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Sunday, October 5, 2014
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.
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.
Philadelphia Decriminalizes It
Those possessing 30 grams or less in the City of Brotherly Love will get nothing more than a $25 fine.
Mayor Nutter signing the bill. Photo via
By Shawn Dwyer
It's official. Philadelphia has become the largest city in the United States to formally decriminalize possession for small amounts of marijuana.
On Wednesday, Mayor Michael Nutter signed legislation that lowers the possession of 30 grams or less of marijuana to a civil offense. Those possessing that amount will be fined $25, while those caught smoking pot in public will pay $100 or be made to perform community service.
But according to police, anyone who is caught selling or distributing weed, in possession of more than 30 grams, or not providing proper identification will still be subject to arrest.
Up to this point, Philadelphia punished all marijuana possessionwith at least a $200 fine, a drug treatment course, and worst of all, an arrest record.
"This comes at a time when many other jurisdictions are re-examining their approach to marijuana law enforcement," the mayor's officetweeted.
The city also announced that it would "teach students to resist all drugs, alcohol & tobacco" through the school district's LifeSkills training program. The mayor also signed an executive order that would provide funds to Community Legal Services to allow former convicts to have their criminal records expunged.
The new law will take effect on Oct. 20. Hopefully the city will next get to work on reforming their draconian seizure laws.
Friday, October 3, 2014
"You can become blind by seeing each day as a similar one. Each day is a different one, each day brings a miracle of its own. It's just a matter of paying attention to this miracle." - Paolo Coehlo
Today's Online Meetings
AA Meeting - 8:00 pm CST: "Big Book Study"
Guest Speaker - 1:00 pm CST: "The Big Book and Mike J"
Copyright 2011 Community of Recovering People LLC
"Do your little bit of good where you are, its those little bits of good put together that overwhelm the world"
Dear Addict's Mom Family,
I would really appreciate it if you would attend The Addict's Mom Live Online Video Meeting Tonight on In the Rooms at 7:00pm EST.
To sign up all you do it go to www.intherooms.com and create an account for f.ree. Then you just sign in tonight around 6:55pm EST and you will see a link to The Addict's Mom Online Meeting. Just Click on the link. You can remain anonymous or not.
I believe this is an important venue for the Addict's Mom and your participation would be greatly appreciated. Our goal is to have as many venues that will have us, so we can increase our members, which will increase our participation and certainly increase our ability to create change. Which is so desperately needed...
Not to repeat myself but honestly our children are dying every day, or being locked up in a cruel and inhumane criminal justice system.
I need your help and participation so we can build upon our relationship with In the Rooms which is one of the most wonderful resources for those whose lives have been touched by addiction.
Honestly I cannot do this myself...I know you got my back...I love you all and want you to know that without your help there would be no Addict's Mom with the deepest appreciation...Barbara
Visit The Addict's Mom at: http://addictsmom.com/?xg_source=msg_mes_network
Survey: People Have More Negative Opinions About Drug Addiction Than Mental Illness
October 2nd, 2014/
A national survey finds Americans are significantly more likely to have a negative attitude about drug addiction than mental illness.
“While drug addiction and mental illness are both chronic, treatable health conditions, the American public is more likely to think of addiction as a moral failing than a medical condition,” said study leader Colleen L. Barry, Ph.D. of the Johns Hopkins Bloomberg School of Public Health. “In recent years, it has become more socially acceptable to talk publicly about one’s struggles with mental illness. But with addiction, the feeling is that the addict is a bad or weak person, especially because much drug use is illegal.”
The survey included a nationally representative sample of 709 participants who were asked about their attitudes toward either mental illness or drug addiction, Newswise reports.
The survey found 22 percent of respondents said they would be willing to work closely on the job with a person with a drug addiction, compared with 62 percent who said they would be willing to work with a person with mental illness. Sixty-four percent said employers should be able to deny employment to people with a drug addiction, compared with 25 percent who said the same about a person with a mental illness. Forty-three percent said they opposed giving people with a drug addiction equivalent health insurance benefits to the public at large, compared with 21 percent who opposed giving the same benefits to people with mental illness.
The findings are published in the journal Psychiatric Services.
“The more shame associated with drug addiction, the less likely we as a community will be in a position to change attitudes and get people the help they need,” study co-author Beth McGinty, Ph.D. said in a news release. “If you can educate the public that these are treatable conditions, we will see higher levels of support for policy changes that benefit people with mental illness and drug addiction.”
Thursday, October 2, 2014
October 2 Chp 33 v 13 v 14 v 15 TWELVE STEPPING WITH STRENGTH FROM THE PSALMS
The lord looks down from Heaven and he sees the whole human race.
From His throne He observes all who live on the earth.
