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PROTOTYPE ISSUE FIGHTING FOR THE BRAIN DISEASE MODEL Better Alternatives

ESCALATION Preventing Study finds alcohol changes the brain from the very first drink

& the RESULTS OF THIS NEW TREATMENT NEW VACCINE PREVENTS NEWSFLASH OVERDOSE

HOPE FOR The Future How alcohol affects epigenetics

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Better Alternatives Compassionate & Discreet Alcohol & Drug Counseling

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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.”

Better Alternatives Compassionate & Discreet Alcohol & Drug Counseling

Area's of Specialty • Substance Abuse • Alcohol Addiction Program • Relapse Prevention • Drug Addiction Program • Prescription– Synthetic • Opioid • Illegal Drugs • Dual-Diagnosis • Depression/ Stress Reduction • Post-traumatic Disorder • Impulse Control • Anger Management

Where you can have a voice in the national discussion on addiction and recovery

“I go to Better Alternative Counseling to help me work through the reality of me being disabled. They are wonderful! Leslie has helped me accept my limitations and gure out how to live my life now. She helped me to nd purpose in my life and to feel useful again. They are not just for drug rehabilitation. They help you deal with life. I recommend them. And am proud to tell everyone that they will help.” “I’ve been going for close to 2 years. And in the time I’ve been going, I have learned a lot about myself and what drugs and alcohol can do to you and not only that they have given me the tools to deal with my PTSD and my bipolar disorder. So much so that I want to be a CDAC counselor myself, and/or a peer support person. Someone that people can call afterhours when they need to get something off of their chest before they take that drink or that drug. Thank you Better Alternative Counseling for everything that you have done for me. I can't wait to help others like you have helped me.”

“I have tried several treatment programs in town, including group discussions. The group discussions here are the best. Leslie cares and is full of suggestions. She is working with me to stop relapses.”

“Simply the best. Very caring & knowledgeable staff that will do everything they can to help you. Call them today.”

This is my third time going receiving treatment at BA and after my assessment this time I remember Leslie telling me, "are you going to do it this time?" Those words are stuck with me and today I celebrate. 124 days clean and sober. In every group session we've had I've always felt comfortable and have been able to be open and honest. They are therapist that talk to you not at you. Better Alternatives has been a vital part of my recovery.”

I wouldn't normally write a recommendation. In fact I never have and will likely never write another, but Better Alternative Counseling isn't just any group. Between Jim, Leslie and the staff I didn't just nd help but also trustworthy condants. During a tough period in my life I found the help garnered by them to be invaluable. The connections I had with these people were as valid and ben- ecial as any I've ever known. I found incredible one on one interaction from people that genuinely cared. I can't say enough about this group.

Learning to Drink

Study finds alcohol changes the brain from the very first drink

“ Drugs of abuse basically hijack the normal learning and memory processes. ” - Dr. Dorit Ron University of California - San Francisco

Preventing escalation

The NIAAA-funded study did not establish a relationship between initial use and addiction, or even problematic drinking. But the hope is that further understanding of how alcohol affects the brain initially could lead to better treatment and prevention efforts down the road. “If we can control that step, we may be able to prevent further escalation,” Dr. Ron says. More research is needed to determine which other components of the brain are affected by initial alcohol exposure. Dr. Ron says she believes the changes that occur during first exposure could be reversed with prolonged abstinence from alcohol. But she said the more a person drinks, the harder it is to reverse those changes as the brain forms stronger connections to drinking.

One drink is all it takes. That’s what one research team found when studying how even the first exposure to alcohol can affect a person’s brain. A team from the University of California - San Francisco exposed mice to alcohol and then studied the synapses (connections) in their brains.The team found that even the first drink produced significant changes in the brain’s biological structure, calling the changes a “learning event.” “This is basically the first step,” says Dr. Dorit Ron, one of the chief researchers. “You are basically placing a memory trace.” Dr. Ron says the entire study was based on the idea that “addiction, and not just alcohol addiction, is thought to be a maladaptive form of learning and memory.” In essence, the study showed that first exposure to alcohol primes the brain for further use and lays the foundation for future “learning.” “Drugs of abuse basically hijack the normal learning and memory processes,” Dr. Ron says. “The behavior becomes habit.”

