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  • Keep your head up – no shame in addiction

    A client come in today for an addiction treatment evaluation. She had so much shame about her drug use that even the relative who brought her in didn’t know what drug she’d been using every day for the last year or so. I told her the same thing I tell all those who ask me for help – it is absolutely up to you to figure out who you feel comfortable telling about your alcohol, drug, gambling, or sex addiction problems. Just keep in mind that being shameful and secretive about your problems can cause addicts in recovery to be secretive when they experience cravings, triggers, and thoughts about using or acting out.

    As hard as it is, disclosing these issues can provide an amazing amount of support while also allowing those close to you to be a real part of your recovery. Importantly, you don’t have to disclose to your significant other, your daughter, or your aunt. You can find an outside support system, either through peer-support groups like the 12-steps or SMART recovery or another group where you feel truly comfortable sharing. Shame will keep you isolated, sharing will help set you free.

    Honesty, trust, and humility, along with the ability to admit that you are not necessarily managing recovery perfectly can actually be seen as strengths, not weaknesses. Try it out.

  • Criminal drug possession – Felony versus misdemeanor

    In all but 13 States in the U.S., drug possession for personal use is still considered a felony punishable by years in prison and hefty fines. This despite the fact that a significant portion of those arrested meet criteria for dependence (addiction) on the drugs they are caught with, and the fact that our own federal drug abuse agencies (The National Institute on Drug Abuse – NIDA) considers addiction to be a medical condition that involves reduced control over the drug use itself. I guess that’s why the federal government also considers possession for personal use as a misdemeanor.

    Drug users don't belong in prisonIn essence these state laws are putting drug users, and especially drug addicts, at risk of being locked up for years, placed on parole, and subject to the endless other barriers to employment and housing, which make it more difficult for these convicted felons to reintegrate into the community. As if fighting drug addiction wasn’t hard enough.

    The question is, would reducing the penalty for drug possession for personal use to a misdemeanor in more states result in increased drug use and crime or would it actually help free up resources being used for incarceration towards more effective strategies for combating the problem?

    California State senator Mark Leno is bringing up a bill for consideration in the state senate (SB1506) that is seeking to do just that – reducing the penalty for possession for personal use of any drug to a misdemeanor. Mind you, this law is not to affect any other drug-related offenses such as drug possession for sale, drug manufacturing, or transportation. What it would do is cap the maximum incarceration length of possession at one year in jail (not more years in prison) as well as cap the maximum community supervision length at 5 years (3 years are commonly assigned for such offenses).

    I know what some of you are saying – drug users know they’re breaking the law and they should be punished for it. Indeed, punishing them for it will make them less likely to use, which will leave them facing no jail time instead of continuously facing single years in jail for reduced drug possession offenses. Besides, if we cut the penalties for drug possession aren’t we being soft on crime? Aren’t we saying that using drugs is okay?

    The problem with that argument is that it assumes that states that have higher penalties for drug possession for personal use have lower rates of crime, drug use, or drug possession arrests. The don’t. Indeed, the 13 states (and D.C.) that already consider drug possession for personal use a misdemeanor have incarceration rates that are no higher, illicit drug use rates that are slightly lower, and addiction treatment admission rates that are on par and even a bit higher than the rates of felony states. Again, that means the states that reduced the penalty for drug possession see less arrests, more people in addiction treatment, and a smaller percentage of their population using such drugs. Interestingly, those results are somewhat similar to the effect complete decriminalization had on drug use, crime, and addiction treatment in Portugal.

    In previous articles we’ve spoken about the stigma of addiction and the barriers people report to entering addiction treatment in the U.S. Aside from cost and lack of information, people usually report that they either don’t want help, think they can handle the problem on their own or are too ashamed to ask for help. We’ve also reported on the ridiculous prison overcrowding problem in California due to the high incarceration rates of drug users. The question of decriminalization has come up many times (see here, here, and here) and the evidence I’ve seen keeps pointing towards the conclusion that reduced penalties get more people into addiction treatment while reducing incarceration rates with no real collateral increased in illicit drug use or crime. When you think about it, since the Harrison Narcotics act of 1914 essentially created the black drug market in the U.S. when it restricted, for the first time, the sale of narcotics, it makes sense that loosening up those restriction would reduce the size of that same black market and with it drug-associated crime.

