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The Council is an affiliate of The National Council on Alcoholism and
Drug Dependence (NCADD), the oldest addiction advocacy organization in
the nation. On June 20th, The Council presented The Honorable Donald
Nasshorn with the prestigious NCADD Bronze Key Award. The Bronze Key is
a national recognition award granted by NCADD for presentation by an
affiliate. It is the highest local award presented by affiliates. The
award was presented by Council Board President William Wiegman, Jr.,
Chief of Police of Lower Southampton Township. 
addiction, treatment and recovery in the United States. This 
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Wednesday, July 2, 2014
Tuesday, July 1, 2014
July 1 v 3 TWELVE STEPPING WITH POWER IN THE PROVERB
Their purpose is to teach people to live disciplined and successful lives,
to help them do what is right, just, and fair.
Step 12 - Having had a spiritual awakening as the result of these steps, we tried to carry this message to other addicts, and to practice these principles in all our affairs .
This is why the 12 steps and 31 proverbs are so successful in changing peoples lives .The steps and Proverbs can not be a one time deal ,you need to work a step and read a Proverb everyday . Take a look at your life are you strung out always failing at everything you try to do cant seem to get anything right . Well here is the sure fire way to get clean and sober and stay that way . A million plus people throughout the world have found success and sobriety .When your ready you will have too get on your knees surrender to your maker , that is the one and only true God creator of heaven and earth . He will supernaturally assist you in giving you the strength to overcome your addictions .First He will comfort you ,then He will take away the desire too use .Then he will begin too clear your mind ,bring you peace and settle you . Yes it is true just ask the million plus living in sobriety .
2 Corinthians 1 : 10 We were under great pressure, far beyond our ability to endure, so that we despaired even of life. Indeed, in our hearts we felt the sentence of death. But this happened that we might not rely on ourselves but on God, who raises the dead. He has delivered us from such a deadly peril, and He will deliver us. On Him we have set our hope that He will continue to deliver us.
Daily Quote
"Acceptance is the key to my relationship with God today. I never just sit and do nothing while waiting for Him to tell me what to do. Rather, I do whatever is in front of me to be done, and I leave the results up to Him; however it turns out, that's God's will for me." - Big Book of Alcoholics Anonymous, p. 420
Today's Online Meetings
AA Meeting - 8:00 pm CST: "Face to Face"
Guest Speaker - 1:00 pm CST: "Being Sober and Becoming Happy"
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CALENDAR LISTING:
“Expanding Your Recovery Toolkit” Workshop July 15 in Doylestown
Free monthly workshop series for individuals and families with a current or pastdrug/alcohol addiction issue. Next session meets Tuesday, July 15, 7 p.m. to 8:30 p.m. at The Council of Southeast Pennsylvania, Inc., 252 W. Swamp Rd., Unit 12, Doylestown, Pa. Featuring presentations on methadone maintenance treatment, a video titled “A Mother’s Desperation”, plus a group discussion period on preventing relapes. Refreshments. To register, call 215-345-6644, ext. 3151 or email RPetrolawicz@councilsepa.org.
Sunday, June 29, 2014
Recovery Bullies
If a bully cannot see they are controlling others with fear, what are they to apologize for in Step 9? Not one of the 12 Steps gives advice on confronting those who hurt you.
By Juliet Abram
06/20/14
Admitting that Alcoholics Anonymous psychologically harmed me has been cathartic and healing. Replies from AA fanatics predict that without their steps catastrophe awaits via jails, mental institutions and death. Where I live, anyone trying to convince me to do anything, let alone stay in a 501(c) non-profit organization, under threat of death is a bully.
Asking me to accept "powerlessness" is asking me to relinquish personal power to make positive changes. The anti-feminist misogynistic books and patriarchal spiritual terms of AA are also condescending. Steppers eager to judge me as an angry, self-centered dry drunk who wants to play the victim are name-calling bullies. The all-knowing 1939 Big Book doesn't know that evidence connects bullying to substance abuse in adults.
