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Rehab: A Comprehensive Guide to Recommended Drug-Alcohol Treatment Centers in the United States. - book reviews

2010-12-13T19:36:00.000-08:00

This book represents the author's personal visits to many chemical dependency treatment centers during a 2-year journey through the 48 contiguous states. It lists 145 centers: 111 are recommended and given detailed descriptions, and the remaining 34 are briefly described in two separate sections. Six of these earned his respect," but are listed separately because they serve women only, and 28 are listed as "honorable mention." The book implies that some centers were visited and not listed, but does not say how many.

Detailed descriptions take four to five pages each (111 centers, 488 pages), and constitute the major section of the book. These descriptions are organized according to a consistent format. Major headings include individual(s) interviewed, brief description, location-accessibility, length of treatment, cost, insurance, residential accommodations, detox unit, age limitations, physical limitations, leaving the premises, gym & recreational program, chapel on premises, treatment, primary therapeutic staff, therapy, relapses, smoking, coffee, food, spacial unit or program for women, AA & NA meetings, family program, aftercare, hospital on premises, admitting hours, key personnel, telephone use, radios/stereos/ cassettes, visitation, author's comments, and rating. Two of these sections are subdivided. Primary therapeutic staff comprises subheadings of patient/therapy staff ratio, percentage of recovering alcoholics/addicts on staff, percentage of counselors certified, psychiatrist or psychologist on staff, and clergy on staff. The therapy section is subdivided into individual therapy and group therapy. Consistent with its heading, the author's comments section contains Hart's opinions and impressions of the facility under discussion; the rating is excellent," very good," or "good." The other sections contain mostly facts about the center's staff, physical facilities and policies.

Facilities listed in the women only and honorable mention categories are each described in one paragraph, emphasizing the author's impressions and opinions.
In the main section of the book, facilities are grouped by states. Forty-one states are represented by at least one treatment center each. States are arranged alphabetically. When a state has more than one center listed, they are arranged alphabetically by name. The honorable mention listings follow the same pattern. The most heavily represented state is California with 18 listings, and Florida is second with 13. Eight states are represented by one center each.

In the introduction, Hart openly acknowledges his perspective as a recovering alcoholic. If he had not, I would still find this viewpoint evident in many of his descriptions. In my view, this perspective adds to the book's value. Recovering people strongly influence the psychosocial climate of most treatment programs.
Hart's introduction also includes a discussion of the criteria he used in deciding whether a facility should be listed. Many of these clearly represent judgment calls, such as love," "simplicity," "inspiration" and "an overall sense of wellness." Other criteria are easier to objectify, such as "solid, tight treatment schedules that emphasized group therapy." Though I found no attempt to quantify any of these criteria, I found this fact more refreshing than troubling for two reasons. First, the writing leaves no doubt about what is opinion and what is fact. Second, the book's mission is not to provide evidence supporting a research hypothesis, but to help people choose treatment programs. To this end, much helpful information is presented quantitatively in the descriptions of the individual centers, such as costs, treatment schedule and staff composition.

Hart is to be commended for including the physical limitations section in which he discusses each center's physical accessibility to people with mobility impairments, and its policies regarding admission of people with severely impaired vision or hearing. Almost a decade after Alcohol Health and Research World devoted an entire issue to the combination of chemical dependencies and other disabilities, I find this matter given less than optimal attention in both the rehabilitation literature and the chemical dependency literature.
The book contains more thorough and useful information about the treatment centers it lists than is offered in most service facility directories with which I am familiar.

In context of my overall favorable impression of this book, I wish to discuss a few remaining concerns. First, large areas of the contiguous 48 states are not represented, and the book offers no suggestions for readers in these areas. I think it would be more useful to these readers if it suggested (a) how to find treatment facilities in one's local area (e.g., offices of the National Council on Alcoholism in most major cities), and (b) how to use the descriptions in the book as a model for evaluating locally available treatment resources.

Second, I wonder how Hart decided which treatment centers to visit. There are many more in the 48 contiguous states than any one person could possibly visit in two years and examine thoroughly enough to provide the descriptions Hart gives for his listed programs. If a particular center in my locality is not in the book, how am I to interpret its absence? Did Hart visit it and find it did not meet his criteria for inclusion? Did he bypass it for a practical reason such as inconvenience to his itinerary?

Third, the data the book provides about treatment facilities can become obsolete very rapidly. Staff turnover, board decisions, and population changes in the surrounding community can all profoundly affect a treatment program. So can the health of one person in a prominent position. Though the book does not say when each listed center was visited, I do not miss this information. The time usually required to bring a book to print offers ample opportunity for even the most recently visited program to undergo important changes. Therefore I recommend that users routinely verify the current status of any information about a treatment facility before making a referral.

These considerations lead me not to criticize the book for omitting information about staff qualifications to serve people with sensory and motor disabilities. When referring a client with a disability, I like to know how well staff understand the implications of the disability, and what attitudes they have toward it. Unless such matters are part of agency policy, they may change and are therefore better left to users' current inquiry than included in a book's descriptive information. A recommendation that users make this inquiry would have strengthened the book.

In sum, I think this book belongs on the desk of any practitioner likely to refer clients for recovery services. Its price is quite modest in comparison with other books of similar size and quality. Considering the prevalence of chemical dependency problems in the U.S. population, I think any human service practitioner should be prepared to make such referrals. Robert G. Hadley, Ph.D., CRC, CIRS, professor emeritus, Rehabilitation Counselor Education Program, California State University, Los Angeles.

Robert G. Hadley "Rehab: A Comprehensive Guide to Recommended Drug-Alcohol Treatment Centers in the United States. - book reviews". Journal of Rehabilitation. FindArticles.com. 16 Aug, 2010. http://findarticles.com/p/articles/mi_m0825/is_n1_v56/ai_8851905/

Drug Abuse and Addiction

2010-12-06T19:36:00.000-08:00

Signs, Symptoms, and Help for Drug Problems and Substance Abuse

Are you struggling with a drug problem that’s spiraled out of control? If so, you may feel isolated, helpless, or ashamed. Or perhaps you’re worried about a friend or family member’s drug use. In either case, you’re not alone. Addiction is a problem that many people face.

The good news is that you or your loved one can get better. There is hope—no matter how bad the substance abuse problem and no matter how powerless you feel. Learning about the nature of addiction—how it develops, what it looks like, and why it has such a powerful hold—will give you a better understanding of the problem and how to deal with it.

Understanding drug addiction

Addiction is a complex disorder characterized by compulsive drug use. People who are addicted feel an overwhelming, uncontrollable need for drugs or alcohol, even in the face of negative consequences. This self-destructive behavior can be hard to understand. Why continue doing something that’s hurting you? Why is it so hard to stop?

The answer lies in the brain. Repeated drug use alters the brain—causing long-lasting changes to the way it looks and functions. These brain changes interfere with your ability to think clearly, exercise good judgment, control your behavior, and feel normal without drugs. These changes are also responsible, in large part, for the drug cravings and compulsion to use that make addiction so powerful.

How addiction develops

The path to drug addiction starts with experimentation. You or your loved one may have tried drugs out of curiosity, because friends were doing it, or in an effort to erase another problem. At first, the substance seems to solve the problem or make life better, so you use the drug more and more.
But as the addiction progresses, getting and using the drug becomes more and more important and your ability to stop using is compromised. What begins as a voluntary choice turns into a physical and psychological need. The good news is that drug addiction is treatable. With treatment and support, you can counteract the disruptive effects of addiction and regain control of your life.

5 Myths about Drug Addiction and Substance Abuse

MYTH 1: Overcoming addiction is a simply a matter of willpower. You can stop using drugs if you really want to. Prolonged exposure to drugs alters the brain in ways that result in powerful cravings and a compulsion to use. These brain changes make it extremely difficult to quit by sheer force of will.
MYTH 2: Addiction is a disease; there’s nothing you can do about it. Most experts agree that addiction is a brain disease, but that doesn’t mean you’re a helpless victim. The brain changes associated with addiction can be treated and reversed through therapy, medication, exercise, and other treatments.
MYTH 3: Addicts have to hit rock bottom before they can get better. Recovery can begin at any point in the addiction process—and the earlier, the better. The longer drug abuse continues, the stronger the addiction becomes and the harder it is to treat. Don’t wait to intervene until the addict has lost it all.
MYTH 4: You can’t force someone into treatment; they have to want help. Treatment doesn’t have to be voluntary to be successful. People who are pressured into treatment by their family, employer, or the legal system are just as likely to benefit as those who choose to enter treatment on their own. As they sober up and their thinking clears, many formerly resistant addicts decide they want to change.
MYTH 5: Treatment didn’t work before, so there’s no point trying again; some cases are hopeless. Recovery from drug addiction is a long process that often involves setbacks. Relapse doesn’t mean that treatment has failed or that you’re a lost cause. Rather, it’s a signal to get back on track, either by going back to treatment or adjusting the treatment approach.

The far-reaching effects of drug abuse and drug addiction

While each drug of abuse produces different physical effects, all abused substances share one thing in common. They hijack the brain’s normal “reward” pathways and alter the areas of the brain responsible for self-control, judgment, emotional regulation, motivation, memory, and learning.
Whether you’re addicted to nicotine, alcohol, heroin, Xanax, speed, or Vicodin, the effect on the brain is the same: an uncontrollable craving to use that is more important than anything else, including family, friends, career, and even your own health and happiness.

Using drugs as an escape: A short-term fix with long-term consequences

Many people use drugs in order to escape physical and emotional discomfort. Maybe you started drinking to numb feelings of depression, smoking pot to deal with stress at home or school, relying on cocaine to boost your energy and confidence, using sleeping pills to cope with panic attacks, or taking prescription painkillers to relieve chronic back pain.
But while drugs might make you feel better in the short-term, attempts to self-medicate ultimately backfire. Instead of treating the underlying problem, drug use simply masks the symptoms. Take the drug away and the problem is still there, whether it be low self-esteem, anxiety, loneliness, or an unhappy family life. Furthermore, prolonged drug use eventually brings its own host of problems, including major disruptions to normal, daily functioning. Unfortunately, the psychological, physical, and social consequences of drug abuse and addiction become worse than the original problem you were trying to cope with or avoid.

Why do some drug users become addicted, while others don’t?

As with many other conditions and diseases, vulnerability to addiction differs from person to person. Your genes, age when you started taking drugs, and family and social environment all play a role in addiction. Risk factors that increase your vulnerability include:

Family history of addiction
Abuse, neglect, or other traumatic experiences in childhood

Mental disorders such as depression and anxiety
Early use of drugs

Signs and symptoms of drug abuse and drug addiction

Although different drugs have different physical effects, the symptoms of addiction are the same no matter the substance. The more drugs begin to affect and control your life, the more likely it is that you’ve crossed the line from drug use to abuse and drug addiction. Unfortunately, when you’re in the middle of it, you may be in denial about the magnitude of the problem or the negative impact it's had on your life. See if you recognize yourself in the following signs and symptoms of substance abuse and addiction. If so, consider talking to someone about your drug use. You’re on a dangerous road, and the sooner you get help, the better.

