March 21, 2008
NIH Podcast Episode #0054
Balintfy: Welcome to the 54th episode of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health-the nation's medical research agency. I'm your host Joe Balintfy. Coming up in this episode: a report about how the Perceived Stigma of HIV/AIDS is Still Problem for Native American Women; we’ll have more about learning How Much is Too Much when it comes to drinking; and get an update about how Heart Disease Continues to Decline in Women. But first, a report on how MRI’s can see drug cravings. That's next on NIH Research Radio.
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MRIs can find Signals that Trigger Drug Cravings
Balintfy: According to a study by the National Institute on Drug Abuse MRIs can find subconscious signals that trigger drug cravings. Here’s Wally Akinso with a report.
Akinso: Using a functional MRI, scientists have discovered that cocaine-related images trigger the emotional centers of the brains of patients addicted to drugs, even when the subjects are unaware they've seen anything. Dr. Steven Grant, NIDA's Chief of the Neuroscience Branch in the division of Clinical Neuroscience and Behavioral Research, said cues outside one's awareness can trigger rapid activation of the circuits driving drug-seeking behavior.
Grant: This study shows that in the area of substance abuse for drug addicts, this processing of very highly relevant information about the presence of stimuli and cues and triggers in the environment that may lead to drug taking are processed by specific areas in the brain in the absence of awareness by the subject.
Akinso: To verify that the patterns of brain activity triggered by the subconscious cues reflected the patients' feelings about drugs, researchers gave the patients a different test two days later, allowing them to look longer at the drug images. The patients who demonstrated the strongest brain response to unseen cues in the functional MRI experiment also felt the strongest positive association with visible drug cues. Dr. Grant said understanding how the brain initiates that overwhelming desire for drugs is essential to treating addiction.
Grant: I think the most immediate payoff here is the empirical demonstration that the drug abuser's behavior can be influenced by even the most leading exposure to drug related stimuli. That it's going register in the brain. It's going to be processed in the brain. And it's going to be processed in parts of the brain that are also involved in drug seeking.
Akinso: He added that these results could improve drug treatment strategies.
Grant: Now what this means for a therapist is it just reiterates what has long been a strategy in the treatment of substance abuse. That the recovering addict needs to be avoiding people, places, and things that are associated with their past drug use and they need to be aware that if they are in overtly exposed to people, places and things that it's going to literally push bottoms in their brains. And they need to develop strategies even though they may not be aware that those buttons are being pushed.
Akinso: This is Wally Akinso at the National Institutes of Health, Bethesda, Maryland.
Perceived Stigma of HIV/AIDS Still Problem for Native American Women
Balintfy: March 20th was National Native HIV/AIDS Awareness Day. The number of Asian and Pacific Islanders, and American Indian and Alaska Natives living with AIDS continues to rise, with an approximately 10 percent increase each year over the past five years. Women of color account for 80 percent of all women estimated to be living with AIDS. One factor:
Cargill: Stigma is alive and well.
Balintfy: Dr. Victoria Cargill is the Director of Minority Research and Clinical Studies in the Office of AIDS Research at the National Institutes of Health.
Cargill: We have women who are afraid understandably because of intimate partner violence to discuss their HIV status with a partner and therefore may choose to either go without partners or may lie and unfortunately place their partners at risk. So stigma is not gone. Stigma has just changed how it appears.
Balintfy: Violence among intimate partners has been reported as very high for the Native American female population. Many studies have shown a correlation between intimate partner violence and sexual risk behaviors for HIV/ AIDS.
Cargill: First of all, HIV in women almost from the beginning of the epidemic has been a problem for women. It has been under-recognized early in the epidemic. However, between 1990 and 1994, we saw a quick up-tick in the number of cases in women and now, where we are currently, women are a significant proportion of the cases reported in women. So all of this continues to let us know that HIV infection is alive and well in women for a number of reasons from the basic science of how HIV is transmitted to the multiple social and economic and power dynamics in relationships that women often experience.
Balintfy: But Dr. Cargill also points out, when it comes to having children, progress has been made.
Cargill: First, I would like to say that women who are HIV positive have the right to consider and decide whether or not they wish to have children. They do not have the right to engage in a behavior to have children that would place someone else at risk. But every woman has the right to make that decision. There are multiple options available to women, but I think, first and foremost, we have to start at the beginning. Any woman who finds herself in the situation of being HIV positive must seek care because it is much easier to get a woman into the best immune shape and overall general health shape possible before she conceives rather than trying to catch up afterwards because there’s no point in having a baby who doesn’t have a mom. That being said, we have been able to successfully reduce the transmission of HIV infection from mother to child to being almost unheard of in this country, that is not true all over the globe.
Balintfy: For more information on HIV/AIDS and women’s issues, visit the Office of Research on Women’s Health web site at orwh.od.nih.gov.
Balintfy: When we come back, part two on How Much is Too Much…
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How Much is Too Much? Part 2
Balintfy: Last episode, we talked with Dr. Mark Willenbring about the risks of drinking in terms of spring break. Now, the Director of the Treatment and Recovery Research Division in the National Institute on Alcohol Abuse and Alcoholism gives us a complete overview of everything from risky drinking to alcoholism.
Willenbring: People may be confused about terms. They may be confused about, “Well what's heavy drinking, what's alcoholism, what's alcohol abuse, are they all the same thing?” And there's kind of a simple way to think about it based on recent research.
First of all you have to drink heavily. Okay, what's heavy drinking? Well drinking heavily is drinking in excess of the NIAAA maximum daily guidelines, which is no more than three for women and no more than four for men. So a day when you drink more than that we call a heavy drinking day. And the more than you drink in a day, of course, the worse it is.
