Briefly Noted

Compared to light drinkers, heavy drinkers have brains that have less energy due to decreases in glucose metabolism, researchers at the National Institutes of Health have found. In a study published online last week in Nature Communications, the researchers combined measures of the left brain (activity) and the right brain (glucose consumption) to better understand the effects of alcohol on people. “The brain uses a lot of energy compared to other body organs, and the association between brain activity and energy utilization is an important marker of brain health,” said George F. Koob, Ph.D., director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), in a statement accompanying the release of the results. “This study introduces a new way of characterizing how brain activity is related to its consumption of glucose, which could be very useful in understanding how the brain uses energy in health and disease.” The research was led by Ehsan Shokri‐Kojori, Ph.D., and Nora D. Volkow, M.D., both of the NIAAA Laboratory of Neuroimaging. Volkow is also the director of the National Institute on Drug Abuse. “The findings from this study highlight the relevance of energetics for ensuring normal brain function and reveal how it is disrupted by excessive alcohol consumption,” said Volkow. “We measured power by observing to what extent brain regions are active and use energy,” explained Shokri‐Kojori. “We measured cost of brain regions by observing to what extent their energy use exceeds their underlying activity.” Using a group of healthy volunteers, researchers showed that different brain regions have different power and cost. They then looked at the effects of alcohol on these measures by assessing a group that included light and heavy drinkers, and found that both acute and chronic use affected brain power and cost. “In heavy drinkers, we saw less regional power, for example, in the thalamus, the sensory gateway and frontal cortex of the brain, which is important for decision‐making,” said Shokri‐Kojori. “These decreases in power were interpreted to reflect toxic effects of long‐term exposure to alcohol on the brain cells.” There was also a disruption of visual processing during acute alcohol exposure, and significant decreases in cost of activity during alcohol intoxication.     

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The federal Department of Justice (DOJ) is impeding efforts to produce high‐quality marijuana for research purposes, according to a report published on Vox. In particular, California entrepreneur George Hodgin, who wants to grow it, and researchers who want to use what he grows are frustrated. “We only want to provide clean, consistent, compliant cannabis for researchers,” Hodgin, CEO of Biopharmaceutical Research Company, told Vox. “We're sitting on one of the most sophisticated cannabis production facilities in the United States. And it's empty, because the federal government is playing politics with something that is apolitical.” Because marijuana is still illegal under federal law, despite the fact that it is legal for medical and recreational purposes in some states, growing the plant for research purposes is only allowed by the federal government by the University of Mississippi. Critics say that is not of high enough quality. “I feel like the government I fought to protect doesn't understand the urgency of this problem,” said Hodgin, a retired Navy SEAL. “My story should be the American dream: A Navy SEAL uses the GI Bill to get a graduate education and start a company that helps Americans and creates jobs. But sadly, the DOJ and DEA are playing politics with science and lives, and instead big government inertia and red tape are blocking critical research.” He added: “Democrats and Republicans have both argued the need for more marijuana to be produced for research. Why would [the Justice Department] ignore them?” Indeed. It's hypocritical for the federal government to say there's no proof marijuana works as medicine, and no proof that it's safe, and at the same time ban what would make it possible to find out whether those things are true.     

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Internalizing and externalizing problems predicted onset of any tobacco use in youth; however, findings differed for internalizing and externalizing problems across tobacco products, researchers found in analyzing the Population Assessment of Tobacco and Health Study of 12‐ to 24‐year‐old never‐users. Self‐reported internalizing and externalizing symptoms were assessed at wave 1 (45,971 subjects), and past‐12‐month use of tobacco products was assessed at wave 2 (38,443 subjects). The researchers found that high‐severity internalizing symptoms at wave 1 increased the risk by 1.5 times of using tobacco by wave 2, and that high‐severity externalizing problems increased the risk of tobacco use by 1.3 times at wave 2. Low‐ and moderate‐severity problems did not predict tobacco onset. The study was funded by the National Institute on Drug Abuse and the Food and Drug Administration. Several authors declared conflicts of interest — one as an expert witness in a lawsuit against the tobacco industry. The article, “Mental Health Problems and Onset of Tobacco Use Among 12‐ to 24‐Year‐Olds in the PATH Study,” was published in the December 2018 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.     

