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Archive for the 'Addiction' Category


Treatment Demand and Training Need in Addiction

Posted by Lakeside on 1st July 2008

Primary care doctors’ perception of treatment demand and need for training in drug addiction issues.

Aim: To learn the opinion of primary care physicians (PCPs) on healthcare provision for the drug addict population and to determine their knowledge and needs as regards to continuing training and their attitudes towards drug addiction.

Methods: We conducted a cross-sectional survey of 301 PCPs in Castilla-La Mancha, Spain using a questionnaire designed to elicit physician’s opinions about drug addiction.

Results: The response rate was 85.0% (256 cases). 84.2% of the doctors considered that 10% of patient visits to primary care centres were related to drug addiction.

The doctors frequently experienced difficulty in:

  • the diagnosis and treatment of organic diseases associated with addiction (18.4%),
  • the assessment of the situation and level of dependence (36.7%),
  • support to treatment of some aspects of drug addiction (51.3%) and,
  • above all, the treatment of these addictions (62.9%).

Of all respondents, 53.8% reported they had received some form of postgraduate training in drug addiction issues.

Only 28.5% considered they had received sufficient information on specialised drug addiction services.

Conclusions: As regards to PCPs’ attitudes to drug addiction, we observed a positive attitude regarding the needs of those who abuse drugs, and the development of intervention programmes.

PCPs believe that addicts deserve treatment, that there should be more treatment programmes and that primary healthcare centres should establish links with specialised services.

José Latorre;  Jesús López-Torres;  Trinidad Sanchez-Nuñez;  Juan Pedro Serrano;  Juan Montañés; Francisco Escobar. Primary care doctors’ perception of treatment demand and need for training in drug addiction issues. Primary Care & Community Psychiatry, Volume 12, Issue 1 January 2007 , pages 33 – 41.


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TSF Research Summary

Posted by Lakeside on 25th June 2008

Concise TSF and Brief-TSF Research Summary

All the elements of TSF have moderate to strong research support, most of which has been replicated.

NB: AA does not participate in research but individual members do. The huge volume of peripheral research supports a strong case for recommending AA participation by alcoholics.

We know: -

  • that Twelve Step Facilitation reduces alcohol abuse , improves related consequences, and improves employment prospects.
  • that Alcoholics Anonymous has good efficacy, and that Peer Sponsoring/social support is an essential element in AA’s success.
  • that recovering people who help recovering people maintain better sobriety and have greater involvement in the general community.
  • that men, women, adolescence, African-Americans, Hispanics and gay men benefit from AA. That all socio-demographic groups are represented.
  • that AA is suitable for head trauma victims, and methadone patients.
  • that AA has wide acceptance and is readily available in almost all communities. The current global membership of AA is approximately 2.06 million.
  • that participation in Alcoholics Anonymous improves medication compliance for mental health patients, improves psychological functioning, Improves coping, reduces child abuse and domestic violence, reduces healthcare usage, reduces hospitalisation, reduces medical symptoms, reduces subsequent treatment demand, reduces mortality, and reduces associated costs.
  • that healthcare workers have good success rates for substance abuse treatment and recovery from alcoholism that can be improved with AA participation.
  • that alcoholics with social networks supportive of drinking have better outcomes if they initiate AA attendance while in treatment.
  • that affiliation with AA is enhanced if prospects gain an awareness of the culture and methods used by AA and that sobriety is better than drinking prior to attending AA.
  • that 80% of Australian, 87% of USA, and 65% of UK doctors believe that Alcoholics Anonymous is the treatment of choice for alcoholism, but overall they do not understand how AA works.
  • that more than 80% of specialist alcohol and drug treatment staff support Alcoholics Anonymous treatment referral and 92% of another specialist A & D service requested training in 12 Step approaches.
  • that AA Peer Sponsor contact at the healthcare worker office/institution increases initiation and sustained attendance at AA meetings.
  • that active and regular AA participation is one of the more effective ways to effect lifestyle changes for alcoholics.
  • that routinely engaging patients in continuing outpatient care is likely to yield better outcomes..
  • that most people in the early stages of alcoholism seek help from GP’s or Community Health Centres.
  • that individuals with substance abuse medical conditions benefit from integrated medical and substance abuse treatment, and approaches such as TSF can be cost-effective.
  • that for every $1.00 invested in intervention $4.30 is saved in future healthcare costs.

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Impulsive Addiction

Posted by Lakeside on 15th June 2008

Addiction may be impulsive Impulsivity May Trigger Addiction, Researchers Say

British researchers say that impulsivity seems to trigger addiction and not the other way around, Science magazine reported June 6.

