Just Say 'Research': Antidrug Program Stresses Science

SPREADING THE WORD: Materials developed by NIDA use a neuroscience approach to teach students about the dangers of drug abuse. A new program from the National Institute on Drug Abuse (NIDA), "Mind Over Matter," is using neuroscience research results to teach, rather than preach to, students about the dangers of addictive drugs. "People have historically seen drug abuse as purely a social problem that results from voluntary behavior and remains voluntary. But science has taught us that addiction is expressed in a behavioral way [and] comes about from the result that drugs have on the brain," says NIDA director Alan Leshner. The program will help fulfill the December 1997 recommendation of the Institute of Medicine's Committee to Identify Strategies to Raise the Profile of Substance Abuse and Alcoholism Research that the science of addiction be more prominent in curricula, from elementary school to medical school. Neuroscience-based teaching about drug addiction uses imaging technologies such as positron emission tomography (PET) and magnetic resonance imaging (MRI) to show what happens when addictive drugs flood the brain. The approach can work, according to Cathrine Sasek, science education coordinator at NIDA, the project officer who developed the program. She frequently talks to middle- and high-school classes. "If you even so much as hint at giving an antidrug talk, you lose them," she reports. "You can, however, talk about the brain-they pay attention to the neurobiology of drug abuse." The program's developers also hope it may spark interest in science. "Young people are intrigued by their bodies, particularly at the middle-school level. We know that science is interesting to them, and it is a vehicle to teach about science and drugs," says Leshner. But there's no guarantee that Mind Over Matter will either prevent drug abuse or propel students onto a science career track. "Showing pictures of a brain on drugs will interest those kids already interested in science, but for the others, it won't mean much," predicts Godfrey Pearlson, a professor of psychiatry at Johns Hopkins Medical Institutions. He uses PET scans to study cocaine-induced binding of dopamine to receptors on brain neurons (see accompanying story). Still, he adds, the approach is worth a try. A good program to combat drug addiction begins with a definition. "Addiction is not withdrawal, it is drug craving and seeking behavior in the face of knowing the negative consequences of such actions," says Alan Leshner, director of the National Institute on Drug Abuse (NIDA). He hypothesizes a "metaphorical switch" as the start of addiction. "Drugs produce long-lasting effects and dramatic changes in the brain, as if a switch goes on that changes voluntary drug use to uncontrollable, compulsive behavior." Probably biochemical, the switch clicks at different levels of usage for different individuals, he adds. The seat of addiction is a pea-sized cluster of brain neurons called the nucleus accumbens (NA). Neurons from a nearby region synapse with those of the NA, triggering release of the neurotransmitter dopamine and branching to the frontal cerebral cortex, disturbing thought processes. The entire neural network is called the mesolimbic reward system. Positron emission tomography (PET) scanning can highlight any part of the addiction process, including the drug, the neurotransmitter it affects, the molecule that transports the neurotransmitter, or the cell surface receptor that binds it. For example, Godfrey Pearlson, a professor of psychiatry at Johns Hopkins Medical Institutions, and his colleagues recently reported evidence that brains of long-time cocaine users "burn out" compared to the brains of people just starting to use the drug (T.E. Schlaepfer et al., American Journal of Psychiatry, 154:9, September 1997). They gave 11 volunteers a chemical that binds weakly to dopamine receptors, which are labeled. When the participants were given cocaine, the resulting rush of dopamine literally knocked off the weak chemical from the receptors. "In the younger people who have used cocaine for a shorter time, we saw a marked increase in the amount of available dopamine. But the individuals who are older and have used cocaine longer show an apparent decrease in available dopamine and an attenuated response to cocaine. This correlation suggests that chronic cocaine use can decrease the number of dopamine receptors," Pearlson says. But drug addiction is more than a dopamine rush in the mesolimbic reward system, some researchers say. Effects on other brain regions produce the complex behaviors that go with the condition or help to trigger it. "Addiction and dopamine binding are two different levels of analysis. Downstream changes in neuronal systems mediate the development and persistence of addiction," explains Martin F. Sarter, a professor of psychology and psychiatry at Ohio State University. Sarter suggests that science-based drug addiction education programs also teach kids to recognize the feelings and behaviors that lead to use of addictive drugs.