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HOPE FOR The Future How alcohol affects epigenetics

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It’s in the Genes Researchers Probe Alcohol’s Effect on Epigenetics

As scientists gain a better understanding of the human genome, one rapidly emerging area of research is the effect of alcohol on epigenetics – external modifications to DNA that turn genes “on” or “off.” Epigenetic changes alter the physical structure of DNA. One example of an epigenetic change is DNA methylation — the addition of a methyl group, or a “chemical cap,” to part of the DNA molecule, which prevents certain genes from being expressed. A recent article in the National Institute on Alcohol Abuse and Alcoholism’s Alcohol Alert reports on a growing body of research showing how alcohol’s influence on epigenetics may be associated with an array of illnesses and disorders. These include fetal alcohol spectrum disorders (FASD), cancer, liver disease and other gastrointestinal disorders, brain development, the body’s internal clock, and immune function. Researchers and clinicians are beginning to explore therapies that might be developed to target the changes occurring through epigenetics. How alcohol affects epigenetics Alcohol consumption leads to

oxygen species (ROS), which are chemically reactive molecules that at high levels can damage cells. Fetal alcohol spectrum disorders Women who drink during pregnancy put their developing fetuses at serious risk for a range of conditions collectively known as FASD. In exploring how epigenetics contributes to FASD, researchers have also begun to investigate two complex enzymes that play a crucial role in cell differentiation during fetal development. One, called polycomb protein, remodels chromatin to turn genes off; the other, called trithorax protein, remodels chromatin to turn genes on. Research suggests that exposure to alcohol may

chemical changes within the body that can affect all the epigenetic mechanisms. For one, excessive alcohol consumption interferes with the body’s ability to process and access a chemical called folate. Folate is critical for methylation, a biochemical process that attaches a methyl group to a specific spot on DNA. DNA methylation acts to lock genes in the “off ” position. Chronic alcohol consumption leads to lower-than-normal methylation, or “hypomethylation.” Research also finds that alcohol metabolism leads to an increase in a substance called NADH, which is a byproduct of alcohol metabolism, and through production of reactive

Researchers and clinicians are beginning to explore therapies that might be developed to target the changes occurring through epigenetics due to alcohol use.

disrupt these two enzyme complexes, altering how cells differentiate during fetal development.

alcohol abuse and alcohol dependence, and may contribute to alcohol relapse and craving. Hope for the future As researchers begin to untangle the exact nature of alcohol’s interactions with epigenetics, they will be able to design better medications to treat or alleviate a wide range of alcohol-related disorders, including FASD, alcohol addiction, cancer and organ damage. In addition, researchers can now analyze DNA methylation patterns for the entire human genome. This work could yield comprehensive maps of DNA methylation changes in alcohol-associated cancers. Those maps then could potentially be used to develop pharmacological treatments that target epigenetic markers and develop new markers for cancer detection and prognosis. 

Liver disease and the gastrointestinal tract

Alcohol affects epigenetics on many levels within the GI tract and liver, where the majority of consumed alcohol is metabolized and cleared from the body. As alcohol enters the liver, it sets off what could be described as a cascade of epigenetic changes that increase the risk of liver disease, liver cancer and immunological problems. In addition, alcohol-associated epigenetic changes may play a role in what researchers call organ “cross- talk” between the GI tract, the liver and other organs. For one, epigenetic changes to genes involved in joining the cells lining the intestines may be partially responsible for “leaky gut,” which allows endotoxins to enter circulation and initiate liver damage. Alcohol-associated cancers As suggested above, alcohol-related changes involved in epigenetics can be linked to the development of liver cancer. In particular, research suggests that some epigenetic changes can transform normal liver cells back into stem cells, which then can develop into liver cancer. In addition, alcohol acts indirectly on a receptor that, when disrupted, is involved in the development of liver cancer. Alcohol’s role in changing DNA methylation patterns, leading to hypomethylation, may be one of the main routes between alcohol consumption and liver cancer as well as other types of alcohol-associated cancers. Changes in brain functioning Alcohol’s epigenetic effects within the brain are complex and intertwined. But increasing evidence suggests that they result in adaptations within the brain that ultimately influence addictive behaviors, including tolerance and alcohol dependence. As seen in other disorders, changes in DNA methylation are one of the epigenetic changes in the brain caused by chronic alcohol consumption. Although researchers still are piecing together the details, findings to date suggest that epigenetic changes in gene expression induced by alcohol consumption may underlie the brain pathology and adaptations in brain functioning associated with

As researchers begin to untangle the exact nature of alcohol’s interactions with epigenetics, they will be able to design better medications to treat or alleviate a wide range of alcohol-related disorders.