People with addictions are known to be more impulsive and engage in more thrill-seeking behaviors than non-addicts, but it has been unclear whether those behaviors predated drug use or were the result of addiction.

Researchers David Belin and Barry Everitt of the University of Cambridge attempted to answer the question by studying rats known to have thrill-seeking or impulsive personalities. The researchers connected the rats to a device that delivered cocaine directly to their brains and then gave the rats control over their drug use. They found that the thrill-seeking rats tried the drug immediately and in high doses, while the impulsive rats used the drug less quickly and in greater moderation.

However, the authors found that after 40 days of access to the drug the impulsive rats had become addicted and could not stop using cocaine even when punished with an electric shock, while the thrill-seeking rats had grown tired of the drug and stopped using.

The research study is published in the June 6, 2008 edition of Science magazine.

See also;

          Theory and Practice of Group Counseling
by Gerald Corey

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TWELVE STEPS TO RECOVERY FROM BURNOUT

Posted by Lakeside on 5th June 2008

 

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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25 Top Posts at BriefTSF

Posted by Lakeside on 1st June 2008

Popular Blogging at BriefTSF

          Understanding and Counselling the Alcoholic
by Jr. Howard J. Clinebell

Amazon books; Read more about this title…


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Posted in Addiction, Adult Children of Alcoholics, Alcohol, Alcoholics Anonymous, Alcoholism, Blogroll, Brief-TSF, Drugs, Higher Power, Inhalants, Medication, PTSD, Pharmacotherapy, Recovery, Relapse prevention, Research, Spirituality, Stages of Change, Symptoms of addiction, TSF, Target populations, Training, Women | No Comments »

Cannabis & Psychotic Risk

Posted by Lakeside on 29th May 2008

Cannabis use and risk of psychotic or affective mental health outcomes

Background; Whether cannabis can cause psychotic or affective symptoms that persist beyond transient intoxication is unclear. We systematically reviewed the evidence pertaining to cannabis use and occurrence of psychotic or affective mental health outcomes.

Methods; We searched databases from their inception to September, 2006, searched reference lists of studies selected for inclusion, and contacted experts. Studies were included if longitudinal and population based. 35 studies from 4804 references were included. Data extraction and quality assessment were done independently and in duplicate.

"we conclude that there is now sufficient evidence to warn young people
that using cannabis could increase their risk of developing a psychotic illness later in life."

Findings; There was an increased risk of any psychotic outcome in individuals who had ever used cannabis (pooled adjusted odds ratio=1·41, 95% CI 1·20-1·65). Findings were consistent with a dose-response effect, with greater risk in people who used cannabis most frequently (2·09, 1·54-2·84). Results of analyses restricted to studies of more clinically relevant psychotic disorders were similar. Depression, suicidal thoughts, and anxiety outcomes were examined separately. Findings for these outcomes were less consistent, and fewer attempts were made to address non-causal explanations, than for psychosis. A substantial confounding effect was present for both psychotic and affective outcomes.

Interpretation; The evidence is consistent with the view that cannabis increases risk of psychotic outcomes independently of confounding and transient intoxication effects, although evidence for affective outcomes is less strong. The uncertainty about whether cannabis causes psychosis is unlikely to be resolved by further longitudinal studies such as those reviewed here. However, we conclude that there is now sufficient evidence to warn young people that using cannabis could increase their risk of developing a psychotic illness later in life.

Theresa HM Moore, Stanley Zammit, Anne Lingford-Hughes, Thomas RE Barnes, Peter B Jones, Margaret Burke and Glyn Lewis. Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. The Lancet 2007; 370:319-328

Life With Hope: A Return to Living Through the Twelve Steps and Twelve Traditions of Marijuana Anonymous


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TSF more economical with greater success

Posted by Lakeside on 27th May 2008

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.

substantially higher abstinence rate among patients treated in 12-step

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%) in contrast to 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.

30% lower costs in the 12-step treatment 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 post-treatment 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.

Research; Keith Humphreys, and Rudolf H. Moos Alcoholism: Clinical and Experimental Research 2007; 31(1):64-68) - 1 This computation is in 2006 dollars, to which we converted for comparative purposes our prior findings, which had been originally reported in 1999 dollars (Humphreys and Moos, 2001).

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ALCOHOLISM MYTHS

Posted by Lakeside on 26th May 2008

FIVE MAJOR ALCOHOLISM MYTHS

Myth 1: An alcoholic is the falling-down drunk on skid row.

Answer: Only three percent of alcoholics are on skid row. Those alcoholics on skid row are undoubtedly in the last stages of the illness. Most people with alcoholism are in the early and middle stages. They have families, they hold regular jobs, they may not appear to be any different from anyone else. The person with alcoholism may be an automobile mechanic, an officer of a large corporation, an actor, a salesman, a press operator, a stock clerk, a secretary, a housewife.

