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Medication
& Therapy for Alcohol Recovery
Proves to be Highly Effective Treatment
(The Sandbox and the Pill)
By Lloyd Vacovsky, Director,
Assisted Recovery Centers
of America, Inc.
The millennium has signaled the dawn of a new
era in the treatment of alcohol and substance dependence in the
United States. New treatment protocols, which include pharmacotherapy,
are attracting increased attention from the Alcohol and Substance
Dependence Treatment Community. At the forefront of this movement
is The Pennsylvania Model of Recovery, which is so named in that
its protocols are based on the research and work of the University
of Pennsylvania School of Medicine, Treatment Research Center in
Philadelphia. This is a medical model, which offers a full range
of empirically tested treatment options to individuals dependent
upon alcohol and other drugs. The Pennsylvania Model differs dramatically
from the Minnesota Model or 12 Step format in that it wholeheartedly
embraces Pharmacotherapy as a cornerstone of treatment, along with
individual and group psychosocial support.
The Pennsylvania Model can be compared to a three-legged
stool. The three legs are the biological, psychological and social
components of recovery. All three components are essential. Take
away one of the legs, and the stool becomes ineffective. The Pennsylvania
Model seeks to address each of these components of addiction, for
individuals seeking recovery.
The biological component includes not only the
physical addiction to the alcohol or drug, as manifested for example
by the presence of "the Shakes", but also the intense
cravings that persist long after the physical discomfort have dissipated.
Most people can deal with the physical discomfort. It is the emotional
issues caused by imbalances in the brain chemistry that precipitate
most relapses. Relapses are common, indeed expected. This despite
the dire consequences that many individuals face by their continued
drinking. Social and non-drinkers do not understand what drives
an alcohol dependent individual to drink alcohol, without regard
to consequences. A simple explanation is that it can be said that
an alcohol dependent person does not drink to feel "good"
but rather drinks in order to not feel "bad". The use
of safe, effective, approved medications addresses the biological
component of the recovery process.
Cognitive Behavioral Therapy is utilized for
the psychological issues which must also be addressed. Recovery
is at best an extremely difficult path. Being burdened by such issues
as clinical depression makes it all but impossible to achieve abstinence.
The use of alcohol is clearly the most common form of self-medication
utilized by individuals suffering from psychological trauma. Simply
stopping the alcohol consumption for example, in most situations,
will not eliminate depression or any other psychological symptom.
Using depression as an example, many individuals simply do not understand
that they are suffering from depression. Depression for them, over
the years, becomes the "norm". They have forgotten the
difference between feeling good and feeling bad. For most alcohol
dependent individuals, feeling "bad" is the "norm"
and alcohol is their only known form of relief.
Equally important are the social issues faced
by individuals in recovery. Learning how to adjust to sobriety is
often more difficult than making the decision to stop. Dealing sober
with family, friends and employers can be so intimidating to individuals
in recovery that many relapse. Alcohol dependent individuals over
the years become extremely skillful in manipulating situations and
lying in order to insure a supply of alcohol. The "news"
that one has made a commitment to stop drinking is most often met
with justifiable skepticism. The individual has probably given the
news about stopping the drinking so often that listeners react much
as those who heard the warning from "the boy crying wolf".
Support from concerned family and friends is essential to recovery,
yet the bridge has been burned so badly, that such support is no
longer offered.
Alcohol dependent individuals often experience
intense isolation and loneliness, even when surrounded by family
and friends. Often they do not realize or are in denial as to the
impact that their drinking has on the people around them. As with
most addicted individuals, alcoholics tend to rely on their own
ability to control their addiction. The end result is usually another
failed attempt to achieve sobriety. Most individuals seeking help
do so only after disastrous events have compelled them to do so.
For recovery to become possible, numerous issues as discussed must
be addressed. In the end, it is critical for the individual to realize
that the help of others is a vital component of recovery.
On December 30, 1994, the United States Food & Drug Administration
approved for use in the treatment of alcohol dependence, the opioid
antagonist Naltrexone HCI. The approval of naltrexone marked a turning
point in the history of treatment for alcohol dependence. Naltrexone
is at the forefront of emerging pharmacotherapy protocols utilized
by the Pennsylvania Model. Since the approval of naltrexone in 1994,
additional medications have been added to the arsenal in the battle
against alcohol dependence. These medications include Ondansetron,
Campral and Topamax.
Within a few minutes of ingestion, Naltrexone
will dramatically reduce or suppress the intense craving to consume
alcohol. The medication is extremely safe, has very minor or no
side effects, is not addicting either physically or emotionally,
can be discontinued at anytime without adverse effects and is generally
administered for six months or less.
It is clear neither that Naltrexone, nor any
of the other effective medications, in themselves are a cure for
alcohol dependence. They are not magic nor are they the silver bullet
that will destroy this disease known as alcoholism. They are however,
extremely valuable tools, that when properly utilized, will enable
motivated individuals to embark upon a successful path to recovery.
The primary difficulty with medications such
as Naltrexone is that they only addresse specific issues of a very
complicated disease. Naltrexone will effectively suppress the cravings,
however it does not address any of the remaining issues for example
clinical depression and or social problems which in themselves can
cause relapse. It does however create a window of opportunity in
which an alcohol dependent individual can address the countless
issues of maintaining sobriety, without the overwhelming desire
to drink alcohol. Even with the use of naltrexone, the path to recovery
is at best difficult.
Alcohol can be compared to a sandbox. Consuming
alcohol enables individuals to stick their head in the sand and
avoid issues and problems. The problems, the pain, do not go away.
They simply lurk in the background, waiting for the individual to
attempt to get their head out of the sand. Relapse occurs when the
individual is not able to deal with the intense cravings, coupled
with their inability to face the almost countless lurking demons
that exist in everyday living. Medications effectively take away
the sandbox, forcing the individual to address the numerous issues
that occur during the recovery process.
