In general, survey respondents were male, averaged 52 years of age, had relapsed several times and started abusing illicit drugs and alcohol in high school or college.

The findings suggest several subjective factors that contributed to the subjects’ relapse included;

• dishonesty to self,
• not working a 12 step program, and
• denial of the problem.

Factors reported to be helpful for future relapse prevention were

• abstinence from substance use,
• working a 12 step program, and
• having spiritual beliefs.

By identifying the specific causes of relapse, future studies may attempt to decrease the percentage of health care providers who relapse by recognizing signs of problematic behavior before they occur.

Long MW, Cassidy BA, Sucher M, Stoehr JD. Prevention of relapse in the recovery of Arizona health care providers. J Addict Dis. 2006;25(1):65-72.

A Sponsorship Guide for 12-Step Programs by M. T. Read more about this title…

Doctors and patients should discuss and address sleep issues as part of recovery

The first few months of recovery from an alcohol problem are hard enough. But they’re often made worse by serious sleep problems, caused by the loss of alcohol’s sedative effects, and the long-term sleep-disrupting impact that alcohol dependence can have on the brain.

Now, a new study gives further evidence that insomnia and other sleep woes may actually get in the way of recovery from alcohol problems. In fact, a person’s perception of how bad their sleep problems are may be just as important as the actual sleep problems themselves, the study suggests.

The study is published in the journal Alcoholism: Clinical and Experimental Research, by a team from the University of Michigan’s Department of Psychiatry. They report the results of a small but thorough evaluation of sleep, sleep perception and alcohol relapse among 18 men and women with insomnia who were in the early stages of alcohol recovery.

The authors say their results show how important it is for alcohol recovery patients, and those who are helping them through their recovery, to discuss sleep disturbances and seek help. Often, sleep isn’t discussed in alcohol recovery programs – but it should be, they stress.

In fact, members of the U-M team have now launched a new study that aims to help those who have just entered treatment for alcohol problems, and are having trouble sleeping. Instead of using sleep medications, which can carry their own risk of addiction, it’s based on a series of "talk therapy" sessions with a trained sleep therapist who can help patients change behaviors and patterns of thinking that contribute to sleep problems.

Sleep and Half Brother Death [Drunk] by John William Waterhouse

In the meantime, the newly published results add to the understanding of how alcohol and sleep intertwine.

"What we found is that those patients who had the biggest differences between their perception of how they slept and their actual sleep patterns were most likely to relapse," says lead author Deirdre Conroy, Ph.D., who led the study as a fellow in the U-M Addiction Research Center. "This suggests that long-term drinking causes something to happen in the brain that interferes with both sleep and perception of sleep. If sleep problems aren’t addressed, the risk of relapse may be high."

"We are now interested in what brain mechanisms are involved in the disrupted sleep of alcohol-dependent individuals," says Brower, who has previously led studies illustrating the prevalence of sleep disorders among people with alcohol dependence and abuse issues, and their correlation with relapse back into drinking. He is the executive director of the U-M Addiction Treatment Services, which provides alcohol and drug treatment to hundreds of patients each year.

The new study involved women who had volunteered for a randomized clinical trial of gabapentin, an experimental treatment for alcohol dependence. Each one started the trial when they had been off alcohol for about a week.

The volunteers spent two separate nights in the sleep-monitoring area of the U-M General Clinical Research Center, wearing electrodes on their head and body that measured their brain waves during sleep, as well as their breathing, muscle activity and heart rhythm. The detailed measurements, which together make up a procedure called polysomnography, allowed the researchers to determine when the volunteers were sleeping, when they were awake, and which stage of sleep they were in.

These sleep data were compared with the participants’ answers on morning evaluations of how they slept – including how long they thought it took them to fall asleep, how long they were awake in the night, and other measures. The two nights of sleep monitoring were done several weeks apart. The researchers also asked the participants to report any alcohol they drank during the six weeks following each sleep test.

In all, the patients overestimated how long it took them to fall asleep, but thought they had been awake in the middle of the night for far less time than they actually were. These perceptions about how they slept were actually more accurate in predicting their potential for relapse to alcohol use than were the actual sleep measurements.

