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Terminating Addiction

Arnold Schwarzenegger praises the START Center, one of the nation's premier addiction research centers

February 2004

by Natalie Gutierrez

"All I know is what the Terminator taught me - never stop fighting - and I never will. The battle has just begun."

These are the prophetic words spoken by character John Connor at the end of the blockbuster science fiction film "Terminator 3: Rise of the Machines."

The movie stars Arnold Schwarzenegger as the Terminator, a cyborg who battles evil to help Connor ultimately save mankind from destruction. In real life, Schwarzenegger is on a mission to help adults and children fight a battle just as destructive as the one in his movie. And the South Texas Addiction Research and Technology (START) Center at the Health Science Center is helping in a major way.


Arnold Schwarzenegger is welcomed to the START Center

Video File Video on File
Schwarzenegger, movie strongman and now governor of California, stopped by the START Center while in San Antonio as part of his involvement with the "After School All Stars," which in 2002 expanded to 15 cities, including San Antonio. Gov. Schwarzenegger is the national chairman of the program whose mission is to encourage youth to say no to drugs, alcohol and violence. His visit helped draw attention to the problem of drug and alcohol addiction in San Antonio and the nation.

"Every study shows that three to six oíclock are the peak hours for kids getting involved in drugs, alcohol and tobacco. It is the beginning of the end for them - the reason they have to come here," Schwarzenegger said, referring to the START Center.

The START Center is one of the nationís premier institutions for research of substance abuse and treatment. The center is both a teaching and a clinical research site. Studies focus on therapeutic interventions such as group and individual therapies and investigational medications to reduce drug and alcohol use.

The age at which a child in the United States becomes addicted to alcohol and drugs is getting lower and lower, said Bankole Johnson, M.D., Ph.D., director of the START Center and one of the scientific worldís most-cited addiction researchers. Dr. Johnson is the Wurzbach Distinguished Professor at the Health Science Center, professor in the departments of psychiatry and pharmacology, deputy chairman for research in the department of psychiatry, and chief of psychiatryís alcohol and drug addiction division.

"We are treating children at the START Center who are alcohol-dependent at age 11 or 12," he informed Schwarzenegger. "It takes three or four years to get dependent, so the question we ask is, where did this child get enough alcohol for this to happen?"

To find an answer to this and other important questions, researchers at the START Center are partnering with San Antonio Fighting Back (SAFB), a local non-profit organization that serves as a catalyst for improving the quality of life for those most at risk within inner-city neighborhoods. The organization is part of the nationwide "After School All Stars" network. The collaboration has been mutually beneficial in that it allows the START Center to expand and strengthen its contact with the community and provides SAFB with a scientific base and evaluation of its community outreach programs. The START Center and SAFB were awarded a three-year $400,000 grant from the U.S. Department of Housing and Urban Development to establish the Community Outreach Partnership Center (COPC). The COPC opened its doors this past October at the Barbara Jordan Center at 2803 E. Commerce on the cityís East Side. Since then, the COPC has served nearly 550 underprivileged and at-risk community residents by providing training, educational activities, and health and human services.

"The START Centerís participation in our organizationís community events provides another aspect of alcohol and drug addiction - treatment," said Linda Tippins, executive director of SAFB. "The START Center offers the research necessary to develop effective strategies to meet the needs of the people we encounter every day," she said. Tippins said approximately 15 visitors to the COPC have already been referred to the START Center for drug or alcohol addiction treatment.

For most of his life, Donald Elbel had a drinking problem. "The START Center saved my life," he said. Elbel began drinking when he was 10 years old. By the time he was 18, he had received his first driving while intoxicated (DWI) offense. After trying numerous rehabilitation programs, Elbel happened upon a newspaper advertisement for the START Center and decided to visit.

"I was lucky I found the START Center on my own," he said. "But partnerships like the one between the START Center and SAFB are important. These will help more people find the help they need," Elbel said.

Elbel, 48, was a patient at theSTART Center from 1998 to 1999. He was among the first 150 participants in a three-month study conducted by START Center researchers involving the drug topiramate. The research team, led by Dr. Johnson, discovered that topiramate, a drug normally used to treat epileptic seizures, effectively reduced cravings in all of the participants, all considered heavy drinkers. The drug also stabilized withdrawal symptoms in the brain such as mood swings and anxiety, thus promoting long-term abstinence.

