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…

Spirituality/religiosity promotes acceptance-based responding and 12-step involvement.

BACKGROUND: Previous investigations have observed that spirituality/religiosity (S/R) is associated with enhanced 12-step involvement. However, relatively few studies have attempted to examine the mechanisms for this effect. For the present investigation, we examined whether acceptance-based responding (ABR) - awareness or acknowledgement of internal experiences that allows one to consider and perform potentially adaptive responses - accounted for the effect of S/R on 12-step self-help group involvement 2 years after a treatment episode.

METHODS: Data were collected as part of a multi-site treatment outcome study with 3698 substance-dependent male veterans recruited at baseline. Assessments were conducted at baseline, discharge, 1-year follow-up, and 2-year follow-up. We utilized structural equation modeling to examine the relationships among latent variables of S/R, ABR, and 12-step involvement over time.

RESULTS: In the final model, S/R was not directly related to 12-step involvement at 2-year follow-up. However, S/R predicted enhanced ABR at 1-year follow-up after accounting for discharge levels of ABR. In turn, ABR at 1-year follow-up predicted increased 12-step involvement at 2-year follow-up after accounting for discharge levels of 12-step involvement.

CONCLUSIONS: S/R promotes the use of post-treatment self-regulation skills that, in turn, directly contribute to ongoing 12-step self-help group involvement.

Authors: Carrico AW, Gifford EV, Moos RH. Spirituality/religiosity promotes acceptance-based responding and 12-step involvement. Drug Alcohol Depend. 2007 Jun 15;89(1):66-73

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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.

Injury Risk Highest Among Binge Drinkers

Binge drinkers have a higher risk of alcohol-related injury than chronic, heavy drinkers, the Health Behavior News Service reported Feb. 22.

Binge-drinking women who otherwise drink in moderation had seven times the risk of injury as nondrinkers, while binge-drinking men increased their injury risk sixfold.

"It’s not only the amount of alcohol consumed that shapes the risk for injury, but also the usual consumption pattern," said study author Gerhard Gmel of the Swiss Institute for the Prevention of Alcohol and Drug Problems. "At highest risk are those who usually consume moderately but sometimes binge drink. This is true for both sexes."

The study was based on records from 8,736 people admitted to hospital emergency departments; researchers examined the relationship of injuries to average weekly alcohol consumption, binge-drinking episodes, and the amount of alcohol consumed prior to admission.

Gmel warned against prevention that focuses only on chronic drinkers, saying that many binge drinkers will be missed.

The research appears in the March 2006 issue of the journal Alcoholism: Clinical and Experimental Research.

From; Join Together Online

Which to treat first; Comorbid anxiety or alcohol disorder?

Therapies that target just one problem are in sufficient for patients who have both.

Men and women with anxiety disorders are at three times the general population’s risk of being alcohol-dependent, and those who seek treatment for an anxiety disorder are at even higher risk of alcohol disorder. This comorbidity can complicate treatment attempts if either disorder remains unaddressed, leading to increased relapse risk and multiple treatment episodes.

Based on our research and clinical work in helping patients with comorbid alcohol dependence and anxiety disorders, this article describes:

• potential relationships between anxiety disorders and alcohol disorder
• pros and cons of 3 approaches to treating this comorbidity
• how to identify and address alcohol disorder in patients with anxiety disorders, depending on available resources.

Research by; Matt G. Kushner, Brenda Frye, Christopher Donahue, Sarah W. Book and Carrie L. Randall.

From; Current Psychiatry, Vol. 6, No. 8 / August 2007

Is emergency department based brief intervention worthwhile in adults presenting with alcohol related events?

BEST EVIDENCE TOPIC REPORTS

A short cut review was carried out to establish whether emergency department (ED) based brief intervention is worthwhile in adults presenting with alcohol related events.

A total of 590 papers were found using the reported search, of which eight represented the best evidence to answer the clinical question.

The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are presented in table 1.

The clinical bottom line is that brief psychotherapeutic intervention is worthwhile in adults who attend the emergency department after an alcohol related event.

Emergency Medicine Journal 2007;24:785-788.

