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Demystifying Relapse: 2-part series on substance use disorder recurrence and treatment
CARF International Senior Managing Director of Behavioral Health Michael Johnson is a contributor of this terrific two-part series on substance use relapse from the National Council for Mental Wellbeing. NATCON and partnering contributors from CARF International, National Association of Addiction Treatment Providers (NAATP), and the Recovery Research Institute are excited to release the Demystifying Relapse series, which includes two issue briefs that explore the complex dynamics of substance use disorder recurrence and the difficulty of reengaging individuals in the recovery process. “I’m grateful to the National Council for Mental Wellbeing for the opportunity to work with them on these two important documents. The U.S. is facing unprecedented challenges in treating persons with substance use disorders, with access to care continuing to be difficult for many. The field, the payers, and the public at large needs to take time to recalibrate how treatment and return to use are viewed in order to have realistic expectations for care, to destigmatize what it means for a person to return to use, and to ensure there is appropriate types of care available to those who need to re-enter the treatment systems,” said Senior Managing Director of Behavioral Health Michael Johnson. “Only when we recognize that persons who return to use need to have care that is individualized to assist them to stabilize, not start over, can we better ensure that treatment systems are more accessible based on the needs of persons served. The treatment for any chronic illness can be difficult as the path to wellness is often not linear. I hope these two papers can start a dialogue on how to reframe the systems to better meet the needs of those who continue with the recurrence of symptoms.” Michael Johnson is the CARF International Senior Managing Director of Behavioral Health. If you are looking to know more or connect with Michael, view his profile below to arrange an interview today.
Since 2022, the U.S. Food and Drug Administration has been actively urging consumers to avoid purchasing or consuming tianeptine -- a synthetic drug commonly called "gas station heroin" that can mimic the actions of opioids like fentanyl. Now, the FDA is upping the urgency of it's warnings as vendors continue to market the drug as a so-called "dietary supplement." UConn's C. Michael White, a Distinguished Professor of Pharmacy Practice, spoke with The Conversation about the problem with tianeptine in a must-read Q-and-A: What is tianeptine and why is it risky? Tianeptine stimulates the same receptors as well-known opioids such as fentanyl, heroin and morphine. When these drugs make their way from the blood to the brain, they bind to the “mu” type opioid receptor that triggers the sought-after pain relief and euphoria of those drugs as well as the dangerous effects like slowed or stopped breathing. High doses of tianeptine can bring euphoric effects similar to heroin and can also bring about the dissociative effect – the perception of your mind being disconnected from your surroundings and body – that is reminiscent of ketamine, an anesthetic that has a role in treating post-traumatic stress disorder and depression but has also commonly been abused as a street drug. Products containing tianeptine are often called “legal high drugs” – sometimes dubbed “gas station drugs” – a term used for all non-FDA-approved synthetic drugs that are sold casually in gas stations, online and elsewhere. What are the major adverse effects that people can experience? Data from clinical trials, case reports and poison control centers shows that tianeptine commonly induces agitation. This is typically accompanied by a fast heart rate and high blood pressure, confusion, nightmares, drowsiness, dry mouth and nausea, among other conditions. The most serious adverse events are slowed or stopped breathing, coma, heart arrhythmia and death. When long-term users try to stop tianeptine use, they often experience withdrawal symptoms reminiscent of opioid withdrawal. Consumers need to be aware that products containing tianeptine may not adhere to good manufacturing practices. This means they could contain lead or have other heavy metal contamination or be contaminated by microorganisms such as salmonella or mold. They could also contain other drug ingredients that are not disclosed. Knowingly or unknowingly combining active ingredients can increase the risk of adverse events. Additionally, the amount of the active ingredient contained in the product can vary widely, even with the same manufacturer. So past use does not guarantee that using the same amount will provide the same effect. How are these drugs sold in the US if they are not FDA-approved? If a drug product is not FDA-approved for prescription or over-the-counter-use, it is the Drug Enforcement Agency that is responsible for controlling market access. Before the DEA can ban an active ingredient in a drug product, it must be designated Schedule I, meaning the drug has no legitimate medical purpose and has high abuse potential. Manufacturers do not have to alert the DEA before selling their products to U.S. citizens. This means the DEA must detect an issue, identify the products causing the issue, identify the active ingredients in the product in question and do a full scientific review before designating it as Schedule I. Tianeptine came to market masquerading as a dietary supplement in gas stations and smoke shops, even though it is a synthetic compound. Tianeptine is also sold online allegedly for research purposes and not for human consumption. Tianeptine is undergoing clinical trials for the treatment of pain and depression, but sellers do nothing to make this type of labeling clear to consumers or to restrict purchases to researchers. What can people do to protect themselves and their families? Non-FDA-approved products containing synthetic drugs are very risky to use and should be avoided. FDA-approved drugs are available by a prescription from a health professional or over the counter with active ingredients on an approved list. If someone in a gas station, smoke shop or over the internet touts the benefits of a non-FDA-approved drug product – for pain or anxiety relief, to increase energy or for a buzz – be aware. It could be dangerous the first time you use it, but using it successfully once also doesn’t mean the experience will be the same the next time, and continued use can cause addiction. If a product is being sold “not for human consumption” or “for research purposes only,” you are at a high risk if you take it. Before you take any dietary supplement, make sure you check the active ingredient to be sure that it is, in fact, a natural product and not a synthetic chemical. If someone you know has bags with unmarked powder, a product labeled for research use or not for human consumption, or tablets or capsules not in standard drug bottles, that is a sign of a potentially dangerous situation. Standard drug tests sold over the counter are not designed to pick up tianeptine. One