Biological Components Of Substance Abuse And Addiction .
-—Geneticswhy does one person become dependent on drugs whileanother, exposed to the same environment andexperiences, does not? As progress in understandingthe role of genetics in various conditions and diseasesincreases, there has been a realization that there is likely to be agenetic component to substance abuse and addiction. That is,inherited differences among individuals affect their response todrugs. To date, much of the work done in this field is related toalcoholism, less is known about the genetics of other drugs ofabuse.Studies in both humans and animals contribute to theunderstanding of genetic factors in substance abuse and dependence. Human studies shed light on the question of whether drugdependency is transmitted between generations. In addition, thestudy of individuals with substance abuse problems as well asanimal studies provide information about what is actuallyinherited. For example, are there genetic differences in sensitivity and responsiveness to drugs? And, if yes, are the differencesdrug-specific, or are they related to general mechanisms associated with the actions of all abused drugs? Finally, the tools ofmodern molecular biology can be used to identify the specificgenes that control various cellular and biochemical functionspossibly involved in an inherited component of substance abuseand addiction.While the existence of inherited differences seems likely, agenetic component alone probably is insufficient to precipitatesubstance abuse and addiction. Unlike disorders such as Huntington’s disease and cystic fibrosis, which result from thepresence of alterations in a single gene, substance abuse is likely394
40 Biological Components of Substance Abuse and Addictionto involve multiple genes that control variousaspects of the biological response to drugs. Inaddition, the complex nature of drug dependency,involving many behavioral and environmentalfactors, indicates that any genetic component actsin consort with other nongenetic risk factors tocontribute to the development of substance abuseand addiction. Thus, neither the presence norabsence of a genetic factor ensures developmentof, or protection from, drug addiction.DO INHERITED FACTORS EXIST?A number of confounding factors complicatesthe study of genetic transmission of substanceabuse liability in humans. One is the highincidence of psychiatric conditions among substance abusers (104), which raises questionsabout the role of psychiatric comorbidity inliability to illicit drug addiction. In particular,antisocial personality disorder (ASPD) is oftenassociated with substance abuse. One studyshows that 84 percent of individuals with ASPDalso have some form of substance abuse duringtheir lifetimes (104). Other psychiatric conditionsthat may be associated with substance abuse aredepression, anxiety disorders, manic-depression,and schizophrenia.Another issue related to studies of the geneticsof liability to abuse of specific drugs is that manydrug abusers engage in multiple drug use, so examining any familial trends in the use of a particulardrug becomes difficult. Finally, rates of illicitdrug use show strong secular trends. Even assuming a vulnerability to drug-specific addictions,there might be tremendous variations in expression of addiction, simply because of differencesin drug availability over time: No matter how vulnerable an individual might be, addiction requiresexposure. Such issues often hamper studies on thegenetic transmission of drug liability.I Family StudiesALCOHOLISMReferences to a familial tendency or hereditary‘‘taint’ of alcoholism date back to classical times(44); an observation repeatedly confirmed byfamily studies. While not all cases axe familial,the risk of alcoholism consistently has been foundto be higher among frost-degree relatives (i.e.,parents, siblings, children) of alcoholics as compared to the general population (79). Moreover,while family studies can establish that a disorder(or liability to a disorder) is transmitted; ingeneral, they are unable to distinguish betweenbiological and cultural transmission (though thisissue can be evaluated in large family studies byanalyzing multiple classes of relatives with differing degrees of genetic relatedness).Results of numerous family studies indicatethat alcoholism segregates within families, withmale first-degree relatives of alcoholics having ahigher incidence (ranging from 