Bullying is defined as "aggressive behavior that is intentional and that involves an imbalance of power. Most often it is repeated over time." Links to bullying prevention and information can be found on well-known 12 Step treatment center Hazelden's website.
Maybe the bullying is really an attempt at being confrontational. But using fear to recruit others to follow AA means AA is not a program of choice. If I'm afraid to speak my mind out of fear of retaliation, then the tormenters have become my higher power. Although currently some former AA friends believe I have a vendetta to put an end to an AA, I know I alone do not have that kind of power.
Are scare tactics something sponsors pass down? Do old timers who bark out orders to "keep it simple stupid" consider themselves bullies? What if instead, the counselors were skilled in motivational interviewing, an approach centered on a person's values, beliefs and preferences. Stanton Peelewrites that MI developer William R. Miller, along with Bill White, have shown "not a single study over four decades had found confrontation therapies to produce a positive result."
In comparison, AA's 62nd General Service Workshop notes that members with sponsors are "healthy people," because sponsors can set a good example and curtail sponsees' bad behavior. If someone can't acknowledge their bullying is wrong, the bad behavior won't be corrected.
AA has no advice for those bullied. In Steps 4 and 5 a member can admit they resent someone for treating them badly and confess their "part in it," but with bullying this becomes classic "victim blaming." In Step 6, a person admits their character defects and prays them away in Step 7. A list is made in Step 8 of admitting all the people you have harmed so that in Step 9 you can make amends to them all. What do the bullies get? They get away with it.
If a bully cannot see they are controlling others with fear, what are they to apologize for in Step 9? Not one of the 12 Steps gives advice on confronting those who hurt you.
Personalities in AA can range from vulnerable and passive to aggressive and dangerous. All are urged to stick to principles not personalities, but the quiet and the meek are likely to follow the loud and the powerful. Admonishing those under attack who defend themselves with "take your own inventory" perpetuates the cycle.
On the flipside, ex-AA members, relieved to be on a new path to recovery, may find anger is their dominant emotion. Proclaiming "AA is a cult!" may feel good, and some overly zealous AA members may well be cultish. But I remind myself that there are innocent AA members out there who have never done me harm. And many of them are victims themselves.
"Sadly adults can be bullies," states bullyingstatistics.org, pointing out that adults are more likely to be verbal bullies rather than physical ones. "They try to humiliate victims, and 'show them who is boss.'" The narcissist bully puts others down to feel good. The verbal bully starts rumors (“they left AA, they're probably in jail’) and sarcasm ("when you need us, we'll be here"). Cyber bullies can be banned, only to come back again under a new alias hurling verbal grenades.
On my last blog on The Fix, commenter time4numa4 stated:
"Here's how that works. People with 3 duis like yourself who keep drinking like get 4. People with 4 [DUIS] get to see the inside of jail for a while. That's you, in jail still with no useful solution. Upon exit, should you keep chippie drinking you'll experience #5 and some hard time in prison."
"Your buddies won't be there to back up your rationalizations while you get a taste of prison time."
and:
"The chance is strong that in your coming disasters you'll cause serious harm to yourself and/or the completely innocent. Your dislike of AA and the people who succeed at living through using it will not assuage the guilt you'd then carry... Live it out, or choose better for yourself at some point as your life declines...No shame in understanding that you'll get what your hand calls for as long as you go along, either good or bad. If you choose badly remember there is a way out [AA] when you've had enough adventures."
Note the nom-de-plume of this commenter reveling in my anticipated demise. Can you imagine another disease where we bully someone's successful, chosen recovery: "Stop taking your blood pressure medication and turn your will and life over to the care of God!"
All bullying amounts to is taking sick enjoyment in causing another to suffer. In the case of opposite views on recovery, it is a case of wanting to be right instead of wanting to listen to—or to genuinely help—each other.
