How can I stop smoking?

The Cochrane Library has evidence that can help

Acupuncture? Nicotine patches? Telephone therapy? Antidepressants? Cognitive behavioural therapy?

Which work? Which have no effect? Which are dangerous? Confused?

Over 40 Cochrane reviews analyse the evidence.

For example, one systematic review (CD000146) shows how nicotine patches can double the odds of successful quitting. Another (CD000031) concludes that the antidepressants bupropion and nortriptyline aid long-term smoking cessation, but selective serotonin reuptake inhibitors (e.g. fluoxetine) do not. Yet another (CD006103) revealed that varenicline (recently approved in the UK by NICE), increased the odds of successful long-term smoking cessation more than threefold compared with pharmacologically unassisted quit attempts.

Ever since Sir Richard Doll and others used careful analysis to show that smoking was a key cause of cancer, there has been pressure to find ways of reducing dependency on tobacco. Richard Doll’s work also showed the importance of putting critical analysis and high quality research at the heart of good decision making.

â€œWith changes in the law providing fresh impetus for smokers to quit, the catalogue of reviews in The Cochrane Library is a great source of the knowledge needed by people wanting to make well informed decisions. The reviews provide reliable evidence on the strengths and weaknesses of many different types of therapy. They should help guide policy-makers who are looking for ways to increase the chances that people who want to stop smoking succeed in putting their cigarettes down for good,â€ says Director of the UK Cochrane Centre, Professor Mike Clarke from the University of Oxford.

They can all be found at http://www.thecochranelibrary.com or visit http://www.eurekalert.org/images/release_graphics/pdf/Cochrane_Smoking_Cessation_Reviews.pdf

Smoking Cessation Therapies — Cochrane Reviews:

A summary of all treatments designed to help people stop smoking that have been reviewed by The Cochrane Library. Simply click on the URL under the review title to see the abstract and if you wish to see the full review.

Also; Nicotine Anonymous: The Book

Prescription Drug Overdose Becomes Big Killer

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.

Anti Craving Medication Works

Extended-Release Naltrexone Works Particularly Well for Abstinent Patients with Dependence

Many patients with alcohol dependence do not receive the full benefits of treatment because they do not adhere to it. In part to address issues with adherence, extended-release (ER) naltrexone, which is released over a month after one injection, was developed. Pharmacotherapy researchers assessed ER-naltrexone efficacy in a subgroup of 82 subjects in a larger clinical trial who had ?4 days of abstinence.

In that subgroup, 380 mg of ER-naltrexone in 28 subjects versus placebo in 28 subjects

increased the time to first drink (median days, 41 versus 12);
increased continuous abstinence over 6 months (32% versus 11%);
increased time to first heavy drinking (>180 versus 20 days);
decreased days with any drinking (median days per month, 0.7 versus 7.2);
decreased days with heavy drinking (median days per month, 0.2 versus 2.9).

Smaller benefits, which were not always statistically significant, were found among 28 subjects treated with 190 mg of ER-naltrexone.

Comments by Michael Levy, PhD:
In this industry-sponsored secondary analysis of a small subgroup of subjects who had achieved just 4 or more days of abstinence before entering treatment, those who received ER-naltrexone in conjunction with psychosocial treatment had better treatment outcomes than those who received placebo. Medications with proven benefit for the treatment of alcohol dependence tend to be underutilized in general. This study suggests that ER-naltrexone is another treatment option for clients with alcohol dependence who have achieved even a short duration of abstinence.

Research Reference: Oâ€™Malley SS, Garbutt JC, Gastfriend DR, et al. Efficacy of extended-release naltrexone in alcohol-dependent patients who are abstinent before treatment. J Clin Psychopharm. 2007;27(5):507â€“512.

From; Join Together Online

Brief-TSF is designed to as adjunctive therapy for anti-craving medication.

Sleep, PTSD and Alcoholism

Sleep disturbances associated with posttraumatic stress disorder and alcohol dependence

Sleep disturbances commonly appear in the context of both posttraumatic stress disorder (PTSD) and alcohol use disorders.

Sleep symptoms typically reported among clinical populations include;

delayed sleep onset,
poor sleep continuity,
early morning awakening, and
disturbed sleep architecture.

