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

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.

See also;

• FDA Steps Up Warnings on Chantix
• Taking Oxycodone / Oxycontin Safely

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?

Multiple psychiatric disorder risk for families with alcohol dependence

First-degree relatives of people dependent on alcohol are not only at increased risk of becoming addicted to alcohol and other drugs such as cocaine, but also of developing psychiatric disorders such as depression and panic disorder, study findings indicate.

Noting that alcohol dependence tends to aggregate within families, John Nurnberger (Indiana University School of Medicine, Indianapolis, USA) and colleagues analyzed data from the family collection of the Collaborative Study on the Genetics of Alcoholism to assess whether other psychiatric disorders may be also be more common in families with a history of alcoholism.

Data were available for 8296 relatives of people with alcohol dependence and 1654 individuals with no family history of alcoholism.

The rate of DSM-IV alcohol dependence was 28.8% for relatives of people with the condition, compared with 14.4% for controls.

Overall, relatives of alcoholics were twice as likely to become addicted to alcohol as people without a family history of alcohol dependence.

Relatives of alcohol-dependent individuals were also at an increased risk of becoming addicted to other drugs, including cocaine, marijuana, opiates, sedatives, and stimulants. The greatest risk was for cocaine dependence, with relatives of individuals with alcoholism more than three times as likely as those without a family history of alcoholism to become dependant on the drug.

Moreover, relatives of alcoholics had a higher risk of depression, panic disorder, post-traumatic stress disorder, and antisocial personality disorder than controls.

“The aggregation of antisocial personality disorder, drug dependence, anxiety disorders, and mood disorders, suggests common mechanisms for these disorders and alcohol dependence within some families,” Nurnberger et al write in the Archives of General Psychiatry.

This represents a “shared specific genetic vulnerability,” they say, which puts people at risk of a number of psychiatric disorders if they have a family history of alcohol dependence.

Research Source: Arch Gen Psychiatry 2004; 61: 1246-1256

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.

Heath Ledger’s father and others are casting the death of the young actor as a warning about the dangers of prescription drug use.

Reacting to the New York medical examiner’s ruling that Ledger, 28, died of an accidental overdose of multiple painkillers and sedatives, the actor’s father, Kim Ledger, said, “While no medications were taken in excess, we learned today the combination of doctor-prescribed drugs proved lethal for our boy. Heath’s accidental death serves as a caution to the hidden dangers of combining prescription medication, even at low dosage.”

The elder Ledger’s comments were reported by the Associated Press on Feb. 7. Ledger died in his New York hotel room on Jan. 22.

Meanwhile, the U.S. Drug Enforcement Administration is looking into how Ledger acquired such a large quantity of prescription drugs, the Boston Herald reported Feb. 7. “We are working with the NYPD to identify any illegally prescribed drugs that may have been prescribed to Ledger,” said DEA spokesman Erin Mulvey.

Toxicology reports found that Ledger died from “acute intoxication by the combined effects of oxycodone, hydrocodone, diazepam, temazepam, alprazolam and doxylamine.”

See also;

Prescription Drug Overdose Becomes Big Killer

Taking Oxycodone / Oxycontin Safely

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

Brain research shows why long-term drug users just can’t say no

Groundbreaking research from the University of Melbourne has shed new light on why long term drug users find it hard to say no, despite dire consequences to their health.

A study into the frontal cortex, the key region of the brain involved in decision making, has shown that drug users have to place much greater demand on the brain to control impulses.

The two year study was conducted by researchers Dr Murat Yücel and Dr Dan Lubman of the ORYGEN Research Centre and the Melbourne Neuropsychiatry Centre, based at the University of Melbourne and was recently published in the July edition of the prestigious international journal Molecular Psychiatry.

“Drugs can capture and hijack some parts of the brain,” said Dr Murat Yücel a lead researcher in the study.

“In this study we found the frontal cortex, an area that is essential for exercising control over thoughts and behaviours, was working inefficiently.”

“These findings may help explain why it takes addicted individuals enormous effort to exercise control over their drug-taking behaviour in the face of adverse consequences, and why they are vulnerable to relapse back into uncontrolled, compulsive patterns of use.”

The studies involved brain-imaging technology to probe the physiological and biochemical properties of a key region of the brain, the frontal cortex.

Participants were asked to complete a test of self-control in which they had to overcome an automatic response in favour of a more controlled alternative response, thus requiring them to control their impulsive tendencies.

They researchers discovered two important differences between the opiate-using group and a group who have never used heroin.

Firstly, the opiate-using group needed to activate more of their brain by placing greater physiological demand on it to avoid making an error on a test of self control.

At the same time, brain cells in the frontal region were revealed to be less healthy than the non opiate-using group.

“What people don’t tend to understand about long term drug users is that this is not a matter of choice. They have a reduced level of biological resources and find it hard to stop.”

Dr Dan Lubman, an addiction psychiatrist and a senior investigator on the project, says this new evidence is likely to lead to the development of innovative strategies for the treatment of addiction

“These findings tell us that we need to provide a combination of pharmaceutical and psychological treatments that will help bolster the efficiency of the frontal cortex and hence the individual’s ability to stop their urge to use drugs.” Dr Lubman said.

“To improve treatments for long term drug users we need to understand at what stage these brain deficits occur. The next question we need to ask is are these latest research findings a consequence of addiction or do they explain people’s vulnerability to problematic drug use?” he said.

In future, the researchers would like to examine whether these processes recover with abstinence.

From a press release of the University of Melbourne, Australia.

Brain Damage, Brain Repair by James W. Fawcett, Anne E. Rosser, Stephen B. Dunnett Read more about this title…

Correlates of alcohol use among methadone-maintained adults

This prospective study (n = 190) examined correlates of alcohol use from baseline data of a longitudinal trial conducted among moderate and heavy alcohol users receiving methadone maintenance therapy (MMT).

The sample included MMT clients who were 18–55 years of age, and were receiving MMT from five large methadone maintenance clinics in the Los Angeles area.

Half of the sample was heavy drinkers and nearly half (46%) reported heroin use. Using a structured questionnaire, correlates of heavy alcohol use included White and Hispanic ethnicity, and fair or poor physical health combined with older age (?50 years). We also found that MMT clients who were younger than 50 years, regardless of health status, were more likely to be heavy drinkers.

Compared with moderate alcohol consumers, a greater number of heavy alcohol users also experienced recent victimization.

To optimize MMT, alcohol screening should be part of routine assessment and alcohol treatment should be made available within MMT programs.

Moreover, special consideration should be provided to the most vulnerable clients, such as the younger user, those with a long-term and current history of heavy drug use, and those victimized and reporting fair or poor health. In addition, promoting attention to general physical and mental health problems within MMT programs may be beneficial in enhancing health outcomes of this population.

Research report; Adeline Nyamathi, Allan Cohen, Mary Marfisee, Steven Shoptaw, Barbara Greengold, Viviane de Castro, Daniel George and Barbara Leake. Drug and Alcohol Dependence. Volume 101, Issues 1-2, 1 April 2009, Pages 124-127. Correlates of alcohol use among methadone-maintained adults

Se also;

• Twelve-Step Programs as an Adjunct to Psychotherapy and Psychopharmacology
• Treating Alcoholism
• AA and Treatment Work Better Together

Clinical Guide to Alcohol Treatment: The Community Reinforcement Approach