"Our study suggests that in early recovery from alcoholism, people perceived that it took them a long time to fall asleep and that they slept through the night," says Conroy. "The reality was that it did not take them as long to fall asleep as they thought it did, and their brain was awake for a large portion of the night. On average, the participants that were less accurate about how they were sleeping were more likely to return to drinking."

Conroy explains that poor sleep quality can lead to mood disturbances. "If recovering alcoholics are irritable because they are not getting quality sleep at night, they might be more vulnerable to return to drinking," she says. "Previous studies show that non-alcoholics with insomnia actually think they are sleeping worse than they are, so they may be more likely to seek appropriate treatment.

Our study shows that an alcoholic in early recovery has a lot of wakefulness in the night but they are not necessarily picking up on this. It is important for the clinician working with the alcohol-dependent patient to have a differential of poor sleep quality in the back of their mind as a potential challenge for the patient throughout alcohol recovery."

Kara Gavin | Source: EurekAlert! Further information: www.umich.edu

The purpose of the present paper was to explore the theory, concept and experience of God in relation to recovery from drug addiction from a scientific perspective.

Examination of a diverse literature was undertaken, including five key threads:

• the universality of the experience of God;
• the induction of spiritual experiences of God through hallucinogenic drugs;
• the nature of drug addiction from an evolutionary neurobiological perspective;
• the 12 Step movement as the prototype for the place of God in recovery from drug addiction; and
• identified ingredients for successful recovery from addiction.

The diverse threads of literature examined can be integrated around the concept of higher power as an important factor in recovery from drug addiction.

Higher power can be manifested in individuals in diverse ways:

• religious,
• ethnic,
• spiritual including the use of entheogens [a psychoactive plant or substance, esp. when taken for spiritual or religious purposes], as well as
• cognitive behavioural development,

But a common final pathway for all is the strengthening of executive functions (the brain’s ‘higher power’).

Practical implications for assisting people with drug addiction to achieve recovery through their own experience of God/development of higher power are outlined.

Research report; John D. Sellman;  Michael P. Baker;  Simon J. Adamson; Lloyd G. Geering. Future of God in recovery from drug addiction. Australian and New Zealand Journal of Psychiatry, Volume 41, Issue 10 October 2007 , pages 800 – 808

Spiritual Connections: How to Find Spirituality Throughout All the Relationships in Your Life by Sylvia Browne Read more about this title…

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

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

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 is not really a treatment for alcoholism but a community resource for those wishing to stop drinking. Uncontrolled studies of AA have shown that people who affiliate with AA tend to stop drinking and find that their lives improve in many respects (Emrick et al. 1993).

However, evaluating AA alongside professionally delivered interventions presents problems and perhaps should not be done.

AA, the original 12 Step program, is not a fixed form of “treatment” and people are free to participate in different ways. Some go a few times and then drop out. Others go more often, but do not actively participate in meetings or “work the program.”

It is possible that both dropouts and passive participants gain some benefit from the AA experience, but this has not been adequately researched. Only a minority of those ever exposed to AA seem to become full, active members over a long period and consistently “work” all the steps.

There is evidence that certain types of people may be more likely to fully affiliate with AA than others (Ogborne and Glaser, 1981; Emrick et al., 1993), but more research is needed and some studies may no longer be relevant given the current range and diversity of AA groups. However, it seems likely that AA would appeal to those who have experienced serious alcohol-related problems and who can accept the need for abstinence and the term “alcoholic”.

When professionals refer clients to AA, as adjunctive therapy, on the assumption that they will benefit from such referrals, it is reasonable to ask about the outcomes of these referrals and to compare these outcomes with those achieved by other means.

Project MATCH (1997) included a 12-step facilitation intervention and results showed that those who were encouraged to go to AA did as well as those provided with other interventions.

Background: Few studies have investigated predictors of short- and longer-term outcomes in relatively well functioning treatment samples.