    I have spent the last 10 years researching the best ways to fight addiction problems and almost everything I’ve seen suggests that treatment and prevention efforts, not long jail or prison sentences, are the best ways to combat the problem. I have seen evidence that very shirt-term incarceration can help certain resistant offenders, but those efforts can easily be applied for misdemeanor and require nothing close to multiple-year sentences. For that reason, I support not only Senator Leno’s SB1506 bill in California, but other efforts around the country to reduce the criminal penalties associated with simple drug possession to get more of the people who need help into addiction treatment and away from jails. It saves us money, it is more humane, and it just makes sense.

    If you want to help Senator Leno pass this bill, contact his office through this link: http://sd03.senate.ca.gov/

     

    Citations/Reading:

    U.S. Census Bureau, 2012 Statistical Abstract, Table 308. Crime Rates by State, 2008 and 2009, and by Type, 2009 (2012).

    Collins et al., (2010). The Cost of Substance Abuse: The Use of Administrative Data to Investigate Treatment Benefits in a Rural Mountain State. Western Criminology Review 11(3), 13-28.

    Gardiner, Urada, and Anglin (2011). Band-Aids and Bullhorns: Why California’s Drug Policy Is Failing and What We Can Do to Fix It. Criminal Justice Policy Review, 23, 108-135.

  • Prescription addiction – still growing

    A recent story in the Associated Press discusses the association between the great increase in prescription painkiller sales in the United States and the increasing rates of prescription addiction and opiate addiction in particular. Increased overdose deaths (more than 15,000 a year by now and the leading cause of accidental deaths in many states) and a slew of new prescription addicts in an increasing number of states including Florida, New York’s Appalachia, New Mexico, Nevada, Utah, and more are making prescription addiction the fastest growing and most alarming epidemic in the country.

    While there are a number of likely explanations at play here, I believe we need to address the following five immediately:

    1. Overdose deaths related to prescription addiction are risingReduce addiction stigma so individuals with newly developed prescription addiction problems feel more comfortable seeking addiction treatment or other help.
    2. Get better at assessing, and intervening, in problematic drug use patterns before they become full fledged addiction.
    3. Find a way to control online prescription sales in order to stem the huge flow of relatively uncontrolled medication, and especially opiate and benzodiazepine, prescriptions.
    4. Educate general practitioners, who are prescribing more and more of these medications, about proper prescription procedures and oversight as well as about prescription addiction issues.
    5. Create a federal prescription monitoring system that will allow us to monitor prescription patterns across state lines to reduce diversion and doctor shopping.
  • Forgetting astrocytes – marijuana, memory, and the brain

    My favorite thing about science are those discoveries that remind us we simply don’t know everything. A recent article by a group of researchers from Canada, China, and France (see original research article in the journal Cell here and a nice summary here) summarizes findings that reveal some surprises about the ways marijuana use affects short term memory.

    Neuroscientists know a good deal about the way we form memories – long-term alterations in the way neurons in certain areas of the brain communicate known as long-term-depression and long-term-potentiation that are controlled, to a large extent, by chemicals (neurotransmitters) called GABA and Glutamate.

    But as usual in human endeavors, we only know to look where we believe we need to. In the case of marijuana and memory, and after this study likely memory formation in general, we always thought that neurons were the sole players in this game. Like our old beliefs about genetics that stated that most of our genetic material is meaningless only to reveal that material to be crucial for gene regulations in a new science known as epigenetics, it seems that neurons are not the only important players in memory.

    The scientists in this recent study were trying to figure out whether GABA or Glutamate were responsible for Marijuana’s (or more precisely THC‘s) effects on memory. To their surprise, they found out it was neither and kept looking, eventually realizing that the real culprits were cells called astrocytes, previously thought to be akin to the brain’s cleaning crew. Apparently, this cleaning crew might also be important for many crucial aspects of our daily functioning… Never assume, right?