-R.L. American Council for Drug Education http://www.ACDE.org College on Problems of Drug Dependence http://views.vcu.edu/cpdd National Clearinghouse for Alcohol and Drug Information http://www.health.org National Center on Addiction and Substance Abuse at Columbia University http://www.casacolumbia.org National Institute on Drug Abuse http://www.nida.nih.gov U.S. Department of Education's Safe and Drug-Free Schools Program http://www.ed.gov/offices/OESE/SDFS Funding for Mind Over Matter came from NIDA, with about $50,000 used to develop the written materials. These include six glossy magazines that open out into posters and a long booklet for teachers on "The Biological Effects of Drugs" that is packed with facts and figures. Ten NIDA staffers with scientific expertise provided the information and reviewed the content of the program, and several outside artists and writers contributed. Feedback for the program, which was field-tested in classrooms, has been overwhelmingly positive, according to Sasek. "We have taken the materials to several teachers' meetings [National Association of Biology Teachers and National Science Teachers Association], and the teachers have loved the materials," she says. "In addition, the prevention community is also very enthusiastic about the materials." Materials are free at these conferences or available from the National Clearinghouse for Alcohol and Drug Information. Many drug-education efforts differ markedly from the science-based approach. A fried egg sizzles on a television screen, with the message "this is your brain on drugs." Celebrities and law-enforcement officers tell classes that drugs kill, while teachers and parents urge students to "just say no." But statistics indicate that these efforts are not effective in reaching many young people. Facts and figures on drug use are abundant. The National Longitudinal Study on Adolescent Health, sponsored by the Department of Education's Safe and Drug-Free Schools Program, queried 12,118 seventh- to 12th-graders in 1997. The study found that 25.7 percent of respondents smoked cigarettes, 17.9 percent drank alcohol, and 25.2 percent smoked marijuana. These figures, however, varied considerably among school districts. Data on trends, while useful, sometimes send mixed messages. For example, a survey by Atlanta-based Parents Resource Institute for Drug Education (PRIDE) conducted in 1996 and 1997 of 141,077 junior and senior high schoolers found a statistically significant increase in monthly drug use among sixth- to eighth-graders but unchanged monthly use among high-school students. And a United States Department of Education survey of 10,000 fifth- and sixth-graders as they progressed in school from 1991 to 1995 found a similar increase in drug use by eighth grade. Yet the 23rd annual Monitoring the Future Survey, released Dec. 20, 1997, by the Department of Health and Human Services (HHS), showed increased drug use among 10th- and 12th-graders, but a leveling off among eighth-graders. Leshner and HHS Secretary Donna Shalala interpret the findings to reflect a glimmer of success in drug abuse education programs, but all the studies conclude that the absolute numbers on drug use remain alarming. The National Center on Addiction and Substance Abuse, based at Columbia University, found that from 1995 to 1996, the proportion of teens who said that they would never try illegal drugs fell from 86 percent to 51 percent. Several of the center's studies identified school as the most common place to procure drugs-suggesting that this might also be the best place to introduce drug abuse education programs such as Mind Over Matter. Mind Over Matter targets grades five to nine, which includes youngsters typically not yet tempted to try drugs as well as those in the highest-risk age group. Program materials include six oversized brochures in which a cartoon character, Sara Bellum, takes students on a guided tour of the brain on drugs. (The original name, Nerve Anna, was rejected because students would associate her with Kurt Cobain, guitarist and singer of the band Nirvana who had a well-known drug abuse problem and died of a self-inflicted gunshot wound in 1994.) The idea is that packaging science information attractively will hold students' attention. The Mind Over Matter magazines discuss marijuana, inhalants, opiates, hallucinogens, steroids, and stimulants. A seventh magazine on nicotine will be available soon. Each magazine opens into a poster that is a real image of a neuron. The writing is vibrant. The narrative on opiates, for example, describes the Cowardly Lion and Dorothy succumbing to the effect of poppies in The Wizard of Oz. The neurobiology is presented in easy-to-understand language, such as: "These cells grow so used to having the opiate around that they actually need it to work normally." A cartoon story introduces neurons, synapses, neurotransmitters, and receptors, and a teacher's guide provides background. Success will be determined by how quickly the initial 2,000-copy print run is depleted and from teacher feedback. JUST THE FACTS: Martha Gagné of the American Council for Drug Education says children respond better to science than to scare tactics. Using science to teach about drug abuse is not a new idea. The American Council for Drug Education, based in New York City, has used information on the nervous system in its publications since its inception in 1977, says director Martha Gagné. Plus, the council's Web site features exercises to demonstrate the effects of particular drugs on the brain and other organs. "The Web site offers scientifically accurate data on substances and their abuse to counteract