Monday, October 6, 2014




Daily Quote

"Every thought you have makes up some segment of the world you see. It is with your thoughts, then, that we must work, if your perception of the world is to be changed." - "A Course In Miracles"


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Sunday, October 5, 2014

October 5 Chp 51 v 17 TWELVE STEPPING WITH STRENGTH FROM THE PSALM


The sacrifice you desire is a broken spirit.You will not reject a broken and repentant heart ,O God .


STEP 1 - We admitted we were powerless over our addiction - that our lives had become unmanageable.


I have said it before and I will say it again. Addiction is the By-product of a broken heart and a very hard head . Many of our prayers go unanswered because we are too busy playing God .God cant fix your broken heart and remove the desire to use if your playing his part .In the Psalm God is giving you a promise that you will not be rejected if your step 1 is sincere from a broken heart .Getting the heart broken is one of the easiest things we do to ourselves. Denial and Pride are two of the most common heart breakers in the world. Throw in outside sources such as abusive addictive parents to your mix and you will wind up with a prideful self preserving person with a iron clad impenetrable heart .Surrender and brokenness are Gods key to removing your self medicating ways .The blinders are gonna have to come off and if your not willing to remove them God will do it for you through your foolishness. You are the greatest of all his creations.The gift of life he has freely given you is not to be lived defeated , addicted , and way below your potential. Intelligence is one of the gifts we have been given but your pride has strangled it into submission and left you stuck in self defeating ways. When your down and only then God will pick you back up again ,brush you off dry your tears and put you back together again.


Proverb 4: 23 Keep thy heart with all diligence, for out of it are the issues of life.
By Joseph Dickerson

Miley Cyrus' ‘Dirty Hippie’ Art Show Featured Illegal Drugs
The pop singer's display featured a bead-covered bong and tabs of LSD.

Miley's "art". Photo via



10/03/14





Miley Cyrus’ “Dirty Hippie” art show that premiered on Sept. 10 in Manhattan during New York Fashion Week was clearly designed to shock. 

During an interview with V Magazine, Miley Cyrus showed a number of the pieces that were part of the show that the magazine described as “a psychedelic jungle.” The question is why so many of the pieces actually include illegal drugs like pharmaceutical pills, tabs of acid, and blunts.

In the interview, Miley Cyrus explained her wild child approach to making art. “During that 4th of July party, I saw this party hat and I thought it might be fun to glue some shit onto it. I just made it for myself to wear. And then someone was like, Oh this is great, you should keep going… [Pointing] There are drugs in that, and then there’s a blunt.” 

As a self-proclaimed pothead and proponent of Molly in her songs, Miley glued some of the drugs to the sculptures. In the show, it was hard to see the specific drugs because they had been painted over and thrown into a chaotic array of stuff from the life of Cyrus. Nevertheless, nobody could mistake the five-foot bong standing proud in a corner as anything other than a five-foot bong.

Cyrus often posts pictures of her colorful artwork on Instagram, and the five-foot bong covered in beads and knick-knacks has been included as well. The premier of the small exhibit took place in conjunction with Jeremy Scott’s fashion show at the height of Fashion Week. The show can still be seen as it remains on display at the V Magazine office’s gallery in New York City.

Although Cyrus has claimed the show proves that she is more than just some “pop dumb dumb,” there is an argument to be made that including drugs in a show that will be seen by many of her underage fans is a stupid choice. Although the therapeutic impact of the work is undeniable, is it necessary for Cyrus to take such artistic therapy to the point of being a dangerous influence?


The Legal Status of a Criminal Confession in AA
AA encourages members to admit their wrongs, past and present. But are the rooms of recovery as sacred as a church's confessional booth?

Shutterstock



09/30/14





When Paul Cox joined AA he never drank again. 

But working the steps dredged up old memories and by the time he reached his fourth and fifth, the nightmares began. He was shocked at visions too heinous to consider. And he pushed them aside for a time, but the haunting dreams continued until, in a tearful confession, he spilled it all to his girlfriend, also in AA. What followed was a series of confessions, first to his AA sponsor who asked, according to court documents, “What’s the matter? How bad could it be, you didn’t murder anyone did you?” 