    The results of this research will no doubt produce some serious changes in the study of memory research as well as in research on the effects of THC and other drugs on memory – it broadens our search for the factors important in the primary and secondary effects of drugs and drug use, both short- and long-term. It could help us produce drugs with less side effects, find ways to counter undesirable effects of drug use, and develop treatments that specifically interfere with illicit drug use mechanisms. Exciting times.

  • Barriers to Addiction Treatment Entry

    By Dr. Adi Jaffe and Tariq Shaheed

    How annoying is it to be running late for work unable to find your keys, wallet, or coveted smart phone? You check under the bed, between the sofa cushions, and in your useful phone valet, before giving up and calling in late to work (if it’s not your phone you’re missing). You ask your wife, who says she hasn’t seen it, and your child, who thinks it’s under the bed (you’ve looked, it’s not). Finally, giving up, you go to your car, where your phone sits smugly right on the passenger seat. As troubling and frequent as this story might be, it’s nothing compared to the difficult experience of over 20 million Americans who annually look for addiction treatment but don’t find it [2]. So what’s keeping so many Americans out of treatment?

    Internal and external barriers to addiction treatment entry

    Barriers to addiction treatment entry are plentyIn a study done in 2008, researchers surveyed a sample of 518 subjects varying in race and age, to find out about the barriers keeping them out of addiction treatment. [1] The study was conducted in Montgomery County Ohio, was a part of nationally funded “Drug Barrier Reduction” effort lead by the National Institute on Drug Abuse (NIDA). Most participants were using crack (38.4%), heroin (25.1%), marijuana (14.9%), and alcohol (11.2%). The researchers found a number of internal and external barriers that keep drug abusers from getting the help they need. Internal barriers included stigma, depression, personal beliefs, and attitudes about treatment, while external barriers (systematic or environmental circumstances that are out of a person’s control) include time conflicts, addiction treatment accessibility, entry difficulty, and cost of addiction treatment. [1]

    The researchers concluded that both internal and external barriers can be addressed and improved, but that eliminating the external barriers to addiction treatment is most feasible and could substantially decrease the number of untreated addicts in the United States. Since addressing an internal barrier like “believing one can quit at anytime” (accounts for 29.3% untreated Americans) still requires the ability of the substance user to get treatment, it seems that addressing external triggers will be more immediately effective. Just as motivation to find an item such as keys, phone, or wallet is not the only factor in obtaining that item, a substance user with no internal barriers to treatment is still constrained by all those external barriers, and still not in substance abuse treatment.

    The most commonly cited external barriers in the study were:

    1. Time conflicts – being unable to get off work for treatment, household obligations, busy schedules and simply not having time for substance abuse treatment.
    2. Treatment accessibility –  living too far away for treatment, not knowing where to go for treatment, having difficulty getting to and from treatment, and not understanding the addiction treatment options. Subjects reported that being wait-listed for a facility, and having to go through to many steps contributed to deterring them from seeking treatment.
    3. Financial barriers included inability to pay for treatment and being uninsured.

    Some common internal barriers include:

    1. Stigma associated with the label of being call an alcoholic or an addict, or stigma regarding addiction treatment. Thus being unwilling to share problems and ask for help.
    2. Psychological distress such as depression and neuroticism which produces a lack of motivation among substance abuse treatment seekers.
    3. Personal beliefs
      1. Religion- God will remove the addiction at the right time
      2. Denial – User doesn’t believe they are an addict
      3. Doesn’t need treatment – For example 30% of heroin abuser believed they would recover without treatment.

    Although getting substance abusers help is difficult, it starts by understanding the nature of the problem. While one person may not believe they are addicted, another may not understand how sliding scale payment for treatment works. Different individuals may need different helpful resources when it comes to understanding their options.

