In a new target population researchers have found that alcoholics who have a particular variant of an opioid-receptor gene appear to respond better to naltrexone, an opioid antagonist that is used to reduce alcohol craving and relapse.

National Institute on Alcohol Abuse and Alcoholism (NIAAA) researchers who reviewed data from the 2001-2004 COMBINE (Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence) study found that 87 percent of patients with the OPRM1 gene variant reported good outcomes with naltrexone treatment, compared to 49 percent of those receiving placebos and 55 percent of individuals lacking the gene variant who received either a placebo or naltrexone.

The study defined good outcomes as abstinence or moderate alcohol consumption without attendant problems.

“Analysis of the large COMBINE patient population increases confidence that the OPRM1 variant is in part responsible for positive responses to naltrexone,” said Ting-Kai Li, director of NIAAA. “This study points to the promise of research on gene-medication interactions to refine treatment selection, improve clinical results, and inform ongoing medications development.”

The research was published in the Feb. 4, 2008 issue of the Archives of General Psychiatry.

See also;

• Brief-TSF can assist patients cease alcohol consumption.
• Anti-craving Naltrexone Injection Reduces Drinking

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From the Alcohol WHO International Agency for Research on Cancer (IARC)

Summary of IARC evaluation

• There is sufficient evidence in humans for the carcinogenicity (cancer causing chemicals) of alcoholic beverages.

• The occurrence of malignant (death causing) tumours of the oral cavity, pharynx, larynx, oesophagus, liver, female breast and colorectum (the bottom part of the bowel) is causally related to the consumption of alcoholic beverages.

• There is evidence suggesting lack of carcinogenicity in humans for alcoholic beverages and cancer of kidney and non-Hodgkin lymphoma. Limited evidence for pancreas.

• There is substantial mechanistic evidence in humans with aldehyde dehydrogenase (a metabolising agent) deficiency that acetaldehyde derived from the metabolism of ethanol in alcoholic beverages contributes to the causation of malignant oesophageal tumours.

• There is sufficient evidence in experimental animals for the carcinogenicity of ethanol.

• There is sufficient evidence in experimental animals for the carcinogenicity of acetaldehyde.

• Overall evaluation: Alcoholic beverages are carcinogenic to humans. Ethanol in alcoholic beverages is carcinogenic to humans. Acetaldehyde associated with alcohol consumption is carcinogenic to humans.

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Encouraging post-treatment self-help group involvement to reduce demand for continuing care services: two-year clinical and utilization outcomes.

BACKGROUND: Accumulating evidence indicates that addiction and psychiatric treatment programs that actively promote self-help group involvement can reduce their patients’ health care costs in the first year after treatment, but such initially impressive effects may wane over time.

This paper examines whether the positive clinical outcomes and reduced health care costs evident 1 year after treatment among substance-dependent patients who were strongly encouraged to attend 12-step self-help groups were sustained at 2-year follow-up.

METHODS: A 2-year quasi-experimental analysis of matched samples of male substance-dependent patients who were treated in either 12-step-based (n=887 patients) or cognitive-behavioral (CB, n=887 patients) treatment programs.

The 12-step-based programs placed substantially more emphasis on 12-step concepts, had more staff members “in recovery,” had a more spiritually oriented treatment environment, and promoted self-help group involvement much more extensively than did the CB programs.

The 2-year follow-up assessed patients’ substance use, psychiatric functioning, self-help group affiliation, and mental health care utilization and costs.

RESULTS: As had been the case in the 1-year follow-up of this sample, the only difference in clinical outcomes was a substantially higher abstinence rate among patients treated in 12-step (49.5%) versus CB (37.0%) programs.

Twelve-step treatment patients had 50 to 100% higher scores on indices of 12-step self-help group involvement than did patients from CB programs.

In contrast, patients from CB programs relied significantly more on outpatient and inpatient mental health services, leading to 30% lower costs in the 12-step treatment programs.

This was smaller than the difference in cost identified at 1 year, but still significant ($2,440 per patient, p=0.01).

CONCLUSIONS: Promoting self-help group involvement appears to improve posttreatment outcomes while reducing the costs of continuing care.

