Addiction Starts Early in American Society, Report Finds (HealthDay)

WEDNESDAY, June 29 (HealthDay News) -- A new study reveals that 90 percent of Americans who are addicted to tobacco, alcohol or other substances started smoking, drinking or using drugs before they were 18 years old.

The study also found that one-quarter of Americans who began using any addictive substance before age 18 are addicted, compared with one in 25 Americans who started using an addictive substance when they were 21 or older.

And nearly half of American high school students now smoke, drink or use other drugs, according to the researchers at the National Center on Addiction and Substance Abuse (CASA) at Columbia University.

They said their findings show that adolescence is the most important period of life for the start of substance abuse and its consequences.

"Addiction is a disease that in most cases begins in adolescence, so preventing or delaying teens from using alcohol, tobacco or other drugs for as long as possible is crucial to their health and safety," Susan Foster, CASA's vice president and director of policy research and analysis, said in a CASA news release. "We rightfully worry about other teen health problems like obesity, depression or bullying, but we turn a blind eye to a more common and deadly epidemic that we can in fact prevent."

In teenagers, the brain is not fully developed, increasing the chances that they'll take risks, including using addictive substances that hamper brain development, impair judgment and increase the risk of addiction, the study authors explained.

The investigators found that 75 percent (10 million) of all U.S. high school students have used addictive substances such as tobacco, alcohol, marijuana or cocaine, and that 20 percent of these students meet the medical criteria for addiction. Currently, 46 percent (6.1 million) of all U.S. high school students use addictive substances and one-third of them meet the medical criteria for addiction.

Nearly three-quarters (72.5 percent) of U.S. high school students have consumed alcohol, 46.3 percent have smoked cigarettes, almost 37 percent have used marijuana, about 15 percent have misused prescription drugs, and over 65 percent have used more than one addictive substance, the study authors stated.

A number of social factors are linked to the high risk of addictive substance use by American teens, according to the researchers. These include: acceptance of substance use by parents, schools and communities; widespread advertising of products such as alcohol and cigarettes; and media depictions of substance use as harmless, glamorous, fun and relaxing.

In addition, tobacco, alcohol, marijuana and prescription drugs are widely available to teens.

Teen substance use is the largest preventable and most expensive public health problem in the United States, according to the study. The immediate costs per year of teen substance use include an estimated $68 billion associated with underage drinking and $14 billion in substance-related juvenile justice costs.

The total national cost of substance use by people of all ages is at least $468 billion per year, or nearly $1,500 for every person in the nation, the report indicates.

"The combination of adolescence, an American culture that glorifies and promotes substance use, and easy access to tobacco, alcohol and other drugs creates a perfect storm for our teens and for taxpayers," Jim Ramstad, a CASA board member who also chaired the report's National Advisory Commission, said in the news release.

"We no longer can justify writing off adolescent substance use as bad behavior, as a rite of passage or as kids just being kids. The science is too clear, the facts are too compelling, the health and social consequences are too devastating and the costs are simply too high," he added.

The study offers a number of recommendations including:

Educating the public that teen substance use is a public health problem and that addiction is a medical problem that in most cases begins in adolescence.Using effective public health strategies to prevent or delay the start of substance use.Routine screenings to identify teens most at risk.Early intervention to prevent further substance use and consequences.Giving teens with substance use disorders appropriate medical treatment.

The study findings are based on online surveys of 1,000 high school students, 1,000 parents of high school students and 500 school personnel; analyses of seven national data sets; interviews with 50 leading experts; five focus groups with students, parents and school personnel; and a review of 2,000 scientific articles and reports.

More information

The American Academy of Pediatrics offers resources about children and substance abuse.

Study Finds Botox Alternative Better at Smoothing 'Crow's Feet' (HealthDay)

MONDAY, June 20 (HealthDay News) -- A more recently approved version of botulinum toxin type A beat the anti-wrinkle medication Botox in a trial that compared the respective powers of each in erasing those unwanted lines of aging around the eyes known as "crow's feet."

"One month after treatment, on a two-to-one preference basis, patients picked Dysport over the Botox in terms of wrinkle improvement," said study co-author Dr. Corey S. Maas, an associate clinical professor at the University of California, San Francisco, as well as a plastic surgeon with The Maas Clinic, based in San Francisco and Lake Tahoe.