27 to 54 percent)than female first-degree relatives (6 to 17 percent)as compared to first-degree relatives of nonalcoholics (20 percent of males, 4 percent of females)(49,103,133). In fitting models of inheritance tofamily data, researchers concluded that observedpatterns of inheritance were consistent with thehypothesis that familial factors predisposing toalcoholism were the same in men and women, butthat nonfamilial environmental factors exertedmore influence in the development of alcoholismin women (20). Familial alcoholics (those with atleast one relative with alcoholism) appear to haveearlier onset, more antisocial symptoms, moresocial complications of alcohol use, and worsetreatment outcome than nonfamilial alcoholics(38,93,111).Familial is not identical to genetic, and in thecase of alcoholism, the familial patterns ofinheritance are not consistent with those of apurely genetic condition (58,109). In addition,evidence suggests that the transmissibility ofalcoholism has increased over time (102). Thus,any genetic factors promoting the development of
Chapter 4-Genetics 41alcoholism are significantly moderated by nongenetic influences.OTHER DRUGSFewer family studies have been conducted onthe genetic transmission of liability to other drugsof abuse. Nonetheless, the evidence availablesuggests that, as in the case of alcohol, addictionto other psychoactive substances appears to run infamilies.One study found evidence for familial aggregation of drug use, based on family history obtainedfrom individuals admitted for substance abusetreatment (78). However, this study also combined use of all illicit drugs into one category andrelied on self-reports by the subject on his or herdrug use as well as that of family members. In alarge family interview study comparing 201opiate addicts and 82 normal controls, as well asinterviews of 1,398 first-degree relatives of these‘subjects, the relatives of opiate users had elevatedrates of drug addiction as compared with thecontrols (105). In addition there was an association between opiate use and the presence ofASPD. Further analysis of these data revealedthat the incidence of both drug abuse and ASPDwas higher among the siblings of the opiatesubjects than among their parents (69,70).Some studies note a familial association between opiate addiction and alcoholism (65).However, another family history study (51),comparing families of 32 alcoholics, 72 opiateaddicts, and 42 individuals addicted to bothsubstances, found that while both opiate addictionand alcoholism clustered within families, cooccurrence of the disorders within families occurred no more frequently than expected bychance, thus supporting the hypothesis of independent transmission. However, a later study of201 opioid addicts and 877 of their first-degreerelatives also showed familial aggregation of bothalcoholism and depressive illness suggesting apossible co-occurence of the disorders (64).Little research has been done to test hypothesesregarding familial transmission of liability toaddiction to specific substances other than opiatesor alcohol. One study involving 350 treated drugabusers and 1,478 relatives, found that alcoholismwas equally common among relatives of individuals who preferentially abused opiates, cocaine,or sedative-hypnotics (27 percent, 31 percent, and24 percent of male relatives, respectively), whereasrelatives of sedative-hypnotic users were subjectto diagnoses of other substance abuses (2 percentof male relatives, versus 11 percent of malerelatives of opiate abusers and 16 percent of malerelatives of cocaine abusers) (80).I Twin and Adoption StudiesWhile family studies can establish that adisorder (or liability to a disorder) runs in afamily, they generally are unable to distinguishbetween biological and cultural transmission.However, two other methods are used to helpdisentangle the effects of genetic and nongeneticfactors. Adoption studies compare the presence ofa trait among biological versus adoptive familymembers or other control groups. In this wayindividuals that share the same environment butdifferent genetic heritages, or vice versa, can becompared. Twin studies, by contrast, involvesiblings raised in the same environment, butcompare how often identical twins, who aregenetically identical, and fraternal twins,1 whoare not, are similar, or concordant, for a trait. Ahigh concordance rate for a trait among identicaltwins versus fraternal twins usually indicates agenetic component for the trait.TWIN STUDIESEvidence fromn twin studies suggests geneticinfluences on drinking‘patterns as well as alcoholrelated problems. Results from twin studiesdemonstrate genetic influences on measures ofalcohol consumption such as abstention, average1 Fraternal twins share the same in utero environment but are genetically no more similar than any two siblings,
