The Co-Occurring Center for Excellence. Addressing mental disorders and alcoholism, addiction co-occurring.

The Co-Occurring Center for Excellence (COCE) was created by SAMHSA in 2003 to provide information and a range of services to mental health and substance abuse administrators and policymakers at state and local levels, their counterparts in tribal and Native populations, clinical providers, other providers, and all other agencies and systems through which clients may enter the treatment system.

COCE provides state-of-the-art and sustainable technical assistance, training, information and resources, and links to other resources that serve persons with co-occurring disorders.

http://www.coce.samhsa.gov/

See also;

• Double Trouble in Recovery
• Dual Diagnosis Anonymous
• Double Trouble in Recovery for Alcoholics
• 12-Step Treatment More Effective than Alternative

The Dual Diagnosis Recovery Sourcebook : A Physical, Mental, and Spiritual Approach to Addiction with an Emotional Disorder by Dennis Ortman Read more about this title…

Antidepressant Induced Mania (ADM) Among People with Co-Occurring Disorders (COD). Sometimes, informally called Bipolar III disorder.

A recent study of medical charts at a bipolar specialty clinic gives new support to the idea that antidepressants can induce mania in some bipolar patients.

For some time, clinicians have been concerned about the problem of antidepressant-induced mania (ADM), but most research has not supported the connection between antidepressants and manic or hypomanic episodes.

This study looked at ADM and examined differences between patients with bipolar disorder and a substance use disorder (SUD) and patients without SUD.

The article presents solid evidence for a significantly increased risk of ADM in patients with co-occurring bipolar disorder and SUD. The article also comments about why the increased risk to these clients may not have been identified in prior research.

Manwani and colleagues investigated medical charts from 98 patients who were treated at a bipolar clinic between 2000 and 2004. These patients accounted for 335 antidepressant trials during that period. Of the sample, 55 patients (accounting for 184 of the trials) had a lifetime history of a SUD.

For this study, an episode of ADM was defined as hypomanic or manic symptoms within 12 weeks of beginning a new antidepressant medication.

There were some substantial differences between patients who did and did not have a SUD history—e.g., clients with SUD were almost twice as likely as those without SUD to be prescribed lithium (48.3% vs. 28.5%), and clients without SUD were twice as likely to receive divalproex as those with SUD (43% vs. 20.1%) and almost three times as likely to be prescribed an antipsychotic (31.8% vs. 11.4%).

The univariate analysis of differences in the number of antidepressant trials leading to ADM between patients with and without a SUD history showed little difference in the percentage of ADM episodes they experienced (20.7% of trials for those with SUD and 21.4% of trials for those without).

However, using a multivariate regression model of analysis, the authors found that:

• Patients with a lifetime SUD were five times as likely to experience ADM,
• The incidence of an antidepressant trial leading to an ADM was greater for clients with Type II or with bipolar disorder not otherwise specified than for Type I,
• Females were more likely than males to have an episode of ADM in response to an antidepressant trial, and
• Bupropion was the antidepressant least likely to cause an ADM.

The authors surmise that older research studies excluding people with a SUD might have led to subject pools that underrepresented individuals considerably more likely to experience an ADM than the subjects studied. Additionally, they describe how other confounding factors might have served to hide the effects of having a history of SUD on the likelihood of suffering an ADM.

A discussion of the limitations of their study (e.g., it was non-randomized, non-blind; concomitant therapy may have obscured treatment effect; no measures of adherence to medication regimens) is also given.

Research; Manwani, S. G., Pardo, T. B., Albanese, M. J., Zablotsky, B., Goodwin, F. K., & Ghaemi, S. N. (2006). Substance use disorder and other predictors of antidepressant-induced mania: a retrospective chart review. Journal of Clinical Psychiatry, 67(9), 1341–1345.