Common signs and symptoms of drug abuse

You’re neglecting your responsibilities at school, work, or home (e.g. flunking classes, skipping work, neglecting your children) because of your drug use.
You’re using drugs under dangerous conditions or taking risks while high, such as driving while on drugs, using dirty needles, or having unprotected sex.
Your drug use is getting you into legal trouble, such as arrests for disorderly conduct, driving under the influence, or stealing to support a drug habit.
Your drug use is causing problems in your relationships, such as fights with your partner or family members, an unhappy boss, or the loss of old friends.

Common signs and symptoms of drug addiction

You’ve built up a drug tolerance. You need to use more of the drug to experience the same effects you used to with smaller amounts.
You take drugs to avoid or relieve withdrawal symptoms. If you go too long without drugs, you experience symptoms such as nausea, restlessness, insomnia, depression, sweating, shaking, and anxiety.
You’ve lost control over your drug use. You often do drugs or use more than you planned, even though you told yourself you wouldn’t. You may want to stop using, but you feel powerless.
Your life revolves around drug use. You spend a lot of time using and thinking about drugs, figuring out how to get them, and recovering from the drug’s effects.
You’ve abandoned activities you used to enjoy, such as hobbies, sports, and socializing, because of your drug use.
You continue to use drugs, despite knowing it’s hurting you. It’s causing major problems in your life—blackouts, infections, mood swings, depression, paranoia—but you use anyway.

What drugs are most commonly abused and what are the signs and symptoms?

Almost all drugs have the potential for addiction and abuse, from caffeine to prescription medication. However, the majority of non-alcohol related addictions are due to a short list of drugs including sleeping pills, painkillers, cocaine, marijuana, methamphetamine, and heroin.
Click here for a PDF factsheet on the symptoms and effects of commonly abused drugs.

Warning signs that a friend or family member is abusing drugs

Drug abusers often try to conceal their symptoms and downplay their problem. If you’re worried that a friend or family member might be abusing drugs, look for the following warning signs:

Physical warning signs of drug abuse

Bloodshot eyes or pupils that are larger or smaller than usual.
Changes in appetite or sleep patterns. Sudden weight loss or weight gain.
Deterioration of physical appearance and personal grooming habits.
Unusual smells on breath, body, or clothing.
Tremors, slurred speech, or impaired coordination.

Behavioral signs of drug abuse

Drop in attendance and performance at work or school.
Unexplained need for money or financial problems. May borrow or steal to get it.
Engaging in secretive or suspicious behaviors.
Sudden change in friends, favorite hangouts, and hobbies.
Frequently getting into trouble (fights, accidents, illegal activities).

Psychological warning signs of drug abuse

Unexplained change in personality or attitude.
Sudden mood swings, irritability, or angry outbursts.
Periods of unusual hyperactivity, agitation, or giddiness.
Lack of motivation; appears lethargic or “spaced out.”
Appears fearful, anxious, or paranoid, with no reason.

Warning Signs of Teen Drug Use

There are many warning signs of drug use and abuse in teenagers. The challenge for parents is to distinguish between the normal, sometimes volatile, ups and downs of the teen years and the red flags of substance abuse.

Being secretive about friends, possessions, and activities.
New interest in clothing, music, and other items that highlight drug use.
Demanding more privacy; locking doors; avoiding eye contact; sneaking around.
Skipping class; declining grades; suddenly getting into trouble at school.
Missing money, valuables, or prescriptions.
Acting uncharacteristically isolated, withdrawn, or depressed.
Using incense, perfume, or air freshener to hide the smell of smoke or drugs.
Using eyedrops to mask bloodshot eyes or dilated pupils.

Drug addiction and denial

One of the most dangerous effects of drug abuse and addiction is denial. The urge to use is so strong that the mind finds many ways to rationalize the addiction. You may drastically underestimate the quantity of drugs you’re taking, how much it impacts your life, and the level of control you have over your drug use.
Denial is an unconscious defense mechanism. Minimizing and rationalizing the addiction is less scary than admitting that your drug use is dangerously out of control. But the cost of denial can be extremely high—including the loss of important relationships, your job, financial security, and your physical and mental health.

Do you have a substance abuse problem?

Do you feel like you can’t stop, even if you wanted to?
Do you ever feel bad or guilty about your drug use?
Do you need to use drugs to relax or feel better?
Do your friends or family members complain or worry about your drug use?
Do you hide or lie about your drug use?
Have you ever done anything illegal in order to obtain drugs?
Do you spend money on drugs that you really can’t afford?
Do you ever use more than one recreational drug at a time?

If you answered “yes” to one or more of the questions, you may have a drug problem.

Getting help for drug abuse and drug addiction

Finding help and support for drug addiction

Visit Narcotics Anonymous to find a meeting in your area.
Call 1-800-662-HELP to reach a free referral helpline from the Substance Abuse and Mental Health Services Administration.

If you’re ready to admit you have a drug problem, congratulations! Recognizing that you have a problem is the first step on the road to recovery, one that takes tremendous courage and strength.
Facing your addiction without minimizing the problem or making excuses can feel frightening and overwhelming, but recovery is within reach. If you’re ready to make a change and willing to seek help, you can overcome your addiction and build a satisfying, drug-free life for yourself.

Support is essential to addiction recovery

Don’t try to go it alone; it’s all too easy to get discouraged and rationalize “just one more” hit or pill. Whether you choose to go to rehab, rely on self-help programs, get therapy, or take a self-directed treatment approach, support is essential. Recovering from drug addiction is much easier when you have people you can lean on for encouragement, comfort, and guidance.
Support can come from:

family members
close friends
therapists or counselors

other recovering addicts
healthcare providers
people from your faith community

Recovering from drug addiction

Addiction is a complex problem that affects every aspect of your life. Overcoming it requires making major changes to the way you live, deal with problems, and relate to others. It’s not just a matter of willpower or simply wanting to quit. Getting off drugs for good is difficult without treatment and ongoing support. The good news is that there are many tools that can help you on your journey to sobriety.

When a loved one has a drug problem

If you suspect that a friend or family member has a drug problem, here are a few things you can do:

Speak up. Talk to the person about your concerns, and offer your help and support. The earlier addiction is treated, the better. Don’t wait for your loved one to hit bottom! Be prepared for excuses and denial with specific examples of behavior that has you worried.
Take care of yourself. Don’t get so caught up in someone else’s drug problem that you neglect your own needs. Make sure you have people you can talk to and lean on for support. And stay safe. Don’t put yourself in dangerous situations.
Don’t cover for the drug user. Don’t make excuses or try to hide the problem. It’s natural to want to help a loved one in need, but protecting them from the negative consequences of their choices may keep them from getting the help they need.
Avoid self-blame. You can support a person with a substance abuse problem and encourage treatment, but you can’t force an addict to change. You can’t control your loved one’s decisions. Let the person accept responsibility for his or her actions, an essential step along the way to recovery for drug addiction.

Your Very Own Article Directory - Cranking Out Adsense Income Day & Noght

2010-11-29T19:30:00.000-08:00

Stop knocking yourself out to make money the hard way!...…

“At Last! You Can Make Money With Google AdSense…Without Having To Write One Word of Content!”

We Spent Thousands Of Dollars And Over 2 Months Of Our Time Creating A Unique Article Directory Script.

You Can Now Run An Article Submission Site That Gets Other People To Submit Articles,

Which Builds Thousands Of Google AdSense Revenue Generating Pages Without You Lifting A Finger

Plus It Builds You An Email List At The Same Time!

Tuesday 9:12 am
From: Jeremy Burns

Dear Fellow Internet Marketer,

Let’s face it, making money on the internet can be a little bit confusing!

There’s no doubt that Google Adsense is a proven money maker, but getting content pages to put those ads on is probably the most difficult thing for any internet to do.

Frankly, good content is one of the few things you just can’t fake.

Of course, some people will tell you can do fine without lots of new content on your site all the time.
WRONG! Just ask them how much their last Google AdSense check was for. The numbers speak for themselves.

Sure, there are lots of ebooks that will teach you how to become a maestro of AdSense, and there are books on how to get content written…but learning all that information and then trying to get content takes time.—a lot of it.

I mean, you practically have to give up your job and start cranking out content full-time to make it pay off.

Sound at all familiar?

But then I got an idea…

I’ve gotten a ton of requests from people who want to make money with AdSense but who just don’t have time to go chasing down fresh content every day. And I mean a ton. So many, in fact, that it made me think, “How can I automate this process?”

It took time, but I came up with a script that lets you run a site that solicits articles from people, post them, and puts Google ads on every single one of those puppies.

Think about it—if you get 50 people submitting an article to you a day, after 100 days you have 50,000 articles, with Google ads on each one…

We’re Talking Serious Money Here!

But wait, you say, why would people submit articles to your site for free?

Well, it’s pretty simple. Inside all of us is an approval-seeking being who wants to see his or her name in print.

Admit it…don’t you smile just a little bit when you see your name on a nameplate, or a sports roster, or in a letter to the editor?

Everybody wants to be a star.

There’s another aspect of human nature that will make people send you free articles.

When someone’s passionate about something, whether they love it or hate it, they’ll write about it for free just to get it out there where others will see it.

But the biggest reason these people will submit these articles to your new Article Directory site is to be able to add their name and link back to their site at the bottom of every article!

They know these articles will be copied from your article site and used by hundreds or even thousands of other people all the while getting their name and resource box links spread all an out the internet!

So what my script does is take advantage of human nature.

Sounds too good to be true?

Well, it isn’t if you have the right tool.

The best part is while all of this is going on- other people are building your massive site for you, a little bit at a time just like the search engines like it!

The Right (and the Wrong) Way to Get Free Content

Getting people to write jillions of free articles for you sounds great, right? But there’s one other thing to consider—how are you going to keep track of all those people’s work and how are you going to track your AdSense revenue?

You need a back office system.

And that’s just what my script includes.

Included is everything you need to run your own article web site and a fully functional administrative backhand to keep track of all your users, and also functions that would allow you to e-mail all your users as well.
Plus you do not have to be a genius to run this system, the backend is just as easy as adding your content into by typing it into the provided boxes-
You do not need to know a thing about html!

“BUT WAIT—THERE’S MORE!
Here’s What All You Get In The Script”

1. Absolutely everything you need to run your own turnkey article web site.

2. A fully functional administrative backend to keep track of all your users and articles!

3. Easy-to-use functions that let you e-mail all your users.

Finally! A way to quickly and easily make thousands of high content Adsense revenue generation page all while letting others do all the work!

If You have always wanted to be able to quit your day job and break into the Internet Marketing world building high content web sites is a great way to do it! Grab this incredible software now!

You see, instead of compiling everything into a thick book that’ll probably just gather dust on your shelf we’ve put everything in an electronic reference work that you can quickly and easily search for exactly what you need.