    Thoughts and limitations regarding the research

    As we pointed out in a recent article, it’s important to know who is participating in addiction research. In this case, the individuals recruited were reporting for substance abuse treatment assessment at a county intake center. This means the clients are likely from relatively low Socioeconomic Status (SES) groups, but also that they are for some reason motivated to find treatment. Those reasons themselves could be internal (decided to make a change) or external (got arrested), but it’s important to know that these findings do not necessarily apply to more affluent, insurance carrying, or addiction treatment uninterested, individuals. We are currently in the process of conducting a more general study to assess needs in that group.

    Also, the time and costs constraints identified by participants can often be overcome by increasing flexibility in searches and by better tailoring the treatment referrals (see our Rehab Finder articles). Costs can be reduced while saving time by looking into outpatient, rather than residential, treatment options. Unfortunately, Americans have been exposed only to the residential treatment model (a la the Dr. Drew and Intervention television shows), but outpatient addiction treatment is effective, costs less, and truly a better fit for many clients (especially those still working, attending school, etc.).

    Finally, not all of the internal beliefs can be written off as unreasonable barriers – indeed, it is likely that most individuals who do not seek official substance abuse treatment, and certainly most of those who never enter official substance abuse treatment, will still recover from their addiction without it. As we pointed out in previous articles (see here, and here), most people who use drugs do recover and many do it with no treatment per se, especially when looking at our biggest substance abuse problem – alcohol. That means that some people termed “in denial” and “not needing treatment” were actually either correct, lucky, or both. Recovery doesn’t have to look like we expect it to, it just has to result in a person who is no longer suffering with addiction.

    A3 Plug (you knew it was coming)

    At A3 we believe information is the key; by dispelling myths about addiction, removing stigma and anonymity, reviewing the latest research in treatment, and finding 21st century solutions to barriers, we hope to reduce the number of untreated. Join us in the fight to educate and treat addiction.

    Citations:

    1. Jiangmin Xua; Richard C. Rappa; Jichuan Wanga; Robert G. Carlsona. (2008) The Multidimensional Structure of External Barriers to Substance Abuse Treatment and Its Invariance Across Gender, Ethnicity, and Age.
    2. An investigation of stigma in individuals receiving treatment for substance abuse

  • Decision-making and alcoholism: what’s the risk?

    By James R. Ashenhurst

    Every day we are faced with decisions to make, both simple and complex: should I buy the bargain brand cereal or do I really want to pay more for those Cheerios? Sometimes, we’re faced with decisions that carry a bit more risk to our health and safety: should I jump out of this plane and skydive like I planned to, or is the risk that something might go wrong too high? In the addiction world, decisions must be made about the risks of buying and using drugs and alcohol: Should I really be driving home from the bar now, risking a DUI? What if the police catch me buying crystal meth?

    People naturally vary in the amount of risk they are generally willing to take. Especially when potential rewards are great, some people will take rather extreme risks, while others are more hesitant. Clearly, the world needs risk-takers to brave the waters with new business ideas, or to risk rejection to gain romance. Risk-taking is by no means a uniformly bad trait. But, when it comes to drug use, how might having a risk-taking personality affect how people choose to use? Understanding how risk-taking relates to drug and alcohol dependence (alcoholism) might help clinicians and addiction treatment centers be more effective by making patients aware of how their own risk-propensity influences their disease.

    The difficult part of answering these questions is deciding how you’re going to figure out exactly how risk-taking a person is. In the past, many researchers used simple self-report questionnaires that boil down to essentially asking participants how risk-taking they think that they are. However, there is a good deal of self-report bias when using these questionnaires; in other words, the accuracy of a person’s answer depends on how self-aware they are and how well they evaluate themselves compared to others (which also requires them to evaluate others objectively). To deal with this problem, Carl Lejuez developed an elegantly simple experimental task that avoids self-report bias: the Balloon Analogue Risk Task [1] (named the BART in honor of The Simpsons, they also made a task called the MRBURNS).

