According to researchers at the University of South Hampton in the United Kingdom, using alcohol to quell a hangover promotes alcohol dependence, affects the brain and should not be a go-to remedy.
The study, led by Lindy Holden-Dye, a neuroscientist at the University of South Hampton’s School of Biological Sciences, published her team’s findings in PLoS One, a peer-reviewed science journal, on May 3.
The researchers analyzed the alcohol dependence and withdrawal patterns of Caenorhabditis elegans, one-millimeter long worms, as it is oddly akin to humans. Holden-Dye explained, “This research showed the worms displaying effects of the withdrawal of alcohol and enables us to define how alcohol affects signalling in nerve circuits which leads to changes in behaviour.”
Although humans are not exactly worms and it is not possible to replicate “complex aspects of human alcohol addiction such as motivation, craving and cue-dependent relapse, it can provide a reductionist correlate of ethanol-induced neural plasticity which underpins negative reinforcement and therefore contributes to alcohol addiction,” thus showing “that neuropeptide signalling has a pivotal role in ethanol withdrawal.”
“Neuropeptides are also involved in chronic alcohol effects in humans and this is leading to new ideas for the treatment of alcoholism, but their precise role is unclear. Our study provides a very effective experimental system to tackle this problem.”
Until more research is conducted the next time you are feeling hungover it might be best to stay clear from the “hair of the dog” that bit you.
“Hangover Remedy Promotes Alcoholism.” The Independent. Relaxnews, 6 May 2010. Web. 11 May 2010. <http://www.independent.co.uk/life-style/health-and-families/hangover-remedy-promotes-alcoholism-1965407.html>.
Researchers at an Israeli clinic offering methadone maintenance treatment have found that the treatment for opiate addiction appears to protect individuals against subsequent hepatitis C infection.
Presenting their findings at this month’s American Society of Addiction Medicine (ASAM) Medical-Scientific Conference, Einat Peles, Ph.D., and colleagues reported that in a group of 207 hepatitis C-negative patients treated at their Tel Aviv clinic between 1993 and 2008, only 25 became hepatitis C-positive. This is seen as a critical finding in that hepatitis C rates among injection drug users have been estimated at 60 to 90 percent.
“This is a very important study because it shows that not only does treatment work for the addiction itself but is a preventive measure for hepatitis C,” commented Gavin Bart, M.D., chair of this year’s ASAM meeting and director of the Division of Addiction Medicine at Hennepin County Medical Center in Minnesota.
The researchers identified the strongest factors predicting hepatitis C seroconversion in the methadone maintenance population as injection drug use history, benzodiazepine use at admission to treatment, and re-admission to the methadone maintenance program.
The study also found greater hepatitis C risk among women and among individuals under 30, though the researchers added that having children appeared to protect against seroconversion. The dose of methadone received did not constitute a risk factor for the illness, according to the research.
“Study Finds Low Hepatitis C Rates in Methadone Maintenance Participants.” JoinTogether.org. 23 Apr. 2010. Web. 04 May 2010. <http://www.jointogether.org/news/research/summaries/2010/study-finds-low-hepatitis-c.html>.
The painkiller OxyContin can be plenty dangerous if you knowingly abuse it, but it has long posed real dangers of overdose, as well, to those who had little thought of getting high. Cutting a pill in half may sound like a swell way to get just a little relief on a day when that chronic pain problem isn’t so bad.
But oxycodone, the chemical name of this often-prescribed opioid painkiller, has traditionally been packaged in high doses meant to release slowly over time so they can be taken once or twice daily. Cutting such pills can release a high dose of opioid medication into the system very fast, risking overdose.
With both sets of risk — accidental overdose and abuse — in mind, the Food and Drug Administration recently approved a new formulation for OxyContin. In its new form, OxyContin will be much harder to crush, cut, ground, chew or dissolve in liquid. It’s hardly the answer to opioid addiction and abuse. But, said the physician in charge of the FDA’s division of anesthesia and analgesic drugs, Dr. Bob Rappaport, “it is still a step in the right direction.”
OxyContin, introduced to the U.S. market in 1996, quickly became a drug of choice for abusers, and, along with related drugs such as Percocet, Vicodin and Methadone, has dramatically driven up overdose rates in the United States. (Between 2004 and 2005 alone, there was a 17 percent increase in emergency department visits attributable to oxycodone abuse.) A recent report by the Substance Abuse and Mental Health Service Administration found that more than a half-million Americans began abusing OxyContin each year for the last several years.