42 Biological Components of Substance Abuse and Addictionalcohol intake, and heavy alcohol use (50,60,92).Twin studies also indicate an inherited risk forsmoking (24).When evaluating how alcoholism develops,twin studies generally support the existence ofgenetic influences on the development of thedisorder. One study found a higher concordancerate for alcohol abuse between identical twins (54percent) versus fraternal twins (28 percent) (57),while two subsequent studies found no suchrelationship (48,92,). A 1991 study (94) examined50 male and 31 female identical twin pairs and 64male and 24 female fraternal twin pairs, with 1member of the pair meeting alcohol abuse ordependence criteria. The study found that identical male twins differed fromn fraternal male twinsin the frequencies of both alcohol abuse anddependence as well as other substance abuseand/or dependence. On the other hand, femaleidentical and fraternal twins were equally likely toabuse alcohol and/or become dependent on othersubstances, but identical female twins were morelikely to become alcohol dependent. Anotherstudy of 356 twin pairs also found higher identicalthan fraternal rates of concordance for problemsrelated to alcohol and drug use as well as conductdisorder (77). The same study also noted thatamong men, heritability was greater for earlyrather than late onset of alcohol problems, whereasno such effect was seen for women. Finally, astudy of 1,030 female twin pairs found evidencefor substantial heritability of liability to alcoholism, ranging from 50 to 60 percent (61).Thus, twin studies provide general agreementthat genetic factors influences certain aspects of. .drinking. Most twin studies also show geneticinfluence over pathological drinking,“includingthe diagnosis of alcoholism, which appears (likemany psychiatric disorders) to be moderatelyheritable. Whether genetic factors operate comparably in men and women, and whether severity ofalcoholism influences twin concordance is lessclear. How psychiatric comorbidity may affectheritability of alcoholism also remains to bestudied.ADOPTION STUDIESAdoption studies have supported the role ofheritable factors in risk for alcoholism (1 1,18,1 17).The results from a series of studies conducted inDenmark during the 1970s are typical. Of 5,483nonfamily adoption cases from the copenhagenarea between 1924 and 1947, the researchersstudied 55 male adoptees, and later compared 20adoptees with 30 nonadopted brothers. They alsostudied 49 female adoptees, comparing them with81 nonadopted daughters of alcoholics. Comparisons also were made with matched controladoptees. The Copenhagen study revealed thatadopted-away sons of alcoholic parents were fourtimes as likely as adopted-away sons of nonalcoholics to have developed alcoholism; evidencealso suggested that the alcoholism in these caseswas more severe. The groups differed little onother variables, including prevalence of otherpsychiatric illness or “heavy drinking.” Beingraised by an alcoholic biological parent did notfurther increase the likelihood of developingalcoholism. That is, rates of alcoholism did notdiffer between the adopted-away children andtheir nonadopted brothers. In contrast, daughtersof alcoholics were not at elevated risk of alcoholism. Among adoptees, 2 percent had alcoholism(and another 2 percent serious drinking problems), compared with 4 percent of alcoholismamong the adopted controls and 3 percent amongnonadopted daughters (44).Another analysis examined factors promotingdrug abuse as well as alcoholism (17). In thisstudy, all classes of illicit drug use were collapsedinto a single category of ‘‘drug abuse. ” Most ofthe 40 adopted drug abusers examined hadcoexisting ASPD and alcoholism; the presence ofASPD correlated highly with drug abuse. Amongthose without ASPD, a biological background ofalcoholism (i.e., alcoholism in a biological parent) was associated with drug abuse. Also,turmoil in the adoptive family (divorce or psychiatric disturbance) was also associated with increased odds for drug abuse in the adoptee.
