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.

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.

http://www.ensuringsolutions.org/resources/resources_show.htm?doc_id=336617&cat_id=989

Publisher

• Ensuring Solutions to Alcohol Problems
• George Washington University Medical Center
• Website: http://www.ensuringsolutions.org/

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.

See also;

• 12-Step Treatment More Effective than Alternative
• AA Offers Recovery Not Religion
• Brief-TSF is designed to as adjunctive therapy for anti-craving medication.
• Subscribe to Twelve Step Facilitation by e-Mail

Handbook of Alcoholism Treatment Approaches (3rd Edition) by Reid K. Hester, William R. Miller Read more about this title…

The Twelve-Step Facilitation Handbook: A Systematic Approach to Early Recovery from Alcoholism and Addiction by Joseph Nowinski, Stuart Baker Read more about this title…

• AA & 12-Step Treatment
• AA Assists Alcoholics Avoid Alcohol
• AA Can Help Most Alcoholics
• AA Fact File
• AA’s 12-Step Recovery Program
• Al-Anon offers new life
• Alcohol and Anxiety
• Alcohol Problems Database
• Alcoholic Defense Mechanisms
• Alcoholics Anonymous and Nursing
• Alcoholics Anonymous Program in India
• Alcoholics can benefit from Al-Anon
• Alcoholics Have Trouble Identifying Emotions
• Alcoholism / Addiction Treatment Saves Money
• Alcoholism in women
• Alcoholism Treatment in a Nursing Home
• Altruism helps AA members stay sober
• An Introduction to Medication for Alcohol Dependence
• Anti-craving Drugs
• Attendance at Narcotics Anonymous and Alcoholics Anonymous Meetings
• Binge Drinking & Brain Damage
• Brain Damage & Cirrhosis
• Brief Intervention in Emergency Room Effective
• Brief-TSF Description
• Brief-TSF holistic treatment
• Brief-TSF Learning Objectives
• Brief-TSF theory
• Buy Brief-TSF
• Characteristics of Children of Alcoholics
• Characteristics of Students with FAS
• Common Problems in Recovery
• Comorbid anxiety or alcohol disorder
• Comparison addiction treatment
• Controlled drinking?
• Counseling and the 12 Steps of AA
• Counselor Characteristics
• Craving Reduction
• Depression & 12-Step Programs
• Developing Willingness to Change
• Dropout from 12-step self-help groups
• Dual Diagnosis
• Early outpatient alcohol rehabilitation
• Effects of gambling addiction
• Elderly substance abuse
• Families, mental health & alcohol abuse
• Female Victims of Child Abuse
• Five Alcoholism Subtypes
• Free Training Alcoholism Anti-craving Medications
• Gender and Alcohol Rehabilitation over 8 Years
• Gender Matching Hypothesis in Alcohol Treatment
• God As We Understood Him
• Healing through social and spiritual affiliation
• Helping Alcoholics
• How Alcoholics Anonymous is changing
• How do alcoholics get to AA?
• Humility and Surrender
• Intimate Partner Violence The Role of Alcohol
• Medical Training About AA Works
• New Zealand’s spiritual aspects in 12-Step Treatment
• Nutritional Therapy in Alcoholic Liver Disease
• Painkiller abuse
• Parents drug abuse and kids anxiety
• Peers Help Alcoholics in Many Ways
• Phases of Recovery
• PTSD and Alcohol Addiction
• Readiness to Change Profiles
• Recovering Alcoholics Effective in Helping Others
• Recovery through the Twelve Steps
• Regular AA meetings improve sobriety
• Research Evidence for TSF
• Risky Partners and Domestic Violence
• Role of shame in women’s recovery from alcoholism
• Sleep problems affect alcoholism recover
• Slogans for everyday life in AA
• Spiritual assessment
• Spirituality and Alcoholics Anonymous
• Spirituality in Alcoholism Recovery
• Stages of an Eating Disorder
• Strategies for Dealing with Common Problems
• Strategies for Dealing With Denial
• Symptoms of alcoholism
• The 12-Steps Promote Acceptance of Addiction
• The Personality Traits of Alcoholics
• The psychiatric management of patients with alcohol dependence
• The Structure of AA
• Treating Alcoholism as a Chronic Disease
• TSF & Brief-TSF Target Populations
• TSF Description
• Twelve step programs
• What about partners of alcoholics?
• What About This Spiritual Awakening Thing
• Women and the Twelve Steps of AA
• Women and the Twelve Steps of AA
• Working with Twelve Step Approaches
• World view change in Adult Children of Alcoholics

Subscribe to Twelve Step Facilitation by e-Mail

Online Videos Train Clinicians to Help Patients Who Drink Too Much

A new, interactive video training program from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health (NIH), demonstrates quick and effective strategies for screening patients for heavy drinking and helping them to cut down or quit.

“The video scenarios demonstrate evidence-based techniques for assessing and managing at-risk drinking and alcohol use disorders,” says NIAAA Director Ting-Kai Li, M.D. “We want to make these techniques widely available to clinicians so that more people with alcohol use problems will get the help they need.”

