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Posts Tagged ‘
alcoholism ’
Introduction
Nineteen million (or eight percent) of Americans could benefit from treatment for “an alcohol problem.” Although 2.4 million people are diagnosed with alcoholism, only 139,000 of them receive treatment with medications.
The most common form of treatment for alcoholism consists of group and/or individual therapy, including community self-help programs. Treatment can often be time consuming. For example, individuals are often encouraged to go to 90 meetings in 90 days or they are involved in structured group therapy three to five days per week at two to three hours per day. Often, people want to know, "Isn’t there a pill that can fix the addiction to alcohol?" Unfortunately, there is not a pill that can cure the addiction, but there are medications that can perhaps make it easier to effectively participate in treatment.
The Food and Drug Administration (FDA) has approved only three drugs in the past 55 years to treat alcoholism. Each of these drugs acts differently in the body to interrupt the addiction process. They are Antabuse, ReVia, and Campral.
For those with an alcohol problem, the oldest medication thought to “cure” the disease is Antabuse (disulfiram). Wyeth-Ayerst Laboratories Division first marketed Antabuse in 1948. This drug causes many unpleasant effects when the individual consumes alcohol, even in small amounts. The effects can range from facial flushing, headache and mild nausea to severe vomiting and increased blood pressure and heart rate.
The expectation is that as a person associates these negative symptoms with drinking, the individual will be less likely to want to drink another time. Usually, the threat of becoming ill after a drink of alcohol will deter most motivated people. However, the effectiveness of the drug depends mostly on the individual’s motivation for remaining abstinent.
While Antabuse will build up in the person’s system those who choose to resume drinking will simply stop taking the medication for a few days prior to consuming alcohol.
Another problem is that people have reported experiencing very mild reactions with the use of mouthwash that has a percentage of alcohol in it, foods with vinegar like salad dressings and ketchup, and certain colognes and aftershave. Your doctor should talk to you about what is best to avoid and what to experiment with in terms of over-the-counter products and medicines.
Antabuse should not be prescribed for people with cirrhosis or other chronic medical conditions, including heart disease or diabetes. Let your doctor make this decision. This drug should also not be prescribed for people over 60 years of age. Severe reactions to Antabuse have included heart attacks, and some cases have even resulted in death.
The FDA approved the use of ReVia (naltrexone) in December 1994 for the treatment of alcoholism. It was initially marketed by DuPont Merck Pharmaceutical company for treating narcotic dependency. ReVia blocks the parts of the brain that experience pleasure from drug/alcohol use.
Studies began to show that when used to assist with treating alcoholism, the drug helped to decrease cravings and relapse when it was used over a period of three to six months. The success of the drug, however, is likely dependent on a person's simultaneous involvement in a structured treatment program that can educate them on addiction, recovery, and relapse prevention behaviors.
The studies on ReVia and alcoholism treatment all occurred in settings that combined psychotherapy and psycho-education with the medication. Therefore, the FDA approved ReVia for alcoholism only as an adjunct to traditional supportive therapy. According to the FDA, “This drug is non-addictive but can cause liver toxicity if prescribed at doses higher than recommended.
ReVia is not recommended for people with active hepatitis and other liver diseases (www.fda.gov).” Side effects include nausea, headache, dizziness, fatigue, and sometimes vomiting and insomnia. This is a daily medication to be taken orally; however, a long-acting injection is being developed.
Campral (acamprosate) is the newest drug approved by the FDA to assist with alcohol abstinence. It was approved in July 2004 for marketing and distribution by Forest Pharmaceuticals, Inc. Though the exact workings of the drug are not understood, it is believed that Campral can restore imbalanced brain chemicals to a normal balance, thereby reducing cravings and thus relapses.
Campral is prescribed once someone has made the decision to remain abstinent and he/she is currently alcohol-free. The medication is most effective when combined with a structured treatment program that can teach relapse prevention skills, or provides social support, such as community self-help groups.
Campral has been used in Europe for over 10 years and has been shown to be useful for individuals with mild to moderate liver problems. Side effects have been reported as diarrhea, fatigue, nausea, gas, and itching. The most common side effect, diarrhea, usually resolves with time.