Methods: Multivariate logistic regression analyses were used to identify predictors of continuous abstinence in 188 individuals during their 2nd year after private 12-step treatment in Sweden, and findings are related to a previous report on 1-year outcomes.

Results: Individual baseline characteristics were not directly related to 2nd year outcomes, while a higher 1st-year drinking severity decreased the likelihood of 2nd-year abstinence.

affiliation with Alcoholics Anonymous increased the likelihood of 2nd year abstinence

Satisfaction with treatment and affiliation with the 12 Step group Alcoholics Anonymous, but not program aftercare during the 1st year increased the likelihood of 2nd-year abstinence.

Conclusion: Results are consistent with previous studies showing that shorter-term outcomes are likely to be maintained, and that baseline characteristics and treatment factors account less for outcomes over longer terms.

Research; Maria C. Bodin & Anders Romelsjö. Predictors of 2-Year Drinking Outcomes in a Swedish Treatment Sample. European Addiction Research 2007;13:136-143

Characteristics of suicide attempts preceded by alcohol consumption.

Acute alcohol ingestion and alcohol dependence are known to increase the risk of impulsive suicide attempt even in non-depressed patients.

The relation between alcohol and suicide risk needs, however, to be clarified. We assessed for this purpose prevalence of recent alcohol intake among suicide attempters and compared suicide attempts preceded (”Alcohol + “) or not by alcohol intake.

We included 160 patients examined in the emergency service of a French general hospital after a suicide attempt. Psychiatric disorders were identified according to the DSM-IV criteria. Patients were rated for depression and alcohol use disorder (MAST).

• Prevalence of alcohol consumption was 40%.
• Patients from the “Alcohol + ” group were significantly older (40 versus 34.8 years, p = 0.03).
• Alcohol abuse was more frequent among suicide attempters with prior alcohol ingestion (49% versus 12%,).
• Alcohol dependence was also more frequent in the “Alcohol + ” group (43% versus 9%).
• Patients from the “Alcohol + ” group
• drank more alcohol each day (6.1 versus 1.3 drinks) and
• more often during the week (3.6 days per week versus 1.4). They had a
• higher number of alcohol intoxications each week (0.9 versus 0.3). They
• drank more often alone (41% versus 12%, p < 0.005) and in the
• morning (21% versus 3%).
• They had higher scores on the Michigan Alcohol Screening test (14.8 versus 2.9).
• Prevalence of drug dependence was higher in the “Alcohol + ” group (21% versus 3%, respectively).

Suicide attempts must be asked about their recent alcohol intake. This alcohol intake is often the symptom of an alcohol abuse or dependence disorder.

Research report; Lejoyeux M, Huet F, Claudon M, Fichelle A, Casalino E, Lequen V. Characteristics of suicide attempts preceded by alcohol consumption. Arch Suicide Res 2008; 12(1): 30-8.

See also;

• Twelve Step Facilitation
• Screening for Alcohol Problems

From: University of Utah, Genetics Science Learning Center.

This website – which is highly interesting, informative, and entertaining — delivers interactive and print-based resources, free of charge, on the neurobiological actions of substances of abuse: heroin, cocaine, methamphetamine, marijuana, LSD, ecstasy, and alcohol. The presentations primarily depict how drugs interact with dopamine neurotransmitters within the brain’s reward pathway. The influences of genetics on addiction are also discussed. Although the simplified mechanisms of drug action and other influences depict only part of the story, even experienced practitioners will find the material of interest as a refresher.

Particularly entertaining yet informative, and well worth a look, is the “Mouse Party,” which takes an interactive look inside the brains of animated mice on drugs, exploring molecular mechanisms of addiction. It provides a small glimpse into the chemical interactions at the synaptic level that cause drug users to feel “high” and want to repeat drug-abusing behaviors.

• Go to the Mouse Party
• Section on How Drugs Alter Brain Reward Pathways
• Main Page on Genetics of Addiction
• Some animations require the Adobe Flash Player (available free at Adobe)

The Science of Addiction: From Neurobiology to Treatment by Carlton K. Erickson Read more about this title…