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

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

Obstetricians Often Overlook Alcohol Consumption In Pregnancy, says the Australian And New Zealand Journal Of Obstetrics And Gynaecology

One in every two pregnant Australian woman still consume alcohol during pregnancy, according to a study in the Australian and New Zealand Journal of Obstetrics and Gynaecology. The responsibility of providing accurate information about the harmful effects of alcohol and its lifelong effects on the child falls on obstetricians and other health professionals.

And yet, almost half of the obstetricians interviewed said they did not routinely ask about alcohol consumption in pregnancy.

An editorial by Professor Elizabeth Elliot from the University of Sydney titled “Alcohol and Pregnancy: the Pivotal Role of the Obstetrician”, discusses the state of awareness about the adverse effects of alcohol consumption during pregnancy and the obstetricians’ participation in educating against maternal drinking.

Only 16% of the obstetricians routinely provided information about the consequences of alcohol in pregnancy, while only 5% gave advice which were consistent with the latest guidelines of The National Health and Medical Research Council of Australia (NHMRC) – which states that, for pregnant women, ‘no drinking is the safest option’.

Professor Elliot says, “Failure to provide information about the dangers of alcohol consumption in the antenatal consultation represents a lost opportunity. Accurate recording of antenatal alcohol exposure will help identify children who require pediatric assessment, since the effects of alcohol may not be obvious at birth.”

“More importantly, identifying the women who are unable to stop drinking provides an important opening for the management of problem drinking and prevention of exposure to alcohol in future pregnancies,” added Professor Elliot.

Alcohol consumption during pregnancy has been associated with increased risks of miscarriage, stillbirth, intrauterine growth restriction, pre-term birth and low birth-weight. However, the best known adverse effect of alcohol exposure on the fetus is the fetal alcohol syndrome (FAS) – which is associated with a wide range of birth defects and ongoing educational, behavioral and psychological problems.

This paper is published in the June 2008 issue of Australian and New Zealand Journal of Obstetrics and Gynaecology (Vol. 48, Issue 3, 2008).

See also;

1. Facial features of fetal alcohol syndrome
2. Alcohol and Pregnancy
3. Alcohol Free Pregnancies
4. Alcohol intervention may help.
5. Brief-TSF can assist patients cease alcohol consumption.

Difference in medical history classified by ICD-10 between male and female alcoholics.

The drinking history and current medical history of patients with alcohol dependence were surveyed in Japan and they were analyzed by demographics; gender, age and changes with time (2 stages).

The results showed that in the course of continued habitual drinking by patients with alcohol dependence, a wide range of physical complications occurred.

The main complications

• in men were gastrointestinal diseases and
• in women were mental and behavioral disorders, showing a gender difference in the medical history.

This result suggested that there is a high possibility that this will contribute to early discovery and early measures against alcohol related problems in women, which are difficult to bring out into the open.

Better alcohol education including mental health is important from an early age.

Nihon Arukoru Yakubutsu Igakkai Zasshi. 2008 Feb;43(1):25-34. Difference in medical history classified by ICD-10 between male and female alcoholics. Shinoda R, Mizukami Y, Nakagawa Y, Maruyama K.

See also;

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

Counseling the Culturally Diverse: Theory and Practice by Derald Wing Sue, David Sue Read more about this title…

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

Predictors of 4 year outcome of community residential treatment for patients with substance use disorders.

Aims This study examined systematically how predictors of substance use disorder (SUD) treatment outcome worked together over time and identified mediators and moderators of outcome.

Design The MacArthur model was applied in this naturalistic study to identify how baseline, discharge and 1-year follow-up factors worked together to predict 4-year improvement in substance-related problems.

Setting Eighty-eight community residential facilities were selected based on geographic representativeness, number of patient referrals and type of treatment orientation.

Participants Of 2796 male patients who completed intake assessments, 2324 were assessed at the 1-year follow-up and 2023 at the 4-year follow-up.

Measurements Self-report measures of

• symptom severity,
• functioning,
• social resources and coping,
• treatment and
• involvement in Alcoholics Anonymous (AA) were collected at baseline and at 1- and 4-year follow-ups.

Provider-rated treatment participation measures were obtained at discharge.

Findings

• Greater substance use severity,
• more psychiatric symptoms,
• more prior arrests and
• stronger belief in AA-related philosophy at treatment entry

predicted improvement significantly in substance-related problems 4 years later.

At the 1-year follow-up,

• being employed and
• greater use of AA-related coping
• predicted outcome significantly.

AA-related coping at 1 year mediated the relationship partially between belief in AA philosophy at treatment entry and 4-year outcome.

Conclusions

The findings highlight the unique and positive impact of AA involvement on long-term SUD treatment outcome and extend understanding of why AA is beneficial for patients.

Research report; Predictors of 4 year outcome of community residential treatment for patients with substance use disorders. Addiction. 2008 Apr;103(4):671-80. Laffaye C, McKellar JD, Ilgen MA, Moos RH.

See also;

• Brief-TSF is designed to as adjunctive therapy for anti-craving medication.
• Twelve Step Facilitation

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

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

Brief-TSF Theoretical Rationale/Mechanism of Action

The theoretical rationale is based in the 12 steps and 12 traditions of AA and includes the need to accept that willpower alone is not sufficient to achieve sustained sobriety, that self-centredness must be replaced by surrender to the group process/conscience, and that long-term recovery consists of a process of spiritual renewal. The primary mechanism action is active participation and a willingness to accept a higher power, even if it is the AA group at first, as the locus of change in one’s life.

Agent of Change

The facilitator in the Brief-TSF treatment model is more truly a facilitator of change than an agent of change. The true agent of change (to sustained sobriety) lies in active participation in AA along with the principles set forth in the 12 steps and 12 traditions that guide this fellowship.