The aim of the present study was to examine multiple forms of sleep disturbances among individuals with comorbid PTSD and alcohol dependence, PTSD only, alcohol dependence only, and a control group.

Both PTSD and alcohol dependence diagnoses were associated with multiple forms of sleep disturbance, but comorbidity of the two disorders did not appear to increase the risk over and above either single disorder for reporting any of the sleep difficulties examined.

As PTSD symptom severity increased, so did

sleep latency,
mid-sleep wakening, and
early morning wakening.

However, contrary to our hypothesis, no significant direct relationship between severity of alcohol use and sleep disturbances was revealed.

These findings suggest a need for thorough assessment of sleep symptoms in patients presenting with PTSD or alcohol dependence.

Sleep disturbances associated with posttraumatic stress disorder and alcohol dependence. Addict Behav. 2007 Sep 29. Waldrop AE, Back SE, Sensei A, Brady KT.

Alcoholic Brain Damage and Thiamine

The Role of Thiamine Deficiency in Alcoholic Brain Disease

A deficiency in the essential nutrient thiamine resulting from chronic alcohol consumption is one factor underlying alcohol-induced brain damage.

Thiamine is a helper molecule (i.e., a cofactor) required by three enzymes involved in two pathways of carbohydrate metabolism.

Because intermediate products of these pathways are needed for the generation of other essential molecules in the cells (e.g., building blocks of proteins and DNA as well as brain chemicals), a reduction in thiamine can interfere with numerous cellular functions, leading to serious brain disorders, including Wernicke-Korsakoff syndrome, which is found predominantly in alcoholics.

Chronic alcohol consumption can result in thiamine deficiency by causing inadequate nutritional thiamine intake, decreased absorption of thiamine from the gastrointestinal tract, and impaired thiamine utilization in the cells.

People differ in their susceptibility to thiamine deficiency, however, and different brain regions also may be more or less sensitive to this condition.

Research; The Role of Thiamine Deficiency in Alcoholic Brain Disease, Peter R. Martin, M.D., Charles K. Singleton, Ph.D., and Susanne Hiller-SturmhÃ¶fel, Ph.D. Alcohol Research & Health; Vol. 27, No. 2, 2003

Natrexone for Alcoholics

A synopsis of the pharmacological rationale, properties and therapeutic effects of depot preparations of naltrexone for treating alcohol dependence.

Although oral naltrexone has been shown to diminish alcohol reinforcement, its limitations as a medication include its small treatment effect size, plasma level fluctuation and adverse events.

The pharmacokinetic profile of naltrexone could be optimised by intramuscular administration, sustaining its release over several weeks.

As a result, plasma levels would remain relatively constant; high enough to reduce drinking, low enough to minimise side effects.

Two injectable naltrexone depot preparations, Vivitrex and Naltrel, have been tested as pharmacotherapy for alcohol dependence.

Their adverse-event profiles seem to be mild compared with oral naltrexone.

Vivitrex has shown efficacy at reducing heavy drinking significantly among alcohol-dependent men.

Naltrel helped reduce relapse and promote abstinence in two samples of alcohol-dependent individuals. Additional efficacy studies are warranted.

Johnson BA. Expert Opin Pharmacother. 2006 Jun;7(8):1065-73. A synopsis of the pharmacological rationale, properties and therapeutic effects of depot preparations of naltrexone for treating alcohol dependence.

Pharmacotherapy Principles & Practice
by Marie A. Chisholm-Burns, Barbara G. Wells, Terry L. Schwinghammer, Patrick M. Malone, Jill M. Kolesar, John C. Rotschafer, Joseph T. DiPiro

Assessment of spirituality and its relevance to addiction treatment.

The prominence of Twelve-Step programs has led to increased attention on the putative role of spirituality in recovery from addictive disorders.

We developed a 6-item Spirituality Self-Rating Scale designed to reflect a global measure of spiritual orientation to life, and we demonstrated here its internal consistency reliability in substance abusers on treatment and in nonsubstance abusers.

This scale and the measures related to recovery from addiction and treatment response were applied in three diverse treatment settings: a general hospital inpatient psychiatry service, a residential therapeutic community, and methadone maintenance programs.

Findings on these patient groups were compared to responses given by undergraduate college students, medical students, addiction faculty, and chaplaincy trainees.

These suggest that, for certain patients, spiritual orientation is an important aspect of their recovery.