The thing is, Cox was pretty certain he had because his nightly apparitions revealed pieces of an alcohol-induced black-out from a much earlier time. As Cox shadowed his own deeds he became more certain, watching frequent re-runs of his crime: The brutal stabbing of a sleeping man and woman in his childhood home. 

So his sponsor sought the counsel of a more seasoned AA member, who also sought the counsel of yet another. And each time, they said, “Don’t drink, go to meetings and don’t tell anyone.” But the confessions continued until the circle grew to seven. It was his girlfriend who eventually outed him, tipping off the cops to what he had done. That led to the interrogation of the remaining confessors, and along with a matching fingerprint from the scene, they had enough to charge Cox with second degree murder. 

The legal battle that ensued shed new light on issues of anonymity and AA confessions. A ping pong between courts had lawyers bantering about such things as cleric-penitent privilege (confessions made in private to a member of the clergy) and how it did or did not apply to Alcoholics Anonymous. In the first trial, the jury was unable to reach a verdict, and a mistrial was declared. A second trial found Cox guilty of manslaughter. But on appeal, Federal Judge Charles Brieant overturned the conviction, and in an unprecedented ruling said that AA was a religious organization, and a confession made to a member could not be used as evidence. A third appeal overturned Judge Brieant’s decision and Cox was again convicted.

So what about all those budding AA neophytes diligently working the steps and preparing to admit to God, themselves and another human being the exact nature of their wrongs? How can they be pushed to confess and then convicted if the deeds are too heinous or in conflict with the confessor’s morals? Some say Step Five is the path to freedom, or is that freedom dependent on the exact nature of the wrongs? Perhaps the real issue is that anonymity is not sacred and a sponsor cannot absolve the penitent of their sins. “The problem with telling people in a meeting, you are subject to the values and mores of those in the group,” says H. Westley Clark, MD, SAMSHA’s director of the Center for Substance Abuse Treatment. “AA cannot pressure a confession and then assure anonymity exists, it is a mischaracterization to offer anonymity…anonymity is not inviolate.” 

Consider the fate of Jamie Kellam Letson who confessed that she killed her college friend with two bullets to the head 30 years earlier. Letson’s sponsor guided her to write a letter to her dead friend and then drove her to the cemetery to read it. That was before the sponsor turned her in and used the letter as evidence. Or Bob Ryder’s AA confession that he had a dead body in his basement that was starting to smell? His sponsor suggested pouring baking soda on the decomposing woman before turning him into authorities two weeks later.

And such confessions of guilt are not limited to the hallowed halls of AA. Back in 1998, more than 200 members of the online support group, Moderation Management, were witness to the online drunken confession of Larry Froisted who admitted to being “wickedly” drunk, purposely setting his house on fire and killing his five year-old daughter, Amanda. Of the 200, only three reported the confession to police. Froisted was later arrested and convicted of his crime.

Crimes committed while drinking and drugging are still crimes, not merely collateral damage from a substance abusing past. And that may be where the confusion lies for the newly sober. Many experts suggest caution and discretion before disclosing information in an AA meeting or to a sponsor.

“Theoretically, everything that is said in an AA meeting is supposed to be kept confidential by all the other attendees, so there would have to be a breach of the AA code if law enforcement is contacted to report a confession,” says Carole Lieberman, MD, Beverly Hills forensic psychiatrist. “Nonetheless, if an alcoholic patient of mine, who was attending AA meetings, asked if he should confess to a crime at an AA meeting, I would certainly counsel him against it.”

Additionally, Lieberman says she would explore with her patient why he wanted to do so. “Was he feeling guilty about his crime and trying to sabotage himself, so that someone would report it and he would be punished?” she says. “Obviously, this would be a self-destructive means of repenting or making amends. If he committed a serious crime, and wanted to turn himself in, then the best way to do so would be to contact law enforcement in the company of one's attorney.”

