The Role of Uncontrollable Trauma in the Development of PTSD and Alcohol Addiction

By Joseph Volpicelli, M.D., Ph.D.; Geetha Balaraman; Julie Hahn; Heather Wallace, M.A.; and Donald Bux, Ph.D.

After a traumatic event, people often report using alcohol to relieve their symptoms of anxiety, irritability, and depression.

Alcohol may relieve these symptoms because drinking compensates for deficiencies in endorphin activity following a traumatic experience. Within minutes of exposure to a traumatic event there is an increase in the level of endorphins in the brain.

During the time of the trauma, endorphin levels remain elevated and help numb the emotional and physical pain of the trauma.

However, after the trauma is over, endorphin levels gradually decrease and this may lead to a period of endorphin withdrawal that can last from hours to days. This period of endorphin withdrawal may produce emotional distress and contribute to other symptoms of posttraumatic stress disorder (PTSD).

Because alcohol use increases endorphin activity, drinking following trauma may be used to compensate this endorphin withdrawal and thus avoid the associated emotional distress. This model has important implications for the treatment of PTSD and alcoholism.

Alcohol Research & Health, Vol. 23, No. 4, 1999

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Affiliation with Alcoholics Anonymous after treatment: A study of its therapeutic effects and mechanisms of action.

Relatively little is known about how substance abuse treatment facilitates positive outcomes.

This study examined the therapeutic effects and mechanisms of action of affiliation with Alcoholics Anonymous (AA) after treatment. Patients (N = 100) in intensive 12-step substance abuse treatment were assessed during treatment and at 1- and 6-month follow-ups.

Results indicated that increased affiliation with AA predicted better outcomes.

The effects of AA affiliation were mediated by a set of common change factors.

Affiliation with AA after treatment was related to maintenance of self-efficacy and motivation, as well as to increased active coping efforts.

These processes, in turn, were significant predictors of outcome. Findings help to illustrate the value of embedding a test of explanatory models in an evaluation study.

Research; Morgenstern, Jon; Labouvie, Erich; McCrady, Barbara S; Kahler, Christopher W; Frey, Ronni M. Affiliation with Alcoholics Anonymous after treatment: A study of its therapeutic effects and mechanisms of action. Journal of Consulting & Clinical Psychology. Vol 65(5), Oct 1997, 768-777.

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Psychological Characteristics of Children of Alcoholics

By KENNETH J. SHER, PH.D.

More than 20 years ago, researchers first noted that children of alcoholics (COA’s) appeared to be affected by a variety of problems over the course of their life span.

Such problems include;

fetal alcohol syndrome, which is first manifested in infancy;

emotional problems and hyperactivity in childhood;

emotional problems and conduct problems in adolescence; and

the development of alcoholism in adulthood.

Although much has been learned over the ensuing two decades, a number of controversial research areas remain. In particular, debate stems from the fact that despite a common interest in COA’s, clinically focused literature and research-focused literature have resulted in two distinct bodies of knowledge. This article reviews important research results, with emphasis on findings generated by the alcohol-research community. Attention also is given to examining the empirical validity of concepts that have been advanced by several influential clinicians from the COA field.

ALCOHOL HEALTH & RESEARCH WORLD, VOL. 21, NO. 3, 1997

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Brief-TSF Description

Brief Twelve Step Facilitation (Brief-TSF) is a new synthesis of experience and research covering the last 65 years. Varied forms of TSF have been devised and utilised by a variety of helpers since Twelve Step Fellowships originated by Alcoholics Anonymous (AA). These range from simple advice to ‘Go to AA’ through various forms of counseling, mandated attendance and coercion to long-term residential treatment.

Brief-TSF, unlike full TSF, is for use by generalist healthcare workers as an adjunctive intervention to their normal practice. It is brief in that Brief-TSF only requires one dedicated session.

Brief-TSF can be used as;

• a discrete structured assertive intervention,
• in an opportunistic supportive mode or,
• simply as a knowledge base for healthcare workers who wish to respect a clients/patients choice of recovery through a twelve step fellowship.