Clearly the disease of alcoholism is no respecter of persons.

About 80% Americans use alcohol and enjoy the relaxation it brings them. Unfortunately about one in fifteen of theses develops the disease of alcoholism. This disease eventually causes premature death or insanity unless it is treated. But it is a slow progressive illness and often requires five to twenty years before its victim becomes unemployable or incapable of being a responsible employee or housewife.

Myth II: Alcoholics are hopeless drunks.

Answer: Nothing could be farther from the truth. While there is no known cure, alcoholism can be arrested with proper treatment. Fifty to seventy percent of employed alcoholics who receive treatment recover and lead normal lives. For example, the businessman and the doctor who founded Alcoholics Anonymous were once considered by their friends to be "hopeless drunks". Instead, they demonstrated that alcoholics are anything but hopeless. And the fellowship of Alcoholics Anonymous, through which hundreds of thousands have received help, offers dramatic proof that people with alcoholism can recover.

Myth III: Alcohol is the cause of alcoholism.

Answer: The exact causes are still not known despite continuing research. However, it is known that alcohol by itself is not the only cause. If it were, then there would be about 80 million alcoholics in the United States — the same number of people who use alcohol.

We can draw parallels with another disease whose cause we do not know– cancer. Some people develop cancer, others do not. Similarly, some drinkers develop alcoholism, others do not. Like cancer. in another way, alcoholism can be treated and the chance of recovery is better in the early stages.

Myth IV: Alcoholics could recover if they had enough will power.

Answer: Recovery from any serious illness requires a strong will to live. This is not what we mean when we talk about will power. People do not recover from illnesses by simply resolving that they will stop being sick! They can resolve to go to the doctor. That can help. They can resolve to follow the doctor’s advice. That can help. They can resolve to follow through with any kind of treatment that is necessary. All theses things can help in their recovery from the illness.

Actually, most people with alcoholism have a great deal of will power. For example, the person who has a responsible job and serious case of alcoholism. By sheer will power he gets to work in the morning on days when with any other illness he would stay home in bed. After a bender he gets up in the morning with butterflies in his stomach and suffers from "the shakes". Somehow he gets shaved without cutting himself too badly, has a shower, puts on his clothes, and takes a bit of the "hair of the dog that bit him" the night before. The nip of alcohol quiets his shaking nerves enough so that he can get a cup of coffee and a slice of toast to sit in his stomach. Then he goes off to work and somehow gets through the day even though he may feel terrible. This is not the picture of a man lacking will power.

Instead, it is a picture of a conscientious man who wishes to keep up appearances — a person who is suffering from an illness and does not know that he can get treatment for it. Like most people, he believes the myths about alcoholism being a moral problem.

Myth V: Alcoholism is a self-inflicted moral problem

Answer: Some people are ready to admit that alcoholism is a disease — but then maintain it is a "self-inflicted disease". This is a pretty silly idea if you look at it carefully in the light of what happens with other illnesses. Being overweight may help bring on a heart attack. Yet, we never say a fat person’s heart attack was self-inflicted. Most people have had the experience of mission sleep and fatiguing themselves, and then catching a cold. Again, no one says that the cold was "self-inflicted", even though, with sufficient rest, they might not have caught the cold. Thus if we say that alcoholism is "self-inflicted", we also must admit that many other illnesses are "self-inflicted". In addition, we do not speak of any disease itself as being a moral problem.


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Teen Drug Use in Primary Care

Posted by Lakeside on 25th May 2008

 

Prevalence of positive substance abuse screen results among adolescent primary care patients

Objectives; To measure the prevalence of positive substance use screen results among adolescent primary care patients and to estimate the prevalence of substance-related problems and disorders.

Results; Overall, 14.8% of adolescents had positive results on the CRAFFT screen.

Prevalence rates differed significantly across practices (P < .001) after adjusting for demographic factors.

The highest positive rates on the CRAFFT screen were at

  • School-based health centers (29.5%) and
  • Rural family practice (24.2%),
  • Middle rate was at the adolescent clinic (16.6%), and
  • Lowest rates were at the health maintenance organization (14.1%) and
  • Pediatric clinic (8.0%).
  • Sick visits had the highest rate (23.2%).
  • Well-child care visits had a significantly lower rate (11.4%, P < .001).

Statistical modeling estimated that 11.3% of all patients had problematic use,

  • 7.1% had abuse, and
  • 3.2% had dependence.

Conclusion; Substance abuse screening should occur whenever the opportunity arises, not at well-child care visits only.