How to Add Google Advertisements (AdSense) to Your Website Using Dreamweaver

2010-11-22T19:30:00.000-08:00

6 Easy Steps to Earning from Your Website

by Christopher Heng, thesitewizard.com
If you use Adobe Dreamweaver, a well-known What-You-See-Is-What-You-Get (WYSIWYG) web editor, to create your website, adding Google advertisements, or AdSense, to your site is simple. This tutorial takes you through the steps of getting the ads onto your website.

Preliminary Matters

Creating a Website
This article assumes that you already have an existing website. If this is not true, please read the Beginner's A-Z Guide on How to Start Your Own Website. That article takes you through all the steps necessary to get your website started, and points you to my Dreamweaver tutorial so that you can design your website.
Signing Up for a Google AdSense Account
You should also have signed up for an AdSense account. If not, and you want to have an overview of the entire procedure, read my article How to Add Google Advertisements to Your Blog or Website.

Steps to Inserting Google Ads on Your Website

Log into your AdSense account and click "AdSense Setup". A new page will load. Click "AdSense for Content". You will be taken through a series of steps that lets you choose the type of advert you want for your site, as well as customize its size and colours. This is necessary because everyone's site looks different, and you will want to change the ad to suit your site's design.
When you are through customising your advertisement to your satisfaction, click "Submit and Get Code". You will be given a snippet of code to insert into your web page. Click somewhere inside the box with this code. The code will automatically be selected. Then click your right button on your mouse and select "Copy".
Start up Dreamweaver and load the page where you want to insert the ad. Adverts can be inserted anywhere on your web page. Their placement on the page depends entirely on you. Common places where people place ads include the side panel, the top of the page, or even within your page's main content.
Note that there is a trade-off involved in your ad placement. Advertisements that are placed in a prominent position on your web page, such as embedded right in the middle of your content, get better clicks and hence better income. This is because more people actually see those advertisements when they're right under their noses. However, putting ads in this position also puts off some visitors, since they interrupt the flow of reading when they're looking at your site.
Advertisements that are tucked away in obscure places on the web page, such as the placements you see on thesitewizard.com, tend to fare poorly, since most people don't notice them. (If they don't see the ad, they won't realise that it is relevant to them, and therefore they won't click it.) However, such placements makes your website more pleasant to use for your visitors.
After your page is loaded in Dreamweaver, make a space for the advertisement. For example, if you are putting your ad near the top of your page, you may want to create a blank line before the advert and one after it. Then click the exact spot where the advertisement is to appear so that your blinking text cursor will appear in that spot.
Without moving the cursor from that spot, switch to Dreamweaver's Code View by clicking the "View" menu followed by the "Code" item. In the future, I shall refer to this sequence of clicking the menu items as "View | Code".
Dreamweaver now shows you the "raw" HTML code for your web page. You should be able to spot the blinking cursor. Select "Edit | Paste" from the menu. If you remember, this means that you should click the "Edit" menu, and then the "Paste" item on the menu that appears.
The supplied code from Google will appear immediately in your window.
Return to the Design mode in Dreamweaver. To do this, select "View | Design" from the menu. You won't be able to see your advertisement in Dreamweaver. That's normal. If you have completed all the steps mentioned, the code is there. It's just not visible in the web editor. Publish your web page to your site in your usual way.
Now go to the page you've just published using your web browser. Note that this must be your "live" published copy on your website, not the local copy on your own hard disk. Make sure that JavaScript is enabled in your web browser, or you won't be able to see your advertisement. If you don't know what JavaScript is, or you don't know how to "make sure" that it is enabled, it means that it's already enabled.
Don't worry if the advertisement does not show up at first. When the page is first loaded, Google needs to send its AdSense bot (computer program) to grab a copy of your page and "read" its content. That's why your page has to be on your website and not your computer before the advertisement will show. After it has retrieved your page, it will select ads that are relevant to it.
To see your ads if you don't see them the first time you load your page, wait a while, then refresh your browser to force the page to be reloaded. If you have waited long enough (to give the AdSense bot time to get a copy of your page), you should be able to see the advertisement. Remember not to click on your own Google ad! If you don't know why, read my other article on AdSense.

Congratulations

Congratulations. You have successfully added Google AdSense advertisements to your site using Dreamweaver.
Copyright © 2008 by Christopher Heng. All rights reserved.
Get more free tips and articles like this, on web design, promotion, revenue and scripting, from http://www.thesitewizard.com/.

Alcoholism in Four Patients with Fetal Alcohol Syndrome

2010-11-15T19:27:00.000-08:00

Recommentdations for Treatment

Authors: Ann P. Streissguth^a; Abbey Moon-Jordan^b; Sterling K. Clarren^c

Affiliations:	^a Professor, Department of Psychiatry and Behavioral Science, University of Washington, Seattle, WA,
	^b Public Health Social Worker, King County Public Health Department, Seattle, WA,
	^c Professor, Department of Pediatrics, University of Washington, Seattle, WA,

DOI: 10.1300/J020V13N02_08

Publication Frequency: 4 issues per year

Published in: Alcoholism Treatment Quarterly, Volume 13, Issue 2 July 1995 , pages 89 - 103

Formats available: PDF (English)

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Abstract

There are no systematic studies of alcolholism or alcohol abuse in patients with Fetal Alcohol Syndrome (FAS). These case histories illustrate how such patients may present at alcohol treatment vromams, and how failure to recognize their FAS symptomatology can result in inappropriate diagnoses andl managemknt. Awareness of the dual diagnosis of alcoholism and FAS can lead to a more successful treatment outcome.

Comparison of opiate-primary treatment seekers with and without alcohol use disorder

2010-11-08T19:23:00.000-08:00

Abstract

Many persons seeking opiate treatment present with complex clinical challenges, which may be exacerbated by alcohol misuse. This report details secondary data analyses aggregating treatment-seeking samples across 10 National Institute on Drug Abuse (NIDA) Clinical Trials Network treatment trials to examine alcohol-related characteristics of opiate-primary (OP) clients and compare broad pretreatment characteristics of those with and without an alcohol use disorder (AUD). Analysis of this aggregate OP client sample (n = 1,396) indicated that 38% had comorbid AUD and that a history of alcohol treatment episodes and recent alcohol problems were common. Further, comparisons of OP clients with and without AUD revealed the former were more likely to have had a history of pervasive difficulties in psychosocial functioning. Findings suggest the need for detection of and intervention for alcohol misuse at the outset of opiate treatment and support for the practice of availing medical, psychological, case management, and other support services.

a Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA 98105-4631, USA

b Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98105, USA

c Duke Clinical Research Institute, Duke University, Durham, NC 27708, USA

Looking For Natural Alcohol Treatment Centers?

2010-11-01T19:16:00.000-07:00

Alcohol treatment centers exclusively for women are no longer hard to find these days. With more people addicted to alcohol, experts also saw the need for addiction treatment program. This also paves the way for the proliferation of alcohol treatment centers.

Contrary to the past where alcoholism was prevalent among men, women of today are now facing the same problem. This is because alcohol is readily available and is among the most commonly used beverage accepted in our society today.

Let’s face it; alcoholism is indeed a problem that cannot be solved overnight. It is also important to deal with the fact that it has affected people regardless of age, social status and gender. This is why more and more women are also now struggling with this problem.

The good thing is, women who struggling with alcoholism can enter alcohol treatment centers exclusively for them. It is in these treatment centers where they can get addiction treatment programs that are specific and focused on their needs.

Hence, it is really important to choose the right treatment centers to ensure getting the expected result. It would help a lot to choose one that also works toward furthering society’s understanding of prevention, addiction and the healing of alcoholism, and substance abuse especially among women.

Women struggling with alcoholism can have the right addiction treatment program only if they go to the right treatment centers that truly address their needs. Here are some of the alcohol treatment centers exclusively for women:

Aurora Centre – It has been providing addiction treatment services for women for over 30 years. It is located at women’s hospital and health care center in Vancouver, Canada.

Aventa – It is an outpatient and residential base treatment exclusively for women struggling with addictions for gambling, drug, and alcohol. It is located in Calgary, Alberta in Canada.

Tuliffiny – specializing in recovery management for young women with alcohol addiction, it is staffed by well experienced people, the majority of whom have also once struggle with either behavioral or addiction problems. Its program for recovery management instills habits of health and wellness for young women.

Serenity Life Counseling – It caters to both day and evening outpatient treatment programs. It treats the person as a whole using the following approach: vocational and individual counseling and therapy, psychological testing, group sessions, acupuncture and more. It is located in the city of Anaheim.

There are other treatment centers that use nature to provide a sanctuary for transformation. These are only a few of a seemingly endless list of treatment centers for women struggling with alcoholism and other substance abuse. In order to get the right addition treatment program, you need to choose only the best among the many centers.

About The Author-- Go to http://www.tulifinny.com/ for an alcohol treatment center. Regardless of your addiction, you can come to us. In our approach, we adapt a holistic recovery program. We created a program with 4 specific categories. Come to us at Alcohol treatment centers, and find out why our addiction treatment program is effective.

Naltrexone in the Treatment of Alcohol Dependence

2010-10-25T19:08:00.000-07:00

John H. Krystal, M.D., Joyce A. Cramer, B.S., William F. Krol, Ph.D., Gail F. Kirk, M.S. and Robert A. Rosenheck, M.D. for the Veterans Affairs Naltrexone Cooperative Study 425 Group

N Engl J Med 2001; 345:1734-1739

Alcoholism is a devastating medical illness with a profound public health impact.1 In 1995, because of its extensive record for safety when administered for other indications, the Food and Drug Administration (FDA) approved naltrexone, an opioid-receptor antagonist, for the treatment of ethanol dependence, in part on the basis of two well-designed single-site studies.2-4 The initial studies suggested that naltrexone substantially increased sobriety and reduced ethanol consumption when combined with psychosocial treatment.Naltrexone was incorporated into the treatment of alcoholism on the premise that stimulation of the μ opioid receptor contributed to the rewarding effects of alcohol.5-7 Data from clinical trials suggested that naltrexone reduced the rewarding effects of alcohol and contributed to reduced alcohol craving and lower alcohol consumption.8,9 Subsequent studies suggested that naltrexone was less effective for treating alcohol dependence and had more adverse effects than was initially suggested.10-15 We conducted a multicenter, double-blind, placebo-controlled evaluation of the efficacy of naltrexone when administered for 3 or 12 months as an adjunct to standardized psychosocial treatment.

Methods

Protocol

The Human Rights Committees of the Department of Veterans Affairs Cooperative Studies Program and the 15 participating Veterans Affairs medical centers approved this study. All patients provided written informed consent. An independent data and safety monitoring board monitored patient safety.The three treatment groups were as follows: patients in the long-term naltrexone group were treated with naltrexone (ReVia, Dupont Pharma) for 12 months; patients in the short-term naltrexone group were treated with naltrexone for 3 months and then received placebo for 9 months; and patients in the placebo group received placebo for 12 months. During a six-month post-treatment follow-up, we assessed the durability of improvement after the period of randomized treatment. Patients were asked to continue through the 18-month follow-up even if they discontinued the study medication or counseling.Patients were enrolled over a two-year period. Double-blind treatment was initiated within a day of randomization. Patients receiving naltrexone started with 25 mg once daily for 2 days, followed by 50 mg once daily for 3 or 12 months. The short-term naltrexone group was switched in a double-blind fashion to matching placebo when naltrexone was discontinued at the 13-week visit. Patients assigned to placebo received one placebo tablet daily for 12 months. Medication for all groups was discontinued after 12 months.

