Combination Strategy to Treat Alcohol Dependence

New combination of treatments is effective for alcohol dependence

McLean Hospital researchers, along with colleagues from 11 other study sites nationwide, report that the medication naltrexone and up to 20 sessions of alcohol counseling delivered by a behavioral specialist are equally effective treatments for alcohol dependence when delivered with structured medical management in the Journal of the American Medical Association.

Results from the National Institutes of Health-supported Combining Medications and Behavioral Interventions for Alcoholism (COMBINE) study show that patients who received naltrexone, specialized alcohol counseling, or both demonstrated the best drinking outcomes after 16 weeks of outpatient treatment. All patients also received Medical Management, an intervention that consisted of nine brief, structured outpatient sessions provided by a health care professional. Contrary to expectations, the researchers found no effect on drinking of the medication acamprosate and no additive benefit from adding acamprosate to naltrexone.

“This was the largest clinical trial looking at the effectiveness of pharmacologic and behavioral treatments for alcohol dependence ever conducted and the results are promising,” said Roger Weiss, clinical director of the Alcohol and Drug Abuse Treatment Program for McLean Hospital, a Harvard Medical School affiliate. Weiss was also the principal investigator of COMBINE for the McLean study site.

Related: Why Can’t Drug Addicts Quit on Their Own?Methods to Treat Addiction

Hugh Masekela Fighting Against Drug and Alcohol Addiction

photo of jazz musican Hugh Masekela

Masekela’s message for ‘addictive’ SA

One of the biggest names in world music – trumpeter Hugh Masekela – has said the message behind his latest album Time is to help the fight against drug and alcohol addiction in his native South Africa.

Masekela himself is a recovering addict, having gone into rehabilitation six years ago before establishing an organisation to help those with similar problems in his homeland. And he told BBC World Service’s The Ticket programme that he felt a duty to help others suffering from the same problems.

“I myself am a recovering addict and alcoholic. Six years ago I came to England, took up counselling, and learned the psychology of addiction.”

Drug-busting Masekela calls a brave new tune

The project, called the Musicians and Artists Assistance Programme of South Africa (Maapsa), is a partnership between several South African celebrities, including musicians Jabu Khanyile and Family Factory, actress Connie Masilo and talkshow host Felicia Mabuza-Suttle. Masekela said: “This organisation will make South Africans aware that addiction is a dynamite powder-keg. In South Africa, people are often praised for being able to drink a lot. They think drinking is something to be proud of.”

Victor Ntoni, another respected musician, said alcohol and substance abuse among musicians was exacerbated by the increasing exploitation of artists in South Africa.

Mabuza-Suttle, one of the trustees of Maapsa, said that because she came from a background of alcoholism, she knew about the devastating effects of addiction on families.

Hugh Masekela Biography

As the brutality of the Apartheid state increased, Hugh finally left the country with the help of Trevor Huddleston and his friends Yehudi Menuhin and Johnny Dankworth who got him admitted into London’s Guildhall School of music. Miriam Makeba who was already enjoying major success in the USA later helped him with Harry Belafonte, Dizzy Gillepsie and John Mehegan to get admission to the Manhattan school of Music in New York. Hugh finally met Louis Armstrong who had sent the Huddleston Band a trumpet after Huddleston told the trumpet king about the bank he helped start back in South Africa before deportation.

With immense help from Makeba and Belafonte, Hugh eventually began to record, gaining his first breakthrough with “The Americanization of Ooga-Booga” produced by the late Tom Wilson who had been producer of Bob Dylan and Simon & Garfunkel’s debut successes. Stewart Levine his business partner in Chissa Records went on to produce hit records for Hugh on Uni Records, beginning with “Alive and Well at the Whisky” in 1967 and then “”Promise of A Future” which contained the gigantic hit song “Grazing in the Grass” in 1968.

By the beginning of the 1970’s he had attained international fame, selling out all of America’s festivals, auditoriums and top nightclubs. Heeding the call of his African roots, he moved to Guinea, then Liberia and Ghana after recording the historical “ Home is where Music is” with Dudu Pokwana.

photo from Ritmo Artists

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The Discovering Alcoholic

photo of the discovering alcoholic

The Discovering Alcoholic is the blog of a “recovering alcoholic clean and sober without relapse since the fall of 94”

I am a member of a substance abuse task force, hold a recovery class every week at a local methadone clinic, always have at least one or two alcoholics/addicts to which I act as a sponsor, and of course there is TDA. I have found through my efforts of attempting to help others that my own spirituality, confidence, and appreciation of life greatly increases.

The key is to know oneself better, understand what pulls the trigger, and to adapt one’s lifestyle and actions into a preventative maintenance program. And it’s not only about staying sober; When you apply these same lessons and the confidence gained in recovery to other aspects in life (business, relationships, parenting), you cannot but help to feel empowered.

