Study Examines Link Between Stress Relapse

A new animal study finds that a stress-related gene and brain chemical may play a role in addiction relapse, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

Researchers from NIAAA and Camerino University in Italy found that rats that showed a preference for alcohol were more sensitive to stress. Those more prone to relapse under stress were examined for genetic patterns that might offer clues to this trait. Researchers found that these rats had higher expression levels of Crhr1, a gene that encodes the stress-related corticotropin-releasing hormone receptor 1 (CRH-R1).

“Our findings demonstrate that the Crhr1 genotype and its expression interact with environmental stress to reinstate alcohol-seeking behavior in this animal model of excessive drinking,” said study leader Anita Hansson, Ph.D., a fellow at NIAAA’s Laboratory of Clinical and Translational Studies.

“This finding helps untangle the complex interplay of genetic and environmental factors that influence relapse,” added NIAAA Director T-K Li, M.D. “It also points to potential approaches for treating individuals at risk for relapse.”

The research appears in the online edition of the Proceedings of the National Academy of Sciences. Research Reference: Hansson, A.C., et al. (2006) Variation at the rat Crhr1 locus and sensitivity to relapse into alcohol seeking induced by environmental stress. Proc. Natl. Acad. Sci.

From Join Together

Brief-TSF addresses relapse prevention as stress relief.

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

“I’ll never touch it again, doctor!” – harmful drinking after liver transplantation.

Alcohol relapse can negatively influence the outcome after liver transplantation (LT).

The aim of our study was to identify factors that could be associated with the recurrence of harmful alcohol consumption after LT.

A total of 387 consecutive patients (23.8% women) who underwent LT for alcoholic cirrhosis in Geneva, Switzerland, and Lyon, France, between 1989 and 2005 were evaluated.

• Mean +/- SD age was 51.3 +/-7.5 years. Follow-up time was 61.2 +/- 47.5 months.

Alcohol consumption relapse and potential factors associated with it were studied.

• The relapse rate of harmful alcohol consumption after LT was 11.9%.

In univariate analysis, alcohol relapse was significantly associated with

• age greater than 50 years,
• year of LT 1995 or earlier,
• duration of abstinence less than 6 months,
• presence of psychiatric comorbidities,
• presence of a life partner, and
• a high score on the High-Risk Alcoholism Relapse (HRAR) scale.

Multivariate logistic regression disclosed the following independent factors of relapse:

• duration of abstinence of less than 6 months;
• presence of psychiatric comorbidities; and
• HRAR score higher than 3.

In patients with none of these factors, alcohol relapse was 5%, while the presence of 1, 2, or 3 factors was associated with relapse rates of 18%, 64%, and 100% of the patients, respectively.

In a large cohort of patients undergoing LT for alcoholic cirrhosis,

• a duration of abstinence of less than 6 months before wait-listing for LT,
• the presence of psychiatric comorbidities, or
• an HRAR score higher than 3

was associated with relapse into harmful drinking.

The presence of more than 1 factor dramatically increased this risk over 50%.

In the pre-LT evaluation in this setting, these factors should be accurately determined.

Research; Haber PS, McCaughan GW. “I’ll never touch it again, doctor!” – harmful drinking after liver transplantation. Hepatology. 2007 Sep 25;46(4):1302-1304.

Liver Transplantation & the Alcoholic Patient: Medical, Surgical and Psychosocial Issues by Michael R. Lucey, Robert M. Merion, Thomas P. Beresford Read more about this title…

Patterns of alcohol consumption and blood alcohol levels in emergency room patients.

The study was conducted in a public hospital of the province of Jujuy, Argentina.

A survey was conducted among all patients during the 24 hours of 4 consecutive days (N = 500) using the Alcohol Use Disorders Identification Test, short version (AUDIT-C). Blood samples were collected in 84% of participants.

Results showed that;

• 37% were hazardous drinkers (men 50% vs. women 23%),
• 29% had symptoms of dependence (men 48% vs. women 11%);
• 17% of men and 3% of women had high blood alcohol levels, equal or greater than 50 mg/dl.

In multivariate logistic regression models men had;

• increased likelihood of hazardous drinking (Adjusted OR 3.2; 95% CI 2.1-5.0),
• symptoms of dependence (Adjusted OR 7.5; 95% CI 4.4-12.7) and
• increased blood alcohol levels (Adjusted OR 8.0; 95% CI 2.2-28.8), compared with women.

Patients admitted due to accidents, violence, or drug use, had;

• increased likelihood of hazardous drinking (Adjusted OR 2.4; 95% CI 1.5-3.9),
• dependence symptoms (Adjusted OR 2.0; 95% CI 1.2-3.3) and
• increased blood alcohol levels (Adjusted OR 7.7; 95% CI 3.0-19.8), compared with those admitted for other reasons.

Alcoholism has a significant impact on the occurrence of injuries and on the demand imposed on health services.

Prevention programs can potentially reduce the negative health and social impact of alcoholism.

Research; Medicina (B Aires). 2008;68(1):31-6. Alcohol consumption in the emergency room. Alderete E, Bianchini P.