Chapter 4-Genetics 43Finally, results from other adoption studiessuggest two possible forms of alcohol abuse(12,19). The two forms have been classified as“milieu-limited” or type 1 alcohol abuse and“male-limited” or type 2 alcohol abuse (21).Type 1 alcohol abuse characterized by mildalcohol problems and minimal criminal behaviorin the parents, is generally mild, but occasionallysevere, depending on presence of a provocativeenvironment. Type 2 is associated with severealcohol abuse and criminality in the biologicalfathers. In the adoptees, it was associated withrecurrent problems and appeared to be unaffectedby postnatal environment.I n summary, adoption studies of alcoholismclearly indicate the role of biological, presumablygenetic, factors in the genesis of alcoholism. Theydo not exclude, however, a possible role fornongenetic, environmental factors as well. Moreover, evidence suggests more than one kind ofbiological background conducive to alcoholism.In particular, one pattern of inheritance suggestsa relationship between parental antisocial behavior and alcoholism in the next generation. Thus,adoption studies, like other designs, suggest thateven at the genetic level, alcoholism is not ahomogeneous construct.WHAT IS INHERITED?Although studies indicate that genetics contributes to alcoholism and probably other drug abuse,they lack information about what exactly isinherited. For example, do individuals with afamily history of drug abuse have an increasedsusceptibility or sensitivity to the effects of drugswith reinforcing properties? If a susceptibilityexists, what are the biological mechanisms thatunderlie it? To understand what might be inherited, both individuals who have a substance abuseproblem and animals models of substance abuseare studied. Various types of information can bederived from these studies. As with family, twin,and adoption studies, much more information isavailable about alcoholism as compared withother drugs of abuse.First, specific inherited risk markers for alcoholism and other substance abuse can be identified. A risk marker is a biological trait orcharacteristic that is associated with a givencondition. Thus, if an individual is found to havean identified marker for substance abuse, he orshe is at risk for developing a drug dependency.To date, no biological characteristic has beenclearly identified as being a risk marker for eitheralcoholism or substance abuse, although evidencesuggests some possible candidates. The identifcation of a valid and reliable risk marker couldprovide important information about the fundamental mechanisms underlying substance abuseand addiction and would be an invaluable aid indiagnosis and treatment.Second, inherited differences in biochemical,physiological, and anatomical processes relatedto differences in drug responses might be identified and studied. Thorough biological assays canbe performed using animal models of substanceabuse. Animal models of substance abuse consistof strains of animals (usually rodents) that havebeen selectively bred to either exhibit a preference for taking a drug, exhibit a preference for nottaking a drug, or differ in some way in theirbehavioral or physiological response to a drug.Thus, such differences represent inherited traitsrelated to drug-taking behavior, and these animalscan be studied to dete rmine what biologicalmechanisms are involved in the expression ofsuch traits.Finally, the genetic technique of linkage analysis can narrow the area on a chromosome wherea gene may be located. It can lead to theidentification of the gene itself, which, in turn,can improve the understanding of the molecularevents that underlie the expression of the gene.There have been few genetic linkage studiesrelated to substance abuse since few specificbiological traits associated with drug dependencyhave been identified. Some studies in humanshave been carried out related to alcoholism but the
44 I Biological Components of Substance Abuse and Addictionfindings of these studies are contradictory andinconclusive (see later discussion).Specific Risk MarkersELECTROPHYSIOLOGICAL ACTIVITYAttempts to correlate distinctive patterns ofspontaneous electrical activity of the brain withalcoholism and substance abuse have been equivocal. A few studies have found distinctive electroencephalograph (EEG) patterns in individuals atrisk for alcoholism (32,39), but others have not(31,59,101). Similarly, the use of alcohol challenge (i.e., giving the subject alcohol and thenrecording EEG) on subjects at high risk foralcoholism has likewise yielded inconclusiveresults. The rationale for challenge studies restson the observation that alcohol has been shown toaffect resting EEG, and thus might have adifferential effect on those at low and high risk foralcoholism (100). Again, some