Individuals that have "a Life" but
cannot get past the cravings in their efforts to abstain from alcohol
find Naltrexone "a wonder drug". Generally, within an
hour, the monkey that has been on their back for years, jumps off,
and does not return if the medication is taken for the recommended
period of time. It is rare however for an individual that is alcohol
dependent not to have numerous and severe issues which effect recovery.
Individuals with more intense issues are far more likely to slip
or relapse.
Again, it must remember that the Naltrexone only
addresses the cravings. Years of drinking are not washed away by
the taking of a pill. Perhaps the most difficult part of recovery
is learning how to be happy. Just as the bottom line of a business
is profit, the bottom line of recovery is happiness and contentment.
The individual must further recognize that happiness and contentment
are not always available to us 24 hours a day, 7 days a week. That
we have good days and bad days, and that the sandbox is not the
answer for the bad days.
Minnesota Model protocols expect failure, over
and over, until the individual has bottomed out. Then, out of desperation,
the individual is expected to rebuild a life that the bottle took
years to destroy. A Pennsylvania Model program does not expect the
individual to fail. This does not mean that failures do not occur.
The lure of the sandbox and all the lurking demons often overwhelm
the individual. However, by properly addressing the Biological,
Psychological and Social issues, the sandbox can be filled with
concrete, never again to be used in desperation.
For information on the Pennsylvania Model
of Recovery, contact the author at Assisted Recovery Centers of
Arizona, 1000 E. Indian School Road, Phoenix, Arizona 85014. (602)
264-7897, Web site located at www.assistedrecovery.com. E-mail at
lloydv@primenet.com. For information on Naltrexone, contact the
Substance Abuse and Mental Health Services Administration (SAMHSA)
at (800) 729-6686 and request Naltrexone and Alcoholism Treatment,
Treatment Improvement Protocol #28, inventory #BKD268. Also you
can contact the University of Pennsylvania School of Medicine, Treatment
Research Center in Philadelphia at their web site located at www.recovery2000.com
|
COMBINE Clinical Trial
Launched , 11 Universities to Join Study
NIAA
Press Release
The National Institute on Alcohol Abuse and Alcoholism (NIAAA)
has begun Combining Medications and Behavioral Interventions
(COMBINE), a nationwide study that targets persons with the
diagnosis alcohol dependence, commonly known as alcoholism.
COMBINE is the first
national study to evaluate the effectiveness of behavioral
treatments alone and in combination with medications. It begins
at a time when advances in genetics, neuroscience and treatment
research are forging new directions for alcoholism treatment
and building expectations among patients, clinical practitioners
and the public for improved treatment outcomes. "More
than 8 million American adults meet clinical criteria for
alcoholism, a condition characterized by an abnormal appetite
for alcohol that leads to significant impairment -- tolerance,
impaired control over intake, physical dependence and, often,
severe craving following sustained abstinence," said
NIAAA Director Enoch Gordis, M.D. "Of persons who receive
treatment, as many as 50 percent relapse at least once and
a minority achieve long-term remission of disease. Identifying
and developing effective treatments is the first priority
of alcoholism research."
Testing Treatments
Over the next 24 months at eleven treatment research centers
across the United States, the COMBINE study will recruit
and randomize 1,375 people who meet current diagnostic criteria
for alcohol dependence. Participants will receive one or
both of two behavioral treatments (moderate-intensity and
lower-intensity) and one or both of two medications (naltrexone
and acamprosate) or a placebo. They will attend outpatient
sessions for 4 months, then return for three followup visits
over the subsequent 12 months.
"COMBINE is based on the accumulated
knowledge of two decades in which NIAAA researchers have
applied rigorous clinical trial methodology to test treatments
for alcoholism," said Richard K. Fuller, M.D., Director
of NIAAA's Division of Clinical and Prevention Research.
"In 1996, Project MATCH, another benchmark multisite
national trial, demonstrated the effectiveness of facilitated
mutual-help involvement and two professionally delivered
behavioral treatments (see NIAAA Reports Project MATCH Main
Findings."
"Also during the past decade,
research on medications to treat alcoholism has rapidly
expanded as neuroscientists have advanced understanding
of the biology of drinking behavior. From among the most
promising pharmacologic and behavioral treatments, COMBINE
is expected to define the optimal treatment combinations,"
said Raymond F. Anton, M.D., Medical University of South
Carolina. Dr. Anton serves as chairperson of the COMBINE
Steering Committee, a position held previously by Stephanie
S. O'Malley, Ph.D., Yale University School of Medicine.
According to current research, the
most promising pharmacologic treatments are naltrexone, approved
by the U.S. Food and Drug Administration in 1994, and acamprosate,
in use in Europe for about 14 years and currently under review
by the U.S. Food and Drug Administration.
Reducing
Craving
Naltrexone, an opioid blocker, interferes with brain neurotransmitter
systems that produce the rewarding effects of alcohol. Researchers
have shown that naltrexone-treated patients are less likely
to relapse to heavy drinking.
Acamprosate is believed
to normalize abnormalities in the glutamate (NMDA) and GABA
neurotransmitter systems involved in alcohol withdrawal and
may ease the discomfort of abstinence, thereby helping to
prevent drinking. Among other questions, COMBINE will explore
whether treatment effectiveness is improved by pairing a medication
that reduces the risk of any drinking with one that reduces
the risk of heavy drinking.
The moderate-intensity behavioral treatment developed for
COMBINE integrates motivational enhancement therapy, cognitive-behavioral
skills training and facilitated patient involvement in mutual-help
groups such as Alcoholics Anonymous-treatments shown by NIAAA's
Project MATCH to increase abstinent days and reduce heavy
drinking.
The lower-intensity behavioral treatment is designed to support
sobriety, enhance medication compliance, and be incorporated
into the daily routine of health care practitioners in primary
and managed care settings.
"Alcoholism results from an interplay of drinker characteristics,
including intrinsic neurochemical factors, some of which may
be genetically modulated, with environmental risk factors.
From brain imaging studies, we know that both medications
and behavioral treatments can influence brain function and
resulting behaviors. Our expectation is that the behavioral
and pharmacologic treatments being tested in COMBINE will
complement and perhaps enhance one another," Dr. Gordis
said.