    Balloon analog risk-taking taskIt works like this: you see a balloon on a computer screen and you can press a button to inflate it by a small amount. Every time you inflate it, you get a small amount of money. But, there is always a chance that when you inflate it, the balloon will pop and you’ll loose all the money you’ve accumulated for that balloon. You can also decide to “cash out” at any point and add the money you’ve earned to a guaranteed bank and move on to the next balloon to pump. Participants actually receive the money they’ve banked in the task. So, how far would you go?

    As it turns out, how people behave in this task relates pretty well to how they behave in the world (this is known as external validity); a person who inflates a lot (and probably pops more than a few balloons) is more likely to not wear a seatbelt, practice unsafe sex and, yes, experiment with drugs and drink problematically [1] [2, 3]. Also, a twin study has shown that risk-taking in the BART is heritable in males [4] and I have demonstrated that behavior is heritable in a rat version of the task [5], suggesting that at least some of it is due to nature and some due to nurture. This is good news for medical research, because it means that there is some discoverable biological pathway that determines, in part, how people behave in the BART.

    Still, this preliminary research about the BART and alcohol was gathered from young undergraduates who do not have long histories of alcoholism or drug dependence. Thus, for my research, I wanted to know how older folks who are diagnosably alcoholic might behave in the BART [6]. We invited 158 gracious volunteers from the Los Angeles community (who identified themselves as having problems with alcohol) to the lab and evaluated their dependency severity under the same guidelines used by psychiatrists in the DSM-IV. We also had them play the BART. My prediction was that participants with more severe alcoholism would also tend to be bigger risk-takers.

    To my surprise, everything flipped around. People who were more risk-taking (inflated the balloons bigger) actually had fewer alcoholism symptoms. In other words, the more severe the case of alcoholism, the less risks they would take in the BART. How could this be, and what does this tell us about the role of risk-taking in alcoholism?

    There are several possibilities. For one, it could be the case that while young risk-takers tend to drink problematically, as alcoholism develops, it is actually the problem-drinkers who are more risk-averse who tend to go on into more severe cases of alcoholism. This theory relies on the idea that risk-taking personality is fixed and doesn’t change much in adulthood; it might be a stable trait that influences the developmental course of alcoholism.

    It could be, however, that the trait is not always stable across a lifetime, and experience with alcohol changes one’s risk-taking personality. If we assume instability, it could be either social and/or biological factors that cause the change. Maybe people with more severe alcoholism face more problems in their personal life, and this changes their temperament to be more risk averse. Or, it could be that the continued exposure to a lot of alcohol changes the parts of the brain that evaluate risks and underlie the decision-making process. It is well-known that chronic exposure to alcohol at high levels for long periods of time changes the quantity and subtypes of neurotransmitter receptors in the brain as part of an adaptive process; the brain adjusts itself to tolerate the constant signals it’s getting from alcohol. Thus, it is a reasonable idea that decision-making parts of the brain could change too.

    Lastly, it could also just be an observation that is specific to this task in this population. While the task has been shown to be externally valid in the college-aged sample, we didn’t reassess that here for older alcoholics. We’re talking about people taking small risks to earn relatively small amounts of money by the end of the task. Usually, participants are rewarded with somewhere between $5 to $20, depending on the study.

    What if larger sums of money were at play? Or access to alcohol was at risk? Once a person is an active alcoholic, what feels risky and what’s not might change too. Acknowledging that you have a problem and starting to try to cut down or abstain might feel more risky than continuing as normal. Nevertheless, even if this flip is specific to behavior in a laboratory task, it means that the relationship between risk-taking and alcoholism is not as straightforward as we might expect.

    So, what do you think? In your experience, are the more severely alcoholic people you’ve known not big risk-takers? If you’re an alcoholic in recovery, does it seem like your risk-taking personality changed over time? Hopefully, we’ll get more clues down the line and we’ll be better positioned to say which theory is correct, and this can then help alcoholics in their own pathway to addiction recovery.

