TIME Addiction

Typical American Smokers Burn Up at Least $1 Million During Their Lifetimes

Alaska smokers will spend over $2 million

American smokers spend at least $1 million dollars on cigarette-related expenditures over their lifetimes, according to a state-by-state analysis done by the financial consultancy company WalletHub.

The most expensive state for smokers is Alaska, where the habit costs over $2 million dollars on average. For a bargain, move to South Carolina, but that still comes in at nearly $1.1 million.

“I and most people really just think of the cost of cigarettes and taxes on the packs, but if you think about the healthcare costs, which can totally be avoided, healthcare insurance premiums, and in the workplace, bias against smokers, that can … add up,” said WalletHub spokeswoman Jill Gonzalez.

The study’s “average smoker” is someone who smokes one pack a day starting from the age of 18 (legal age to buy) and ending at 69 (the average age of death for a smoker).

So, if you’re looking for another excuse to quit, perhaps take a quick peak down millionaire’s row.

TIME Research

Here’s What Alcohol Advertising Does To Kids

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Booze ads reach kids far younger than the legal drinking age

Alcohol advertising that reaches children and young adults helps lead them to drink for the first time—or, if they’re experienced underage drinkers, to drink more, according to a study in the journal JAMA Pediatrics.

“It’s very strong evidence that underage drinkers are not only exposed to the television advertising, but they also assimilate the messages,” says James D. Sargent, MD, study author and professor of pediatrics at Dartmouth’s Geisel School of Medicine. “That process moves them forward in their drinking behavior.”

The study found that young people were only slightly less likely than their older counterparts to have seen an alcohol ad. While 26% of young adults between the ages of 21 and 23 had seen a given alcohol advertisement, 23% of 15 to 17 year olds said they’d seen the same one. Researchers also found that young people who could accurately identify alcoholic products and who said they liked the ads were more likely to try drinking or to drink more.

Based on the findings, Sargent says that alcohol manufacturers should self-regulate more to limit the number of children they reach. The tobacco industry, which has volunteered not to buy television ads or billboards, could serve as model for alcohol manufacturers, he says.

“Alcohol is responsible for deaths of people during adolescence and during young adulthood,” says Sargent. “It seems to me that the industry should be at least as restrictive as the tobacco industry.”

“The spirits industry is committed to responsible advertising directed to adults and adheres to a rigorous advertising and marketing code,” said Lisa Hawkins, vice president of Public affairs at the Distilled Spirits Council, in a statement. The Distilled Spirits Council is a trade association that represents alcoholic beverage companies.
TIME Addiction

The Problem With Treating Pain in America

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A new federal report reveals holes in how we treat chronic pain

Chronic pain affects an estimated 100 million Americans, and between 5 to 8 million use opioids for long-term pain management. Data shows the number of prescriptions written for opioids as well opioid overdose deaths have skyrocketed in recent years, highlighting a growing addiction problem in the U.S. In response, the National Institutes of Health (NIH) released a report on Monday citing major gaps in the way American clinicians are treating pain.

In September, the NIH held a workshop to review chronic pain treatment with a panel of seven experts and more than 20 speakers. The NIH also reviewed relevant research on how pain should be treated in the United States. On Monday the NIH published its findings in the Annals of Internal Medicine, detailing a lack of research into better treatment methods and poor preparedness among physicians. “The prevalence of chronic pain and the increasing use of opioids have created a ‘silent epidemic’ of distress, disability, and danger to a large percentage of Americans,” the report authors write. “The overriding question is: Are we, as a nation, approaching management of chronic pain in the best possible manner that maximizes effectiveness and minimizes harm?”

The answer is no, the report reveals. The number of opioid prescriptions for pain has gone from 76 million in 1991 to 219 million in 2011, and according to recent Centers for Disease Control and Prevention (CDC) data, the latest figures show around 17,000 opioid-related overdose deaths in 2011. Between 2007 and 2010, the number of hospitalizations for opioid addiction increased four-fold. As TIME recently reported, the growing opioid problem means the nation also has a growing heroin problem, since both drugs offer similar highs, and heroin is cheaper and doesn’t need a prescription.