Juliet Abram is a hardware shop clerk, writer, and artist. She is also a former court mandated attendee of Alcoholics Anonymous. Her activist cause for 12 Step alternatives in Ohio is the AARMED with Facts blog.
(NOTE—This is one of the new voices The Fix has commissioned for our new blog section. And if you'd care to add your voice to the mix, check our brief and simple requirements.)
A Veteran Addiction Researcher Tells All
Whats going on in Iraq and Vietnam with drug addiction? What's up with Obamacare? With research and unlicensed addiction counselors? The word from Dr. Richard Rawson.
By John Lavitt
06/27/14
Dr. Richard Rawson PhD has been on the front line of addiction research and treatment development for 40 years. A member of the UCLA Department of Psychiatry for over 20 years and the Co-Director of the UCLA Integrated Substance Abuse Programs at the Jane & Terry Semel Institute for Neuroscience & Human Behavior, Dr. Rawson oversees an impressive portfolio of addiction research. A major focus of his work is the study of how treatment strategies are applied in a wide range of institutions and societies.
During the past decade, Dr. Rawson has worked with the U.S. State Department on large substance abuse projects, exporting technology and addiction science to the Middle East and Southeast Asia. Currently the principal investigator of the Pacific Southwest Addiction Technology Transfer Center and the NIDA Methamphetamine Clinical Trials Group, Dr. Rawson focuses on improving the educational standards for addiction treatment professionals.
In his interview with The Fix, Dr. Rawson provides an insightful historical perspective on the evolution of addiction treatment and research. With a body of unique experiences and work, Dr. Rawson elucidates the present state of addiction treatment and research in light of the Affordable Care Act while providing a rare illumination of what is to come.
You recently completed the Iraq Drug Demand Reduction Initiative. You were given a State Department contract to conduct a national household survey of drug use in Iraq. What did you learn from that survey and how is that knowledge being used?
Our work actually predates the survey. From 2011 to 2013, we had a previous State Department contract in collaboration with SAMHSA (the Substance Abuse and Mental Health Services Administration, a federal agency) where we worked with a team from Baghdad Medical University in Iraq. The focus of the work was training them in basic information about addiction and treatment strategies, helping them to develop treatment services in Baghdad. We wanted to understand what were the drug problems in Iraq and where was the treatment needed.
It’s going to be a fascinating next ten years of figuring out how to move substance use services into mainstream healthcare, how to educate and serve mainstream healthcare.
To give a little background, during the time of Saddam Hussein from 1980 to 2003, there really were no drug problems in Iraq. From everything I can find and from all the past data that still exists, limited as it is, because of his dictatorship and very tight control of the borders and capital punishment for any drug-related offenses, the availability and use of drugs in Iraq was extremely limited. Some of the first studies done after the Americans went into Iraq suggested the major drug problems were psychiatric medications like anti-psychotics. They were drugs that here in America nobody would ever abuse because they are not particularly enjoyable, but that’s literally all that was available.
Once the U.S. invaded and once we took down Saddam’s government and the borders opened up, drugs have been coming into the country in large amounts. Next door in Iran they have arguably what could be the world’s worst addiction problems with heroin and methamphetamine. Drugs started coming into Iraq across that very long and porous border.
In 2011, we went in and started working with the folks in Baghdad. We took them to Cairo where we had connections at Cairo University, then we took them to Beirut to show them Suboxone treatment in practice. As a result, there are about 15-20 Iraqi doctors, nurses, psychologists and pharmacists who now have a basic background in addiction treatment. They have a treatment unit in Iraq that was one of the first treatment options in Iraq and several satellites have branched off from that unit. The United Nations is now providing them with ongoing support to extend the training and expand the treatment options.
The other piece that we did in that first contract was to chair a meeting called the Community Epidemiology Workgroup in Baghdad that included law enforcement, education, health, security people and army officers to talk about the nature of the drug problem in Iraq. We published a paper about the findings from that report a couple of months ago. One of the major findings from the report and the resulting recommendation was that they needed to do a survey in Iraq, a household survey to get a better handle on the drug problem. That survey is in the field right now.