Alcoholism Affects 13 Percent
The most severe condition in the spectrum of alcohol problems,
alcoholism affects about 13 percent of Americans at some time
in their lives. Chronic, heavy drinkers are prone to cirrhosis
and other liver diseases, neurological disorders, cardiovascular
damage, pancreatic disease, and certain cancers. Approximately
one in four urban hospital beds is occupied by a patient being
treated for the consequences of drinking.
In addition to the 8 million Americans
with alcohol dependence, about 6 million meet diagnostic criteria
for alcohol abuse disorder, a pattern of harmful or hazardous
drinking that persists despite interpersonal, social, employment,
or legal problems but does not entail physiological addiction.
Millions more engage in risky drinking patterns that could
lead to alcohol problems, including impaired productivity,
property damage, and injuries.
More than one-half of adult Americans
have direct family experience of alcohol problems, which cost
American society more than 100,000 lives and approximately
$185 billion each year.
The COMBINE study is recruiting people
aged 18 years and older. Persons interested in participating
may determine their geographic eligibility by calling 866-80-STUDY.
Participants must be willing to be screened for alcoholism
and be abstinent for a minimum of 4 and a maximum of 21 days
prior to entering the study. There is no cost for participating
in the COMBINE study. |
New
Advances in Alcoholism Treatment
Alcohol
Alert From NIAAA
More than 700,000 Americans receive alcoholism treatment on
any given day (1). However, the techniques of alcoholism therapy
have traditionally been based on clinical experience and intuition,
with little rigorous validation of their effectiveness (2).
Over the past 20 years, modern methods of evaluating medical
therapies have been increasingly applied to alcoholism treatment.
These methods include the use of control groups for comparison
purposes, random assignment of study participants to different
treatment groups and, to the greatest extent possible, followup
of all patients who entered the study (3). This issue focuses
on the results of recent controlled clinical studies on the
effectiveness of self-help groups, psychosocial approaches,
and medications in achieving and maintaining abstinence.
Twelve-Step Self-Help Programs
Self-help groups are the most commonly sought source of help
for alcohol-related problems (4). Alcoholics Anonymous (AA),
one of the most commonly known self-help groups, outlines 12
consecutive activities, or steps, that alcoholics should achieve
during the recovery process. Alcoholics can become involved
with AA before entering professional treatment, as a part of
it, or as aftercare following professional treatment. Although
AA appears to produce positive outcomes in many of its members
(5,6), its efficacy has rarely been assessed in randomized clinical
trials (7). One randomized study of patients entering employee
assistance programs compared inpatient treatment combined with
AA with referral to AA alone (8). This study found that inpatient
treatment, a combination of professional treatment and AA, will
achieve better results for more people than AA alone (8). Ouimette
and colleagues (9), as part of a nonrandomized observational
study involving 3,000 patients in Department of Veterans Affairs
hospitals, compared predominantly 12-step programs with predominantly
cognitive-behavioral programs as well as with courses of therapy
that combined both approaches.
In cognitive-behavioral therapy (CBT), the therapist helps the
client learn new skills to cope with problems and to change
harmful behavior patterns, such as alcohol abuse. One year after
completion of treatment, the three types of programs had produced
comparable improvements on measures of alcohol consumption and
related problems.However, participants in the 12-step programs
achieved more sustained abstinence and higher rates of employment
compared with participants in the other two programs (9).
Interpretation of these results is complicated by the nonrandom
assignment of patients to the different treatment types (9).
The beneficial effects of AA may be attributable in part to
the replacement of the participant's social network of drinking
friends with a fellowship of AA members who can provide motivation
and support for maintaining abstinence (4,10). In addition,
AA's approach often results in the development of coping skills,
many of which are similar to those taught in more structured
psychosocial treatment settings, thereby leading to reductions
in alcohol consumption (4,11).
Psychosocial Therapy
The following sections deal with selected recent approaches
or considerations relevant to the psychosocial treatment of
alcohol-related problems.
Motivational Enhancement
Therapy
Developed specifically for Project MATCH,1 motivational enhancement
therapy (MET) begins with the assumption that the responsibility
and capacity for change lie within the client (12,13). The therapist
begins by providing individualized feedback about the effects
of the patient's drinking. Working closely together, therapist
and patient explore the benefits of abstinence, review treatment
options, and design a plan to implement treatment goals.
Analysis suggests that MET may be one of the most cost-effective
of available treatment methods (14). In one study (15), the
motivational interviewing technique—a key component of
MET—was shown to overcome patients' reluctance to enter
treatment more effectively than did conventional techniques.
Couples Therapy
Evidence indicates that involvement of a nonalcoholic spouse
in a treatment program can improve patient participation rates
and increase the likelihood that the patient will alter drinking
behavior after treatment ends (16).
There are various approaches to marital family therapy. Behavioral-marital
therapy (BMT) combines a focus on drinking with efforts to strengthen
the marital relationship through shared activities and the teaching
of communication and conflict evaluation skills (17). O'Farrell
and colleagues (18) combined couples therapy with the learning
and rehearsal of a relapse prevention plan.Among alcoholics
with severe marital and drinking problems, the combination approach
produced improved marital relations and higher abstinence rates
through 30 months of followup compared with patients undergoing
only BMT (18,19).
Brief Interventions
Many persons with alcohol-related problems receive counseling
from primary care physicians or nursing staff in the context
of five or fewer standard office visits (20). Such treatment,
known as brief intervention, generally consists of straightforward
information on the negative consequences of alcohol consumption
along with practical advice on strategies and community resources
to achieve moderation or abstinence (21,22).
Two controlled trials in the United States and Canada demonstrated
that this approach reduced drinking (23,24), alcohol-related
problems (24), and patients' use of health care services (23).
Most brief interventions are designed to help those at risk
for developing alcohol-related problems to reduce their alcohol
consumption. Alcohol-dependent patients are encouraged to enter
specialized treatment with the goal of complete abstinence (21).