In all cases, a primary care physician or psychiatrist can prescribe and monitor the medications. Also, in all cases the recommendation is to use medication as a part of a comprehensive plan for treating addiction. The person with an alcohol problem should be willing to participate in some sort of supportive treatment program, ranging from community self-help groups like Alcoholics Anonymous / Narcotics Anonymous, Rational Recovery, etc, to a structured treatment program involving a combination of group and individual therapy and education. Recovering from addiction involves a lifestyle change. The medications can only assist in making the changes easier by reducing cravings and/or drinking behaviors so that you can focus on recovery.
Sources and Recommended Websites:
www.addictionrecoveryguide.org
www.fda.gov
www.medscape.com
www.niaaa.nih.gov
www.nida.nih.gov
Forest Pharmaceuticals, Inc. Campral Brochure. 2005.
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Tags: alcohol, alcoholism, Antabuse, Campral, drawbacks, Laura Buck, medications, resources, ReVia, side effects, therapy
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An Invisible Epidemic
A great deal has been written about alcoholism and drug addiction over the last two decades. However, information regarding prescription drug abuse and addiction only seems to surface when someone famous has a problem, needs treatment, or dies.
Historically, prescription drug addiction has been the most under reported drug abuse problem in the nation according to the National Institute of Drug Abuse. It may also be the least understood. Addiction to and withdrawal from prescription drugs can be more dangerous than other substances because of the insidious nature of these drugs.
Two types of the most commonly abused prescription drugs are opioids and benzodiazepines. Opioids are generally used to control pain. Benzodiazepines, or tranquilizers, are used to manage anxiety. These drugs are prescribed for short-term use such as acute pain and anxiety that is in reaction to a specific event. They may also be prescribed for chronic pain or generalized anxiety.
Prescription drug addiction is no different from alcoholism or an addiction to any other substance. People who suffer from chronic pain are in a very difficult position. Painkillers will relieve their pain. For people who suffer from constant and chronic pain, narcotics may be necessary to allow them to have any quality of life. Unfortunately, they may risk becoming physically and psychologically dependent, and addicted to the medication.
While it is true that the drugs themselves are highly addictive, not everyone who takes painkillers becomes an addict. The statistics of those suffering from chronic pain that become addicted to these drugs are actually pretty low according to the Chronic Pain Advocacy League, a grass roots organization dedicated to helping those who suffer the debilitating effects of chronic pain. However, this is not to say that those who suffer with chronic pain are not at increased risk of prescription drug addiction.
There is a difference between dependence and addiction. Dependence occurs when tolerance builds up and the body needs the drug in order to function. Withdrawal symptoms will begin if the drug is stopped abruptly.
In contrast, when a person turns to the regular use of a drug to satisfy emotional, and psychological needs, they are addicted to that substance. Physical dependence exists as well, but the drug has become a way to cope with (or avoid) all kinds of uncomfortable feelings.
Many prescription drug addicts are initially prescribed the drug for medical reasons. Somewhere along the line, however, the drug begins to take over their lives and becomes more important than anything else. Nothing will stop them from getting their drug of choice.
It may be difficult to understand how someone could let this happen. How could someone who is reasonably intelligent and sophisticated in regards to drug addiction become an addict?
Addiction has nothing to do with intelligence. And addiction to prescription drugs is no different than any other substance abuse problem. Some 12-step recovery program members have described addiction as a disease of the emotions.
Detoxification is a treatment devoted to purging toxins from the body in a medically and psychologically supervised environment. There are many treatment facilities located throughout the country. Many insurance plans cover inpatient detoxification. Some insurance companies will pay for a week, or maybe two. Some health insurance plans may pay for rehabilitation as well. It's important to get help and not to try to get off pills on your own.
Unfortunately, some people may feel that they can't afford to take a week or two out of their lives to spend in a treatment facility to undergo detoxification. The demands of children, a job, school, or other responsibilities may make inpatient treatment seem like a luxury. It is not. It is unquestionably better to leave the routine responsibilities of your life for a week than it is to suffer the inevitable outcome of prolonged drug addiction.
Social workers are involved in quite a few areas regarding treatment. Hospital social workers can help refer an individual to find the right treatment program. Many social workers advocate for their patients. Inpatient detoxification programs tend to have long waiting lists. Therefore, having the help of a social worker intervene on a patient's behalf can make the difference between getting into a program or not.
