Among adolescents with conduct symptoms and substance use disorders

Abstract
The prevalence of cannabis use is rising among adolescents, many of whom perceive little risk from cannabis. However, clinicians who treat adolescent substance users hear frequent reports of serious cannabis-use disorders and problems. This study asked whether cannabis produced dependence and withdrawal among such patients, and whether patients’ reports supported previous laboratory findings of reinforcing effects from cannabis. This was a screening and diagnostic study of serial treatment admissions. The diagnostic standard was the DSM-lll-R dependence criteria, and the setting was a university-based adolescent substance treatment program with male residential and female outpatient services. The patients were 165 males and 64 females from consecutive samples of 255 male and 85 female 13—19-year-olds referred for substance and conduct problems (usually from social service or criminal justice agencies). Eighty-seven patients were not evaluated, usually due to early elopement. Twenty-four others did not meet study admission criteria: one dependence diagnosis and three lifetime conduct-disorder symptoms.

The main measures were items from diagnostic interview instruments for substance dependence, psychiatric disorders, and patterns of substance use. Diagnoses were:

substance dependence: 100%
current conduct disorder: 82.1%
major depression: 17.5%
attention-deficit/hyperactivity disorder: 14.8%

The results show that most patients claimed serious problems from cannabis, and 78.6% met standard adult criteria for cannabis dependence. Two-thirds of cannabis-dependent patients reported withdrawal.  Progression from first to regular cannabis use was as rapid as tobacco progression, and more rapid than that of alcohol, suggesting that cannabis is a reinforcer. The data indicate that for adolescents with conduct problems cannabis use is not benign, and that the drug potentially reinforces cannabis-taking, producing both dependence and withdrawal. However, findings from this severely affected clinical population should not be generalized broadly to all other adolescents.

3 July 1997: accepted 26 November 1997
Thomas J. Crowley, Marilyn J. Mcdonald, Elizabeth A. Whitmore, Susan K. Mikulich
©1998 Elsevier Science Ireland Ltd. All rights reserved.

In June 1997, the Department published preliminary results from the first 7 months of a new 3 year study into the incidence of drugs in road accident fatalities. At that time the Department committed itself to publishing a further report on the study  when at least 12 months data were available.

This report summarises the findings from the first 15 months of the study (up to 7 January 1998), and reports on the findings from 619 road user fatalities. As before, these include drivers, riders of two-wheeled vehicles (21 of them cyclists), passengers in vehicles and pedestrians.

Table 1 gives the percentage of those testing positive for medicinal and illicit drugs by road user groups. The figures for medicinal drugs include those cases where more than one such drug was found; those for illicit drugs are shown separately. This table is directly comparable to that published in the report issued in June 1997 (based on 301 fatalities).

The figures released on drugs and driving indicate that the scale of illicit drug use among people who have been killed in road accidents has increased considerably over the last decade. They show that among all road users, medicinal drugs were present in six per cent of fatalities. Illicit drugs (mainly cannabis) in 16 per cent, and alcohol in 34 per cent (23 per cent over 80 mg per 100ml) Among drivers alone four percent of those killed had taken medicinal drugs, 18 per cent illicit drugs and 30 per cent, (22 per cent over 80mg per 100 ml) alcohol. All these figures indicate a considerable increase in drug taking compared with the previous 1985-87 study.

Speaking at the PACTS (Parliamentary Advisory Committee on Transport Safety) conference, Keith Hellawell, the UK Anti-Drugs Co-ordinator said: “These figures do not allow simplistic conclusions but they do show that illicit drug use may be a significant factor on road fatalities. In my new role as UK Anti Drugs Co-ordinator I am drawing up a strategy to deal with drugs and the harm they can cause. I look forward to working with colleagues in a wide range of agencies as we learn more about this problem.”

Interim results of survey, January 1998. Published DETR.