The brief intervention approach has also been successfully applied
outside the primary care setting. Evidence suggests that 25
to 40 percent of trauma patients may be alcohol dependent (25).
Gentilello and colleagues (26) conducted a randomized controlled
study among patients in a trauma center who had detectable blood
alcohol levels at the time of admission.
The researchers found that a single motivational interview at
or near the time of discharge reduced drinking levels and re-admission
for trauma during 6 months of followup (26).
Monti and colleagues (27) conducted a similar randomized controlled
study among youth ages 18 to 19 admitted to an emergency room
with alcohol-related injuries. After 6 months, although all
participants had decreased their alcohol consumption, the group
receiving brief intervention had a significantly lower incidence
of drinking and driving, traffic violations, alcohol-related
injuries, and alcohol-related problems (27). Brief intervention
among freshman college students previously identified as being
at high risk for harmful consequences of heavy drinking has
been shown to result in a significant decline in alcohol-related
problems (28,29).
Treating Alcohol and Nicotine Addiction Together
Nicotine and alcohol interact in the brain, each drug possibly
affecting vulnerability to dependence on the other (30). Consequently,
some researchers postulate that treating both addictions simultaneously
might be an effective, even essential, way to help reduce dependence
on both. A recent study by Hurt and colleagues (31) showed that
treatment for nicotine dependence did not interfere with abstinence
from alcohol or other drugs. Furthermore, such concurrent treatment
not only enhanced cessation from smoking, it also did not induce
already abstinent smokers to relapse to drinking.
Pharmacotherapy
More recently, research has focused on the development of medications
for blocking alcohol-brain interactions that might promote alcoholism.
In 1995 the U.S. Food and Drug Administration approved the use
of the medication naltrexone (ReViaTM) as an aid in preventing
relapse among recovering alcoholics who are simultaneously undergoing
psychosocial therapy. This approval was based largely on two
randomized controlled studies that showed decreased alcohol
consumption for longer periods in naltrexone-treated patients
compared with those who received a placebo (32,33). As is the
case with all diseases, however, naltrexone is only effective
if taken on a regular basis (34). Like all medications, naltrexone
has side effects. One recent study reported a high rate of side
effects, which probably explains why this study, in contrast
with most other studies, failed to find naltrexone effective
(35).
Acamprosate showed promise in treating alcoholism in several
randomized controlled European trials involving more than 3,000
alcoholic subjects who were also undergoing psychosocial treatment.
Analysis of combined results showed that more than twice as
many alcoholics receiving acamprosate remained abstinent up
to 1 year compared with subjects receiving psychosocial treatment
alone (36).
Research suggests that some medications may be more effective
for certain types of alcoholics. For example, when ondansetron
(Zofran®) was combined with psychotherapy, alcoholics who
had begun drinking heavily before age 25 (i.e., early-onset
alcoholics) decreased their alcohol consumption and increased
their number of abstinent days, but later onset alcoholics did
not (37).
Sertraline (Zoloft®), in contrast, appears to reduce drinking
in late-onset, but not early-onset, alcoholics (38). However,
fluoxetine (Prozac®), a medication related to sertraline,
has not been found to be effective in late-onset alcoholism
(39). In conclusion, research supports the concept of using
medications as an adjunct to the psychosocial therapy of alcohol
abuse and alcoholism. However, additional clinical trials are
required to identify those patients most likely to benefit from
such an approach, to determine the most appropriate medications
for different patient types, to establish optimal dosages, and
to develop strategies for enhancing patient compliance with
medication regimens.
Commentary by NIAAA Director
Enoch Gordis, M.D.
Alcoholism clinicians have access today to a wide range of treatment
options for their patients. Some of these treatments, such as
12-step self-help programs, have been around a long time. Others—including
brief intervention and various therapies borrowed from other
fields, such as motivational enhancement therapy and couples
therapy—are relatively new concepts that have been shown
to be effective in reducing the risk for alcohol-related problems.The
key change that has occurred, of course, is the advent of alcoholism
clinical research, which over the past 15 years or so has made
significant progress toward rigorous evaluation of both existing
therapies and newly developed therapies for use in treating
alcohol-related problems.
Finally, continued research on alcohol's effects in the brain
and on the links between brain and behavior, which has already
led to the development of medications to reduce craving, is
likely to provide clinicians with a range of highly specific
medications that will, when used in conjunction with behavioral
therapies, improve the chance for recovery—and the lives—of
those who suffer from alcohol abuse and dependence.
1Project MATCH is a national, multisite, randomized clinical
trial that produced data on the outcomes of specific alcoholism
treatment approaches.
References
(1)
NIAAA. 10th Special Report to the U.S. Congress on Alcohol and
Health. NIH Pub No. 00-1583. Bethesda, MD: the Institute, 2000.
(2) Woody, G.E.; McLellan, A.T.; Alterman, A.A.; and O'Brien,
C.P. Encouraging collaboration between research and clinical
practice in alcohol and other drug abuse treatment. Alcohol
Health Res World 15(3):221-227, 1991. (3) Fuller, R.K., and
Hiller-Sturmhöfel, S. Alcoholism treatment in the United
States: An overview. Alcohol Res Health 23(2):69-77, 1999. (4)
Humphreys, K.; Mankowski, E.S.; Moos, R.H.; and Finney, J.W.
Do enhanced friendship networks and active coping mediate the
effect of self-help groups on substance abuse? Ann Behav Med
21(1):54-60, 1999. (5) Emrick, C.D.; Tonigan, J.S.; Montgomery,
H.; and Little, L. Alcoholics Anonymous: What is currently known?