We have now done interviews with 2,000 individuals and the goal is 3,600. The teams are out surveying as we speak in Iraq. It will be the first national survey of drug use ever done in Iraq and hopefully we’ll have the data sometime this fall. We are both doing interviews and taking saliva samples because it is not clear how forthright the people are willing to be in Iraqi society about their use of drugs and alcohol. Under Saddam which was only ten years ago, if they were using drugs and alcohol, they would be shot. It wasn’t something you were likely to talk about so the accuracy of the survey in the context of Iraq’s history is challenging. That’s why we are also taking saliva drug samples to inform the self-report or confirm the self-report.
You received both your undergraduate degree in 1970 and your PhD in 1974 in Experimental Psychology from the University of Vermont. What then motivated you to enter the field of addiction treatment? Is there a personal reason why you made this choice?
I wish I had a better answer to that question. It was 1974 when I finished my PhD, it was during the Vietnam war; a time when many of us were looking for positions in academia. I was expecting to get a position as an assistant professor in a nice college and teach undergraduates and do a little research, but those were not the options available to me.
One of the options that I found most intriguing was a position at UCLA where they had one of the first grants issued by the National Institute on Drug Abuse. This particular grant was studying the medication naltrexone and a set of behavior therapies for the treatment of heroin addiction. Since that seemed like a very new area and an area where there wasn’t a lot of knowledge, I thought it was a good opportunity. At that point, I must admit I had no particular interest in addiction research or treatment per se.
In 1980, you worked for a nonprofit agency, setting up methadone clinics across California. Do you think methadone treatment for opioid addictions has proven effective? Should methadone clinics continue to operate given the recent advances with opioid antagonists like naltrexone and Suboxone?
After my first five years doing addiction work with patients using naltrexone and behavior therapy, I spent one year in New York City where I got to see the use of naltrexone and those other treatments in action. But I also got to see the use of methadone and the use of LAAM. LAAM was another medicine that was being developed in conjunction with methadone, but it had a longer lasting effect. (Editor’s Note – Like methadone, LAAM or levomethadyl is an opioid analgesic that is not used for relief of pain but was used in the past as a narcotic abuse therapy adjunct in the United States.) I became intrigued by the tremendous benefits that patients seemed to derive from these medications.
I came back to California and was given the opportunity to work on setting up what was essentially a service delivery system that focused on methadone. While we established those clinics, however, we continued to use naltrexone and LAAM and behavioral strategies for the patients as well. Although labeled as methadone clinics, it wasn’t simply methadone, but a variety of treatments.
In answer to your question about methadone and its future in relation to the other available medicines, I don’t think we’ve ever heard anyone say, “Well, gee whiz, we have a new antibiotic so maybe we shouldn’t use penicillin anymore.” There’s always going to be a need for methadone. Methadone is a tremendously effective treatment. It has the benefits of being relatively inexpensive as a medication. Around the world where we are seeing big problems with injection drug use and HIV, there’s nothing even close to methadone for its efficacy, effectiveness and efficiency.
And it will always play a role in the United States as well. There are some patients who need methadone because the other medications are not as effective with them. We are always going to need multiple medications. It’s not that a new one comes along and we drop the old ones. We are going to need all of them.
In 1984, you started the Matrix Institute in Beverly Hills during the peak of the cocaine epidemic and worked there until the end of 1995. Can you describe the goal of the Matrix Institute, its methodologies in terms of an intensive outpatient treatment program and whether you consider it to be a success?
With a number of partners in 1984, we opened the doors of the Matrix Institute. This was during the Reagan years, and our approach to the drug problem was to ‘Just Say No’ so there really was very little in the way of federal funding for research or the development of new knowledge. I was interested in looking at what kinds of treatments could be developed that would assist this newly emerging group of people who were using and abusing cocaine. The knowledge in the early 80s, at least the purported knowledge, was that cocaine wasn’t addicting, that cocaine was a drug that people took too much of occasionally, but they didn’t really get addicted to it. Well, 30 years later, we’ve recognized that’s certainly not the case.
