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

Alcoholics Anonymous careers

BACKGROUND: Most formal treatment programs recommend Alcoholics Anonymous (AA) attendance during treatment and as a form of adjunctive aftercare, but we know very little about treatment seekers’ patterns of AA involvement over time and how these relate to abstinence.

METHOD: This paper applies latent class growth curve modeling to longitudinal data from 349 dependent drinkers recruited when they were entering treatment and were re-interviewed at one or more follow-up interviews one, three and five years later, and who reported having attended AA at least once.

RESULTS: Four classes of AA "careers" of meeting attendance emerged:

The low AA group mainly just attended AA during the 12 months following treatment entry.

The medium and high AA groups were characterized by stable attendance at the second and third follow-ups-at about 60 meetings a year for the medium group and over 200 meetings per year for the high group, followed by slight increases for the medium group and slight decreases for the high group by year five.

The declining AA group doubled its meeting attendance post baseline, to almost 200 meetings during the year following treatment entry, but by year five they were only attending about six meetings on average.

Decreases in AA meetings did not necessarily signal disengagement from AA; at the five-year follow-up, a third of the low AA group and over half of the declining AA group said they felt like a member of AA. Activities other than meeting attendance, such as having a sponsor, otherwise paralleled the meeting careers, but social networks were similar by year five.

Rates of abstinence by year five (for the past 30 days) were

• 43% for the low AA group,
• 73% for the medium group,
• 79% for the high group and
• 61% for the declining group.

Rates of dependence symptoms and social consequences of drinking did not differ between the groups at year five.

CONCLUSIONS: The prototypical AA careers derived empirically are consistent with anecdotal data about AA meetings: some never connect; some connect but briefly; and others maintain stable (and sometimes quite high) rates of AA attendance. However, contrary to AA lore, many who connect only for a while do well afterwards.

Research; Kaskutas LA, Ammon L, Delucchi K, Room R, Bond J, Weisner C. Alcoholics anonymous careers: patterns of AA involvement five years after treatment entry. Alcohol Clin Exp Res. 2005 Nov;29(11):1983-90.

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Helping, spirituality and Alcoholics Anonymous

OBJECTIVE: The purpose of this study is to examine how helping activities and spirituality–perhaps key influences on sobriety–change over alcoholism recovery.

The study also explores interrelations among Alcoholics Anonymous (AA), helping and spirituality.

METHOD: Questionnaires were administered to recovering alcoholics (118 men, 80 women) recruited at AA and Women for Sobriety meetings, treatment programs and through personal connections. A helping scale measured Recovery Helping (8-item alpha = 0.78), Life Helping (12-item alpha = 0.62), and Community Helping (6-item alpha = 0.60). The Daily Spiritual Experiences scale assessed two components of spirituality identified by factor analysis: Theism and Self-Transcendence. Two components of an AA scale, Involvement and Achievement, were also treated separately on the basis of factor analysis.

RESULTS: Structural equation modeling revealed that

• longer sobriety predicted significantly more time spent on Community Helping,
• less time spent on Recovery Helping and
• higher levels of Theism, Self-Transcendence and AA Achievement.
• Model covariances revealed that both AA components were related to more Recovery Helping and higher Theism.
• Both spirituality components related to all forms of helping, with one exception.

CONCLUSIONS: The findings highlight important changes in helping with length of sobriety.

• As their sobriety accumulates, recovering alcoholics seem to devote less time to informal helping and more time to organized community projects–perhaps indicating evolving needs and abilities.
• The results also suggest roles for AA and spirituality in encouraging helping, and they indicate that some forms of spirituality relate to AA affiliation.

Future work might establish whether and when helping in different domains contributes to the maintenance of abstinence and to other drinking-related outcomes.

Research Report; Zemore SE, Kaskutas LA. J Stud Alcohol. 2004 May;65(3):383-91. Helping, spirituality and Alcoholics Anonymous in recovery.

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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: O’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):507–512.

From; Join Together Online

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

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-Sturmhöfel, Ph.D. Alcohol Research & Health; Vol. 27, No. 2, 2003

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

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 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

Alcoholism is a multigenerational disease as evidenced by this report.

Abstract; To test the hypothesis of a sex-linked factor influencing the occurrence of alcoholism and alcohol abuse, alcoholism or abuse rates were compared for 136 sons of the sons vs 134 sons of the daughters of 75 alcoholics. No substantial difference between the groups of grandsons was found in frequency of officially registered alcoholism or alcohol abuse, or both, which suggests no sex-linked factor is involved. The total sample was also used to calculate the risk of such registration for the grandson; the rate of registration by the grandsons’ fifth decade of life was 43%, approximately three times that of the general male population, and even higher than the equivalent rate in brothers of alcoholics. This result is incompatible with an assumption of a recessive gene being involved in the occurrence of alcoholism, though it fits with the assumption of a dominant gene.

L. Kaij and J. Dock. Grandsons of alcoholics. A test of sex-linked transmission of alcohol abuse. Arch Gen Psychiatry. Vol. 32 No. 11, November 1975.