Especially in an era of social media and cell phones, caution is advised when discussing things with participants, according to SAMSHA’s Clark. “Sometimes someone can be almost tricked into disclosing and you don’t know the motives of your sponsor,” he says. “There is no ethical surveillance…you need to give pause before disclosing.”

The problem for the newly sober is poor cognitive discernment and according to Dix, NY LCSW Richard Buckman, who has been in recovery for many years, “What happens in early recovery is that you say things you shouldn’t say,” he says. “That’s why sponsorship is encouraged.”

According to Buckman, when someone confesses to a crime, members of the group could help them see how to do the right thing. “I know stories of people who have gotten sober and in an effort to live life fully, they turn themselves into authorities.”

So how do 12-step groups build trust under the shadow of possible arrest after a Step Five confession?

“A huge component is trust and feeling safe talking about what they have done,” says Faye S. Taxman, PhD, a university professor in the Criminology, Law and Society Department at George Mason University and director of the Center for Advancing Correctional Excellence at the Washington, DC university. “If it results in negative consequences, they will feel suspicious…If arrests become more prevalent it undermines communities for self-help.”

AA was founded on spiritual principles of anonymity and disclosure. Interestingly however, AA literature defines anonymity at the personal level: anonymity provides protection for all members from identification as alcoholics. The Understanding Anonymity pamphlet never mentions safety from disclosure of a crime. 

In Cox’s situation, his confessions were to appease his gnawing guilt and on appeal the court ruled that his discussions were not to seek spiritual guidance, many occurred outside AA and were therefore not protected. 

William Nottingham Beebe perhaps wishes he had stopped at Step Eight (make a list of those we have harmed). His Step Nine, a letter apologizing to the woman he raped at a UVA fraternity house more than 20 years earlier, led to his arrest in Las Vegas. Much like Cox, Beebe admits he had spoken over the years to his sponsor and other AA members about the incident and it appears he had no intention of serving time for his crime. The letter, to many, seemed merely a way to advance his recovery, appease guilt, and justify his actions as alcohol-related. The problem was, the letter re-opened wounds for Liz Seccuro, his victim, and she decided to press charges. 

In her victim statement Seccuro wrote: "I recognize he has 'turned his ship around,' but that does not mitigate the need for punishment. In his apology, he was grasping at moral absolution so he could move on with his life. He wanted a blank check, a clean slate."

And according to USA Today, Prosecutor Charles Worrell said that Beebe's “decision to apologize was selfish--a decision that traumatized Seccuro all over again. The genesis of AA and the use of step nine in this particular instance was a way for Mr. Beebe to deal with the demons he had within himself." 

Such confessions can reinjure victims and can cause problems for those hearing the confession. Sometimes it is too difficult for the individual to hear. Buckman explains that vicarious traumatization can occur. And what that means is that the person hearing it can be impacted emotionally.

He says the best thing for sponsors is to guide the newly sober into using caution before disclosing. “It is not in their best interest to confess to a crime in that setting,” he says. “It’s best to reserve that for someone with a great deal of experience or a clergy member…it’s best to have the guidance of a mentor with experience.”

There are many in AA who believe a healthy, solid recovery means making amends even if that means going to jail for past crimes. “Imagine a scenario where someone confesses and the community helps the person recognize his or her responsibility to do the right thing, like turning themselves in,” says Taxman. “The process of recovery is taking ownership of what was done. They need accountability. I think we as a society need these types of community-based groups to help us deal with our problems.”

Taxman continues. “Keeping the trust is extremely important. The arrests sends a poor message to the community and they become suspicious of baring their soul in a meeting. The most important part for self-help communities is to realize they have responsibility and sometimes it is legal.”

Neil Kaltenecker Campbell, the executive director of the Georgia Council on Substance Abuse and a Faces & Voices of Recovery board member, who is also in recovery, says an important question when considering such things, is what will keep someone sober? 

“You have to own up to your past and take responsibility for saying what you did in your addiction,” she says. “Recovery is about personal responsibility.”