of the main reasons that people use these alternative substances of abuse over regular opioids, cannabis or amphetamines is that they are much harder to detect through work- or at-home drug screens by parents, schools, employers, probation officers and so on. If the DEA is not responding to emerging threats quickly enough, individual states can also act to ban sales of dangerous active ingredients in products. As of January 2024, at least 12 states have banned the sale of tianeptine, according to the FDA, although people in those states can still illegally procure it from the internet. So contacting your state legislators could be a place to start exercising your power to help prevent the harms from these products. This is an important piece, and if you are looking to know about tianeptine and the threat it poses to consumers in America, then let us help. Dr. C. Michael White is an expert in the areas of comparative effectiveness and preventing adverse events from drugs, devices, dietary supplements, and illicit substances. Dr. White is available to speak with media -- click on his icon now to arrange an interview today.
Peer Support Program Helps Patients With Substance Use Disorders
Recognizing that stigma may keep people from accessing treatment and recovery resources, ChristianaCare Union Hospital is partnering with the Cecil County Health Department and Voices of Hope to make peer recovery specialists available at the bedside for patients who have experienced a drug overdose or live with substance use disorder. Ten peer recovery specialists are available at Union Hospital seven days a week from 8:30 a.m. to 1 a.m. to talk with patients about behavioral health care navigation, access to treatment and referrals to harm-reduction and recovery-support resources. Patients can be connected with a certified peer recovery specialist if they are brought to the Emergency Department because of a drug overdose, or if they screen positive for substance use while they are a patient in the hospital. ChristianaCare Union Hospital is partnering with the Cecil County Health Department and the Maryland nonprofit Voices of Hope to make peer recovery specialists, pictured in blue t-shirts, available at the bedside for patients who have experienced a drug overdose or live with substance use disorder. Patients are not required to speak with a peer recovery specialist, but the specialists’ unique combination of lived experience and training to help people experiencing behavioral health issues offers an opportunity for people with substance use disorder to get help without fear of judgment or stigma. “Substance use disorder continues to be a serious health problem that affects people of all ages and walks of life,” said Lanre Akinkunmi, M.D., interim chief medical officer and medical director for population health at ChristianaCare Cecil County Campus. “The good news is that it is treatable, and when people are in the hospital or the emergency department, they are often most receptive to discussions about treatment. Through this expanded use of peer recovery specialists at Union Hospital, we are making a positive impact on the health of our patients and our community.” A voice of experience Peer recovery specialists who work on the weekdays are employed by the Cecil County Health Department, supported by a grant from the National Association of County and City Health Officials. Voices of Hope, a nonprofit focused on recovery support for people in Harford and Cecil counties in Maryland, employs the peer specialists working evenings and weekends. “This program is a great example of using resources wisely and effectively. We already know the tremendous work being done by Voices of Hope and Cecil County Health Department to help our neighbors who have been impacted by substance use disorder,” said Lisa Fields, manager of Community Engagement at the Cecil County Campus. “By partnering on this important program, we are building trust with our patients and helping them to get on the road to recovery.” Since the expanded program launched in September, there have been about 40 referrals for patients to speak with peer support specialists, and more than half of them have agreed to some kind of treatment, Fields said. Unique connection “Helping people get through what I went through really warms my heart,” said Hannah Dean, a peer recovery specialist with the Cecil County Health Department who works at Union Hospital. “I love what I do.” Cecil County’s death rate from drug overdoses is nearly twice as high as the rest of Maryland and more than three times the U.S. rate. The drug overdose death rate in Cecil County more than doubled between 2016 and 2020, according to the 2022 Cecil County Community Health Needs Assessment. Because peer support specialists have lived experience with substance use disorder and recovery, along with specialized training to support people struggling with mental health or substance use issues, they can connect with patients on a personal level and offer empathetic guidance, said Lauren Levy, health officer for the Cecil County Health Department. “Allowing peer recovery specialists to engage bedside with patients who may be struggling with substance use disorders will not only enhance access to behavioral health treatment but will also help reduce stigma surrounding substance use disorders and foster a more compassionate and supportive community,” Levy said. “We are honored to be a part of this innovative private-public collaboration and to work alongside ChristianaCare Union Hospital and Voices of Hope, Inc. This project helps to break down barriers to treatment and provide immediate support to those in need.” A history of support ChristianaCare has long been a pioneer in the use of peer recovery specialists, going back to the launch of Project Engage at ChristianaCare’s Wilmington Hospital in 2008. Union Hospital first partnered with the Cecil County Health Department 10 years ago to provide a peer recovery specialist in the Emergency Department. That program, the first of its kind in Maryland, was recognized with a best practice award from the Maryland Association of Counties in 2014. However, it operated only on weekdays during daytime business hours, and its ability to connect with hospital patients slowed during the COVID-19 pandemic. This reinvigorated peer recovery program is strengthened by the high level of collaboration among these Cecil County organizations, said Erin Wright, chief operations officer for Voices of Hope. “As community-based organizations, we are in a position to make a difference, and our perspective in the care for people with substance use disorder is really valuable,” said Wright, who has been in recovery for eight years. “As someone who has been through it, we are able to have that empathy. Even if the person does not want to go to treatment, you sit with them and maybe plant a seed.” Catharine Murray hopes her role as a certified peer recovery specialist can help someone struggling with addiction see recovery as a viable option for themselves. “This wasn’t available to me when I was trying to get better. I want to make it more accessible to others,” she said.