But heavy drinking by itself isn't a disorder. We call it at-risk drinking because it puts you at risk for developing problems later. So it's sort of like with people have a cholesterol level of 350. That's not a problem. They don't know they've got a problem. But it puts them at risk for developing a heart attack later. Or people who are obese. Being obese by itself is not necessarily a problem. But it puts people at risk for things like arthritis of the knees or heart attacks and high blood pressure.
So at-risk drinking is kind of like that. It puts you at risk for problems later. And you don't know necessarily if you’re going to develop them or if you do, when you might. So it's a little problematic to know. So it's best to avoid it. But people do this pretty commonly and it turns out that more than 40 percent of people who are daily or near daily heavy drinkers don't meet any criteria for a disorder. But they are at much elevated risk for it. So what is a disorder then? So there's heavy drinking and that's gotta be there. I mean, if you're not drinking heavily you really can't be alcohol dependent, right? You can't have an alcohol use disorder.
Well, and alcohol use disorder, which includes other diagnostic terms like abuse and dependence, which really are kind of irrelevant at this point, alcohol use disorder is simply heavy drinking with symptoms. Well what kind of symptoms? The earliest and most sensitive symptoms are symptoms that suggest you don't have full control over your drinking.
So drinking above limits that you've set, or for longer periods of time. Drinking in spite of problems that occur or even just feeling bad, so waking up in the morning and feeling hung-over and saying, “I'm not going to do that again,” and then doing it again and then doing it again. That's a sign of problem. Or saying, “I'm only going to drink two drinks tonight” and getting intoxicated. Or saying, “I'm going to stop by at the bar to have a drink or two with my friends after work and then I'm going to go home and have dinner with my family,” and then showing up at nine or 10 o' clock drunk. Those are, those are the first indicators. Another sensitive indication is drinking in a way that puts you or others in a physically hazardous situation. The most common form of that is drunk driving.
So if people have some of those kinds of symptoms, that's a real suggestion that they've got a problem brewing, so to speak. And they should really take stock of that, and the nice thing is if you catch it early it's much, you're much more likely to be able to treat it successfully, either through abstaining or, in some cases, if you catch it really early, especially at the at-risk stage, you're -- people are able to cut down to stay within reasonable limits without having to abstain. So that's another complicated topic, but people have to kind of sort that out for themselves.
A lot of the symptoms we typically associate with alcoholism, things like unemployment, homelessness, the Skid Row bum, the lost weekend, these kinds of things really occur late in the disorder and only in the most severe forms of the disorder. And only about ten to 20 percent of people who have alcohol dependence actually have that form of chronic severe relapsing dependence. Most people who develop dependence do it when they're younger or possibly in mid-life. About a third develop it between the ages of 18 and 25, and another 20 to 30 percent in their 30's. And a lot of times the main symptoms are these symptoms of loss of control over use. And so those are the things that people should really be looking for. And if you don't have those, that's good, but if you're drinking too much then you need to cut down just for your health.
Balintfy: To learn more about alcohol and alcoholism, visit www.niaaa.nih.gov.
Balintfy: Up next, Heart Truth: Heart Disease Continues to Decline in Women. Stay tuned.
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Heart Truth: Heart Disease Continues to Decline in Women
Balintfy: Heart disease deaths in American women continue to decline according to newly analyzed data announced by National, Heart, Lung, and Blood Institute. Here again is Wally Akinso with a report.
Akinso: NHLBI experts examined the preliminary data for 2005, and the data shows that women are living longer, having healthier lives, and dying of heart disease at much later ages than in the past years. Dr. Patrice Desvigne-Nickens, program director with the Heart Failure and Arrhythmia's Branch at the NHLBI's Division of Cardiovascular Diseases, discusses the state of heart disease in women.
Nickens: Heart disease is the number 1 killer of American women. In fact heart disease kills one in four American women and accounts for more deaths than all deaths in cancer combined.
Akinso: In New York City, the Heart Truth campaign, a heart health awareness campaign for women, rolled out the red carpet for the 6th annual Red Dress Collection Fashion Show. The awareness campaign is led by its official national ambassador First Lady Laura Bush and the NHLBI.
Nickens: Our First Lady Laura Bush has been an ambassador for the Heart Truth campaign and she's really been a wonderful spokesperson, describing some of the symptoms of a heart attack and making sure that women are aware, no what to do to take action, and convey that information in a way that's convincing and empowers women to know their risk and take action. It's really simple only five steps, don't smoke, exercise, eat correctly, maintain an ideal weight, and know your numbers; high blood pressure, high cholesterol and diabetes are treatable diseases but their silent. You must know your numbers. So you must see a physician and if necessary take action.
Akinso: More than 20 celebrated women united with America's top designers on the runway to showcase the annual collection of one-of-a-kind Red Dresses and raise awareness of heart disease. Dr. Nickens says the Heart Truth's Red Dress reminds women of the need to protect their heart health, and inspires to take action.
Nickens: The National Heart, Lung, and Blood Institute partners with the Fashion industry, several top designers and celebrities showcase up to 20 red dresses that were designed for just for the show. The significance of the red dress is that it is a symbol to alert women of the importance of heart disease.
Akinso: Dr. Nickens says just by leading a healthy lifestyle such as following a heart healthy eating plan, getting regular physical activity, maintaining a healthy weight, and not smoking, Americans can lower their risk by as much as 82 percent. For more information about the event and downloadable pictures visit www.hearttruth.gov. This is Wally Akinso at the National Institutes of Health, Bethesda, Maryland.
Balintfy: And that’s it for this episode of NIH Research Radio. Please join us again on Friday, April 4th when our next edition will be available for download. I'm your host, Joe Balintfy. Thanks for listening.
NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland, an agency of the US Department of Health and Human Services.