Predicting behavior

A new study also suggests that the earlier a person starts drinking, the stronger those connections may become. Researchers recently set out to identify which substance people use first in their lives and found the majority of people try alcohol before any other substance.The team also looked at how a person’s age when they start drinking affects substance use later in life. Researchers say the earlier someone starts drinking, the more likely they are to use more than one illicit substance, and they’re also more likely to develop an addiction. “It’s a very nice predictor for polysubstance use,” says Dr. Adam Barry, the study’s chief author. “The later you delay, the closer you are to 21, the less likely you are to be alcohol dependent or dependent on other substances.”

“ Alcohol consumption among youth doesn’t occur in a vacuum. ” - Dr. Adam Barry, Texas A&M University

 strategies that prevent drug use and then applying those in an alcohol setting.” Curbing use Researchers acknowledge there’s a difference between a first sip and a first binge drinking event. But they say age at first use of any kind is still a good predictor of behavior later in life. To combat problematic drinking, Dr. Barry says educators need to address all factors of a child’s life, not just the substance itself. In keeping with new guidelines from the National Institute on Drug Abuse, Dr. Barry and his team recommend beginning substance education as early as third grade. “Alcohol consumption among youth doesn’t occur in a vacuum,” Dr. Barry says. “It’s really just trying to find evidence-based

Better Alternatives Compassionate & Discreet Alcohol & Drug Counseling

Better Alternatives Compassionate & Discreet Alcohol & Drug Counseling

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.

Better Alternatives Compassionate & Discreet Alcohol & Drug Counseling

Better Alternatives Compassionate & Discreet Alcohol & Drug Counseling

“The concept of addiction as a disease of the brain challenges deeply ingrained values about self-determination and personal responsibility.” – Dr. Nora Volkow, Dr. George Koob, Dr. AThomas McLellan

Fighting for the Brain Disease Model Model can complicate messaging in treatment plans

Fighting public opinion can be an uphill battle, sometimes even a futile one. Despite years of progress and scientific advancements, researchers and treatment providers still find themselves having to convince the general public that substance use disorder is a disease. But it’s a message that can often complicate treatment plans as much as it seeks to inform.

Setting the Record Straight Earlier this year, three of the nation’s leading drug experts wrote a paper seeking to explain, once and for all, how substance use affects the brain in the same way as similar diseases. In an article published in the New England Journal of Medicine, NIDA Director Dr. Nora Volkow, NIAAA Director Dr. George Koob, and Treatment Research Institute founder Dr. AThomas McLellan say they hope to reaffirm the brain disease model while simultaneously addressing common misconceptions about addiction. “The concept of addiction as a disease of the brain challenges deeply ingrained values about self-determination and personal responsibility that frame drug use as a voluntary, hedonistic act,” the authors write. The authors argue that public skepticism about the brain disease model comes from researchers’ inability to articulately describe the relationship between changes in neurobiology and the behaviors associated with addiction. Although countless scientific studies have proven the brain disease model to be accurate and effective, the authors admit more work may be needed to change public perception. “A more comprehensive understanding of the brain disease model of addiction may help to moderate some of the moral judgment attached to addictive behaviors and foster more scientific and public health–oriented approaches to prevention and treatment,” the authors write.

“You have to emphasize the responsibility on the part of the person, but you also have to explain why the behaviors are happening.” – Bob Rohret, MARRCH executive director

 Scientific studies attest that a person’s brain chemistry can be altered as a result of addiction.This fact can provide a needed explanation as to why continued use can still be a problem for people who clearly desire to get clean. “When you start to apply an explanation of why certain behaviors occur,” Rohret says, “it provides people some comfort in understanding why they’re doing what they’re doing.” Mixed Messages But as confident as many in the medical community are about the nature of substance abuse disorder, the idea that addiction is a disease presents something of a double-edged sword for treatment providers. “The messaging has to be sort of finessed,” says Bob Rohret, executive director of the Minnesota Association of Resources for Recovery and Chemical Health (MARRCH). “You have to emphasize the responsibility on the part of the person, but you also have to explain why the behaviors are happening.” Rohret says treatment providers have to inform those in recovery about the nature of their disease, while also making sure knowledge of that disease doesn’t become a crutch or an excuse for inaction. When presented correctly, Rohret says patients should understand their addiction and responsibility toward it in much the same way someone with heart disease may understand their affliction. Although they cannot change the biological makeup of their body immediately, they can make behavioral changes and take actionable steps that lead to more positive outcomes.

Better Alternatives Compassionate & Discreet Alcohol & Drug Counseling

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