     

    1. Lejuez, C.W., et al., Evaluation of a behavioral measure of risk taking: the Balloon Analogue Risk Task (BART). Journal of Experimental Psychology: Applied, 2002. 8(2): p. 75-84.

    2. Fernie, G., et al., Risk-taking but not response inhibition or delay discounting predict alcohol consumption in social drinkers. Drug and Alcohol Dependence, 2010. 112(1-2): p. 54-61.

    3. Lejuez, C.W., et al., Differences in risk-taking propensity across inner-city adolescent ever- and never-smokers. Nicotine Tob Res, 2005. 7(1): p. 71-9.

    4. Anokhin, A.P., et al., Heritability of risk-taking in adolescence: a longitudinal twin study. Twin Research and Human Genetics, 2009. 12(4): p. 366-71.

    5. Ashenhurst, J.R., M. Seaman, and J. David Jentsch, Responding in a Test of Decision-Making Under Risk is Under Moderate Genetic Control in the Rat. Alcoholism: Clinical and Experimental Research, in press.

    6. Ashenhurst, J.R., J.D. Jentsch, and L.A. Ray, Risk-Taking and Alcohol Use Disorders Symptomatology in a Sample of Problem Drinkers. Experimental and Clinical Psychopharmacology, 2011. 19(5): p. 361-70.

     

     

  • Addiction research – Who are we studying?

    I teach a class on the psychology of addiction (Psych 477 at California State University in Long Beach) and as I have been preparing the lectures something has become very clear to me – textbooks patently gloss over important details about the addiction research they cite. One of the most obvious gaps I’ve noticed this semester concerns the population of research subjects most addiction research is conducted on. An example will clarify:

    A student group in my class had to read a study assessing the residual effects of methamphetamine on mood and sleep. They were amazed that no changes in mood were observed and that participants slept a full 6-8 hours the night after being administered meth! Would you have been surprised with these results given that we all have been told that crystal meth improves mood and causes insomnia?

    Would it matter at all if I told you that the participants in the study were current meth abusers who use an average of 4 times every week?

    For anyone not aware of the tainted history of health research in the U.S. (I’m including psychological research in this group), go ahead and read about the Tuskegee Syphilis Experiment and Stanford Prison Experiment (video here). There are other examples including Stanley Milgram‘s obedience studies, and more but as exciting as the discussion of these studies is, it’s time to get back to my main point.

    It is mostly due to the ethically-questionable, psychologically damaging, research above that research institutions are now required to vet proposed research studies using Institutional Review Boards (IRBs) to assure that human participants in studies are consenting to participate of their own free will, are not coerced, and are not suffering undue damage. This is also true of addiction research. Rarely does the public consider this fact however when they are being reported on research relevant to addiction. I know this because the kids in my class never gave it a second thought.

    When reading about addiction research, think about the subjects participating in itNearly all addiction research, especially studies utilizing “hard” drugs like cocaine, meth, opiates, etc., are required to make use of a very limited part of society – drug using individuals with a history of use of the specific drug of interest who are specifically not interested in treatment. Individuals who have never tried the drug or who want to be treated for drug abuse or dependence (addiction) are excluded due to ethical concerns. In most studies, participants can not qualify if they are addicted to drugs other than those being studies (except smoking, for which exceptions are usually made since we’d be able left with no participants otherwise) or have any associated mental health disorders, which are very common among addicted individuals. I would further assert that for at least a substantial portion of these research participants, the term “addicts” may not be appropriate since many addicts would not willingly give up using their favorite substance for a week or two to be replaces with a hospital bed and an experimenter controlled dose of drug or placebo. Taken together, our research subjects are pretty obviously not representative of all drug users, or all addicts, or all anything else. They make up a very specific group – less than perfect, but what we have to work with.

