Smoking and Schizophrenia: Understanding and Breaking the Cycle of Addiction

Newswise, April 21, 2016– Smoking addiction in schizophrenia can be explained by significantly increased activation of the ventro-medial prefrontal cortex (vmPFC), a region involved in the brain reward system.

These new data, the result of a study by researchers at the Institut universitaire en santé mentale de Montréal (CIUSSS EST, Montreal) and the University of Montreal confirms the tendency to smoke and low smoking cessation rates of people with schizophrenia.

“Smoking is a real problem for people with schizophrenia,” said Stéphane Potvin, a researcher at the Institut universitaire en santé mentale de Montréal and lead author of the study.

"Their health and life expectancy are often undermined by this addiction, whose brain mechanisms were until now largely unknown," said the associate professor at the University of Montreal’s Faculty of Medicine.

Essentially, the research team observed greater neuronal activation of a specific region of the brain (vmPFC) in schizophrenia smokers compared with healthy subjects when presented with appetitive cigarette images.

At the behavioural level, the researchers also found that schizophrenia smokers had more depressive symptoms than did participants in the control group.

“These observations suggest that smoking has a greater rewarding effect in schizophrenia smokers. This corroborates the hypothesis already formulated of their increased vulnerability to this addiction but also demonstrates the great difficulty for them when it comes to quitting smoking," said Potvin.

The prevalence of smoking in people with schizophrenia is high, and cessation rates are low. Schizophrenia smokers are twelve more times likely to die from heart disease related to smoking than are those who do not smoke.

“It is necessary to explore avenues that will help people in their efforts to free themselves from smoking,” said Potvin. “

That is why we want to continue our research into whether this activation of the ventro-medial prefrontal cortex (vmPFC) is caused by the disease itself or by the effects of antipsychotics,” concluded the researcher.

Marijuana Use Now Could Pose Verbal Memory Risk Later

Newswise, February 10, 2016 — Marijuana is the most frequently used illicit drug in the United States, according to a recent survey from the National Survey on Drug Use and Health, and new data suggest that marijuana use now could pose a serious cognitive function risk later in life.

Stefan Kertesz, M.D., an associate professor with the University of Alabama at Birmingham School of Medicine, is part of a recently published nationwide study reporting potential long-term consequences with implications for public health.

Impaired cognitive functioning is an acute effect of marijuana use, and there is increasing evidence that such effects may persist later in life after marijuana use has ceased. Heavy, long-term use of marijuana has been associated with cognitive impairment, particularly in learning and remembering new information.

Kertesz and other researchers found past exposure to marijuana use to be significantly associated with worse verbal memory in middle age.

Their paper used data from the Coronary Artery Risk Development in Young Adults (CARDIA) study which started in 1985, where more than 5,000 healthy adults were regularly asked about marijuana use. 

In contrast to studies that focus on people known to have an addiction, this study focused on community-based adults, where casual use tends to be more common than addiction.

In the final year of the study, CARDIA participants underwent simple cognitive tests, including a word memory test. Individuals were presented with 15 words and then asked to try to remember them. After 25 minutes, they were later asked to recall the words. 

The tests showed that there was a significant decline in verbal memory among persons whose cumulative marijuana use exceeded the equivalent of one joint a day for five years.

“For every five years of marijuana exposure, one out of two participants would remember one word less,” Kertesz said.

Kertesz also said that it is important to realize that marijuana is more potent today than it was in the 1980s, raising the possibility that users of today’s marijuana may face cognitive consequences of greater magnitude than those reported.

“It’s crucial to recognize that young brains are truly different and not fully developed until age 22 and are at more risk from marijuana,” he said. 

“Parents and teachers need to be vigilant that this poses a larger risk to adolescents.”

Data from 2012 indicates that, among students in the 12th grade (ages 17-18 years), 37 percent had used marijuana within the last year, 23 percent within the last 30 days and 6.5 percent daily.