In: McCrady, B.S., and Miller, W.R. Research on Alcoholics Anonymous:
Opportunities and Alternatives. New Brunswick, NJ: Rutgers Center
of Alcohol Studies, 1993. pp. 41-76. (6) Humphreys, K.; Moos,
R.H.; and Cohen, C. Social and community resources and long-term
recovery from treated and untreated alcoholism. J Stud Alcohol
58(3):231-238, 1997. (7) Tonigan, J.S.; Toscova, R.; and Miller,
W.R. Meta-analysis of the literature on Alcoholics Anonymous:
Sample and study characteristics moderate findings. J Stud Alcohol
57:65-72, 1996. (8) Walsh, D.C.; Hingson, R.W.; Merrigan, D.M.;
et al. A randomized trial of treatment options for alcohol-abusing
workers. N Engl J Med 325(11):775-782, 1991. (9) Ouimette, P.C.;
Finney, J.W.; and Moos, R.H. Twelve-step and cognitive-behavioral
treatment for substance abuse: A comparison of treatment effectiveness.
J Consult Clin Psychol 65(2):230-240, 1997. (10) Longabaugh,
R.; Wirtz, P.W.; Zweben, A.; and Stout, R.L. Network support
for drinking, Alcoholics Anonymous and long-term matching effects.
Addict 93(9):1313-1333, 1998. (11) Morgenstern, J.; Labouvie,
E.; McCrady, B.S.; Kahler, C.W.; and Frey, R.M. Affiliation
with Alcoholics Anonymous after treatment: A study of its therapeutic
effects and mechanisms of action. J Consult Clin Psychol 65(5):768-777,
1997. (12) Project MATCH Research Group. Matching alcoholism
treatments to client heterogeneity: Project MATCH posttreatment
drinking outcomes. J Stud Alcohol 58(1):7-29, 1997. (13) Miller,
W.R.; Zweben, A.; DiClemente, C.C.; and Rychatrik, R.G. Motivational
Enhancement Therapy Manual. Project MATCH Monograph Series Vol.
2. NIH Pub. No. 94-3723. Rockville, MD: NIAAA, 1995. (14) Cisler,
R.; Holder, H.H.; Longabaugh, R.; Stout, R.L.; and Zweben, A.
Actual and estimated replication costs for alcohol treatment
modalities: Case study from Project MATCH. J Stud Alcohol 59(5):503-512,
1998. (15) Miller, W.R.; Meyers, R.J.; and Tonigan, J.S. Engaging
the unmotivated in treatment for alcohol problems: A comparison
of three strategies for intervention through family members.
J Consult Clin Psychol 67(5):688-697, 1999. (16) Steinglass,
P. Family therapy: Alcohol. In: Galanter, M., and Kleber, H.D.,
eds. The American Psychiatric Press Textbook of Substance Abuse
Treatment. 2d ed. Washington, DC: American Psychiatric Association,
1999. (17) O'Farrell, T.O. Marital and family therapy in alcoholism
treatment. J Subst Abuse Treat 6:23-29, 1989. (18) O'Farrell,
T.J.; Choquette, K.A.; and Cutter, H.S.G. Couples relapse prevention
sessions after behavioral marital therapy for male alcoholics:
Outcomes during the three years after starting treatment. J
Stud Alcohol 59(4):357-370, 1998. (19) McCrady, B.S.; Epstein,
E.E.; and Hirsch, L.S. Maintaining change after conjoint behavioral
alcohol treatment for men: Outcomes at 6 months. Addict 94(9):1381-1396,
1999. (20) Fleming, M., and Manwell, L.B. Brief intervention
in primary care settings: A primary treatment method for at-risk,
problem, and dependent drinkers. Alcohol Res & Health 23(2):128-137,
1999. (21) NIAAA. Alcohol Alert No. 43: "Brief Intervention
for Alcohol Problems." Bethesda, MD: the Institute, 1999.
(22) DiClemente, C.C.; Bellino, L.E.; and Neavins, T.M. Motivation
for change and alcoholism treatment. Alcohol Res Health 23(2):86-92,
1999. (23) Fleming, M.F.; Barry, K.L.; Manwell, L.B.; Johnson,
K.; and London, R. Brief physician advice for problem alcohol
drinkers: A randomized controlled trial in community-based primary
care practices. JAMA 277(13):1039-1045, 1997. (24) Israel, Y.;
Hollander, O.; Sanchez-Craig, M.; et al. Screening for problem
drinking and counseling by the primary care physician-nurse
team. Alcohol Clin Exp Res 20(8):1443-1450, 1996. (25) Gentilello,
L.M.; Donovan, D.M.; Dunn, C.W.; and Rivara, F.P. Alcohol interventions
in trauma centers: Current practice and future directions. JAMA
274(13):1043-1048, 1995. (26) Gentilello, L.M.; Rivara, F.P.;
Donovan, D.M.; et al. Alcohol interventions in a trauma center
as a means of reducing the risk of injury recurrence. Ann Surg
230(4):473-483, 1999. (27) Monti, P.M.; Colby, S.M.; Barnett,
N.P.; et al. Brief intervention for harm reduction with alcohol-positive
older adolescents in a hospital emergency department. J Consult
Clin Psychol 67(6):989-994, 1999. (28) Marlatt, G.A.; Baer,
J.S.; Kivlahan, D.R.; et al. Screening and brief intervention
for high-risk college student drinkers: Results from a 2-year
follow-up assessment. J Consult Clin Psychol 66(4):604-615,
1998. (29) Roberts, L.J.; Neal, D.J.; Kivlahan, D.R.; Baer,
J.S.; and Marlatt, G.A. Individual drinking changes following
a brief intervention among college students: Clinical significance
in an indicated preventive context. J Consult Clin Psychol 68(3):500-505,
2000. (30) Schiffman, S., and Balabanis, M. Associations between
alcohol and tobacco. In: Fertig, J.B., and Allen, J.P., eds.
Alcohol and Tobacco: From Basic Science to Clinical Practice.
NIAAA Research Monograph No. 30. NIH Pub. No. 95-3531. Bethesda,
MD: the Institute, 1995. pp. 17-36. (31) Hurt, R.D.; Eberman,
K.M.; Croghan, I.T.; et al. Nicotine dependence treatment during
inpatient treatment for other addictions: A prospective intervention
trial. Alcohol Clin Exp Res 18(4):867-872, 1994. (32) Volpicelli,
J.R.; Alterman, A.I.; Hayashida, M.; and O'Brien, C.P. Naltrexone
in the treatment of alcohol dependence. Arch Gen Psychiatry
49:876-880, 1992. (33) O'Malley, S.S.; Jaffe, A.J.; Chang, G.;
et al. Naltrexone and coping skills therapy for alcohol dependence:
A controlled study. Arch Gen Psychiatry 49(11):881-887, 1992.
