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Posted on June 10, 2013 at 5:01 am by Sparrow

Loss of control of drinking

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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.

Alcoholic Liver Disease

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Alcohol and substance abuse.

Alcoholic liver disease is an important cause of cirrhosis, liver-associated death, and need for liver transplant. Up to 50% of recipients use some alcohol, and perhaps 10% drink addictively.

Careful evaluation by an addiction medicine specialist is the best predictive instrument before transplant surgery, whereas the 6-month rule lacks sensitivity and specificity.

Addictive drinking, but not minor slips, is associated with increased mortality.

There is no standard therapy for alcoholism in alcoholics waiting for a transplant or for those who have undergone a transplant.

Stably abstinent, methadone-maintained opiate-dependent patients should continue methadone; are generally good candidates for liver transplant; and show low relapse rates.

Pre- and post-transplant smoking rates are high and cause significant morbidity and mortality. Transplant teams should encourage smoking cessation treatments.

Marijuana use in liver transplant recipients is common, although risks associated with this practice are unknown.

Research report’; Lucey MR, Weinrieb RM. Alcohol and substance abuse Semin Liver Dis. 2009 Feb;29(1):66-73. Epub 2009 Feb 23.

Reductions in Drinking for Hep C Patients

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Significant Reductions in Drinking Following Brief Alcohol Treatment Provided in a Hepatitis C Clinic

BACKGROUND: Although the hepatitis C virus (HCV) alone increases the risk of cirrhosis, alcohol use is thought to act synergistically with HCV to significantly hasten the development of fibrosis.

OBJECTIVE: The authors assessed the impact of brief medical counseling or integrated-care approaches to lessen or eliminate alcohol use in these vulnerable patients.

METHOD: This retrospective study describes the effect of brief alcohol treatment delivered in a hepatitis clinic on drinking outcomes and antiviral treatment eligibility: 47 heavy-drinking chronic hepatitis C patients received a brief intervention performed by medical clinicians, with follow-up by a psychiatric nurse-specialist.

RESULTS: At the last follow-up, 62% of patients reported >50% drinking reduction; these included 36% who achieved abstinence. Only 6% of patients were excluded from antiviral therapy.

DISCUSSION: Brief treatment addressing heavy drinking delivered by hepatitis clinicians with psychiatric-specialist follow-up was associated with abstinence or a significant reduction in alcohol consumption in over 50% of patients.

Eric Dieperink, M.D., Samuel B. Ho, M.D., Sara Heit, M.S., R.N., C.N.S., Janet M. Durfee, R.N., M.S.N., APRN, Paul Thuras, Ph.D., and Mark L. Willenbring, M.D. Psychosomatics 51:149-156, March-April 2010

Common Problems in Recovery

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Common Problems in Patients Recovering from Chemical Dependency

Chemical dependency is a common, chronic disease that affects up to 25 percent of patients seen in primary care practices.

The treatment goal for patients recovering from chemical dependency should be to avoid relapse.

This requires physicians to have an open, nonjudgmental attitude and specific expertise about the implications of addiction for other health problems.

Firstline treatment for chemical dependency should be nonpharmacologic, but when medication is necessary, physicians should avoid drugs that have the potential for abuse or addiction.

Medications that sedate or otherwise impair judgment also should be avoided in the recovering patient.

Psychiatric illnesses should be aggressively treated, because untreated symptoms increase the risk of relapse into chemical dependency.

Selective serotonin reuptake inhibitors may help to lower alcohol consumption in depressed patients, and desipramine may help to facilitate abstinence in persons addicted to cocaine.

If insomnia extends beyond the acute or postacute withdrawal period, trazodone may be an effective treatment.

If nonpharmacologic management of pain is not possible, nonaddictive medications should be used.

However, if nonaddictive medications fail, long-acting opiates used under strict supervision may be considered. Uncontrolled pain in itself is a relapse risk.

Research; Fam Physician 2003;68:1971-8. Common Problems in Patients Recovering from Chemical Dependency. EDNA MARIE JONES, DOUG KNUTSON, and DANELL HAINES.

Dual Disorders : Counseling Clients With Chemical Dependency and Mental Illness

Faith Community Nurses Addiction Problems

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Faith Community Nurses and the Prevention and Management of Addiction Problems

Faith Community Nurses can have a role in the prevention and management of problems associated with the use and abuse of psychoactive substances, prescription drugs, and over-the-counter medications.

Religious perspectives of faith communities on the use of drugs vary considerably, as do the religious perspectives of addiction.

Nevertheless, Faith Community Nurses work in these communities and understand the unique culture of these groups.

The Faith Community Nurse has many functions including health educator, health advocate, personal health counselor, referral agent, coordinator of volunteers, developer of support groups, and integrator of health and faith.

Consequently, the Faith Community Nurse is involved with individuals, families, and members of the community.

These connections provide many opportunities for the Faith Community Nurse to institute programs to prevent addictions, help people understand the problems of addiction, help provide a caring community for people suffering from addictions, and guide people to the help they need.

In addition, the nurse has opportunities to conduct research that would enhance the understanding of the topic.

Research; Joan A. Bard. Faith Community Nurses and the Prevention and Management of Addiction Problems. Journal of Addictions Nursing, Volume 17, Issue 2 July 2006 , pages 115 – 120

Alcohol Problems Database

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Alcohol and Alcohol Problems Science database

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has created this portal to support researchers and practitioners searching for information related to alcohol research.

This page includes links to a number of databases, journals, and Web sites focused on alcohol research and related topics. Also included is a link to the archived ETOH database, the premier Alcohol and Alcohol Problems Science Database, produced by NIAAA from 1972 through December 2003.

http://etoh.niaaa.nih.gov/Introduction.htm

Double Trouble in Recovery

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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

Brain Chemicals Trump Willpower in Addicts

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Brain Chemicals Trump Willpower in Addicts, NIDA Director Says

Understanding brain chemistry, not building up willpower, is the key to preventing adolescent alcohol and other drug addiction, according to Nora Volkow, director of the National Institute of Drug Abuse (NIDA).

