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.

“With 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,” 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

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.

See also;

• The Most Effective Form of Harm Reduction
• What About This Spiritual Awakening Thing?

Illicit drugs alcohol, and addiction in human immunodeficiency virus.

Drug and alcohol use complicate both the prevention and treatment of human immunodeficiency virus (HIV) infection.

Substance use is one of the major engines driving HIV transmission, directly, through the sharing of injection drug use equipment and indirectly, through increasing risky sexual behaviors.

Drug and alcohol dependence compromise effective HIV treatment by influencing both access and adherence to antiretroviral therapy.

Exposure to addictive substances may have direct immunosuppressive effects independent of their impact on access and adherence to treatment.

Measures effective at minimizing HIV transmission attributable to drug and alcohol use include HIV testing and referral to treatment, syringe and needle exchange programs, opioid replacement therapy (i.e., methadone and buprenorphine), and behavioral interventions targeting HIV risk behaviors among both HIV-infected and HIV-uninfected people.

Measures effective at optimizing HIV treatment among alcohol and drug-dependent patients include HIV testing with referral to treatment and substance use treatment that is linked to or integrated into HIV treatment.

Due to the intertwining problems of substance use and HIV infection, physicians and other health care providers must address the issues of illicit drugs and alcohol use as mainstream medical problems in order to provide optimal care for HIV-infected patients.

Research; Samet JH, Walley AY, Bridden C. Illicit drugs alcohol, and addiction in human immunodeficiency virus. Panminerva Med. 2007 Jun;49(2):67-77.

What are the social and economic effects of gambling addiction?

In 1998 the National Gambling Impact Study Commission funded a study to determine the overall cost to society posed by problem and pathological gamblers in the United States.

The results showed that approximately $5 billion was lost annually, with an additional $40 billion in lifetime costs for productivity reductions, social services and creditor losses. Studies have concluded that two out of three pathological gamblers commit illegal acts in order to pay gambling-related debts. This places a hardship on our legal systems, prison systems and public assistance programs.

The following consequences of problem gambling all result in economic costs for states, communities and individuals:

• Job loss, unemployment
• Debt, bankruptcy
• Embezzlement, fraud, check forgery
• Eviction, forced home sales
• Crime, arrest, incarceration
• Poor physical and mental health, suicide
• Alcohol and drug abuse

The families of problem gamblers also suffer greatly from physical and psychological abuse; harassment and threats from bill collectors and creditors; increased stress stemming from neglect and divorce; and the extra financial burden placed on them to repay debts.

Sadly, children are negatively affected by gambling addiction in several ways.

• Physical and emotional abandonment is a very real phenomenon.
• “Casino kids” are left in cars or on the periphery of the gambling action while their parents gamble, or may spend hours with babysitters, thus missing the nurturing they need.
• Children of pathological gamblers are typically abused verbally, mentally and physically by the gambler, and often even more so by the co-dependent spouse.
• Finally, these children are much more likely to develop gambling addiction than their peers.

Excerpted from research: Effects of Problem Gambling. California Council on Problem Gambling (Anaheim, CA); 2006.

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

The Role of Stress in Alcohol Use, Alcoholism Treatment, and Relapse

By Kathleen T. Brady, M.D., Ph.D., and Susan C. Sonne, Pharm.D.

Addiction to alcohol or other drugs (AODs) is a complex problem determined by multiple factors, including psychological and physiological components. Stress is considered a major contributor to the initiation and continuation of AOD use as well as to relapse.

Many studies that have demonstrated an association between AOD use and stress have been unable to establish a causal relationship between the two. However, stress and the body’s response to it most likely play a role in the vulnerability to initial AOD use, initiation of AOD abuse treatment, and relapse in recovering AOD users.

This relationship probably is mediated, at least in part, by common neurochemical systems, such as the serotonin, dopamine, and opiate peptide systems, as well as the hypothalamic-pituitary-adrenal (HPA) axis. Further exploration of these connections should lead to important pharmacological developments in the prevention and treatment of AOD abuse.

Studies indicate that treatment techniques which foster coping skills, problem solving skills, and social support play a pivotal role in successful treatment.

In the future, individualized treatment approaches that emphasize stress management strategies in those patients in whom a clear connection between stress and relapse exists will become particularly important.

Alcohol Research & Health, Vol. 23, No. 4, 1999

A comparative evaluation of substance abuse treatment

This article first explains the conceptual framework and plan of a naturalistic, multisite evaluation of Department of Veterans Affairs (VA) substance abuse treatment programs. It then examines the effectiveness of an index episode of inpatient treatment and the effectiveness of continuing outpatient care and participation in self-help groups.