(34) Volpicelli, J.R.; Rhines, K.C.; Rhines, J.S.; et al. Naltrexone
and alcohol dependence: Role of subject compliance. Arch Gen
Psychiatry 54(8):737-742, 1997. (35) Kranzler, H.R.; Modesto-Lowe,
V.; and Van Kirk, J. Naltrexone vs. nefazodone for treatment
of alcohol dependence: A placebo-controlled trial. Neuropsychopharmacology
22(5):493-503, 2000. (36) Swift, R.M. Drug therapy for alcohol
dependence. N Engl J Med 340(19):1482-1490, 1999. (37) Johnson,
B.A.; Roache, J.D.; Javors, M.A.; et al. Ondansetron for reduction
of drinking among biologically predisposed alcoholic patients:
A randomized controlled trial. JAMA 284(8):963-971, 2000. (38)
Pettinati, H.M.; Volpicelli, J.R.; Kranzler, H.R.; et al. Sertraline
treatment for alcohol dependence: Interactive effects of medication
and alcohol subtype. Alcohol Clin Exp Res 24(7):1041-1049, 2000.
(39) Kranzler, H.R.; Burleson, J.A.; Brown, J.; and Babor, T.F.
Fluoxetine treatment seems to reduce the beneficial effects
of cognitive-behavioral therapy in type B alcoholics. Alcohol
Clin Exp Res 20(9):1534-1541, 1996. Information furnished by
National Institute on Alcohol Abuse and Alcoholism |
|
Addiction
Is a 'Brain Disease'
NIDA
News Release
Scientific advances have offered remarkable insights into how the
human brain works and how it molds behaviors that affect drug addiction,
say the directors of the National Institute on Drug Abuse (NIDA)
and the National Institute on Alcohol Abuse and Alcoholism (NIAAA),
National Institutes of Health, in a newly published article.
Building on these foundations, scientists can now investigate issues
that were previously inaccessible, such as how environmental factors
and genes affect how the brain responds to drugs of abuse to drive
the process of addiction. The report, by NIDA Director Dr. Nora
D. Volkow, and NIAAA Director Dr. Ting-Kai Li, is published in the
December 2004 issue of Nature Reviews Neuroscience.
"Drug addiction is a brain disease," says Dr. Volkow.
"Although initial drug use might be voluntary, once addiction
develops this control is markedly disrupted. Imaging studies have
shown specific abnormalities in the brains of some, but not all,
addicted individuals. While scientific advancements in the understanding
of addiction have occurred at unprecedented speed in recent years,
unanswered questions remain that highlight the need for further
research to better define the neurobiological processes involved
in addiction."
Recent
studies have increased our knowledge of how drugs affect gene expression
and brain circuitry, and how these factors affect human behavior.
They have shed new light on the relationship between drug abuse
and mental illness, and the roles played by heredity, age, and other
factors in increased vulnerability to addiction. New knowledge from
future research, say Dr. Volkow and Dr. Li, will guide new strategies
and change the way clinicians approach the prevention and treatment
of addiction.
More Addiction Research Needed
Topics of future investigations will include:
Studies that further explain the brain's circuitry involved in making
addicted individuals more responsive to biochemical changes caused
by drugs of abuse;
- Explorations that look more deeply into the
genetic and environmental factors associated with addiction, as
well as the relationship between addiction and co-occurring mental
illness;
- Developing tailored preventive interventions
that take socioeconomic, cultural, age, and gender characteristics
into consideration;
- Investigating new and existing medications
that show potential as therapeutic options; and
- Pairing cognitive-behavioral strategies
with medications to treat the brain changes brought about by chronic
drug exposure.
"These new methodologies will provide us
with a greater understanding of drug addiction," the scientists
say. "But, to effectively treat and prevent drug addiction,
we need to remove the condition's social stigma and enhance the
involvement of the medical community. We also need to boost the
contributions of the pharmaceutical industry in developing new medications
and encourage the participation of insurers." |
Finding
the Right Treatment Program Is Important
About.com
If you or someone you care for is dependent on alcohol or drugs
and needs treatment, it is important to know that no single treatment
approach is appropriate for all individuals. Finding the right treatment
program involves careful consideration of such things as the setting,
length of care, philosophical approach and your or your loved one's
needs.
The U.S. Department of Health and Human Services,
Substance Abuse and Mental Health Services Administration's Center
for Substance Abuse Treatment (CSAT) provides a toll-free, 24-hour
treatment referral service to help you locate treatment options
near you. For a referral to a treatment center or support group
in your area, call:
1-800-662-HELP
1-800-487-4889 (TDD)
1-877-767-8432 (Spanish)
To find information online about a treatment
center in your area click
here.
Questions to Ask
Here are 12 questions to consider when selecting
an alcohol or substance abuse treatment or rehabilitation program,
according to the Center for Substance Abuse Treatment:
1. Does the program accept your insurance?
If not, will they work with you on a payment plan or find other
means of support for you?
2. Is the program run by state-accredited, licensed
and/or trained professionals?
3. Is the facility clean, organized and well-run?
4. Does the program encompass the full range
of needs of the individual (medical: including infectious diseases;
psychological: including co-occurring mental illness; social; vocational;
legal; etc.)?
5. Does the treatment program also address sexual
orientation and physical disabilities as well as provide age, gender
and culturally appropriate treatment services?
6. Is long-term aftercare support and/or guidance
encouraged, provided and maintained?
7. Is there ongoing assessment of an individual's
treatment plan to ensure it meets changing needs?
8. Does the program employ strategies to engage
and keep individuals in longer-term treatment, increasing the likelihood
of success?
