Alcoholics and Loss of control of drinking

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.

Experiences of alcohol dependence: a qualitative study

INTRODUCTION AND AIMS OF THE STUDY:

Despite the increasing incidence of alcohol misuse and the costs it incurs, British society continues to hold equivocal and ambiguous attitudes towards drinking, and understanding of the nature of alcohol dependence and related issues is limited.

This qualitative study aimed to investigate the experiences of individuals with alcohol dependence to enhance understanding of the illness, identify key issues and common themes and provide insight into the experiences of the participants during their alcohol dependent period and recovery.

METHOD:

A qualitative approach, using narrative method, was used. Eight participants, all members of Alcoholics Anonymous (AA), were interviewed by the researchers. Using a grounded theory approach and content analysis, the in-depth narratives of the eight participants were systematically analysed.

RESULTS:

While participants continued to deny the existence of a problem to those around them, their behaviours indicated that they were aware of the problem but were afraid to admit it openly through fear of other people’s reactions.

Participants generally regarded GP’s as helpful but other health professionals less so, especially nurses and Accident and Emergency staff.

Participants considered that the success of treatment depended on their own motivation and willingness to engage in radical behaviour change.

They considered that reaching this stage represented a turning point in their illness. The point at which this stage was reached appeared to be different for each participant.

CONCLUSIONS:

This systematic analysis of a small sample of alcohol dependent individuals gives insight into their experiences during alcohol dependency and the journey to recovery.

The findings suggest that denial of the problem to the outside world occurs simultaneously with individuals being aware of their problem.

Participants felt the illness carries a stigma and their negative experiences of health professionals other than GP’s suggests that nurses and other health workers need to revise their understanding of alcohol dependence and their approach to it.

AA was a significant factor in recovery for these participants.

Research report; J Fam Health Care. 2007;17(6):211-4. Experiences of alcohol dependence: a qualitative study. Dyson J.

See also;

• BriefTSF is designed to help breakdown denial
• Twelve-Step Programs as an Adjunct to Psychotherapy and Psychopharmacology

Understanding Stress: Characteristics and Caveats

By Hymie Anisman, Ph.D. and Zul Merali, Ph.D.

Exposure to stressful situations is among the most common human experiences. These types of situations can range from unexpected calamities to routine daily annoyances.

In response to stressors, a series of behavioral, neurochemical, and immunological changes occur that ought to serve in an adaptive capacity. However, if those systems become overly taxed, the organism may become vulnerable to pathology. Likewise, the biological changes, if sufficiently sustained, may themselves adversely affect the organism’s well-being.

Several factors may dictate an individual’s response to environmental stressors, including

• characteristics of the stressor (i.e., type of stressor and its controllability, predictability, and chronicity);
• biological factors (i.e., age, gender, and genetics); and
• the subject’s previous stressor history and early life experiences.

Research on the physiological and psychological responses to different types of stressful stimuli is presented, focusing particularly on processes that may be relevant to the development of alcohol use disorders.

Stressful events may profoundly influence the use of alcohol or other drugs (AODs). For example, the resumption of AOD use after a lengthy period of abstinence may reflect a person’s attempt to self-medicate to attenuate the adverse psychological consequences of stressors (e.g., anxiety).

Alternatively, stress may increase the reinforcing effects of AODs.

Alcohol Research & Health. Vol. 23, No. 4, 1999

Postural sway among abstinent alcoholics can be improved up to a point

Excessive sway during quiet standing is a common and significant consequence of chronic alcoholism, even after prolonged sobriety, and can lead to fall-related injury and even death.

A new study of residual postural instability in alcohol-abstinent men and women shows that alcoholics improve with prolonged sobriety, but the improvement may not fully erase the problem of instability.

Results will be published in the March 2010 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

“Caricatures depict acutely intoxicated individuals with a stumbling, weaving, wobbly gait,” said Edith V. Sullivan, professor in the department of psychiatry and behavioural sciences at Stanford University School of Medicine and corresponding author for the study. “With sobriety, gait and balance become stable. However, even with prolonged sobriety, people with long-term chronic alcohol dependence can have difficulty in standing upright. Their balance can be marked by sway that exceeds what most of us experience while standing still in one place, especially with feet together and hands down by one’s side, that is, without use of natural stabilizing factors.”

