Study Examines Link Between Stress RelapseA new animal study finds that a stress-related gene and brain chemical may play a role in addiction relapse, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA).Researchers from NIAAA and Camerino University in Italy found that rats that showed a preference for alcohol were more sensitive to stress. Those more prone to relapse under stress were examined for genetic patterns that might offer clues to this trait. Researchers found that these rats had higher expression levels of Crhr1, a gene that encodes the stress-related corticotropin-releasing hormone receptor 1 (CRH-R1).”Our findings demonstrate that the Crhr1 genotype and its expression interact with environmental stress to reinstate alcohol-seeking behavior in this animal model of excessive drinking,” said study leader Anita Hansson, Ph.D., a fellow at NIAAA’s Laboratory of Clinical and Translational Studies.”This finding helps untangle the complex interplay of genetic and environmental factors that influence relapse,” added NIAAA Director T-K Li, M.D. “It also points to potential approaches for treating individuals at risk for relapse.”The research appears in the online edition of the Proceedings of the National Academy of Sciences. 

Research Reference: Hansson, A.C., et al. (2006) Variation at the rat Crhr1 locus and sensitivity to relapse into alcohol seeking induced by environmental stress. Proc. Natl. Acad. Sci.

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What symptoms of alcoholism does Brief-TSF address?

Many signs and symptoms of alcohol abuse may not be apparent even to a close relative or friend.

However, some can be easily seen and some may be hidden by other symptoms; or denied by the drinker.

The Brief-TSF course describes the signs and symptoms of alcohol abuse and alcoholism and provides ways of uncovering them.

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,
• pancreas disease,
• brain damage, 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 and
• denial of the 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 and
• financial insecurity.

Spiritual affects of alcohol addiction.

The spiritual affect of alcohol addiction are;

• Dysthymia or mild chronic depression,
• restlessness,
• irritability,
• discontentment,
• self-centeredness,
• insecurity,
• self-pitying,
• resentful,
• fearful and
• feeling useless.

Partner Brief-TSF

Brief-TSF includes intervention with significant others in an alcohol dependents life. Significant others may be

• partners of alcoholics,
• children of alcoholics,
• adult children of alcoholics,
• parents of alcoholics,
• grand parents of alcoholics and
• work colleagues.

Partner Brief-TSF has similar goals and methods to Brief-TSF. The overall goal is referral of the significant other to Al-anon or Alateen.

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Rates and Correlates of Relapse Among Individuals in Remission From DSM-IV Alcohol Dependence: A 3-Year Follow-Up.

Background: There is little information on the stability of abstinent and nonabstinent remission from alcohol dependence in the general U.S. population. The aim of this study was to examine longitudinal changes in recovery status among individuals in remission from DSM-IV alcohol dependence, including rates and correlates of relapse, over a 3-year period.

Methods:This analysis is based on data from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of U.S. adults aged 18 years and older originally interviewed in 2001 to 2002 and reinterviewed in 2004 to 2005. The Wave 1 NESARC identified 2,109 individuals who met the DSM-IV criteria for full remission from alcohol dependence. Of these, 1,772 were reinterviewed at Wave 2, comprising the analytic sample for this study. Recovery status at Wave 2 was examined as a function of type of remission at Wave 1, with a focus on rates of relapse, alternately defined as recurrence of any alcohol use disorder (AUD) symptoms and recurrence of DSM-IV alcohol dependence. Logistic regression models were used to estimate the odds of relapse among asymptomatic risk drinkers and low-risk drinkers relative to abstainers, adjusted for a wide range of potential confounders.

Results: By Wave 2,

• 51.0% of the Wave 1 asymptomatic risk drinkers had experienced the recurrence of AUD symptoms, compared with
• 27.2% of low-risk drinkers and
• 7.3% of abstainers.

Across all ages combined, the adjusted odds of recurrence of AUD symptoms relative to abstainers were

• 14.6 times as great for asymptomatic risk drinkers and
• 5.8 times as great for low-risk drinkers.