9. Does the program offer counseling (individual
or group) and other behavioral therapies to enhance the individual's
ability to function in the family/community?
10. Does the program offer medication as part
of the treatment regimen, if appropriate?
11. Is there ongoing monitoring of possible
relapse to help guide patients back to abstinence?
12. Are services or referrals offered to family
members to ensure they understand addiction and the recovery process
to help them support the recovering individual?
Source: Center
for Substance Abuse Treatment.
|
Treating
Addiction: Beyond AA (OPINION)
International
Medical News Group
Manijeh Nikakhtar, M.D.
Louis F. Markert, Ph.D.
In terms of diagnosing and treating alcohol and drug addiction,
we remain trapped within the spiritual mindset of the 1930s.
Those who propose new approaches to chemical
dependency are stymied. Unless their scientific premises conform
to the spiritual model of Alcoholics Anonymous (AA), they get little
or no funding for research in the field of addiction (Audrey M.
Burnam et al., "Improving block grant allocation formulas,"
RAND Drug Policy Research Center Research Brief RB-6006, 1997).
As a result, the AA 12-step industry maintains
a virtual monopoly over the nation's recovery programs. Though AA
12-step programs are open to all who wish to participate, they remain
surprisingly antagonistic to partnering with medical scientists—this
in spite of AA cofounder Bill Wilson's recognition nearly 50 years
ago that the "discoveries of the psychiatrists and biochemists
have vast implications for us alcoholics" (Francis Hartigan,
"Bill W.: A Biography of Alcoholics Anonymous Cofounder Bill
Wilson," 2000).
It is ironic that so many of Bill Wilson's followers
have lost sight of his vision, barring the doors to the very people
who can bring them immediate support. The belief that all symptoms
of addiction will eventually disappear with successful mastery of
the 12 steps stands as a barrier to the introduction of new and
effective treatments.
Health professionals must address the limits
of traditional recovery programs by becoming more active in all
issues related to drugs, such as preventing the development and
distribution of new harmful psychoactive substances, developing
drug legislation, and setting guidelines for the allocation of research
funds.
The 12-step AA program strives to program every
newcomer with the belief that he or she is an addict who will always
remain so and is powerless to change, and whose only hope for a
normal healthy life is to surrender to a higher power by committing
to "grow along spiritual lines."
All who enter AA are indoctrinated with this
dogma. It is impossible not to follow it—at least outwardly—and
still participate in the fellowship. Newcomers are taught from their
first meeting that they have a new birthday and a new identity,
introducing themselves accordingly with the ritualistic phrase,
"Hi, I'm Jim. I'm an addict."
No one can speak the truth: "Hi, I'm Jim.
I've been self-medicating my depression unknowingly."
Addiction is a complex and multifactorial disorder.
The key to recovery lies in following an appropriate medical regimen,
not in redefining one's self.
Convincing addicted individuals that their problem
derives from a character defect, by its very nature, has the primary
effect of lowering self-esteem. Alternatively, informing them that
they may be vulnerable to drugs because of a biologic predisposition
to addiction can educate and empower them to avoid situations that
exacerbate their condition.
The medical community must help society to more
clearly see the whole picture of addiction. Chemical dependency
and addiction affect all aspects of a person's life: economic, biological,
social, psychological, educational, and vocational. Effective treatment
programs must be comprehensive, providing what is known in today's
parlance as "wrap-around services" that address the general
psychobiologic aspects of addiction, as well as the unique underlying
problems and needs of each individual.
The system incarcerates thousands of ill or nonviolent
citizens for the possession of drugs that most are using to self-medicate.
Their incarceration simply affirms their "character defects"
and presents opportunities to learn more ways to get drugs and commit
crimes to maintain their habits. Drug users move in and out of the
revolving doors of prisons and inadequate recovery programs that
do nothing to break the cycle of addiction.
Both the World Health Organization and the National
Institute of Drug Abuse have indicated the need for a comprehensive
treatment model for addiction. So far, however, few programs have
emerged that present drug users with either a comprehensive psychosocial
and psychobiological orientation or the dignity and respect accorded
patients with other illnesses.
AA cofounder Bill Wilson's statement that "the
discoveries of the psychiatrist and the biochemist have vast implications
for us alcoholics" rings true more loudly today than when he
first uttered it 4 decades ago. With the knowledge and procedures
we now have, it is time to set aside 1930s solutions that will no
longer work for our 21st-century problems. |
Symptoms
of Alcohol Withdrawal
Source: National
Institutes of Health
Withdrawals Can Be Mild, Moderate
or Severe
Alcohol withdrawal refers
to a group of symptoms that may occur from suddenly stopping the
use of alcohol after chronic or prolonged ingestion.
Not everyone who stops drinking
experiences withdrawal symptoms, but most people who have been drinking
for a long period of time, or drinking frequently, or drink heavily
when they do drink, will experience some form of withdrawal symptoms
if they stop drinking suddenly.
There is no way to predict
how any individual will respond to quitting. If you plan to stop
drinking and you have been drinking for years, or if you drink heavily
when you do drink, or even if you drink moderately but frequently,
you should consult a medical professional before going "cold
turkey."
Withdrawal Symptoms:
Mild to moderate psychological symptoms:
Feeling of jumpiness or nervousness
Feeling of shakiness
Anxiety
Irritability or easily excited
Emotional volatility, rapid emotional changes
Depression
Fatigue
Difficulty with thinking clearly
Bad dreams
Mild to moderate physical symptoms:
Headache - general, pulsating
Sweating, especially the palms of the hands or the face
Nausea
Vomiting
Loss of appetite
Insomnia, sleeping difficulty
Paleness
Rapid heart rate (palpitations)
Eyes, pupils different size (enlarged, dilated pupils)
Skin, clammy
Abnormal movements
Tremor of the hands
Involuntary, abnormal movements of the eyelids
Severe symptoms:
A state of confusion and hallucinations
(visual) -- known as delirium tremens
Agitation
Fever
Convulsions
"Black outs" -- when the person forgets what happened
during the drinking episode |
Liver Patients Offered a Lifeline
Jo Revill, Health Editor
Observer (London)
Sunday, January 2, 2005
The increasing
number of middle-aged patients with chronic liver disease caused by
heavy drinking is forcing doctors to look at new ways of saving their
lives. A pioneering trial to help seriously
ill people will begin this month, using the patient's own cells
to regenerate the organ. By injecting patients with their own stem
cells, the basic 'building blocks' for all kinds of cells, doctors
hope that the liver can regrow itself to a point where the organ
starts to work again.