Matrix was set up with the expressed intention of collecting information on stimulant dependence and using that information to develop strategies based on evidence that were effective treatments. It was our intention to look at the data we collected and to develop treatments that had evidence to support their use.
For the first five years or so when patients would come into Matrix and they would pay for the treatment themselves, they would also have to sign a consent form that basically said we don’t really know how to treat cocaine dependence. In fact, by coming into treatment at Matrix, you essentially were entering an experiment where we were trying to learn about cocaine dependence and trying to develop treatment strategies.
From 1995 to 2002, you focused your work on what would become a national plague – methamphetamine abuse and crystal meth addiction. From 1996 to1999, you were a member of the Federal Methamphetamine Advisory Group for the White House Office of Drug Control Policy and Attorney General Janet Reno. How damaging are methamphetamines and is the battle against them being lost?
While I was still at Matrix in the late 80s, the Department of Public Health in San Bernardino County asked us to open an office out there. While we were seeing hundreds and eventually thousands of cocaine users in Beverly Hills, in San Bernardino they were seeing the same great demand for treatment but for methamphetamine dependence. We opened an office in 1987 and we started seeing hundreds of methamphetamine users. With the same empirical approach we were developing in Beverly Hills, we started to collect data on methamphetamine use – what it did, who it affected, how methamphetamine addictions affected the person, what kind of effects did it have on their body and their brain.
In 1996, General Barry McCaffrey called a meeting to address the problem of methamphetamines. McCaffrey was Drug Czar under President Bill Clinton. He had been alerted by the Federal Attorney in San Diego who said that methamphetamine abuse was a huge problem on the West Coast and no one was addressing it. McCaffrey calls this meeting, and it turns out that we were the only ones who had any data. The data that we presented helped the government begin to address the methamphetamine problem in a larger way.
Over the next decade, there was a tremendous effort by the National Institute on Drug Abuse to develop medications and behavioral treatments for methamphetamine dependence. There were many other efforts on the law enforcement side to reduce the availability of precursor chemicals to stop the rampant Mom and Pop production of methamphetamine.
As we sit here now in 2014, methamphetamine is still most definitely a substantial public health problem across much of the country. We have not made significant progress in the area of medication development. The precursor controls of reducing the availability of drugs like ephedrine have reduced the production of methamphetamine in the United States.
The Mom and Pop labs or, as we used to refer to them, the Beavis and Butthead labs that dominated methamphetamine production in this country in the late 1990s and early 2000s were not able to continue to operate without access to the precursor chemicals. Most of the middle-sized labs in people’s garages and in Breaking Bad-like campers have mostly gone away. Now we have these portable laboratories of small-time users that are found in backpacks and on kitchen counters. Beyond these tiny individual user laboratories, the Mexican drug cartels stepped in and took over both the production and distribution of methamphetamine through giant-sized industrial labs. As fast as we develop laws to restrict the precursor chemicals or we restrict the other ways to get the drugs, the drug traffickers seem to find a way around them.
Today, the methamphetamine problem is still severe in many parts of the United States. We still need a lot more knowledge and information. The good news is that the precursor controls have reduced the spread of methamphetamine from the West Coast to the East Coast by stopping the homemade labs that were springing up when ephedrine was readily available. We actually don’t see very much methamphetamine use on the East Coast or the Northeast because it basically never got there. But it remains a problem in the West, the Southwest and in the Midwest. Many of the people now entering the criminal justice system in those parts of the country are affected by methamphetamines. We have a long ways to go.
Boozy Genes—The Making of an Alcoholic?
The more we learn about the genetics of alcoholism, the clearer it becomes that evidence-based treatment should become the norm.
06/23/14
Alcoholism has long been known to run in families. In fact, based on previous twin studies, more than 50% of the overall risk can be attributed to inheritance. This suggests that genetics plays a role. But, how?