MORE: Why You’ve Never Heard of the Vaccine for Heroin Addiction

Past addiction epidemics disproportionally affected non-white, low-income, inner-city citizens, but the current outbreak of prescription painkiller abuse is affecting mainstream white America. “[Past epidemics] made it easier for the public and even healthcare professionals to think about people with addiction as ‘those people,'” says Dr. Andrew Kolodny, the chief medical officer of the rehabilitation nonprofit Phoenix House. “Hopefully that’s changing.”

The NIH says that based on its assessment, healthcare providers in the United States are poorly prepared for managing pain, and many hold stigmas against their own patients seeking relief. “[Providers] are sometimes quick to label patients as ‘drug-seeking’ or as ‘addicts’ who overestimate their pain,” the authors write. “Some physicians ‘fire’ patients for increasing their dose or for merely voicing concerns about their pain management.”

For better care, the NIH says the medical community needs to start applying individualized treatment for chronic pain, and a multi-disciplinary approach should be used. Since pain is both physical and emotional and can affect all aspects of a person’s life, there should be more than one speciality involved in patient management. The NIH says there’s a lack of data that favors long-term use of opioids, and that other treatments like physical therapy and alternative and complementary medicine should be considered.

Clinicians do not have enough guidance when it comes to prescribing strategies, the NIH notes, arguing that the root of the problem is our overall lack of knowledge of how to effectively treat pain. The NIH says new study designs are needed to better research chronic pain treatment.

Critics of the response to the current opioid problem say a lack of federal attention has let the problem grow. “The opioid addiction problem didn’t begin under [President Obama’s] watch, but it’s gotten very bad on his watch,” says Kolodny. “There’s been 175,000 deaths over 15 years and the president cut funding to the National Institute on Drug Abuse, and he’s cut funding to Substance Abuse and Mental Health Services Administration for addiction treatment. I think the federal government is doing an awful job to tackle this public health crisis, with the exception of the CDC.”

The NIH says the challenge of when to use opioids and when to avoid them remains a question that available data can’t answer, and it’s a knowledge gap that needs to be filled as soon as possible. “For the more than 100 million Americans living with chronic pain, meeting this challenge cannot wait,” the report concludes.

TIME Addiction

Why You’ve Never Heard of the Vaccine for Heroin Addiction

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Addiction is a growing epidemic in the United States. So why don't we have a vaccine?

Every week, the chemist Kim Janda at the Scripps Research Institute gets at least one email—from an heroin addict or a person who loves a heroin addict—that goes something like this:

“I know you have no idea who I am, but I, as any true mother, want to save my son’s life—as does he! The problem is he can’t beat the craving and we are out of money. I will do whatever it takes to help him…Is there any way that he can become a part of a study for this vaccine?”

Janda responds to each email with the bad news that he has no current trials to enroll them, despite the fact that he has created what is likely the most promising vaccine against heroin addiction ever developed. Unfortunately, as is the case with lots of promising addiction research, no one wants to bankroll it.

“No pharmaceutical company is going to fund trials for heroin, no way,” says Janda, who’s been working on addiction vaccines for decades. “For meth? No way. Forget about it.” Janda has also worked on a meth vaccine. He has one for cocaine and one for a date rape drug too, but the heroin vaccine is the one he’s most confident about because it was proven to work a in clinical trials on rats. “The heroin one has been our best success in over 25 years of working—it’s the best data we’ve seen,” says Janda.

In 2013, preclinical trials of the drug on heroin-addicted rats showed those vaccinated didn’t relapse into addiction and were not hooked by high amounts of heroin in their system. “It’s really dramatic,” says Dr. George Koob, director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) who was involved in the heroin vaccine research. “You can inject a rat with 10 times the dose of heroin that a normal rat [could handle] and they just look at you like nothing happened. It’s extraordinary.”