Deprivation in childhood linked to impulsive behaviour in adulthood – new study
Inflation is running high around the globe, largely fuelled by Russia’s war in Ukraine and the COVID pandemic. As a result, many households are having to choose between eating and heating. Deprivation has a terrible immediate effect on children – as anyone who has experienced real hunger knows – but it can also affect things like impulsive behaviour in later life. “Trait impulsivity”, the preference for immediate gratification, has been linked to spending more on food, especially unhealthy, highly calorific food. Studies have shown that children who experience poverty and food insecurity tend to have a higher body-mass index as adults than those who do not. In a study published in Scientific Reports earlier this year, my colleagues and I showed that children who experience deprivation make more impulsive choices than children who don’t. We studied 146 children, with an average age of eight, living in some of the most deprived areas of England and compared them with children living in some of the most affluent neighbourhoods. Children were given a choice between taking home a small amount of money (for example, £1) or getting £10 a week, or even more a year later. How long a person is willing to wait for the larger amount of money can be used to calculate a “discount rate” that shows how much the waiting time reduces the value of the money. An impulsive person might prefer £1 now because the value of £10 in six months is “discounted” to less than £1 right now. This means that, for them, the £10, is discounted by £9 over the six-month wait. A less impulsive person might be willing to wait six months for £10, but not wait for a whole year for £15. This means that, for them, the value of the £15 is discounted by £5 over the additional six-month wait. This discount rate is a measure of how impulsive someone is. The results showed that children living in the most deprived areas had significantly higher discount rates than children living in the least deprived areas, regardless of age or intelligence, indicating that deprivation was the causal factor in the children’s choice. A stable trait This preference for immediate outcomes is a stable personality trait that remains constant throughout a person’s life. In our most recent study, published by the Royal Society, we investigated impulsivity in over 1,000 older adults aged between 50 and 90. We found that older adults, living in the most deprived areas, show the same preference for smaller-sooner financial outcomes as the children in our first study. We also found that a person’s job predicted the choices they made. Adults working in technical or routine occupations, such as mechanics or cleaners, chose to receive smaller amounts of money than wait for larger amounts compared with people in professional occupations, such as engineers or scientists. These findings are concerning because impulsivity doesn’t just predict obesity. These findings tell us a lot about why people living in poorer areas tend to be unhealthier than people living in wealthy areas. People who experience deprivation as children are more likely to choose to do things that, although they might be pleasurable in the short term, are unhealthy in the long run. This includes overeating, taking drugs, smoking cigarettes and gambling. We know too, that impulsivity can help to explain why some people go on to become addicts, while other people can avoid some of the more harmful effects of drugs and alcohol. Deprivation is one of many factors that can lead to impulsive behaviour throughout a person’s lifetime. Genetics also plays a role in impulsivity. Policymakers can’t do anything about a person’s genes but they can influence the nation’s long-term mental and physical health by minimising child poverty. Failing to do so will have long-term implications for the children living through today’s cost of living crisis.
