Biomarkers in Alcohol Misuse: Their Role in the Prevention and Detection of Thiamine Deficiency
In Western countries alcohol misuse is the most frequent cause of thiamine (vitamin B1) deficiency (TD) and consequent neuro-impairment.
Studies have demonstrated that between 30 and 80% of alcoholics are thiamine deficient, and this puts them at risk of developing the Wernicke–Korsakoff (WK) syndrome.
The relative roles of alcohol and TD in causing brain damage remain controversial and it is important to try to determine the role played by each factor.
Animal studies support an additive effect of alcohol exposure and TD, and indicate the potential for interaction between alcohol and TD in human alcohol-related brain damage.
Early diagnosis of alcohol-related TD is therefore an important aspect of effective intervention and treatment.
Alcohol biomarkers provide a direct and indirect way of estimating the amount of alcohol being consumed, the duration of ingestion and the harmful effects that long-term alcohol use has on body functions.
Appropriate use of these markers is very helpful when considering a diagnosis of alcohol-related TD.
Research report; Rosanna Mancinelli, and Mauro Ceccanti. Biomarkers in Alcohol Misuse: Their Role in the Prevention and Detection of Thiamine Deficiency. Alcohol and Alcoholism 2009 44(2):177-182;
Bipolar Patients with Comorbid Substance Use Disorders; Diagnostic and Treatment Considerations:
Comorbidity of bipolar disorder (BD) and alcoholism and substance use disorders (SUDs) represents a serious public health problem and a major challenge to treatment systems.
Bipolar disorder is among the top causes of disabilities worldwide, and reportedly the fourth leading mental illness as a source of disease burden in established market economies. Large epidemiologic surveys in the United States have consistently confirmed a high association between bipolar disorder and SUDs. The Epidemiological Catchments Area Study reported bipolar I and bipolar II disorders as having the highest association with SUDs when compared with any other major psychiatric disorder.
The prevalence of lifetime alcohol abuse or dependence in persons with bipolar I disorder and bipolar II disorders were found to be 46%, and 39.2% respectively.
Similarly, the National Comorbidity Survey reported respondents with mania to be 8 to 9 times more likely to have an additional lifetime disorder of drug or alcohol dependence compared with the general population. The most recent and largest epidemiologic survey of more than 42,000 respondents in the United States, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), reported that mania and hypomania were associated with very high rates of SUDs. Those with mania were 6 times more likely to have alcohol dependence and 14 times more likely to have drug dependence over the past 12 months.
Research from; Psychiatric Annals, Volume 38 · Number 11, NOVEMBER 2008
There is a long-recognized association between alcohol consumption and aggressive behavior. But does aggression and hostility continue into sobriety?
This study was designed to examine aggression in a group of socially well-adapted recovered alcoholics.
The question addressed was whether the treatment, together with long-term abstinence from alcohol, could reduce aggression and hostility in recovered alcoholics.
Sixty four male stable alcoholics with at least 3 years sobriety were compared with 69 non-alcoholics. Neither group had any other psychological problems.
Both groups were given a questionnaire on general characteristics as well as aggressive and hostility traits.
After a 3-year abstinence, men from the recovering alcoholics group displayed greater signs of hostility and covert aggression. They were different from non-alcoholics on measures for indirect aggression, irritability, negativism, suspicion, resentment, and guilt.
Research report; Ziherl S, Cebasek Travnik Z, Kores Plesnicar B, Tomori M, Zalar B. Trait aggression and hostility in recovered alcoholics. Eur Addict Res 2007; 13(2): 89-93.
While the war on drugs continues to attract world attention, it is often overlooked that alcoholism remains a major worldwide health concern. No matter what your expertise, the Handbook of Alcoholism can help you acquire the necessary skills to treat problem drinkers and alcohol-dependent patients. In three sections;
Patient Care,
Research, and
Useful Data and Definitions
this comprehensive handbook not only addresses the underlying psychological problems of alcoholism, but helps you to better diagnose and treat the non-psychiatric medical disorders caused by the disease.
Alcoholics and addicts can attest to their countless attempts to stop or cut back on their drinking or drugging. They learn but cannot really accept that they have no power over alcohol or drugs.