Co-Occurring Disorders Research and Resources Monthly Review. The Co-Occurring Center for Excellence (COCE), of the Substance Abuse and Mental Health Services Administration (SAMHSA), Vol. 1, No. 5, December 2006. Readers interested in finding out more about COCE should visit the Web site: http://coce.samhsa.gov/

See also;

• Double Trouble in Recovery
• Double Trouble in Recovery for Alcoholics
• Dual Recovery Anonymous
• Dual Diagnosis Anonymous
• Subscribe to BriefTSF by e-Mail

Dual Diagnosis, Counseling the Mentally Ill Substance Abuser by Katie Evans, J. Michael Sullivan Read more about this title…

• Alcohol Related Brain Injury
• Adolescent Children of Alcoholics
• Alcoholic jealousy
• Alcoholics Anonymous with Narcotics Anonymous
• ALCOHOLISM MYTHS
• Anti-craving Naltrexone Injection Reduces Drinking
• Brief-TSF Description
• Brief-TSF is Holistic Treatment
• Client Impressions About Alcoholics Anonymous
• Comparison of Addiction Treatment
• Counselor Characteristics
• Dentists and Alcohol and Drug Use
• Free Inhalant Abuse Education
• Inappropriate Treatment for Alcohol Withdrawal is Common
• Predictors of Relapse in Alcoholism
• Prescription Drug Overdose Becomes Big Killer
• Sleep, PTSD and Alcoholism
• Spiritual Assessment
• Sweet Tooth and Alcoholism
• Teen Drinking Leads to Risk of Alcoholism
• The Dry Drunk
• Thyroid Function in Depression and Alcohol Abuse
• Training; Domestic Violence and Substance Abuse
• TSF Description
• Twelve Steps to Recovery from Burnout
• Subscribe to BriefTSF by e-Mail

Acamprosate efficacy in alcohol-dependent patients: summary of results from three pivotal trials.

In 2004, the United States Food and Drug Administration (FDA) approved acamprosate for use in conjunction with psychosocial support in the maintenance of abstinence in alcohol-dependent patients who are abstinent at treatment initiation.

That approval was based primarily on a re-analysis of three European double-blind, placebo-controlled trials in which complete abstinence was the primary outcome measure.

The current report presents data from the re-analysis of the pivotal trials, which were 13-, 48-, and 52-week studies. A total of 998 DSM-III-R alcohol-dependent patients were included in the studies, with the majority abstinent at randomization. Using a more stringent definition of abstinence, re-analysis of the rate of complete abstinence, percent days abstinent, and the time to first drink confirmed the original findings for the efficacy of acamprosate in the treatment of alcohol dependence.

Rate of complete abstinence was significantly higher with acamprosate than placebo (p < .05); both percent days abstinent and time to first drink were also significantly greater among acamprosate-treated than placebo-treated patients (p < .01).

These findings support the use of acamprosate in the treatment of alcohol dependence and illustrate some of the issues that can arise in the FDA process for approval of medications to treat the disorder.

Am J Addict. 2008 Jan-Feb;17(1):70-6. Acamprosate efficacy in alcohol-dependent patients: summary of results from three pivotal trials. Kranzler HR, Gage A.

See also;

• 12-Step Treatment More Effective than Alternative
• Brief-TSF is designed to as adjunctive therapy for anti-craving medication.
• Subscribe to BriefTSF by e-Mail

Handbook of Alcoholism Treatment Approaches (3rd Edition) by Reid K. Hester, William R. Miller Read more about this title…

Predictors of relapse in 300 Brazilian alcoholic patients: a 6-month follow-up study.

Three hundred alcoholic patients were interviewed at hospitalisation and again 3 and 6 months thereafter in Porto Alegre, Brazil, from March 2002 to January 2004.

Assessment included the SCID-I to check for the presence of Axis I mental disorders, a questionnaire focusing on patient relationship with AA groups, and specific questions about participation in psychotherapy. A logistic regression analysis was performed to determine predictive variables for relapse or abstinence 6 months after discharge.

Previous treatment for alcohol dependence and being single proved to be associated with relapse,

Findings; adherence to AA, the presence of a comorbid depressive disorder, and probably adherence to psychotherapy could be associated with abstinence.

adherence to AA could be associated with abstinence

These findings reinforce the importance of psychotherapy and AA groups for alcoholics to remain abstinent for longer.