Many recovering prescription drug addicts become involved in 12-step help programs. Groups like Pills Anonymous can be very helpful and supportive. The meetings can help alleviate some of the guilt and shame through hearing and sharing the similarities of yours and others' experiences. Unfortunately, there are very few Pills Anonymous meetings around the country in comparison to the numbers of Alcoholics Anonymous or Narcotics Anonymous. So many pill addicts go to those meetings in addition to or instead of Pills Anonymous meetings.
Some people struggling with pill addiction will enter therapy at this point in their lives. Therapy can help you find out what emotional need the pills served and what will fill that need now.
Social workers who are licensed in clinical social work, can offer the patient both the insight-oriented perspective as well as the cognitive and behavioral perspective. It is important for the therapist to be aware of the unique stressors each recovering addict must face when going back to the environment that they were active in.
Social workers are uniquely capable of working with these issues since they work with both the internal and external stresses and support systems. Social workers are trained to look at the person in their environment and focus on the psychological, social, economic, and familial aspects of the individual. Social workers are often part of the interdisciplinary treatment teams providing a range of services including individual, family, and group counseling, case management, education, advocacy, and resources referrals.
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The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.
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Tags: addiction, alcoholism, dependence, drugs, help, Patti Geier, prescription, prescription drugs, recovery, social, workers
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My Partner Is Alcoholic. What Can I Do?
Many problem drinkers are unable to admit to this problem. The cry for help may therefore come from someone close who suffers as a result. The cry often comes at a time when he or she is unable to cope any longer with the drinker. As such, the drinker may self-righteously feel they do not have a problem as they had been drinking like this for years. They may resist treatment and often blame others for their problems. Many marriages fail at this point. One spouse can no longer tolerate the alcohol and the alcoholic refuses to take responsibility. This makes treatment of alcoholics extremely difficult.
It is important for people to understand the stages of recovery and that each stage carries challenges that some alcoholics will struggle for a long time to overcome. Five stages of recovery are discussed: precontemplation, contemplation, preparation, action and maintenance.1
In the precontemplation stage, the alcohol problem has not yet been identified let alone accepted by the alcoholic. During this stage, their defences, most notably denial, are strong. They actively reject any notion of alcohol problems and show anger towards anyone suggesting a problem. They reject treatment and may rely on the support of their drinking buddies to affirm that they do not have a problem.
In the contemplation stage, the alcoholic toys with and finally accepts that they have a problem with alcohol. This acceptance can be overwhelming, at times leading to depression and/or anxiety. These intense feelings must be expected and planned for as part of a treatment process.
In the preparation stage, the alcoholic learns what treatment is necessary in order to recover. Depending on the severity, this can include detoxification, inpatient or outpatient counseling and marital and/or family therapy and possibly even prescription medications.
The next stage, action, is when the treatment plan is implemented and activities are undertaken to address the alcoholism. The support of family and sober friends is crucial here as alcoholics learn to defend themselves, not from admitting alcoholism, but from being pulled back towards drinking by former drinking buddies. Also crucial at this stage is developing an understanding of one's own family history that may have contributed to their drinking problems.
The final stage involves relapse prevention and is referred to as maintenance. This stage is life-long. One of the best-known maintenance programs is Alcoholics Anonymous (AA). This program is based upon self-help, group model. Members meet regularly to manage the challenges of sobriety.
Recovery from alcohol starts with clear, blunt information from friends and family, and by trained professionals such as physicians, social workers or psychologists. Some family and even some professionals beat around the bush when confronting an alcoholic. This is music to the alcoholic's ears. Fuzzy messages allow them to maintain their denial. Thus, one must clearly and fully confront the alcoholic. Clear messages leave no wiggle room.
If you think your spouse has a problem with alcohol:
1. Confront him or her forthrightly. If you are concerned for your safety, then do so in the company of a friend or professional.
2. Get help for yourself too. Learn about alcoholism, your role in the recovery process and of the impact on your family's well-being.
3. Recognize that it may take some time if your spouse is in the first stage of recovery. He or she has yet to even acknowledge a problem. This can be an insurmountable challenge for some people.
4. Recognize that alcoholism can pose a risk not only to the alcoholic but also to those around him or her. At all times, make sure children are appropriately supervised and cared for. Alcohol related problems are a major cause for referrals to child protective services.
Lastly, can a therapist help? Yes, but unfortunately, not in all cases. Much will depend on the stage of recovery, the willingness of the alcoholic to change, the social supports available and a good treatment plan.