Meanwhile, heroin addiction and overdose deaths are sharply increasing in the United States. A record number of people now use the drug, many of them “graduating” to heroin from painkillers. In July 2014, the CDC reported that 46 Americans die from an overdose of prescription painkillers every day. Doctors wrote 259 million prescriptions for pain killers in a single year—enough for every U.S. adult to have a bottle of pills. Painkillers and heroin both come from the opioid poppy, but heroin is considerably less expensive than painkillers and, while it’s illegal, it does not require a prescription.

“In the 60s and 70s, if someone was addicted to heroin, it meant they began by putting the needle in their arm,” says Dr. Andrew Kolodny, chief medical officer of the rehabilitation nonprofit Phoenix House. “That’s different from the average person using heroin today. It’s affecting mainstream, white America.”

The heroin vaccine, should it go to market, would not be the first pharmacological attempt to treat addiction. There are a handful of FDA-approved drugs like naltrexone and acamprosate for drug and alcohol addiction, and buprenorphine, which treats opioid addiction by curbing withdrawal symptoms. But they’re imperfect. For example, the medications must be taken every day, and stopping too quickly can also cause withdrawal.

Lack of funding for vaccine research aside, success has been elusive for the trials that have tested addiction vaccines on humans. A 2014 cocaine vaccine study showed disappointing results, and in 2011 a late-stage trial for a vaccine to help nicotine smokers fell short.

Such setbacks in the field hinder Janda’s own work and hopes at getting funding for his vaccines, he says.

Creating a vaccine for addiction is tricky because addictive drugs toy with the body and the brain, tapping directly into the brain’s reward systems, which are needed for survival. Vaccines have to interfere with that—without causing a number of other problems.

Janda’s vaccine works a bit like a sponge in the blood stream. If a person—or, in this case, rat—is inoculated, that “sponge” sucks up the drug and prevents it from reaching the brain. Some drugs for addiction will block receptors in the brain so when a drug reaches the brain it can’t activate it like it used to; the heroin vaccine prevents the drug from reaching the brain at all.

Janda and Koob are hoping to get investigational new-drug (IND) distinction from the FDA so that they can test the vaccine in humans. They have backing from the National Institutes of Health experts—National Institute of Drug Abuse allocated $27.1 million dollars to addiction-vaccine research in 2014—but it’s not enough for a human clinical trial.

Addiction vaccines are not without skeptics. Some experts think that the vaccine approach to addiction is small minded, since addiction is physical and psychological—and a vaccine would only treat part of the problem. Others cite earlier trials of other vaccines that didn’t pan out, such as a recent one for cocaine addiction. “I understand why there are skeptics,” says Dr. Andrew Kolodny of Phoenix House. “We have this expectation that for every kind of medical problem, there’s a perfect pill out there. But I think vaccines do hold tremendous promise for future treatments of addiction.”

If the heroin vaccine is to make it to human clinical trials, and even to market, it needs more research and the research needs more money. And while our understanding of addiction has evolved in recent years, many still view addiction as a moral failure of the addict, not something that can be cured or prevented using the same framework used for any communicable disease.

“I am not sure Americans realize that if they treated alcoholism and drug addiction they would save quadrillions of dollars in health care costs,” says Koob. “Go into any emergency room on the weekend and you will see half are there for alcohol and drugs. If for no other reason, investing in research on addiction will reduce health care costs in the future. That’s something I believe in.”

TIME Addiction

How Your Period Affects Your Desire to Quit Smoking

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What that time of the month may mean for your resolution to quit smoking

Ladies, listen up. If you’re trying to quit smoking, you may want to pay attention to that time of the month, a new study says.

When it comes to nicotine addiction, prior research shows some gender differences can come into play. Women tend to get addicted to cigarettes more quickly and have a harder time quitting. Experts have puzzled over why that is, and in a new study published in Psychiatry Journal, researchers suggest that women’s menstrual cycles may cause changes in the brain that affect their desire to smoke, and may interfere with their ability to quit.