Brief-TSF is intended to be utilised in ‘mainstream’ healthcare as an earlier intervention to prevent harms such as family breakdown, legal sanctions, medical complications, anti-social behaviour, employment interruption & etc.

Brief-TSF consists of a brief and structured approach to facilitating early recovery from alcoholism. It is intended to be implemented on an individual basis and is based in behavioural, spiritual, and cognitive principles that form the core of 12 step fellowships such as Alcoholics Anonymous (AA). It is suitable for those who are alcohol dependent.

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Slogans for everyday life and the ethical practices of Alcoholics Anonymous

Alcoholics Anonymous has developed an oral tradition for teaching people to alter their relation to their own desires and their own freedom fundamentally, teaching that is done through practice rather than through ideas.

Our study of AA’s innovative organisational tools for building long-lasting mutual-help groups shows that the same tools that build the organisation also exemplify and embody the organisation’s ethical worldview.

To that extent, AA’s group practices are worth studying not only from the point of view of learning about bottom-up, non-expert-led networks but also to shed light on the development of a popular pragmatist ethics in which little techniques – anonymity, the focus on the 24-hour cycle, etc. – deconstruct the Kantian distinction between means and ends.

This study of the everyday ethics of AA members argues that AA’s unique role in the history of popular ethical practices can be traced to several original features.

• First, AA incorporates elements of the disease model of alcoholism while remaining fundamentally a spiritual programme, thus mapping an important hybrid terrain often ignored by students of medicalisation.
• Secondly, AA was able to steer away from the political controversies about temperance, prohibition, and control of alcoholic beverages that had made the old temperance movement founder.
• Thirdly and most importantly, AA uniquely managed to combine the once-in-a-lifetime experience of total transformation that is characteristic of religious conversion with the development of a series of slogans and mental techniques for dealing with the ‘trivial’ details of life.

This paper first outlines the hybrid terrain of AA, between medicine and religion, and then examines a few of the techniques that are at the core of AA’s success, including anonymity, the Higher Power, and the twenty-four hour cycle.

Valverde M. & White-Mair K. (1999), One Day At A Time and other Slogans for Everyday Life the Ethical Practices of Alcoholics Anonymous. Sociology (1999), 33:393-410

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New Findings on Asian Alcohol-Protection Gene

Only certain East Asian populations have a high prevalence of a gene that protects against alcohol over-consumption, and researchers speculate that some event must have occurred over the past few thousand years to make this genetic protection advantageous, Reuters reported.

Yale University researchers said that unknown environmental factors are the likely cause for the prevalence of the ADH1B*47His gene variant among some Asian populations, but not others. The gene causes rapid metabolism of alcohol into acetaldehyde, a chemical that produces hangovers, flushing, nausea and other unpleasant symptoms that make even moderate drinking a poor experience.

Researchers found that the gene variant was very prevalent in East Asia, fairly common in West Asia and North Africa, and rare in other parts of the world. In Asia, the gene was most common among speakers of the Hmong and Altaic languages. Within these groups, environmental factors apparently made survival more likely among individuals with the gene than those who lacked the variant.

However, researchers doubt that protection against alcoholism was the key to survival, noting that consumption of highly concentrated forms of alcohol is a relatively recent phenomenon. One possibility is that the gene protected these populations from toxins in their traditional foods that was not present in the diets of other populations.

The study was published in the journal PLoS One.

See also;

• Brief-TSF can assist patients cease alcohol consumption.
• 12-Step Treatment More Effective than Alternative
• Subscribe to Twelve Step Facilitation by e-Mail

Counseling the Culturally Diverse: Theory and Practice by Derald Wing Sue, David Sue Read more about this title…

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Brief-TSF Theoretical Rationale/Mechanism of Action

The theoretical rationale is based in the 12 steps and 12 traditions of AA and includes the need to accept that willpower alone is not sufficient to achieve sustained sobriety, that self-centredness must be replaced by surrender to the group process/conscience, and that long-term recovery consists of a process of spiritual renewal. The primary mechanism action is active participation and a willingness to accept a higher power, even if it is the AA group at first, as the locus of change in one’s life.