The following research of the 1970’s began to explore this phenomenon and in the process confirming a basic tenet of Alcoholics Anonymous.
We alcoholics are men and women who have lost the ability to control our drinking. We know that no real alcoholic ever recovers control. All of us felt at times that we were regaining control, but such intervals – usually brief – were inevitably followed by still less control, which led in time to pitiful and incomprehensible demoralization. We are convinced to a man that alcoholics of our type are in the grip of a progressive illness. Over any considerable period we get worse, never better. Alcoholics Anonymous, pp 30.
Abstract of research report; This study evaluates the ability of alcoholics to regulate their blood alcohol levels (BAL) within a designated range by relying primarily on interoceptive (internal) cues. Forty male alcoholics and 20 control subjects were exposed to an initial training session in which they received sufficient ethanol to maintain them within a designated BAL range over a 2 1/2-hour period.
They were then exposed to two experimental sessions, one providing "overfeedback" and one "underfeedback." During each session, subjects had ten drinking decisions to make with respect to regulation of their BAL.
The results indicated that alcoholics displayed greater "loss-of-control" than control subjects.
This finding supported the hypothesis that alcoholics may possess a neurophysiologic feedback dysfunction that contributes to their relative inability to regulate ethanol intake.
A. M. Ludwig, F. Bendfeldt, A. Wikler and R. B. Cain. Loss of control in alcoholics. Archives of General Psychiatry. Vol. 35 No. 3, March 1978.
Safe Treatment of Pain in the Patient With a Substance Use Disorder
Conditions associated with severe pain can and do develop in persons who have active addiction or who are in remission from an addictive disease, and these patients may require treatment for pain relief. This presents a challenge to clinicians: How can pain be relieved in these patients without exacerbating or reactivating the addictive disorder?
There is little research data on this topic; however, experiential and anecdotal reports collected over the past 3 decades indicate that there are safe and effective approaches to pain management in these patients. In general, the pain treatment regimen for a person recovering from an addiction involves the use of long-acting opioids, such as sustained-release oxycodone, methadone, or buprenorphine, administered on a fixed dosage schedule, with another person holding the medication. Specific dosing recommendations are provided.
By: Penelope P. Ziegler, MD; Psychiatric Times (CMP Medica), 24(1), 2007.
One of the first psychiatrists to describe alcoholism as a disease rather than a moral failing or criminal activity.
Harry M. Tiebout was also one of the first to wholeheartedly endorse Alcoholics Anonymous as an effective force in the struggle against compulsive drinking.
This volume brings together, for the first time, some of Tiebout’s most influential writings. Many of these pieces–from explorations of the therapeutic approach to alcoholism to instructive discussions of the act of surrender so crucial to recovery–are seminal documents in the history, treatment, and understanding of alcoholism.
Together, they represent the significant contribution of one man to the countless lives shaken by alcoholism and steadied with the help of Alcoholics Anonymous, psychiatric intervention, and the foresight and commitment of doctors like Harry Tiebout.
Early detection, including screening and brief interventions (for nondependent problem drinkers)
Comprehensive assessment and individualized treatment plan
Care management
Individually delivered, proven professional interventions
Contracting with patients
Social skills training
Medications
Specialized services for medical, psychiatric, employment or family problems
Continuing care
Strong bond with therapist or counselor
Longer duration (for alcohol dependent persons)
Participation in support groups
Strong patient motivation
Research Sources: McLellan, T.A. 2002; Miller,W.R. 2002; National Institute on Drug Abuse. 1999; Project MATCH Research Group. 1997.
Active participation in a support group can contribute to long-term recovery.
Project MATCH and other studies in the 1990s definitively proved that AA can be an active ingredient of treatment both during a professional intervention and afterward, depending on the patient’s type of therapy.
Patients who joined the AA fellowship or who had an AA sponsor after receiving twelve step facilitation therapy had better abstinence records than those who received an intervention but did not continue their AA participation upon completion.
Other research indicates AA participation may be less effective for patients who receive cognitive behavior therapy because the programs have different goals that may confuse patients.
What researchers still don’t understand, however, are the precise mechanisms of AA participation.