Kathleen Phalen Tomaselli has written for the Washington Post, the LA Times, USA Today and American Medical News, among other publications. She last wrote about gambling in high placesand the state of addiction funding research.


Keeping It Up in the Porn Industry
To make it in the porn industry, male performers juice up on ED meds. Many end up dependent on them—and some end up in the emergency room.

Shutterstock



09/30/14





About a year ago, Danny Wylde wound up in the emergency room with a large needle sticking out of his erect penis. That wasn’t the problem; it was the treatment. 

After taking 80 milligrams of the erectile dysfunction drug Cialis—four times the recommended daily maximum—the 28-year-old porn performer had developed the erection to end all other erections, or rather, the erection that justwould not end. By the time he took himself to the emergency room, this pharmaceutically-assisted boner had been raging for more than 12 hours straight. If it continued, he risked doing permanent damage to his penile tissue, even losing his career-defining member entirely. The doctors had only one solution: Using a syringe to drain the blood from his penis.


Performing in porn is like being a professional athlete, an occupation now widely linked with drug abuse

Over his eight years in the adult industry, Wylde had routinely used Cialis and occasionally dabbled in the injectible erectile-dysfunction drug Bimix, which is shot directly into the penis. This was the third time it had landed him in the hospital—but this time was different. The ER doctor told him that unless he stopped abusing erectile dysfunction drugs, he might lose the ability to get an erection. “That's when I kind of freaked out,” said Wylde. “I'm not gonna give [sex] up at age 28 so that I can do porn for a couple more years.” He retired from performing the very next day.

It was a devastating decision. “That had been my career for eight years. This was my job, my means of income, my identity—all of that just fell apart overnight,” he says “It was earth-shattering.” You might wonder: Why not continue in porn, only without the pharmaceutical help? Impossible, says Wylde. “Prior to taking the drugs, I failed scenes,” he said. “I would not be able to do it.” 

(Studies have shown that regular usage of Cialis and Viagra by young men in the general populace may lead to psychological dependency on EDs along with the thwarting of normal sexual functionality, which itself increases dependency. ED drug usage in the porn industry far exceeds the public average among young men.)

Wylde’s story might sound extreme, but the off-label use of these prescription drugs is a norm in the adult industry. “I’m aware of two male performers who I actually believe don't take them,” said Wylde. “Everyone else I'm pretty sure does. I would say most people take them every scene.” Sometimes they’re supplied on set by producers or directors. In fact, in 2012 a stagehand sued Adult Entertainment Broadcast Network, alleging that he was forced to inject Trimix into performers’ penises, despite his objection to administering the drugs to men without prescriptions.

Several of the adult industry insiders that I spoke with said ED drugs, especially injectables, are more out in the open on gay porn shoots, partly because of the constant flow of inexperienced male talent and so-called “gay-for-pay” performers in need of assistance becoming aroused. “On straight porn sets, guys try to hide it a little more because of machismo, or they think some girls are uncomfortable with seeing it and knowing a guy has a medicated erection,” says Wylde.

At the start of his career, before he ever touched ED drugs, Wylde tried to perform without a little help. “I was unable to get an erection for more than, like, 30 seconds at a time,” he said. “So we had to cancel the scene.” Then he was introduced to a doctor who gave him samples of Viagra, Cialis and Levitra. I spoke with another male performer, who wished to remain anonymous, who told me about a doctor in so-called Porn Valley who is known for providing ED prescriptions to adult performers. (Unsurprisingly, this doctor did not respond to requests for comment.) Of course, counterfeit, illegal versions of these drugs are available online without a prescription.

Despite the prevalence of ED drugs in the industry, few performers are willing to talk openly about it. When I asked a popular male performer who asked to not be identified whether he’d ever seen other guys on-set taking these drugs, he said, “Male performers are not gonna take ED stuff around other male performers, you should know that. What guy wants to admit that he isn't a naturally sexual stallion?” As for his own regimen, he says, “I generally take half a Viagra if I have two scenes in a day as a little booster. The phrase is, ‘It can't hurt you it can only help you.’”