The researchers studied 34 men and women who smoked over 15 cigarettes a day. The participants filled out questionnaires and underwent MRI scans on their brains while they looked at smoking-related images.

The women underwent the imaging twice to take into account two different points during the menstrual cycle: the follicular phase and the mid-luteal phase. The follicular phase is the first part of a woman’s cycle which starts on the first day of her period and ends when ovulation starts. The luteal phase is from when ovulation starts to day one of the woman’s next cycle. The researchers looked at the mid-luteal phase so that ovulation had ended and and levels of the hormones estrogen and progesterone were higher.

While the study didn’t find differences in cravings between the men and the women overall, the researchers did find that women experienced more of the brain activations associated with uncontrollable urges to smoke at the beginning of the follicular phase. “Hormonal decreases of [estrogen] and progesterone possibly deepen the withdrawal syndrome and increase activity of neural circuits associated with craving,” study author Adrianna Mendrek a neuroscientist at the Institut universitaire en santé mentale de Montréal in a statement.

During the follicular phase, Mendrek and her colleagues observed that women had more activity in the frontal, temporal and parietal lobe of the brain, while during the luteal phase only the right hippocampus was similarly active. Understanding how the menstrual cycle influences cravings for cigarettes may help women quit, the authors suggest, though there may be more at play than the hormones associated with getting a period.

“The data do suggest that it may be easier for women to quit during the mid-lutael phase rather than in early follicular phase, but the psychosocial factors are probably much more important here,” says Mendrek in an email to TIME. For instance, beliefs about PMS and the fact that it can cause stress and depression may play into whether women find quitting smoking easier at different points during their cycle.

The current study was small with only 34 participants, and earlier research looking at whether women are more responsive to nicotine during various points in their cycle has been inconclusive. The researchers acknowledge that the findings are preliminary, but that they do support the need for more gender-specific cessation research and the possibility that it could help to take into account the menstrual cycle. For now, more confirmation is needed, as well as a better understanding of what biological and psychosocial factors contribute to smoking behaviors.

TIME Addiction

Alcohol Poisoning Kills 6 Americans a Day

CDC says alcohol poisoning deaths are a greater problem than previously thought

America has a drinking problem, with 2,200 people dying each year from alcohol poisoning. That’s an average of six alcohol-related deaths a day, a new Centers for Disease Control and Prevention (CDC) report says.

Alcohol poisoning happens when people drink an excessive amount of alcohol in a short amount of time, causing high levels of alcohol in the body to interfere with and even shutdown parts of the brain that are critical for controlling vitals like heart rate, body temperature, and breathing. Eventually, that can lead to death.

Over 38 million Americans binge drink an average of four times a month, and consume an average of eight drinks per binge, according to the new CDC Vital Signs report. Interestingly, the report shows that the majority of alcohol poisoning deaths happen in adults between the ages of 35 and 64, and 76% of those who die are men, revealing binge drinking is not a behavior solely observed among young people. The CDC reports that while the most deaths occur among non-Hispanic whites, American Indians and Alaska Natives have the most deaths per million people. The death rates also vary widely state to state. For example, alcohol poisoning deaths in Alaska add up to 46.5 deaths per million residents, and in Alabama it’s 5.3 per million residents.

The CDC says the report shows alcohol poisoning deaths are a greater problem than previously believed, and that the numbers are likely an underestimate since alcohol-related deaths are known to be underreported. Alcoholism was a factor in 30% of the deaths and other drug use was a factor in only 3%.

“Alcohol poisoning deaths are a heartbreaking reminder of the dangers of excessive alcohol use, which is a leading cause of preventable deaths in the U.S.,” CDC principal deputy director Ileana Arias said in a statement.

In response, the CDC is calling for more members of the medical community to screen and talk to their patients about alcohol, since numbers show only one in six U.S. adults has reported ever talked about their drinking with a health professional. States with stronger alcohol policies also have less binge drinking, and should partner with community workers including police and health workers for better programs, CDC says.

