Thursday, July 29, 2010

Suicides, Violence and Drug Abuse Mark the Strains of an Endless War

St. Louis Post-Dispatch

On average, one U.S. soldier killed himself each day last month. That is the highest single-month suicide total reported by the U.S. Army since the Vietnam War ended more than 35 years ago.

It's also a symptom of a much larger problem.

The physical and emotional burden of fighting simultaneous wars in Iraq and Afghanistan has fallen disproportionately on too few American families. After nine years, the strain of near-constant deployment and redeployment is obvious.

Last year, for the first time in decades, the Army's suicide rate exceeded that of similar-age civilians. Six Missouri Army National Guard soldiers have committed suicide so far this year.

As for last month's toll, the 32 Army suicides mean that about as many U.S. soldiers died by their own hands as in combat in Afghanistan.

And that's only part of the story.

The grim statistics don't count veterans who already have returned home and separated from the service. Nor do they count Marines, sailors or airmen.

In 2008, an influential RAND Corp. report estimated that at least 300,000 troops returning from Iraq and Afghanistan suffer from post-traumatic stress or major depression. That's roughly one in every five. People with such illnesses are at increased risk of suicide or violent behavior.

Military officials also are reporting high rates of alcohol and drug abuse. Divorce rates are up. So are rates of domestic violence and crime.

All of this has occurred even as the military has made a major effort to increase counseling for returning troops and to address the psychological needs of combat veterans.

But warrior culture, military culture, does not lend itself to such things.

The ideal is, and always will be, the tough soldier who ignores physical and emotional injuries as he presses ahead with his mission.

Faced with an entrenched enemy, military commanders of the 18th century often recruited what was called a "forlorn hope" to lead the assault. Think of it as a suicide squad.

The members of the squad went in first, fighting until victory was achieved or reinforcements arrived.

When you think about it, that's a little like how the all-volunteer military works. Except that instead of sending them once into the breech, we've sent them three and four and five and six times.

Now we must be the reinforcements.

U.S. Sen. Claire McCaskill, D-Mo., a member of the Armed Services Committee, wants to allow service members to receive confidential counseling. That's an important step that would allow some troubled service members to talk about their problems without sacrificing their careers.

Ms. McCaskill also is supporting legislation that would allow therapists to be embedded with National Guard units so that they would be available to anyone who needs help in the combat zone.

The military and the VA are facing shortages of psychiatrists and therapists, but so are civilian health care providers. Those shortages must be addressed as part of a national physician work force development policy.

But that's going to take time; the problem for returning service men and women is acute now. All indications are that it will remain acute for the foreseeable future - long after the shooting stops in Iraq and Afghanistan.

We sent those young people into harm's way. We have a moral obligation to address the physical and mental problems their service created.

Tuesday, July 20, 2010

Protein Regulator Shows Promise Against Addiction

US News & World Report

Little things can make a big difference in the brain. Case in point: A tiny snippet of RNA may help guard cocaine-using rats against addiction to the drug, a new study shows.

The minuscule molecular guard is a hairpin-shaped piece of RNA known as a microRNA. Raising levels of a microRNA called miR-212 in the brains of cocaine-using rats led the animals to take less of the drug than rats with normal microRNA levels, researchers report in the July 8 Nature. Similarly, blocking the microRNA’s action increased the rats’ cocaine use.

If the results hold true in people, researchers may be able to develop new therapies for treating addiction to cocaine and other drugs of abuse. “Once you get out of whack, this is something that might help bring you back,” says Yale neuroscientist Marina Picciotto, who was not involved in the study.

It’s unlikely that the research will lead to gene therapy to raise levels of microRNAs in people’s brains. But small-molecule drugs that mimic the microRNA’s action might be helpful.

Just 21 to 23 RNA units long, microRNAs are major regulatory molecules that govern part of the process by which instructions contained in DNA are transformed into proteins. The molecules generally block protein production. So it was a surprise to find levels of a protein called CREB increase with rising levels of miR-212, says Paul Kenny, a neuroscientist at the Scripps Research Institute in Jupiter, Fla.

CREB has been found to help fight addiction by decreasing the rewarding experience of taking cocaine, sometimes to the point that rats actually develop an aversion to the drug. It took Kenny and his colleagues years to work out exactly how cocaine use boosts miR-212 production and how the microRNA, in turn, increases production of CREB protein. The process involves several steps and intermediate proteins, including a protein called Raf1 that had never before been shown to be involved in the response to drugs.

The miR-212 microRNA blocks an inhibitor of Raf1 in the striatum, a part of the brain involved in learning habits like driving a car and learning to avoid making the same mistake twice. With its inhibitor in check, Raf1 is free to stimulate CREB production, Kenny and his colleagues show in the new study.

Protecting against cocaine addiction may be a side benefit of mir-212’s normal job of regulating CREB production and other biochemical processes in the brain, Kenny says. The microRNA helps set the correct level of CREB production to keep it from getting too low, which leads to addiction and anxiety, or too high, which leads to depression.

Any therapy targeting CREB would have to strike this delicate balance as well, he says. “Obviously there could be some very profound side effects,” Kenny says.

