Topiramate as add-on therapy in non-respondent alcohol dependant patients: a 12 month follow-up study.

INTRODUCTION: Topiramate is a neuromodulator drug with different action mechanisms that could be implicated in alcohol dependence. It has been studied in open and double-blind studies.

METHOD: In a group of patients (n = 64) undergoing standard treatment for alcohol dependence (according to ICD-10 criteria) with poor outcomes, a 12 month observational, prospective and multicenter study was conducted to assess the usefulness and tolerability of topiramate as addon therapy.

Outcome measures were retention rate, alcohol consumption (days of drinking per month and number of Standard Drink Units [SDU] per day, and results of Alcohol Dependence Intensity Scale [ADIS]), craving and priming visual scales and serum transaminase levels.

RESULTS: In these patients, adding topiramate medication leads to a significant decrease (p<0.001) in all the variables studied, including those derived from the craving and priming visual scales, the ADIS as well as the number of drinks/day and SDU/day consumed, the MCV and GGT values.

Mean topiramate dose was almost 200 mg/day. Only three patients dropped out due to adverse reactions.

CONCLUSIONS: Topiramate showed positive results for alcohol dependence in real clinical practice, with a significant decrease in

• craving-priming and
• dependence intensity scales,
• number of drinking days per month reported and
• transaminase levels.

Topiramate seems to be a useful and well-tolerated pharmacological aid for patients with bad evolution in their alcohol dependence treatment.

Research; Fernandez Miranda JJ, Marina Gonzalez PA, Montes Perez M, Diaz Gonzalez T, Gutierrez Cienfuegos E, Antuna Diaz MJ, Bobes Garcia J. Topiramate as add-on therapy in non-respondent alcohol dependant patients: a 12 month follow-up study. Actas Esp Psiquiatr. 2007 Jul-Aug;35(4):236-42.

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An Evaluation of the Therapeutic Programme Conducted by the Southern Regional Alcohol-Abuse Treatment Centre: Study on the Programme’s Results One Year after Discharge from Inpatient Care.

Given the clinical and social problems caused by the consumption of alcohol in most industrialised countries, there is a strong need to develop and evaluate the effectiveness of integrated care programmes.

In this study, the authors describe the results observed in 124 sequentially admitted subjects at various points throughout the course of the first year after their discharge from the Southern Regional Alcohol-Abuse Treatment Centre (CRAS) in Lisbon, Portugal.

An inpatient stay at this unit of CRAS lasts for between 5 and 7 weeks and implies that the patient must submit him/herself to a therapeutic model which has been adapted from the Minnesota model which includes attendance at 12 Step Alcoholics Anonymous meetings.

At the end of the year under study 44.3% of the patients were still abstinent, 40.3% were consuming alcohol and 15.4% did not reply.

51 patients (41.1% of the initial sample) were still in regular contact with CRAS for further treatment at that point.

The variable that was found to possess the most significant association with a favourable outcome was adherence to the therapeutic programme over the course of that year.

Domingos Neto, Miguel Xavier, Paula Lucena, Ana Vieira da Silva. An Evaluation of the Therapeutic Programme Conducted by the Southern Regional Alcohol-Abuse Treatment Centre: Study on the Programme’s Results One Year after Discharge from Inpatient Care. European Addiction Research 2001;7:61-68

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Paths of entry into Alcoholics Anonymous: Consequences for participation and remission.

Three groups of individuals with alcohol use disorders who, in the first year after initiating help-seeking were compared:

• those who entered Alcoholics Anonymous (AA) only,
• those who entered professional treatment and AA together, and
• those who entered professional treatment only.

A sample of initially untreated individuals (N = 362) was surveyed at baseline and 1 year, 3 years, 8 years, and 16 years later.

At each contact point, participants described their participation in AA and treatment and their current alcohol-related functioning. They also described their reasons for entering AA and/or treatment and the perceived benefits of these sources of help.

• Compared with individuals who initially participated only in treatment but later entered AA, those who entered treatment and AA together participated in AA longer and more frequently and were more likely to achieve remission.
• Among individuals who initially participated only in AA, those who later entered treatment had poorer remission outcomes than those who did not enter treatment.
• Longer duration of participation in AA was associated with a higher likelihood of remission at all four follow-ups;
• individuals who dropped out of AA were more likely to relapse or remain nonremitted.

those who entered treatment and AA together participated in AA longer and more frequently and were more likely to achieve remission.