While AA affiliation is associated with self-efficacy, motivation and coping efforts, all significant predictors of good outcome following a professional intervention, some studies have shown that patients who adopt more of the fellowship’s basic tenets – such as acknowledging that alcoholism is a disease, admission of their powerlessness over alcohol and working the twelve steps of the program – relapse at the same rates as patients who adopt very few.
This suggests that the active ingredient may be less about AA per se than continuing participation in support groups that promote a lifestyle inconsistent with the problematic use of alcohol and other drugs.
Persistent pain is prevalent among people with substance use disorders.
It is not known, however, whether such pain increases the risk of relapse following periods of abstinence.
Researchers assessed data on pain and substance use in 397 adults who, as part of a larger randomized trial, had been interviewed periodically in the 24 months after their discharge from an urban, residential alcohol and drug detoxification unit.
Pain was measured with the pain item on the SF-36 Health Survey. Analyses were adjusted for potential confounders (e.g., demographics, addiction severity, depressive symptoms).
Sixteen percent of subjects reported persistent pain (moderate-to-higher levels of pain at all available interviews) in the 24 months after detoxification.
Subjects reporting persistent pain were significantly more likely than those with mild or no pain to have used the following in the past 30 days at the 24-month follow-up:
heroin/opioids not prescribed for pain (odds ratio, 5.4);
heavy amounts of alcohol* (odds ratio, 2.2).
Comments: Persistent pain is common among alcohol and drug users who have undergone residential detoxification and increases the likelihood of relapse. This study suggests that clinicians must be careful to screen for pain symptoms in patients with substance dependence. When persistent pain is present, thoughtful management is required to minimize risks associated with undertreatment while not fostering opioid analgesic abuse.
Research References:Larson MJ, Paasche-Orlow M, Cheng DM, et al. Persistent pain is associated with substance use after detoxification: a prospective cohort analysis. Addiction. 2007.
The Mindbody Prescription: Healing the Body, Healing the Pain by John E. Sarno
An AA sponsor is a close 1-on-1 collaboration between an older sober member and a relative newcomer to sobriety. Its a two way helping relationship – the sponsor affirms their own sobriety and the sponsee gains new insights.
AIMS: The aim of this study was to explore the roles of Alcoholics Anonymous (AA) sponsors and to describe the characteristics of a sample of sponsors.
METHODS: Twenty-eight AA sponsors, recruited using a purposive sampling method, were administered an unstructured qualitative interview and standardized questionnaires. The measurements included: a content analysis of sponsors’ responses; Severity of Alcohol Dependence Questionnaire-Community version (SADQ-C) and Alcoholics Anonymous Affiliation Scale (AAAS).
RESULTS: Sample characteristics were as follows:
the median length of AA attendance was 9.5 years (range 5-28);
the median length of sobriety was 11 years (range 4.5-28);
the median number of sponsees per sponsor was 1 but there was a wide range (0-17, interquartile range 3.75); and
the sponsors were highly affiliated to AA (median AAAS score 8.75, range 5.5-8.75, maximum possible score 9).
Past alcohol dependence scores were surprisingly low:
5 (18%) sponsors had mild,
14 (50%) moderate and
9 (32%) severe dependence according to the SADQ-C (median 26.5, range 11-56).
Sponsorship roles were as follows: 16 roles were identified through the initial content analysis. These were distilled into three super-ordinate roles through a thematic analysis:
encouraging sponsees to work the programme of AA (doing the 12 steps and engaging in AA activity);
support (regular contact, emotional support and practical support); and
carrying the message of AA (sharing sponsor’s personal experience of recovery with sponsees).
CONCLUSIONS: The roles identified broadly corresponded with the AA literature delineating the duties of a sponsor. This non-random sample of sponsors was highly engaged in AA activity but only had a past history of moderate alcohol dependence.
Research; The role of AA sponsors: a pilot study. Whelan PJ, Marshall EJ, Ball DM, Humphreys K. Alcohol Alcohol. 2009 Jul-Aug;44(4):416-22. Epub 2009 Mar 18.
I’ll Quit Tomorrow: A Practical Guide to Alcoholism Treatment
Bipolar Patients with Comorbid Substance Use Disorders; Diagnostic and Treatment Considerations:
