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

Mental health professional

Rethink – A guide for mental health professionals

This is the first in a series of Rethink reports on mental health recovery. It identifies 100 ways in which people working across the mental health sector can support the recovery of people with mental health problems. It highlights four key tasks:

• Developing a positive identity
• Framing the ‘mental illness’
• Self managing the mental illness
• Developing valued social roles

The author Dr Mike Slade says: “Recovery is an idea which has developed out of the experience of people living with, and beyond, mental illness. The mental health system already helps many people to live meaningful and purposeful lives, but we can do better.”

Free download available at; Mental Health Rethink

• See also;
• 12th Step Works
• Alcoholic, Addictive Behaviors
• What is AA?
• Brief-TSF can assist patients cease alcohol consumption.

Stricter Sobriety Standards for California Health Professionals November 30, 2009

Nurses, doctors, dentists and other health professionals in California who are in treatment for alcohol and other drug problems will now be subject to stricter oversight and could be immediately removed from practice should they relapse, the Los Angeles Times reported.

Health workers will now be required to take more than 100 drug tests during their first year in treatment. One positive drug test result will be enough to have a health professional be temporarily suspended from practice.

All restrictions to licenses will be posted online for public access.

The new standards were created by the state legislature last year to address the way recovery programs for doctors were being handled. The Medical Board of California ended its diversion program in 2008 after several audits found that doctors were not monitored properly and those who relapsed were not being fired.

The new standards will apply to the seven boards that oversee diversion programs, which allow licensed health professionals with addiction problems to undergo drug tests and group therapy to address their illness.

Licensed health professionals who are on probation for abusing substances will also be subject to the new rules.

Critics of the new standards include Ellen Brickman, president of the National Organization of Alternative Programs, which advocates for treatment rather than punishment for impaired healthcare professionals. “I’m listening to this and I’m cringing,” said Brickman. “I’m not optimistic that this is going to work the way they want it to. It won’t keep people from abusing substances. It will keep them out of the system, where they’ll be sicker before anybody can do anything about it.”

NIAAA Expert Discusses Minority Disparities in Alcohol Use and Treatment

In our continuing editorial series with experts from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), Coalitions Online interviewed Ricardo Brown, Ph. D., Health Science Administrator and Minority Health and Health Disparities Coordinator.

Here, in recognition of Black History Month, Dr. Brown discusses the disparities in alcohol use and treatment among minorities and stresses the need for greater minority participation in clinical studies.

Q: What are the major differences in alcohol use among minorities?

Among Asian Americans, Chinese Americans have higher rates of abstinence from alcohol, while Japanese Americans report higher rates of heavy drinking. With respect to adolescent drinking, African American teens drink less than non-Hispanic white and Latino teens.

Q: How do the health effects and mortality rates of alcohol use differ among minorities?

Despite having higher abstinence rates, alcohol-related deaths are higher among African-American males than white males. Alcohol-related mortality rates for white Hispanic Latino men is double that for non-Hispanic white men. Among Native Americans, the leading cause of death is alcohol-related.

Q: What are some of factors that might influence these varying rates?

Genes and environmental factors, and their interaction, play an important role.

Environment can play a part in shaping use, treatment and prevention, and some people have a genetic predisposition to alcohol drinking.

Some examples of environmental factors are location and insurance coverage. For example, minority patients who enter treatment programs generally have success rates that are equal to those of white patients. However, depending on where they live and the resources of their neighborhood, they may not have access to treatment.

Hispanics/Latinos and African Americans are also less likely to have insurance coverage for treatment. However, we need to conduct more studies to determine the exact multi-dimensional factors that influence use of alcohol. Getting more minorities to participate in clinical trials is a challenge we’re facing now and one way to address the disparities is by getting increased participation by minority groups so we can understand the underlying mechanisms responsible for disparities between groups of people.

Q: What is the role of the community in helping to address these disparities?

They can be a stronger force in encouraging people from all walks of life to participate in clinical and epidemiological studies, so that the outcomes of those studies can be applicable to all groups. It’s also important for any local community or university-based group to be involved in their local alcohol research center, which are located throughout the country.

Q: What efforts does the NIAAA do to address these disparities?

Our Director Dr. Ting-Kai Li is aware of these disparities and he’s working closely with the National Center for Minority Health Disparities and other organizations to address them. He is also developing mechanisms for increasing enrolment of African-Americans and other ethnic minorities in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

Dr. Ricardo Brown is NIAAA’s Health Science Administrator and Minority Health and Health Disparities Coordinator. For more information about the NIAAA and its programs, visit www.niaaa.nih.gov.

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

Alcohol hospital admissions hide individual tragedies, say doctors (issued Tuesday 22 Jul 2008)

The new government figures released today (Tuesday 22 July 2008) revealing that 811,000 people in England were admitted to hospital with alcohol misuse problems in 2006 hide the individual tragedies that hospital frontline staff see day in day out, said the British Medical Association.

The BMA’s Head of Science and Ethics, Dr Vivienne Nathanson, added:

“While this figure is rightly very frightening and shocking, it also hides the hundreds and thousands of individual tragedies that doctors witness every day. Alcohol misuse is related to over 60 medical conditions including heart and liver disease, diabetes, strokes and mental health problems – it costs the NHS millions of pounds every year and is linked to accidents and street violence.

The truth is there is nothing glamorous about drinking too much alcohol – it wrecks health, lives and families.

“The BMA will be responding in full to the government’s consultation on alcohol and we will certainly be backing tough action like introducing mandatory regulation and labelling and restricting ‘happy hours’ and irresponsible drinks promotions . There can be no more softly, softly approach. The access and affordability of alcohol must be tackled head on.”

Full story at; British Medical Association, The professional association for doctors

See also;

• If you have healthcare training this manual may help.
• Science of Addiction
• Early or Adaptive Stage of Alcoholism
• Types of Dysfunctional Families

Understanding and Counseling Persons With Alcohol, Drug, and Behaviorial Addictions by Howard Clinebell Read more about this title…

There is a culture clash between alcohol marketing and public health aspirations

It is of no coincidence that a number of recent Harm Reduction Digests have addressed the issue of the reduction of alcohol-related harm.

Despite the dominant focus on illicit drug use in the popular discourse, alcohol remains Australia’s number one drug problem, as it is in many other developed countries.

Munro and de Wever use the ‘four Ps’ of marketing:

• product,
• price,
• place and
• promotion, to critique the two decades industry self-regulation of alcohol marketing.

They conclude that if we are going to develop policies which effectively change Australian drinking culture to reduce alcohol-related harm, we need first to accept that the alcohol industry and the health field have separate and conflicting interests.

Research; Geoffrey Munro & Johanna de Wever. Drug and Alcohol Review, Volume 27, Issue 2 March 2008 , pages 204 – 211. Culture clash alcohol marketing and public health aspirations

See also;

• Brief-TSF can assist patients cease alcohol consumption.
• Alcohol Science Database

Alcohol and Public Policy: No Ordinary Commodity by Thomas Babor 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…