. And as people learn from experience, the front brain, with its logic and reason, probably gets a greater say. "When you are young, passion and hope are so strong that's it's almost impossible to stop loving someone," Hatfield says. "After you've been kicked around by life, however, you start to have a dual response to handsome con men: 'Wow!' and 'Arrrrrrgh!' "It takes not will power but painful experience to make us wise." Somehow, it all comes together, for better or for worse, the sum total of what's found in the mating dance of the ancient reptilian brain, the passion of the limbic brain and the logic of the neocortex. Oh, what a ride.
We had the first meeting of the 2008 course this past week and I have a bright, energetic and diverse group of about 15 students who all seem quite interested in the topic. It was necessary this year to review the basic neurophysiology and pharmacologic priciples, but the group seemed to soak them up readily and now has a good handle on these basics.
This year I did try to post the syllabus on Blackboard, along with a link to the course website and from my Blackboard "Control panel" it looked like I did so. However, since several registered students have not been able to find anything there, I guess it's "back to the drawing board" for me on that. Until I can use Blackboard more reliably, I will have to continue to depend on the website I've been using for the past ten or so years.
This is the first year that I'm also using a blog for the course, or the first time I'm really using a blog for anything. Prior to this, I've been using this space just to post links and items of interest without much in the way of comment. So I'm posting this now and will be very interested to see whether any comments come back from the students, and whether this can develop into a forum for group discussion outside of the class period.
CSAP's Model Programs The SAMHSA Model Programs featured on this site have been rigorously evaluated and have provided solid proof that they have prevented or reduced substance abuse and other related high-risk behaviors. All programs have been reviewed by SAMHSA's National Registry of Evidence-based Programs and Practices (NREPP). This Web site serves as a comprehensive resource for anyone interested in learning about and/or implementing these programs.
CSAP's Northeast CAPT's Database of Effective Prevention Programs CSAP's Northeast CAPT has created an online, searchable database of effective prevention programs approved by a variety of federal and research agencies. The database allows visitors to compare selection criteria across agencies, review information about the sources those agencies used for their evaluations, and find contact information and descriptions of each intervention. CSAP's Western CAPT's Best and Promising Practices This searchable database includes practices that have been shown to be effective in preventing substance abuse and/or the risk factors for substance abuse. Information is provided regarding training, technical assistance and/or materials that facilitate replication of each practice. U.S. Department of Education's Safe and Drug-Free Schools' Exemplary and Promising Programs The U.S. Department of Education's Safe and Drug-Free Schools Program has used an expert panel process to identify programs that should be promoted nationally as promising or exemplary. A 15-member Expert Panel oversaw a valid and reliable process for identifying effective school-based programs that promote healthy students and safe, disciplined, and drug-free schools. Using this process, the panel identified 9 exemplary and 33 promising programs. Office of Juvenile Justice and Delinquency Prevention (OJJDP) The OJJDP Model Programs Guide is a user-friendly, online portal to scientifically tested and proven programs that address a range of issues across the juvenile justice spectrum. Developed as a tool to support the Title V Community Prevention Grants Program, the Guide has been recently expanded. The Guide now profiles more than 175 prevention and intervention programs and helps communities identify those that best suit their needs. Users can search the Guide's database by program category, target population, risk and protective factors, effectiveness rating, and other parameters. Juvenile justice practitioners are encouraged to take advantage of this helpful resource. Blueprints for Violence Prevention The Center for the Study and Prevention of Violence at the University of Colorado at Boulder, with support from the Centers for Disease Control and Prevention and OJJDP, designed and launched a national violence prevention initiative to identify violence prevention programs that are effective. The project has identified 11 model programs that meet a strict scientific standard of program effectiveness. Another 18 programs have been identified as promising. These interventions have been summarized in a series of "blueprints" that describe their theoretical rationales, core components, evaluation designs and results, and practical implementation experiences across multiple sites.
News Release 2007 Report by Florida Medical Examiners Commission on Drugs Identified in Deceased Persons June 12, 2008 Today, the Florida Department of Law Enforcement (FDLE) and the Florida Medical Examiners Commission released the state’s annual report on Drugs Identified in Deceased Persons. The report contains information compiled from autopsies performed by medical examiners across the state in 2007. During that period, there were more than 168,900 deaths in Florida. Of those, 8,620 individuals were found to have died with one or more of the drugs specified in this report in their bodies.
Medical Examiners specifically collected information on these drugs: Ethyl Alcohol, Amphetamines, Methamphetamines, MDMA (Ecstasy), MDA, MDEA, Alprazolam, Diazepam, Flunitrazepam (Rohypnol), other Benzodiazepines, Cannabinoids, Carisoprodol/Meprobamate, Cocaine, Gamma-Hydroxybutyric Acid (GHB), Inhalants, Ketamine, Fentanyl, Heroin, Hydrocodone, Hydromorphone, Meperidine, Methadone, Morphine, Oxycodone, Propoxyphene, Tramadol, and Phencyclidine (PCP).