The proportions of individuals who had experienced the recurrence of dependence were

• 10.2%, for asymptomatic risk drinkers
• 4.0%, for low-risk drinkers and
• 2.9%,  for abstainers

The adjusted odds ratios relative to abstainers were

• 7.0 for asymptomatic risk drinkers and
• 3.0 for low-risk drinkers.

Age significantly modified the association between type of remission and relapse. Differences by type of remission were not significant for younger alcoholics, who had the highest rates of relapse.

Conclusions: Abstinence represents the most stable form of remission for most recovering alcoholics.

Study findings highlight the need for better approaches to maintaining recovery among young adults in remission from alcohol dependence, who are at particularly high risk of relapse.

Research; Deborah A. Dawson, Risë B. Goldstein, Bridget F. Grant. Rates and Correlates of Relapse Among Individuals in Remission From DSM-IV Alcohol Dependence: A 3-Year Follow-Up. Alcoholism: Clinical and Experimental Research (2007) 31 (12), 2036–2045.

Brief-TSF can assist patients cease alcohol consumption.

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Impact of parental history of substance use disorders on the clinical course of anxiety disorders.

Abstract; Background Among the psychological difficulties seen in children of parents with substance use problems, the anxiety disorders are among the most chronic conditions.

Although children of alcoholic parents often struggle with the effects of parental substance use problems long into adulthood, empirical investigations of the influence of parental substance use disorders on the course of anxiety disorders in adult offspring are rare.

The purpose of this study was to examine prospectively the relationship between parental substance use disorders and the course of anxiety disorders in adulthood over the course of 12 years.

Methods; Data on 618 subjects were derived from the Harvard/Brown Anxiety Research Project (HARP), a longitudinal naturalistic investigation of the clinical course of multiple anxiety disorders. Kaplan-Meier survival estimates were used to calculate probabilities of time to anxiety disorder remission and relapse. Proportional hazards regressions were conducted to determine whether the likelihood of remission and relapse for specific anxiety disorders was lower for those who had a history of parental substance use disorders than for individuals without this parental history.

Results; Adults with a history of parental substance use disorders were significantly more likely to be divorced and to have a high school level of education.

History of parental substance use disorder was a significant predictor of relapse of social phobia and panic disorders.

Conclusions; These findings provide compelling evidence that adult children of parents with substance use disorders are more likely to have relapses of social phobia and panic disorders.

Clinicians who treat adults with anxiety disorders should assess parental substance use disorders and dependence histories. Such information may facilitate treatment planning with regards to their patients’ level of vulnerability to perceive scrutiny by others in social situations, and ability to maintain a long-term panic-free state.

Research; Impact of parental history of substance use disorders on the clinical course of anxiety disorders. Maria E. Pagano, Richard Rende, Benjamin F. Rodriguez, Eric L. Hargraves, Amanda T. Moskowitz, & Martin B. Keller. Substance Abuse Treatment, Prevention, and Policy 2007, 2:13

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TSF TARGET POPULATIONS

Clients Best Suited for This Counseling Approach

TSF has been utilized in controlled outcome studies with alcohol abusers and alcoholics and with persons who have concurrent alcohol-cocaine abuse and dependency. It has been used with clients of diverse socioeconomic, educational, and cultural backgrounds and a range of maladjustment.

Clients Poorly Suited for This Counseling Approach

Individuals who have severe symptoms of addiction to cocaine or opiates, who are unemployed, and who also have no source of spousal or other family support appear to have the poorest prognosis. That is not to say that alternative treatments have proven effective with that group of individuals. When treating addiction to cocaine, it is recommended that sessions be scheduled twice a week for the first 3 weeks.

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Dissociation and alexithymia among men with alcoholism

Aim: The aim of the present study was to evaluate the relationship between alexithymia (The Inability to label or identify emotions) and dissociation (See below) among men with alcoholism.

Methods: Participants were 176 patients consecutively admitted to the inpatient unit of a addiction treatment center. The Toronto Alexithymia Scale, the Symptom Checklist-Revised, the Dissociative Experiences Scale, the Beck Depression Inventory, the Spielberger State-Trait Anxiety Inventory, and the Michigan Alcoholism Screening Test were administered to all participants.