A Significant Number of Adults Can't Identify Signs of Substance Abuse in Seniors

According to a New National Survey by Harris Poll on behalf of Caron Treatment Centers Poll finds majority of adults age 35-50 (51%) report substance abuse is not a growing problem among seniors (age 60+); Yet nearly 1 in 3 (31%) say their aging parent has engaged in problematic behaviors 

WERNERSVILLE, Pa., Sept. 24, 2015 /PRNewswire-USNewswire/ -- Many American adults aren't involved with their parent's health issues or knowledgeable when it comes to symptoms of substance use disorders (SUDs), according to findings from a new national survey by Caron Treatment Centers, a leading not-for-profit provider of addiction treatment and behavioral healthcare.

The online survey, commissioned by Caron and conducted by Harris Poll among more than 1,000 U.S. adults age 35-50 with a living parent, step-parent, or parent-in-law aged 60+ who they regularly contact (at least once a month), reveals alarming misperceptions about their parents' behavior and the consequences of drinking alcohol and taking prescription medication.

The survey demonstrates a disconnect between how involved adults say they are in their parent's healthcare and the steps they take to support their parent's wellness. It also shows the majority of adults (51%) don't think substance abuse is a growing problem among seniors; however, according to the National Council on Alcoholism and Drug Dependence (NCADD), alcohol and prescription drug problems among adults age 60+ are one of the fastest growing health issues in America.

Furthermore, the NCADD states adults age 65+ take more prescribed and over-the-counter medications than any other age group in the U.S. Misuse is prevalent among seniors not only because doctors prescribe more medications with greater frequency, but also because an individual's body becomes more susceptible to the effects of alcohol/drugs with age. Additionally, many don't realize combining alcohol and prescription medication can cause health complications and even death.

"We're in the midst of an epidemic regarding seniors and substance use disorders," said Dr. Joseph Garbely, M.D., Medical Director at Caron.

"Tragically, the majority of seniors who struggle with SUDs and related issues don't get the help they need and their health declines rapidly. It's critical that adults with aging parents understand the signs and symptoms of SUDs and are empowered with tools to talk to their parents, and in some cases their parent's doctors, about these issues."

Adults Believe They Could Spot Signs of Substance Abuse In Their Parents But Poll Shows Many Could Not Identify Major Symptoms 

Experts say nearly 2.8 million Americans age 50+ meet the criteria for SUD which is expected to nearly double (5.7 million) by 2020, according to the National Institutes of Health (NIH).

Nearly one-third of adults (32%) surveyed by Harris Poll said it's uncommon for people to start abusing alcohol and/or drugs after turning 60. In reality, many seniors experience problems with alcohol abuse after age 60. A Mayo Clinic study found at least 41% of adults age 65+ said their issues started after turning 60.

In early 2015, Caron developed a senior program after observing the specialized needs of the population.

Experts at Caron with extensive experience working with seniors created the personalized treatment approach to encompass several factors including low motivation, lifestyle changes, and unique triggers like retirement, death of a spouse, limitations to mobility, isolation, and the development of a chronic illness. Additionally, there are often significant co-occurring issues that must be treated in order to help seniors achieve recovery.

Experts at Caron say it's critical to start a dialogue with aging parents about their overall mental wellbeing – including their growing vulnerability to substance abuse and behavioral health issues. Although four in five adults (84%) said they'd be able to recognize symptoms of substance abuse in their parent, a significant amount didn't identify the following as signs:

• Anxiety (54%)
• Sleeping problems (46%)
• Failing to keep up with medical appointments/treatments (43%)
• Depressed mood (38%)
• Recurring accidents/injuries/falls (37%)
• Confusion/disorientation (36%)
• 12% were unsure of the signs

Adults Lack Awareness of Dangers of Drinking Alcohol While Taking Prescription Medication; Trust Doctors to Discuss Abuse

Caron's survey revealed confusion around the potentially deadly combination of alcohol and prescription medication:

• One in ten adults (10%) admitted uncertainty about what substances their parent uses
• 11% said their parent consumed alcohol while taking prescription medication at age 60+
• About 2 in 5 (37%) said it's okay for seniors to have one glass of wine/beer while taking prescription medication
•  