ChristianaCare is out to revolutionize health care. One of the country’s most dynamic health care systems, ChristianaCare is partnering with two leaders in medical and therapy services to provide comprehensive, integrated virtual health services 24/7 to colleges, universities and other institutions of higher education. Together with PursueCare and SimpleTherapy, ChristianaCare created a bundled health care product that combines general medical services from ChristianaCare’s Center for Virtual Health, mental health and addiction treatment programs from PursueCare and hyper-personalized musculoskeletal care from SimpleTherapy. ‘The future of health care is virtual’ “At ChristianaCare, we know that the future of health care is virtual,” said Sharon Anderson, MS, RN, FACHE, ChristianaCare’s chief virtual health officer and president of ChristianaCare’s Center for Virtual Health. “When college students are able to access medical, behavioral health and musculoskeletal services through their phone or laptop, from their dorm room or a private space on campus, they’ll be more likely to get help when they need it. This is about delivering care to students on their terms, so that they can be healthy and supported with high-quality care throughout their college experience.” Personalized virtual health solutions will be available to students at participating higher education institutions through a customized portal accessible from any computer or mobile device. Students will be able to access assessments, resources and virtual treatment via modules or telemedicine sessions with licensed providers. The offering provides students with unlimited, on-demand care from a multidisciplinary team solving for a multitude of conditions. “For college and university student health services and administrators, this partnership offers a powerful new way to provide comprehensive, affordable health solutions that benefit students,” Anderson said. “In a highly competitive recruiting environment, these solutions are easy to implement and can add tremendous value. We are excited to partner with colleges and universities to strengthen their student health programs by creating a comprehensive virtual care solution to meet their student’s health care needs.” Through a single digital portal, participating students can access internal and family medicine providers from ChristianaCare’s Center for Virtual Health. PursueCare’s Joint Commission-accredited mental health, psychiatric and medication-assisted treatment providers, and SimpleTherapy’s licensed physical therapists specializing in musculoskeletal care, acute or chronic pain management, and strength and mobility training can all be accessed through the portal. Students will also have the option of using PursueCareRx for their pharmacy needs. PursueCareRx is a competitively priced full-service pharmacy that accepts most major insurance and delivers directly to customers. “Young adults face an escalating mental health and substance use crisis,” said Nick Mercadante, founder, and CEO of PursueCare. “Colleges and universities are frequently unable to comprehensively serve the increased need, and research suggests substance use, mental health and suicide carry a significant social stigma. Our goal is to work collaboratively with campus health resources to bring a low-barrier solution students can access privately, any time, on their terms. Additionally, partnering with a world-class health system like ChristianaCare means we can help support whole-person care needs.” “Chronic musculoskeletal disorders have never been more prevalent and traditional care pathways are often ineffective and costly,” said Arpit Khemka, co-founder and CEO of SimpleTherapy. "SimpleTherapy removes barriers for students allowing them to take control of their musculoskeletal health, reducing their need for high-cost, high-risk services, such as surgery and opioids, to manage pain. This results in higher compliance rates and more successful outcomes." Customized and co-branded product The product is designed for colleges, universities and all other higher education institutions. For a flat fee, a school will be able to offer care that is customized and co-branded with school-specific content to be an extension of existing campus health services. It provides curated resources for rapid pre-assessment, on-demand chat and discreet, personalized access to care for students on or off-campus. The innovative patient portal aims to improve and strengthen how schools offer health care solutions to their student population while reducing any potential interruptions of academic and athletic pursuits by making it possible for students to conveniently access care from anywhere. In addition, the offering eliminates social stigma and other access obstacles for students who are at-risk or potentially at-risk, making it more likely that students will avail themselves of treatment options and remain in school. These services are currently licensed to operate in Delaware, New Jersey, Pennsylvania and Maryland. Applications for licenses are underway in other states. ChristianaCare has long been a trailblazer in virtual health. Among its achievements, during the COVID-19 pandemic, ChristianaCare developed a COVID-19 virtual monitoring program that helped 37 companies in 14 states safely reopen with daily symptom monitoring, testing and connections to care for more than 10,000 employees. It’s Center for Virtual Health makes receiving care radically convenient, offering a full continuum of virtual care delivery programs. These programs include virtual primary care, specialty care programs and a Hospital Care at Home Program bringing hospital level of care to a patient’s home. The Center for Virtual Health cares for thousands of patients using state-of-the-art virtual care capabilities supporting patients in receiving care anytime, anyplace, including in the comfort of their own homes. For more information about the program, visit StudentCareSolutions.com.
Addiction expert on FDA plan to lower nicotine levels
Erin Calipari, assistant professor of pharmacology, is available for media commentary on the Food and Drug Administration (FDA)'s plans for a proposed rule to require companies to lower the nicotine levels in cigarettes. Erin is lead researcher at the Vanderbilt Center for Addiction Research, and her research focuses on the neuroscience behind addiction. She can speak to how the brain gets addicted to substances and the many ways in which addiction takes a toll on the human body, as well as nicotine dosing. Much of Erin's research also focuses on gender differences in addiction and the need to understand female-specific factors that contribute to Substance Use Disorder.
Covering the music beat? Then tune in and get in touch with our resident hip-hop expert
Augusta University Professor Adam Diehl is an expert in hip-hop culture, lyrical analysis, rap as a form of literature and specifically, the works of Kendrick Lamar. Diehl gives an update on what's new in hip-hop and of course, answers questions about Lamar and his highly anticipated new album. How has the hip-hop music scene changed over the last 5 years? The hip-hop music scene has changed faster than any other genre the last five years. Whereas country still uses radio play and music videos to gauge success (along with album sales and streaming numbers) and rock uses touring to supplement and offset recording costs, pop and hip-hop have a great advantage in that they can raise people to stardom almost overnight. In fact, several of the biggest pop stars like Billie Eilish and Post Malone made their rapid ascents through the same channel many of the top hip-hop stars did: Soundcloud. Because this platform allowed new artists the chance to put their music alongside heavyweights, it democratized the listening process. What sent Soundcloud soaring? To put it succinctly, Soundcloud was the great reset of the hip-hop world. But when COVID hit and musicians couldn't tour for upwards of two years, the hip-hop community soared past country and rock (which they were already outselling pre-pandemic) because they didn't base their profit model on touring. Even pop stars were at a disadvantage, because the TV appearances and interviews they used to promote their new releases were few and far between for at least a year, and virtual events just couldn't replicate award show appearances and performances. Hip-hop, meanwhile, continued to be "Black America's CNN" and reported on the protests and outrage following the high-profile deaths of George Floyd and Breonna Taylor. The resurgence of Black Lives Matter brought mainstream media and cultural attention to the Black community, and as such the importance of hip-hop grew, just as it did in the wake of the Rodney King verdict and the deaths of Trayvon Martin, Michael Brown and Eric Garner. How has the economy of music changed? Most people under 20 don't own any CDs. What money these kids don't spend on music can now go to a modern cultural institution: the music festival. Increasingly, cities are hosting these previously camping-required concerts, which has been a particular advantage for hip-hop artists, who don't need roadies or sometimes even other people on stage. All they need is a setlist with six to 10 catchy songs, an entrancing light show, a DJ/engineer and a strong stage presence, and they can captivate the audience as easily as some of the all-time greats of any genre. Going forward, the music industry is going to be about return on investment. Instead of developing artists over a five-year period and then letting them blossom for two to three decades, they are looking for someone to explode in popularity instantly, stay in the spotlight and public consciousness consistently for three to five years, and then maybe stick around. TikTok is, in many ways, analogous to this career arc: the videos are short, the makers are -- to some extent -- largely forgettable, and the popularity relies heavily on a "hook." It's no surprise that hip-hop has been the most adopted genre by TikTokers: the genre has been more effective than any other in terms of codifying "catch phrases." And that's what TikTok is going for: something to hook viewers into watching more. Did the Super Bowl appearance by hip-hop artists take the genre to a whole new level as far as mainstream music? If the Super Bowl halftime show in 2022 did anything, it showed that rap and hip-hop are now as household friendly as rock, country and pop. Perhaps because so many best-selling rock acts had already played the halftime show, and perhaps because the pop acts of recent years had failed to maintain the public's attention, the 2022 halftime show featured one of hip-hop's founding fathers: Dr. Dre. His menagerie of artists' careers stretched over 30 years, and the time constraints of the show made hip-hop the ideal soundtrack. In a 13-minute set, six performers all got their moment in the California sun, and the mega-mix model so often used in clubs was perfect to segue from artist to artist. What 30 to 35 years ago was "Parental Advisory" is now the music that parents listen to. The target demo of the Super Bowl would've thought someone like Simon & Garfunkel or The Eagles much more risky picks than Dr. Dre & Co., even if their music was more family-friendly. Many casual music fans thought Kendrick Lamar was the head-scratcher because of his shorter tenure in the spotlight, but the younger generations watching were much more interested in what Kendrick did than "old heads" like Snoop Dogg and Mary J. Blige. Was this new album by Kendrick Lamar overdue? The new Kendrick Lamar album comes right on time: it is the definitive COVID album. If he had released in spring/summer 2020 when he originally intended (i.e. if the early March 2020 pgLang rollout was foreshadowing his record release), this would be a substantially different work of art. Instead, the project voices what so many people have endured in the pandemic: domestic turmoil. The tracks cover a vast array of topics -- from vaccinations to transgenderism to cancel culture -- but the unifying theme is therapy. As much emphasis as physical health got over the past two years, the pandemic was arguably just as bad if not worse for people's mental health. Accordingly, this album goes into dark valleys in Kendrick's and his family's trials and traumas: child abuse, sex addiction, separation/divorce, deaths, etc. In the two years that society has been persevering through the pandemic, countless marriages and millions of lives have been shaken to their cores. Listening to this double-album adds another tremor to our already-jostled souls. Tracks like "We Cry Together" capture the rapid-fire romantic arguments that can quickly escalate from disappointment to suicidal ideation, and "United in Grief" recreates the sense of a panic attack with its intensifying lyric delivery and drumbeats. Anxiety and depression are the recurring moods of this album, and the track list ranges in sonic textures -- from Lamar's tried-and-true vintage gangsta rap beats to the utterly unpredictable piano flourishes that come straight from a spoken word poetry reading -- to reflect the all-too-familiar combination of monotony and chaos that the world has undergone for the last two years. It is unforgettable -- just like COVID-19 -- but also, perhaps, something we'd rather not relive. Why do some consider Lamar the most influential rapper of our generation? Kendrick Lamar only has two real rivals for most influential rapper of the generation: Kanye West and Drake. Although Kanye is 10 years older, his career overlaps to a large degree with Kendrick's. Kanye's influence certainly comes more in the production of songs than in lyrical delivery, but his subject matter has been very contagious. Kendrick's mentioning of a Birkin bag in "N95" would never have happened if not for Kanye's lyrical (and career) forays into high fashion. Drake, on the other hand, is probably the rapper most influenced by Kanye...who went on to influence the most artists. Without Drake, many rappers wouldn't have had the blueprint for being singers as well as MCs. What Kendrick brings to the conversation is, in a way, more elusive; however, he without a doubt has raised the bar for lyrical delivery and flow, such that rappers have a better chance at success if they are comically basic than if they are merely competent. It's as if Kendrick took Eminem's velocity and used it to speak on bigger picture issues. Kendrick has also proven to be a fashion-forward rapper, collaborating with Reebok, Nike and Converse over the last few years. His influence might be most prominent in the "realness" of his lyrics: without Kendrick's "everyday life music," the emergence and popularization of "Soundcloud rap" might have been significantly limited. Instead, he uses Kodak Black -- one of the most successful of all Soundcloud-era rappers -- on Mr. Morale & the Big Steppers. If Kendrick isn't the most influential rapper of his generation, it's because his ambition and execution have placed him with the all-time greats, and oftentimes that puts artists at odds with their contemporaries. In 100 years, people won't remember some big acts because popularity wears off, but they will still celebrate Kendrick because his work is excellent. Looking to know more? Hit up Adam Diehl today -- simply click on his icon now to arrange an interview.
Flavoured vapes less harmful to young people than smoking, could help teen smokers quit
Flavoured vapes are much less harmful to young people than smoking, and could help teen smokers quit tobacco – according to new research from the University of East Anglia. A new study published today looks at young peoples’ use of vape flavours, reporting the views and experiences of more than 500,000 under 18s. It finds that flavours are an important aspect of vaping that young people enjoy, suggesting that flavoured products may help them switch away from harmful tobacco smoking. But the researchers warn that more needs to be done to make sure that youngsters who have never smoked are not attracted to vaping. Lead researcher, Prof Caitlin Notley, from UEA’s Norwich Medical School, said: “There has been a lot of concern that young people may start vaping because they are attracted to e-liquid flavours, and that it could potentially lead them to start smoking tobacco. “We wanted to find out more about the links between vape flavours, the uptake of vaping among young people, and whether it leads to regular vaping and, potentially, tobacco smoking.” The research team studied all available evidence (58 studies) on young peoples’ use of e-liquid flavours. Prof Notley said: “We found that flavoured e-liquids are an important aspect of vaping that young people enjoy. This suggests that flavoured products may encourage young people to switch away from harmful tobacco smoking towards less harmful vaping. “Flavours may be an important motivator for e-cigarette uptake – but we found no evidence that using flavoured e-liquids attracted young people to go on to take up tobacco smoking. “And we also found no adverse effects or harm caused by using liquid vape flavours. “However, there is also a need to monitor flavour use to ensure that young people who have never smoked are not attracted to taking up vaping. “Ensuring the continued availability of a range of e-liquid flavours is likely to be important in encouraging young people who smoke to switch to vaping as a less harmful alternative,” she added. The team found that the overall quality of the evidence on use of e-cigarette flavours by young people was low. In particular, many studies did not clearly define e-liquid flavours and could not therefore be included within the review. The study was led by UEA in collaboration with researchers at University College London, the University of Bristol and University Hospitals Bristol and Weston NHS Foundation Trust. ‘Youth Use of E-Liquid Flavours – A systematic review exploring patterns of use of e liquid flavours and associations with continued vaping, tobacco smoking uptake, or cessation’ is published in the journal Addiction on November 17, 2021.