He made their hearts , so He understands everything they do .(Gods Big Book)
STEP 2 - Came to believe that a Power greater than ourselves could restore us to sanity.
God understands everything we do .What a powerful statement ! GOD sees us and is constantly watching over us ! When I was wondering in the wilderness of my various addictions , desperately seeking happiness and fulfillment , my response to this statement would have been that's creepy . Now this statement brings an unexplained peace and comfort .God understands every aspect of your life ! When I was wandering in my wilderness God was watching over me ! All those times I took it right too the edge of a cliff GOD was with me. All those nights I cried myself to sleep GOD was sitting by my bedside . Those nights where I was in a place I should not have been , consumed with fear , I was gonna get caught up in something I would not be able to get out of , God was there . The million times I hit my knees and prayed to God to get me out of this one and I will never do it again . I lied and GOD knew but GOD was with me anyway . Finally everything we do , not some things , everything . GOD is with you every minute of everyday you cant see God or hear GOD if you keep listening and looking to the world for the answer .
Genesis 2:7 Then the Lord God formed the man of dust from the ground and breathed into his nostrils the breath of life, and the man became a living creature. (Gods Big Book)
Wednesday, October 1, 2014
Risk of Opioid Overdose, Addiction Outweighs Benefits in Many Cases: Neurologists
September 30th, 2014/
The risk of death, overdose and addiction from prescription opioids outweighs the benefits in treating headache, chronic low back pain and other non-cancer conditions, according to a new position paper from the American Academy of Neurology.
The doctors’ group says research shows that half of patients who take opioids for at least three months are still on them five years later, HealthDay reports.
“Whereas there is evidence for significant short-term pain relief, there is no substantial evidence for maintenance of pain relief or improved function over long periods of time without incurring serious risk of overdose, dependence, or addiction,” the statement noted.
“More than 100,000 people have died from prescription opioid use since policies changed in the late 1990s to allow much more liberal long-term use,” Dr. Gary Franklin of the University of Washington in Seattle said in an academy news release. “There have been more deaths from prescription opioids in the most vulnerable young to middle-aged groups than from firearms and car accidents,” he added. “Doctors, states, institutions and patients need to work together to stop this epidemic.”
The group advises doctors to consult with a pain management specialist if a patient’s daily opioid dose reaches 80 milligrams to 120 milligrams, especially if the patient isn’t showing a major reduction in pain levels and improvement in physical function. The statement outlines a number of steps doctors can take to prescribe opioids more safely and effectively. These include creating an opioid treatment agreement, screening for current or past drug abuse, screening for depression and using random urine drug screenings.
New Drug and Alcohol Regulations for Railroad Maintenance Workers Delayed
September 30th, 2014/
The Federal Railroad Administration (FDA) has delayed implementing new alcohol and drug regulations for railroad maintenance workers. It is extending the comment period at the request of industry groups, The Hill reports.
Some railroad employees, including engineers, conductors and dispatchers, have long been subject to drug and alcohol regulations. The new rules would expand to include track workers, the article notes. Under the regulations, track workers would be subject to random drug testing. They could be tested before employment, after accidents or in cases in which there is reasonable suspicion of drug use.
“(Track workers) directly affect the safety of railroad operations, because they work on or near railroad tracks, operate on-track or fouling equipment and assist in directing trains through work areas,” the agency wrote.
The delay was requested by American Public Transportation Association, the American Short Line and Regional Railroad Association, the Association of American Railroads and the National Railroad Construction and Maintenance Association. The public comment period has been extended to November 25.
In 2012, a report by the Amtrak Inspector’s office found a growing number of Amtrak employees were testing positive for drugs and alcohol, increasing the risk of a serious railroad accident. The report stated that drug and alcohol use by conductors, mechanics and engineers who operate the trains greatly exceeds the national average for the railroad industry. Amtrak’s signal operators and mechanics tested positive for drugs four times as frequently as those working for other railroads. Cocaine and marijuana are the most frequently used drugs.
The report recommended that Amtrak test a larger percentage of its workers and expand its program for physical observation.
“Expanding Your Recovery Toolkit” Workshop Oct. 21 in Doylestown
Free monthly workshop series for individuals and families with a current or pastdrug/alcohol addiction issue. Next session meets Tuesday, Oct. 21, 7 p.m. to 8:30 p.m. at The Council of Southeast Pennsylvania, Inc., 252 W. Swamp Rd., Unit 12, Doylestown, Pa. Featuring presentation on “Thinking S.M.A.R.T. in Recovery,” with two keynote speakers and group discussion period led by the program’s new facilitators, Billy McFadden and Steve Osborne. Refreshments. To register, call 215-345-6644, ext. 3151 or emailRPetrolawicz@councilsepa.org.