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;
Nine Elements of Effective Alcohol Treatment for Adolescents
In evaluating a broad spectrum of treatment programs and approaches, researchers have identified common themes among the treatments that are most effective in helping teens. Drug Strategies, a Washington-based nonprofit research institute that promotes more effective approaches to the nation’s drug problems, found these key elements in an extensive review.
Whether clients or counselors, students or teachers, we are all imperfect human beings. We are here because we have a yearning to grow.
And the strongest motivator for growth is pain. When we are significantly harmed or deprived mentally, emotionally or physically and have no safe people or role models to help us understand and rebound or heal, our mind creates defense mechanisms and coping strategies to hide our real pain and vulnerability.
This may serve us well over a short time period, but backfires in a longer time frame. When we become habituated to our means to hide painful reality, we forget our true self behind the fabrications.
Psychotherapy is a unique relationship, a kind of connection that is unlike any other kind of relationship a person has in their life. In some ways, it can be more intimate than our most intimate relationships, but it also paradoxically values a vestige of professional distance between therapist and client.
Therapists, alas, are just as human as the clients they see and come with the same human foibles. They have bad habits, as we all do, but some of those habits have the very real potential of interfering with the psychotherapy process and the unique psychotherapy relationship.
So without further ado, here are twelve things you wish your therapist didn’t do — some of which may actually harm the psychotherapeutic relationship.
Showing up late for the appointment.
Eating in front of the client.
Yawning or sleeping during session.
Inappropriate disclosures.
Being impossible to reach by phone or email.
Distracted by a phone, cell phone, computer or pet.
Expressing racial, sexual, musical, lifestyle and religious preferences.
Bringing your pet to the psychotherapy session.
Hugging and physical contact.
Inappropriate displays of wealth or dress.
Clock watching.
Excessive note-taking.
Full story and expansion of these annoyances at PsychCentral
Five-year follow up for sobriety in a cohort of men who had attended an Alcoholics Anonymous programme in India.
BACKGROUND: There are little data from India on the long term follow up of patients with alcohol dependence who have undergone a de-addiction programme.
A cohort of patients who completed a detoxification and de-addiction programme based on the Alcoholics Anonymous model were followed up for a period of 5 years.
METHODS: A cohort design was used. A community outreach programme of a de-addiction centre was the setting for the study.
One hundred and eighty-two patients who completed a detoxification and de-addiction programme based on the Alcoholics Anonymous model were followed up. Sobriety at 5 years’ of follow up was the outcome measure.
RESULTS: One hundred and fifty-one (83%) patients were followed up at 5 years.
The majority (90; 59.6%) did not change their alcohol consumption and
a small minority (25; 16.5%) remained completely sober over the 5-year period.
Sobriety at 1 year was significantly associated with complete abstinence at 5 years (chi2 = 53.8; df = 1; p < 0.001).
More patients coming from distant places (RR 0.84; 95% CI: 0.71, 0.98; p < 0.03) and
those with health workers in their localities (RR 0.81; 95% CI: 0.68, 0.96; p < 0.01) were completely abstinent.
These variables were also significantly associated with sobriety even after adjusting for other confounders using logistic regression.
CONCLUSION:. The results of the 5-year outcome are modest.
More patients coming from distant places and those with health workers in their localities remained completely abstinent suggesting the possible role of the individual’s motivation and the need for continued community support in maintaining sobriety.
Research; Kuruvilla PK, Jacob KS. Five-year follow up for sobriety in a cohort of men who had attended an Alcoholics Anonymous programme in India. Natl Med J India. 2007 Sep-Oct;20(5):234-6.
See also;
Twelve Step Facilitation is designed to support people returning to their community
Alcohol screening brief intervention and referral in the emergency department an implementation study
INTRODUCTION: Alcohol is the single greatest contributor to injury in the United States. Numerous studies have reported that a standardized screening, brief intervention, and referral to treatment (SBIRT) intervention can effectively minimize future alcohol consumption, reduce injury recurrence, and decrease the number of repeat ED visits. To date, SBIRT studies have been conducted in settings in which physicians or research assistants carried out SBIRT. Little is known about ED nurses carrying out SBIRT. The purpose of this study was to examine ED nurse training needs and identify both barriers to, and enablers of, SBIRT implementation in the emergency department.
METHODS: Two coordinators from each of the 5 ED sites selected for the study attended a 1-day SBIRT educational session. Site coordinators then trained their staff nurses to conduct SBIRT. Site coordinators were surveyed at the midpoint and end of the 6-month implementation study period. Patient data from each facility was collected.