Acute effects on central nervous system functions and behaviour. The acute effects of cannabis use have been recognized for many years, and features such as mild euphoria, relaxation, increased sociability, heightened sensory perception and increased appetite have been described in earlier reports. The acute effects of higher doses, including perceptual changes, depersonalization and panic have also been well described previously (ARF/WHO, 1981). Research conducted since the last WHO report has focused mainly on quantifiable effects such as those on memory, psychomotor performance and appetite; however, some work has also been done on the acute psychotropic effects of cannabis. A recent report done by Mathew et at. (1993), showed that cannabis smoking was associated with significant depersonalization that was maximal 30 minutes after smoking. Other behavioural changes associated with cannabis intoxication included loss of time sense, sensation of high, anxiety, tension and confusion.   (Mathew et al 1993).

Several studies have shown that cannabis appears to increase the perceived rate of the passage of time. Consistent with earlier observations, numerous studies in the past ten years have confirmed that cannabis impairs psychomotor performance in a wide variety of tasks, such as handwriting, tests of motor coordination, divided-attention, digit-symbol substitution, and operant tasks of various types (Solowij et at., 1991). The consistency of results is probably attributable to improved experimental technique, as reflected by greater attention to the importance of task complexity, standardization of THC administration. studies of dose-effect relationships, and of sharper definition of acute versus residual effects.

Youth Results Mapping may forever alter the way that prevention programs are evaluated, according to Barry M. Kibel, Ph.D., a senior research Scientist at Pacific Institute for Research and Evaluation, Chapel Hill, NC, and the principal investigator for CSAP-funded High-Risk Youth Grants in Cincinnati and Atlanta. This approach promises to be cheaper, more efficient, and able to develop a comprehensive program evaluation as much as five times sooner than traditional methods.
“There is a major paradigm shift underway in the prevention yield from a problem solving-deficit model to the asset-buiIding model,” said Dr. Kibel, at the 1997 CSAP High-Risk Grantee Conference last summer.
Under a problem-solving-deficit model most kids who had problems are thought to have problems for the same reasons. and programs were designed to keep them out of trouble.
“The new approach emphasizes the uniqueness of every youth, adult and community—and builds on these strengths,” says Dr. Kibel. It requires that a program  be “reinvented  as  you  go along.”
“The new asset-building approach can be best evaluated by anecdotes,” says Dr. Kibel. “In using anecdotes and complex stories that describe the specific success of a specific individual in a program, the new model emphasizes that everyone is different.”
Dr. Kibel explains that there are two types of anecdotal stories. The simple and causal story is where a baby gets a flu shot and does not get the flu—cause and effect. In the prevention field, unlike the baby and the flu shot, all programs have complex, synchronistic stories where many outside factors beyond the program factors beyond the program influence the outcome of each individual.
An example of a complex story in the prevention  field  would  be  an  18-year-old Hispanic woman with a drinking problem, who has not completed high school, and enters a community center program. As the result of bonding with one of the counselors, and obtaining direction from one of her former teachers who lives in the neighborhood, the young woman has significantly reduced alcohol consumption and is working on a high school equivalency diploma. This is a complex story of a client engaged in “healing and transformation,” in which the community center has provided part of the outcome, along with outside factors such as the teacher and the client has made a contribution to her own positive outcome and future.
This anecdotal story, unlike the simple cause-effect story, emphasizes the uniqueness of each client and the importance of otherwise hard to-measure outside influences on client outcomes
This new paradigm in the evaluation of prevention programs, known as Results Mapping, is only 2 years old. According to Dr. Kibel, Results Mapping is a system for relating anecdotal information in a structured format. It is a scientific process because there are rules and conventions for recording and scoring anecdotal information.