The Associated Press reported April 3 that Volkow said that adolescent brains are still developing and react differently to drugs than those of adults. Volkow, a researcher with a long history of exploring the brain circuitry involved in addiction, has been shifting some of NIDA’s research efforts toward examining how the brains of adolescents and people who don’t become addicted to alcohol or other drugs differ from the brains of those who do develop drug problems. “What is it that makes a person more vulnerable to take drugs or not?” said Volkow.

“Now we have Nora’s picture rather than a picture of fried eggs,” said Joanna Fowler, a former colleague of Volkow’s at the Brookhaven National Laboratory. “We can go beyond that knee-jerk picture of a brain to a real brain … If you can conceptualize (addiction) as a brain disease rather than a moral weakness or lack of willpower, you can more easily bring resources to bear.”

Former NIDA head Alan Leshner said Volkow has promoted the idea that addiction “has to be seen as a health issue as well as a criminal or social-justice issue. She has definitely moved neuroscience forward.”

Volkow said she always has been fascinated in the brain and issues of free will. She noted that the brain is not fully matured until the early 20s, with the frontal cortex — the brain’s cognitive and reasoning center — the last to be finished. Thus, for teens, “to stand up and say ‘I’m not going to do it’ is much harder than (for) an adult,” Volkow said.

Brain immaturity may also explain teen risk-taking and why scare tactics can backfire in drug prevention. “It is that notion of ‘I dare you,’” she said. “It may be appealing to an adolescent because they are seeking for danger in many instances.”

Teens and 12 Step Attendance

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Do Adolescents Affiliate with 12 Step Groups? A Multivariate Process Model of Effects.

Research with adolescents has revealed good effects for 12-step attendance on substance use outcomes, but no studies have examined the effects of 12-step affiliation, or active involvement, beyond simple measures of attendance.

Prior research with adults has shown that measures of affiliation are more predictive than measures of attendance.

This study (1) assessed attributes that may influence 12-step attendance and affiliation; (2) tested whether 12-step affiliation in the first 3 months posttreatment possessed unique predictive power above that attributable to attendance alone; and (3) examined the extent to which motivation, coping and self-efficacy measured at 3 months mediated the relation between 12-step affiliation and substance use outcome in the ensuing 3 months.

Adolescent inpatients (N = 74, 62% female), who were aged 14-18 years (mean [SD] ? 15.9 [1.19] years), were interviewed during treatment and at 3 and 6 months post-discharge.

More severely substance-involved youth were more motivated for abstinence and more likely to attend and affiliate with 12-step groups.

A high degree of collinearity between 12-step attendance and affiliation suggested that those attending were also likely to be those actively involved.

Motivation was found to influence the relationship between 12-step affiliation and future substance use outcome.

Given the widespread treatment recommendations for adolescent 12-step involvement, more study is needed to determine what kinds and what aspects of 12-step groups and fellowships are helpful to adolescent change efforts and what alternatives should be developed.

Research; JOHN F. KELLY, MARK G. MYERS, and SANDRA A. BROWN. Do Adolescents Affiliate with 12 Step Groups? A Multivariate Process Model of Effects. J Stud Alcohol. 2002 May; 63(3): 293â€“304.

Alcohol Problems in Adolescents and Young Adults: Epidemiology. Neurobiology. Prevention. Treatment (Recent Developments in Alcoholism)
by Marc, Ed. Galanter

Helping Helps

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Helping Helps the Helper

Aims; The helper therapy principle suggests that, within mutual-help groups, those who help others help themselves. The current study examines whether clients in treatment for alcohol and drug problems benefit from helping others, and how helping relates to 12-step involvement. Design Longitudinal treatment outcome.

Participants; An ethnically diverse community sample of 279 alcohol- and/or drug-dependent individuals (162 males, 117 females) was recruited through advertisement and treatment referral from Northern California Bay Area communities. Participants were treated at one of four day-treatment programs.

Measurements; A helping checklist measured the amount of time participants spent, during treatment, helping others by sharing experiences, explaining how to get help and giving advice on housing and employment. Measures of 12-step involvement and substance use outcomes were administered at baseline and a 6 month follow-up.

Findings; Helping and 12-step involvement emerged as important and related predictors of treatment outcomes. In the general sample, total abstinence at follow-up was strongly and positively predicted by 12-step involvement at followup, but not by helping during treatment; still, helping positively predicted subsequent 12-step involvement. Among individuals still drinking at follow-up, helping during treatment predicted a lower probability of binge drinking, whereas effects for 12-step involvement proved inconsistent.

Conclusions; Findings support the helper therapy principle and clarify the process of 12-step affiliation.

Research report; Sarah E. Zemore, Lee Ann Kaskutas & Lyndsay N. Ammon, In 12-step groups, helping helps the helper. Addiction; March 2004

Peer Support in Action: From Bystanding to Standing By

Loss of control of drinking

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Alcoholic Liver Disease

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Reductions in Drinking for Hep C Patients

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Common Problems in Recovery

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Faith Community Nurses Addiction Problems

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Alcohol Problems Database

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Double Trouble in Recovery

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Brain Chemicals Trump Willpower in Addicts

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Teens and 12 Step Attendance

Research; JOHN F. KELLY, MARK G. MYERS, and SANDRA A. BROWN. Do Adolescents Affiliate with 12 Step Groups? A Multivariate Process Model of Effects. J Stud Alcohol. 2002 May; 63(3): 293â€“304.

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Helping Helps

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