The survey also showed nearly nine in 10 adults (87%) trust their parent's doctor would discuss the proper use, side-effects, storage, and disposal of prescription medications before prescribing. Additionally, the majority of adults (83%) said they trust the people who manage their parent's health to identify substance abuse signs; however, only 18% of providers discuss storage/disposal of drugs and over 40% of primary care doctors report difficulty discussing potential drug abuse with patients, according to the American College of Physician Medicine (ACPM). Safe storage and disposal is also important to understand because of a rising trend in individuals taking medication from others' medicine cabinets.

"Most doctors are well intentioned, but unfortunately we cannot rely on them alone to manage their patient's care," said David Rotenberg, Chief Clinical Officer at Caron.

"A typical patient in our senior program has been prescribed medication from multiple doctors. The doctors may not know this and may not think to ask the patient. Additionally, doctors sometimes fail to discuss proper use or potential side effects of prescribed medications or to emphasize the dangers of alcohol. We are expanding our work with the medical community to better educate doctors about substance use disorders. However, it's also critical that communities and families are educated and can raise awareness."

Nearly One Third of Adults Have Observed Instances of Risky Behavior among Parents Including Drinking and Driving

While many adults may not be able to recognize signs of substance abuse, almost one third (31%) reported their parent has engaged in behavior while age 60+ that may be cause for concern. Specifically:

• 13% of adults said their parent has drunk 3+ drinks at one time
• 11% said their parent has driven after drinking
• 10% said their parent has taken multiple prescriptions or OTC medications at once

Adults are likelier to say their father has engaged in risky behavior, drinking while taking prescription medications (14% vs. 7%) or drinking and driving (15% vs. 8%), compared to their mother.

Adults Report Limited Involvement in Parents' Healthcare, Many Do Not Play Active Role in Care

Over 2 in 5 adults (44%) said they don't talk to their parent about their health and fewer take an active role in their parents' healthcare:

• 18% check to ensure their parent is taking their medications
• 17% accompany their parent to doctor visits
• 14% pick up/refill medications for their parent
• 3% received/are receiving formal training to provide care for their parent

Awareness Needed to Address Seniors and Substance Abuse

It's important adults are aware of the substance abuse dangers among seniors and can help make informed decisions to keep themselves and their parents safe. While many doctors play a role in trying to manage these issues, the earlier adults identify their parent may have a problem, the better chance for a successful recovery.

Experts caution not to wait for a parent to experience an extreme consequence before taking action. To this effect, Caron has been educating physicians and retirement home staff, training them to better understand the signs/symptoms of substance abuse and prevention strategies.

In 2016, Caron will break ground on its $15 million Carole and Ray Neag Medical Center which will support treatment for seniors.

For more information and to learn more about seniors and substance abuse visit www.caron.org or follow us on Twitter: @CaronTreatment.

About Caron Treatment Centers

With nearly 60 years in the field, Caron Treatment Centers provides lifesaving addiction and behavioral healthcare treatment in Wernersville, Pennsylvania and at Caron Ocean Drive and Caron Renaissance in Palm Beach County, Florida. Caron's regional offices in Atlanta, Boston, New York City, Philadelphia and Washington, DC offer community and recovery support. Caron has the most extensive continuum of care including adolescents, young adults, adults and seniors. Caron's treatment is customized to meet the needs of individuals and families – with highly trained teams prepared to address co-occurring disorders. Caron offers an innovative approach to ongoing recovery care for its alumni and their families.

Methodology
This survey was conducted online within the U.S. by Harris Poll on behalf of Caron Treatment Centers betweenJune 18-26, 2015 among 1,007 U.S. adults ages 35-50 who have a living parent, step-parent, or parent-in-law aged 60+ who they regularly contact (once a month or more often). Figures for age, sex, race/ethnicity, education, region and household income were weighted, where necessary, to bring them into line with their actual proportions in the population. Propensity score weighting was used to adjust for respondents' propensity to be online.