Detoxification from alcohol abuse.

The alcohol withdrawal syndrome (AWS) is a common management problem in hospital practice for neurologists, psychiatrists and general physicians alike.

Although some patients have mild symptoms and may even be managed in the outpatient setting, others have more severe symptoms or a history of adverse outcomes that requires close inpatient supervision and benzodiazepine therapy.

Many patients with AWS have multiple management issues;

• withdrawal symptoms,
• delirium tremens (DT’s),
• the Wernicke–Korsakoff syndrome,
• seizures,
• depression,
• polysubstance abuse,
• electrolyte disturbances and
• liver disease,

These require a coordinated, multidisciplinary approach. Although AWS may be complex, careful evaluation and available treatments should ensure safe detoxification for most patients.

The alcohol withdrawal syndrome; Journal of Neurology, Neurosurgery, and Psychiatry 2008;79:854-862, A McKeon, M A Frye, Norman Delanty.

See also;

• 12-Step Treatment More Effective than Alternative
• Brief-TSF can assist people cease alcohol consumption.
• Alcohol Related Brain Injury

Slaying the Dragon: The History of Addiction Treatment and Recovery in America by William L. White Read more about this title…

This article presents the results of a qualitative study on lesbians’ recovery from addiction. The study involved semi-structured interviews with 20 lesbians in recovery from addiction and was analyzed using grounded theory method.

The central theme that emerged was self-acceptance, both as a lesbian and as a recovering alcoholic/addict, with considerable interaction between the two.

Categories that contributed to this theme were

• learning to recover,
• relationships with other people, and
• relationship with something bigger than self.

The discussion addresses how this information can be used to assist lesbians trying to recover from addiction.

Research report; Connie R. Matthews, Peggy Lorah, Jaime Fenton, Toward a Grounded Theory of Lesbians’ Recovery from Addiction, Journal of Lesbian Studies, Volume: 9 Issue: 3, 2005 Page Range: 57 - 68

Encouraging post-treatment self-help group involvement to reduce demand for continuing care services: two-year clinical and utilization outcomes

Background: Accumulating evidence indicates that addiction and psychiatric treatment programs that actively promote self-help group involvement can reduce their patients’ health care costs in the first year after treatment, but such initially impressive effects may wane over time.

This paper examines whether the positive clinical outcomes and reduced health care costs evident 1 year after treatment among substance-dependent patients who were strongly encouraged to attend 12-step self-help groups were sustained at 2-year follow-up.

Methods: A 2-year quasi-experimental analysis of matched samples of male substance-dependent patients who were treated in either 12-step-based (n = 887 patients) or cognitive-behavioral (CB, n = 887 patients) treatment programs.

The 12-step-based programs placed substantially more emphasis on 12-step concepts, had more staff members "in recovery," had a more spiritually oriented treatment environment, and promoted self-help group involvement much more extensively than did the CB programs.

The 2-year follow-up assessed patients’ substance use, psychiatric functioning, self-help group affiliation, and mental health care utilization and costs.

substantially higher abstinence rate among patients treated in 12-step

Results: As had been the case in the 1-year follow-up of this sample, the only difference in clinical outcomes was a substantially higher abstinence rate among patients treated in 12-step (49.5%) in contrast to CB (37.0%) programs.

Twelve-step treatment patients had 50 to 100% higher scores on indices of 12-step self-help group involvement than did patients from CB programs.

30% lower costs in the 12-step treatment programs

In contrast, patients from CB programs relied significantly more on outpatient and inpatient mental health services, leading to 30% lower costs in the 12-step treatment programs. This was smaller than the difference in cost identified at 1 year, but still significant ($2,440 per patient, p = 0.01).

Conclusions:

• Promoting self-help group involvement appears to improve post-treatment outcomes while reducing the costs of continuing care.
• Even cost offsets that somewhat diminish over the long term can yield substantial savings.
• Actively promoting self-help group involvement may therefore be a useful clinical practice for helping addicted patients recover in a time of constrained fiscal resources.

Research; Keith Humphreys, and Rudolf H. Moos Alcoholism: Clinical and Experimental Research 2007; 31(1):64-68) - 1 This computation is in 2006 dollars, to which we converted for comparative purposes our prior findings, which had been originally reported in 1999 dollars (Humphreys and Moos, 2001).

