Substance Use Disorders American Dental Association.

Research tells us that dentists are no more-or less-likely to develop substance use disorders (alcohol or drug abuse or dependence) than the general population. In other words, 10-15 percent of dentists will have a drug and/or alcohol problem sometime in their lives.

Substance use disorders are part of the human condition, and touch as many as one in four American families.

What IS different for dentists and other health professionals than for the general population is the public trust that goes with the privilege to practice, and the responsibility to obey the state dental practice acts and controlled substance regulations.

An untreated substance use disorder in a dentist can not only threaten the dentist’s life and family stability, but place patients, and the practice itself, in jeopardy.

More at; American Dental Association

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Increase in Nicotine Receptors Makes Quitting Harder

Smokers have more nicotine receptors in their brains than nonsmokers, making it more difficult for them to quit, according to researchers at Yale University.

Researchers used brain-scanning technology to compare the nicotine receptors of 16 smokers who had abstained for four days with scans from a group of 16 nonsmokers. They found that the density of common nicotine receptors was higher among smokers during early abstinence, contributing to withdrawal symptoms.

"Nicotine craving is an important factor associated with relapse," said lead author Julie Staley. "This study paves the way for determining whether medications normalize the number of receptors and why some smokers, such as women and those with neuropsychiatric disorders, have more difficulty quitting smoking."

Research report: Staley, J. K., et al. (2006) Human Tobacco Smokers in Early Abstinence Have Higher Levels of Nicotinic Acetylcholine Receptors than Nonsmokers. J. Neurosci., 26: 8707-8714.

From; Join Together Online

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Lemberg (1992) proposes a model of development whereby a person moves from voluntary dieting through a number of stages to reach a fully entrenched eating disorder.

Stage 1: Normal, voluntary dieting behaviour.

Unfortunately dieting behaviours have become the “norm”, with

• 47% of people in Australia having tried to lose weight in the past twelve months.
• 68% of fifteen year old girls are dieting at any one time,
• 8% of these are on a severe diet.

While these diets are severe enough to be considered an eating disorder, they are unhealthy and result in rapid weight changes, disrupted metabolism, dehydration, low energy and lack of essential vitamins, minerals and nutrients.

Stage 1B: (in Bulimia Nervosa only).

The hunger associated with dieting and restriction leads to severe and constant cravings, which result in loss of control and overcompensation by bingeing on large amounts of food.

Stage 2: A Diagnosable Disorder.

At this stage the dieting behaviour has become a diagnosable mental illness according to the Diagnostic & Statistical Manual IV-TR (APA, 2000). At this stage there are serious consequences and a morbid fear of fatness, and the dieting is no longer under the person’s control.

However the person is unable to see the negative consequences and is in denial of the eating disorder. In bulimia nervosa the bingeing behaviours, rather than being due to dietary restriction, occur more generally as a result of stress or negative emotional states.

Stage 3A: Autonomous Behaviour.

At this stage the person is generally able to see there is a problem, but as the behaviours are no longer under the person’s control, the disorder does not resolve even if precipitating conditions have been resolved.

Stage 3B: Illness becomes the identity.

At this stage, rather than the eating disorder behaviours being a solution to a problem, the person now identifies him or herself only with the eating disorder and has difficulty separating themselves from the illness. The eating disorder behaviours are now constant rather than used as coping strategies, and the person feels they are nothing without their illness.

They identify with being the illness, i.e. I am anorexic, rather than I have anorexia.  The prospect of giving up the disorder can lead to existential fears of nothingness.

Recovery requires not only finding alternative coping strategies, but helping the person address the underlying issues of existential reality.

Overeaters Anonymous may help with any eating disorder.

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A cohort study of male subjects attending an Alcoholics Anonymous program in India: One-year follow-up for sobriety.

A cohort of subjects in India who completed detoxification treatment and a de-addiction program based on the Alcoholics Anonymous (AA) model were followed-up at 1 year to investigate the factors associated with complete abstinence.

Patients (N = 187 men) who were admitted consecutively to an addiction facility and fulfilled Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for alcohol dependence were recruited for the study.

Patients with major psychopathology were excluded. The final outcome at 1 year was determined by visiting the patients and talking to the families and members of the local AA group.

Of the 187 men initially recruited, 5 were excluded because of major psychopathology, 1 committed suicide, and 7 could not be traced.

Of the 174 patients available for follow-up, 58 (33.3%) remained sober (complete abstinence for the past year) at 1 year.

Patients coming from distant places and those with follow-up workers in their localities fared better than those from the local area and those from towns where there was no one to motivate them to continue with AA meetings.

These variables were significantly associated with sobriety even after adjustment for other confounders using multivariate techniques. A third of the cohort remained sober at 1-year follow-up.

The patients’ initial motivation and continued support once they returned to their communities were associated with sobriety at follow-up.

Research report; Kuruvilla PK; Vijayakumar N; Jacob KS. A cohort study of male subjects attending an Alcoholics Anonymous program in India: One-year follow-up for sobriety. Journal of Studies on Alcohol 65(4):546-549, July 2004.

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