Well, except that it sometimes does hurt when abused. A few years ago, award-winning porn director Axel Braun had to send a popular male performer to the hospital. They had wrapped a sex scene a few hours earlier and were waiting to shoot some dialogue when Braun noticed the star still had an erection. “He was pasty white and his 12-inch penis was bursting through his pants.” The performer’s erection persisted for six hours. It turned out he had used the injectable Caverject and ended up having the blood drained from his penis at the hospital. “There are only a handful of guys in the whole industry who don't use ED drugs and still can perform at a high level,” says Braun.

What happened to both Braun’s performer and Wylde is called priapism. Dr. Richard Lee, a urologist at the Iris Cantor Men's Health Center, says, “Imagine a tourniquet around your finger. If you’ve got a tourniquet around your finger for a long time, you’re gonna cause damage to the tissues of the finger. So if you’ve got repeated episodes of priapism, then, yeah, you’re gonna have an issue.” But he says that the general class of erectile dysfunction medications is “relatively safe” and that if used properly, “You should be able to use them indefinitely."

But male porn stars’ use of these drugs is by definition not-as-directed, because most don’t have erectile dysfunction to begin with. What’s more, the pressures of professional sex can be conducive to overuse. A whole lot is riding on their erections, as porn director Joanna Angel points out. “Literally an entire 50K-worth of production could all be ruined if your penis can't get hard,” she says. “If they can't perform, it's not just going to ruin their day, it's going to ruin everyone's day on set.” Not only do male performers have to be able to get an erection, they sometimes have to maintain it, or summon it off and on, over the course of three hours, she says.

Wylde says there’s nothing natural about what’s required of male performers. “If your sole job is to have an erection and get it done quickly so that everyone can get home on time,” he said, “you need to be a machine” —or a medicated human. In that sense, performing in porn is like being a professional athlete, an occupation now widely linked with drug abuse. “Look at UFC, football, basketball. Look at weight lifting,” he says. “Nobody is natural. All of that is a result of steroids and performance enhancing drugs.” The truth, he says, is that without the help of ED drugs “you're just going to be horrible at it—unless you're a mutant.”

Beyond just the endurance required, there is the occasional unsexiness of the sex. “I just don't think most men have an experience where basically you meet somebody and you're supposed to engage in some sexual encounter with them without perhaps having any attraction to that person and perhaps without that person having any interest in you,” he says.

It’s uncommon to become physically addicted to ED drugs, says Dr. Lee, but Wylde is convinced that he was at least psychologically dependent. His push-pull relationship to the drugs certainly relates to that of addiction. He used Bimix for a couple months and then ended up in the hospital the first time, which led him to stop for several years. But then he says, “I used it on several occasions during times where I just felt stressed out in my life and was having a hard time doing my job,” he said. “I went back to it and then I would have these really lengthy erections after work and it scared me and I would try to stop and would, usually for months to a year, and then at the end, the last year or two I was basically just using Cialis, but more frequently and using more of them per scene.”

Now, a year after that fateful hospital trip, Wylde is in some ways glad it happened, because it pushed him into editing and production work. It also revitalized his sex life. “I luckily had a partner who stayed with me through that process and kind of rekindled my sexual experience outside of using those drugs,” he says. “Now things are great. All is in working order, which is nice.” Despite his experience, Wylde has no hard feelings toward the industry, which he now works in behind the scenes. “People have asked me if I think it's a problem, am I against using ED drugs? My answer is not really. The reason is, I don't think that most people should get into porn to be honest. It’s not what people think.”

Tracy Clark-Flory is a staff writer at Salon and a freelance journalist

The Best Treatment for Alcohol Use Disorder Your Addiction Counselor Isn’t Telling You
Pharmacological solutions for alcohol use disorder are often met with disdain, despite clinical studies supporting them as the most effective solutions by far.