A Growing Approach
Results Mapping is a growing approach to evaluation of programs in the prevention field.
‘At least 25 percent of the alcohol and drug prevention field have made the shift, but evaluation and plan-fling tools have not kept up with the shift,” says Dr. Kibel.
Who is using Results Mapping as an alternative to the old model of evaluation? The States of Connecticut and Colorado now use Results Mapping in evaluating all of their alcohol and drug abuse prevention programs. At the local level, programs in Tennessee, California, Arizona, Florida, Illinois, Texas, and New York are using Results Mapping. CSAP is funding programs in Ohio and Georgia that are being evaluated by Results Mapping.
And   why  are   State   and   Federal  prevention
programs using Results Mapping evaluation? This model for evaluation is much cheaper, according to Dr. Kibel, and it is a form of empowerment evaluation.
Results Mapping places the formulation of program data back into the hands of the program directors and staff. There is less dependency on an outside or consultant evaluator. Unlike other more impersonal forms of evaluation, Results Mapping allows clients to become an active part of the evaluation process. Program staff members are encouraged to sit down with clients and write down what the client has to say about their experiences with a specific prevention program.
“The methodology of Results Mapping is not incompatible with outcome-based funding approaches. In fact, the opposite is true. The way we score the anecdotal information provides the best possible information regarding how well a program is doing in moving its target population toward difficult to reach, long-term outcomes,” says Dr. Kibel.
For a 5-year prevention program, it could take 5 to 6 years to see any comprehensive evaluations. With Results Mapping, results could be seen from the same 5-year program in 6 months.
Dr. Kibel emphasizes that Results Mapping is a very scientific process. When there is concern that a handful of stories provide a distorted or highly exaggerated accounting of the accomplishments of a program, there are answers in making a valid and scientific program evaluation.
“Programs need to provide more stories-enough for a comprehensive picture of program accomplishments to emerge. Programs need to score and rank their stories, much as judges rate athletic performances, based on the contribution these represent to clients,” he added.
According to Dr. Kibel, because Results Mapping can provide timely evaluations, as often as every 6 months, it has the potential of becoming an important new tool and resource for prevention program directors and staff Results Mapping is a new evaluation methodology that may become a cornerstone in future prevention programs throughout the country.

Prevention Pipeline     Nov/Dec 1997

Adolescent Alcohol and Marijuana Treatment

After declining in the 1980s, tobacco, alcohol, and marijuana use among adolescents has been on the rise again in the 1990s. Marijuana and alcohol use are highly intertwined, according to data from the National Household Survey on Drug Abuse (NHSDA; OAS, 19%). While 60 percent of adolescents aged 12-17 were not actively using in the last year, 24 percent were using alcohol, 15 percent were using both alcohol and marijuana, and 1 percent were using  marijuana only; moreover, 2 out of 3 weekly adolescent users were using both alcohol and marijuana (McGeary, Dennis, French, .& Titus, 1998). As one might expect, the frequency of’ substance use increased with age and  grade in school, and was slightly higher among males. Contrary to stereotypes, frequent use was less likely among minorities and more likely among those who were employed. Further, there are no significant differences in the patterns of’ alcohol or marijuana use among adolescents in terms of’ their welfare status, income, or the metropolitan status of’ their community.
Over time, generations have been defined by peaks in the use of alcohol, opioids cocaine, and then crack. Among adolescents in the 1990s, the defining drug has clearly become and continues to be marijuana. In fact, among 12-17 year olds, marijuana is now the primary substance of abuse among adolescents entering treatment (QAS, 1997).
High rates of marijuana and alcohol use among adolescents are related to many earlier problems. Relative to non-users, adolescents who reported weekly marijuana and alcohol use are about four times more likely to report past year behavior problems related to attention deficit hyperactivity disorders, conduct disorder or delinquency (57 percent vs. 4 percent), dropping out of school (25 percent vs. 6 percent), being involved in a major light (47 percent vs. 11 percent) and being involved in one or more illegal activities during the past year (69 percent vs. 17 percent) (McGeary, Dennis, French, & Titus, 1998). Moreover, they were 8 to 23 times more likely during the past year to have the  following:

•  
  • Committed a theft       (33% vs. 4%)
  • Damaged property      (31% vs. 3%)
  • Shoplifted                  (41% vs. 4%)
  • Been on probation      (16% vs. 1%)
  • Been arrested             (23% vs. 1%)
  • Sold drugs                  (31% vs. 0%)