1. DiClemente, C.C., Bellino, L.E. and Neavins, T.M. Motivation for Change and Alcoholism Treatment. National Institute on Alcohol Abuse and Alcoholism. Alcohol Research and Health .23:2. 1999.
To read more articles by Gary Direnfeld, MSW, RSW, go to www.yoursocialworker.com
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The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.
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Tags: alcoholic, alcoholism, Gary Direnfeld, help, helping, partner, recovery, spouse, stages
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Introduction
Each year, drug and alcohol abuse contributes to the deaths of more than 120,000 Americans. Substance abuse costs taxpayers in excess of $294 billion each year in preventable health care costs, extra law enforcement, auto accidents, crime, and lost productivity.
An estimated 9 percent of the American population was dependent on or an abuser of substances in 2003. Nearly 15 million people were dependent on alcohol (1 in 13); nearly 4 million were addicted to illicit drugs; and 3 million were abusers of both drugs and alcohol.
Males are twice as likely as females to abuse or become dependent on substances except for the population of ages 12 to 17, when the abuse rates are nearly equal. The highest rate of substance abuse is in the age 18 to 25 population.
- Alcoholism lasts a lifetime and cannot be cured. However, it can be treated. A 2001-2002 survey showed that 36 percent of adults with alcohol dependence that began more than one year ago are now in full recovery.
- Alcohol problems are highest among young adults and lowest among adults over age 65.
- Teenagers who start drinking at age 14 or younger greatly increase their chances that they will develop alcohol problems at some point in their lives.
- Use of marijuana, LSD, methamphetamines, anabolic steroids, and cigarettes decreased significantly among high school students from 2003 to 2004, according to a National Institute on Drug Abuse study. However, abuse of inhalants increased for the second year. A single session of repeated inhalant abuse can disrupt heart rhythms and cause death from cardiac arrest or lowered oxygen levels that induce suffocation.
- Abuse of alcohol, heroin, crack cocaine, tranquilizers, and sedatives remained stable among teenagers from 2003 to 2004.
- Among adults, heroine is the substance of choice for 57 percent of substance abusers. Nearly 25 percent of users are dependent on cocaine, and 19 percent are addicted to sedatives.
- Prescription drug abuse is on the rise in the United States, particularly among older adults, teenagers, and women. An estimated 47 million Americans have used prescription drugs nonmedically during their lifetimes, and 15 million have done so in the past year.
- Women are more likely than men to be prescribed abusable prescriptions, particularly narcotics and anti-anxiety drugs. Women are also more likely to become addicted to sedatives, anti-anxiety drugs, and hypnotics.
- An increasing number of patients are treated in hospital emergency rooms and substance abuse treatment centers for nonmedical use of prescription drugs.
- Prescription drugs are often used in combination with other medications, illegal drugs, or alcohol. Reported combinations include potentially life-threatening mixtures of depressants and alcohol.
- The three classes of prescription drugs most commonly abused include narcotic analgesics used to treat pain, depressants for anxiety and sleep disorders, and stimulants.
- Vicodin is the drug of choice among high school seniors and OxyContin is the second most often abused prescription drug. Students who have used one of these drugs for nonmedical purposes are likely to use other drugs as well.
- Drug addiction is treatable with behavioral and medication therapies. Counseling, psychotherapy, support groups, and family therapy are often used. Medications block the effects of drugs and reduce drug cravings and withdrawal symptoms.
- In general, the more treatment given, the better the results. Medication therapies alone are not as effective as when combined with counseling. Likewise, patients who stay in treatment for three months or longer have better outcomes than those who are in treatment for a shorter period of time.
- The best drug treatment programs provide a combination of therapies and services, such as drug education, case management, and counseling.
- In 2003, 3.3 million Americans over age 12 received treatment for drug dependency. More than half participated in a self-help group. Drug abusers find assistance and treatment at rehabilitation facilities, mental health centers, hospitals, private doctor's offices, emergency rooms, and jails.
- Research shows that even the most severely addicted individuals can actively participate in treatment.
Sources:
National Institute on Alcohol Abuse and Alcoholism
National Institute on Drug Abuse
Substance Abuse and Mental Health Services Administration
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Tags: addiction, alcohol, alcoholism, dependency, drug addiction, prescription drugs, treatment, trends
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