Arch Pediatr Adolesc Med. 2007;161(11):1035-1041.
      Teens Under the Influence: The Truth About Kids, Alcohol, and Other Drugs- How to Recognize the Problem and What to Do About It
by Katherine Ketcham

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Getting active

Posted by Lakeside on 22nd May 2008

Getting active in Recovery in AA

This is an extract from the book ‘Living Sober’ by Alcoholics Anonymous.

(A more complete extract can be down loaded as a PDF file for printing to give to patients / clients and you can buy the complete book via Amazon)

It is very hard just to sit still trying not to do a certain thing, or not even to think about it. It’s much easier to get active and do something else-other than the act we’re trying to avoid.

So it is with drinking. Simply trying to avoid a drink (or not think of one), all by itself, doesn’t seem to be enough. The more we think about the drink we’re trying to keep away from, the more it occupies our mind, of course. And that’s no good. It’s better to get busy with something, almost anything, that will use our mind and channel our energy toward health.

Thousands of us wondered what we would do, once we stopped drinking, with all that time on our hands. Sure enough, when we did stop, all those hours we had once spent planning, getting our drinks, drinking, and recovering from its immediate effects, suddenly turned into big, empty holes of time that had to be filled somehow.

Most of us had jobs to do. But even so, there were some pretty long, vacant stretches of minutes and hours staring at us. We needed new habits of activity to fill those open spaces and utilize the nervous energy previously absorbed by our preoccupation, or our obsession, with drinking.

Anyone who has ever tried to break a habit knows that substituting a new and different activity is easier than just stopping the old activity and putting nothing in its place.

Recovered alcoholics often say, "Just stopping drinking is not enough." Just not drinking is a negative, sterile thing. That is clearly demonstrated by our experience. To stay stopped, we’ve found we need to put in place of the drinking a positive program of action. We’ve had to learn how to live sober.

Fear may have originally pushed some of us toward looking into the possibility that we might have a drinking problem. And over a short period, fear alone may help some of us stay away from a drink. But a fearful state is not a very happy or relaxed one to maintain for very long. So we try to develop a healthy respect for the power of alcohol, instead of a fear of it, just as people have a healthy respect for cyanide, iodine, or any other poison. Without going around in constant fear of those potions, most people respect what they can do to the body, and have enough sense not to imbibe them. We in A.A. now have the same knowledge of, and regard for, alcohol. But, of course, it is based on firsthand experience, not on seeing a skull and crossbones on a label.

We can’t rely on fear to get us through those empty hours without a drink, so what can we do?

We have found many kinds of activity useful and profitable, some more than others. Here are two kinds, in the order of their effectiveness as we experienced it.

A. Activity in and around A.A.

When experienced A.A. members say that they found "getting active" helpful in their recovery from alcoholism, they usually mean getting active in and around A.A.

B. Activity Not related to A.A.

It’s curious, but true, that some of us, when we first stop drinking, Seem to experience a sort of temporary failure of the imagination.

It’s curious, because during our drinking days, so many of us displayed almost unbelievably fertile powers of imagination. In less than a week, we could dream up instantly more reasons (excuses?) for drinking than most people use for all other purposes in a lifetime. (Incidentally, it’s a pretty good rule of thumb that normal drinkers-that is, nonalcoholics-never need or use any particular justification for either drinking or not drinking!)

When the need to give ourselves reasons for our drinking is no longer there, it often seems that our minds go on a sit own strike. Some of us find we can’t think up nondrinking things to do! Perhaps this is because we’re just out of the habit.

The following list is just a starter for use at that time. It isn’t very thrilling or adventurous, but it covers the kinds of activity many of us have used to fill our first vacant hours when we were not at our jobs or with other nondrinking people. We know they work. We did such things as:

  • Taking walks
  • Reading
  • Going to museums and art galleries.
  • Exercising swimming, golfing, jogging, yoga, or other forms of exercise your doctor advises.
  • Starting on long-neglected chores
  • Trying a new hobby
  • Revisiting an old pastime
  • Taking a course.
  • Volunteering
  • Doing something about your personal appearance.
  • Taking a fling at something frivolous! Not everything we do has to be an earnest effort at self-improvement, although any such effort is worthwhile and gives a lift to our self-esteem. Many of us find it important to balance serious periods with things we do for pure fun.
  • Fill this one in for yourself. Let’s hope the list above sparked an idea for you which is different from all of those listed. . . . It did? Good! Go to it.

One word of caution, though. Some of us find we have a tendency to go overboard, and try too many things at once. The best approach is called "Easy Does It."

Living Sober (#2150)

Attached Files:


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