Enhancement of Compliance

Medication was provided in bottles with caps (MEMS, Aprex, Union City, Calif.) that recorded the date and time of each opening and showed the number of hours that had elapsed since the previous opening. All patients participated in a feedback program designed to enhance compliance with the once-daily medication regimen for 12 months.16 The Medication Usage Skills for Effectiveness monthly feedback system has been demonstrated to enhance compliance among patients with psychiatric disorders by teaching daily cues (e.g., linking doses to a specific time, meal, or daily activity) and reviewing dosing calendars on a computer screen (with data downloaded from the patients' MEMS caps).16,17 Plasma 6-beta-naltrexol was measured in some patients at 13 and 24 weeks.

Counseling

Patients received individual 12-step facilitation counseling18 for 13 months and were encouraged to attend Alcoholics Anonymous meetings. Counseling was aimed at reinforcing abstinence, providing basic relapse-prevention information, promoting acceptance of drug therapy, and reducing attrition. Visits were once weekly for 16 weeks, every 2 weeks during weeks 17 to 36, and once monthly during weeks 37 to 56.

Screening and Eligibility Criteria

We screened veterans 18 years of age or older who had a recent history of drinking to intoxication (heavy drinking two times in at least 1 week in the 30 days before screening) and who had been given a diagnosis of alcohol dependence according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV).19 All patients were outpatients who had been sober for five days before randomization. Specific exclusion criteria included previous use of naltrexone, liver disease, a psychiatric diagnosis other than alcoholism requiring current psychotropic medication, homelessness, other substance abuse or dependence (excluding nicotine or occasional marijuana use), any past illicit opiate use, and marijuana dependence. Patients who had pending legal charges with the potential for incarceration or who received a disability pension related to alcoholism were excluded, to avoid any secondary motive to sustain disability status or legally imposed treatment requirements.Base-line and monthly assessments included a review of drinking,20 medication use, and counseling progress. Compensation ($20) was provided for the time required to complete monthly ratings, including drinking calendars, whether the patient was taking a study medication, attended counseling sessions or Alcoholics Anonymous meetings, or had discontinued participation. Longer interviews at 6, 12, and 18 months were compensated at $50 per session.

Outcomes

Three variables were defined that would allow us to answer the primary questions of the study (at 3 and 12 months): time to relapse during the first 3 months (number of days from randomization until relapse, with relapse defined as the first day of heavy drinking [six or more drinks for men and four or more for women]); the percentage of drinking days over a 12-month period (the number of drinking days reported during that period divided by the number of days for which data were available); and number of drinks per drinking day over a 12-month period (the total number of drinks reported during the period divided by the number of days on which consumption of one or more drinks was reported).Our objectives were to determine whether the short-term (3-month) use of naltrexone, as compared with placebo, decreased drinking (measured by the time to relapse) in alcohol-dependent patients and whether the long-term (12-month) use of naltrexone, as compared with placebo and short-term naltrexone, decreased drinking (measured by the percentage of drinking days and the number of drinks per drinking day).

Statistical Analysis

Data were held and analyzed by the Veterans Affairs Cooperative Studies Program. A two-sided level of significance of 0.0167 for each comparison among groups was needed to produce an overall P value of 0.05 after Bonferroni correction. The sample size of 200 yielded sufficient power for the comparison of the three-month curves for time to the first episode of heavy drinking.The primary analysis was based on the intention to treat. Secondary analyses were planned on the basis of actual treatment or to include only patients who complied with the treatment regimen. The Kaplan–Meier product-limit estimator was used to estimate the time to the three-month outcomes.21 Differences in the proportion of drinking days and numbers of drinks per drinking day were analyzed by the chi-square test and t-test. Analyses of drinking days included only days for which data were available and on which the patient was able to drink (e.g., not incarcerated or hospitalized). Secondary analyses were performed by analysis of covariance and an accelerated failure-time model with the SAS procedure Lifereg.22 Compliance with medication was defined by the percentage of days on which the medication bottle was opened during the period; the covariates for counseling and Alcoholics Anonymous were the numbers of sessions attended during the period.

Results

The study was conducted from April 1997 to October 2000. We screened 3372 alcohol-dependent veterans to assign 627 patients to three groups of 209 patients each (with 30 to 50 patients per site). Base-line characteristics of the patients are shown in Table 1Table 1Base-Line Characteristics of the 627 Patients., and adverse events during treatment in Table 2Table 2Adverse Events Reported More Commonly in the Naltrexone Group Than in the Placebo Group.. There were no significant differences among the groups in any base-line measures (except family history of alcoholism) or follow-up measures of compliance with the protocol (Table 3Table 3Compliance with the Protocol.), including attendance at monthly follow-up visits, duration of compliance with the medication, percentage of days on which medication was taken, attendance at counseling sessions or Alcoholics Anonymous meetings, and adverse events. Overall, 73 percent of the patients completed the trial. The reasons for not completing the trial did not differ significantly among treatment groups: 95 patients were lost to follow-up, 21 withdrew, 14 moved or were unable to return, 12 died, and 28 discontinued participation for other reasons.MEMS monitors showed that 89 percent of the patients took at least some medication for 52 weeks. Plasma 6-beta-naltrexol levels in blood samples obtained from 189 patients at week 13 and 69 patients at week 24 were consistent with MEMS data; they showed that 84 percent of the patients were taking the medication. Complete drinking data were collected from 78 percent of the patients for the first 13 weeks and 52 percent of the patients for 52 weeks. Full or partial 52-week data on drinking were available for 93 percent of the patients.In the first 13 weeks, we obtained data from 378 patients who received naltrexone and 187 patients who received placebo. We found no significant differences in the primary end point of time to relapse. The median time to relapse overall was 135 days. There were also no significant differences between the naltrexone groups and the placebo group in terms of the relapse rate, percentage of drinking days, or number of drinks per drinking day (Table 4Table 4Outcomes of Treatment.). At 52 weeks, there were no significant differences among the three groups in the percentage of drinking days or the number of drinks per drinking day (Table 4).Patients who were more compliant with medication and those who attended more counseling or Alcoholics Anonymous sessions had better outcomes, whether they took naltrexone or placebo (Table 5Table 5Secondary Analyses of Primary End Points.). Analyses of covariance, with one covariate taken at a time, showed that compliance with medication, counseling, and attendance at Alcoholics Anonymous meetings had strong effects on the number of days to relapse that were independent of treatment assignment. Analyses of covariance for the percentage of drinking days, taking one covariate at a time, showed that compliance with medication, counseling, and attendance at Alcoholics Anonymous also had strong effects that were independent of treatment assignment. None of the covariates alone had a significant effect on the number of drinks per drinking day (Table 5). Analyses of the multiple-covariate models found that attendance at counseling sessions and Alcoholics Anonymous meetings had the greatest effect on the percentage of drinking days and that compliance with medication had the greatest effect on the number of drinks per drinking day (Table 5).In post hoc analyses, we examined possible interactions of the primary outcomes with treatment site, disability, psychiatric diagnoses, family history, motivation,23 craving,24 dependence,25 and age at onset of drinking. No interactions were found (data not shown).

Discussion

In this large, multisite study, in which we used the same alcoholism outcome measures that were employed in earlier single-site studies, we did not detect an effect of naltrexone. Relative to placebo, naltrexone did not prevent or delay relapse to heavy drinking, reduce the number of drinking days, or decrease the amount of alcohol consumed during episodes of drinking. Major outcomes were not influenced by the duration of naltrexone administration, the degree of compliance with study medication, participation in counseling sessions, or attendance at Alcoholics Anonymous meetings. Our data do not support the treatment of alcohol dependence with naltrexone combined with a psychosocial treatment program in men with chronic, severe alcohol dependence.Naltrexone is the second medication approved by the FDA for the treatment of alcoholism for which a finding of efficacy has not been replicated in a multicenter, placebo-controlled study. Disulfiram was the other.26 Previous small, single-site studies compared the short-term effects (over 12 weeks) of naltrexone and placebo.2,3 In a systematic review of previous studies, Garbutt et al. concluded that “naltrexone reduces the risk of relapse to heavy drinking and frequency of drinking compared with placebo but does not substantially enhance abstinence, i.e., avoidance of any alcohol consumption.”27 In contrast, we and others12,14 have found no significant differences in favor of short- or long-term naltrexone treatment. Our study was larger than other studies and had longer patient follow-up. Patients who interrupted their treatment were not dropped from the study and could return to treatment, as happens in clinical practice. Although the eligibility criteria stipulated a minimal drinking level, patients with high and low drinking rates at base line were enrolled equally in all treatment groups.With respect to the level of training of counselors and the frequency of clinical contact, the counseling we provided was typical of treatment available within Veterans Affairs medical centers and was similar to that provided in previous studies. Consistently with previous studies, we found evidence that patients who were more compliant with prescribed medication, attended more counseling sessions, and participated in more Alcoholics Anonymous meetings had better treatment outcomes.28-30 However, these associations cannot be interpreted as causal, because abstinent patients might have been more likely to take medication, to attend counseling sessions, and to participate in Alcoholics Anonymous meetings. Our results were more consistent with those of two Veterans Affairs studies evaluating treatment for alcoholism, in which good compliance was associated with less drinking in the disulfiram, lithium, and placebo groups.29,30 Some limitations of our study should be noted. We studied a severely affected population typical of male Veterans Affairs patients: that is, older, heavier drinkers, with long duration of alcoholism. Inclusion of patients with mild alcohol dependence would increase variability in outcomes and require a larger sample to find differences. We cannot rule out the possibility that a different dose of naltrexone or the use of adjunctive medications along with naltrexone might have been effective in our patients. The results might not be generalizable to patients with less chronic and severe alcohol dependence, non–Veterans Affairs settings, or women.In summary, in a large study, we found no evidence that naltrexone combined with psychosocial therapy was an effective treatment for alcohol dependence. Our data raise doubts about the current use of naltrexone for patients with chronic, severe alcohol dependence. Our findings do not rule out the possibility that naltrexone in combination with other medications or with other types of psychosocial interventions, or in other patient groups, may have a role in the treatment of alcoholism.

Supported by the Cooperative Studies Program of the Department of Veterans Affairs Office of Research and Development. Naltrexone and matching placebo were donated by Dupont Pharmaceuticals, which also analyzed blood naltrexone levels.

Source Information

From the Department of Veterans Affairs Alcohol Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Conn. (J.H.K., J.A.C., R.A.R.); the Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (J.H.K., J.A.C., R.A.R.); the Department of Veterans Affairs Cooperative Studies Program Coordinating Center, Perry Point, Md. (W.F.K., G.F.K.); and the Northeast Program Evaluation Center, Department of Veterans Affairs Connecticut Healthcare System, West Haven, Conn. (R.A.R.).Address reprint requests to Dr. Krystal at the Alcohol Research Center (G7E), the Department of Veterans Affairs Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT 06516-2770, or at john.krystal@yale.edu.