the often-misleading material that now clogs up traffic on the information highway," she adds. The site has been active since June 1997. According to Gagné, several hundred teachers access it monthly, mostly to retrieve lesson plans and curriculum tips. The College on Problems of Drug Dependence (CPDD) is a Philadelphia-based professional organization of about 400 scientists who research drug abuse and addiction. According to the group's mission statement, CPDD "serves as an interface among academic, governmental, and corporate communities, interacting with regulatory and research agencies as well as with educational, treatment, and prevention facilities in the drug abuse field." The organization has a journal and an annual meeting; its members provide consulting services and expert witness testimony and sponsor programs to attract young investigators to drug abuse research, says president Linda Dykstra, William Rand Kenan Jr. Professor of Psychology and Pharmacology at the University of North Carolina in Chapel Hill. ON THE TUBE: Penn's Anna Rose Childress will be featured on a PBS documentary, reporting her findings on signals triggering cocaine craving. Television also is embracing a scientific approach to drug abuse education. On March 29, PBS stations will present the first installment of "Moyers on Addiction: Close to Home," a five-part documentary exploring social, political, and scientific aspects of drug addiction. The second part, "The Hijacked Brain," will feature the work of Anna Rose Childress, a clinical associate professor in the department of psychiatry at the University of Pennsylvania School of Medicine and a clinical psychologist with the drug dependence treatment unit of the Philadelphia Department of Veterans Affairs Medical Center. In their research, she and her coworkers show participants videos of cocaine-related scenes while their brains are being PET scanned. "We have confirmed that limbic structures indeed activate in response to signals which trigger cocaine craving in humans; this does not happen in response to viewing nature videos or in control subjects who have no cocaine history," Childress says. Such signals include people, locations, objects, sounds, sights, and smells that are associated with the drug, she adds. Some drug-education programs may backfire because inquisitive students do not believe the information given. Threats that marijuana use inexorably leads to heroin use do not ring true to students who know this is not always the case. "We learned in the '70s and '80s that hyperbole and exaggeration do not work," says Leshner. Lynn E. Zimmer, a professor of sociology at Queens College in New York and coauthor with John Morgan of Marijuana Myths, Marijuana Facts: A Review of the Scientific Evidence (New York, The Lindesmith Center, 1997), agrees with Leshner. "It is hard to scare kids away from anything. I am concerned that massive exposure to antidrug messages is counterproductive. How could they possibly believe all the bad things about drugs?" she asks. Zimmer does not believe that any current drug education programs work. The Partnership for a Drug Free America, she maintains, overloads kids from preschool age with antidrug messages. The D.A.R.E. (Drug Abuse Resistance Education) program, in which police officers teach fifth- and sixth-graders drug-resistance skills, has also had mixed results. "Kids exposed to the program have a stronger antidrug attitude during that time, when they are not really thinking about drugs, and you can get them to respond. But there is no benefit once kids pass that age," Zimmer says. The Mind Over Matter approach may penetrate typical adolescent arrogance because it is not judgmental. But some researchers think this might not be enough to overcome human nature. "We have known for years that cigarettes are bad, and that has had no effect," Pearlson points out. The best way to cut drug use among youth, suggest Zimmer and Pearlson, is to take a variety of approaches. But the key to any program, Zimmer maintains, is to provide information, not a guilt trip or fear. "Many places in Europe have a more harm-reduction form of drug education. Young people are given more information about how at one point, drugs go from potentially dangerous to quite risky. This is not done in the U.S.," she contends. If a student in the U.S. asks a teacher what a dangerous dose of a particular drug is, Zimmer says, the teacher must refer the student to a drug counselor. A science-based view of drug abuse education is most effective, according to Gagné, when it follows other programs that begin in preschool. "The best approach to preventing drug use is to start as early as possible and instill life skills in children that allow them to accept drug prevention education as they get older," she says. Children need to learn ways to build self-esteem, coping strategies, and decision-making abilities. "Then, if scientific facts are presented-unlike media dramatization and scare tactics-children and youths get a sense of truthfulness and reality, and they are more likely to believe what they hear," she concludes. Ricki Lewis, a freelance science writer based in Scotia, N.Y., is the author of several biology textbooks. She can be reached online at 76715.3517@compuserve.com.

Just Say 'Research': Antidrug Program Stresses Science

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