Even cost offsets that somewhat diminish over the long term can yield substantial savings.

Actively promoting self-help group involvement may therefore be a useful clinical practice for helping addicted patients recover in a time of constrained fiscal resources.

Humphreys K, Moos RH. Encouraging posttreatment self-help group involvement to reduce demand for continuing care services: two-year clinical and utilization outcomes. Alcohol Clin Exp Res. 2007 Jan;31(1):64-8.

Brief-TSF is designed to encourage 12-Step involvement.

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Youth Involved in AA-Related Helping Less Likely to Test Positive for Alcohol and Drugs

Youth who become active in Alcoholics Anonymous-related helping (AAH) while they are in treatment are less likely to test positive for alcohol and drugs during treatment, a new study finds.

Researchers at Case Western Reserve University studied almost 200 juvenile offenders. The study also evaluated a questionnaire, called the SOS tool, which helps clinicians identify youths low in service participation and suggests AAH activities to promote their recovery, MedicalXpress reports.

Such activities include;

• acts of good citizenship,
• formal service positions,
• public outreach and
• sharing personal experience to another person struggling with addiction.

These activities are;

• free,
• available seven days a week, and
• do not require a long-term commitment,
• prior experience,
• special skills or a
• specific length of time sober, the article notes.

“The SOS tool provides a snapshot of a patient’s level of service participation. An SOS score of 40 or higher is associated with greater abstinence as measured by urine toxicology screens,” lead researcher Maria Pagano said in a news release.

• “Given AAH participation during treatment significantly improves the likelihood of long-term abstinence, interventions that facilitate early engagement in service are critical during the few weeks of treatment when motivation to change behavior is the highest.”

The findings appear in The American Journal on Addictions.

In 2010, Dr. Pagano published a study that found adults who became involved in Alcoholics Anonymous-related service-type work were more likely to stay sober 10 years after treatment.

See more at: 12th Step Work Helps Youth

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Treating Alcoholism as a Chronic Disease

Alcoholism is a diagnosable disease similar to other chronic, relapsing conditions such as asthma, diabetes and high blood pressure. All of these illnesses:

• Have strong genetic and behavioral components
• Can be identified with reliable diagnostic methods
• Can be effectively managed with behavior change and medication
• Show similar patterns of symptom control and relapse

Yet we continue to deal with alcoholism as a social problem more often than as a health issue, primarily because of the stigma, or social disapproval, that accompanies addiction to any drug.

As a result, too few people get the treatment they need. This drives up alcohol-related health care costs, disrupts families, cuts productivity in the workplace and threatens the safety of our communities.

Recent advances in neuroscience have enabled researchers to uncover the biological roots of alcoholism and study how changes in brain chemistry can lead to addiction.

These advances also have led to the development of new medications to treat alcoholism. This means that physicians can prescribe medication in addition to behavior change to manage alcoholism, just as they routinely do for asthma, diabetes and high blood pressure.

The strong case for treating alcoholism as a chronic disease builds on a great deal of evidence:

• Numerous points of comparison among alcohol-related problems, asthma, diabetes and high blood pressure;
• Genetics and behavior increase the risk for developing alcoholism;
• Alcohol is a drug that affects people differently;
• The direct effect of alcohol on brain chemistry;
• New medications for treating alcoholism reduce craving for the drug;
• Treating alcoholism as an acute illness has negatively influenced perceptions about treatment; and
• Stigma has led to inequities in the health care system that make treatment for alcoholism less accessible than that for other chronic diseases.
• The primer concludes with straightforward steps that employers, policy makers, health care professionals and individuals can take to ensure that alcoholism is treated as a chronic disease.

Treating Alcoholism as a Chronic Disease was developed in consultation with David Lewis, MD, founder of Brown University’s Center on Alcohol and Addiction Studies. It is available on-line at EnsuringSolutions.org.

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Inhalants

Inhalants are common products found right in the home and are among the most popular and deadly substances kids abuse. Inhalant abuse can result in death from the very first use.