We are indebted to the members of the Data Monitoring Committee (K. Dickerson, Providence, R.I.; J. Fertig, Bethesda, Md.; M. Fisher, Madison, Wis.; H. Goldman, Baltimore; R. Meyer, Washington, D.C.; M. Shuckit, San Diego, Calif.) and the Planning Committee (R. Anton, Charleston, S.C.; S. O'Malley and B. Rounsaville, New Haven, Conn.; C. O'Brien and J. Volpicelli, Philadelphia).

Appendix

In addition to the authors, the members of the Department of Veterans Affairs Cooperative Study 425 Group were as follows: K. Drexler, F. Mohammad, L. Siklosky, K. Walker, C. Arnold-Hunter, and R. Head, Atlanta; J. Hermos, H. Behr, B. Kinne, D. Savage, and J. Wickis, Boston; L. Rugle, O. Kausch, H. Zegarna, K. Conti, H. Adkins, G. Harris, and C. Cartier, Cleveland; B. Adinoff, L. Burney, J. Fields, B. Hudson, J. Corder, and A. Quintero, Dallas; J. Grabowski, R. Wancha, Y. Ruiz, S. Chermack, S. Fleming, K. Gamel, and B. Sullivan, Detroit; L. Madlock, R. Murray, J. Williams, R. Lewandowski, and T. Owens, Memphis, Tenn.; M. FeBornstein, J. Pena, B. Cotton-Brown, M. Cowie, A. Connelly, W. Hill, A. Holmes, and J. Fiery, New Orleans; P. Casadonte, S. Kushner, S. Johnson, J. Siegris, N. Lynch, E. Richardson, and A. Butcher, New York; S. Nixon, C. Shaw, R. Joswick, D. Bertoch, and H. Engebretson, Oklahoma City; L. Haynes-Tucker, L. Moffet, J. Weintraub, R. Lutz, S. Clinton, F. Pohlman, R. Royal, and S. Harris, Menlo Park, Calif.; I. Maany, J. DeStefano, M. Andem, C. Hackett, J. McNeely, S. Dyanick, D. Torpey, S. Poole, E. Moeller, and A. Scheamania, Philadelphia; G. Kaplan, H. MacAskill, P. Charnley, and C. Williams, Providence, R.I.; C. Stock, P. Stevenson, S. Plumb, M. Dean, and J. Hunter, Salt Lake City; P. Banys, I. Rhew, S. Staccone, J. Kelly, and S. Shives, San Francisco; A. Saxon, M. Willey-Allen, J. Williams, K. Lunna, V. Ruscigno, S. Brown, and K. Shaffer, Seattle; J. Collins, S. Kilby, T. Burke, L. Linzy, C. Dalzell, M. Rhoads, J. Kelly, N. Banks, J. Arflin, and D. Briones, Perry Point, Md.; and M. Miller and C. Messick, Albuquerque, N.M.

Drug Rehabilitation; The Key Component

2010-10-18T19:08:00.000-07:00

by: Jay B Stockman

Drug and alcohol use can be traced back to 4000 B.C., in Egypt. By the 19th century, active substances were being extracted from the raw materials, and these psychoactive substances were being sold without any regulations. By the early 1900s there were an estimated 250,000 drug addicts in the United States. The anti-war upheaval of the 1960s brought with it a dramatic increase in drug use and increased social acceptance. The 1980s saw a decline in most drug use, with a slight increase in Cocaine use. Despite this overall decline, most Americans still regard illegal drug use as one of the nation's most serious problems. Opinion polls show the public favors a variety of different approaches to the drug problem. In addition to strict laws, it is vital to effectively treat individuals already suffering from drug dependence and substance abuse, through education, therapy, medicine, and group support. Drug rehabilitation is a key component to a successful campaign against the use of illegal drugs.

At its fundamental level, humans use substances such as alcohol and psychoactive drugs because these substances give the user a feeling of pleasure. Pleasure is a very powerful force. Our brains are wired in such a way that if you do something that gives you pleasure you will probably want to do it again. All drugs that are addicting can energize and enhance the brain's pleasure circuit. Addiction is a chronic disease that affects ones brain, and ones behavior. Addicted individuals abuse drugs without regard to the consequences of health, relationships, money, work etc. It is a consuming disease that not only effects the individual directly, but others indirectly. If left untreated, this disease can lead to the social death, as well as the actual death of the inflicted individual. Proper management must be instituted immediately to return the individual to a life that is more manageable, and drug free. A program of drug rehabilitation best achieves this goal.

Nobody chooses to become a drug addict or alcoholic, this disease cannot be wished away, it has to be treated.

Drug rehabilitation is the process of medical or psychotherapeutic treatment for substance abuse. The goal of any drug rehabilitation program is to provide comprehensive drug treatment and alcohol rehabilitation services, and introduce individuals to a new lifestyle free of chemicals. Successful treatment of substance abusers depends upon the severity and nature of the addiction, as well as motivation. Some treatment programs use medicines that neutralize the effects of the drug. Acupuncture has also been successful in treating the cravings that accompany drug withdrawal. Comprehensive substance abuse counseling and education is another component for a successful plan. Evaluating the efficacy of any treatment plan is difficult because of the chronic nature of drug abuse, and the fact that the disease is usually complicated by personal, social, and health factors.

Statistics show that getting sober is easy; staying sober is the hard part, and the first year of recovery is the most difficult. It may take a number of attempts before success is achieved. Nobody chooses to become a drug addict or alcoholic, this disease cannot be wished away, it has to be treated.

About the Author

Jay B Stockman is a contributing editor for Drug Rehab Programs Visit http://newdrug-rehab-center.com/ for more information.

Dr. Jay B Stockman is an individual contributor to Google Health Co-op

Dr. Jay B Stockman's public Google Health Co-op profile

Objective Of Alcohol Rehabilitation Program

2010-10-11T19:00:00.000-07:00

By: Paul Johnson

The main objective of alcohol rehabilitation programs is to
free you from the bondage of alcoholism. These programs
help you to discover newer ways to live without alcohol.

Different alcohol rehabilitation centers are offering
various types of alcohol rehabilitation programs to treat
alcoholism. Here is some information that may help you for
selecting the right alcohol rehabilitation program.

Consult a good alcohol rehabilitation center for finding a
suitable alcohol rehabilitation program. Doctors and
alcohol rehabilitation specialists will study your case and
conduct certain tests on you to find out a suitable program
for you.

Every individual has a unique history to alcoholism. Hence,
the rehabilitation program must be tailor-made to suit your
case.

Generally, the alcohol rehabilitation programs include
services such as hospitalization, medication, diet,
exercise, counseling, sauna, spiritual therapy, hypnosis,
amino acids and community activity.

Depending upon your case, doctors will recommend the
services that need to be included in the rehabilitation
programs designed for you.

The doctors would advice you to join either the "outpatient
treatment program" or the "residential inpatient treatment
program" depending on your intensity of alcohol dependency.
Here are some details about both the options.

Outpatient Alcohol Rehabilitation Program

If you do not have a long history of alcoholism, an
outpatient rehabilitation/ treatment program might be the
correct option. You might need counseling and guidance as a
part of your treatment.

Outpatient alcohol rehab program is a suitable option
treatment of alcoholism at its early stage. This program is
recommended for those individuals, whose occupational and
family environments are intact and for those who
demonstrate a high degree of commitment to quit alcohol.

This program provides adequate support service for your
day-to-day life.

Residential/ Inpatient Alcohol Rehabilitation Program

If you have experienced a long period of alcoholism,
doctors might recommend you for a residential or inpatient
alcohol rehabilitation program. The inpatient treatment
program provides 24-hour support and it is highly
effective.

This treatment is not just confined to amelioration of
symptoms. Rather this variant of alcohol rehab focuses on
addressing and resolving the factors that contribute to
alcoholism. Under the inpatient alcohol rehabilitation
program besides medication, you will participate in
educational lectures.

Counseling based treatment will be given to you on personal
basis as well as in small group settings. Some of the
inpatient alcohol rehabilitation programs also include
additional activities such as yoga and spiritual methods of
recovery.

The alcohol rehabilitation program also includes several
support services even after abstinence is achieved. This
ensures a perfect recovery and prevents a possible relapse.
This includes promoting religious involvement, imbibing
good health practices, proper diet, exercise, sleep
therapy, and self-enhancement projects.
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rehab - its effectiveness, and where to get treatment
Website contains valuable articles and information about
the widespread alcohol addiction problem. Click ==>
http://www.alcohol-rehab-success.com/alcohol-rehab-program.html

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About the Author
Paul Johnson works as a software developer, often working
long hours under great stress. A few years ago he realized
alcohol was becoming a problem. He researched and
personally experienced the issues involved in alcohol
rehab. Now he's written a series of useful articles on
alcohol rehabilitation.

Comparative Effectiveness and Costs of Inpatient and Outpatient Detoxification of Patients with Mild-to-Moderate Alcohol Withdrawal Syndrome

2010-10-04T19:00:00.000-07:00

Motoi Hayashida, M.D., Sc.D., Arthur I. Alterman, Ph.D., A. Thomas McLellan, Ph.D., Charles P. O'Brien, M.D., Ph.D., James J. Purtill, B.A., Joseph R. Volpicelli, M.D., Ph.D., Arnold H. Raphaelson, Ph.D. and Charles P. Hall, Ph.D.

N Engl J Med 1989; 320:358-365

Abstract We compared the effectiveness, safety, and costs of outpatient (n = 87) and inpatient (n = 77) detoxification from alcohol in a randomized, prospective trial involving 164 male veterans of low socioeconomic status. The outpatients were evaluated medically and psychiatrically and then were prescribed decreasing doses of oxazepam on the basis of daily clinic visits. The inpatient program combined comprehensive psychiatric and medical evaluation, detoxification with oxazepam, and the initiation of rehabilitation treatment.

The mean duration of treatment was significantly shorter for outpatients (6.5 days) than for inpatients (9.2 days). On the other hand, significantly more inpatients (95 percent) than outpatients (72 percent) completed detoxification. There were no serious medical complications in either group. Outcome evaluations completed at one and six months for 93 and 85 percent of the patients, respectively, showed substantial improvement in both groups at both follow-up periods. At one month there were fewer alcohol-related problems among inpatients and fewer medical problems among outpatients. However, no group differences were found at the six-month follow-up, nor were differences found in the subsequent use of other alcoholism-treatment services. Costs were substantially greater for inpatients ($3,319 to $3,665 per patient) than for outpatients ($175 to $388).

We conclude that outpatient medical detoxification is an effective, safe, and low-cost treatment for patients with mild-to-moderate symptoms of alcohol withdrawal. (N Engl J Med 1989; 320:358–65.)

