Naltrexone Works Better for Some Populations More than Others

  • Naltrexone is one of the most effective pharmacological treatments for alcohol dependence.
  • However, naltrexone does not work for everyone.
  • A new study has found that naltrexone is effective for women, and individuals with the A118G polymorphism of the mu opioid receptor gene (OPRM1).
There are few pharmacological treatments for alcohol dependence (AD). An opioid receptor antagonist called naltrexone is one of the most effective, and yet it is not effective for everyone. This study investigated the influence of gender and the A118G polymorphism of the mu opioid receptor gene (OPRM1) on response to naltrexone, finding that naltrexone decreased alcohol-induced euphoria in women and those with the specific genotype.

More at; ATTC – Addiction Science Made Easy.

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Women and the Twelve Steps of Alcoholics Anonymous: A Gendered Narrative

This paper examines how women “work” the twelve steps of Alcoholics Anonymous (AA) from a gendered perspective.

Feminist critics of AA have

  • challenged the language of AA’s Twelve Steps,
  • the spiritual nature of the steps, and
  • the male-dominated culture of the Twelve-Step program.

This paper offers insight into how women in AA approach, interpret, and utilize the Twelve Steps to recover from alcoholism.

Through survey and narrative data, findings suggests

  • that women working AA’s Twelve Steps become empowered and
  • change for the better in spite of the male-dominated culture and language of the Twelve Steps and
  • regardless of the difficulty they may have encountered in completing these steps.

In particular, the first three steps-the “surrender steps”-

  • encourage women to let go of their alcoholic obsession and
  • begin a spiritual path of recovery.

Steps Four through Nine require

  • women to “clean house” and
  • get rid of old self-destructive ways so that they may develop a new and stronger sense of self.

Finally, on completing Steps Ten through Twelve, women

  • experience a spiritual awakening and
  • then, in turn, “pass on” what they have learned from the Twelve Steps to other women in the program.

Woven throughout these women’s experiences is

  • an acknowledgment of gender and
  • the role it plays in how they work the Twelve Steps.

In the end, these women express a sense of personal empowerment that is particular to a gender-specific orientation to the Twelve Steps of AA.

Research; Jolene M. Sanders, Women and the Twelve Steps of Alcoholics Anonymous: A Gendered Narrative. Alcoholism Treatment Quarterly, Volume: 24 Issue: 3, 2006

Al-anon, Adult Children of Alcoholics, Gambler Anonymous, Narcotics Anonymous,


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Thyroid function in depression and alcohol abuse : a retrospective study

Admission thyroid function tests were reviewed in 115 euthyroid patients with depression (66), depression and alcohol abuse (30), or alcohol abuse (19).

Estimated free thyroxine (EFT) levels ranged from 0.7 to 2.7 ng/100 ml (normal, 1.0 to 2.1).

Levels above 2.1 ng/100 ml were associated with agitation and values under 1.1 with alcohol abuse.

Mean EFT levels differed significantly among six diagnostic subgroups and paralleled rank order for severity of depression (none, secondary, reactive, single uncategorized, recurrent, psychotic).

Alcohol abuse negatively affected EFT: there was a significant decrease of mean EFT level from nonabusers to abusers and, further, to intoxicated abusers. A positive association between EFT level and severity of depression, and a negative one with alcohol use, were significant when other variables considered were controlled. These two factors accounted from 28.2% of variability in EFT levels, with a minimal additional contribution of medication effect.

T. Kolakowska and M. E. Swigar. Thyroid function in depression and alcohol abuse: a retrospective study. Arch of general Psychiatry. Vol. 34 No. 8, August 1977

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Future of God in recovery from drug addiction

The purpose of the present paper was to explore the theory, concept and experience of God in relation to recovery from drug addiction from a scientific perspective.

Examination of a diverse literature was undertaken, including five key threads:

  • the universality of the experience of God;
  • the induction of spiritual experiences of God through hallucinogenic drugs;
  • the nature of drug addiction from an evolutionary neurobiological perspective;
  • the 12 Step movement as the prototype for the place of God in recovery from drug addiction; and
  • identified ingredients for successful recovery from addiction.