Sullivan said that quantifying the sway can be accomplished by using a force plate to record the sway path in fractions of an inch over fractions of seconds during quiet standing. This provides “sway path tracking” as well as measurement of body tremor, which are micro-movements often reflective of central nervous system damage that can be found both in Parkinson’s disease and alcoholism.

Researchers used a “force platform” to measure postural sway – with and without stabilizing conditions from touch, vision and stance – in 34 alcoholic men, 15 alcoholic women, 22 control men, and 29 control women. They then analyzed “biomechanical control mechanisms” that indicate skeletomuscular control over balance, which – under normal circumstances – means the muscles, joints, and skeletal structure are working synergistically, in a give-and-take manner.

“Results show the sway paths of alcoholics are longer and cover a wider area than those of controls for a given time,” said Sullivan. “However, it is important to note that the standing stability of sober alcoholics can be improved by using stabilizing factors. These factors can include simple aids like turning a light on in a dark room, touching a banister while walking down a flight of stairs, or walking or standing with feet apart rather than with ankles close together.”

Sullivan added that the disproportionately greater sway in the anterior-posterior (front-to-back) direction than the medial-lateral (side-to-side) direction that they found is associated with chronic alcoholism as well as pathology of the anterior superior vermis of the cerebellum.

“This part of the brain is often disturbed in alcoholism, and lesions there, whether or not a result of alcoholism, can cause impairment in gait and balance,” she said. “It is interesting to note that while alcoholic men and women can quell their imbalance with stabilizing factors, alcoholic women do not necessarily improve to control levels.” Until more is known about improving this deficit, Sullivan suggested that people who are at risk utilized simple strategies to stabilize balance and to avert falls.

Mechanisms of action in integrated cognitive-behavioral treatment versus twelve-step facilitation for substance-dependent adults with comorbid major depression.

OBJECTIVE: In a population of veterans with co-occurring substance use disorders and concomitant major depressive disorder, the current study compared mechanisms of change and therapeutic effects relevant to both disorders between integrated, dual disorder-specific cognitive behavioral therapy (ICBT) and twelve-step facilitation (TSF).

METHOD: Veterans (N = 148) were given standard pharmacotherapy for depression and were randomly assigned to receive 24 weeks of either TSF or ICBT. Process measures were selected to quantify (1) changes in self-efficacy in ICBT, (2) changes in ability to terminate negative affect in ICBT, (3) twelve-step affiliation (TSA) in TSF, and (4) changes in social support in both conditions. Measures of depression and substance use were administered to all participants before treatment, during treatment, and at the end of treatment.

RESULTS: Self-efficacy increased among both TSF and ICBT participants during treatment, whereas self-reported ability to regulate negative affect did not change.

Consistent with predictions, TSF participants increased community TSA during treatment, whereas those receiving ICBT reduced TSA.

Changes in self-efficacy and TSA were associated with improvement in substance use outcomes at the end of treatment.

Hypothesized changes in social support were not supported.

CONCLUSIONS: Both ICBT and TSF produce improvements in self-efficacy, and these changes are related to substance use outcomes for depressed substance abusers.

In TSF, intervention-specific changes in TSA occur during the course of treatment and are related to substance use outcomes.

Research; J Stud Alcohol Drugs. 2007 Sep;68(5):663-72. Mechanisms of action in integrated cognitive-behavioral treatment versus twelve-step facilitation for substance-dependent adults with comorbid major depression. Glasner-Edwards S, Tate SR, McQuaid JR, Cummins K, Granholm E, Brown SA.

Tolerance Equals More Consumption for Older Problem Drinkers

Adults over age 60 who have alcohol problems tend to drink more than their younger counterparts, probably because they have developed greater tolerance for alcohol, according to researchers at Ohio State University.

Science Daily reported that a study found that alcohol-dependent individuals over age 60 consumed an average of more than 40 drinks per week, compared to 25-35 among younger people with similar levels of dependence.

Researchers said that older drinkers developed tolerance for alcohol, meaning they had to drink more to get the same effects.

The older drinkers also reported more monthly binge-drinking episodes.

“A combination of high levels of drinking and the physiological effects of aging are particularly problematic for older adults,” noted researcher Linda Ginzer.

Younger Americans were still more likely to have drinking problems than older Americans, however.