The author does a good job of sharing his journey in daily posts. Here is an example:

These meetings have also been a blessing to my own recovery, but never so much as today. Today was very special, I did not have a great topic, no announcements, in fact I didn’t even speak. This was because today the meeting was not “mine”, it was theirs. A patient (and good friend) led the meeting today and he looks like only one of many that are ready to take up the mantle. So here’s a TDA Salute to a new recovery community and especially to those that have begun to act as beacons in their own right, illuminating the path of recovery for those at sea.

Related: National Alcohol and Drug Addiction Recovery MonthQuitters: USA Alcohol Consumption DecliningPiano Man Rehab

Brett Favre Overcomes Painkiller Addiction

photo of Brett Favre Nov 2006

Brett Favre’s addiction to painkillers (1996)

After the seizure had ended and he had come to his senses, Favre looked into a sea of concerned medical faces and saw Packers associate team physician John Gray. “You’ve just suffered a seizure, Brett,” Gray told him. “People can die from those.” Favre’s heart sank. Upon hearing from doctors in the room that his dependence on painkillers might have contributed to the seizure, he thought, I’ve got to stop the pills, I’ve just got to.

Last season Favre went on such a wild ride with the prescription drug Vicodin, a narcotic-analgesic painkiller, that Tynes feared for his life. He scavenged pills from teammates. At least once he took 13 tablets in a night. But on Tuesday of last week, during his final telephone call before entering the Menninger Clinic, a rehabilitation center in Topeka, Kansas [which moved to Florida in 2003], to treat his dependency (and also to evaluate his occasional heavy drinking), Favre told SI that he hadn’t taken Vicodin since the seizure. “I quit cold turkey,” he said, “and I entered the NFL substance-abuse program voluntarily. I don’t want a pill now, but I want to go into a rehab center because I want to make sure I’m totally clean.

Tynes wiped her eyes. She took a deep breath. She sniffled a few times. “You know,” she said, “he’s changed already. He talks to me again. He takes Brittany and me out. He pays attention to us. A few days ago he hugged me and he thanked me for everything I’ve done, and he said some really nice things to me.”

She wiped her eyes again. “I said, ‘I can’t believe it. The old Brett’s back!'” Time will tell. The true test will start in September.

Time has shown the answer, after struggles for several years, as Brett Favre has continued his amazing NFL career with great success.

Through triumph & tragedy, Deanna and Brett Favre remain a constant

After doctors found severe liver damage in 1996, Brett agreed to enter rehab, and was able to kick his addiction. He and Deanna were married several months later and welcomed daughter Breleigh in 1999, but his problems with substance abuse had not ended. By 1999, Brett had returned to heavy partying, and was abusing alcohol. Deanna contacted a divorce attorney, which helped scare her husband into quitting drinking entirely, according to Deanna.

The 1990s tested their relationship, but Deanna ultimately appreciated that Brett chose to seek help. “He was battling a disease,” she says. “I was trying to support him, and when he started making the right choices by getting the help he needed, that made a difference.”

Life had stabilized for the Favres by 2003: Brett was sober and a Super Bowl-winning icon in Green Bay, and Brittany and Breleigh were healthy and happy. “We were at a good spot in our lives,” Deanna says.

Then, in December 2003, Brett’s father died in a car accident. The following October, Deanna’s 24-year-old brother Casey was killed when his all-terrain vehicle hit a patch of gravel and flipped. Casey had recently overcome his own drug problems, and his girlfriend was eight months pregnant when he died.

In her memoir, Deanna described the loss of her brother as the darkest time in her life, but the darkness would not pass quickly – just days after Casey’s funeral, Deanna was diagnosed with breast cancer at 35.

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National Alcohol and Drug Addiction Recovery Month

September is National Alcohol and Drug Addiction Recovery Month. Voices of recovery, Sissy Napalapalai, Donald Kurth, M.D., Patti Oest:

The Feds sent me to Rehab and I learned of Drug Court and wondered why didn’t the Feds have a program similar to this one??!! My prayers were answered and was offered a chance to be the very first participant in a pilot program called PADI (pronounced just as my name sounds!) Court. This program saved my life and allowed me to be with my children. I started dating my husband, got married, and had another daughter. When my daughter was born, I began thinking about what I wanted to pursue for a career. I did some soul searching, and thought about how the Feds saw something in me worth saving and how I may be able to help others the way I was helped (saved). Whenever I thought about possibly being a substance abuse counselor I felt a passion burn within. I knew that is what I needed to do. I went through an accredited program for drug and alcohol counseling training (DACT).

Related: Center for Substance Abuse TreatmentCalifornia Drug Rehab CentersStudy: Drug Treatment Success Rates in England

Quick Stats on Binge Drinking

From the Center for Disease Control (Aug, 2008):

The National Institute of Alcohol Abuse and Alcoholism defines binge drinking as a pattern of drinking that brings a person’s blood alcohol concentration (BAC) to 0.08 grams percent or above. This typically happens when men consume 5 or more drinks, and when women consume 4 or more drinks, in about 2 hours. Most people who binge drink are not alcohol dependent.