The diverse threads of literature examined can be integrated around the concept of higher power as an important factor in recovery from drug addiction.

Higher power can be manifested in individuals in diverse ways:

  • religious,
  • ethnic,
  • spiritual including the use of entheogens [a psychoactive plant or substance, esp. when taken for spiritual or religious purposes], as well as
  • cognitive behavioural development,

But a common final pathway for all is the strengthening of executive functions (the brain’s ‘higher power’).

Practical implications for assisting people with drug addiction to achieve recovery through their own experience of God/development of higher power are outlined.

Research report; John D. Sellman;  Michael P. Baker;  Simon J. Adamson; Lloyd G. Geering. Future of God in recovery from drug addiction. Australian and New Zealand Journal of Psychiatry, Volume 41, Issue 10 October 2007 , pages 800 – 808
Spiritual Connections: How to Find Spirituality Throughout All the Relationships in Your Life
by Sylvia Browne

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Alcoholics Anonymous careers

BACKGROUND: Most formal treatment programs recommend Alcoholics Anonymous (AA) attendance during treatment and as a form of adjunctive aftercare, but we know very little about treatment seekers’ patterns of AA involvement over time and how these relate to abstinence.

METHOD: This paper applies latent class growth curve modeling to longitudinal data from 349 dependent drinkers recruited when they were entering treatment and were re-interviewed at one or more follow-up interviews one, three and five years later, and who reported having attended AA at least once.

RESULTS: Four classes of AA "careers" of meeting attendance emerged:

The low AA group mainly just attended AA during the 12 months following treatment entry.

The medium and high AA groups were characterized by stable attendance at the second and third follow-ups-at about 60 meetings a year for the medium group and over 200 meetings per year for the high group, followed by slight increases for the medium group and slight decreases for the high group by year five.

The declining AA group doubled its meeting attendance post baseline, to almost 200 meetings during the year following treatment entry, but by year five they were only attending about six meetings on average.

Decreases in AA meetings did not necessarily signal disengagement from AA; at the five-year follow-up, a third of the low AA group and over half of the declining AA group said they felt like a member of AA. Activities other than meeting attendance, such as having a sponsor, otherwise paralleled the meeting careers, but social networks were similar by year five.

Rates of abstinence by year five (for the past 30 days) were

  • 43% for the low AA group,
  • 73% for the medium group,
  • 79% for the high group and
  • 61% for the declining group.

Rates of dependence symptoms and social consequences of drinking did not differ between the groups at year five.

CONCLUSIONS: The prototypical AA careers derived empirically are consistent with anecdotal data about AA meetings: some never connect; some connect but briefly; and others maintain stable (and sometimes quite high) rates of AA attendance. However, contrary to AA lore, many who connect only for a while do well afterwards.

Research; Kaskutas LA, Ammon L, Delucchi K, Room R, Bond J, Weisner C. Alcoholics anonymous careers: patterns of AA involvement five years after treatment entry. Alcohol Clin Exp Res. 2005 Nov;29(11):1983-90.

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Study says alcohol addiction responds to the Alcoholics Anonymous 12-step program

The Alcoholics Anonymous (AA) program for beating alcohol addiction has a long history and has helped millions of people around the world back to health.

It works as a 12-step program – the Steps being the program of the system which guide the user away from their dysfunctional relationship with drink. The 12-steps involve belief in and surrender to a ‘higher’ power which the AA people always stress need not be a formal ‘God’. So does the 12-step approach work for those who are not religious?

Those enrolled in a 12-step program like Alcoholics Anonymous did better than those who did not.

Researchers at the Massachusetts General Hospital/Harvard Addiction Program studied a group of 227 alcoholics. Those enrolled in a 12-step program like Alcoholics Anonymous did better than those who did not. It is the camaraderie and support you get in the 12-step program that likely provides the benefit, the researchers say.