Called “Video Cases: Helping Patients Who Drink Too Much,” the program is available online at www.niaaa.nih.gov/guide.

Based on the NIAAA Clinician’s Guide, the online program features four 10-minute video case scenarios, each led by an expert clinician who offers insights and engages viewers in considering different strategies for treatment and follow-up.

Continuing education credit for physicians and nurses who use the training program will be provided through Medscape.com.

“The videos model clinicians interacting with patients with different levels of alcohol involvement and who are in different stages of readiness to change,” noted Mark Willenbring, M.D., director of NIAAA’s Division of Treatment and Recovery Research. “The video scenarios take place in several different settings to show that clinicians in primary care, mental health, and other specialties are all in a prime position to make a difference.”

In addition to the video case studies, the program includes a 15- to 20-minute tutorial on the NIAAA Clinicians Guide. With video narration and animated graphics, this section teaches clinicians how to:

• Ask patients about alcohol use
• Assess heavy drinkers for alcohol use disorders
• Help at-risk drinkers to cut back to safer drinking levels
• Help patients with alcohol use disorders to quit, including treating them with newer, effective medications for dependence when indicated

The tutorial and case studies require about an hour to complete.

“As physicians, we see the serious impact that excessive alcohol use can have on patients, their families and public safety,” said Ronald M. Davis, M.D., president of the American Medical Association. “Scientific evidence shows if we can prevent alcohol consumption from becoming a problem, we can help stop thousands, even millions, of alcohol-related diseases and injuries. The AMA encourages physicians to learn how to conduct screening and brief interventions for at-risk drinking behavior and how to identify and treat alcoholism.” 

See also;

• Twelve-Step Programs as an Adjunct to Psychotherapy and Psychopharmacology
• Subscribe to Twelve Step Facilitation by e-Mail

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.

From; Join Together Online

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.

See also;

• Brief-TSF can assist patients cease alcohol consumption.
• Twelve Step Facilitation

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
• Brief-TSF can assist patients cease alcohol consumption.

1. AA & 12-Step Treatment
2. AA Can Help Most Alcoholics
3. Al-Anon offers new life
4. Alcohol and Anxiety
5. Alcoholic Defense Mechanisms
6. Alcoholics Anonymous and Nursing
7. Alcoholism Treatment in a Nursing Home
8. An Introduction to Medication for Alcohol Dependence
9. Anti-craving Drugs
10. Binge Drinking & Brain Damage
11. Brief Intervention in Emergency Room is Effective
12. Brief-TSF Description
13. Characteristics of Children of Alcoholic
14. Common Problems in Recovery
15. Counseling and the 12 Steps of AA
16. COUNSELOR CHARACTERISTICS
17. Craving Reduction
18. Depression & 12-Step Programs
19. Developing Willingness to Change
20. Dropout from 12-step self-help groups
21. Effects of gambling addiction
22. Foetal alcohol disorder linked to crime:
23. Free Training Alcoholism Anti-craving Medication
24. Gender Matching Hypothesis in Alcohol Treatment
25. Helping Alcoholics
26. Humility and Surrender
27. New Zealand’s spiritual aspects in 12-Step Treatment
28. Painkiller abuse
29. PTSD and Alcohol Addiction
30. Recovering Alcoholics Effective in Helping Others
31. Recovering People Working in the Recovery Field
32. Recovery through the Twelve Steps
33. Research Evidence for TSF
34. Risky Partners and Domestic Violence
35. Self-help Reduces Healthcare Demand
36. Sleep problems affect alcoholism recovery
37. Slogans for everyday life in AA
38. Spiritual assessment
39. Stages of an Eating Disorder
40. Strategies for Dealing with Common Problems
41. Strategies for Dealing With Crises
42. Strategies for Dealing With Denial
43. Symptoms of alcoholism
44. The 12-Steps Promote Acceptance of Addiction
45. Treating Alcoholism as a Chronic Disease
46. TSF Description
47. Twelve step programs
48. What about partners of alcoholics?
49. What About This Spiritual Awakening Thing
50. Women and the Twelve Steps of AA
51. World view change in Adult Children of Alcoholics

Training Acamprosate Anti-Craving Medication for Alcoholism

SAMHSA Launches E-Learning Courses

The US Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Knowledge Application Program (KAP) is pleased to announce its first online e-learning course,

Acamprosate: A New Medication for Alcohol Use Disorders.

The self-paced course provides information about the use, side effects, and contraindications of acamprosate; information to discuss with clients; and a comparison of medications for alcohol use disorders. On completion of the course, users will know how to include acamprosate in a treatment plan for appropriate clients.

The course is based on the acamprosate Substance Abuse Treatment Advisory published in fall 2005. Users who successfully complete the course will receive one NAADAC-approved continuing education unit (CEU) at no cost and can print out their CEU certificate.

The course is self-paced so that users can log out of the course and return at a later time to continue where they left off. If unsuccessful, users can take the course again.

To access the “Acamprosate: A New Medication for Alcohol Use Disorders” e-learning course, go to www.kap-elearning.samhsa.gov.

See also; Brief-TSF can assist patients cease alcohol consumption.