Over the past 20 years, scientists have leveraged new genetic—and genomic, or whole-genome—technologies to discover some of the major genetic variants associated with alcoholism. Since 1989, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) has funded the Collaborative Studies on Genetics of Alcoholism study, or COGA—a US-based, multi-site study involving many researchers—with the hope of identifying the specific genes that contribute to the susceptibility to developing alcoholism. And, while the study has found a significant handful of genes, the take-away is that alcoholism is not only a complex disease—many genes, each contributing a small effect—but a heterogeneous one: there are different “types” of alcoholism, and each one is defined by one’s personal genetic makeup, or genotype.
Every alcoholic’s story is, in fact, unique. And, science is beginning to back up this idea of multiple pathways to the same disease.
Says Howard Edenberg, a professor of biochemistry and molecular biology at the Indiana University School of Medicine and one of the principal investigators on COGA, “It’s most critical to start any discussion [of the genetics of alcoholism] with the clear understanding that we’re not dealing with a single-gene disease,” he says. “We’re dealing with a complex genetic disease in which there’s good evidence that…no one gene is determinative.”
Additionally, alcoholism does not have one cause, and it is not entirely genetic—environment and personality play a large role in whether someone will develop a substance use disorder of any kind, including one with alcohol. However, understanding that some people are, in fact, more sensitive to drinking alcoholically than others, scientists are aiming to both determine what makes them more vulnerable and how to better treat people based on their genetic makeup.
COGA
Decades ago, scientists observed that some East Asians—people of Chinese, Japanese, Vietnamese, or Korean descent, among others—became “flushed” when they drank. This so-called “Asian flush” experienced by between 40 and 50 percent of East Asians has since been attributed to a mutation in a gene that metabolizes alcohol. When the by-product of the breakdown of alcohol, called acetaldehyde, builds up in their bodies, they experience an uncomfortable sensation of warmth, rapid heart rate/palpitations, and nausea and/or weakness. Researchers traced this to the ALDH1 gene, the enzyme that breaks down alcohol into acetaldehyde. In small doses, one feels hung over; in large, as with Asians with this specific gene variant, it can be toxic. Needless to say, this gene acts to protect one against alcoholism, for some lending an up-to-six-fold decreased risk.
Out of over 11,000 people interviewed and tested, COGA chose to study 262 families that had two or more first-degree relatives of the patient diagnosed as alcohol-dependent. The study—which used genomics tools like linkage analysis, genome-wide association studies (or, GWAS), and candidate gene studies—identified two genes involved in the metabolism of alcohol (aldehyde dehydrogenase ALDH2 and alcohol dehydrogenase ADH1B) that have the strongest effect on the risk of alcoholism. Significant linkages were found on chromosomes 1, 2, 4, and 7, and later, several more genes were localized, including ADH4 and GABRA2 on chromosome 4, and CHRM2 on chromosome 7. Studies continue to reveal other genes, and with increasingly large sample sizes afforded by meta-analyses, entire biological pathways are beginning to be elucidated.
GABA, or gamma-aminobutyric acid, is the most common inhibitory neurotransmitter in the human nervous system. Mutations in the receptor for this protein, called GABRA2, affect GABA’s function. As seen in many substance use and other psychiatric disorders including alcoholism, decreased GABA function could lead to increased impulsivity. CHRM2 is a gene that makes a specific receptor for acetylcholine, another common neurotransmitter controlling neuronal excitation levels in the brain.
COMPLEX DISEASE
Every alcoholic’s story is, in fact, unique. And, science is beginning to back up this idea of multiple pathways to the same disease. An added prospective arm to the COGA study followed teenagers as they grew up, and those with the ADH gene mutation became early drinkers, whereas those with the CHRM2 risk gene were more apt to be depressed and those with the GABRA2 variant showed more trouble with conduct problems. “The ADH risk variants may contribute to the development of alcoholism directly by promoting heavy drinking, whereas the GABRA2 variants predispose a person to conduct problems, which are themselves a risk factor for alcoholism,” writes Indiana University’s John Nurnberger, Jr., an investigator on COGA, in an article for Scientific American in 2007 (with co-author and COGA researcher Laura Bierut of Washington University). “Meanwhile CHRM2 may act through depression and other internalizing symptoms to foster drinking.”