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About 4 Percent of Pain Patients Abuse Meds, Study Estimates

A new study finds that 3.8 percent of chronic-pain patients misuse prescription medications like OxyContin and Percocet, a rate about four times higher than among the general population, Reutersreported Aug. 3.

Researcher Michael F. Fleming of the University of Wisconsin at Madison and colleagues also found that patients who had addiction problems tended to exhibit "aberrant" behavior, such as requesting early refills, raising dosage without authorization, intentionally oversedating themselves, or using opioids for reasons other than treating pain.

The study included 801 patients with an average age of 49 and who, on average, had had pain problems for 16 years.

Healthcare workers need to take this into consideration when assessing substance abuse.

Research Reference: Fleming, M.F., Balousek, S.L., Klessig, C.L., Mundt, M.P., Brown, D.D. (2007) Substance Use Disorders in a Primary Care Sample Receiving Daily Opioid Therapy. The Journal of Pain, 8(7): 573-582.

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

Attendance at Narcotics Anonymous and Alcoholics Anonymous meetings, frequency of attendance and substance use outcomes after residential treatment for drug dependence: a 5-year follow-up study.

This study investigates the relationship between frequency of attendance at Narcotics Anonymous and Alcoholics Anonymous (NA/AA) meetings and substance use outcomes after residential treatment of drug dependence.

It was predicted that post-treatment NA/AA attendance would be related to improved substance use outcomes.

Using a longitudinal, prospective cohort design, interviews were conducted with drug-dependent clients (n = 142) at intake to residential treatment, and at 1 year, 2 years and 4-5 years follow-up. Data were collected by structured interviews. All follow-up interviews were carried out by independent professional interviewers.

• Abstinence from opiates was increased throughout the 5-year follow-up period compared to pre-treatment levels.
• Clients who attended NA/AA after treatment were more likely to be abstinent from opiates at follow-up.
• Abstinence from stimulants increased at follow-up but no additional benefit was found for NA/AA attendance.
• There was no overall change in alcohol abstinence after treatment but clients who attended NA/AA were more likely to be abstinent from alcohol at all follow-up points.
• More frequent NA/AA attenders were more likely to be abstinent from opiates and alcohol when compared both to non-attenders and to infrequent (less than weekly) attenders.

Conclusions NA/AA can support and supplement residential addiction treatment as an aftercare resource.

In view of the generally poor alcohol use outcomes achieved by drug-dependent patients after treatment, the improved alcohol outcomes of NA/AA attenders suggests that the effectiveness of existing treatment services may be improved by initiatives that lead to increased involvement and engagement with such groups.

Gossop M, Stewart D, Marsden J. Attendance at Narcotics Anonymous and Alcoholics Anonymous meetings, frequency of attendance and substance use outcomes after residential treatment for drug dependence: a 5-year follow-up study. Addiction. 2007 Nov 20.

Brief-TSF can assist patients cease alcohol consumption.

Drug commonly used for alcoholism craving curbs urges of pathological gamblers

A drug commonly used to treat alcohol addiction has a similar effect on pathological gamblers – it curbs the urge to gamble and participate in gambling-related behavior, according to a new research at the University of Minnesota.

Seventy-seven people participated in the double-blind, placebo controlled study. Fifty-eight men and women took 50, 100, or 150 milligrams of naltrexone every day for 18 weeks.

• Forty percent of the 49 participants who took the drug and completed the study, quit gambling for at least one month.
• Their urge to gamble also significantly dropped in intensity and frequency.

The other 19 participants took a placebo. But, only 10.5 percent of those who took the placebo were able to abstain from gambling.

Study participants were aged 18 to 75 and reported gambling for 6 to 32 hours each week.

Dosage did not have an impact on the results, naltrexone was generally well tolerated, and men and women reported similar results.

“This is good news for people who have a gambling problem,” said Jon Grant, M.D., J.D., M.P.H., a University of Minnesota associate professor of psychiatry and principal investigator of the study. “This is the first time people have a proven medication that can help them get their behavior under control.”

The research is published in the June 2008 issue of the Journal of Clinical Psychiatry.

Compulsive gamblers are unable to control their behavior, and the habit often becomes a detriment in their lives, Grant said. He estimates between 1 to 3 percent of the population has a gambling problem.