The trial is experimental, but follows other
work which shows that stem cells have helped patients with heart
failure. The dire shortage of donor organs for transplant has encouraged
the specialists to think of new ways of helping patients who otherwise
have a very bleak future.
One in 20 people in Britain is now dependent
on alcohol and a similar number are at serious risk of liver disease.
Physicians and government experts have warned that alcohol-related
harm - severe liver disease and injuries caused by drink-related
violence - are on the rise as the nation's drinking habits become
heavier.
Deaths from liver disease in patients under 50
have risen sevenfold in the past 30 years and surgeons have warned
they are seeing a growing number of patients with cirrhosis of the
liver, a condition where the healthy liver tissue is gradually replaced
by scarred, useless tissue. The disease is insidious, because apparently
healthy people may have it without knowing and the first signs do
not occur until a late stage of the disease.
When alcohol is drunk, it is quickly absorbed
and passes in the bloodstream to the liver, where it can cause excessive
fat to be deposited within the liver cells. Between 20 and 30 per
cent of those who drink heavily beyond the initial stages of liver
damage will develop alcoholic hepatitis, a condition which can be
fatal. A smaller number, about 10 per cent, go on to develop cirrhosis.
Although alcohol is the leading cause of cirrhosis, it can also
be brought on by forms of hepatitis or by some toxic chemicals.
Scientists at Imperial College London believe
stem cell therapy holds out enormous hope for those who need new
organs. Professor Nagy Habib, head of liver surgery at London's
Hammersmith Hospital, who is running the trial, said: 'The liver
is a wonderful organ in the way it can regenerate itself, but if
there is a lot of damage it stops functioning properly. If we can
get 15 to 20 per cent of the organ regenerated, then that is enough
to really improve the patient's condition. These cells seem to have
the fantastic ability to become whatever is needed in order to repair
the damage.'
By injecting the patient's own stem cells, taken
from their blood, directly into the bloodstream, the researchers
hope they may be able to improve the function of the liver by getting
the stem cells to repopulate the liver.
The procedure, known as leukapheris, involves
taking blood from a patient and then separating it into its component
parts. The stem cells are taken from the white blood cells, while
the red blood cells are returned to the body through the arm. Habib
and his team then inject the stem cells into the hepatic artery,
the vessel which goes into the liver.
Habib believes they have to look at all the potential
cures. There are about 700 liver transplants in the UK each year,
but 7,500 die annually from liver disease. Alcohol is the major
reason for a transplant, followed by the virus hepatitis C. 'The
demand for a transplant has really risen,' said Habib. 'We don't
have the equivalent of a kidney dialysis machine for these patients,
so unfortunately most of them will die while waiting for an organ.'
It is not yet known how many stem cells may be
needed for the trial to succeed. The worse the patient's liver function,
the more cells may be necessary. 'If you can provide 1 per cent
of liver cell mass, and then allow that 1 per cent to grow over
a three-month period, it's possible that the liver will have enough
healthy cells to behave properly, and start to produce what it needs,'
said Habib.
Like many specialists, he worries that people
do not understand the damage that can be done by heavy, prolonged
drinking. 'If people could see what life was like in the final stages
of liver failure, they might think seriously about giving up at
a much earlier point,' he said. 'The liver is a very forgiving organ,
but there's a limit to how much alcohol it can process before the
damage sets in.' |
Alcohol
Abuse vs. Alcohol Dependence.
What Is The
Difference?
About.com
Q: What is the difference between alcohol
abuse and alcohol dependence?
A: Alcohol abuse is described as any "harmful use" of
alcohol.
The Diagnostic and Statistical Manual of Mental
Disorders IV describes alcohol abusers as those who drink despite
recurrent social, interpersonal, and legal problems as a result
of alcohol use. Harmful use implies alcohol use that causes either
physical or mental damage.
Those who are alcohol dependent
meet all of the criteria of alcohol abuse, but the will also exhibit
some or all of the following:
- Narrowing of the drinking repertoire (drinking
only one brand or type of alcoholic beverage).
- Drink-seeking behavior (only going to social
events that will include drinking, or only hanging out with others
who drink).
- Alcohol tolerance (having to drink increasing
amounts to achieve previous effects).
- Withdrawal symptoms (getting physical symptoms
after going a short period without drinking).
- Drinking to relieve or avoid withdrawal symptoms
(such as drinking to stop the shakes or to "cure" a
hangover).
- Subjective awareness of the compulsion to
drink or craving for alcohol (whether they admit it to others
or not).
- A return to drinking after a period of abstinence
(deciding to quit drinking and not being able to follow through).
Typically, those drinkers who are diagnosed as
only alcohol abusers can be helped with a brief intervention, including
education concerning the dangers of binge drinking and alcohol poisoning.
Those who have become alcohol dependent generally
require outside help to stop drinking, which could include detoxification,
medical treatment, counseling and/or self-help group support.
|
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American Council on Alcoholism (ACA) is a national non-profit 501
(c) 3 health organization and a member of the following organizations: |
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American Council on Alcoholism is an information
and referral service for individuals who suffer from alcohol dependence,
their families, treatment professionals and the general public
who are seeking a broad range of information on alcohol, alcohol
dependence, alcohol abuse and options for recovery.
Search words for this site include: alcoholism treatment, alcohol,
alcoholic, alcoholism, alcohol abuse, treatment, drunk driving,
dui, dui courts, dwi, drug courts, prevention, substance abuse,
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binge drinking, underage, naltrexone, drinking problem, alcohol
recovery.
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