Source; Alcoholism: Clinical and Experimental Research August 2006

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Or how to avoid burnout

  1. We admitted difficulty living as a health-care professional only, that our problems arise from this single focus in life.
  2. We came to believe that accepting help and support from everything life has to offer could restore our physical, mental, emotional, social and spiritual health.
  3. We made a decision to turn our will and our lives over to the care of our fellows who have learned these lessons and a Higher Power as we understand one.
  4. We made a searching and fearless personal inventory of our problems, strengths, goals and dreams.
  5. We shared our list with trusted others, including our Higher Power, acknowledging our character weaknesses, virtues and humanity.
  6. We became entirely ready to accept the help available to address our basic human needs.
  7. With humility and an open mind we sought to correct the shortcomings in our lives.
  8. We made a list of all persons and institutions we resented or harmed and became willing to address these issues.
  9. We made direct amends where necessary and took any action required to relieve these tensions, except when to do so would harm others.
  10. We continue to monitor internal feelings and needs, promptly admitting when we had a problem.
  11. We remained open and responsive to the help, guidance and love we can receive from others who care about us, including our Higher Power.
  12. Having achieved personal revitalisation as the result of these steps, we try to carry this message to the others in our lives and to practice these principles in all our affairs.

After Kaufman M. (1999) The Twelve-Steps for physicians who seek rehumanising. Ontario Medical Review. November.

 

         Resilient Practitioner, The: Burnout Prevention and Self-Care Strategies for Counselors, Therapists, Teachers, and Health Professionals
by Thomas M. Skovholt

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alcoholic teenagers in record store Students with a dense family history of alcoholism are most at risk of alcohol-use disorders

This study looks at first-, second- and third-degree relatives instead of just one parent, usually paternal

Not all university students will “mature out” of their heavy-drinking habits.

A new study examines the density of college students’ family history of alcoholism.

This type of measure – looking at first-, second- and third-degree relatives – identified a significant number of at-risk individuals who would have been missed using regular family-history measures.

While many university students tend to “mature out” of heavy-drinking behavior by the time they become young adults, some go on to develop alcohol-use disorders (AUDs). Most genetic research on an individual’s family history of alcoholism (FHA) has looked at the parents’ – usually paternal – alcohol use. New findings indicate that looking at the density of FHA – including first-, second- and third-degree relatives – is much more telling.

Results will be published in the August issue of Alcoholism: Clinical & Experimental Research.

“Using a density measure of FHA can identify a greater number of individuals who may be at risk for developing an alcohol problem,” said Christy Capone. “The greater number of affected relatives … the greater the potential risk of developing an AUD. Ours is the first published study to examine this measure among college students.”

“Family density appears to be a promising method to identify a higher percentage of at-risk individuals,” agreed John Hustad, research associate at Brown University. “For example, in this study, approximately 44 percent of the at-risk participants would have been missed if a typical family-history measure had been used instead of the family-history density approach.”

The study population for this research consisted of 408 undergraduate students (293 females, 115 males) from a northeastern U.S. university who were asked to complete an anonymous survey for course credit during the 2005-2006 academic year.

“Our use of a density measure identified a large proportion of students, about 29 percent, who are at potentially greater risk for development of AUDs based on their report of alcoholism among first- and second-degree relatives,” said Capone. “Our other key finding was the relationship between FHA and other potential risk factors – behavioral undercontrol, age of onset of drinking (AOD), and cigarette use.”

All of these risks factors are inter-related, added Hustad. “First, family-history density was related to AOD, behavioral undercontrol, and current cigarette use which, in turn, are related to alcohol use and/or alcohol-related problems in this sample of college students. Second, behavioral undercontrol was associated with alcohol problems but not the degree of alcohol consumption; this suggests that individuals with a family-history density of AUDs and behavioral undercontrol are more likely to behave irresponsibly when drinking.”

“The importance of identifying these risk factors is the idea that they can be useful markers of at-risk status and can help us to develop appropriate intervention strategies,” said Capone. “Although, given the fact that many students come to college already having experience with alcohol, I believe that preventive interventions should begin early in the high-school years or during the transition from middle school to high school.”

Hustad agreed. “Due to the relationship between earlier AOD and more alcohol-related problems during college, it is clear that education and prevention efforts should begin well before the college years,” he said. “Until that happens, the risk factors identified in this research can be easily implemented in any screening and brief intervention for incoming college students. For example, these results suggest that effective interventions addressing tobacco use may have a positive influence on both smoking and alcohol-related consequences.”