Sugar: why some people experience side-effects when they quit
It might surprise you to learn that sugar consumption has actually been steadily decreasing since 2008. This could be happening for any number of reasons, including a shift in tastes and lifestyles, with the popularity of low-carbohydrate diets, like keto, increasing in the past decade. A greater understanding of the dangers of eating excess sugar on our health may also be driving this drop. Reducing sugar intake has clear health benefits, including reduced calorie intake, which can help with weight loss, and improved dental health. But people sometimes report side-effects when they try eating less sugar – including headaches, fatigue or mood changes, which are usually temporary. The reason for these side-effects is poorly understood. But it’s likely these symptoms relate to how the brain reacts when exposed to sugary foods – and the biology of “reward”. Carbohydrates come in several forms – including as sugars, which can naturally occur in many foods, such as fructose in fruits and lactose in milk. Table sugar – known as sucrose – is found in sugar cane and sugar beet, maple syrup and even honey. As mass production of food has become the norm, sucrose and other sugars are now added to foods to make them more palatable. Beyond the improved taste and “mouthfeel” of foods with high sugar content, sugar has profound biological effects in the brain. These effects are so significant it’s even led to a debate as to whether you can be “addicted” to sugar – though this is still being studied. Sucrose activates sweet taste receptors in the mouth which ultimately leads to the release of a chemical called dopamine in the brain. Dopamine is a neurotransmitter, meaning it’s a chemical that passes messages between nerves in the brain. When we’re exposed to a rewarding stimulus, the brain responds by releasing dopamine – which is why it’s often called the “reward” chemical. The rewarding effects of dopamine are largely seen in the part of the brain involved in pleasure and reward. Reward governs our behaviour – meaning we’re driven to repeat the behaviours which caused dopamine to be released in the first place. Dopamine can drive us to seek food (such as junk food). Experiments in both animals and people have shown how profoundly sugar activates these reward pathways. Intense sweetness surpasses even cocaine in terms of the internal reward it triggers. Interestingly, sugar is able to activate these reward pathways in the brain whether it’s tasted in the mouth or injected into the bloodstream, as shown in studies on mice. This means its effects are independent of the sweet taste. In rats, there’s strong evidence to suggest that sucrose consumption can actually change the structures in the brain that dopamine activates as well as altering emotional processing and modifying behaviour in both animals and humans. Quitting sugar It’s obvious that sugar can have a powerful effect on us. So that’s why it’s not surprising to see negative effects when we eat less sugar or remove it from our diet completely. It’s during this early “sugar withdrawal” stage that both mental and physical symptoms have been reported – including depression, anxiety, brain fog and cravings, alongside headaches, fatigue and dizziness. This means giving up sugar can feel unpleasant, both mentally and physically, which may make it difficult for some to stick with the diet change. The basis for these symptoms has not been extensively studied, but it’s likely they’re also linked to the reward pathways in the brain. Although the idea of “sugar addiction” is controversial, evidence in rats has shown that like other addictive substances, sugar is able to induce bingeing, craving and withdrawal anxiety. Other research in animals has demonstrated that the effects of sugar addiction, withdrawal and relapse are similar to those of drugs. But most of the research that exists in this area is on animals, so it’s currently difficult to say whether it’s the same for humans. The reward pathways in the human brain have remained unchanged by evolution – and it’s likely many other organisms have similar reward pathways in their brains. This means that the biological impacts of sugar withdrawal seen in animals are likely to occur to some degree in humans too because our brains have similar reward pathways. A change in the brain’s chemical balance is almost certainly behind the symptoms reported in humans who remove or reduce dietary sugar. As well as being involved in reward, dopamine also regulates hormonal control, nausea and vomiting and anxiety. As sugar is removed from the diet, the rapid reduction in dopamine’s effects in the brain would likely interfere in the normal function of many different brain pathways, explaining why people report these symptoms. Although research on sugar withdrawal in humans is limited, one study has provided evidence of withdrawal symptoms and increased sugar cravings after sugar was removed from the diets of overweight and obese adolescents. As with any dietary change, sticking to it is key. So if you want to reduce sugar from your diet long term, being able to get through the first few difficult weeks is crucial. It’s important to acknowledge, however, that sugar isn’t “bad” per se – but that it should be eaten in moderation alongside a healthy diet and exercise
Social Work is Advancing Addiction Science Research
Tens of thousands of Americans die from drug use and addiction every year, with overdoses killing over 63,000 people in America in 2016, according to the National Institute on Drug Abuse. Add in deaths linked to alcohol overuse and tobacco, and the number climbs above half a million Americans. The collective work of several researchers at the USC Suzanne Dworak-Peck School of Social Work, in collaboration with other USC faculty and outside organizations, is advancing knowledge of substance use disorders. Social work has become a hub where researchers and practitioners drive understanding and improve treatment for this disease that impacts millions of families each year. “Either as a cause or consequence, addiction relates to every problem we deal with in social work,” said John Clapp, professor and associate dean for research and faculty development at the USC Suzanne Dworak-Peck School of Social Work. Addiction’s complexity The social work field is uniquely poised to help effect change because of its holistic approach to individual well-being and the public good. According to Clapp, substance use disorder problems are inherently ecological, impacting and being impacted by individuals, families, peers, neighborhoods, communities and public policy in complex and dynamic ways. Untangling those causes and effects and interdependencies is one part of the solution. The other part is understanding that simple solutions may stay out of reach. “We will not find a one-size-fits-all answer,” said Clapp. Looking at addiction as a genetic, psychological or sociological issue only shows one piece of the overall cause. A comprehensive approach is essential, he said, especially when