Polysubstance abuse of alcohol and nicotine has been overlooked in our understanding of the neurobiology of addiction and especially in the development of novel therapeutics for its treatment. Estimates show that as many as 92% of people with alcohol use disorders also smoke tobacco. The health risks associated with both excessive alcohol consumption and tobacco smoking create an urgent biomedical need for the discovery of effective cessation treatments, as opposed to current approaches that attempt to independently treat each abused agent. The lack of treatment approaches for alcohol and nicotine abuse/dependence mirrors a similar lack of research in the neurobiology of polysubstance abuse. This review discusses three critical needs in medications development for alcohol and nicotine co-abuse: (1) the need for a better understanding of the clinical condition (i.e. alcohol and nicotine polysubstance abuse) (2) the need to better understand how these drugs interact in order to identify new targets for therapeutic development and (3) the need for animal models that better mimic this human condition. Current and emerging treatments available for the cessation of each drug and their mechanisms of action are discussed within this context followed by what is known about the pharmacological interactions of alcohol and nicotine. Much has been and will continue to be gained from studying comorbid alcohol and nicotine exposure.

Background Effective non-surgical long-term weight loss solutions remain elusive. Objective To compare a behavioral weight loss program (BWL) with a stress management-based program (Emotional Brain Training, EBT) on weight loss, blood pressure, depression, perceived stress, diet and physical activity. Participants/setting Individuals with a body mass index (BMI) of ≥ 28 and ≤ 45 kg/m2 were recruited in Lexington, Kentucky in January 2014 and randomized to a behavioral weight loss program (BWL) or a stress management program (EBT) for a 20 week intervention. Of those recruited, 49 participants were randomized to EBT or BWL. Randomization and allocation to group were performed using SAS software (v 9.3, 2011, SAS Institute Inc.). Weight, blood pressure, depression, perceived stress, dietary intake and physical activity were measured at baseline, 10, and 20 weeks. Main outcome measures Weight and Body Mass Index (BMI) Statistical analyses Linear models for change over time were fit to calculate 95% confidence intervals of intervention effects. Results BWL produced greater changes in BMI than EBT at both 10(p=0.02) and 20 weeks (p=0.03). At 10 weeks, both EBT and BWL improved BMI, systolic blood pressure, depression and perceived stress (p<0.05). BWL also improved diastolic blood pressure (p=0.005). At 20 weeks, EBT maintained improvements in BMI, systolic blood pressure, depression, and perceived stress while BWL maintained improvements only in BMI and depression (p<0.05). Conclusions BWL produced greater weight loss than EBT; however, EBT produced sustained improvements in stress, depression, and systolic blood pressure. A combination of the two approaches should be explored.

No abstract