Spiritual assessment in biomedicine

The recent surge of interest in links between spirituality and health has generated many assessment approaches that seek to identify spiritual need and suggest strategic responses for health care practitioners.

The interpretations of spirituality made within health frameworks do not do justice to the way spirituality is understood in society in general.

Spiritual assessment should not impose a view or definition of spirituality, but should seek to elicit the thoughts, memories and experiences that give coherence to a person’s life.

Spiritual assessment tools should not be used without adequate exploration of the assumptions made. Assessment processes need to be adequately conceptualised and practically relevant.

In agencies organised according to biomedical priorities, spirituality is a personal coping mechanism that need not be incorporated into the health treatment plan.

Integration is the patient’s issue - patients must work out how to incorporate their experience of the biomedical system into the rest of their lives.

Social perspectives that regard spirituality as a means of social support view spiritual care as the responsibility of the cultural and religious communities supporting the patient.

Practitioners operating within a social model may be more intentional about involving these communities in care, but they still leave the decision to participate to the patient and family.

In both these approaches, it is for patients to decide whether they will seek spiritual care alongside the health care being provided.

However, spiritual care may be seen differently within a biopsychosocial framework. Here spirituality is related to quality of life and is thus one of the individual characteristics that shape health beliefs and motivations. It affects compliance and outcomes, and is thus legitimately an area of interest for clinicians.

Criteria for appropriate spiritual assessment

Spiritual assessment should thus not impose a view, let alone a definition, of spirituality, but should seek to elicit the thoughts, memories and experiences that give coherence to a person’s life. This implies taking seriously the idea that spirituality preserves identity and sense of self, particularly in professionalised environments, and ensuring that professional practice assessments are made within a framework that matters to the patient.

This means identifying spiritual needs and resources in ways that

• Respect patients’ perspectives and do not infringe privacy;
• Involve all members of the interdisciplinary team to the extent that they are able and willing to contribute;
• Permit clear documentation of needs, strategic responses to these needs, resources required, and outcomes;
• Integrate strategies into an overall care plan in ways that are readily understood by all members of the interdisciplinary team;
• Provide a shared framework for continuity of care between community agencies and inpatient services; and
• Provide a place for religious care but do not conflate spiritual issues with religious practice. While spiritual care in general may be provided by a team, specific religious care is best provided by a person from the same faith community, preferably one willing to participate in the team.

Appropriate process for spiritual assessment

Spiritual assessment must be a process, not merely an event, as it needs to take account of emergent insights and accommodate the patient’s exploration of particular issues if he or she so chooses.

The discussion here applies to health care contexts in which process is possible (such as general medical practice, community health or residential care), rather than the brief encounters of day surgery or the emergency room.

The process should begin with a form of screening, preferably one that maps significant relationships within the domain of spirituality. This screening can be carried out descriptively, noting connections as they emerge in taking patient histories and in general clinical and informal encounters by all members of the team.

For more information see; Bruce D Rumbold. A review of spiritual assessment in health care practice. Medical Journal of Australia 2007; 186 (10): S60-S62

Characteristics of Students with Fetal Alcohol Syndrome and Fetal Alcohol Effect

Students with FAS/E are as different from each other as any group of children. They come from all socioeconomic backgrounds. Each child presents a complex individual portrait of competencies and delays. Students with FAS/E must be recognized as individuals rather than as members of a homogeneous group.

FAS/E can affect individuals in varying degrees, from mild to severe in the following areas:

Cognitive Functioning.

The intellectual abilities of students with FAS/E can vary greatly. Many students with FAS/E have graduated from high school with minimal extra support and adaptations. To date, a wide range of IQ has been documented: 29 to 120 for FAS and 42 to 142 for FAE.

Other conditions commonly observed in children with FAS/E include:

• Learning Disabilities (LD),
• Attention Deficit/Hyperactivity Disorder (AD/HD),
• difficulty with sequencing,
• difficulty with memory,
• difficulty understanding cause/effect relationships, and/or
• weak generalizing skills.