Furthermore, the relevance of this issue may be underestimated in the way treatment is framed in a range of clinical facilities.

Research; Galanter M, Dermatis H, Bunt G, Williams C, Trujillo M, Steinke P. Assessment of spirituality and its relevance to addiction treatment. J Subst Abuse Treat. 2007 Oct;33(3):257-64.

Obstetricians Often Overlook Alcohol Consumption

Obstetricians Often Overlook Alcohol Consumption In Pregnancy, says the Australian And New Zealand Journal Of Obstetrics And Gynaecology

One in every two pregnant Australian woman still consume alcohol during pregnancy, according to a study in the Australian and New Zealand Journal of Obstetrics and Gynaecology. The responsibility of providing accurate information about the harmful effects of alcohol and its lifelong effects on the child falls on obstetricians and other health professionals.

And yet, almost half of the obstetricians interviewed said they did not routinely ask about alcohol consumption in pregnancy.

An editorial by Professor Elizabeth Elliot from the University of Sydney titled “Alcohol and Pregnancy: the Pivotal Role of the Obstetrician”, discusses the state of awareness about the adverse effects of alcohol consumption during pregnancy and the obstetricians’ participation in educating against maternal drinking.

Only 16% of the obstetricians routinely provided information about the consequences of alcohol in pregnancy, while only 5% gave advice which were consistent with the latest guidelines of The National Health and Medical Research Council of Australia (NHMRC) – which states that, for pregnant women, ‘no drinking is the safest option’.

Professor Elliot says, “Failure to provide information about the dangers of alcohol consumption in the antenatal consultation represents a lost opportunity. Accurate recording of antenatal alcohol exposure will help identify children who require pediatric assessment, since the effects of alcohol may not be obvious at birth.”

“More importantly, identifying the women who are unable to stop drinking provides an important opening for the management of problem drinking and prevention of exposure to alcohol in future pregnancies,” added Professor Elliot.

Alcohol consumption during pregnancy has been associated with increased risks of miscarriage, stillbirth, intrauterine growth restriction, pre-term birth and low birth-weight. However, the best known adverse effect of alcohol exposure on the fetus is the fetal alcohol syndrome (FAS) – which is associated with a wide range of birth defects and ongoing educational, behavioral and psychological problems.

This paper is published in the June 2008 issue of Australian and New Zealand Journal of Obstetrics and Gynaecology (Vol. 48, Issue 3, 2008).

Successful Membership of AA

Assessing sobriety and successful membership of Alcoholics Anonymous

The goal of this study was to identify appropriate measures of successful membership of Alcoholics Anonymous (AA) and to investigate membership patterns and perceptions of sobriety across sociodemographic categories of AA membership.

The study uses a cross-sectional survey design, and participants (n=77) were community-based members of nine individual AA groups. All data were collected using a self-completion questionnaire, which included open-ended and closed questions on understanding of successful AA membership, meeting attendance, 12-stepping activity, and length of membership.

The following results of the study were seen:

association of successful AA membership with sobriety as well as
longevity of membership,
attendance at AA meetings, and
commitment to 12-step work

Research report; Gabhainn, S.N. Assessing sobriety and successful membership of Alcoholics Anonymous. Journal of Substance Use, 8(1):55-61, 2003.

Brief-TSF is designed to encourage these elements.

Abstinence and well-being among members of AA

Abstinence and well-being among members of alcoholics anonymous: Personal experience and social perceptions.

The subjective experience of well being was examined in abstinent Alcoholics Anonymous (AA) members. In addition, the social perceptions of an abstinent alcoholic’s well being were examined in three nonalcoholic French-Canadian samples:

male police officers,
Catholic nuns, and
university women.

The lowest ratings of well being were reported by

short-term abstinent AA members and
university women,

The highest ratings were reported by Catholic nuns.

However, the level of well being among abstinent AA members was positively related to the length of abstention.

The three nonalcoholic groups evaluated an abstinent AA member more positively than a non-abstinent alcoholic.

These evaluations of an abstinent AA member converged with the AA members’ self-evaluations on the measure of well being.

Research; Kairouz, S.; Dibe, L. Abstinence and well-being among members of alcoholics anonymous: Personal experience and social perceptions. Journal of Social Psychology, 140(5):565-579, 2000