Results: Fifty-three patients were considered as having alexithymia.

The alexithymic group had a significantly higher rate of dissociative relationships members (patients with pathological dissociation; 62.3%) according to Bayesian probability.

Trait anxiety, overall psychiatric symptom severity, and pathological dissociation predicted alexithymia on covariance analysis.

A multivariate analysis of covariance demonstrated that these predictors were related only to difficulty of identifying feelings, whereas trait anxiety was a significant covariant for difficulty of expressing feelings as well.

Conclusion: Alexithymic phenomena are interrelated with dissociation and chronic anxiety among men with alcoholism.

Definition; Dissociation is a state of acute mental state in which certain thoughts, emotions, sensations, and/or memories are compartmentalized because they are too overwhelming for the conscious mind to integrate.

Evren C, Sar V, Evren B, Semiz U, Dalbudak E, Cakmak D. Dissociation and alexithymia among men with alcoholism Psychiatry Clin Neurosci. 2008 Feb;62(1):40-7.

See also;

• Brief-TSF is designed to address these issues.

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Do Doctors’ Drinking Habits Affect Management of Patients’ Alcohol Problems?

Two different studies explored whether a physician’s approach to his patients’ alcohol use is complicated by his own drinking habits.

Kaner et al interviewed 29 general practitioners (GPs) in Northern England and found the following:

Some GPs felt that their own alcohol use provided them insight into their patients’ use and helped facilitate discussion with patients. Others, however, separated their drinking from their patients’ drinking.

Some GPs recognized and addressed risk only in patients who drank more or differently from them.

Aalto et al surveyed all Finnish primary care physicians (n=3193), 60% of whom completed all survey questions (63% women; mean age 42 years).

Of these respondents, 15% (7% of women, 27% of men) were heavy drinkers, scoring >=8 on the Alcohol Use Disorders Identification Test (AUDIT). Fifty-nine percent offered brief interventions (Bis)-9% regularly and 50% occasionally.

In analyses controlling for demographic and training characteristics, AUDIT scores did not predict either regular or occasional use of Bis.

Physician drinking can influence clinical practices around alcohol issues. It does not appear, however, to explain the infrequent use of brief interventions.

Reprinted with permission from Alcohol and Health: Current Evidence.

Reference:

• Kaner E, Rapley T, May C. (2006) Seeing through the glass darkly? A qualitative exploration of GPs’ drinking and their alcohol intervention practices. Fam Pract., 23(4): 481-487.
• Aalto M, Hyvönen S, Seppa K. (2006) Do primary care physicians’ own AUDIT scores predict their use of brief alcohol intervention? A cross-sectional survey. Drug Alcohol Depend., 83(2): 169-173.

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Self-help and other supports bolster treatment success

Combining treatment with self-help programs, such as the Alcoholics Anonymous 12-step program, also improves outcomes, and is more effective than either treatment or self-help participation alone.

Attendance at Alcoholics Anonymous meetings is significantly related to post-treatment abstinence. Although mandated AA attendance alone, without treatment, has not been proven effective, one major study showed AA to be as effective as treatment.

Research report; Runder the Influence Part 2: Treating Addictions, Reducing Corrections Costs. Katherine Merrow & Richard A. Minard , Jr. February 5, 2003. New Hampshire Center for Public Policy Studies in association with the Institute for Policy and Social Science Research, University of New Hampshire

BriefTSF can be used successfully in the correction setting

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Role of shame in women’s recovery from alcoholism: The impact of childhood sexual abuse

This study compares the recovery experience of female members of Alcoholics Anonymous (AA) who reported a history of childhood sexual abuse (68 percent) with those who did not report experiencing childhood sexual abuse.

A sample of 53 women was obtained from AA.

A significant relationship was found between shame and two measures of difficulties in recovery,

• problems in social adjustment and
• relapse.