A recent study adds to the multiple-pathways idea. In a paper appearing in Translational Psychiatry in May, a research team from the United States and Germany led by Alexander Niculescu, III, used a computational approach to discover genes involved in alcoholism. The group narrowed a larger group of associated genes down to a panel of 11, which were then shown to be able to be used to differentiate between alcoholics (and alcohol-dependents) and controls in three independent test cohorts. Niculescu grouped these genes into three “behaviorally relevant” categories—including anxiety, mood, and cognition—which put them into a broader “mindscape-dimensional” view of genes involved in alcoholism and other major psychiatric disorders.
One of the genes that falls into both the anxiety and cognition category is the DRD2 gene, which makes a dopamine receptor molecule. DRD2 has also been studied as a possible target for personalized treatment.
“Rather than thinking of targeting particular genes, you may be able to target [a] pathway,” Edenberg says, citing a good example unrelated to alcoholism as being the discoveries made surrounding statins, which influence one enzyme but affect cardiovascular disease as a whole by targeting cholesterol production. “If we get a better understanding of the mechanisms behind disease, we will be in a much better [place] to both design and target therapy.”
Unfortunately, the idea of one gene causing alcoholism is nothing more than a myth. A study from a consortium of five UK universities riled up the mainstream science media last fall, encouraging headlines that touted the discovery of an “alcoholism gene.” What co-lead author Quentin Anstee’s lab at Newcastle University found was that mice with a genetic mutation in the GABRB1 gene “overwhelmingly preferred” drinking alcohol over water. While it’s an astonishing finding in mice, humans are much more complex and influenced by myriad environmental factors—which themselves impact the function of many interconnected genes, proteins, and processes.
PERSONALIZED MEDICINE BASED ON GENETIC TESTING
It’s becoming more likely with every discovery that alcoholism—like cancer, for instance—is a heterogeneous disease, meaning that while it looks similar on the outside, it’s actually many different conditions on the inside. In fact, several recent studies have verified that different genetic “types” of alcoholism exist—patients respond differently to the same medication based on their genetic makeup and its effect on how they metabolize the drug (a field known as “pharmacogenetics”). According to a recent review in CNS Drugs, three particular genes—the μ-opioid receptor, the dopamine D4 receptor, and the serotonin transporter gene—have shown the most promise in recent studies as targets for personalized therapy using available drugs for alcoholism (naltrexone and acamprosate, as well as off-label drugs sertraline (Zoloft), olanzapine (Zyprexa), and ondansetron).
In one of the first pharmacogenetic studies, published in early 2011 in the American Journal of Psychiatry, alcoholics were divided into treatment groups based on a specific mutation in their serotonin transporter gene. Mutations in this gene have been linked to many conditions, including not just alcoholism, but depression, obsessive-compulsive disorder, romantic love, hypertension, and generalized social phobia. Those with two specific mutations were better able to reduce their number of drinks on drinking days and their total number of drinking days using the drug ondansetron, a serotonin-3 receptor antagonist typically used to treat nausea and vomiting. Other groups, namely David Goldman’s lab at NIAAA, are studying this specific receptor subtype, also known as the 5-HT3 receptor.
“[The] work on the serotonin transporter and serotonin-3 receptor genotypes is [the] most promising,” says Bankole Johnson, chairman of psychiatry and professor of neurobiology at the University of Maryland School of Medicine and the 2011 study’s lead author. Current research out of Johnson’s lab include a clinical trial entering phase III examining the effectiveness of low-dose ondansetron and a study to examine the effects of naltrexone and acamprosate on liver and kidney function in alcoholics.