Shutterstock



09/29/14





Between the Harms Reduction community, the SMART Recovery® community, and Alcoholics Anonymous, pharmacology as a solution for alcohol use disorder is not viewed in a very positive light. Harms Reduction, by far the most tolerant of pharmacology solutions of any of the recovery movements, is still reluctant to utilize pharmaceutical options until after therapy has proven ineffective. Among these movements, Alcoholics Anonymous is the most intolerant towards medications. In fact, a survey conducted by the Journal of Alcohol Studies in 2000 found that out of a random sample of 277 members, 29% of them were directly pressured by AA members to go off their medication. The study also found that the more frequently Alcoholics Anonymous meetings were attended, the less likely AA members were to view medication as a positive treatment option. 

Even the most modern of recovery movements ignore the benefits of pharmacological treatment due to their philosophical roots. Both Harms Reduction and SMART Recovery® are movements founded by psychologists who have rightfully observed through evidence-based medicine that alcohol use disorder can be treated with therapy alone. In fact, Cognitive-Behavioral Therapy and Motivational Interviewing are both proven to be effective treatments for alcohol use disorder. Relying on these techniques, Harms Reduction and SMART Recovery seem to question why they should use medication at all, when alcohol use disorder can be treated by therapy alone. Many in the psychology and addiction counseling community seem to have drawn the same conclusion.

Alcoholics Anonymous members have an even stranger approach to alcohol addiction treatment. Medical proponents of AA seem to push insistently for a disease concept of alcohol addiction. They are particularly interested in the idea that alcoholism is a genetic/neurological disorder. As a genetic disorder, AA distinguishes between the “real alcoholic” whose disease is incurable and a “hard drinker” who can recover with therapy. AA members use this distinction as comparison for justifying why therapy will not work but AA does. If “real alcoholism” is a genetic or neurological disease, then medical proponents of AA have a clear justification for not offering therapy, or offering therapy secondarily after 12-step therapy, or even in conjunction with 12-step therapy. Ironically, with the conclusion that alcoholism is a medical disease, AA medical proponents do not conclude that medical treatment should follow. Extreme AA proponents would argue that alcoholism is a spiritual disease, not a medical one. This view, of course, is not recognized in any medical literature. Medical professionals who are AA proponents are generally hesitant to espouse the belief that alcoholism is purely a “spiritual disease,” since such a position is not defensible under scientific scrutiny. So medical proponents of AA favor the disease concept of alcoholism; why then do they refuse to offer medical treatment to their patients?

As an epidemiologist, my mission is to determine the best course of action to treat a population. I am personally astounded by the recovery community’s general lack of epidemiological guidance when developing drug and alcohol treatment programs for public health. Oddly enough, drug and alcohol addiction is the one area of medicine in which epidemiologists do not spearhead the public treatment of a medical problem. The efficacy of drug treatment programs in America is low, embarrassingly low. In fact, the (conservatively estimated) $70 billion dollar treatment industry is lucky to demonstrate any efficacy at all. This has been the case since the emergence of the inpatient rehab in the 1980s, and since rehab treatment models have remained static since that time, recovery rates have not improved significantly either. 

In comparison with epidemiological efforts to combat nicotine addiction, these results present a stark contrast. Abstinence rates for nicotine are at an all-time high of 82% in the United States according to the CDC. Epidemiological nicotine addiction treatment has been the only drug program to have significantly impacted drug use in a free society in recorded history. So what do epidemiologists do right that the drug rehabilitation industry is doing wrong? 

The answer is pharmacological assistance in quitting addiction. Let me say it again: Medication is a vital key in helping a population quit addiction. Let’s look at nicotine addiction: it is very widely known and well accepted that nicotine is one of most addictive drugs ever encountered. Faced with such an addictive drug, how is it possible that epidemiologists were able to move the needle in smoking rates? The answer is that they embraced a medical-psycho-social model of recovery. Acomprehensive study from the Western Journal of Medicine in 2002 found that from over 6,000 articles on nicotine cessation, two conclusions emerged. The first was that taking FDA-approved medication for nicotine cessation more than doubled the likelihood of quitting smoking. The second conclusion was that this likelihood was increased even further by coupling anti-smoking medication with evidence-based therapy for behavioral modification. 