The report reveals incidences of Amphetamine, MDA, Meperidine, Methamphetamine and all Methylated Amphetamines decreased when compared with 2006. These decreases include cases in which the drug levels were both lethal and non-lethal.
Incidences of Oxycodone, Methadone, Cocaine, Hydrocodone, Alprazolam, Diazepam, Ethyl Alcohol, and Heroin increased in 2007.
The report indicates the three most frequently occurring drugs found in decedents were Ethyl Alcohol (4,179), all Benzodiazepines (2,627), and Cocaine (2,179). The drugs that caused the most deaths were Cocaine, Methadone, all Benzodiazepines (includes Alprazolam), Oxycodone, Ethyl Alcohol, Hydrocodone, and Morphine. Despite the increase in heroin incidences, deaths caused by heroin still remain lower than in 2005 or any prior year.
The report indicates that prescription drugs (Benzodiazepines, Carisoprodol/Meprobamate, and all Opiods, excluding Heroin) continued to be found more often than illicit drugs in both lethal and non-lethal levels.
“This year’s report again reflects that using drugs often leads to fatal consequences,” said FDLE Commissioner Gerald Bailey. “FDLE and our law enforcement partners are working aggressively to take illegal narcotics off the streets, and to educate Florida’s families about the dangers of the abuse of prescription drugs.”
“The rate of deaths caused by prescription drugs is over three times as high as the rate of deaths caused by all illicit drugs combined,” said Director of the Office of Drug Control Bill Janes. “We have not yet implemented a statewide monitoring plan that will help reduce the problem. The monitoring plan is our priority effort, but that is not enough. We are working to increase awareness among our families by focusing our efforts on communities, schools, businesses, churches, and the media. Prescription drugs are not safe and must be secured. Doctors and pharmacists must help law enforcement identify and stop doctor shoppers. We are also looking for ways to curb illegal internet sales. Only through a comprehensive, coordinated strategy will we be able to reverse this tragic, unacceptable trend.”
DISCLAIMER: ANY EDITORIAL VIEWS EXPRESSED ON THIS WEBSITE BELONG PERSONALLY TO DR. ALAN TRACHTENBERG. NO OFFICIAL ENDORSEMENT IS IMPLIED for any posted position, proposal or policy. The appearance of the doctor's views, opinions or interests on this website is not meant to imply official approval or support by any agency, institution or organization with which Dr. Trachtenberg is affiliated or for which he may work, with the SOLE EXCEPTION being To Create, Inc. (2CREATE). Views expressed directly on this web page were professional opinions held personally by Dr. Trachtenberg at the time they were posted. They are subject to change without notice. Web links and other material on this page are posted because they may be of interest to health professionals, clients of 2CREATE or other members of the public, but no endorsment of truth or quality of content is implied. In fact, there are bookmarks on this page to sites with which Dr. Trachtenberg has significant reservations and/or major disagreements. (Determination of which sites those may be is left as an exercise for the student.) Materials on this page are provided for discussion only and do not constitute medical advice. If you feel any information on this page may be relevant to your own health, please discuss it with your physician or other licensed health professional. Use of this site or 2CREATE's services, including Online Consultation(TM), does not constitute creation of a doctor-patient relationship with Dr. Trachtenberg.
Literature search tools (eg, PubMed, available at: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi;; Toxnet, available at:http://toxnet.nlm.nih.gov/)Clinical guidelines (eg, National Guidelines Clearinghouse, available at: http://www.ngc.gov/; and Primary Care Guidelines,available at: http://medicine.ucsf.edu/resources/guidelines/)
EVIDENCE BASED INFORMATION ON DRUG THERAPY from the Therapeutics Initiative of the Universityof British Columbia in Vancouver, Canada-University of British Columbia:
Every Doc Can Do Research Program Page from the USAFP, including the Every Doc Can Do Research Workbook from the Madigan Fellows and the Clinical Investigations Committee:
NLM's Health Services Technology Assessment Texts (HSTAT)is a searchable collection of large, full-text clinical practice guidelines, technology assessments and health information.
COCHRANE COLLABORATIVE COMPLEMENTARY MEDICINE (CM)FIELD:the Complementary Medicine (CM) Field was established to help promote and facilitate the production of systematic reviews in topics such as acupuncture, massage, chiropractic, herbal medicine, homeopathy and mind-body therapy.
FDA Policy on Science-based Food Labelling (including Dietary Supplements): Better Health Information for Better Nutrition - A major FDA initiative announced in 2002
NAS Report on "The Polygraph and Lie Detection" (2003); Board on Behavioral, Cognitive, and Sensory Sciences and Education (BCSSE), Committee on National Statistics (CNSTAT):
QualityTools?, a clearinghouse for practical, ready-to-use tools for measuring and improving the quality of health care; from the Agency for Healthcare Research and Quality (AHRQ):