Agent of Change

The facilitator in the Brief-TSF treatment model is more truly a facilitator of change than an agent of change. The true agent of change (to sustained sobriety) lies in active participation in AA along with the principles set forth in the 12 steps and 12 traditions that guide this fellowship.

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Bulimia Nervosa and Substance Use Disorder Similarities and Differences

Abstract

The purpose of this study was to compare bulimia nervosa (BN) and substance use disorders (SUD) in cognitive-motivational terms.

The cognitive orientation theory was used as a framework for testing the hypothesis that the commonality between BN and SUD consists of a similar motivational disposition for eating disorders, rather than for addiction, as was previously claimed.

It was expected that BN and SUD patients would differ from controls but not from each other.

The participants were 31 BN, 20 SUD, and 20 healthy controls. They were administered questionnaires for assessing anxiety, depression, addiction and the cognitive orientation for eating disorders.

On most parameters BN and SUD scored higher than controls but did not differ from each other except in norm beliefs.

Treatment of BN should consider the similarity of BN to SUD in the pathological tendency for eating disorders.

Research; Bulimia Nervosa and Substance Use Disorder Similarities and Differences; A. Ram;  D. Stein;  S. Sofer; S. Kreitler. Eating Disorders, Volume 16, Issue 3 May 2008 , pages 224 – 240

See also;

• Recovery MP3 tracks for all 12-Step Fellowships
• HALT being Hungry, Angry, Lonely, Tired
• If you have healthcare training this manual may help.
• Subscribe to Twelve Step Facilitation by e-Mail

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Protective resources and long-term recovery from alcohol use disorders.

AIMS: This study examined indices of personal and social resources drawn from social learning, behavioral economics, and social control theories as predictors of medium- and long-term alcohol use disorder outcomes.

DESIGN AND MEASURES: Individuals (N = 461) who initiated help-seeking for alcohol-related problems were surveyed at baseline and 1, 3, 8, and 16 years later.

At baseline and each follow-up, participants provided information about their personal and social resources and alcohol-related and psychosocial functioning.

FINDINGS: In general, protective resources associated with;

• social learning (self-efficacy and approach coping),
• behavioral economics (health and financial resources and resources associated with Alcoholics Anonymous), and
• social control theory (bonding with family members, friends, and coworkers)

predicted better alcohol-related and psychosocial outcomes.

A summary index of protective resources associated with all three theories significantly predicted remission.

Protective resources strengthened the positive influence of treatment on short-term remission and partially mediated the association between treatment and remission.

CONCLUSIONS: Application of social learning, behavior economic, and social control theories may help to identify predictors of remission and thus to allocate treatment more efficiently.

Research; Moos RH, Moos BS. Protective resources and long-term recovery from alcohol use disorders. Drug Alcohol Depend. 2007 Jan 5;86(1):46-54.

Motivational Interviewing, Second Edition: Preparing People for Change by William R. Miller, Stephen Rollnick Read more about this title…

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Faith Community Nurses and the Prevention and Management of Addiction Problems

Faith Community Nurses can have a role in the prevention and management of problems associated with the use and abuse of psychoactive substances, prescription drugs, and over-the-counter medications.

Religious perspectives of faith communities on the use of drugs vary considerably, as do the religious perspectives of addiction.

Nevertheless, Faith Community Nurses work in these communities and understand the unique culture of these groups.

The Faith Community Nurse has many functions including health educator, health advocate, personal health counselor, referral agent, coordinator of volunteers, developer of support groups, and integrator of health and faith.

Consequently, the Faith Community Nurse is involved with individuals, families, and members of the community.

These connections provide many opportunities for the Faith Community Nurse to institute programs to prevent addictions, help people understand the problems of addiction, help provide a caring community for people suffering from addictions, and guide people to the help they need.

In addition, the nurse has opportunities to conduct research that would enhance the understanding of the topic.

Research; Joan A. Bard. Faith Community Nurses and the Prevention and Management of Addiction Problems. Journal of Addictions Nursing, Volume 17, Issue 2 July 2006 , pages 115 – 120

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