Knowing that FDA-approved anti-addiction medication works for smoking, and that anti-addiction medication coupled with therapy works even better, one wonders why the FDA hasn’t approved medication for those with alcohol use disorder? In fact, they have, and these medications are very likely the ones that your counselor or sponsor is not telling you about. In fact, the majority of the rehabs in the United States do not use any of this medication. Neither therapy methods alone nor 12-steps alone work nearly as effectively as therapy plus medication. No study in existence shows therapy or 12-step involvement to be as effective as a combined therapy and medication program. 

So what are these FDA approved medications and how effective are they? The FDA has approved two different medications for use with alcohol use disorder. The first is acamprosate (Campral is the brand name). Acamprosate has been in use since the 1980s for alcohol use disorder treatment in Europe and was accepted by the FDA in 2004. It functions in a number of ways to correct chronic drinking in the brain, but its primary function is to correct initial depression that alcoholics get when they first quit drinking and reduce cravings by inhibiting receptors that alcohol up-regulates. In layman’s terms, it calms the feelings of restlessness, irritability, and discontent that alcoholics experience when they first quit drinking. Acamprosate is meant to be taken daily for the first 12 months of abstinence. 

The second medication is Naltrexone. Naltrexone is an opioid inhibitor that has been FDA approved as a constant low dose (daily intake) or as a supplement prior to drinking. If the goal is abstinence, this drug can serve two purposes. In chronic alcoholics, a constant low dose inhibitor may stop the immediate cravings for alcohol although long term use of daily intake, monthly injections, or implants may actually up-regulate the opioid system resulting in worse relapses after the patient is taken off the medication. Naltrexone is actually best served as an emergency relapse drug. Patients, prior to relapse, have taken this drug and report significantly lower impact of their relapse. In fact, naltrexone works so well to reduce relapse that many alcoholics use it to successfully drink on a regular basis with very few reports of high binge drinking. It is entirely possible that rather than going to AA meetings, the majority of alcoholics in the near future can simply carry a bottle of naltrexone with them for drinking occasions. Until that time, for those who want to be abstinent, naltrexone works as a great emergency relapse drug in combination with acamprosate.

Think of these drugs like asthma medications. Most asthma patients have a daily inhaler and an emergency inhaler. For people suffering from alcohol use disorder, acamprosate is the daily drug and naltrexone is the emergency relapse drug. Any program that does not prepare alcoholics to reduce the impact of relapse is simply unrealistic. Of those attempting life-long abstinence, over 99% will drink at least once within a 20-year period. It is an ethical responsibility of health practitioners to prepare those with alcohol use disorder for this reality and provide information about how to mitigate it when it occurs. 

The combination of acamprosate plus naltrexone and cognitive-behavioral therapy currently shows the highest rates of recovery of any system in clinical trials. This combination has been studied thoroughly over the past decade with abstinence rates reaching higher than 65%. No other program, not Alcoholics Anonymous, nor SMART Recovery®, comes close to achieving these rates of abstinence, yet hardly any treatment program in the country is engaging in this practice. It’s time health practitioners abandon personal preferences and start asking what is optimal for treatment. Engaging in optimal treatment with pharmaceutical and therapy combinations should be the first protocol used by any alcohol rehabilitation program, and only if that fails should alternative or off-label treatments be used. In light of the overwhelming evidence of the combined pharmaceutical and therapy efficacy, the rehabilitation industry’s refusal to use this protocol is puzzling at best. 

Matthew Leichter is a writer based in Baltimore, Maryland. He is a published healthcare statistican and epidemiologist currently pursuing a doctorate in epidemiology from Capella University and has worked as an epidemiologist for Humana, Blue Cross Blue Shield, IMS Health, Cognilytics, and Walgreens. He last wrote about how Obamacare is killing AA and why smart recovery will never replace AA.