Posted by Sparrow on 23rd July 2008
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.
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Posted in Addiction, Alcohol, Alcoholism, Assessment, Detoxification, Disease of addiction, Drugs, Medication, Stages of Change, Symptoms of addiction | No Comments »
Posted by Sparrow on 15th July 2008
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.
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Posted by Sparrow on 5th July 2008
Long-term effects of pharmacotherapy on relapse prevention in alcohol dependence.
Background: There is growing evidence that pharmacological treatment with two of the best validated anticraving medications, acamprosate and naltrexone, is efficacious in promoting abstinence in recently detoxified alcohol-dependent subjects.
Objective: The stability of effects after termination of treatment remains to be answered, especially when combining both the drugs.
Method: After detoxification, 160 alcohol-dependent subjects participated in a randomized, double-blind, placebo-controlled trial. Patients received naltrexone or acamprosate or a combination of naltrexone and acamprosate or placebo for 12 weeks. Patients were assessed weekly by interview, self-report, questionnaires and laboratory screening. Additionally, follow-up evaluation based on telephone interview of participants, general practitioners and relatives was conducted 12 weeks after terminating the medication.
Results: At week 12, the proportion of subjects relapsing to heavy drinking was significantly lower in the group with combined medication compared with both placebo and acamprosate (P < 0.05).
No difference was detectable between acamprosate and naltrexone, both of which were superior to placebo (P < 0.05).
12 Week Relapse rates were;
- 28% (combined medication),
- 35% (naltrexone),
- 50% (acamprosate) and
- 75% (placebo).
After follow-up (week 24), combined medication led to relapse rates significantly lower than placebo, but not lower than acamprosate.
Again, both naltrexone and acamprosate were superior to placebo.
24 Week Relapse rates were
- 80% (placebo),
- 54% (acamprosate),
- 53% (naltrexone) and
- 34% (combined medication).
Conclusions:
The results of this study highlight the stability of effects of pharmacotherapy on relapse prevention in alcohol dependence.
Research; Kiefer F; Andersohn F; Otte C; Wolf K; Jahn H; Wiedemann K. (2004), Long-term effects of pharmacotherapy on relapse prevention in alcohol dependence. Acta Neuropsychiatrica, October 2004, vol. 16, no. 5, pp. 233-238(6)
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Posted by Sparrow on 18th June 2008
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.
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Posted in Addiction, Alcohol, Alcoholism, Disease of addiction, Gamblers Anon, Gambling, Loss of control, Medication, Research, Stages of Change, Symptoms of addiction | No Comments »
Posted by Sparrow on 15th June 2008
New medications for addiction treatment can significantly improve treatment outcomes for many patients, especially when combined with counseling, support and aftercare.
This free online course helps addiction treatment counselors understand how these medications work with the brain mechanisms involved in alcohol dependence, and how medications can be part of a comprehensive treatment program that helps patients regain control over their lives.
Author’s Welcome and Introduction
An outline of this program from Carlo C. DiClemente, PhD
Main Presentation, Part 1
An overview of alcohol dependence, focusing on the epidemiology of alcohol dependence, diagnosing alcohol dependence and misuse, and the effects of alcohol on the brain. We also introduce medications for alcohol dependence.
Main Presentation, Part 2
Psychosocial interventions for the treatment of alcohol dependence; how medication and psychosocial intervention impacts abstinence; and patient readiness for change.
Case Studies
Examples of real-life situations that may be faced when counseling patients for alcohol abuse, designed to illustrate how both psychosocial support and medications can work together to help patients maintain abstinence.
Patient Education Materials (PDF, 372K)
These full-color materials are designed to educate and assist patients with alcohol dependence.
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Posted by Sparrow on 11th June 2008
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
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Posted in 12-Step Groups, Addiction, Adjunctive therapy, Alcohol, Alcoholism, Assessment, Contrast to other models, Medication, Mutual-help, Policy, Recovery, Research, Self-help, Target populations | No Comments »
Posted by Sparrow on 6th June 2008
Handbook of Alcoholism
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.
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The Twelve-Step Facilitation Handbook:
A Systematic Approach to Early Recovery from Alcoholism and Addiction
by Joseph Nowinski, Stuart Baker
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Posted by Sparrow on 28th April 2008
The objectives of this research were to assess the prevalence of substance use among Dutch dental students and to determine their attitudes about substance use and its consequences.
METHODS: In association with a national study of drug use among US dental students, a questionnaire was translated from English into Dutch and administered to dental students at two dental schools in The Netherlands. Students received an anonymous 115-item questionnaire in the fall of 1996.
RESULTS: Alcohol was the students’ drug of choice for
- lifetime (95%),
- past year (94%) and
- past month (88%) use.
No significant correlations were found between alcohol use and gender, schools, and years in dental education.
In the past month,
- 58% of students reported drinking on 5 or more days;
- 53% had 5 or more drinks on the same occasion,
- 20% had 5 or more drinks on the same occasion on 5 or more days; and
- 17% reported getting drunk at least monthly.
Prevalence rates for past month use of tobacco was 24% and marijuana, 4%.
Male students smoked twice as much as females, with significant differences found for all three periods of use (X2>19.00, P<0.01).
When asked whether their schools offered policies and education programs on alcohol and other drugs, 52% of students reported that these were not available.
CONCLUSIONS: Dental schools should develop effective programmes to educate students about responsible use of alcohol and other licit and illicit drugs. Schools should also inform students about their susceptibilities to substance abuse and dependency.
Community Dent Oral Epidemiol. 2001 Feb;29(1):48-54. Substance use among Dutch dental students. Plasschaert AJ, Hoogstraten J, van Emmerik BJ, Webster DB, Clayton RR.
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Posted by Sparrow on 26th April 2008
Prevalence of alcohol and drug use in a highly educated workforce.
This study examined alcohol and licit and illicit drug use in a highly educated medical related workforce.
A comprehensive health survey of a 10% random sample of a workforce (n = 8,567) yielded a 60% response rate (n = 504) after accounting for 15 undeliverable surveys.
- Many respondents reported past-year use of alcohol (87%).
- Thirteen percent of respondents consumed three or more drinks daily; 15% were binge drinkers.
- Twelve percent of the workforce was assessed as having a high likelihood of lifetime alcohol dependence;
- 5% of respondents met criteria for current problem drinking.
- Overall, 42% reported using mood-altering prescription drugs (analgesics, antidepressants, sedatives, or tranquilizers).
- Eleven percent reported using illicit drugs (cocaine, hallucinogens, heroin, or marijuana) in the past year.
Significant relationships were found between gender, age, ethnicity, and occupation with some measures of alcohol consumption and use of mood-altering drugs.
These results indicate prevention and early intervention programs need to address use of mood-altering substances (including alcohol) in highly educated workforces.
Research; J Behav Health Serv Res. 2002 Feb;29(1):30-44. Prevalence of alcohol and drug use in a highly educated workforce. Matano RA, Wanat SF, Westrup D, Koopman C, Whitsell SD.
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