In terms of health care, adolescents who used marijuana and alcohol weekly were also twice as likely to have been to the emergency room during the past year (33 percent vs. 17 percent). In fact, marijuana is now the primary substance mentioned in both adolescent emergency room admissions and autopsies (OAS, 1995).
Adolescent substance use is likely to have a long—term impact on both the individual and on society. The table below uses data on adults from the National Household Survey on Drug Abuse to look at their probability of having one or more symptoms (Sx) of tobacco, alcohol, and/or marijuana disorders based on their age of first use. Relative to people who started using over the age of 18, those adolescents who started using under time age of 15 are more likely to report major problems related to their use as adults about twice as often for  tobacco (26 percent vs. 13 percent), four times as often for alcohol (27 percent vs. 7 percent) and about six times as often for marijuana (24 percent vs. 4 percent (Dennis, McGeary, French, & Hamilton, 1998). Conversely, among adults reporting one or more substance disorder symptoms in time National Household Survey on Drug Abuse, over 85 percent started using under the age of 18 — with about 40 percent starting under the age of 15.  Despite the rise in substance use, range of related problems, and potential for long-term consequences, few adolescents have ever been in treatment. While 14 percent of adolescents reported one or more past year alcohol disorder symptoms, 8 percent reported one or more cannabis disorder symptoms and 4 percent reported other substance disorder symptoms — only 1 percent reported ever having been to a substance abuse treatment program (McGeary, Dennis, French & Titus, 1998).

While substance use is often a chronic condition, treatment (toes help. Long-term studies of adult substance abuse treatment show that about 25-85 percent of adults recover after a given treatment episode and tend to stay better; that those who relapse tend to deteriorate without further re-intervention; and that each time there is a re-intervention, another proportion tend to be moved into the recovery column (Simpson & Savage, 1980). While information is still emerging about adolescent treatment effectiveness, there is considerable tension between efforts to develop short-term, cost-effective treatments and findings that 50 percent or more adolescents relapse to marijuana or alcohol use within the first 3 months after discharge (Brown & Vik, 1994; Brown, Vik, & Creamer, 1989; Catalano, Hawkins, Wells, Miller, & Brewer, 1991; Kennedy & Minami, 1993). There are, however, several promising options for improving treatment effectiveness by focusing on motivational enhancement, relapse prevention, problem solving, coping strategies, case management, family support, family therapy, and working with the adolescents concerned others to change their environments (Azrin, et al., 1994; Brown, et al, 1994; Graham et al., 1996; Kadden et al., 1989; Liddle et al., 1995).

The Substance Abuse and Mental Health Services Administration (SAMHSA) has recognized the need for further study of adolescent treatment. As part of the Department of Health and Human Services Secretary’s Youth Initiative, the Center for Substance Abuse Treatment h as embarked on a major randomized field experiment to directly evaluate live of the most promising models of adolescent outpatient treatment and hopes to have the main findings by the fall of 2000 (Dennis, Babor, Diamond, Donaldson, S.Godley, Tims, 1998 or see www.chestnut.org/cyt Substance use among adolescents is at a new high and related to a multitude of problems for the public health system, government, society, and America’s families. While the Federal and State governments are and should continue to increase their prevention efforts to   reduce   use  among  the  next  generations,  the substantial numbers of adolescents in the current generation are already using and need more formal treatment. 11 Unfortunately, they are not likely to get it under the current system. Government leadership is needed to head off the likely long-term consequences of this problem for both the health of these individuals and for the nation.