studies have seendistinctive responses (100,101), while other havenot (39,59).A logical extension of studying resting EEGactivity is examining event-related potentials(ERPs). ERPs are patterns of brain electricalactivity produced in response to a particularstimulus (e.g., auditory, visual); they can reflecta variety of sensory and cognitive processes.Since ERPs may reflect heritable differences incognitive function or capability that may in turncontribute to liability to alcoholism, some havesuggested that ERP changes may allow discrimination between those at low and high genetic riskfor alcoholism. The results of these studies havealso been equivocal. Some have found characteristic responses among individuals at risk foralcoholism (3,4,33,52,53,89,90,125) while othershave not (95,96,97,98). In addition to beingequivocal, the specificity for alcoholism of suchfindings is unclear. In particular, it is not yetknown whether similar findings might be identified in subjects with (or at risk for) illicit drugabuse.Currently, both EEG and ERP findings seembest viewed as possible markers. Further studiesare needed to confirm or refute the positive resultsthat have been observed. In addition, while ERPfindings in particular might relate to aspects ofsensory, perceptual, or cognitive functioning thatmay differ among those at risk for alcoholism,how such differences contribute to risk foralcoholism and perhaps substance abuse is notwell understood.BIOCHEMICAL ASSAYSSerotonin—Results over the last two decadesfrom both human and animal studies have supported a relationship between low levels ofcentral nervous system (CNS) (i.e., brain andspinal cord) serotonin and impulsive and violentbehavior (130,131). Since problematic use ofalcohol (as well as other drugs) has long beenassociated with a wide range of violent behavior,scientists have examined the relationship between alcoholism and serotonergic abnormalities.While a consistent relationship between alcoholism and low CNS levels of serotonin and itsmetabolizes is lacking, mounting evidence supports the presence of such abnormalities in asubgroup of alcoholics with early-onset problemsand a history of violence (16,67,68,107,130).Because measures of serotonin activity aredifficult to obtain, researchers have used pharmacologic probes of serotonin function, such ashormonal response to drugs that affect serotonin.These indirect measures have also indicated arelationship between impulsivity, substance abuse,and abnormal serotonin function (37,42,71,83).For alcoholism, given that early-onset alcoholism and ASPD overlap substantially (16), thespecificity of the serotonin findings is unclear,especially as similar results have been found insubstance abusers with ASPD (71). However, atleast one report has indicated that, even aftercontrolling for the presence or absence of ASPDand illicit drug abuse, other neurochernical findings remained significantly associated with alcoholism (106). While further work might delineate
Chapter 4-Genetics 45the relationship between decreased CNS serotonin levels and Specific psychiatric syndromes,current evidence suggests relatively specific biological differences may exist between early- andlate-onset alcoholics; raising the possibility ofdefining biologically homogeneous subgroups.Aldehyde and alcohol dehydrogenase enzymes-Many Asians rapidly develop a prominent facial flush following ingestion of a smallamount of alcohol. Continued drinking leads tonausea, dizziness, palpitations, and faintness.This reaction is due to inactivity in individuals’aldehyde dehydrogenase, an enzyme that helpsmetabolize (i.e., break down) alcohol in the body.Ineffective enzyme activity results in a buildup ofthe chemical acetaldehyde in the blood followingalcohol consumption. Clinicians have taken advantage of the aversive properties of acetaldehydebuildup by using the drug Antabuse to inhibitaldehyde dehydrogenase, thus inducing a severeform of the adverse reaction in abstinent alcoholics who begin to drink (30,135).Alcohol dehydrogenase is another enzymeinvolved in the metabolism of alcohol. A mutantform of alcohol dehydrogenase also produces atransient increase in the acetaldehyde concentration after alcohol ingestion. This form of theenzyme also has been reported in Asian populations.The two enzymes, aldehyde and alcohol dehy drogenase, probably interact in some individualsto amplify the adverse reaction to alcohol consumption (129). Since this reaction discouragesheavy drinking,“the observation that it commonlyoccurs in some populations where alcoholism isrelatively rare suggests that alcohol and aldehydedehydrogenase mutations might be a major determinant of alcohol consumption, abuse, and dependence. This would seem to hold true forTaiwan and Japan where the reaction occurs in 