While the drug is not a cure for gambling, Grant said it offers hope to many who are suffering from addiction. He also said the drug would most likely work best in combination with individual therapy.

“Medication can be helpful, but people with gambling addiction often have multiple other issues that should be addressed through therapy,” he said.

See also;

• Effects of Gambling Addiction
• Gamblers Anonymous
• How can I overcome my addiction to gambling?
• Subscribe to Twelve Step Facilitation by e-Mail

Counselling for Problem Gambling (Living Therapy) by Richard Bryant-Jeffries Read more about this title…

One-Year Outcomes among Members of a Dual-Recovery Self-Help Program.

Research Objective: Self-help is gaining increased acceptance among treatment professionals as empirical support for of its effectiveness is growing and the advent of managed care warrants the use of cost-effective modalities. Traditional “one disease-one recovery” self-help programs cannot serve adequately the needs of the dually-diagnosed.

This paper presents one-year outcome data from a longitudinal study of the effectiveness of self-help for the dually-diagnosed.

Subjects are members of Double Trouble in Recovery (DTR), a 12-step self-help program designed to meet the special needs of those diagnosed with both a mental health disorder and a chemical addiction.Study.

Design: The study uses a 12-month prospective longitudinal design with follow-ups at 12 and 24 months after baseline. Subjects (N = 310) were recruited at 25 DTR meeting sites throughout New York City. Semi-structured instruments assess history and current status of mental health and substance abuse, treatment in both areas, and self help participation (DTR as well as traditional 12-step groups such as AA and NA).

Population Studied: Community-based individuals dually-diagnosed with a mental health disorder and substance abuse.

Principal Findings: S’s are mostly members of underserved minority groups with long histories of substance abuse and mental health disorders.

Most S’s attend outpatient treatment (for drug use, mental health or dual-diagnosis - 77%) and take psychotropic medications (87%).

At the 12 months follow-up,

• 76% were still attending DTR;
• 68% were also attending AA or NA.

Mean number of symptoms S’s. experienced in the past year decreased significantly;

• two-thirds (69%) of S’s reported that their mental health was “better” in the past month than it was at baseline.
• One-third (29%) reported substance use in the past year, compared to 42% at baseline (p = .002).

Substance use (less) was significantly associated with DTR attendance:

• Total time abstinent was related to lifetime length of DTR attendance (r = .25, p = .002) and
• past year substance use was related to number of months of DTR attendance in the past year (r = -.17, p = .02).

Conclusions: For dually-diagnosed individuals, continued participation in dual recovery self-help groups plays a significant role in the recovery process, particularly in the area of substance use.

Implications for Policy, Delivery or Practice: Participation in dual-recovery self-help groups, both during and after formal treatment, should be encouraged as part of an integrated lifelong recovery plan for dually-diagnosed individuals.

Research; One-Year Outcomes among Members of a Dual-Recovery Self-Help Program. Laudet A, Magura S, Vogel H, Knight E, Staines G; Abstr Acad Health Serv Res Health Policy Meet. 2000; 17.

More at; Double Trouble in Recovery

See also;

• 12-Step Treatment More Effective than Alternative
• AA and Treatment Work Better Together
• Subscribe to Twelve Step Facilitation by e-Mail

Dual Diagnosis; Counseling the Mentally Ill Substance Abuser by Katie Evans, J. Michael Sullivan Read more about this title…

Alcoholics Anonymous and Narcotics Anonymous benefit adolescents who attend

While Alcoholics Anonymous (AA) has existed for more than 70 years, and is the most commonly sought source of help for alcohol-related problems in the United States, there is little “hard scientific evidence” showing that AA and Narcotics Anonymous (NA) can improve substance-use outcomes. This study examined how helpful AA and NA may be for adolescents, finding long-term benefits even though many youth discontinue attendance after time.

Results will be published in the August issue of Alcoholism: Clinical & Experimental Research.

“It is difficult to evaluate the efficacy of mutual-help organizations like AA through randomized controlled experiments because the AA ‘intervention,’ being a community organization based on anonymity, cannot be directly under the control of the researcher in the usual way,” explained John F. Kelly.

Yet their popularity and cost-effectiveness cannot be denied, added Kelly.