Health Hazards

Health Effects and Risks. Nearly all abused inhalants produce effects similar to anesthetics, which act to slow down the body’s functions. When inhaled in sufficient concentrations, inhalants can cause intoxicating effects that can last only a few minutes or several hours if inhalants are taken repeatedly. Initially, users may feel slightly stimulated; with successive inhalations, they may feel less inhibited and less in control; finally, a user can lose consciousness.

More Information

Signs of Inhalant Abuse

Parents and healthcare workers can be aware of the following signs of an inhalant abuse problem:

• Chemical odors on breath or clothing;
• Paint or other stains on face, hands, or clothes;
• Hidden empty spray paint or solvent containers and chemical-soaked rags or clothing;
• Drunk or disoriented appearance;
• Slurred speech;
• Nausea or loss of appetite;
• Inattentiveness, lack of coordination, irritability, and depression;
• Missing household items.

More at Inhalants

See also;

• Is Your Teen Using Drugs or Drinking?
• Alcohol intervention may help.
• Types of Dysfunctional Families

Drug Information for Teens: Health Tips About the Physical And Mental Effects of Substance Abuse : Including Information about Marijuana, Inhalants, Club Drugs, Stimulants, Hallu (Teen Health Series)

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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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Delivery of a brief motivational intervention to patients with alcohol-related facial injuries: role for a specialist nurse.

In this paper we focus on providing an alcohol screening and intervention service within maxillofacial surgery.

Two trained nurses screened patients with alcohol-related facial injuries who attended maxillofacial outpatient clinics, and gave brief motivational interventions to those who had been drinking to a hazardous level.

Patients were followed up at 3 and 12 months after the intervention. 195/249 patients (78%) drank to a hazardous level.

One hundred and ninety-five patients received an intervention. Duration of intervention was between 5 and 65 minutes. Reasons for refusal to participate included lack of interest or time, and the main reason for exclusion was length of time since injury.

The follow up rate was 103 (53%) at 3 months and 134 (69%) at 12 months.

CONCLUSIONS: The high level of hazardous drinking among people with facial trauma suggests a clear need for alcohol screening and intervention. It is feasible for nursing staff to deliver brief interventions in a busy maxillofacial trauma clinic.

Oakey F, Ayoub AF, Goodall CA, Crawford A, Smith I, Russell A, Holland IS. Delivery of a brief motivational intervention to patients with alcohol-related facial injuries: role for a specialist nurse. Br J Oral Maxillofac Surg. 2008 Mar;46(2):102-6. Epub 2007 Dec 21.

Related articles

• Concept of Alcoholism (twelvestepfacilitation.com)
• Brief Intervention in Emergency Room Effective (twelvestepfacilitation.com)
• Seventeen Percent of Hospital Patients Drink Too Much (twelvestepfacilitation.com)

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Researchers say that men with clinical depression are more likely to kill themselves if they drink heavily or also suffer from a type of personality disorder known for aggressive and impulsive behavior, Reuters reported Dec. 23.

Researcher Gustavo Turecki and colleagues looked at a group of men with major depressive disorder, including 104 who committed suicide and 74 percent who are living. They found that those who were classified as alcohol abusers or dependent were four times more likely to kill themselves, while those with “Cluster B” personality disorders were 17 times more likely to commit suicide.

“Why some patients with major depressive disorder die by suicide while others with seemingly the same disorder do not, is a question of enormous clinical relevance,” the researchers noted. “…[H]igher levels of impulsive and aggressive behaviors, combined with behavioral disinhibition facilitated by substance use, may mediate suicide in major depressive disorder.”

Drinking and personality disorders were especially dangerous for younger men with depression. “If a clinician has a patient that has major depression and comorbidity with substance-related problems and the presence of cluster B personality trait and is younger, these are patients you want to make sure you pay close attention to,” said Turecki.

The study appears in the November 2005 issue of the American Journal of Psychiatry. Reference; Dumais, A., et al. (2005) Risk Factors for Suicide Completion in Major Depression: A Case-Control Study of Impulsive and Aggressive Behaviors in Men. Am J Psychiatry 162: 2116-2124. From; Join Together

The Practical Art of Suicide Assessment: A Guide for Mental Health Professionals and Substance Abuse Counselors by Shawn Christopher Shea Read more about this title…

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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.

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