Source Information

From The Veterans Administration Medical Center And The Department Of Psychiatry Of The University Of Pennsylvania (M.H., A.I.A., A.T.M., C.P.O., J.J.P., J.R.V.), And The School Of Business And Management, Temple University (A.H.R., C.P.H.), Philadelphia. Address Reprint Requests To Dr. Hayashida At The Veterans Administration Medical Center, Bldg. 3, University And Woodland Aves., Philadelphia, Pa 19104.

Combating Alcoholism A Highly Addictive But Stoppable Habit

2010-09-27T18:50:00.000-07:00

From Moses Wright

Drinking is seen as a social activity and seldom do people realize that social drinking can escalate and become a case for alcoholism. Alcohol addiction is a serious problem and can be the reason for your professional downfall. Alcohol addiction has lingering effects on your mind and body, causing you to lose control of aspects of your daily life. Yet, this problem is seldom surfaced. Addicts and their family members are sometimes even unaware that they are facing a drinking problem.

Alcoholism is difficult to combat because many addicts are able to mask their addiction well while a few others think that it is not a real issue. Secondly it is difficult to combat alcoholism alone as it is highly addictive. The good news is that there are alcohol rehabilitation programs available to assist those who have this addiction.

Many people find it difficult to believe, much less admit, that one of their close family members are alcoholics. Many will ignore the symptoms of alcoholism, when faced with the possibility that one of the family members show signs of addiction, preferring to remain in the dark about it. The most common signs of alcoholism are: members of your family drinking early in the morning or as soon as they awaken. Some people resort to hiding evidence of their drinking habits by discarding bottles quietly. Others might imbibe large quantities of alcohol throughout the day and end up being drunk most of time.

One of the first steps one can take is also unfortunately the hardest. And that is to recognize the addiction and acknowledge that one has a problem. Only then, does the idea of looking for help really come to mind and be a good start to the road of recovery. Admitting addiction and looking for help is very important as the withdrawal symptoms can be harsh, and without external help, it will be hard to overcome.

One could be easily tempted to take a small sip to deal with the withdrawal symptoms and backslide into alcoholism. Therefore, it is advisable for most alcoholics to gain the help of a support group or enroll in an alcohol rehabilitation program in order to stay sober.

Currently, online services offer a comprehensive list of alcohol rehabilitation centers as there are a number to be found in almost every city and town. In addition, there are various programs catered to suit everyone s needs and preferences. It would be good to attend alcohol rehabilitation program near you to minimize time and effort needed to attend the meetings.

The starting weeks will be tough as it is during then that the worst cravings will hit. It is important to show love, support, and understanding during this difficult time if you have close friends or family who are affected. Above all, remember that perseverance is the key. It might seem very difficult at the beginning, but because you have already embarked on the hardest part, one should not give up just yet!

Combating alcohol addiction does not only begin and end at the rehabilitation center. It is a 24 hours program that needs discipline and motivation to see it through and it also goes on for 7 days a week. Because it is a trying time for the person trying to remain sober, bear in mind that every bit of understanding offered will be helpful until the worst is over.

Moses Wright is the webmaster of Rehabilitation Program. You can find more useful information on Alcohol Abuse Rehabilitation and Rehabilitation Services on his website. You can reprint this article if you keep the content and live link intact.

Activities in Drug Rehabilitation Center

2010-09-20T17:58:00.000-07:00

Drug rehabilitation Centers are very important as they help in recovering people who are addicted to drugs and alcohol and make them normal. In the drug rehabilitation center the doctors help the patients to get over or help them to recover from their addiction which otherwise they are unable to recover. It is very difficult for an individual to get over his addiction without any treatment or medication .

The mere fact of being in a rehabilitation center is very threatening and a person who has never been to a rehabilitation center cannot even imagine.

One should have a clear understanding as to what one should expect when they enter the rehab.

There are numerous types of drug rehabilitation centers and all of them are unique in their own way. In a drug rehabilitation center both the psychological as well as the physical aspects of the dependency on drugs or alcohol are addressed.

In order to overcome the physical dependency the doctors present in the rehab prescribe medicines which may help the patient to ease out the difficulties in withdrawal. This is a very challenging task as it tries to break the individual’s habit or addiction.

It is thought that people who are addicted they have a chemical dependency within their brains. So for them it is even more difficult to stay away from the substance which they crave for. So the doctor should prescribe those medicines and that treatment which will help them to recover faster.

There are different situations for every drug addict. There are no fixed parameters for all. Different people have different requirements. Individual counseling and group therapy are part of the treatment. When it comes to group therapyFree Articles, patients are expected to take part in the sessions where other addicts are present who are at different stages of their recovery process.

It is not a guarantee that even when an individual completes his treatment of recovery he is absolutely recovered. Doctors should prescribe that treatment which really affects the usage of drugs and alcohol

The time taken by the patients in the drug rehab varies depending upon the several factors like how serious is the addiction or from how long the person has been addicted. In certain cases the minimum time a person is expected to stay is thirty days in a drug rehabilitation center

ABOUT THE AUTHOR

Serenity Manor East is leading alcohol and drug rehabilitation center in New York. We exist to provide a safe, nurturing, and effective course of alcohol and drug treatment, in a serene, high end environment, that will empower all who walk through our doors to go on to live a productive and happy life.

Cost-effectiveness of inpatient substance abuse treatment

2010-09-13T18:38:00.000-07:00

During the 1980s, short-term hospital stays became an increasingly important treatment for substance abuse disorders (Gfroerer, Adams, and Moien 1988). Many states enacted laws requiring employers to include substance abuse treatment in their insurance plans, and the use of inpatient treatment increased sharply (Weisner, Greenfield, and Room 1995). Although the advent of managed care has curtailed the growth of the inpatient sector, hospital and residential stays still account for nearly one-half of the funds spent on substance abuse treatment in the United States, or more than $2 billion a year (Barnett and Rodgers 1997).

This article analyzes the cost-effectiveness of inpatient substance abuse treatment, using readmission rates as the outcome measure. Our goal is to identify the characteristics of inpatient treatment programs that yield the most benefit at the least cost. Despite the widespread use of inpatient treatment, there has been a paucity of cost-effectiveness studies. The Institute of Medicine's review of drug abuse treatment literature found no studies of the cost-effectiveness of inpatient care (Gerstein and Harwood 1990). Two literature reviews found that the cost and effectiveness of different modes of alcoholism treatment are not correlated; however, the authors did not find the evidence persuasive enough to make recommendations about funding or treatment decisions (Finney and Monahan 1996; Holder et al. 1991).
The cost of inpatient treatment increases with its duration. There is conflicting evidence on how the length of treatment affects outcomes. Some observational studies have found that longer stays are associated with better outcomes in therapeutic communities (Bleiberg et al. 1994), halfway houses (Moos, Pettit, and Gruber 1995), and hospitals (Welte et al. 1981). Observational studies may suffer from selection bias, however. When the length of stay (LOS) is not randomly assigned, it is likely to be a function of the same patient characteristics that affect outcome.

Randomized clinical trials are designed to avoid this selection bias. Random assignment to a longer inpatient stay has not resulted in better outcomes for patients being treated for alcoholism (Mattick and Jarvis 1994) or drug abuse (McCusker, Vickers-Lahti, Stoddard, et al. 1995). This finding may not be definitive. Many LOS trials have few subjects and limited statistical power. Moreover, the results of trials may not apply to patients with the most severe disorders. Trials usually exclude these patients as it is regarded as unethical to enroll them in a protocol where they might be assigned a short LOS.

The cost of treatment also depends on the intensity of staffing. It is uncertain if intensively staffed programs yield better outcomes. A comparison of two inpatient alcohol treatment programs, one with 40 percent fewer staff, found no significant difference in effectiveness (Stinson et al. 1979). However, an evaluation of residential programs for adolescent drug abusers suggested that higher staffing levels were associated with better outcomes (Friedman and Glickman 1987).

There is little information on the effect of longer stays and more intensive levels of staffing on the cost of inpatient treatment. Also lacking is an analysis of whether the extra cost is justified by additional effectiveness.
The Department of Veterans Affairs (VA) relies heavily on inpatient programs to treat veterans with substance abuse disorders. In the 1994 fiscal year, VA provided 1.42 million days of inpatient substance abuse treatment (Piette, Baisden, and Moos 1995) at a cost of some $468 million. Until 1996, VA eligibility rules encouraged treatment in the inpatient setting. Most veterans qualify for care based on their income; low-income veterans were eligible for free outpatient care only if it was in preparation for a hospital stay or needed to prevent one.

VA's inpatient substance abuse programs have been studied using readmission as a measure of effectiveness (Peterson, Swindle, Phibbs, et al. 1994). Programs that performed better than expected had longer intended treatment duration, used assessment interviews involving family or friends, treated more patients on a compulsory basis, and had fewer early discharges and higher rates of participation in aftercare. The study used readmission after 180 days as the outcome. Only small changes resulted when the follow-up period was changed to 30, 60, 90, or 365 days.
We expand on this earlier study by considering costs and cost-effectiveness and by employing random effects regression.

DATA

Data on the design of treatment programs were obtained by mailed survey to all administrators of VA inpatient treatment programs in October 1990 (Peterson, Swindle, Phibbs, et al. 1994). The survey gathered information on the design of the program, such as the intended LOS and methods used in treatment, as well as a count of the number and type of direct treatment staff. We obtained detailed cost and utilization data for the preceding year, the period October 1, 1989 to September 30, 1990. Information on patients was obtained from the Patient Treatment File, the VA database of hospital discharges. The VA discharge file includes a unique patient identifier, patient demographics, diagnoses, and LOS. We obtained data on program cost and staffing from the Cost Distribution Report, the cost-accounting system used by VA medical centers. We divided the total cost from this report by the total days of inpatient care from the discharge file to find the average cost per day of care for each program. The components of the average daily cost of treatment are presented in Table 1. Using the assumption that all patients incur costs at the program's mean daily rate, we multiplied each patient's LOS by daily cost to find the total cost of treatment. The VA cost report reported research costs of $10.01 per patient day and education costs that averaged $17.42 per day. These costs were excluded from our analysis.

The VA cost report may suffer from some inaccuracies (Swindle, Beattie, and Barnett 1996). We created an alternative estimate of the cost of treatment staff. The number of each type of staff reported in the program survey was multiplied by the national average salary and benefits cost obtained from the VA summary expense journal, the Computerized Accounting for Local Management. We substituted this estimate of the cost of each program's staff to create an alternative measure of treatment cost.

We studied treatment provided by 98 programs that could be matched to the discharge file and cost report. These programs treated 38,683 unique patients during the year ending September 30, 1990. We examined the cost and effectiveness of the first treatment received by each patient during the study year. When a patient received more than one treatment during the year, we included only this first treatment as the index treatment for our analysis.