Researchers found that binge drinking was more common among Americans classified as alcohol abusers than among those who were heavy drinkers but not seen as problem drinkers.

“That suggests binge drinking may be a better measure of problem drinking than just the total amount of drinks someone has per week,” Ginzer said.

The findings, drawn on findings from the National Epidemiologic Survey on Alcohol and Related Conditions, were unveiled at a recent meeting of the Gerontological Society of America. From; Join Together Online.

• See also;
• Brief-TSF is designed to address these issues.
• Alcohol & Medication Interactions
• Physical effects of alcohol on women

Alcohol factors in suicide mortality rates in Manitoba, Canada.

OBJECTIVE: To identify alcohol-related factors that influence mortality rates from suicide.

METHOD: We examined the impact of per capita consumption of total alcohol, spirits, beer, and wine; unemployment rate; and Alcoholics Anonymous (AA) membership rate on total, male and female suicide mortality rates in Manitoba during 1976 to 1997. Time series analyses with autoregressive integrated moving average modelling were applied to total, male and female suicide rates. The analyses performed included total alcohol consumption, spirits consumption, beer consumption, and wine consumption. Missing AA membership data were interpolated with cubic splines.

RESULTS:

• Total alcohol consumption, and consumption of beer, spirits, and wine individually, were significantly and positively related to female suicide mortality rates.
• Spirits and wine were positively related to total and male mortality rates.
• AA membership rates were negatively related to total and female suicide rates.
• Unemployment rates were positively related to male and total suicide rates.

CONCLUSIONS:

The data confirm the important relations between per capita consumption measures and suicide mortality rates.

Additionally, the results for AA membership rates are consistent with the hypothesis that AA membership can exert beneficial effects observable at the population level.

Mann RE, Zalcman RF, Rush BR, Smart RG, Rhodes AE. Can J Psychiatry. 2008 Apr;53(4):243-51. Alcohol factors in suicide mortality rates in Manitoba.

see also;

• 12-Step Treatment More Effective than Alternative
• AA Offers Recovery Not Religion
• Brief-TSF can assist patients cease alcohol consumption.
• Subscribe to Twelve Step Facilitation by e-Mail

Are Brief Alcohol Interventions Likely to be Effective in Routine Primary Care Practice?

A number of meta-analyses have demonstrated the modest efficacy of brief interventions (BI) for nondependent unhealthy alcohol use in primary care settings.

Whether this level of efficacy can be expected when BIs are delivered outside of research studies in not known.

This systematic review identified 22 randomized trials including over 5800 patients. Investigators classified the trials on a spectrum from tightly controlled (efficacy design) to real world (effectiveness design) studies.

The scale considered whether patients presented to health care with a range of conditions, whether practices delivered a full range of medical services, whether practitioners routinely worked in the service rather than being funded by the trial, and whether the intervention could be delivered within standard visit times.

• Participants who received BI drank approximately 3 standard drinks per week less than those who did not.
• Longer duration of intervention was not significantly associated with a larger effect.
• The effect of BI on drinking was similar in studies regardless of whether they were tightly controlled or had more real world characteristics.

Comments by Michael Levy, PhD

This meta-analytic study showed the benefit of BI in reducing alcohol consumption in both controlled and real world primary care settings.

It seems logical to assume similar results could be achieved in community treatment programs.

Since BI in the studies reviewed was designed to achieve a reduction in alcohol consumption, treatment programs could consider implementing BI for patients who are not interested in achieving abstinence but who want to reduce their intake.

Reference: Kaner EF, Dickinson HO, Beyer F, et al. The effectiveness of brief alcohol intervention in primary care settings: a systematic review. Drug Alcohol Rev. 2009;28(3):301–323.

From; Join Together Online

Concept of Alcoholism

In TSF and Brief-TSF alcoholism is considered an illness that affects individuals both mentally and physically in such a way that they are unable to control their use of alcohol. Viewed from this perspective, the concept of controlled use of alcohol amounts to denial of the primary problem, that is, loss of control. Specific causative factors (ie, stress) are of less relevance in recovery than is acceptance of both the loss of control and the need for abstinence and a willingness to follow the pathway laid out in the 12-steps.

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

• See also;
• Abstinence Solves Thinking Problems
• Adolescents have deficits in frontal brain activation
• Brain Damage & Cirrhosis