Healy, Melissa. “Painkiller OxyContin Gets a Safety Makeover.” Great Falls Tribune. McClatchy Newspapers, 20 Apr. 2010. Web. 28 Apr. 2010. <http://www.greatfallstribune.com/>.
Alcohol use disorders (AUDs) are always a concern with patients in methadone maintenance treatment for opioid addiction. Mixing alcohol with methadone can adversely affect patient compliance and treatment outcomes.
Staff members in opioid treatment programs (OTPs) need to be aware that screening and treating methadone patients for AUDs is an important part of patient care, and cannot be overlooked.
Why Some People Develop AUDs
Heredity and other genetic factors that cannot be modified play an important role in AUDs. But health care practitioners can help patients modify other factors that trigger alcohol disorders.
Triggering factors were examined in a recent study in England involving a small cohort of 50 OTP patients, 27 (54 percent) of whom were alcohol dependent. More than half said they used alcohol to relax, relieve boredom, improve mood, forget problems, or fall asleep more easily. Almost one-third said they drank to increase the psychoactive effects of methadone or other drugs, and one-fourth drank to calm themselves after using other drugs.
Effects of Alcohol on the Body
Alcohol depresses the central nervous system. The exuberant behavior often associated with drinking does not result from a stimulant effect, but from loss of inhibition. People who lose inhibitions are more likely to drink too much or use other harmful drugs while under the influence of alcohol.
Like methadone and other opioids, alcohol increases dopamine levels in the pleasure center of the brain. But an excessive amount of alcohol can lead to depression and other distressing feelings. It induces sedation and impairs judgment and mental and motor skills. It increases the chance of traffic or work-related accidents and other mishaps, and raises the risk of death from injury. Over the long term, excessive alcohol intake can damage organ systems; the results — such as cirrhosis of the liver — are well known.
Some people develop tolerance to alcohol after consuming large amounts over a long period. Even greater amounts are then needed to achieve the same effects. Tolerance does not occur at the same rate for all effects; it develops more quickly for mental functions, such as taking a test, than for activities needing eye-hand coordination, such as driving. Thus, someone who doesn’t appear to be impaired may in fact be in no condition to drive.
Effects of AUDs on Opioid Treatment Outcomes
Patients on methadone maintenance who chronically misuse alcohol face a less favorable and more complex course of treatment:
- Higher death rates during and after methadone maintenance treatment
- More medical problems, eg, accelerated progression of hepatitis C infection to cirrhosis and liver failure
- More psychological problems, including depression, antisocial personality disorder, obsessive-compulsive behavior, phobic anxiety, psychosis, and suicide
- More behavioral problems, often a reason for premature discharge from treatment; problems may include lack of cooperation, intoxication that makes safe dosing impossible, and threats of violent acts towards staff, other patients, or both
- Increased use of illicit drugs during treatment
- Poorer social and family function and peer relations
- Increased criminal activity, and escalating legal problems
Screening for Alcohol Use
Because drinking alcohol is an individual treatment issue, and AUDs impact treatment outcomes, all patients should be screened for alcohol use before methadone maintenance treatment begins, and monitored for use throughout therapy. Screening allows OTP staff to record data for diagnostic use, advise patients about potential alcohol/drug interactions, educate patients about risks of alcohol use, and suggest ways to reduce alcohol intake.
Screening also enables OTPs to determine the level and frequency of alcohol use, and to assess the possibility of related health risks.
Two self-scoring tests commonly used in screening OTP patients are the Alcohol Use Disorders Identification Test (AUDIT) and the Michigan Alcohol Screening Test (MAST). AUDIT includes questions about the amount and frequency of alcohol use, binge drinking, dependence symptoms, and alcohol-related problems. It is particularly useful because it can identify people who have problems with alcohol, but may not be dependent. AUDIT also helps clinicians identify hazardous (or risky) drinking habits, harmful drinking habits, and alcohol dependence (see Sidebar). MAST includes questions about drinking behavior and alcohol-related problems, and is especially useful for identifying alcohol dependence.
The Addiction Severity Index (ASI) provides information about factors that contribute to applicants’ abuse of alcohol and drugs. It consists of 200 questions, and is administered by a trained technician or counselor.
Breathalyzer tests, another effective screening tool, may help clarify drinking patterns. Some patients can avoid a positive breathalyzer test at the OTP by timing their alcohol intake. Urine alcohol screens may help, because after a drinking session, they yield a positive result for a longer period than a breathalyzer test.
Staff should be alert for clues to possible alcohol abuse: more than 10 years of heroin abuse; daily use of heroin, cocaine, and alcohol; history of psychiatric conditions and chronic pain; age younger than 30 years; and being male.
OTPs will encounter a variety of drinking patterns and behaviors in new and current patients. Many patients will benefit from brief interventions and education. Others may need medication to help treat their alcohol use disorders. Part II in this series will focus on treating alcohol problems within the OTP. It will cover medical, counseling, and administrative considerations, including risk management.
“Managing Alcohol Use Disorders in OTP Patients.” Addiction Treatment Forum Reports on Substance Abuse and Addiction Therapies. Web. 19 Apr. 2010. <http://www.atforum.com/newsletters/2010winter.php#alcoholuse>.
People who socialize with heavy drinkers are more likely to imbibe a bit too much themselves.
And the same holds true for teetotalers: Those who have non-drinking friends and relatives are more likely not to consume alcohol themselves, a new study found.
“People are organized by their drinking behavior more than would be predicted by chance alone,” said study lead author Dr. J. Niels Rosenquist, a research fellow in the departments of psychiatry and health-care policy at Massachusetts General Hospital and Harvard Medical School. “There appears to be clustering.”
The effect, which may be just as great as family history and genetics, suggests that new interventions for alcohol abuse may be in order.
“In addition to working with individuals who are drinking more than is good for them, we need to come up with new ways to address this on more of a public health level, looking at groups of people and some of the settings in which they congregate and reinforce each other’s drinking habits,” said Dr. Ralph Manchester, director of the University Health Service at the University of Rochester in New York.
The study authors gathered data on more than 12,000 people who were participating in the long-running Framingham Heart Study. People were asked about their alcohol consumption and their social networks several times over a span of 30 years, from 1971 to 2003.
People whose friends or relatives drank heavily were 50% more likely to also drink heavily compared to people who weren’t connected with heavy drinkers. And they were 36% more likely to consume a lot of alcohol if a friend of a friend was a heavy drinker, the study found.
There was even a measurable effect if a friend of a friend of a friend drank a lot — in other words, three degrees of separation.
The researchers also found in general that being surrounded by heavy drinkers increased the reported alcohol consumption by about 70%, while being surrounded by abstainers decreased reported alcohol consumption by half.
While drinking habits of friends and relatives did influence individuals, how nearby neighbors and co-workers conducted themselves did not.
The study findings are published in the April 6 issue of Annals of Internal Medicine.
Previous studies have found similar ripple effects for weight gain, smoking, happiness and depression, but, unlike alcohol, these went only one way. For example, if an individual was around people who gain weight, that individual was more likely to pack on pounds as well.
“There seems to be sort of a social transmission, and this fits into that broader pattern,” said Dr. Marc Galanter, director of the division of alcoholism and drug abuse at New York University School of Medicine.
And the social-transmission factor seems to be stronger among females, though it’s not clear why.
“The gender of your friend is significant, meaning that if you have two friends, male and female, and the male started drinking heavily, that would be less likely to affect you than if a female started drinking heavily,” said Rosenquist.
The question then is what could be the reason for that, Rosenquist said.
“This is pure speculation at this point, but it may be something to do with social norms by gender,” he added. “For example, women tend to drink less under certain social norms and, if they start drinking heavily, it may be more noticeable among groups of friends and colleagues and may have a bigger effect on their drinking behavior than if a male started drinking heavily.”
Of course, some people have long suspected that heavy drinking could travel in social circles.
“We know from alcoholism treatment that you want to stay away from people who have drinking problems if you have a drinking problem,” Galanter said.
Gardner, Amanda. “Alcohol Intake of Friends, Family Impact Your Drinking Habits – USATODAY.com.” News, Travel, Weather, Entertainment, Sports, Technology, U.S. & World – USATODAY.com. HealthDay, 9 Apr. 2010. Web. 13 Apr. 2010. <http://www.usatoday.com/news/health/2010-04-08-social-drinking_N.htm>.
“People have seen the headlines related to Heath Ledger, Michael Jackson, Anna Nicole Smith and they think that’s tragic but maybe contained to Hollywood,” Dr. Jeffrey H. Coben of West Virginia University School of Medicine in Morgantown told Reuters Health.
“But the fact of the matter is we are seeing, across the country, very significant increases in serious overdoses associated with these prescription drugs,” Coben warned.
Between 1999 and 2006, US hospital admissions due to poisoning by prescription opioids, sedatives and tranquilizers rose from approximately 43,000 to about 71,000.
That increase of 65 percent is about double the increase observed in hospitalizations for poisoning by other drugs and medicines, Coben and colleagues found.
Opioids — examples include morphine, methadone, OxyContin and the active ingredient in Percocet — are powerful narcotic painkillers that can be habit-forming. Some examples of sedatives or tranquilizers include Valium, Xanax, and Ativan.
What’s behind the rise in poisoning by prescription painkillers, sedatives and tranquilizers? “There is not any single cause,” Coben said. “There is increasing availability of powerful prescription drugs in the community and attitudes toward their use tend to be different than attitudes toward using other drugs, especially among young people, who report that prescription drugs are easy to obtain, and they think they are less addictive and less dangerous than street drugs like heroin and cocaine.”
Accidental – or unintentional — poisoning by opioids, sedatives and tranquilizers rose by 37 percent during the 7-year study period, while unintentional poisonings by other substances increased by just 21 percent.
“Unintentional poisoning is now the second leading cause of unintentional injury death in the US,” Coben and colleagues note in their report. Among people 35 to 54 years old, unintentional poisoning surpassed motor vehicle crashes as the leading cause of unintentional injury death in 2005.
Even people who take opioid painkillers for legitimate medical reasons are at risk of overdosing. In a study reported by Reuters Health earlier this year, researchers followed nearly 10,000 adults who had received at least three opioid prescriptions within 90 days to treat chronic pain like back pain. Of these, 51 experienced at least one overdose, and six died as a result. The researchers also found that the higher the painkiller dose, the more likely the patients were to overdose.
In the current study, Coben’s team found that intentional poisonings – suicide, self-inflicted poisoning, or poisoning someone else — from prescription opioids, sedatives, and tranquilizers more than doubled, from about 10,000 in 1999 to nearly 24,000 in 2006. That compared to just a 53 percent increase in intentional poisonings from other substances.
The biggest percent increase in hospitalizations for poisoning for a specific drug was a quintupling for methadone, according to the team’s report published in the American Journal of Preventive Medicine. This may be due to the more than 10-fold increase in overall retail sales of this drug from 1997 to 2006, they state.
Poisoning by benzodiazepines such as Xanax and Ativan — drugs that possess sedative, hypnotic, anti-anxiety, anticonvulsant and muscle relaxant activities — rose 39 percent over the study period.
Poisoning by barbiturates, which also have sedative, hypnotic and anti-anxiety actions, actually fell 41 percent, as did hospitalizations for poisoning by antidepressants (a decrease of 13 percent).
Hospitalizations from prescription drug poisonings most often involved women 35 to 54 years old living in urban settings and most of the cases were unintentional, “although the intent of a large number of cases was undetermined,” Coben and colleagues note in their report.
Their findings stem from a comprehensive look at the US Nationwide Inpatient Sample, a database that contains records for roughly 8 million Americans hospitalized annually.
“A multifaceted approach is needed” to stem the tide in poisoning by opioids, sedatives and tranquilizers, Coben said. “Doctors need to perhaps rethink the types and quantities of medications they are prescribing,” he told Reuters Health. “And we need to get better messages out to the public in terms of the dangers associated with these medications and combinations of these medications that are being used.”
“We also need to think about law enforcement strategies with regard to illegal markets for distributing prescription drugs,” Coben said.
Brooks, Megan. “Prescription Drug Overdoses on the Rise in U.S. | Reuters.” Business & Financial News, Breaking US & International News | Reuters.com. 06 Apr. 2010. Web. 07 Apr. 2010. <http://www.reuters.com/article/idUSTRE6350MR20100406>.
One often hears alcohol addiction referred to as alcoholism and drug addiction referred to as drug abuse. Because of this, some people may wonder if there is a difference between the words abuse and addiction. In some respect, there is, especially when alcohol is the substance that is causing the problem. This is because some people only engage in alcohol abuse; that is, they may go months without drinking, but once they have one drink, they will not stop until they have reached the point of extreme intoxication.
Alcoholism, on the other hand, rightfully refers to someone who is constantly drinking, and usually cannot go for any length of time without having a drink. In other words, they will drink at least once a day and most likely several times during a 24-hour period. Drug abuse, on the other hand, and drug addiction are pretty much the same. The primary reason for drug abuse is because one has a true addiction to the drug or drugs being abused. Like the person suffering from alcoholism will drink often, the drug abuser will take drugs on a very frequent basis.
Whether or not a problem is abuse or addiction, however, is not really important. What is important is that people who engage in alcohol abuse or suffer from alcoholism receive alcohol abuse treatment. Similarly, it does not matter whether one is considered as engaging in drug abuse or is drug addicted. If drugs are being used improperly or illicitly, that person needs drug abuse treatment.
“Is It Abuse or Is It Addiction?” www.alcoholanddrugabuse.com. Web. 02 Apr. 2010. <http://www.transworldnews.com/NewsStory.aspx?id=295366&cat=10>.
Some of the same brain mechanisms that fuel drug addiction in humans accompany the emergence of compulsive eating behaviors and the development of obesity in animals, according to research funded by the National Institute on Drug Abuse (NIDA), a component of the National Institutes of Health.
The study, conducted by researchers at the Scripps Research Institute, was released today in the online version of Nature Neuroscience and will also appear in the journal’s May 2010 print issue. When investigators gave rats access to varying levels of high-fat foods, they found unrestricted availability alone can trigger addiction-like responses in the brain, leading to compulsive eating behaviors and the onset of obesity.
“Drug addiction and obesity are two of the most challenging health problems in the United States,” said Dr. Nora D. Volkow, director of NIDA. “This research opens the door for us to apply some of the knowledge we have gathered about drug addiction to the study of overeating and obesity.”
Both obesity and drug addiction have been linked to a dysfunction in the brain’s reward system. In both cases overconsumption can trigger a gradual increase in the reward threshold-requiring more and more palatable high fat food or reinforcing drug to satisfy the craving over time.
Researchers conducted this study in three groups of male rats over a 40-day period. Each day, the three groups had unlimited access to standard lab food. In addition, two of the groups also had access to high-fat, cafeteria style foods for short (one-hour) or long (18-23 hours) periods.
After 40 days, all groups were denied access to the high-fat foods. Throughout the study, researchers observed the feeding behaviors of each group, noting caloric intake, weight gain, and brain response.
The results support the notion that type 2 dopamine receptors (D2DR)-brain receptors that have been shown to play a key role in addiction-also play a key role in the rats’ heightened response to food. In fact, as the rats became obese, the levels of D2DR in the brain’s reward circuit decreased. This drop in D2DR is similar to that previously seen in humans addicted to drugs like cocaine or heroin.
“The results of this study could provide insight into a mechanism for obesity,” said Paul J. Kenny, one of the study’s co-authors and an associate professor at the Scripps Jupiter, Fla., research facility. “It’s possible that drugs developed to treat addiction may also benefit people who are habitual overeaters.”
Study results also suggest that environmental factors, such as increased or unlimited access to high-fat food options, can contribute to the problem of obesity.
“Hopefully, this study will change the way people think about eating,” said Paul Johnson, a co-author and graduate student in the department of molecular therapeutics. “It demonstrates how just the availability of food can trigger overconsumption and obesity.”
The study titled: “Addiction-like reward dysfunction and compulsive eating in obese rates: Role for dopamine D2 receptors,” by Paul M. Johnson and Paul J. Kenny in Nature Neuroscience can be found online at:
Johnson, Paul M. “Dopamine D2 Receptors in Addiction-like Reward Dysfunction and Compulsive Eating in Obese Rats : Nature Neuroscience : Nature Publishing Group.” Nature Publishing Group : Science Journals, Jobs, and Information. Web. 29 Mar. 2010. <http://www.nature.com/neuro/journal/vaop/ncurrent/full/nn.2519.html>.
Misuse of prescription drugs is a growing problem on college campuses, where the drugs are used recreationally as well as to aid in studying, the San Diego Union-Tribune reported Feb. 15.