We did not include 77 of the 175 VA inpatient programs. These were excluded because the VA databases did not always allow us to distinguish the cost and utilization of individual programs when several alternative programs operated in a single medical center. The excluded programs were larger, less intensively staffed, and had longer intended LOS (Peterson, Swindle, Phibbs, et al. 1994). There was no difference in patient characteristics, as measured by the severity of illness index developed for VA substance abuse patients (Phibbs, Swindle, and Recine 1997).
METHODS

Cost-effectiveness analysis requires a single measure of outcome. Our only information on patients came from the discharge database. Given this limitation, [TABULAR DATA FOR TABLE 1 OMITTED] we defined a treatment as effective if the patient was not readmitted to any VA hospital within the United States for medical detoxification, substance abuse rehabilitation, or psychiatric care within 180 days of discharge from the index treatment. Using this definition, 75.0 percent of the treatments were effective. Data from non-VA programs were not available, so readmission to other facilities was not considered by our study.

Variables and their mean values are presented in Table 2. Medical and psychiatric conditions, and the substances abused by patients, are based on the diagnoses in the discharge file. Prior admissions represent the number of inpatient treatment episodes in the year before the index treatment. "High-income" means an income of more than twice the upper limit established by the VA eligibility test; in 1990, a single veteran with income in excess of $34,480 would have been considered high-income, as would a veteran with two dependents and an income in excess of $48,276.

We wished to find the patient and program level characteristics that explain the cost of treatment and the probability of readmission for further treatment. If we had used the program as the unit of observation, patient characteristics would have entered our model as a mean value for each program, resulting in a substantial loss of statistical power. A patient-level analysis, however, cannot make the standard assumption that the error terms are independent. When the error terms of patients in the same program are correlated, then standard models overstate the statistical significance of the regression coefficients.

Random-effects models account for the correlation of patients within programs. We had a continuous dependent variable, cost, and a dichotomous dependent variable, an indicator of whether the patient was readmitted within six months. Random-effects models can be used in both linear (Laird and Ware 1982) and logistic regression (Wong and Mason 1985). We used simple random-effects regressions, treating the intercept as a random variable whose variation is explained by program characteristics. We did not estimate any program-by-patient interaction terms.

We were interested in discovering the program characteristics that affect readmission rates while controlling for patient characteristics. One important patient characteristic is the number of times the patient was hospitalized in the previous year. This depends on the characteristics of both patient and program, but we wished to control for only the patient's contribution. To keep program factors out of this measure of patient severity, we excluded previous admissions to the program that provided the index treatment.
We considered the program-level factors previously found to predict rates of readmission (Peterson, Swindle, Phibbs, et al. 1994). Because our focus was on cost-effectiveness, we added factors associated with resource use, including the intensity of staffing and program size.

We wished to consider the effect of program-level factors that influence the LOS. We used the intended length of a completed treatment, according to the program director. We did not use the actual LOS because it would reflect patient-level characteristics as well as the design of the program.

We did not include early discharge or participation in aftercare in our analysis. These variables were excluded because of our concern that they are endogenous, that is, that they are correlated with the error term. The [TABULAR DATA FOR TABLE 2 OMITTED] unobserved patient attributes associated with retention in treatment are likely to be correlated with the likelihood that the patient avoided readmission. Inclusion of endogenous variables could bias our regression coefficients.

Table 3: Cost of Inpatient Substance Abuse Treatment VA Medical
Centers, 1990 Fiscal Year; Random-Effects Regression (N = 38,683
patients, 98 programs)

                                              Coefficient   p-Value

Intercept                                       1,303.56     .512

Program-Level Factors

Intended length of stay (days)                    122.88     .000
Log program size                                 -524.66     .002
Wage index                                      1,977.58     .003
Treatment staff per patient (FTE)               2,228.64     .000
Percent compulsory admissions                     966.85     .013
[greater than] 50% family/friends assessment      248.67     .270

Patient-Level Factors

3 or more prior admissions                       -496.71     .000
2 prior admissions                               -229.79     .003
1 prior admission                                 -95.12     .048
Age                                                13.41     .177
Age-squared                                        -0.21     .036
Service-connected disability                      -66.16     .024
High income                                        96.19     .542
Non-veteran                                        44.71     .845
Not married                                       148.42     .000
African American                                  410.47     .000
Opiate diagnosis                                 -281.21     .038
Marijuana                                         242.47     .003
Nicotine                                          384.87     .010
Amphetamine                                        26.60     .809
Schizophrenia                                    -328.20     .000
Bipolar disorder                                  124.03     .210
Post-traumatic stress disorder                    390.15     .000
Depression                                        396.29     .000
Other personality disorder                        410.69     .071
Heart disease                                      78.35     .188
Arthritis                                         416.34     .000
Back problems                                     281.18     .000
Cancer                                            737.65     .000
Liver diagnoses                                   334.76     .001
HIV                                               361.28     .240
Alcohol withdrawal                               -637.47     .000

Bleiberg, J. L., P. Devlin, J. Croan, and R. Briscoe. 1994. "Relationship Between Treatment Length and Outcome in a Therapeutic Community." International Journal of the Addictions 29 (6): 729-40.
Finney, J. W., and S.C. Monahan. 1996. "The Cost-Effectiveness of Treatment for Alcoholism: A Second Approximation." Journal of Studies on Alcohol 57 (3): 22943.

Friedman, A., and N. Glickman. 1987. "Residential Program Characteristics for Completion of Treatment by Adolescent Drug Abusers." Journal of Nervous and Mental Disease 175 (7): 419-24.
Gerstein, D. R., and H.J. Harwood (eds.). 1990. Treating Drug Problems: A Study of the Evolution, Effectiveness, and Financing of Public and Private Drug Treatment Systems. Washington, DC: National Academy Press.

Gfroerer, J. C., E. H. Adams, and M. Moien. 1988. "Drug Abuse Discharges from Non-federal Short-stay Hospitals." American Journal of Public Health 78 (12): 1559-62.

Holder, H., R. Longabaugh, W. R. Miller, and A. V. Rubonis. 1991. "The Cost Effectiveness of Treatment for Alcoholism: A First Approximation." Journal of Studies on Alcohol 52 (6): 517-40.
Kamlet, M. S. 1992. A Framework for Cost-Utility Analysis of Government Health Care Programs. Washington, D C: Office of Disease Prevention and Health Promotion, Public Health Service, U.S. Department of Health and Human Services.

Laird, N., and J. Ware. 1982. "Random-Effects Models for Longitudinal Data." Biometrics 38 (4): 963-74.

Mattick, R., and T. Jarvis. 1994. "Inpatient Setting and Long Duration for the Treatment of Alcohol Dependence?: Outpatient Is As Good." Drug and Alcohol Review 13 (2): 127-35.
McCusker, J., M. Vickers-Lahti, A. Stoddard, R. Hindin, C. Bigelow, M. Zorn, F. Garfield, R. Frost, C. Love, and B. Lewis. 1995. "The Effectiveness of Alternative Planned Durations of Residential Drug Abuse Treatment." American Journal of Public Health 85 (10): 1426-29.

Mechanic, D., M. Schlesinger, and D. D. McAlpine. 1995. "Management of Mental Health and Substance Abuse Services: State of the Art and Early Results." Milbank Quarterly 73 (1): 19-55.
Moos, R. H., B. Pettit, and V. Gruber. 1995. "Longer Episodes of Community Residential Care Reduce Substance Abuse Patients' Readmission Rates." Journal of Studies on Alcohol 56 (4): 433-43.
Peterson, K., R. Swindle, C. Phibbs, B. Recine, and R. Moos. 1994. "Determinants of Readmission Following Inpatient Substance Abuse Treatment: A National Study of VA Programs." Medical Care 32 (6): 535-50.

Phibbs, C. S., R. W. Swindle, and B. Recine. 1997. "Does Case Mix Matter for Substance Abuse Treatment? A Comparison of Observed and Case Mix-Adjusted Readmission Rates for Inpatient Substance Abuse Treatment in the Department of Veterans Affairs." Health Services Research 31 (6): 755-71.
Piette, J. D., K. L. Baisden, and R. H. Moos. 1995. Health Services for VA Substance Abuse Patients: Utilization for Fiscal Year 1994. Palo Alto, CA: U.S. Department of Veterans Affairs, Program Evaluation and Resource Center, HSR&D Center for Health Care Evaluation.

Stinson, D. J., W. G. Smith, I. Amidjaya, and J. M. Kaplan. 1979. "Systems of Care and Treatment Outcome for Alcoholic Patients." Archives of General Psychiatry 36 (5): 535-39.

Swindle, R. W., M. C. Beattie, and P. G. Barnett. 1996. "The Quality of Cost Data: A Caution from the VA Experience." Medical Care 34 (3): MS83-MS90.

Weisner, C., T. Greenfield, and R. Room. 1995. "Trends in the Treatment of Alcohol Problems in the U.S. General Population, 1979 through 1990." American Journal of Public Health 85 (1): 55-60.
Welte, J., G. Hynes, L. Sokolow, and J. Lyons. 1981. "Effect of Length of Stay in Inpatient Alcoholism Treatment on Outcome." Journal of Studies on Alcohol 42 (5): 483-91.

Wong, G., and W. Mason. 1985. "The Hierarchical Logistic Regression Model for Multilevel Analysis." Journal of the American Statistical Association 80 (391): 513-24.

Paul G. Barnett, Ph.D. is a health economist with the HSR&D Center for Health Care Evaluation and the Program Evaluation and Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, and the Department of Health Research and Policy, Stanford University School of Medicine. Ralph W. Swindle, Ph.D. is a research health scientist with the HSR&D Service, Roudebush VAMC, Indianapolis, IN, and the Department of Medicine, Indiana University School of Medicine and the Regenstrief Institute for Health Care. Address correspondence and requests for reprints to Paul G. Barnett, Ph.D., Health Economist, Center for Health Care Evaluation, Veterans Affairs Palo Alto Health Care System, 795 Willow Rd. (152 MPD), Menlo Park, CA 94025. This article, submitted to Health Services Research on July 23, 1996, was revised and accepted for publication on February 28, 1997.

Paul G. Barnett "Cost-effectiveness of inpatient substance abuse treatment". Health Services Research. FindArticles.com. 16 Aug, 2010. http://findarticles.com/p/articles/mi_m4149/is_n5_v32/ai_20575055/

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2010-09-06T18:33:00.000-07:00

Below is a list of drug rehab related websites.