30to 50 percent of individuals.The genetics of the aldehyde and alcoholdehydrogenases are well described. The production of the different forms of these enzymes iscaused by variations of their normal genes. Thepresence of these gene variations in an individualaccounts for variations in the metabolism ofalcohol (54). Thus, the presence of these genescan also effect alcohol consumption. For example, the gene variations that code for the ineffective form of aldehyde dehydrogenase is not onlyless common in alcoholics, but also is rare inJapanese patients with alcoholic liver disease(27, 121,135). Despite identification of such genes,the relationship between their inheritance and thefamilial transmission of alcoholism remains unstudied.Alcohol challenge-A number of studies havebeen conducted investigating the effect of administering alcohol to young adult sons of alcoholics(99). These studies indicate that, despite similarity of blood alcohol levels, sons of alcoholicsdemonstrate less intense subjective responses toalcohol, as well as less intense upper body sway(110,111,113,114). Thus, one mechanism bywhich alcoholism might develop is that sincethese individuals have less of a reaction toalcohol, they would find it more difilcult toself-regulate alcohol consumption, thus increasing the risk of developing dependence. In conjunction with these findings, other studies havefound that sons of alcoholics demonstrate slightlylower levels of certain hormones (i.e., prolactin,cortisol, adrenocorticotropin hormone (ACTH))after ingesting alcohol as compared to controls(82,1 14,115,116,1 18). The relationship, if any, ofthese decreased hormonal levels to alcohol consumption is unclear.COGNITIVE DIFFERENCESStudy of high-risk populations (e.g., sons ofalcoholics) has revealed temperamental, as wellas biological, differences between high-risk andcontrol subjects, leading to the suggestion thatvulnerability to alcoholism can be conceptualizedfrom a behavior-genetic perspective (127). Heritable, constitutional differences, in other words,might affect temperament and, hence, risk foralcoholism and addiction to other drugs. Inparticular, these differences might influence cog-
46 Biological Components of Substance Abuse and Addictionnitive styles, learning ability, and capability tocontrol one’s own behavior.In general, it appears that sons of alcoholicsdemonstrate group differences from low-riskpopulations in that the former tend to haveimpairment on tests of cognitive development,academic achievement, and neuropsychologicalfunction (34,12,8). However, the magnitude ofthese differences may depend greatly on how thepopulation is ascertained. To date, little is knownof what specific psychological, temperamental, orcognitive factors might distinguish between highrisk subjects who actually go on to developalcoholism from those who do not (128).I Biological Mechanisms.Animalsthat have been bred for specificcharacteristics are a valuable tool in drug use andabuse research. For example, certain strains ofrodents differ in their response to the analgesicand body temperature regulating effects of morphine, the motor activating effects of stimulantdrugs, and the convulsant producing properties ofbenzodiazepines (28,122). Since the essentialcharacteristic of human drug abuse and addictionis persistent drug-seeking behavior, the mostsalient models are those of genetic differences indrug self-administration and the factors associated with it (e.g., tolerance). While there are somegenetic models of self-administration or preference for different drugs (i.e., alcohol, opiates,cocaine) (28,41), more information is availableabout the hereditary biological mechanisms thatunderlie the self-administration of alcohol thanother drugs.ALCOHOLA general working hypothesis is that alcoholicsare sensitive to the low-dose rewarding propertiesof alcohol, are less sensitive to the high-doseactions of ethanol (i.e., have a higher aversivethreshold) and develop tolerance to the aversiveeffects of alcohol. The fact that rats can beselectively bred to have such alcohol drinkingcharacteristics supports a genetic link to thesetraits.Dopamine and alcohol intake-Studies ofdopamine content in the brains of two differentstrains of rats bred for either preference ornonpreference for alcohol have found 25 to 30percent lower levels of dopamine in the nucleusaccumbens and the olfactory tubercle of thealcohol-preferring rats (45,74,86). No other differences in dopamine content have been observedin other brain areas. These data suggest anabnormality in the dopamine system projectingfrom the ventral tegmental area to limbic regions(nucleus accumbens and/or olfactory tubercle) ofthe alcohol-preferring rats. Since this system isthought to be involved in mediating the actions ofvarious drugs of