In conclusion, compared with individuals who participated only in professional treatment in the first year after they initiated help-seeking, individuals who participated in both treatment and AA were more likely to achieve remission.

Individuals who entered treatment but delayed participation in AA did not appear to obtain any additional benefit from AA.

Moos, Rudolf H. and Moos, Bernice S.  Paths of entry into Alcoholics Anonymous: Consequences for participation and remission.  Alcoholism: Clinical & Experimental Research 29(10):1858-1868, October 2005.

Brief-TSF is designed as adjunctive therapy with AA.

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Some women in the U.S. and U.K. are choosing to skip dinner and drink alcohol instead in hopes of losing weight, but the strategy is flawed because of the high caloric content of alcohol, the Telegraph reported March 19.

In a practice dubbed “drunkorexia,” women may drink a glass or two of wine rather than eating a meal in a pattern that seems to combine two dangerous behaviors: binge drinking and eating disorders.

“They get fully hooked, it is an extremely noxious thing,” said Janet Treasure, head of the eating-disorders unit at the Institute of Psychiatry in London. “It is more common with bulimia than anorexia but you get the combination of empty calories with no nutritional value and the risky behavior that goes with being drunk.”

“You are more likely to be binge drinking,” added Susan Price of the British Dietetic Association. “What you should do is eat a healthy balanced diet and choose low calorie mixers and non-alcohol low calorie soft drinks.”

Diets that focus on limiting daily food intake may unintentionally encourage the problem, but experts note that alcohol has more calories on a gram-for-gram basis than carbohydrates or protein. A 250 ml glass of wine, a standard large pour in pubs, contains more calories than a light lunch, for example. Some beers contain 250 calories per pint.

From Join Together Online

See also;

• Brief-TSF can assist people cease alcohol consumption.
• ‘Drunkorexics’

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Bupropion and nicotine patch as smoking cessation aids in alcoholics

This is a double-blind placebo-controlled study of sustained-release bupropion as a smoking cessation aid in alcoholics undergoing treatment for their alcoholism.

Participants (N=58) were enrolled within 1 week of entry into alcohol treatment from community and Veterans Affairs Substance Use Disorder programs.

All participants received nicotine patch and were invited to attend a smoking cessation lecture and group. Cigarette smoking and alcohol outcomes were measured at 6 months.

Bupropion when added to nicotine patch did not improve smoking outcomes.

One third of participants on bupropion reported discontinuing the drug during weeks 1-4.

Participants reported cigarette outcomes with nicotine patch that are similar to those seen in the general population.

All study participants significantly reduced cigarette use.

Comorbid affective disorder or antipersonality disorder did not affect outcomes.

Alcohol outcomes were improved in those who discontinued cigarettes.

Research; Grant KM, Kelley SS, Smith LM, Agrawal S, Meyer JR, Romberger DJ. Bupropion and nicotine patch as smoking cessation aids in alcoholics Alcohol. 2007 Aug;41(5):381-391.

The Easy Way to Stop Smoking: Join the Millions Who Have Become Nonsmokers Using the Easyway Method by Allen Carr Read more about this title…

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Concise Alcoholics Anonymous and TSF Research Summary

All the elements of TSF have moderate to strong research support, most of which has been replicated.

NB: AA does not participate in research but individual members do. The huge volume of peripheral research supports a strong case for recommending AA participation by alcoholics. Additionally, testimony of the effectiveness of AA are the two million current sober members of Alcoholics Anonymous.