The study was conducted among 3018 patients from 15 VA programs that emphasized 12-Step, cognitive-behavioral (CB), or eclectic treatment.

Casemix-adjusted 1-year outcomes showed that patients in 12-Step programs were the most likely to be abstinent, free of substance abuse problems, and employed at the 1-year follow-up.

Patients who obtained more regular and more intensive outpatient mental health care, and those who participated more in 12-Step self-help groups, were more likely to be abstinent and free of substance use problems at the 1-year follow-up.

These findings support the effectiveness of 12-Step treatment and show that patients with substance use disorders who become more involved in outpatient care and self-help groups tend to experience better short-term substance use outcomes.

Moos RH, Finney JW, Ouimette PC, Suchinsky RT. A comparative evaluation of substance abuse treatment. Alcohol Clin Exp Res. 1999 Mar;23(3):529-36.

Drugs, Brains, and Behavior: The Science of Addiction

This new, 30-page, full-color booklet explains in layman’s terms how science has revolutionized the understanding of drug addiction as a brain disease that affects behavior. 

The ‘Science of Addiction’ booklet discusses the reasons people take drugs, why some people become addicted while others do not, how drugs work in the brain, and how addiction can be prevented and treated.

The booklet is available to read, download or order at: http://www.drugabuse.gov/scienceofaddiction/

http://www.drugabuse.gov/scienceofaddiction/sciofaddiction.pdf

Publication Year: 2007

Publisher

National Institute on Drug Abuse (NIDA)
6001 Executive Boulevard
Bethesda, md 20892
Phone: 301-443-1124
Website: http://www.nida.nih.gov

This study analyzed the Alcoholics Anonymous (AA) participation of 55 patients during the 3 months after their discharge from structured treatment, when dropout is high.

Three levels of meeting attendance were discerned:

• low,
• mid-level, and
• “90 meetings in 90 days.”

Of greatest interest, the mid-level group showed mixed interest in AA practices despite substantial meeting attendance, that is,

• they admitted powerlessness over alcohol, but had less enthusiasm for the higher power concept, and relapsed significantly;
• they were likely to have a sponsor, but were less involved with other AA members; and
• they reported working the 12 Steps, but were less interested in the AA literature.

Findings suggest that individuals who are attending AA but having difficulty embracing key aspects of the program need professional assistance that focuses more on AA practices and tenets and meeting attendance.

Barriers to affiliation can also serve as opportunities for furthering both counselling goals and affiliation.

Research; Paul Elliott Caldwell and Henry S.G. Cutter. Journal of Substance Abuse Treatment. Volume 15, Issue 3, May-June 1998, Pages 221-228

• See also:
• Twelve Step Facilitation
• Brief-TSF Description
• AA and Treatment Work Better Together
• Alcohol Related Brain Injury
• THE TWELVE REWARDS OF RECOVERY

New Government Body to Help De-addiction

NEW DELHI (ICNS): A new consultative mechanism at the national level would be set up to advice central and state governments on issues related to drug de-addiction and rehabilitation.

The body, named National Consultative Committee on De-addiction and Rehabilitation (NCCDR), would help address issues connected with drug demand reduction.

It would especially stress education and awareness building, de-addiction and rehabilitation, said an official release from ministry of social justice and empowerment said on July 16.

The ministry has been extending financial assistance to over 350 non-Governmental Organizations for running 41 counselling centers and 401 de-addiction centers in the country.

The ministry has also taken up regular awareness generation programs to tackle issue of alcoholism and drug abuse in the country.

Meira Kumar, Minister for Social Justice and Empowerment would chair the body, while Subbulakshmi Jagadeesan, Minister of State for Social Justice and Empowerment would be the vice chairperson.

The functions of the new committee would be to advise Central and State Governments to the entire gamut of issues related to drug abuse prevention, de-addiction, rehabilitation and harm reduction.

The Ministry of Social Justice and Empowerment has been implementing a scheme for prevention of alcoholism and substance (drugs) abuse.

Full story at; The Indian Catholic

See also;

• AA and Treatment Work Better Together
• Brief-TSF can assist patients cease alcohol consumption.
• Twelve Step Facilitation is designed to support people returning to their community

Slaying the Dragon: The History of Addiction Treatment and Recovery in America by William L. White Read more about this title… Recommended