TIME Addiction

The Best Way to Kick Your Smoking Habit

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The more techy interventions, the better

If you’re really committed to quitting smoking for good, it’s time to get tech-savvy.

A new study published in the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report shows that people who use both phone hotlines and online cessation services to help them quit are much more likely to say they’ve abstained from smoking compared to people who opt for just one or the other.

In general, smoking quitlines are proven to be successful interventions for smokers who want to kick the habit. They offer guidance, support and resources to keep quitters on track. Most quitlines also offer a web version of their services, but until now, it hasn’t been clear that more information really is better.

MORE: Here’s the Best Way to Get Someone to Quit Smoking

The new study suggests that it is. Researchers looked at 7,901 people who reported using either phone-only interventions, internet interventions only, or a combination of both. People who used both methods were significantly more likely to report they hadn’t smoked in 3o days when researchers followed up with them. The researchers speculate that dual usage may improve a quitter’s likelihood of succeeding, possibly because they’re strongly committed to their goal.

“Although telephone and Web-based interventions are effective in tobacco cessation, providing access to multiple types of cessation services might improve the odds of users in achieving long-term cessation,” the researchers write. The hope is that physicians will counsel patients on considering both interventions.

Our ever-connected climate may make this easier, and many public health initiatives are seeing success in sending educational text reminders. The National Institutes of Health (NIH) is paying particular attention to how social media and cell phones can best be used to help break addiction. In October, the NIH pledged $11 million to studying the use of social media to help understand, prevent and treat substance use and addiction.

So if you’re ready to accept the challenge of going cigarette-free in 2015, set yourself up for success and log in.

TIME Addiction

Here’s Who’s Most Likely To Black Out While Drinking

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Blacking out, or getting so drunk that you can’t remember anything that happened the night before, is all too common among underage drinkers, according to a new study published in the journal Alcoholism: Clinical & Experimental Research.

In the study, Marc Schuckit, professor of psychiatry at the University of California San Diego, and his colleagues looked at data on 1,402 drinking teenagers in England when they were 15, 16, 18 and 19. They discovered that by the time the teens reached 19, 90% of them had drank so much they experienced a blackout. About half of them had blacked out multiple times.

More than half of people reported having a blackout at every year of follow-up.

Teens who blacked out while drinking tended to be female—likely because they weigh less and have less body water to dilute the alcohol—to smoke, have sensation-seeking and impulsive behaviors, lack conscientiousness and have friends who also drank or used other substances. “It’s not as if a blackout in these kids was an isolated phenomenon,” says Schuckit. “Blackouts are unfortunately often considered to be a funny thing as opposed to dangerous. I am not sure the average person realizes the dangers associated with blackouts.”

A blackout can occur when someone drinks well over their limit. Alcohol is considered a depressant, and when the dose is high enough, depressants are known to impair memory acquisition. When someone blacks out, it means that while they appear to be awake, alert and intoxicated, their brain is actually not making long-term memories of what’s happening. If a person experiencing a blackout is asked what happened to them just 10 minutes ago, they will have no idea.

There are very few, if any, longitudinal studies that have looked at the impact of blacking out on the brain, but experts guess that it isn’t good. High blood alcohol levels are known to cause memory problems later in life, and blacking out is an indicator of drinking too much. Some people may hit that point with fewer drinks than others, and it’s possible that some have a genetically predisposed sensitivity to alcohol’s effects—but blacking out always means you’ve drank too much.

For young people, that behavior concerns experts. “When you really get drunk, literature shows you are opening yourself up to a huge number of problems,” says Schuckit, citing a greater likelihood of getting into accidents and fights, or doing things that one may later regret, including sex.

The study looked at British students, and prior data suggests that they drink more than American students. Still, Schuckit says it should be taken more seriously among young drinkers everywhere.

Read next: This is What Alcohol Does to Your Sleep

TIME Addiction

E-cigs Are the New Cool Thing for Teenagers

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High schoolers are more likely to smoke e-cigs than regular cigarettes

Electronic cigarettes are hugely popular with teenagers all across the United States, new government data shows, but fewer teens are smoking regular cigarettes—suggesting that e-cigs may attract young people who wouldn’t otherwise smoke.