Though the hypothesis that experiences of child sexual abuse predicted difficulty in recovery was not supported, these data suggest that shame may be an important variable in both the etiology and treatment of alcoholism in women.

Research; Wiechelt, S.A.; Sales, E. Role of shame in women’s recovery from alcoholism: The impact of childhood sexual abuse. Journal of Social Work Practice in the Addictions, 1(4):101-116, 2001.

Healing the Shame that Binds You: Recovery Classics Edition (Recovery Classics) by John Bradshaw Read more about this title…

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Substance abuse among the elderly: A growing problem

In her early years, Eva would probably have been called a "teetotaler." Except for an infrequent sip of wine on special occasions, she never drank alcoholic beverages. But after her children moved away and her husband and many of her close friends died, Eva turned to the bottle for escape and companionship. Now in her late 70s, Eva is an alcoholic.

Harry has had problems with substance abuse since his late teens. Although drinking binges were often followed by periods of sobriety, he inevitably returned to his addictive ways. At 75, he is on several prescription medications, some of which should not be taken with alcohol. His children, long ago burned out from trying to persuade him to get help, have come to believe that you really can’t "teach an old dog new tricks."

These two composite situations illustrate what has been called one of the fastest growing health problems in this country–substance abuse among the elderly. More people are living longer and more of them are abusing drugs and alcohol in their later years.

Recent census data estimates that nearly 35 million people in the United States are 65 years or older. Substance abuse among those 60 years and older (including misuse of prescription drugs) currently affects about 17 percent of this population. By 2020, the number of older adults with substance abuse problems is expected to double.

As demographics change, attitudes about and use of alcohol and drugs change as well. "In January 2006, the leading edge of the baby-boom generation (those born during the population swell of 1946-1964) will turn 60," said Frederic Blow, professor in the Department of Psychiatry at the University of Michigan and a Huss Research Chair on Older Adults and Alcohol/Drug Problems at Hazelden’s Butler Center for Research. "These individuals have had more exposure to alcohol and illegal drugs, and there is more acceptance among them about using substances to ‘cure’ things. We expect to see an increase in drug and alcohol use; and more use means more problems."

Blow said there has also been an attitude shift regarding addiction and treatment, and that gives him hope that older substance abusers will get the help they need. "There is less shame and guilt associated with substance abuse now and more acceptance of treatment as a way to make things better," he said.

According to Blow and other experts, when people age, their sensitivity to alcohol increases as their tolerance decreases. Also, the percent of their body weight composed of water decreases, and alcohol–which is water-soluble–affects them more quickly and to a greater degree. Alcohol takes longer to metabolize in older persons, accumulating in their bodies and leading to intoxication if consumption is not controlled. Because of their physical make-up, older women are more vulnerable to the negative effects of alcohol.

As a whole, more older men have substance abuse problems than do older women, but women are more likely than men to start drinking heavily later in life. Substance abuse is more prevalent among persons who suffer a number of losses, including death of loved ones, retirement, and loss of health. The fact that women are more likely to be widowed or divorced, to have experienced depression, and to have been prescribed psychoactive medications that increase the negative effects of alcohol help explain these gender differences.

Unfortunately, health care providers often overlook substance abuse among older adults because they don’t know what to look for or they mistakenly assume that older adults cannot be successfully treated. Loved ones, too, may excuse an older relative’s substance abuse as a result of grief or loss or a reaction to boredom. Or family members may not want to confront an elder, fearing they will offend or anger them or get "written out of the will," said Blow.

Yet Blow said there is "good evidence" that older adults do as well as young people when it comes to treating substance abuse and that they may even do somewhat better. "Older adults can recognize all kinds of benefit from treatment," stressed Blow. "There are often direct health benefits, improved cognition, more independent living, more and better social connectedness, and new hobbies. The benefits are enormous."

The U.S. Substance Abuse and Mental Health Services Administration (http://www.samhsa.gov/) offers a wide range of information and resources to help identify, treat, and prevent substance abuse among older adults.

The pamphlet " How to Talk to an Older Person Who Has a Problem With Alcohol or Medications" is available on the Hazelden Web site.

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