The greater adherence to treatment observed among depressive alcohol dependents can be explained by the fact that this is a comorbid condition that acts as a protective factor against relapse.

Predictors of relapse in 300 Brazilian alcoholic patients: a 6-month follow-up study. Subst Use Misuse. 2008;43(3):403-11. Terra MB, Barros HM, Stein AT, Figueira I, Athayde LD, Ott DR, De Azambuja Rde C, Da Silveira DX.

See also;

• Brief-TSF is designed to address these issues.
• 12-Step Treatment More Effective than Alternative
• Subscribe to BriefTSF by e-Mail

• 12-Step Recovery Theory And Application
• AA And Al-Anon
• AA And The Disease Concept Of Alcoholism
• Adolescent Children Of Alcoholics
• Al-Anon Offers New Life
• Alcohol Consumption In Patients Pancreatitis
• Alcohol Metabolization
• Alcohol Related Brain Injury
• Alcoholic Brain Damage And Thiamine
• Alcoholic Jealousy
• Alcoholics Anonymous
• Alcoholics Can Benefit From Al-Anon
• Alcoholism And Personality Disorders
• Alcoholism Is Also Genetic
• Alcoholism Myths
• Anti-Craving Naltrexone Injection Reduce
• Benefits Of Alcoholics Anonymous
• Beyond Codependency
• Brief-TSF Description
• Children With Alcohol Dependent Fathers
• Counselor Characteristics
• Craving Reduction
• Effective Professional Interventions
• Effects Of Gambling Addiction
• Free Inhalant Abuse Education
• Just For Today Card
• Mindfulness Can Help Recovery
• Prescription Drug Overdose Becomes Big Killer
• Process Of Recovery For Alcoholic Women
• Research Evidence For TSF  .
• Return To Drinking After Liver Transplantation For Alcoholic Liver Disease
• Role Of Significant Others
• Screening Can Decrease Teen Risk Behaviour
• Sleep Problems Affect Alcoholism Recover
• Spirituality And Helping In Alcoholics Anonymous
• Strategies For Dealing With Common Problems
• Strategies For Dealing With Denial
• Sweet Tooth And Alcoholism
• Symptoms Of Alcoholism
• Teen Drinking Leads To Risk Of Alcoholism And Social Exclusion
• The Aging Alcoholic
• The Classification Of Alcoholics
• The Dry Drunk
• Thyroid Function In Depression And Alcohol Abuse
• TSF Description
• Twelve Step Recovery Is Spiritual
• Twelve Steps To Recovery From Burnout
• What About Partners Of Alcoholics?

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Patient-Provider E-mail Communication as an Adjunctive Tool in Addiction Medicine

Frequent electronic mail communication between patients and their addiction specialist can be utilized as an adjunct in the treatment of alcohol or substance dependency.

Selected patients benefit from mandatory daily electronic mail communications with their provider through enhanced accountability, frequent self-assessment, deterrents to isolation, and a sense of continuous access to care. Participants have found the experience easy and enjoyable and all have maintained continuous sobriety.

We present our experience using this modality as a series of illustrative case reports and a discussion of the implications of using electronic mail with patients in addiction medicine.

Research report; Patient-Provider E-mail Communication as an Adjunctive Tool in Addiction Medicine. Gregory B. Collins, Mark S. McAllister, Donald B. Ford. Journal of Addictive Diseases, Volume: 26 Issue: 2

Factors that Foster and Hinder the Process of Recovery for Alcoholic Women.

Alcoholism is a chronic, progressive, potentially fatal disease that crosses gender, race, ethnicity, age, and socioeconomic strata.

Much of what is known about the disease of alcoholism has been uncovered studying male alcoholics.

A phenomenological study was undertaken to identify those contextual factors that fostered and hindered the process of recovery for alcohol dependent women.

Criteria for participation in the study were: women self-identifying as recovering from alcoholism, aged 25 years and older, able to converse and write in English, and abstinent from alcohol use for a minimum of two years. Eleven women (6 Caucasian, 4 African-American, one Native American; 8 heterosexual and 3 lesbians) in recovery for alcohol dependency were recruited by networking and snowball sampling. The women ranged in age from 32 to 76 years of age and had been in recovery from 2 to 37 years. Data were collected through individual audio tape recorded interviews that lasted 45 minutes. Data were analyzed using the constant comparative method for content analysis.