Researchers surveyed 1,941 Hawaii high school students about their smoking behaviors as well as their relative risk for picking up smoking. Risk was assessed based on factors like sensation-seeking and prevalence of smoking among peers, parent support and academic involvement.

They found, in their study published in the journal Pediatrics, that about 17% of the high schoolers smoked e-cigarettes only, 12% smoked both e-cigarettes and conventional cigarettes, 3% only smoked conventional cigarettes, and 68% said they did not smoke.

MORE: Debate Over E-Cigs Lights Up

Students who smoked tobacco cigarettes, or who smoked both cigarettes and e-cigs, fell within the highest risk category for picking up the habit. E-cigarette users were lower on the risk threshold than those two groups, suggesting it’s attracting young people who wouldn’t necessarily be interested in conventional smoking. E-cigarette users and dual smokers were also more likely that nonsmokers to believe e-cigarettes are healthier than regular cigarettes.

“The fact that e-cigarette only users were intermediate in risk status between nonusers and dual users raises the possibility that e-cigarettes are recruiting medium-risk adolescents, who otherwise would be less susceptible to tobacco product use,” the authors write.

Part of this perception and attraction to e-cigs could be the fact that they are heavily marketed in public places the authors suggest.

MORE: In Children’s Hands, E-Cigarettes Can Be Deadly

The trouble with e-cigs is that there’s still not enough research to make any definitive conclusions on their risks or benefits. Some experts argue that since e-cigarettes have fewer unhealthy components than traditional cigarettes, they are a better option. They have even been trumpeted as a possible quitting device. Other experts argue that e-cigarettes are just another gateway to nicotine use, and are therefore unacceptable. Whether young people can access them and get hooked is of great concern.

Currently, the U.S. Food and Drug Administration (FDA) only regulates e-cigarettes marketed for therapeutic purposes, and many products continue to be marketed and sold with little FDA interference. The agency has proposed a rule that would give it more regulatory power over e-cigarettes that would look similar to other tobacco products, but nothing has been finalized. The FDA has also suggested a ban on sale of e-cigs to minors. The agency admits there’s a lot that consumers don’t know about e-cigs, like if they lead young people to smoke other tobacco products or how much nicotine is actually inhaled in each use.

TIME Photojournalism Links

Photojournalism Daily: Dec. 12, 2014

A compilation of the most interesting photojournalism found on the web, curated by Mikko Takkunen

Today’s daily Photojournalism Links collection highlights Fernando Moleres‘ work on the rehabilitation of young Internet gaming addicts in China. There are more than 600 million web users in the country and around 10% of online minors are said to show signs of Internet-related addictions. Moleres documents a center in southern Beijing, which treats severely addicted youth — some have spent up to 20 hours a day online — using a tough-love approach with military discipline, drugs and psychotherapy. The excellent photographs capture the center’s 60-some boys and six girls (ranging from mid- to late-teens) going through soldier-like morning drills, group therapy sessions and neurological examinations, all in the hope of breaking their isolating web habits. It’s an intriguing look at a very modern problem.

Fernando Moleres: Inside an Internet gaming disorder rehab center in China (Al Jazeera America)

Natalie Keyssar: Ferguson in focus: A Look Back at a Community Upended (MSNBC) These photographs made in late August and late November show a community still coming to terms with the death of unarmed black teenager Michael Brown.

Best photos of 2014 (European Pressphoto Agency)

William Daniels Wins 2014 Tim Hetherington Grant (TIME LightBox) The French photographer was awarded the grant for his ongoing work in Central African Republic.

Photography is art and always will be (The Guardian) Guardian’s photography critic Sean O’Hagan hits back at a commenter claiming photographs cannot be considered fine art.

Michel du Cille, Pulitzer Prize-winning photojournalist, dies at 58 (The Washington Post)

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