The aim of this conference was to review the pharmacological and molecular basis of the therapeutic properties of marijuana and THC, and to evaluate their clinical applications. Fifty scientists and physicians from the United States, Israel, France, Germany and Sweden gathered for two days to present papers in their areas of expertise.
The prolonged storage of THC in the body, whatever its route of absorption, was again discussed in reference to the persistent properties of this drug, even after its acute effects have dissipated. The marijuana cigarette manufactured and distributed by the National Institute on Drug Abuse for clinical research contains toxic substances in greater amounts than those contained in a tobacco cigarette of the same weight. NIDA has not been able to develop a standard marijuana cigarette with uniform concentrations of THC devoid of tars and other noxious agents. THC, taken orally, has been approved by the FDA for the treatment of vomiting and as an appetite stimulant under the name of “Marinol.’ This drug may be prescribed by physicians; however, it is not as effective as other presently available medications
The addiction/tolerance mechanisms of THC and marijuana are similar to those induced by opiates, cocaine, nicotine and alcohol. The evidence of persistent, abnormal biochemical alterations (produced by THC in the brain and recorded with PET scans) were presented by scientists from Brockhaven National Laboratory. These were related to the persistent alterations by marijuana of the brain molecular mechanism, which control DNA expression and correlated with changes in memory, attention, awareness, and goal-oriented behavior. THC interacts with ‘receptors’ in brain cells, which are part of a regulatory “anandamide cannabinoid” system that regulates the function of brain cells and their neuro-transmission (signal transduction). Through this mechanism, THC interacts with the receptors to brain neurotransmitters (norepinephrine, dopamine, GABA, acetylcholine), altering the release of these substances. By the same mechanism, THC modifies the effects of many drugs commonly used like psycho-stimulants and psycho-depressant, opiates, alcohol and stimulants: some are enhanced and some are decreased. THC acts as a major ‘deregulator’ of all brain regulation of basic bodily functions. However, unlike ‘anandamide’ and its physiological ligands, THC sticks to the receptor molecule for hours, even days, and disturbs its signalling function in a persistent fashion. This fundamental impairment of the intracellular signalling mechanism can be observed in all cells of vital body organs: brain, heart, lung, kidney, immunity cells, and the reproductive system, carrying the risk of impairing future generations before they are born.
THC receptors identical to those of the brain cells have been identified in cells of the immunity system, of sex organs and of germ cells (gametes). They are present on the head of sperm cells and in the cells of the testes that generate the sperm. These molecular studies confirm those performed in 1976-1978, by researchers at Columbia University who reported that marijuana smokers had decreased sperm count and abnormal forms of sperm. This alteration of sperm was due to the effect of THC on spermiogenesis, the process of sperm formation in the testes. Marijuana is ‘gametotoxic’, toxic to germ cells, and is fetotoxic, impairing foetal development and is in animal species.
Marijuana in the treatment of pain was discussed in a special international panel,. The difficulty of separating the subjective perception of pain from its objective measurement was discussed, and it appears to be insuperable to solve; marijuana smoking can actually lower the threshold of pain perception. THC is not an effective all-purpose analgesic when compared to aspirin, Tylenol or opiates. An evaluation of THC and of marijuana smoke in the following conditions was discussed: emesis and vomiting in cancer chemo-therapy (where orally administered THC or marijuana smoking were less effective than alternate medications); glaucoma (where THC and smoked marijuana were not deemed acceptable); use of marijuana and THC have proven unsuitable as sedative or for pain management in anesthesiology; in neurological disorders, epilepsy and multiple sclerosis. In management of the AIDS wasting syndrome, the reported therapeutic results of THC and of marijuana smoke were inconclusive.
The effects of marijuana in psychiatry were evaluated in the following conditions: schizophrenia, alcoholism and acute psychiatric syndromes. Marijuana smoking may trigger some of these ailments or worsen their course.
Dr. Paul C. ]anssen, who has designed some of the most widely used medications in psychiatry, anaesthesia and dermatology, gave a special lecture entitled: How to Search for the Ideal Drugs of the Future.’ He emphasized the importance of obtaining a perfect fit between a drug and a specifically localized receptor in order to obtain the ideal therapeutic effect. Cannabinoids do not seem to possess this property of ideal therapeutic drugs.

Environmental Tobacco Smoke (ETS) has been determined by the U.S. Occupational and Environmental Health Authorities to be a human carcinogen.  The authors using atmospheric nicotine measurements to estimate non-smokers’ smoke ETS lung cancer risks in a particular workplace, estimate the U.S. non-smoking adult population’s median nicotine lung exposure and believe they can explain the stimulated 5,000 passive smoking deaths per year from lung cancer alone.  Applying these measurements in the workplace can identify the exposure and risks of the non-smokers at a particular workplace.

Scientist have found powerful evidence suggesting that genetics plays a dominant role in making some people particularly susceptible to nicotine addiction.

A comparison of the smoking habits of more than 2,000 pairs of twins, showed much greater similarity on smoking behaviour between identical (same gene) twins than non-identical twins.