    In some studies that attempt to make a direct comparison between controls (or drug naive participants) and drug users, this is likely less of an issue. This can happen when researchers try to examine brain structure differences, or performance on a specific psychological or physical test. In such cases researchers can at least statistically identify contributions of length of use, method of use, and other relevant data on differences between people who use and those that don’t. There are probably still some serious differences between “true” addicts, recreational users, and semi-chronic users that would be important to understand here, but we can’t so we don’t. But when it comes to assessing mood effects, or indeed any of a number of subjective effects of drugs, drug cravings, and withdrawal, this limitation in the population to be studied is something that often needs to be made explicitly clear to most public consumers of research. Since we can’t assess changes in mood, absorption rate, anxiety, or any other such measure (some exceptions for very low doses in very specific circumstances) among people who are new to the drug, we end up assessing them among people with a lot of experience, but not enough of a problem to want addiction treatment. Again, this should be considered a pretty specific type of drug user in my opinion.

    There are other types of studies – those conducted with abstinent ex-users or addiction treatment intervention studies utilizing addicts who want, or who reported to, treatment on their own or in response to advertisements. While these studies make use of populations that can be considered at least closer to the individuals they are specifically aimed at – assessing the return of  cognitive function after short or long term abstinence or testing a new intervention on those who want treatment – they still bring on limitations that need to be specifically considered.

    An important point – most researchers recognize these issues and make them explicitly part of their research publications, in a specific section called “Limitations” but what seems troubling is that the public doesn’t have any awareness of these issues. So when someone tells you that “they just found out meth doesn’t actually make people lose sleep,” take a second to ask “for who?”

  • Treating alcohol withdrawal with benzodiazepines – Safe if mindful

    Alcohol withdrawal can lead to some pretty horrible side effects

    Contributing co-author: Andrew Chen

    Alcohol withdrawal can be extremely unpleasant (see here for an overview). Symptoms vary from person to person, but most people will experience some negative symptoms of alcohol withdrawal if they try to stop drinking after long term use.

    Mild to moderate symptoms include headache, nausea, vomiting, insomnia, rapid heart rate, abnormal movements, anxiety, depression, and fatigue. Severe symptoms of alcohol withdrawal include hallucinations, fever, and convulsions (known as DT’s or delirium tremens). Most people undergoing alcohol detox do not require hospitalization, but in severe cases, hospitalization may be necessary (1). Since their introduction in the 1960s, benzodiazepines have been the drug of choice for treating severe cases of alcohol withdrawal.

    Benzodiazepines, or benzos for short, are a class of psychoactive drugs that work to slow down the central nervous system by activating GABA receptors. This provides a variety of useful tranquilizing effects. Aside from relieving symptoms of alcohol withdrawal, benzodiazepines are also commonly prescribed to treat insomnia, muscle spasms, involuntary movement disorders, anxiety disorders, and convulsive disorders.

    The most common regimen for treating alcohol withdrawal includes 3 days of long-acting benzodiazepines on a fixed schedule with additional medication available “as needed.” (2)

    The two most commonly prescribed benzos are chlordiazepoxide and diazepam. Chlordiazepoxide (Librium) is preferred for its superior anticonvulsant capabilities while diazepam (Valium) is preferred for its safety against overdose with alcohol. Short-acting benzos like oxazepam and lorazepam are less frequently used for treating alcohol withdrawal (1).

    Compared to other drugs, benzos are the safest and most effective method for treating difficult alcohol withdrawal. However, benzodiazepines do come with their own potential for dependence and abuse. Ironically, symptoms of benzodiazepine withdrawal are quite similar to those of alcohol withdrawal. Tapering off dosage is the best way to prevent serious withdrawal symptoms. To avoid such complications, benzodiazepines are only recommended for short-term treatment of alcohol withdrawal.

    In short

    Benzos can be very useful for helping long terms alcoholics deal with the difficult withdrawal symptoms that can accompany the detox period. Just be mindful so as not to find yourself right back where you started.