See also;

• Brief-TSF can assist patients cease alcohol consumption.
• Twelve-Step Programs as an Adjunct to Psychotherapy and Psychopharmacology
• Subscribe to BriefTSF by e-Mail

Understanding and Counseling: Persons With Alcohol, Drug, and Behavioral Addictions by Howard Clinebell Read more about this title…

The marriage of drug abuse treatment and twelve-step strategies

Research supports the idea that involvement with 12-step fellowships is a very good way to achieve and maintain recovery, but it is not for everyone.

Some research has indicated that although 12-step and other treatment approaches are compatible, patients’ level of commitment or engagement in prescribed behaviors is very low.

They stress that some way must be found to get patients engaged and committed and that the 12-step affiliation needs to be considered an important, rather than a casual, part of treatment.

Patients, many of whom have already been attending meetings before entering treatment, must recognize that 12-step organizations, including Alcoholics Anonymous (AA), are social organizations with a way of living with a program and a fellowship.

At the end of formal treatment, patients must become engaged in and committed to the processes of 12-step programs.

Research report; Forman, R.F.; Humphreys, K.; Tonigan, J.S. Response: The marriage of drug abuse treatment and twelve-step strategies. Science and Practice Perspectives, 2(1):52-54, 2003.

Brief-TSF is designed to increase levels of commitment to recovery.

Alcoholic jealousy: an old and current dilemma.

The relation between alcohol and jealousy is a deeply rooted belief within the general population as well as in the medical, and particularly psychiatric, environment.

Furthermore, in recent years there has been a growing interest on the forensic aspects of pathological jealousy, since they are a frequent cause of severe violence, homicide and suicide.

Some authors have described a high prevalence of pathological jealousy in alcoholic patients, even awarding it a specific value in alcoholism.

Nevertheless, recent studies do not completely support this relation, and draw attention to other factors.

Results from the various studies contain several definitions and classifications of pathological jealousy, and although most of them highlight the prevalence of jealousy in alcoholic patients, they question its specific quality.

Also, the presence of pathological jealousy in subjects with psychiatric disorders other than alcoholism is suggested, indicating the existence of predisposing and triggering factors which could explain the development of pathological jealousy.

Yet, the important methodological difficulties in the published articles and the shortage of studies do not allow the confirmation of the alcoholic etiology in pathological jealousy; this is the reason why considering alcoholic jealousy as a separate entity is debatable.

In this sense, the best diagnosis in these patients would be paranoid disorder combined with alcoholic dependence, hence, a dual diagnosis.

Research; Jiménez-Arriero MA, Hernández B, Mearin Manrique I, Rodríguez-Jiménez R, Jiménez Giménez M, Ponce Alfaro G. Alcoholic jealousy: an old and current dilemma. Adicciones 2007; 19(3): 267-72

Emotional Wellness: Transforming Fear, Anger, and Jealousy into Creative Energy

Does Drinking Reduce Stress?

By Michael A. Sayette, Ph.D.

For centuries, people have used alcohol to relieve stress-that is, the interpretation of an event as signaling harm, loss, or threat. The person usually responds to stress with a variety of behavioral, biological, and cognitive changes. Alcohol consumption can result in a stress response dampening (SRD) effect, which can be assessed using various measures.

Numerous individual differences and situational factors help determine the extent to which a person experiences SRD after consuming alcohol.

Individual differences include

• a family history of alcoholism,
• personality traits,
• extent of self-consciousness,
• cognitive functioning, and
• gender.
• Situational factors influencing alcohol’s SRD effect include
• distractions during a stressful situation and
• the timing of drinking and stress.

The attention-allocation model and the appraisal disruption model have been advanced to explain the influence of those situational factors.

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

Alcohol use disorders represent a substantial public health problem all over the world affecting approximately 2 billion alcohol users worldwide as estimated by the WHO in 2000.

Given the harmful effects of alcohol on the distressed individuals and society as a whole, there is an increasing urge for the development of new, more efficient medications.

Although, investigation of the mechanisms underlying the actions of ethanol in the central nervous system has been ongoing for more than a century, the exact mechanism by which ethanol exerts its effect is still a matter of debate.

In recent years, scientists discovered evidence that alcohol acts on several neurotransmitter systems in the brain to create its alluring effects.

Besides altering the release of neurotransmitters like dopamine, ethanol alters the function of a number of neurotransmitter receptors as well as transporters.

When ethanol is used for longer period of time, changes in these specific neurotransmitter functions occur possibly underlying the development of alcohol dependence.

Therefore, modulators of these targets of ethanol can be useful pharmacotherapeutic agents in the treatment for alcohol dependence.

The aim of this review is to summarize the patent background of these potential candidates clustering them according to their mechanism of effects.

Research; Nagy J. Recent patents on pharmacotherapy for alcoholism. Recent Patents CNS Drug Discov. 2006 Jun;1(2):175-206.

See also;

• Twelve Step facilitation
• Brief-TSF professional training is complimentary to pharmacotherapy.

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.