A member of the team, Dr. Pamela Madden said “Our evidence indicates that strong genetic effects are responsible for both starting smoking and for long-term smoking.  Innate differences in initial sensitivity to nicotine may play an important role, with many individuals who experience a strong adverse reaction  giving up smoking after the first or second attempt”. The Health Education Authority said “If convincing evidence of a genetic effect emerges, then we may consider targeting children of smoking parents”.

Madden, P et al.Washington University School of Medicine, Missouri.
Report ‘Behaviour Genetics’ June95

This study was based on the treatment at an outpatient clinic of 40 – 50 daily users with a habit of from 6 months to 25 years.  The researchers observed users have a special way of thinking, or pattern of thought.  This is more visible in long term use and the use of cannabis more often than every six weeks for two years will increase the effect on cognitive function and make serious dysfunction worse. The study showed negative outcomes for verbal ability, logical – analytic ability, psychomobility, memory, analytic-synthetic ability and psychospatial ability.  The chronic effect of cannabis was seen to be a loss of quality of these abilities.  It is also suggested that this specific ‘cannabis pattern’ is a result of prefrontal lobe dysfunction in the brain.

The Process of Prevention

Since the 1920’s books have been published that show the diffusion of innovative change – almost 3,000 studies have been published that look at how communities  change.  As  a  result  of  this research we now know that change is very predictable – and there are six stages.  (Figure 1 ).   A classic example of this process is the situation in the USA with smoking (later replicated in Britain where we would appear to be between stages 4 and 5).

To be successful it is essential to go through all stages – research suggests that for an individual to change from level 3 to 5 takes about 8 years – culturally for society it will take longer. To succeed everyone has to be working together – and success can be measured over time with the numbers seen to be changing.

Currently those promoting illegal drugs have also been working to this model. They have, with the help of the media, been working at changing attitudes and awareness of drugs (level 1) They  have also been disseminating their own version of the ‘facts’ about drugs: ‘cannabis is less harmful than alcohol and nicotine’… ‘ it is normal for all young people to use drugs’…  ‘we are all drug users, if we take aspirin or coffee etc…’(which is Level 2 argument). The result is we now have a substantial minority of the population actively considering using drugs (which is Level  3).

The NDPA has an enormous task ahead to use the process of prevention and turn around the problem of youth drug use.  Our website will help us in this task  by creating more awareness of the need for  effective prevention, the successes  of good practice in prevention internationally, (level 1) and in disseminating up to date and accurate information at levels 3 & 4. Our communities do not have unlimited years to begin good local programmes; the problems are with us now.  We hope you will share with us any information you have about good prevention programmes – we will do our best to include this in our future issues.

Reshaping of the DNA scaffolding that supports and controls the expression of genes in the brain may play a major role in the alcohol withdrawal symptoms, particularly anxiety, that make it so difficult for alcoholics to stop using alcohol.

The finding is reported by researchers at the University of Illinois at Chicago and the Jesse Brown VA Medical Center in the April 2 issue of the Journal of Neuroscience.

DNA can undergo changes in function without any changes in inheritance or coded sequence. These “epigenetic” changes are minor chemical modifications of chromatin — dense bundles of DNA and proteins called histones.

“This is the first time anyone has looked for epigenetic changes related to chromatin remodeling in the brain during alcohol addiction,” said Dr. Subhash C. Pandey, professor and director of neuroscience alcoholism research at the UIC College of Medicine and the Jesse Brown VA Medical Center in Chicago, the lead author of the study.

Chemical modification of histones can change the way DNA and histones are wound up together. Histone acetyltransferases (HATs) are enzymes that add acetyl groups to histones and loosen the packing, promoting gene expression. On the other hand, histone deacetylases (HDACs) remove acetyl groups from histones, causing them to wrap with DNA more tightly, decreasing gene expression.

The UIC researchers had previously shown in an animal model that levels of neuropeptide Y in the amygdala modulate anxiety and alcohol-drinking behavior. In the new study, they looked at the HDAC activity, acetylation of histones, and expression of the genes for NPY in the amygdala and the anxiety-like behaviors associated with withdrawal from chronic alcohol use.