Social/Emotional Functioning

Students with FAS/E may display a variety of atypical responses to unfamiliar or frustrating situations. Increased anxiety may result in withdrawal, outbursts or other acting out behaviours that may be harmful to the student or others in the group. A young child with FAS/E may have severe temper tantrums and find it hard to adjust to change. Many adolescents with FAS/E are prone to depression, poor judgment and impulsivity. They are often described as innocent, immature and easily vicitimized.

Other responses commonly observed in children with FAS/E include:

• stealing, lying and defiance,
• difficulty predicting and/or understanding the consequences of behaviour,
• easily manipulated and led by others,
• difficulty making and keeping friends,
• overly friendly and affectionate, easily approached by strangers, and/or
• perseverative or “stubborn.”

Physical Functioning

Basic physiological responses may be abnormal in students with FAS/E. This may present in one or more of the following ways:

• A high threshold for pain which can result in the student not being aware of a serious injury or infection.
• No perception of hunger or satiation.
• Difficulty perceiving extreme temperatures.
• Difficulty with visual/spatial perception and balance.

Some children with FAS/E excel in individual sports that require gross motor coordination such as swimming, skiing and roller-blading. Others have significant delays in gross and fine motor skill development which can affect all areas of functioning. In mild cases, delays in motor abilities can influence the acquisition of skills such as tying shoelaces and printing neatly. In more severe cases, children with FAS/E may have had problems learning to chew and swallow food.

Students with FAS/E have a higher than average incidence of a number of other medical concerns. These include:

• difficulties with vision,
• difficulties with hearing,
• heart problems,
• growth deficiency,
• neurological conditions such as seizure disorders, and/or
• impaired bone and/or joint development.

Teachers should be alert to the fact that a number of these health concerns can directly impact the student’s ability to achieve success in the classroom. In some cases, a student’s medical report will include recommendations for the school that may assist in program planning.

The student with FAS/E can bring gifts to your classroom, including a sense of humor, creativity, caring, a love of animals, determination, musical and artistic talent and a desire to please.

Through formal and informal assessments, you will be able to develop a plan that draws on your student’s strengths to support his or her educational needs. It is important to think about where the child has started from, where he or she is today, and the long term goals for tomorrow.

An essential ingredient throughout the process is developing and supporting the student’s self-esteem. Nothing lights up a child’s face more than achieving something through a learning experience. It is important to set up a classroom where this can take place as often as possible.

Alcoholics Anonymous and long term matching effects.

AIMS: (1) To examine the matching hypothesis that Twelve Step Facilitation Therapy (TSF) is more effective than Motivational Enhancement Therapy (MET) for alcohol-dependent clients with networks highly supportive of drinking 3 years following treatment; (2) to test a causal chain providing the rationale for this effect. DESIGN: Outpatients were re-interviewed 3 years following treatment. ANCOVAs tested the matching hypothesis. SETTING: Outpatients from five clinical research units distributed across the United States. Participants: Eight hundred and six alcohol-dependent clients. INTERVENTION: Clients were randomly assigned to one of three 12-week, manually-guided, individual treatments: TSF, MET or Cognitive Behavioral Coping Skills Therapy (CBT). MEASUREMENTS: Network support for drinking prior to treatment, Alcoholics Anonymous (AA) involvement during and following treatment, percentage of days abstinent and drinks per drinking day during months 37-39.

FINDINGS:

• The a priori matching hypothesis that TSF is more effective than MET for clients with networks supportive of drinking was supported at the 3 year follow-up;
• AA involvement was a partial mediator of this effect; clients with networks supportive of drinking assigned to TSF were more likely to be involved in AA;
• AA involvement was associated with better 3-year drinking outcomes for such clients.

CONCLUSIONS:

• in the long-term TSF may be the treatment of choice for alcohol-dependent clients with networks supportive of drinking;
• involvement in AA should be given special consideration for clients with networks supportive of drinking, irrespective of the therapy they will receive.

Research; Longabaugh R, Wirtz PW, Zweben A, Stout RL. Network support for drinking, Alcoholics Anonymous and long-term matching effects.Addiction. 1998 Sep;93(9):1313-33.

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…