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A project that began a year ago (see ADAW, Jan. 15, 2018), Shatterproof's rating system of addiction treatment programs took another step last month when the nonprofit announced it would start out with a pilot, now that it has $5 million. Saying the current addiction treatment system is broken, Shatterproof founder and CEO Gary Mendell said the project was made possible by funding from two foundations (the Laura and John Arnold Foundation and the Robert Wood Johnson Foundation) and a coalition of five insurance companies. “People who need help for addiction don't know what to look for or where to turn,” said Sam Arsenault, director of national treatment quality initiatives at Shatterproof, in the Dec. 18 announcement of the project. “We are taking rating system best practices from health care and other business sectors and applying them to addiction treatment. This will not only provide critical information to individuals looking for care but also drive a long overdue transformation of the addiction treatment industry.” The Shatterproof Rating System will utilize data from three sources: insurance claims, provider surveys and consumer experience, with collaboration from the National Quality Forum (NQF), a membership organization composed of payers. Initially, the program will begin with a pilot, with analysis done by RTI International. “Consumers can find information and accurate data on the quality of nursing homes, hospitals, physicians and most other types of providers,” said Tami Mark, director of behavioral health financing and quality measurement at RTI International. “It's time that patients have reliable information on addiction treatment.”     

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The U.S. Preventive Services Task Force (USPSTF) recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school‐aged children and adolescents. However, there is not enough evidence to recommend tobacco‐cessation interventions in this population, according to the draft recommendation, released in June. The USPSTF is not part of the U.S. government, but its recommendations are taken into consideration by clinical and payer organizations. It only makes recommendations for interventions when it has found adequate evidence that the interventions do more good than harm. In the case of tobacco interventions, the task force found no evidence at all of harms of providing behavioral prevention interventions. However, once kids are already using nicotine, there is not enough evidence to recommend for or against cessation options. The recommendations were first published in the Annals of Internal Medicine and in Pediatrics in 2013; the final draft recommendations were issued in June, for public comment by July 22. For a link, go to https://www.uspreventiveservicestaskforce.org/Page/Document/draft‐recommendation‐statement/tobacco‐and‐nicotine‐use‐prevention‐in‐children‐and‐adolescents‐primary‐care‐interventions .     

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Researchers have found that attention‐deficit hyperactivity disorder (ADHD) may be a risk factor for developing smartphone addiction, based on the neurobiological substrates underlying each separately and those that are shared. The study found a greater than six times likelihood that children with ADHD also had smartphone addiction. The study looked at the prevalence of smartphone addiction and its association with depression, anxiety, and ADHD symptoms in a total of 4,512 South Korean middle and high school students, who completed surveys. There were 338 subjects (7.5%) in the smartphone addiction group. The odds ratio of the ADHD group compared to the non‐ADHD group for smartphone addiction was 6.43, the highest among all variables. The study, “The relationship between smartphone addiction and symptoms of depression, anxiety, and attention‐deficit/hyperactivity in South Korean adolescents” is published in the March issue of the Annals of General Psychiatry.     

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Last week, the federal Centers for Disease Control (CDC) issues a warning about a cluster of pulmonary illnesses possibly linked to vaping. The cases have primarily been among adolescents and young adults. In some cases the young people had also used cannabis.     

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By the time this issue of ADAW is published, the final figures will be out. At press time, some $400 million in a $2 trillion stimulus package designed to combat economic problems from the coronavirus pandemic is going to the Substance Abuse and Mental Health Services Administration, according to Andrew Kessler, principal with Slingshot Solutions. Both the Senate and House versions allocated $400 million. The Senate bill proposed $425 million, while the House proposed $435 million. In both bills, $15 million goes to the Indian Health Service and $50 million to suicide prevention. In the Senate bill, $250 million is allocated to certified community behavioral health clinics (CCBHCs), while that number is $200 million in the House version. These clinics currently exist in only eight states, Kessler pointed out. The CCBHC money will allow states to apply for grants and put forth their own behavioral health priorities, said Kessler. Watch next week's issue for details.