    Citations:

    1. Williams, D., McBride, A. (1998) The drug treatment of alcohol withdrawal symptoms: A systematic review. Alcohol & Alcoholism. 33(2), 103-115

    2. Saitz, R., Friedmn, L. S., Mayo-Smith, M.F. (1996) Alcohol withdrawal: a nationwide survey of inpatient treatment practices. 10(9), 479-87

  • A3 Verified – Matrix Institute on Addictions

    A3 is doing its RehabFinder work this month and we have a brand new and exciting addition to our Verification roster – The West Los Angeles clinic of the Matrix Institute on Addictions (they can be reached at 310-935-1322). We’ve already featured one of the amazing founders of Matrix, Ms. Jeanne Obert, but during these past few weeks, we’ve gotten to have a more in depth look under the hood…

    Matrix Institute on Addictions – Research based outpatient treatment

    The Matrix Institute’s treatment protocol, manual, and method, were developed under a grant from the Substance Abuse and Mental Health Services Administration (SAMHSA), which we have mentioned many times in our writing on All About Addiction. Research  using the Matrix Institute manual has shown it to be successful enough that SAMHSA lists it on it National Registry of Evidence-based Programs and Practices (NREPP), a prestigious list of effective treatment approaches.

    The Matrix Institute on AddictionsMatrix Institute is nationally and internationally recognized for its structured, outpatient treatments and research-supported elements and is accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF). The Matrix Institute is also a proud member of the National Association of Addiction Treatment Providers (NAATP). One of the best things about the Matrix Institute addiction treatment program is that they accept almost all insurance carriers and have an amazingly affordable cost of treatment of only $1,900 per month! For a treatment program with such a track record, these are amazing statistics.

    The Matrix Institute and ongoing training and research

    Matrix Institute is absolutely one of the leaders in the field of addiction treatment when it comes to working with researchers to  find new, effective treatments for substance abuse.  Research at Matrix has helped in the development of new treatments that keep patients in treatment longer, and help them have greater success.  Some of the research we have participated in has resulted in new medications for alcohol dependence, (Campral and Revia) and opioid dependence (Suboxone or Buprenorphine).

    Currently, Matrix is working with the National Institute on Drug Abuse (NIDA) to find a medication to help people with methamphetamine dependence.

    The Matrix Model has been developed, refined and evaluated through research over the past 25 years. This is why All About Addiction (A3) is proud to stand together with The Matrix Institute on Addictions in improving the kind of addiction treatment available by making standardized, affordable treatment a reality.

    (Disclosure – Dr. Jaffe is a group facilitator and educator at the Matrix Institute in West Los Angeles)

  • Before we jump to Whitney Houston conclusions

    I’ve had numerous calls from media outlets who want to talk about Whitney Houston and her celebrity drug problem since this past Saturday. It seems as if everyone wants to jump to conclusions that I’m simply not ready to make yet. Given Ms. Houston’s drug abuse history and her involvement with Bobby Brown, it seems as if every aspect of Whitney’s personality is written off as having to do with her addiction.

    Unfortunately, we don’t know what killed Whitney Houston yet. Was it accidental drowning after being drowsy and possibly under the effect of a sedative? Was it a dangerous combination of alcohol and benzodiazepines? Was it an intentional or accidental overdose? Or was it a simple accident in which a tired celebrity, too stressed and too tired, drowned in her bathtub in a fancy hotel?

    The point is that for any professional to begin proclaiming anything specific about Whitney’s death is unprofessional and unbecoming. We, as a society, chase the famous consistently for some vicarious living and pleasure. I hope that at least those among us trained in emotional care-giving can take a step back and wait until it’s appropriate to make any real conclusions. Otherwise, we’re really no better than Entertainment Tonight or a British tabloid, are we?

    When it comes to discussion Whitney Houston’s struggle with drugs, I believe the cat is already out of the bag (and probably out of the cage and yard as well). Still, as I’ve pointed out numerous times in writings, a struggle with addiction does not itself mean any specific outcome. Many, actually most, addicts do recover from their addiction and a whole slew of them recover to full, exciting, and fulfilling lives. Until Saturday evening there was no reason to believe Whitney wasn’t going to join that company.

    So while we ponder the events that led to the loss of one of America’s singing sensation, let’s respect her memory by taking our time and drawing conclusions that are informed, not ill-formed.