“AA and NA are explicitly focused on abstinence and addiction recovery, they are widely available across most communities, they provide entry to a social network of recovery-specific support and sober events that can be accessed ‘on demand’ – particularly at times of high-relapse risk such as evenings and weekends, the services are free, and AA/NA can be attended as intensively, and for as long, as individuals desire,” he said.

However, he added, despite growing evidence that adults benefit from AA and NA, little is known about how these abstinence-focused organizations help youth, and what is known lacks scientific rigor.

“This knowledge gap is particularly noteworthy given that adolescents and young adults face more barriers to AA and NA than older adults and yet appear to be referred there just as frequently by treatment providers,” said Kelly. “Youth tend to have less severe addiction problems, on average, and consequently do not feel a strong need to stop using alcohol and/or drugs. ‘Why should they bother to go to abstinence-oriented organizations like AA and NA, and would they benefit even if they did go?’” These are the questions Kelly and his colleagues wanted to address.

The researchers recruited 160 adolescent inpatients (96 males, 64 females), with an average age of 16 years, who were enrolled at two treatment centers in California having a focus on abstinence and based on a 12-step model. The study participants’ length of stay ranged from four to six weeks, after which they were re-assessed on a number of clinical variables at six months, and one, two, four, six, and eight years.

“We found that most of the youth attended at least some AA/NA meetings post-treatment,” said Kelly. “Those patients with severe addiction problems and those who believed they could not use alcohol/drugs in moderation attended the most.

The NA and AA focus on abstinence/recovery probably resonates better with these more severely dependent individuals who also typically need ongoing support.”

Even though many of the youth discontinued AA/NA after time, they nonetheless appeared to benefit from attendance.

“We found that patients who attended more AA and/or NA meetings in the first six months post-treatment had better longer term outcomes, but this early participation effect did not last forever – it weakened over time,” said Kelly. “The best outcomes achieved into young adulthood were for those patients who continued to go to AA and/or NA. In terms of a real-world recovery metric, we found that for each AA/NA meeting that a youth attended they gained a subsequent two days of abstinence, independent of all other factors that were also associated with a better outcome.”

A little can go a long way, he added. “During the first six months post-treatment,” said Kelly, “even small amounts of AA/NA participation – such as once per week – was associated with improved outcome, and three meetings per week was associated with complete abstinence. This suggests youth may not need to attend as frequently as every day, sometimes recommended clinically, to achieve very good outcomes.”

Kelly believes that part of the reason for the success of AA/NA among adolescents who attend meetings is related to their developmental needs.

“Given the need for social affiliation and peer-group acceptance outside of the family at this stage of life, peers can exert strong influence on the behavior of young people,” he noted. “When you couple this fact with the reality that most adolescents and young adults are experimenting with, or heavily using, alcohol and other drugs, it may be hard to find suitable peer contexts that can facilitate recovery. In fact, we know that most youth relapses are connected with social contexts where alcohol/drugs are present; unlike adults, youth rarely relapse alone. So, organizations such as AA/NA may provide support, and encourage and provide alternatively rewarding sober social activities.”

See also;

• AA and Treatment Work Better Together
• Brief-TSF is designed to address these issues.
• Twelve-Step Programs as an Adjunct to Psychotherapy and Psychopharmacology
• Subscribe to Twelve Step Facilitation by e-Mail

Why ’not drinking’?

We members of Alcoholics Anonymous see the answer to that question when we look honestly at our own past lives. Our experience clearly proves that any drinking at all leads to serious trouble for the alcoholic, or problem drinker. In the words of the American Medical Association:

Alcohol, aside from its addictive qualities, also has a psychological effect that modifies thinking and reasoning. One drink can change the thinking of an alcoholic so that he feels he can tolerate another, and then another, and another.

The alcoholic can learn to completely control his disease, but the affliction cannot be cured so that he can return to alcohol without adverse consequences.

And we repeat: Somewhat to our surprise, staying sober turns out not to be the grim, wet-blanket experience we had expected! While we were drinking, a life without alcohol seemed like no life at all. But for most members of A.A., living sober is really living-a joyous experience. We much prefer it to the troubles we had with drinking.

One more note: anyone can get sober. We have all done it lots of times. The trick is to stay and to live sober. That is what this booklet is about.

Living Sober, 1975, Alcoholics Anonymous World Services, Inc