The data revealed the factors that fostered recovery from alcoholism were:

• working a program of recovery,
• developing a support system,
• making amends for past behaviors,
• recognizing recovery as a life-long process, and
• helping other alcohol dependent women struggling in recovery.

The identified factors that hindered the process of recovery were:

• everyday stress,
• feeling stigmatized for being alcoholic, and
• dealing with painful childhood memories.

Research report; M. Kathleen Brewer. The Contextual Factors that Foster and Hinder the Process of Recovery for Alcohol Dependent Women. Journal of Addictions Nursing, Volume 17, Issue 3 September 2006 , pages 175 - 180

Brief-TSF addresses all these issues.

On completion of BriefTSF, you will be able to use Brief-TSF as adjunctive therapy and;

Understand and use questionnaires for assessing alcohol use.

• Separate the differences between alcoholics and problem drinkers
• Guide alcoholics to self-assessment and acceptance of their condition
• Gauge suitability of alcoholics for Alcoholics Anonymous

Understand the barriers to alcoholics acceptance of their condition

• Understand alcoholism as an illness
• Help an alcoholic to work through denial, and self defeating thinking and emotions
• Understand the stages of change in recovery from alcoholism
• Understand the impaired thinking and behaviour of alcoholics
• Foster rational and spiritual responses to dangerous drinking reminders and situations
• Help the alcoholic understand the key remedies to craving and compulsive thinking.

Understand the self help methods of Alcoholics Anonymous, Alateen and Al-anon

• Be able to work with recovering members of self help groups such as AA, Al Anon and Alateen.
• Help and support prospective members in contacting an AA or Al-anon Peer Sponsor

Understand the ‘tools of recovery’ and practices of the AA program and culture.

• Support prospective and new members of AA in their quest for sobriety using AA meetings, slogans and AA members.
• Detect the barriers to ‘doing the program’ in AA
• Discuss remedies for dangerous actions and thinking with the alcoholic
• Promote relapse prevention and better responses to relapse
• Support an alcoholic in using the tools of relapse prevention
• Help alcoholics gain new motivation, hope and action after a relapse

Partners of Alcoholics

• Understand the thinking and actions of partners, children and parents of alcoholics
• Help with understanding of alcoholic family forces and the enabling of alcoholism
• recognise symptoms of child, youth and adult abuse within alcoholic families
• Recognize impaired and healthy caring actions of significant others
• Guide partners of alcoholics to self assessment and acceptance of their condition
• Judge suitability of partners and children of alcoholics for self help groups such as Al-anon or Alateen

Work Stress and Alcohol Use

Employees who drink heavily or who abuse or are dependent on alcohol can undermine a workforce’s overall health and productivity.

To better understand the reasons behind employee abusive drinking and to develop more effective ways of preventing problem drinking in the workforce, researchers have developed a number of paradigms that guide their research.

One such paradigm is the alienation/stress paradigm, which suggests that employee alcohol use may be a direct or indirect response to physical and psychosocial qualities of the work environment. Although in the alcohol literature, work alienation and work stress traditionally have been treated as separate paradigms, compelling reasons support subsuming the work-alienation paradigm under a general work-stress paradigm.

Researchers have developed several models to explain the relationship between work stress and alcohol consumption:

• the simple cause-effect model,
• the mediation model,
• the moderation model, and
• the moderated mediation model.

Of these, the moderated mediation model particularly stands out, because it simultaneously addresses the two fundamental issues of how and when work stressors are related to alcohol use.

Recent research supports a relation of work related stressors to elevated alcohol consumption and problem drinking. Future research should focus on the relation between work stressors and alcohol use among adolescents and young adults, because they are just entering the workforce and are the most likely to engage in heavy drinking. Longitudinal studies also are needed to better explain the relation between work stress and alcohol use.

By Michael R. Frone, Ph.D. Alcohol Research & Health, Vol. 23, No. 4, 1999