College prevention programs used to dealing with alcohol and illicit drugs are devoting more attention to drugs like Ritalin and Adderral, but with limited success. Richard Clark, director of medical toxicology at the University of California at San Diego, said that the drugs are being used as mood-lifters and appetite suppressants as well as to improve concentration.
Students say these drugs are easy to obtain on campus for a few dollars and that there is no stigma attached to their use. “I think it’s far more widespread than studies suggest today because the drugs work and because it’s so easy for people to get the drugs in this country,” said Clark.
The drugs are virtually undetectable, unlike alcohol or marijuana, and are obtained from friends, not drug dealers.
“A good chunk of college drug-prevention programs don’t actually do any good,” said James Lange, director of drug and alcohol programs at San Diego State University. Ironically, what has helped reduce misuse of prescription drugs at SDSU has been the economically driven decision to stop the campus health center from diagnosing attention-deficit disorders and prescribing drugs to treat the condition, said Lange; a campaign to address alcohol problems also may have helped because many prescription-drug users also are heavy drinkers.
“Colleges Confront Misuse of Prescription Drugs.” Join Together. San Diego Union-Tribune, 09 Mar. 2010. Web. 16 Mar. 2010. http://www.jointogether.org/.
Alcohol and marijuana use among teens is on the rise, ending a decade-long decline, a study released March 2 found.
“I’m a little worried that we may be seeing the leading edge of a trend here,” said Sean Clarkin, director of strategy at The Partnership for a Drug-Free America, which was releasing the study. “Historically, you do see the increase in recreational drugs before you see increases in some of the harder drugs.”
The annual survey found the number of teens in grades 9 through 12 who reported drinking alcohol in the last month rose 11 percent last year, with 39 percent — about 6.5 million teens — reporting alcohol use. That’s up from 35 percent, or about 5.8 million teens, in 2008.
For pot, 25 percent of teens reported smoking marijuana in the last month, up from 19 percent.
Until last year, those measures for pot and alcohol use had been on a steady decline since 1998, when use hovered around 50 percent of teens for alcohol and 27 percent for pot.
The study also found use of the party drug Ecstasy on the rise. Six percent of teens surveyed said they used Ecstasy in the past month, compared with 4 percent in 2008.
If parents suspect their teen is using, they need to act quickly, Clarkin said. Monitor them more closely, talk with them about drugs, set rules and consult outside help, like a counselor, doctor, clergy or other resource, he said.
The researchers asked teens how they felt about doing drugs or friends who did them. The study found a higher percentage of teens than in the previous year agreed that being high feels good; more teens reported having friends who usually get high at parties; and fewer teens said they wouldn’t want to hang around kids who smoked pot.
Stacy Laskin, now 21 and a senior in college, said marijuana was everywhere during her high school years. Laskin said she tried pot and drank alcohol in high school, but didn’t make it a habit like other kids she knew.
“The behavior I saw people go through — and to see how far people can fall — really turned me away more than anything else,” Laskin said in an interview with The Associated Press.
Her close friend from high school died in 2008 from a heroin overdose. Laskin, a psychology major at Salisbury University in Maryland, was so torn by her friend Jeremy’s death that she decided to help others and is working on her second internship at a drug treatment center.
“Just seeing the negative impact made me want to get involved,” she said.
- Teen abuse of prescription drugs and over-the-counter cough medicine remained stable from 2008 to 2009. About 1 in 7 teens reported abusing a prescription pain reliever in the past year; and about 8 percent of the teens questioned reported over-the-counter cough medicine abuse in the past year.
- Teen steroid and heroin use remained low at 5 percent for lifetime use.
The Partnership’s “attitude tracking” study was sponsored by MetLife Foundation. Researchers surveyed 3,287 teens in grades 9 through 12. Data were collected from questionnaires that teens filled out anonymously from March to June 2009. The study has a margin of error of plus or minus 2.3 percentage points.
The New York-based Partnership is a nonprofit group working to reduce the use of illicit drugs.
To see full results of the study, please visit http://www.drugfree.org/Portal/DrugIssue/Research/Teen_Study_2009/National_Study
Associated Press. “Teen Pot, Alcohol Use Rising.” MSNBC. 2 March 2010. Web 3 March 2010. http://www.msnbc.msn.com/