RESULTS: Ten site coordinators were trained and held subsequent training sessions with nursing staff in their respective emergency departments. All sites encountered barriers to implementation, but 2 of 5 sites were able to implement the SBIRT process fully by the end of the evaluation period. A total of 3265 patients were screened for alcohol use problems. Of those screened, 678 (21%) were classified as hazardous drinkers. Overall, 56% of the positive-screened patients received 3 to 5 minutes of a brief intervention. After the brief intervention, between 9% and 82% of patients were referred for further care.
DISCUSSION: The SBIRT process can be conducted successfully by emergency nurses. However, substantial operational barriers to widespread routine implementation exist. These barriers need to be addressed before emergency nurses incorporate SBIRT as routine part of ED care.
Desy PM, Perhats C. Alcohol screening brief intervention and referral in the emergency department an implementation study. J Emerg Nurs. 2008 Feb;34(1):11-9. Epub 2007 Dec 3.
Despite decades of using a chronic disease metaphor for alcoholism and, more recently, drug addiction, we continue to provide treatment based on an acute model of care.
Is it time to shift to a chronic care approach similar to disease management models?
To explore this question, a recent study analyzed data demonstrating the chronic nature of addiction.
Over 50% of people who resolve drug problems following treatment receive multiple episodes of care, usually over several years.
Data from 2003 from programs receiving public funds revealed that 64% of people were readmissions to treatment and 19% had more than four admissions.
In a study of 448 persons following treatment, 82% transitioned at least once between relapse, treatment re-entry, incarceration, and periods of abstinence over a 2-year period.
Alarming results of a study from 23 states revealed that only 17% of persons discharged from intensive treatment were transitioned to outpatient continuing care.
Several emerging practices for a chronic care model and their results were also reviewed, revealing the following:
telephonic follow-up resulted in fewer positive cocaine urine tests;
assertive continuing care for adolescents demonstrated greater access to and participation in continuing care as well as greater abstinence;
recovery management check-ups at 90-day intervals combined with motivational interventions for those who had relapsed provided a faster return to, and greater participation in, treatment as well as a lesser need for treatment at 2-year follow-up.
The authors discuss the need for substantial system changes required across all elements of the addiction treatment system if a chronic care model is to be implemented.
Comments by Michael Boyle, PhD: Providers do what they are paid to deliver. If we want to change to a potentially more effective model of addiction treatment, the funding bodies must implement new billing codes and rates for continuing recovery management. Providers need to strive to remove any sense of failure, shame, or guilt persons may have regarding their return to use and need for additional assistance.
Reference: Dennis M, Scott CK. Managing addiction as a chronic condition. Addict Sci Clin Pract. 2007;4(1):45-55.
Professional Interventions That Facilitate 12-Step Self-Help Group Involvement.
Facilitating patients’ involvement with 12-step self-help organizations, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), is often a goal of substance abuse treatment.
Twelve-step-facilitation (TSF) interventions have been found to be more effective than comparison treatments in increasing patients’ 12-step group involvement and in promoting abstinence.
Future TSF evaluation research should address the effectiveness of incorporating TSF interventions with cognitive-behavioral treatment methods, the relative impact of brief versus extended TSF interventions, and the cost-effectiveness and health care cost-offset of TSF interventions within managed health care systems.
Although the United States has developed an extensive array of professional alcohol treatment services over the past 30 years, the peer-led, voluntary fellowship known as Alcoholics Anonymous (AA) continues to be the most widely accessed resource for people with alcohol problems (McCrady and Miller 1993).
This article discusses the rationale for interventions that facilitate alcohol-dependent patients’ affiliations with AA and related mutual-help organizations (e.g., Narcotics Anonymous [NA]).
The article also reviews recent research comparing those interventions with other treatment methods.
Research; Professional Interventions That Facilitate 12-Step Self-Help Group Involvement. Journal article by Keith Humphreys; Alcohol Research & Health, Vol. 23, 1999
See also;
Twelve Step Facilitation is designed to support people returning to their community
I’ll Quit Tomorrow: A Practical Guide to Alcoholism Treatment
Nine Elements of Effective Alcohol Treatment for Adolescents
Anger Management For Dummies (For Dummies (Psychology & Self Help))
AA & 12-Step Treatment
Facilitating patients’ involvement with 12-step self-help organizations, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), is often a goal of substance abuse treatment. 