Pandey and his colleagues found that acute exposure to alcohol decreases HDAC activity; increases the acetylation histones; increases levels of NPY — and reduced anxiety in the animals.

Conversely, anxiety-like behaviors during withdrawal in animals with chronic alcohol exposure was associated with an increase in HDAC activity and decrease in histones acetylation and NPY levels.

Importantly, blocking the observed increase in HDAC activity using an HDAC inhibitor during alcohol withdrawal brought up histone acetylation and NPY expression levels in the amygdala and prevented the development of anxiety-like behaviors.

“Our findings suggest that HDAC inhibitors may have potential as therapeutic agents in treating alcoholism,” Pandey said.

The researchers also found that levels of a protein known as CREB binding protein, which has HAT enzymatic activity, were increased by acute alcohol but were decreased during ethanol withdrawal.

They concluded that the enzymes that are involved in remodeling of chromatin play an important role in the anxiety that accompanies alcohol withdrawal as well as in the anti-anxiety effects of acute alcohol use.

“We need new strategies to treat alcoholism that are directed toward the prevention of withdrawal symptoms,” Pandey said. “Anxiety associated with withdrawal from alcohol abuse is a key factor in the maintenance of alcohol addiction.”

Source: University of Illinois at Chicago (2008, April 4). Brain DNA ‘Remodeled’ In Alcoholism. ScienceDaily. Retrieved August 17, 2008, from http://www.sciencedaily.com­ /releases/2008/04/080402084340.htm

Alcohol and drugs deaths in Scotland are twice the UK average
New report finds carrying of knives a key factor
DRINK PROBLEM: research suggests killings and suicides are linked to alcohol and drugs
Alcohol and drug abuse is pushing Scots to kill or take their own lives almost twice as often as people in other parts of Britain, a report revealed today.
Researchers found there were 500 killings in Scotland over five years and 5,000 suicides over six years.  Both these figures are almost double those in England and Wales.The culprits were normally young men attacking other young men, they said, and the carrying of knives was a key factor.Scientists also found the North-South divide was highest among teenagers .  The findings were revealed in a Scottish Government-commissioned report, Lessons for Mental Health Care in Scotland, carried out at the University of Manchester.
Scientists looked at all suicides and homicides in the population north of the border, as well as those committed by people who had sought help from mental health services. Homicide rates in Scotland were 2.12 per 100,000 people compared to 1.23 per 100,000 in England and Wales.  And suicide rates in Scotland were 18.7 per 100,000 of the population, compared to 10.2 per 100,000 in England and Wales.  Rates for suicide and killing among the mentally ill were also found to be higher in Scotland.
A total of 12% of killers and 28% of those who took their own lives had mental health problems.
Research director Professor Louis Appleby said the number of killings and suicides linked to alcohol and drug misuse was “striking”.  He said: “Alcohol and drug misuse runs through these findings and it appears to be a major contributor to risk in mental health care and broader society. The findings suggest alcohol and drugs lie behind Scotland’s high rates of suicide and homicide.”
Referring to the high homicide figure, Prof Appleby said: “National homicide rates are high because of particularly high rates in certain areas of the country, namely Glasgow and Clyde and Argyll.”  In Scotland, as across Britain, homicide is a crime committed primarily by young men against young men, the report said.   Alcohol and drugs had often been taken and the weapon was usually a knife or another sharp object.
Prof Appleby said politicians should focus on drugs and alcohol and the carrying of knives, rather than mental health, when seeking to tackle the problem.   He said: “Drugs and knives are a dangerous mix, so policy response to these deaths should focus on alcohol and drug abuse in young people and on the carrying of knives by young men.  The rise in homicide rates in recent years is the result of an increase in killings by young people, mainly men under 25 years, but most are not mentally ill.  A public health approach to homicide would target alcohol and drug use before mental health illness.”
Of 1,373 suicides among the mentally ill studied, there was a history of alcohol misuse in 57% of cases and drug abuse in 38%.  Of 58 killings looked at among the mentally ill, more than 70% were committed by people with alcohol problems and around 77% had drug problems.
The report also made a string of recommendations.  These included improving mental health services for young people, removal of ligature points from hospital wards and tightening up security on wards.
Source:The Press & Journal : 16/06/2008
________________________________________

Parenting practices during the middle years of elementary school, such as supervision and monitoring, may affect adolescent initiation of marijuana use, according to a new NIDA-supported study conducted by Dr. Chuan-Yu Chen and colleagues from the Johns Hopkins University Bloomberg School of Public Health.

The scientists followed 1,222 youth from elementary school through young adulthood to determine if early parenting practices protect youth from early onset of marijuana use.  The researchers measured three dimensions of parenting-parental monitoring, parental involvement/reinforcement, and coercive parental discipline parenting (attempts to correct child behavior by using serious threats such as physical and nonphysical punishment)-as well as opportunity to first try marijuana.

The scientists found that children with the lowest levels of parental monitoring and parental involvement/reinforcement were almost 30 percent more likely to try marijuana for the first time when compared with the most highly monitored children.  Similarly, children with higher levels of coercive discipline were more likely to try the drug for the first time. Overall, the scientists observed a delay and reduction in the opportunity to first try marijuana among children with the highest levels of parental involvement/reinforcement, which lasted through early adulthood.
• WHAT IT MEANS: Numerous studies have documented associations between parenting practices and an array of health-compromising behaviors in adolescents. The results of this study expand upon existing evidence and suggest that parenting practices such as early increased monitoring and supervision may have lasting effects by reducing and delaying marijuana use through young adulthood. Additional research is needed to better understand the role of parental practices in preventing and delaying adolescent drug use.

Source:   Pediatrics. June 2005 issue

By Peter Stoker for  Drug Watch International
14th November, 2003

Fall in UK this year came late and glorious; the fall of cannabis law came premature and dismal. Plans laid by Home Secretary David Blunkett on his accession in fall 2001 came to fruition as voting in the Commons (316 160) and the Lords (63 37) .gave him the go ahead to downgrade cannabis from Class B to Class C next 29th January. The change means that cannabis remains illegal, a position Government have strongly affirmed, but simple possession of small quantities is less likely to provoke arrest, unless the possessor provokes it in some way. Dealer penalties have been adjusted back up to their former Class B levels.

There was no such thing as a free vote in the Commons. Debate time was severely limited, three line whips shepherded government MPs into the correct division ,lobby, and for all the serious concerns expressed on both sides of the house, Mr Blunkett got what he wanted. Quite why he wanted it is open to conjecture; even his own party member, Kate Hoey, asked “Why are we doing this now?” and fingered the now notorious “Lambeth Experiment” in which an autonomous try at decriminalising cannabis took place, as “doomed to success from the beginning, because the Home Office had decided it would be successful whatever the outcome”.

However much he may have wanted it, it seems that the Home Secretary didn’t want the flak that went with it. As Blunkett went AWOL, his opposite number Oliver Letwin remarked that the Home Secretary was “seeking spurious, short term popularity … that is not a responsible way to conduct the government of this .country … we should consider the fate of our young people”. Blunkett’s substitute, Carolinr Flint, was less than impressive as far as Letwin was concerned; he described her as being “… all over the place” and dismissed as derisory her claim that reclassification would “assist in educating young people about the dangers of drugs” and “preventing drug misuse”.

The Government argued, somewhat dyslexically, that the change for cannabis from Class B was necessary in order to differentiate it from drugs in Class A. Lord Williamson found this logic less than convincing, saying that he had learnt the difference on his first day in school. Some Westminster watchers have suggested Blunkett   at least initially   thought a concession on cannabis would silence the drug lobby. Some hopes. Taking a more disturbing line, in the Lords debate, Baroness Howells wondered if it was all a plot to legalise it and boost tax revenue. Lord Mancroft saw no harm in this, having argued the principle these many years.

Government argued its case by dismissing all the advances in knowledge made by DWI and others in recent years. There would he no increase in use from this relaxation in the law; there is no Gateway effect with cannabis; THC levels have not increased significantly; criminalisation and prison should not follow a mere joint.