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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.

“At Jabez, I was able to reestablish the confidence

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Services Comprehensive Services for Complex People Particularly for people experiencing homelessness, substance use disorders cannot be treated apart from the concerns of the whole person in the context of their environment. • Intra-agency working relationships; both formal and informal linkages with external organizations such as shelters, clinics, state welfare agencies, legal aid, hospitals and the Department of Corrections. • Residential treatment for men. • Outpatient treatment for adult men and women 18 years of age or older.

Integrated Services Substance use treatment services for homeless people have been offered either in a sequential or a parallel manner. In a sequential approach, the client is treated for one problem first followed by another, often by different systems of care. For example, it is not uncommon for clients to be told they must receive treatment for their substance use disorder before they can be treated for their mental illness.The requirement for homeless people to go through substance use treatment in order to be “housing ready” is another example of providing services sequentially. In a parallel approach, the client receives services from two or more systems simultaneously, such as receiving medical care at one site, mental health services at another, and treatment for substance-related problems from yet another agency.The effectiveness with which these services are coordinated varies; when coordination is poor clients may receive confusing or even conflicting messages, or fail to have important issues addressed.

Housing is viewed as integral to effective treatment and consequently is given high priority early in the treatment process. • Services are physically co-located to the extent possible. • Individual team members understand and appreciate the perspectives brought by other disciplines and are involved in various levels of cross- training. Open and regular communication is valued; differences in opinion are encouraged. • Traditional hierarchical relationships among disciplines are diminished. At Jabez Recovery Management Services, services are provided through interdisciplinary teams that address consumers’ physical health, mental health, substance use, and social service needs concurrently.

To address the needs of homeless people, who often have co-occurring conditions, evidence from the field suggests that an integrated approach to treatment is the most beneficial for the client, wherein treatment for multiple concerns is provided concurrently in a well- coordinated manner. At Jabez Recovery Management Services, services are provided through interdisciplinary teams that address consumers’ physical health, mental health, substance use, and social service needs concurrently.

Client-centered Approaches All programs provided at Jabez Recovery Management Services utilize client-centered care regardless of the treatment setting, characteristics of the client population, or the program goals. Client-centered care, in general, refers to customized individual treatment that is based on the client’s needs, wishes, capacities, and timeframe rather than on the program’s pre-determined benchmarks for client outcomes. • Client-centered care defined; meeting the person where they’re at. • The client is actively involved in setting goals and planning his/her own treatment program. • Power differential between provider and client is minimized. • Primary role of the provider is to listen carefully, help the client to identify achievable goals, and facilitate incremental steps that the client wants and is ready to take. • The client is regarded as the expert on the client.

We provide addiction counselling services to the dually-diagnosed individual that is also suffering from a mental illness. Our services are conducted in an outpatient and/or residential setting. WhatWe Do

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Core Values & Goals To fulfill Jabez Recovery Management Services’ mission and vision, we adhere to these core values: • Offering understanding and hope in a welcoming environment. To deliver the highest quality services that respect the dignity of each person served: employees, volunteers, and visitors. • Values excellence in service delivery to consumers that protects their confidentiality. • To demonstrate a compassionate, caring attitude and achieve consistently caring, supportive safety‐first environment. • We are committed to being an inclusive organization where ALL people are treated fairly and recognized for their individuality. • We believe in recognizing, understanding, and respecting differences among all people. • Every individual at JRMS has an ongoing responsibility to advance diversity. • Utilizes evidence‐based practices; and advance diversity; and Pursues ongoing quality improvement for all of our systems and services.

A Dual Recovery Program The Jabez Program is an integrated dual diagnosis program, servicing adults age 18 and older with a diagnosis of mental illness and substance abuse. Services are available 7 days per week, 24 hours per day.

WE PROVIDE QUALITY BEHAVIOR MODIFICATION, RECOVERY COACHING, AND A SECURE, STRUCTURED ENVIRONMENT TO LIVE.

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Help with Financial Management The combination of both the substance abuse didactic curriculum, 12 step involvement and life skills training at Jabez Home will make a significant difference in the individual’s road to recovery. Our staff will be able to teach and guide them through the difficulties inherent in making significant changes in their life patterns on a 24/7 basis. Our hope is that at the end of the program, the consumers will be able to move toward positive goals like employment, home rental or ownership, new educational goals, etc.

Vision Statement Jabez Recovery Management Services’ representation is synonymous with drug‐free living, setting the standard for excellence in Behavioral Modification. To be bellwethers in creating an environment in which recovering people thrive.

Mission Statement Jabez Recovery Management Services’ representation is synonymous with drug‐free living, setting the standard for excellence in Behavioral Modification. To be bellwethers in creating an environment in which recovering people thrive. WE MAKE BETTER LIVES

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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.”

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9044 LA SALLE BLVD, DETROIT, MI 48206 NEAR ROSA PARKS AND NORTH END WWW.JABEZRECOVERY.ORG 313.894.7400

9044 LaSalle • Detroit, MI 48206

9044 La Salle Blvd, Detroit, MI 48206

JABEZRECOVERY.ORG recovery. Our programs are designed to capitalize on your strengths and coach you through all stages of change in an outpatient or residential setting. (313) 894-7400 We provide a compassionate approach to addiction and mental illness

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