CENTRAL CITY INTEGRATED HEALTH

10 Peterboro St., Detroit, MI 48201-2722 Phone: 313.831.3160 www.centralcityhealth.com

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Our Mission Meeting Community Need The Midtown Detroit area is federally designated as a high poverty area within a city that has experienced severe economic stress for the past two decades.

The service area census tracts have a population of 13,422, with approximately 3,944 homeless individuals living in shelters, temporary housing, or on the streets. There are three homeless shelters located within the service area, along with 3,500 residents of public housing. Central City Integrated Health is on a main bus line and within walking distance of the majority of public housing units in Midtown and offers healthcare services which are easily accessible to this underserved community. Target Populations Our target popul tion are individuals whose income is less than 200% Federal Poverty Level, diagnosed with severe and persistent mental illness, living in public housing, the uninsured/underinsured, women, children, domestic violence victims, veterans, the homeless and other at-risk populations. Establishing a primary health care home for these target populations will reduce the strain on local hospital emergency departments, improve the management of chronic health conditions, and will have a positive impact on the health disparities caused by lack of access to appropriate health services. The most critical need for these special populations is expanded access to affordable primary care, behavioral health care, dental services, housing, employment, and support services–all services provided by Central City Integrated Health.

Our Values Central City Integrated Health is guided by a set of values in fulfilling its mission and vision. 1. An environment that supports health and recovery 2. An atmosphere of welcoming and accessibility to people seeking our services 3. An environment characterized by empowerment, openness, trust, teamwork, integrity and cultural sensitivity 4. An expectation that consumers and stakeholders are treated with dignity and respect 5. A commitment to service excellence and evidenced-based practices to improve the outcomes for those we serve and assure a skilled, professional staff 7. Persons served take both an active part in their treatment and the organization 8 Person-centered principles in the delivery of care continuous quality improvement 6. An environment that promotes

Providing Integrated Health Our facility has six exam rooms that support the integration of primary care, behavioral health care, and substance abuse treatment with the addition of patient education program. Patient monitoring and education focuses on improvements in individual and population health status. The health center monitors key clinical performance indicators, including cancer screenings, prenatal care for pregnant women, infant birth weights, pediatric immunizations, oral health, cardiovascular disease including hypertension, smoking cessation, diabetes and obesity, and depression, utilizing the benchmarks established for Healthy People 2020 and the Health Resources and Services Administration’s health disparity program to achieve the goals of improving the health status of the individuals. Our comprehensive Quality Assessment program that has been designed to insure ongoing evaluation and provide recommendations for service improvements.

Patient monitoring and education focuses on improvements in individual and population health status.

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Housing & Employment

Central City Integrated Health recognizes the importance of an individual having safe housing to overall health and well-being.There is no health without housing. Central City Integrated Health is also committed to providing consumers with the opportunity to obtain meaningful employment in the community. Employment is an essential element in the recovery model. CCIH provides assistance in finding and engaging in employment, educational programs, and volunteer opportunities

Due to the ongoing success of our housing programs, we were awarded an additional U.S. Department of Housing and Urban Development grant to expand our supported housing services to the homeless by another 50 units.The total funding received from HUD for our housing developments is $3.5 million and provides the community with 279 affordable housing units to homeless individuals with advanced needs. CCIH provides assistance with housing applications, move-in support, and eviction prevention Apartments renovation located in the heart of the Cass Corridor was completed.This $6.1M project created housing for veterans in Detroit and was led by Central educational programs. In March, the Charlotte

City Integrated Health and local developer Joseph Early.The unprecedented affordable housing development transformed a building built in the early 1920’s that was known to be a drug haven and hotbed for crime into twenty- seven stunning, state-of-the-art 750 sq. ft. one-bedroom units. CCIH is active in the lives of residents by providing tenant-based activities. Family housing developments have been provided with adult literacy training and tools to assist their children with studying for school. Summer activities have been organized to keep children engaged and to prevent summer learning loss. CCIH is also engaged as the lead service agency with 7 housing developments that have over 350 designated advanced need units.