abuse (see ch. 2) and alcohol isthought to increase dopamine levels in the system(see ch. 3), it may indicate that an abnormalfunctioning of the mesocorticolimbic dopaminesystem might be involved in promoting highalcoholdrinking“behavior. That is, the alcoholpreference may be related to the ability of alcoholto compensate for the abnormality. The nature ofthis abnormality is unknown but may be due toone or more of the following factors: decreaseddopamine synthesis, a lower number of dopamineneurofibers, and/or reduced functional activity ofdopamine neurons.Some evidence exists that the mesocorticolimbic dopamine system may respond to systemicethanol administration to a greater degree in thealcohol-preferring strains than in the nonpreferring strains. Studies have found that levels ofdopamine metabolizes were higher in areas of thissystem (i.e., caudate nucleus, medial prefrontalcortex, and olfactory tubercle) after ingestion ofalcohol in alcohol-preferring rats as compared tononpreferring rats (35,36). Also, one study hasreported that the oral self-administration of alcohol, under experimental conditions where theanimal was allowed to receive alcohol as a rewardfor performing a task, increased the synapticlevels of dopamine significantly more in thenucleus accumbens of these alcohol-preferring
.--—.Chapter 4-Genetics 47rats than in nonpreferring rats (132). It was alsoestablished that the alcohol-preferring strain ofrats will self-administer alcohol directly into theventral tegmental area (73,74). These studiessuggest that the mesocorticolimbic dopaminesystem is involved in regulating alcohol drinkingbehavior and that alcohol may be a strongerpositive reinforcer in alcohol-preferring rats thanin the nonpreferring rats.Differences in dop amine receptor populationshave also been reported. Two genetically determined high-alcohol seeking lines of rats havebeen reported to have fewer of one type ofdopamine receptor (i.e., the D2 receptor) in theirlimbic system compared with the nonalcoholicrats (74,124), Twenty percent fewer D2 receptorswere observed in the olfactory tubercle andnucleus accumbens of these rats. These studies,along with ge
associated with substance abuse. One study shows that 84 percent of individuals with ASPD also have some form of substance abuse during their lifetimes (104). Other psychiatric conditions that may be associated with substance abuse are depression, anxiety disorders, manic-depression, and s
III. Statewide Trends in Substance Abuse Part 1: Demographics of People in Substance Abuse Treatment In fiscal year 2012, there were 105,189 total admissions to substance abuse treatment 81.2% of people in substance abuse treatment were white, and 7.1% were black, approximately reflecting the relative proportions of these races in the population.
The Case for a Coordinated Substance Abuse Prevention Plan This Substance Abuse Prevention Plan for Hancock County brings together an assessment of our current situation and proposes six major goals addressing a diverse range of concerns: Underage Drinking Illegal drug use High risk substance abuse Prescription Drug Abuse
Substance abuse is a long standing problem in child welfare (awareness could explain some increase) Child Welfare and Substance Abuse agencies generally don't work together Standardized screening indicates that 43% of the parents associated with a foster care placement meet criteria for substance abuse or substance dependence
Prevalence of Substance Misuse & Abuse (2011) 20.6 million persons ( 12 years) classified as 'substance dependence' or 'substance abuse' in past year (8% of population) 14.1 million - alcohol 3.9 million - illicit drugs . Substance Dependence or Abuse in the Past Year among
Center for Substance Abuse Treatment. Substance Abuse Treatment: Group Therapy. Treatment Improvement Protocol (TIP) Series, No. 41. HHS Publication No. (SMA) 15-3991. Rockville, MD: Substance Abuse
Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 2009. Originating Office . Office of Program Analysis and Coordination, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 20857 HHS
how a State's substance abuse prevention system is addressing State needs . This report is a summary of the most recent CSAP system review for New Jersey . The system review conducted on May 1-3, 2012, examined the progress of the New Jersey substance abuse prevention system and Synar program in improving the substance abuse indicators and
Albert Woodfox and Herman Wallace were convicted of the murder in 1972 of prison guard Brent Miller. They were placed in isolation together with a third man, Robert King, who was accused of a different crime. Robert King was released in 2001 after serving 29 years in solitary. Herman Wallace and Albert Woodfox remain in solitary confinement in .