“It is important to remember that not everyone with density of familial alcoholism will go on to develop a long-term problem with alcohol themselves,” said Capone. “Alcohol dependence is a very complex disorder and FHA is but one influence on its development. However, college students who are heavy drinkers and have a greater density of familial alcoholism are certainly at higher risk of continuing to drink in a problematic fashion after the college years.”

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         Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism
by AA Services

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Group counseling therapy Treatment response of bipolar and unipolar alcoholics to an inpatient dual diagnosis program

BACKGROUND: Depressed and bipolar alcoholics represent a significant affective subgroup that has a poorer prognosis than either diagnosis alone. To date few systematic treatment programs have been developed to treat dual diagnosis.

METHODS: An inpatient treatment program was developed at St Patrick’s Hospital Dublin to treat dual diagnosis clients with alcohol dependence and either unipolar or bipolar affective disorder.

Clients (N=232) were assessed for depression, anxiety, elation, cravings, drink and drug intake on admission, discharge, 3 and 6 months post-discharge from the program.

RESULTS:

  • In the overall group there was a reduction in number of drinking days and units per drinking day over the study (p<.01).
  • There was a 71.8% complete abstinent rate at 3 months and 55.8% at 6 months in the depression group, non-significantly greater than for the bipolar group at 64.7% and 54.1% respectively.
  • Gamma GT, MCV and craving scores were significantly reduced over time (p<.01).
  • Mania, depression and anxiety inventory scores fell over time in both groups (p<.01).
  • 15-21-year olds were more severely anxious, had higher illicit drug use, and were more likely to relapse to drug use than older clients.
  • Bipolar 1 clients were significantly more likely than bipolar 2 clients to be on mood stabilisers at all follow-up stages (p<.001).

LIMITATIONS: No control group was used.

CONCLUSIONS: There is evidence for efficacy of a specifically designed dual diagnosis inpatient treatment program as both depressed and bipolar alcoholics had significant reductions in all measurements of mood, craving, and alcohol/drug consumption by self report and biological markers, suggesting both diagnoses can be effectively treated together.

Research; J Affect Disord. 2008 Mar;106(3):265-72. Epub 2007 Aug 16. Treatment response of bipolar and unipolar alcoholics to an inpatient dual diagnosis program. Farren CK, Mc Elroy S.

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by Dennis Ortman

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pills Washington residents are dying from unintended drug poisoning in numbers beginning to approach deaths in car crashes, and overdose deaths blamed on legal drugs now exceed fatal overdoses caused by illicit drugs, the Spokane Spokesman-Review reported Feb. 4th 2008.

Prescription-drug overdoses have increased 800 percent in Washington between 1995, when 45 overdose deaths were reported, to 2004, when 411 state residents died from overdoses on drugs like hydrocodone and methadone. “Prescription drug overdose deaths have been climbing through the roof,” said Jennifer Sabel, an epidemiologist at the Washington Department of Health. “Even doctors don’t really realize the magnitude of the deaths.”

In nearby Idaho, drug poisonings rose from 32 in 2000 to 62 in 2004. Some victims died because they misused patches containing powerful painkillers like Fentanyl, while others suffered from a toxic mix of prescription painkillers and alcohol or over-the-counter medications like Benadryl. “Users may be lulled into thinking prescription medications are safe as opposed to ‘street drugs,’ ” said Spokane County Medical Examiner Sally Aiken.

Overall opiate-related deaths in Washington rose from 260 in 1995 to 555 in 2004; auto crashes kill about 650 residents in the state each year. Mentions of prescription opiates on death certificates has risen even as involvement of illicit drugs like heroin have fallen by a third during the same period.

The trend is echoed by research conducted by the federal Centers for Disease Control and Prevention (CDC), which found that mentions of narcotic painkillers on death certificates rose 91 percent between 1999 and 2002. “This is a national problem,” said Dr. Gary Franklin, medical director for Washington’s Department of Labor and Industries.

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