"So, we can say that when it comes to addressing the smile lines around the eyes, the crow's feet, at one month the Dysport is more effective than Botox," Maas said. "And that's a big deal, because Botox is such a recognized household name now. And it's such a great drug. But when you have something that comes in that's as good in some areas, let alone even better, it's big news for all of us, both doctors and patients."

Maas and his colleagues report the findings in the June 20 online edition of the Archives of Facial Plastic Surgery.

In 2002, the U.S. Food and Drug Administration first approved a particular form of botulinum toxin type A; this drug is popularly known as Botox and is manufactured by Allergan Inc.

An alternate version of the same botulinum toxin was approved in Europe in 2001 for general cosmetic applications. The drug, known as Dysport, is manufactured by Medicis Aesthetics; this version of botulinum was approved for use in the United States in 2009.

To compare the efficacy of both, the research team focused on 77 women and 13 men aged 18 and up between 2009 and 2010. None had previously undergone a facelift, brow lift or laser/chemical resurfacing. None had been exposed to botulinum in any form in the six months prior to the study launch, nor had any experienced adverse side effects as a result of previous exposure to botulinum.

Pre-procedure photographs were taken of all the patients, both while at rest and while contracting their foreheads and eyebrows. Wrinkling was subsequently graded on a five-point scale.

Next, the team the launched a so-called "split face" study, in which the right and left sides of each patient's face were each exposed to one of the drugs. Calculating that the strength ratio of the two drugs is about three-to-one, the researchers injected 10 units of Botox into the crow's feet region of one side of the face, compared with 30 units of Dysport on the other, according to the report.

One month following injection, the patients were asked to contract their muscles as hard as they could, while photographs were again taken.

The result: both the researchers and a majority of patients concurred that Dysport appeared to produce a better outcome. Specifically, two-thirds of the patients expressed a preference for Dysport, ranking Dysport nearly one point higher on the five-point wrinkling scale.

The authors noted, however, that when the patients relaxed their faces there was no appreciable difference between the Dysport and Botox sides.

"Now we want to be careful not to overplay this," stressed Maas. "From our findings, it's clear that there's a better smoothing effect and clearing of lines around the eyes with Dysport. But does that also mean that Dysport is better at achieving the same thing around the mouth or forehead or neck? We really can't make that conclusion."

Maas added that, "the cost of the two amounts respectively are about the same. Maybe actually a little bit less for Dysport, but not substantially less."

He also acknowledged that although the manufacturers of both drugs were approached to support the current investigation, only the maker of Dysport ultimately contributed funding to the effort.

"And what I would personally say about that," noted Maas, "is that if you already own 90 percent of the market why would you fund a study where if you tied you lost? But I will add that Allergan didn't like the dosing or the statistical analysis we used, despite the fact that I believe the body of scientific evidence supports the way we handled both."

But Allergan issued a statement Monday that challenged the findings on several grounds, which included the small size of the study, the short length of the trial and, most importantly, the dosing ratio the researchers used when deciding how much of each product to use on the patients' faces.

"It is important to understand that no two botulinum toxins are alike and each has a unique molecular structure, formulation, potency and safety profile," the company said in its statement. "In fact, the U.S. FDA-required product labels for BOTOX Cosmetic and other botulinum toxins state that different botulinum toxin products are not interchangeable and no consistent dose ratio exists among botulinum toxin products."

"The most significant flaws in this study's design were the attempted dose conversion and injection pattern. In this study, patients were treated with 10 units of BOTOX Cosmetic and 30 units of Dysport. As stated above, BOTOX Cosmetic and Dysport are not interchangeable and there is no established dose conversion, meaning 10 units of BOTOX Cosmetic does not equal 30 units of Dysport. When patients are treated with BOTOX Cosmetic for its approved indication in the glabellar (vertical frown lines between the eyebrows), they typically receive 20 units, which is the FDA-approved dose. In addition to specific dosing regimens, BOTOX Cosmetic also has a unique injection pattern for proper administration, pending the treatment area and individual patient."

Dr. Doris Day, a dermatologist with Lenox Hill Hospital in New York City, also cautioned that the attempt to analytically stack two "very similar" drugs against one another can pose difficulties.

Commenting on the study, she said, "The problem with any study trying to compare them is that there are variations in the reconstitution measures and final numbers of units used for each drug, and that can have a large impact on the final effect of the treatment. Because these are biologics, and because there are slight differences in the manufacturing process, there will be some differences in how the final product works."

Day pointed out that both drugs are FDA-approved and have good safety track records to date.

More information

For more on botulinum toxin, visit the U.S. Department of Health and Human Services.