We know: -

• that Twelve Step Facilitation reduces alcohol abuse, improves related consequences, and improves employment prospects.
• that Alcoholics Anonymous has good efficacy, and that Peer Sponsoring/social support is an essential element in AA’s success.
• that recovering people who help recovering people maintain better sobriety and have greater involvement in the general community.
• that men, women, adolescence, African-Americans, Hispanics and gay men benefit from AA. That all socio-demographic groups are represented.
• that AA is also suitable for head trauma victims, and methadone patients.
• that AA has wide acceptance and is readily available in almost all communities. The current global membership of AA is approximately 2.06 million.
• that participation in Alcoholics Anonymous improves medication compliance for mental health patients, improves psychological functioning, Improves coping, reduces child abuse and domestic violence, reduces healthcare usage, reduces hospitalization, reduces medical symptoms, reduces subsequent treatment demand, reduces mortality, and reduces associated costs.
• that healthcare workers have good success rates for substance abuse treatment and recovery from alcoholism that can be improved with AA participation.
• that alcoholics with social networks supportive of drinking have better outcomes if they initiate AA attendance while in treatment.
• that affiliation with AA is enhanced if prospects gain an awareness of the culture and methods used by AA and that sobriety is better than drinking prior to attending AA.
• that 80% of Australian, 87% of USA, and 65% of UK doctors believe that Alcoholics Anonymous is the treatment of choice for alcoholism, but overall they do not understand how AA works.
• that more than 80% of specialist alcohol and drug treatment staff support Alcoholics Anonymous treatment referral and 92% of another specialist A & D service requested training in 12 Step approaches.
• that AA Peer Sponsor contact at the healthcare worker office/institution increases initiation and sustained attendance at AA meetings.
• that active and regular AA participation is one of the more effective ways to effect lifestyle changes for alcoholics.
• that routinely engaging patients in continuing outpatient care is likely to yield better outcomes..
• that most people in the early stages of alcoholism seek help from GP’s or Community Health Centers.
• that individuals with substance abuse medical conditions benefit from integrated medical and substance abuse treatment, and approaches such as TSF can be cost-effective.
• that for every $1.00 invested in intervention with alcoholics $4.30 is saved in future healthcare costs.

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Alcoholics Anonymous is not organized in the formal or political sense. There are no governing officers, no rules or regulations, no fees or dues.

The need for certain services to alcoholics and their families throughout the world has, however, been apparent from the beginning of the Fellowship. Inquiries have to be answered. Literature has to be written, printed, and distributed. Requests for help are followed up.

There are two operating bodies:

1. A.A. worldwide services, directed by A.A. World Services, Inc., are centered in the General Service Office in New York City, where 79 workers keep in touch with local groups, with A.A. groups in treatment and correctional facilities, with members and groups overseas, and with the thousands of “outsiders” who turn to A.A. each year for information on the recovery program. A.A. Conference approved Literature is prepared, published, and distributed through this office.

2. The A.A. Grapevine, Inc., publishes the A.A. Grapevine, the Fellowship’s monthly international journal. The magazine currently has a circulation of about 106,000 in the U.S., Canada, and other countries. The Grapevine also produces a selection of special items, principally cassette tapes and anthologies of magazine articles, which are spin offs from the magazine.

The two operating corporations are responsible to a board of trustees (General Service Board of A.A.), of whom seven are nonalcoholic friends of the Fellowship, and 14 are A.A. members.

A General Service Conference, consisting of 93 delegates from A.A. areas in the United States and Canada, and trustees, A.A.W.S. and Grapevine directors, and staff from the General Service Office and the Grapevine in New York, meets once a year and provides a link between the groups throughout the U.S. and Canada and the trustees who serve as custodians of A.A. tradition and interpreters of policies affecting the Fellowship as a whole.

At the local group level, formal organization is kept to a minimum. The group may have a small steering committee and a limited number of rotating officers — “trusted servants” whose responsibilities include arranging meeting programs, providing refreshments, participating in regional A.A. activities, and maintaining contact with the General Service Office.

The principle of consistent rotation of responsibility is followed in virtually all A.A. service positions. Positions in the local group are usually rotated semiannually or annually. Delegates to the General Service Conference traditionally serve no longer than two years and alcoholic trustees of the General Service Board are limited to a four year term.

A.A. FACT FILE PREPARED BY GENERAL SERVICE OFFICE OF ALCOHOLICS ANONYMOUS

This document is available on the A.A. Web site: www.aa.org

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The Symptoms of Alcohol Dependence or Alcoholism

What symptoms of alcoholism does adjunctive Brief-TSF address?

Brief-TSF and the symptoms of alcohol abuse.

Medical, psychosocial and spiritual professional healthcare workers are regularly presented with symptoms of alcohol abuse that are readily assessed or which may be masked by other symptoms; or denied.

The Brief-TSF course explores the signs and symptoms of alcohol abuse and dependence and provides screening and assessment tools along with best practice evidence based application of their use.

Medical symptoms of alcoholism.

The medical symptoms of alcoholism are; Hangovers, blackouts, injuries, lethargy, weight gain or loss, poor coordination, high blood pressure, impotence, vomiting, nausea, cirrhosis of the liver, pancreatic disease, brain damage, peripheral neuropathy and tolerance to alcohol.