statistics from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) show alcohol use disorders alone as the third leading cause of preventable death in the world. A hub for addiction science The need for a transdisciplinary response to this worldwide crisis was behind the 2018 creation of the USC Institute on Addiction Science (IAS), a joint venture between social work and the Keck School of Medicine of USC, with membership from 10 different schools, colleges and hospitals. Its vision is to strengthen the discipline of addiction science and improve the lives of those touched by the disease. Clapp is co-director of the institute and one of its founding architects. IAS is quickly becoming the foremost place for a broad effort focused on addiction that brings together researchers from the fields of public health, social work, law, public policy, mathematicians, computer engineers and others in recognition of the promise of new approaches to longstanding problems. The USC Suzanne Dworak-Peck School of Social Work has eight faculty making substantial contributions to the prevention of addiction-related disorders as members of the IAS: Professor Avalardo Valdez, associate professors Julie Cederbaum and Alice Cepeda, and assistant professors Jordan Davis, Shannon Dunn, Jungeun Olivia Lee, Danielle Madden, and Hans Oh. “Social work brings one of the broadest perspectives on the underpinnings and solutions to the addiction crisis,” said Adam Leventhal, director of IAS and professor of preventive medicine and psychology at Keck. “By approaching addiction as a health condition and a social justice issue, social work brings to the table the opportunity for high-impact, multi-modal intervention and social policy approaches, which are needed to address the addiction epidemic.” A holistic approach Social work faculty are raising the bar in addiction science research, developing new and novel approaches to improving outcomes for those affected by addiction. In a study recently published in Addiction, a multidisciplinary team lead by Davis and Clapp found gender differences in the risk factors for relapse following treatment for opioid use disorder. The study was the first in this field to use machine learning techniques to process large data sets and identify risk factors for relapse, said Davis, who also serves as associate director of the USC Center for Artificial Intelligence in Society (CAIS). The findings may result in more personalized treatment for opioid use disorder with lasting results. This dovetails with additional research Davis is conducting with computer science engineers at CAIS to collect and input neighborhood and census data into their models in an effort to better understand how these macro variables affect relapse. “We are finding that data points such as crime statistics, population density and concentrated poverty tend to be some of the most important predictors of relapse, over and above individual-level predictors such as impulsivity, motivation or gender,” Davis said. These findings echo Clapp’s description of addiction as ecological and point to the need for holistic solutions. “These machine learning techniques are helping us gain an apparent picture of what the most important factors are surrounding someone’s recovery,” Davis said. “Environment matters greatly.” Davis is also collaborating closely with Eric Pedersen, associate professor at Keck School of Medicine at USC, on several research efforts examining substance use among veterans. Most recently, they have assembled a survey group of approximately 1,200 veterans whom they survey quarterly about their well-being. A recently conducted survey of the group found that veterans with PTSD prior to the COVID-19 pandemic were now managing their symptoms with more frequent alcohol and cannabis use. Another joint research endeavor between the two is examining the use of mindfulness smart phone apps to help reduce substance use in Operation Enduring Freedom/Operation Iraqi Freedom veterans with PTSD and alcohol use disorder. Where well-being and inequalities intersect Jungeun Olivia Lee also seeks to decode the network of relationships between socioeconomic status, adverse childhood experiences and drug use. Her experience as a social work practitioner working directly with clients drives her motivation to demonstrate to policymakers what she sees as a linkage between unemployment, economic stress and substance use disorders. She is lead author on a paper published in Nicotine & Tobacco Research that found unemployment may advance nicotine addiction among young adults, rather than the idea that nicotine addiction may lead to unemployment. Lee’s research interests lie at the intersection of substance use and co-occurring mental health, social inequalities (such as poverty and low socioeconomic status), and adverse childhood experiences. She is interested in combining these three areas of inquiry to explore their influence on addictive behavior that can persist over generations of at-risk families, such as adolescent mothers and their children. Her memories of working directly with clients struggling with the impact of addiction remain clear in her mind. When Lee hears policymakers and others suggest that individual willpower will solve substance use disorder problems, she has a straightforward response: “People are not born with addiction.” In her view, many factors contribute to the triggered distress, including socioeconomic status and adverse childhood experiences. Lee is exploring an idea with other IAS researchers to investigate the relationship between financial strain and employment uncertainty and addiction. “Individual circumstances, such as losing a job, certainly influence substance use, but policy-level decisions, such as the generosity of unemployment insurance, can mitigate the impact,” she said. Transdisciplinary collaboration with social scientists, psychologists and medical researchers at IAS and across the USC campus enriches and amplifies her work. “We are breaking down discipline-specific silos and bringing new and valuable perspectives to this work,” she said. “The synergy is both useful and inspiring.” Looking ahead Researchers also hope to spark interest in the field among the next generation. A new minor for undergraduate students in addiction science was introduced at USC in Fall 2020. The minor is an interdisciplinary collaboration of the Keck School of Medicine, the USC Suzanne Dworak-Peck School of Social Work, the USC School of Pharmacy and the USC Dornsife College of Letters, Arts, and Sciences. It is designed to provide students with a transdisciplinary approach to understanding and treatment of the broad spectrum of addiction-related problems. The goal of addiction science research and education is to improve the long-term effect of addiction treatment and save lives. As society’s understanding of the cause of addiction grows, researchers like those in the school of social work and the IAS strive to bridge the gap between science, practice and policy to positively impact outcomes for those affected by addiction.