The researchers are investigating how mir-212 is regulated and whether it is protective against other drugs, such as nicotine and alcohol addiction.

Wednesday, July 7, 2010

Pat O'Brien to Address Alcoholism and "Unfortunate Scandal" in Memoir

Seattle Post

Former Access Hollywood and The Insider anchor Pat O'Brien intends to write a tell-all detailing his struggle with alcohol addiction and his "unfortunate scandal," in which he left slurred sexually graphic voicemail messages on a woman's phone, he tells the New York Post.

O'Brien, who will co-write the memoir — tentatively titled I Love Your Work — with biographer Andrew Morton, will also address his 2004 divorce from his wife, Linda, which occurred a year before his voicemails leaked.

In the voicemails, O'Brien asked an unidentified woman to join him for drugs and sex. He subsequently entered drug rehab before returning to The Insider. He did another stint in rehab in March 2008 and six months later was fired from The Insider after writing e-mails to co-workers that insulted co-host Lara Spencer.

"I was not in total recovery or in alcoholics anonymous at the time. I was still messed up," O'Brien, 62, told the Post's Page Six.

O'Brien, who says he's been sober for more than 600 days, is considering a multiyear radio deal.

I Love Your Work is scheduled to hit shelves from St. Martin's Press in fall 2011.

Thursday, July 1, 2010

Teen Girls Becoming More Open to Drugs, Alcohol

Business Week

American teenage girls may be more receptive to using alcohol and taking drugs than in years past, a new report says.

Girls appear more inclined than ever to reach for drugs and booze to help them emotionally, according to a survey by the nonprofit Partnership for a Drug Free America. For example, the 2009 survey of high school students found 53 percent of girls agreeing with the notion that drugs "help you forget your troubles," up from 48 percent in 2008.

The survey, which examines changes in substance use and attitudes, found the use of alcohol and marijuana jumped considerably more among girls than boys between 2008-2009.

Also, fewer teen girls than a year earlier frowned on illegal drug use by their friends, and fewer considered the "party" drug ecstasy addictive, the study found.

"There's been a change in the culture," said Dr. Marc Galanter, director of the division of alcoholism and drug abuse at the New York University's Langone Medical Center in New York City. He was not involved with the study.

"Women previously had more constrained roles in terms of the propriety of indulging in behaviors such as public intoxication and the like. Now with women in the workforce and becoming more liberated, they are not so constrained," he said.

According to the research, supported by the MetLife Foundation, use of alcohol by girls increased 11 percent but not significantly among boys. However, while more girls (59 percent) than boys (52 percent) drink alcohol, boys still use more illegal drugs than girls do.

Among the nearly 3,300 teens from private, public and parochial high schools included in the survey, 81 percent of girls reported seeing drugs as a way to handle school stress, versus 75 percent of boys.

"It's really another sign of a changing landscape in America," said Steve Pasierb, the Partnership's president and CEO. "Drug use has become tactical ... kids say 'I'm doing this to manage my life, to escape the pressures in school, to deal with stress.'"

The study cited previous research finding three times as many girls as boys reporting depression in 2008. Parents should be especially attentive to their daughters' moods and worries, Pasierb said.

The changes occurring now may "have a big impact on strategies and prevention efforts that will need to be taken," Galanter added.

Pasierb believes that drug use is rising, in part, because schools have fallen down on drug education as a result of budget cuts and a focus on testing.

Also, he said parents have not been keeping up with shifts in teens' attitudes.

Many parents may view things through the memories of their own youth when teens experimented with drugs, "maybe got drunk on occasion, but basically grew up and turned out okay," said Pasierb.

Today's teens who end up in drug and alcohol rehab centers are not just the slacker teens, but also the "over-programmed teens -- straight-A students who are driven," said Pasierb. This highly motivated group says, "I'm going to get into Yale, but I'm going to need a little Ritalin, and maybe get drunk once in awhile," he noted.

Drug use now stems more from a pursuit of life-management strategies rather than the rebelliousness of the past, he added.

Prescription drug abuse is also a serious problem, Pasierb said. One out of five teens admits using prescription drugs not prescribed for them, with the family medical cabinet the most likely source, he added.

According to the research, use of the drug ecstasy rose for both boys (7 to 11 percent) and girls (5 to 8 percent. Recreational use was cited by 41 percent of boys, compared to 32 percent of girls.

Marijuana use increased during the same period for boys (34 to 39 percent) and for girls (28 to 36 percent).

The percentage of girls who thought ecstasy was addictive declined from 82 to 77 percent compared with a 2 percent decline in boys (70 to 68 percent).

Only 33 percent of teen girls said they don't want to hang around drug users - a drop from 38 percent in 2008.

To head off drug abuse, Galanter said parents need to foster an "open relationship with their kids, to talk with them and find out what they're doing" because kids whose parents talk to them about drug use are more likely to resist it.

For parents reluctant to discuss the issue, the Partnership's Web site offers tools and information to help parents talk to their teens, said Pasierb.

He offered this advice to parents: "Don't write it (drug use) off as a youthful indiscretion. We know that parents can have a big impact and that the earlier the intervention, the better the results."