* Approximately 92% of US adults who drink excessively report binge drinking in the past 30 days
* Although college students commonly binge drink, 70% of binge drinking episodes involve adults over age 25
* The rate of binge drinking among men is 2 times the rate of women
* Binge drinkers are 14 times more likely to report alcohol-impaired driving than non-binge drinkers
* About 90% of the alcohol consumed by youth under the age of 21 in the United States is in the form of binge drinks
* About 75% of the alcohol consumed by adults in the United States is in the form of binge drinks
* The proportion of current drinkers that binge is highest in the 18 to 20 year old groups (51%)

Binge drinking is associated with many health problems, including but not limited to

* Unintentional injuries (e.g. car crash, falls, burns, drowning).
* Intentional injuries (e.g. firearm injuries, sexual assault, domestic violence).
* Alcohol poisoning.
* Sexually transmitted diseases.
* Unintended pregnancy.
* Children born with Fetal Alcohol Spectrum Disorders.
* High blood pressure, stroke, and other cardiovascular diseases.
* Liver disease.
* Neurological damage.
* Sexual dysfunction.
* Poor control of diabetes.

Evidence-based interventions to prevent binge drinking and related harms include

* Increasing alcoholic beverage costs and excise taxes.
* Restricting the number of locations that sell alcoholic beverages in a given area.
* Consistent enforcement of laws against underage drinking and alcohol-impaired driving.
* Campus-based strategies to reduce high risk drinking among college students.
* Physician screening, counseling and/or referral for alcohol problems.

Related: Robin Williams Reflects on RehabUSA Alcohol Consumption Declining

Quitters: USA Alcohol Consumption Declining

Quitters: U.S. alcohol consumption declining

Overall alcohol use—particularly consumption of beer—is declining in the US, according to a new study published in the August 2008 issue of The American Journal of Medicine. Researchers examined 50 years of data and found several changes in alcohol intake but no change in alcohol use disorders. Americans are drinking significantly less beer and more wine, while hard liquor use has remained fairly constant. More people now report that they are non-drinkers. People born later in the 20th century drink more moderately than older people. As we age, our individual alcohol consumption goes down.

Writing in the article, Yuqing Zhang, DSc, Boston University School of Medicine, and his co-investigators state, “The findings in this study may be considered encouraging in many ways: the average amount of alcohol has decreased in more recently born cohorts, the percentage of the population exhibiting ‘moderate’ alcohol intake has been increasing steadily, and the percentage reporting ‘heavy’ drinking has decreased over time…

Piano Man Rehab

photo of Billy Joel

Singer Billy Joel spent time at the Betty Ford clinic for alcoholism treatment in 2005.

Billy Joel leaves US rehab clinic

Singer Billy Joel has left a Californian rehabilitation clinic where he was being treated for alcohol abuse. His publicist confirmed that the 55-year-old had now checked out of the Betty Ford clinic, in Rancho Mirage, where he had spent 30 days.

Photo taken on November 14, 2007.

Piano Man Finds Inner Harmony

“I’m just not drinking,” says the Piano Man – who had struggled with a love of bottles of red and bottles of white. “I don’t know if I will never have a glass of wine again for the rest of my life, but right now I am not taking any chances. “There was a time in my life when I was drinking too much, and so I have stopped,”

Related: Piano Man: The Very Best of Billy Joel52nd StreetAging of the Population in RehabThe Stranger

Methods to Treat Addiction

The six steps that are included in many addition treatment programs are: detoxification, diagnosis, cognitive therapy, family therapy, medication and some 12-step type program. WebMD has an article examining Rehab’s Role in Treating Addiction

Experts now agree that addiction is a brain disease with a genetic component, Gordon says. But it’s also affected by behavior. This behavioral component makes addiction comparable to other chronic illnesses such as diabetes and high cholesterol. Medicine has not found a way to “cure” these diseases with a pill or an operation. Instead, they require a lifetime of treatment, coupled with lifetime behavioral changes.

While most addiction treatment programs set abstinence as a goal, a relapse isn’t a reason to give up on a patient as hopeless — just as you wouldn’t give up on a diabetes patient who goes on a sugar binge, says Michael Scott, MD of the Sierra Tucson treatment clinic in Tucson, Ariz. “Addicts have their ups and downs, but you can take that information and work with it to see how to do better,” Scott tells WebMD.

About 50% of patients at Butler Hospital’s programs remain clean and sober for a year after treatment, Gordon says. But many of those who relapse “don’t go into a black hole,” he says. Instead they return to treatment to build on the behavioral skills they learned the first time.

Studies show a connection between treatment success and the “length and intensity of treatment,” says Galusha. That usually means at least three weeks of treatment lasting several hours a day (whether as an inpatient or outpatient), followed by frequent attendance at AA or other group therapy for about a year.

How to find a good clinic? Ask your doctor or friends, suggests Berger. Look for a clinic that is staffed with addiction-certified counselors and medical staff, says Galusha. And look for a clinic with medical staff that can treat the psychiatric problems that so often accompany substance abuse, says Gordon. That usually means access to psychiatrists as well as counselors, he says.

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