Psychological signs of alcohol dependence.

The psychological symptoms of alcohol dependence are; Poor concentration, sleep problems, cloudy thinking, depression, anxiety/stress, aggression, loss of control of drinking, denial of effects of alcohol.

Social aspects of alcohol abuse

The social aspects of alcohol abuse are; Difficulties and arguments with family or friends, difficulties performing at work or home, unemployment, withdrawal from friends and social activities, legal problems, financially insecure.

Spiritual affect of alcohol addiction.

The spiritual affect of alcohol addiction are; Dysthymia or mild chronic depressed, ‘restless, irritable and discontent’ (Alcoholics Anonymous, 1976 p Page xxviii), self-centered, insecure, self-pitying, resentful, fearful and feeling useless.

Healthcare workers such as nurses, doctors, psychologists, social workers, faith based workers (pastors, Rabbis, priests, ministers, other clergy), counselors and trained volunteers will recognize these symptoms and be able to address them after completion of the Brief-TSF training course.

Brief-TSF incorporates screening, assessment, disturbing denial, identifying loss of control of alcohol, taking an alcohol abuse and treatment history, assessing effects of alcohol and drugs, relapse prevention, psychological aspects and an overview of Alcoholics Anonymous (AA).

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Stages of Affiliation with Alcoholics Anonymous

 How do alcoholics get to AA?¹

AA has grown to over 100,000 groups with more than two million members simply on word-of-mouth recommendation. Often the recommendation has come from friends, family, employers, healthcare workers or law courts.

People progress through stages of affiliation with others and with Alcoholics Anonymous in pursuit of solutions to their problems. Two paths are identified; Direct Affiliation and Facilitated Affiliation².

The stages are not necessarily discrete where a person moves in clear progression from one stage to the next. A person is more likely to move up and down, sometimes jumping a stage in regression or progression. However, AA reports that 51% of current members stayed sober from their first meeting.

Facilitation plays a significant part in the process of AA affiliation as approximately 60%³ of AA members seek help from the helping professions prior to attending AA.

These stages of affiliation generally follow Prochaska and DiClemente Stages of Change model and are;

• Pre-contemplation,
• Contemplation,
• Preparation,
• Non-affiliation,
• Affiliation,
• Misaffiliation,
• Affiliation-mandated,
• Supra-affiliation,
• Altruistic affiliation,
• Ambivalent affiliation,
• Disaffiliation,
• Re-affiliation.

Related Reading:

Despite decades of using a chronic disease metaphor for alcoholism and, more recently, drug addiction, we continue to provide treatment based on an acute model of care.

Is it time to shift to a chronic care approach similar to disease management models?

To explore this question, a recent study analyzed data demonstrating the chronic nature of addiction.

• Over 50% of people who resolve drug problems following treatment receive multiple episodes of care, usually over several years.
• Data from 2003 from programs receiving public funds revealed that 64% of people were readmissions to treatment and 19% had more than four admissions.
• In a study of 448 persons following treatment, 82% transitioned at least once between relapse, treatment re-entry, incarceration, and periods of abstinence over a 2-year period.
• Alarming results of a study from 23 states revealed that only 17% of persons discharged from intensive treatment were transitioned to outpatient continuing care.

Several emerging practices for a chronic care model and their results were also reviewed, revealing the following:

• telephonic follow-up resulted in fewer positive cocaine urine tests;
• assertive continuing care for adolescents demonstrated greater access to and participation in continuing care as well as greater abstinence;
• recovery management check-ups at 90-day intervals combined with motivational interventions for those who had relapsed provided a faster return to, and greater participation in, treatment as well as a lesser need for treatment at 2-year follow-up.

The authors discuss the need for substantial system changes required across all elements of the addiction treatment system if a chronic care model is to be implemented.

Comments by Michael Boyle, PhD:
Providers do what they are paid to deliver. If we want to change to a potentially more effective model of addiction treatment, the funding bodies must implement new billing codes and rates for continuing recovery management. Providers need to strive to remove any sense of failure, shame, or guilt persons may have regarding their return to use and need for additional assistance.

Reference:
Dennis M, Scott CK. Managing addiction as a chronic condition. Addict Sci Clin Pract. 2007;4(1):45-55.

From; Join Together Online

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