Inner City Clubhouse Our psychosocial rehabilitation program, the Inner City Clubhouse, moved to its new site this summer.The socialization and pre-employment services are now located in a two-story building that gives consumers access to wellness activities, literacy classes, learning culinary skills in a professional kitchen, and the ability to develop computer skills.The clubhouse also encourages the consumers in advocacy which resulted in the Lieutenant Governor coming to the clubhouse to exchange ideas about the values of this consumer-focused program. Cozy Corners is a sundry store located at 640 Temple in Detroit and is a temporary employment program that is provided to the Inner City Clubhouse Members.The store sells beverages and snacks to the tenants and visitors in the building.The store requires a wide range of retail skills that include selling, stocking shelves, maintaining inventory, ordering, and price-setting. In addition, the consumers assume the responsibility of running the store with the assistance of a job coach.This is a transitional employment opportunity and individuals are provided with vocational skill building on a temporary, part-time basis. Overview of the Program • Eligibility is based on consumer choice. No CCIH consumer is excluded who wants to participate. • Competitive employment is the goal.The focus is community jobs that anyone can apply for that pay at least minimum wage, including part-time and full-time jobs. • Follow-along supports are continuous. Individualized supports to maintain employment continue as long as the consumer wants the assistance. • Consumer preferences are important. Choices and decisions about work and support are based on the person’s preferences, strengths, and experiences. Job search starts soon after a consumer expresses interest in working.

The socialization and pre-employment services are now located in a two-story building that gives consumers access to wellness activities, literacy classes, learning culinary skills in a professional kitchen, and the ability to develop computer skills.

I need... Medical Care Behavioral Health Housing Services Health Education Employment Re-entry Support

CENTRAL CITY INTEGRATED HEALTH

10 Peterboro St., Detroit, MI 48201-2722 Phone: 313.831.3160 www.centralcityhealth.com

CENTRAL CITY INTEGRATED HEALTH

10 Peterboro St., Detroit, MI 48201-2722 Phone: (313) 831.3160

Central City Integrated Health does not discriminate in the provision of services to individuals based on their inability to pay, race, color, sex, national origin, disability, religion or sexual orientation.

2017 Central City Integrated Health. c

Community Re-Entry Services Central City Integrated Health has a continued commitment to provide jail and prison diversion services. Our ongoing participation in theWayne County 3rd Circuit Court Mental Health Program, the State of Michigan pilot diversion program, has effectively provided resources for individuals to remain in the community.The recidivism rate of those who participate in our programs is below 10% compared to 30% in Detroit.

CCIH is committed to assisting returning citizens in successfully transitioning back into their communities. CCIH provides an array of services, including mental health care, substance disorder treatment, employment, housing services, and social services. Our programs not only significantly decrease the recidivism rates of the people we serve, but also assure that they are able to participate fully in the community. Referrals to our programs are frequently provided in collaboration with the criminal justice system and other community organizations.These partnerships increase the effectiveness of our services.

Our programs not only significantly decrease the recidivism rates of the people we serve, but also assure that they are able to participate fully in the community.

Programs and Services Mental Health Court— is a collaboration with Wayne County’s Third Circuit Court, the Detroit

Wayne Community Mental Health Authority, and the Wayne County Department Health.The consumers who chose to participate in the Mental Health Court are diverted from lengthy jail sentences.The services include intensive case management, psychiatric services, peer supports, health care coordination, and employment. CCIH works closely with court personnel to assure that individuals are provided with the assistance to become active participants in the community.

Criminal Justice Liaison Services— CCIH provides the linkage between Wayne County courts and jails for an individual to return to the community.The liaison works with the criminal justice system and community based programs to develop post-release services. Our work is supported by the Detroit Wayne Mental Health Authority. Our team is trained to work with individuals diagnosed with mental illness, developmental disabilities, and substance use disorders. Jail Diversion Services— CCIH is participating in a State of Michigan funded pilot to help develop successful diversion services. Often meeting candidates in the Wayne County jail system prior to release, the CCIH staff provides an intensive treatment program based on an Assertive Community Treatment model. We collaborate with the Wayne County Sheriff ’s Department to impact residents county-wide.