Several studies have found specific genotypes to be associated with a better response to naltrexone; in particular, alcoholics with a specific variation of an opioid-receptor gene have a lower rate of relapse than those with a different variation. Naltrexone, an opioid receptor antagonist, works by blocking the opioid receptors—and therefore, the high that drinking alcohol triggers. Other studies are looking at how specific genotypes—mutations in certain genes—affect the way in which alcoholics metabolize disulfiram (Antabuse) and topiramate (Topamax), to name a few.
Just how far are we from being able to hand an alcoholic a genetic test and use this to determine the most personalized—and effective—treatment? It’s still the early days, Edelman says, who doesn’t think “we’re going to be doing genetic testing in terms of prevention work in the foreseeable future.” Genetic testing services, especially direct-to-consumer ones that also typically delve into ancestry genes, offer far from a complete picture. Even if you have a protective version of some gene, there could still be plenty of genes that influence the tendency toward alcoholism that have yet to be discovered.
Still, genetic testing will be “of critical importance,” when it comes to treatment options in the near future, Johnson says. “Alcohol dependence is heterogeneous. Therefore, treatments that target each of the various subtypes will be far more successful than one-size-fits-all. The future is genetic testing to determine who might respond to a particular medication, which [alcoholics] can then be given.”
Jeaneane Swanson is a regular contributor to The Fix. She last wrote about erasing your traumas and side effects of antidepressants.
Saturday, June 28, 2014
June 28 v 26 TWELVE STEPPING WITH POWER IN THE PROVERB
He who trusts in his own heart is a fool,
But whoever walks wisely will be delivered.
STEP 3 Made a decision to turn our will and our lives over to the care of God as we understood Him.
What do we do if we were never taught to depend on God . Sure I went to catholic school where I spent eight years following impossible rules and useless dead traditions that we performed lifelessly year after year . Growing up , I learned too survive by trusting my gut ! My world was built on the here and now ,too get what I wanted whenever I wanted it . After time as I got older and colder I began too realize life was wearing me down and , I was tired of running ducking and dodging all the trouble . My self medicating ways were taking a heavy toll and life was getting pretty useless and I was getting tired of me . For most of my life I did not like me and addiction was causing me too really hate myself . I spent years in the sea of regret , fear , and guilt attached too me were the chains of addiction . I was beginning too sink and I did not care anymore ! It is one thing too believe in God but it is useless to live life without God calling the shots . That is why steps one thru three are a must if your tired of being sick and life is way too heavy . God will pick you up ,carry you , protect you , and guide you , but you have to give in , give up , and give Him all of you !
Job 11:13-15
Surrender your heart to God, turn to him in prayer,and give up your sins—even those you do in secret.Then you won’t be ashamed;you will be confident and fearless.
He who trusts in his own heart is a fool,
But whoever walks wisely will be delivered.
STEP 3 Made a decision to turn our will and our lives over to the care of God as we understood Him.
What do we do if we were never taught to depend on God . Sure I went to catholic school where I spent eight years following impossible rules and useless dead traditions that we performed lifelessly year after year . Growing up , I learned too survive by trusting my gut ! My world was built on the here and now ,too get what I wanted whenever I wanted it . After time as I got older and colder I began too realize life was wearing me down and , I was tired of running ducking and dodging all the trouble . My self medicating ways were taking a heavy toll and life was getting pretty useless and I was getting tired of me . For most of my life I did not like me and addiction was causing me too really hate myself . I spent years in the sea of regret , fear , and guilt attached too me were the chains of addiction . I was beginning too sink and I did not care anymore ! It is one thing too believe in God but it is useless to live life without God calling the shots . That is why steps one thru three are a must if your tired of being sick and life is way too heavy . God will pick you up ,carry you , protect you , and guide you , but you have to give in , give up , and give Him all of you !
Job 11:13-15
Surrender your heart to God, turn to him in prayer,and give up your sins—even those you do in secret.Then you won’t be ashamed;you will be confident and fearless.
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