"After taking topiramate for about two weeks, I immediately noticed that my urge to drink was gone," Elbel said. "Iím no longer on the medication and Iím still sober. It is great to have my life back. I donít need to drink anymore."

In May 2003 the British journal The Lancet published the findings and the study received coverage in The Wall Street Journal, The New York Times, The Washington Post, The Associated Press and on CNN.

Three years earlier, the Journal of the American Medical Association (JAMA) published findings of another study conducted at the START Center. During a five-year study, researchers found that ondansetron, a drug normally used to treat nausea and vomiting in chemotherapy patients, was highly effective in treating alcoholics with neurochemical abnormalities.

The study enrolled 321 patients in San Antonio and Houston. START Center scientists formed the hypothesis that individuals classified as "early onset alcoholics" have abnormalities of serotonin, a neurotransmitter or "chemical messenger" in the brain.

"For decades it has been known that, for some, alcoholism runs in the family, and that certain brain abnormalities may be transmitted," Dr. Johnson said. "Typically, early onset alcoholics begin drinking in their youth, develop anti-social problems and are the hardest to treat. The study showed that ondansetron resulted in an abstinence rate of about 70 percent in biological alcoholics who received therapy."

"In the future, we expect to be able to use genetics to identify those at greatest risk for alcoholism even before they get it. And if they get it, we should be able to provide them with a highly effective therapy," Dr. Johnson said.

The study was funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Dr. Johnsonís team also received a five-year, $3.2 million NIAAA competitive renewal grant and an award from the Texas Commission on Alcohol and Drug Abuse to further investigate the medicationís effectiveness.

If approved by the U.S. Food and Drug Administration, these medications could provide powerful treatment options for many of the 14 million Americans -
1 in every 13 adults - who abuse alcohol or are alcoholics.

The findings show promise for adolescent alcoholics as well. START researchers are among some of the first to conduct studies with ondansetron among adolescents. This is significant since the NIAAA reports that more than 40 percent of individuals who start drinking before the age of 13 will develop alcohol abuse or alcohol dependence at some point in their lives. It also reports that if drinking is delayed until age 21, a childís risk of serious alcohol problems is decreased by†70 percent.

"Few medication trials have been conducted for adolescents with alcohol dependence," said Michael A. Dawes, M.D., assistant professor in the department of psychiatry at the Health Science Center and START Center researcher. "An eight-week study we conducted showed that ondansetron is safe and well-tolerated and has promise for decreasing consumption in adolescents with current alcohol dependence," he said. "These findings underscore the need for future studies in this population."

Dr. Dawes said START Center researchers have submitted applications to fund further adolescent studies involving both ondansetron and topiramate.

In the meantime, researchers at the START Center will never stop fighting in their quest for a cure for alcohol and drug addiction. For millions of adults and children, this means new hope to conquer the battle against this destructive and deadly disease.

And with the outstanding results of the START Center and SAFB partnership,
San Antonians may once again hear Schwarzenegger utter the famous words, "Iíll be back," to laud the efforts of Dr. Johnson and his research team to terminate addiction.

DEADLY STATISTICS

>In 2002, an estimated 22 million Americans suffered from drug or alcohol dependence or abuse. (Substance Abuse and Mental Health Services Administration in the U.S. Department of Health and Human Services - HHS)

>In 2002, Texas had the highest rate of alcohol-related
deaths in the country. (Mothers Against Drunk Drivers - MADD)

>In 2002, about 11 million people reported driving under the influence of illegal drugs during the past year. (HHS)

>San Antonio has the second highest rate of alcohol-related health problems in Texas behind Dallas. (National Institute on Alcohol Abuse and Alcoholism - NIAAA)

>Alcohol is implicated in more than 100,000 deaths annually. (NIAAA)

>Drunk driving is the nationís most frequently committed crime, killing someone every 30 minutes. (MADD)

>More than 40 percent of individuals who start drinking before the age of 13 will develop alcohol abuse or alcohol dependence at some point in their lives. (NIAAA)

>Research was conducted in 1998 to determine the total cost attributable to the consequences of underage drinking. The cost was more than $58 billion per year, based on year 2000 dollars. (NIAAA)

>If drinking is delayed until age 21, a childís risk of serious alcohol problems is decreased by 70 percent. (NIAAA)

>Early substance abuse increases the likelihood of developing psychiatric disorders in the late 20s. (NIAAA)



Will Sansom contributed to this story.

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