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Treating addiction with vaccines is a relatively new idea with many unanswered questions

ARE VACCINES THE ANSWER

that arise out of a lack of research. But a new study suggests vaccinating against illicit drugs is not only possible, it could be extremely effective. At the Scripps Research Institute in California, researchers were looking for a way to guard against the lethal and addictive effects of synthetic opioid “designer drugs.” A potentially deadly opioid, fentanyl, is often used as a heroin substitute or mix-in by drug dealers, so researchers developed a vaccine to try to mitigate its effects. Researchers injected mice with three rounds of the vaccine and then exposed them to doses of fentanyl. They found the vaccinated mice did not display any “high” behaviors even months after the last series of vaccine injections. Researchers say the immune systems of the mice developed antibodies that successfully blocked the drug from reaching the brain. “The results were the best we’ve ever seen for any drug vaccine,” says Paul Bremer, a graduate student at Scripps Research Institute who worked on the study.

A new

HAS BEEN SHOWN TO PREVENT OVERDOSES AND STOP OPIOID “DESIGNER DRUGS” FROM AFFECTING THE BRAIN vaccine

The results were the best we’ve ever seen for any drug vaccine. - Paul Bremer, Scripps Research Institute

“ WE WERE ABLE TO BLOCK EXTREMELY LARGE - Paul Bremer DOSES OF FENTANYL TO PROTECT AGAINST OVERDOSES

SAFE AND POWERFUL Not only was the vaccine able to stop intoxication (something researchers suggest could aid in opioid addiction treatment), the vaccine also proved extremely effective in blocking the potentially lethal effects of fentanyl as well. While the chemical is not necessarily toxic in itself, it does produce psychoactive effects that can shut down breathing and stop a person’s heart. Researchers say mice injected with the vaccine could withstand doses of fentanyl up to 30 times the normal rate. “It was just a rst generation vaccine, but it did prove to be very potent,” Bremer says. “We were able to block extremely large doses of fentanyl to protect against overdoses.” A SINGLE PURPOSE Researchers say the vaccine would not protect against heroin or oxycodone, and a mixture of vaccines would be needed to protect against all opioids. But that was somewhat by design. To make sure the vaccine would not interfere with any medications a person may take responsibly later in life, researchers targeted specic molecules so the vaccine would only block fentanyl and its derivatives.

“For unrelated drugs that you would be taking, there would be no effect from the vaccine,” Bremer says. LOOKING TOWARD THE FUTURE Although still in the early stages of development, researchers say the vaccine represents an exciting step forward in drug vaccine research. The lab is beginning more advanced trials on a similar heroin vaccine which should give them a better idea of how successful the fentanyl vaccine could become. But until more testing can be completed, researchers say they were pleased with the progress and excited for the future of vaccines in the treatment of addiction. “This concept of using a vaccine for addiction isn’t just an academic pursuit, it could really be used in practice,” Bremer says. “I think it’s really promising.”

OUR MISSION IS TO ACHIEVE WELLNESS IN THE COMMUNITY BY PROVIDING AN INTEGRATED ARRAY OF BEHAVIORAL AND PHYSICAL HEALTH CARE WITH THE UTMOST DIGNITY AND RESPECT.

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PH: 313.831.3160 GET INVOLVED 10 PETERBORO ST., DETROIT, MI 48201-2722

CENTRAL CITY INTEGRATED HEALTH

CENTRAL CITY INTEGRATED HEALTH

WE ARE HERE TO HELP REMOVE BARRIERS TO CARE CCIH believes in the basic principles of recovery and providing an open door. We offer primary and mental health services to individuals with evidence-based resources to regain a meaningful life that goes beyond reduction and remission of symptoms. Recovery for those with mental health is defined as a process, vision, and guiding principle, but in order to recover, individuals need hope and resources. Through our range of programs, we assist people with tools they need to maintain a meaningful life, despite physical health and mental health challenges.

10 PETERBORO ST., DETROIT, MI 48201-2722 PH: 313.831.3160 WWW.CENTRALCITYHEALTH.COM GET INVOLVED

CENTRAL CITY INTEGRATED HEALTH

Complete health care for the entire family including:

Health screenings, well-child visits, and physicals Care for diabetes, asthma, blood pressure, and cholesterol OB/GYN, pediatric & adolescent medicine, internal & geriatric medicine, and HIV/AIDS care Quick access to lab and x-ray services (urinalysis, blood glucose, and pregnancy testing)

10 Peterboro St., Detroit, MI 48201-2722 Phone: 313.831.3160 www.centralcityhealth.com

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