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Narconon Drug Rehab. The Real Dangers of Alcohol Rehab with Narconon

2010-08-30T18:19:00.000-07:00

Author: Christian Shire

Although she is a branch of the Church of Scientology for a number of reasons, which hide this fact, and no promotional material will never reveal this Narconon Narconon program membership Scientology.The drug and alcohol rehabs based on the works and writings of Scientology founder L. Ron Hubbard and gurus, and even if did not have actual scientific training (addressed in this song), the science on which the organization bases its treatment methods depend Narconon all professionals works.Medical enough basic scientific claims are disproved treatments go ahead, but the faithful from Narconon for more of their science, their claims seem to be back. You see not allow independent confirmation of the data, and are very secretive about, alcohol, alcohol rehab, rehab, all the information and use statistics.Why Narconon could youOne aspect of Narconon's philosophy, which seems at face value to a sense of killing, that is, because the drug has created dependence and related problems as in life, drug use (drugs) in the treatment of drug addiction only worsened the problems.Of course, if you think about it you can see that the drugs are medically and Necessary medicines Completely independent! and that the use of aspirin is very unlikely, the worst problem with addiction is, unfortunately, their philosophy of abstinence from all drugs, not only ridiculous, it is also dangerous, so dangerous that the American Medical Association expressed concern about the safety of the Narconon detox program (the dangers of the Narconon). The Detox off of some drugs, like alcohol, can be very dangerous, and in some cases even be fatal if administered pharmaceuticals, and is a serious risk of seizures, convulsions and even fatal heart problems. Fortunately, these risks can be controlled by the minimal use of certain central nervous system depressants, and these drugs is to reduce the symptoms of alcohol detoxification, but in a rehabilitation Narconon, alcoholics Given unnecessary drugs, and are left to take their opportunities scientist.Narconon with back spasms and convulsions of a wrong and bad for a philosophy equally absurd and dangerous, and not the workMost treatments in a facility offering Narconon do about as much sense as a source of drugs necessary for cardiac failure and human risk of this drug and alcohol rehabs enter.If a legitimate threat to the health and wellbeing of those you need medication, especially if you need rehabilitation and alcohol detox, you should not think of any Narconon program distributed as safe or appropriate in care.Anyone should be considering a rehab to make sure it is their time, energy and money to a treatment facility that offers them the best way to ensure a full recovery and the required service life of sobriety in order to obtain a system, not scientific and clinical use proven therapies, and a device that is not the risk is not your health and your life Necessary Possibly by withholding and not intoxicating medications.Do you search find, ask your doctor, a challenging program and get the help you deserve. Do not take a chance with Narconon.

Office-Based Treatment of Opiate Addiction with a Sublingual-Tablet Formulation of Buprenorphine and Naloxone

2010-08-23T18:25:00.000-07:00

Addiction to opiates, usually to heroin, remains a continuing problem in the United States and is increasing in Europe.1-5 Opiate-substitution pharmacotherapy reduces the use of illicit opiates and the high-risk and criminal behaviors associated with it.6-8 However, two currently available opiate-substitution therapies, methadone and levomethadyl acetate, are provided only in a strictly regulated environment in which medication is taken under clinical observation, with limited provision for take-at-home dosing.9 Such monitoring is necessary because of concern about the diversion of these drugs to illicit use but is also known to dissuade many addicted persons from seeking help.10 Furthermore, under the same regulations, access to opiate-substitution pharmacotherapy is limited to persons with defined histories of documented, chronic opiate addiction; those with relatively recent addiction are ineligible.9 Buprenorphine is a partial μ-opiate–receptor agonist and a κ-opiate–receptor antagonist11,12 that is used in many countries for the treatment of moderate to severe pain. Sublingual administration of buprenorphine circumvents first-pass drug inactivation. Although this agent, like methadone and levomethadyl acetate, has the potential to be abused,13-15 its potential for abuse can be diminished by combining it with naloxone.16 Indeed, buprenorphine, alone or in combination with naloxone, has recently been approved in the United States and other countries for the treatment of opiate addiction. Recent legislation in the United States17 allows physicians to administer buprenorphine or a combination of buprenorphine and naloxone to treat opiate-addicted patients in their offices.We conducted a randomized, placebo-controlled, multicenter trial to evaluate the safety and efficacy of a sublingual-tablet formulation of buprenorphine and naloxone in an office-based setting. The ratio of buprenorphine to naloxone in the formulation was 4:1, with the aim of reducing or preventing potential misuse of buprenorphine by the parenteral route.18-20

Methods

Subjects

Men and women who met the diagnostic criteria for opiate dependence according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV),21 who were seeking opiate-substitution pharmacotherapy, who were between the ages of 18 and 59 years, and who were able to give informed consent and comply with study procedures were eligible to participate. Participants were enrolled between October 21, 1996, and September 30, 1997. Women who were pregnant or nursing were excluded. Other criteria for exclusion included any medical condition that made study participation medically hazardous; aspartate or alanine aminotransferase levels greater than three times the upper limit of normal; a current, primary, Axis I psychiatric diagnosis (according to the DSM-IV) other than opiate, caffeine, or nicotine dependence; and use of methadone, levomethadyl acetate, or naltrexone within the 14 days before enrollment. Subjects were compensated $10 per day to complete the study assessments during the double-blind trial; they were not paid for taking any of the study treatments.The study was approved by the Human Rights Committee of the Veterans Affairs Cooperative Studies Program Coordinating Center (Perry Point, Md.) and by the institutional review boards of participating sites and was conducted in accordance with the Declaration of Helsinki. All the subjects provided written informed consent. A data and safety monitoring board provided independent monitoring of the study. Haybittle–Peto horizontal boundaries,22 with a criterion of 3 SD, were used in the interim analyses conducted to determine whether the study should be terminated early.

Procedures

There were two parts to the study: first, a 4-week, double-blind, placebo-controlled efficacy trial, and second, an open-label safety phase lasting 48 weeks (for persons who had participated in the efficacy trial) or 52 weeks (for those who had not participated in the efficacy trial). The double-blind trial was conducted at eight sites (in Boston; Cincinnati; Hines, Ill.; Los Angeles; New York; Philadelphia; San Francisco; and West Haven, Conn.). The open-label phase was conducted at four other sites as well (in Baltimore, Miami, New Orleans, and San Juan, Puerto Rico). Subjects who received at least one dose of the combined medication consisting of buprenorphine and naloxone (but not those who received buprenorphine alone) in either part of the study constituted the group in whom safety was assessed. All study visits took place in a physician's office in a clinical research program located in an environment distinct from the clinic where methadone and levomethadyl acetate were provided.During the double-blind trial, subjects were randomly assigned to daily treatment with buprenorphine (16 mg) in combination with naloxone (4 mg), buprenorphine alone (16 mg), or placebo. A 16-mg dose of buprenorphine was chosen on the basis of results of previous studies,23-25 after adjustment for the bioavailability of the sublingual-tablet formulation.Subjects came to the clinic each weekday and were administered medication on site. Take-home doses were dispensed on Fridays for use on the weekends and were also provided for use on clinic holidays. Those who were assigned to active treatment with buprenorphine alone received a dose of 8 mg on day 1 of the study; those who were assigned to the combination treatment received buprenorphine alone on days 1 and 2 (8 mg on day 1 and 16 mg on day 2) to minimize the risk of naloxone-induced opiate withdrawal. All the tablets were identical in appearance and taste and were provided by Reckitt Benckiser Healthcare (Hull, United Kingdom), through a Cooperative Research and Development Agreement between Reckitt and Colman Pharmaceuticals (Richmond, Va.; currently Reckitt Benckiser Pharmaceuticals) and the National Institute on Drug Abuse, National Institutes of Health. The data were held by the National Institute on Drug Abuse; Reckitt and Colman was not involved in the study design, in the collection of data, in the preparation of the manuscript, or in the decision to submit the manuscript for publication.All the subjects received counseling regarding human immunodeficiency virus infection and up to one hour of individualized counseling per week. Emergency counseling (e.g., after a relapse) and referrals (e.g., to community legal aid programs) could be provided, but no other counseling or services (e.g., regarding family or employment issues) were offered.26 During the open-label phase of the study, subjects who were to receive the combined treatment were given buprenorphine alone for the first two days of therapy (8 mg on day 1 and 8 or 12 mg on day 2), after which they were given the combination tablet, up to a total daily dose of 24 mg of buprenorphine and 6 mg of naloxone. For the first two weeks, the medication was administered each weekday at the clinic (as it had been in the double-blind trial). After that, up to a 10-day supply of medication could be provided, at the discretion of the investigators, for subjects' use at home. Individualized counseling was available at the clinics, but the subjects were also encouraged to obtain behavioral-treatment services outside the study.

Measures of Treatment Efficacy

The primary outcome measures in the double-blind trial were the percentage of opiate-negative urine samples and subjects' self-reported craving for opiates. Urine samples were collected on Mondays, Wednesdays, and Fridays with the use of a urine-collection cup containing a temperature sensor (Franklin Collectors, Francus Medical Marketing) and specimen authenticity verified by measurement of urine temperature; direct observation was used when an assessment of urine temperature might not have been reliable (e.g., in febrile persons). The samples were analyzed centrally (at Northwest Toxicology, Salt Lake City) for the presence of opiates (e.g., morphine, codeine, and the corresponding metabolites) and for other substances of abuse (Abuscreen Online Immunoassay, Roche Diagnostic Systems). A few compounds (e.g., oxycodone and meperidine) cross-react only poorly with this assay, but other assay procedures were not used.Criteria for a positive test were based on general clinic practices and on federal guidelines for immunoassay testing in place at the time. Urine samples containing less than 300 ng of drug or metabolite per milliliter were considered negative for that substance, except in the case of amphetamines, for which the cutoff value was 1000 ng per milliliter. Samples not provided when due were recorded as missing. The subjects' craving for opiates was assessed at each clinic visit in terms of the peak craving during the preceding 24 hours, measured with a 100-mm visual-analogue scale (where 0 represented “no craving” and 100 “the most intense craving I ever had”). The initial (base-line) assessment was obtained on day 1 before administration of the study medication.The principal secondary outcome measures included the subjects' and the clinicians' impressions of overall status since enrollment in the study and since the previous visit. Other secondary measures were the percentages of urine samples that were negative for other drugs of abuse (amphetamines, barbiturates, benzodiazepines, cocaine, and methadone), subject retention, the rates of adverse medical events, findings on electrocardiography, and the results of clinical (chemical and hematologic) analyses. Impressions of overall status were rated on Mondays, Wednesdays, and Fridays with the use of a 100-mm visual analogue scale (where 0 represented “much worse,” 50 “no change,” and 100 “much better”). Adverse medical events were assessed weekly; in addition, any events spontaneously reported during daily visits to the clinic were recorded.27 Electrocardiography and laboratory testing were performed at screening before enrollment and at the end of week 4.During the open-label phase, urine samples were collected randomly two times each month, and the results were made available to the investigators. Other evaluations were performed during screening and at the following intervals: clinical (chemical and hematologic) evaluations, monthly; pregnancy tests, monthly; electrocardiography, weeks 4, 12, 24, 36, and at the end of the study; and physical examination, at the end of the study. Adverse events were evaluated weekly.

Statistical Analysis

Estimates of the sample size that would be required for the double-blind trial were derived with the use of effect sizes and variances obtained from a previous study.24 To detect a difference of 10 percentage points between the combined-therapy group and the placebo group in the percentage of urine tests negative for opiates or a 10-point difference between the two groups in the craving score with a type I error of 0.05 and a power of 0.80, the inclusion of 63 and 86 subjects per group, respectively, would be required. To assess the craving for opiates, a total of 384 subjects (128 per group) was needed (with a total of 48 per site [16 per group per site]), after allowance for approximately 33 percent attrition. Comparison of the combined-therapy group and the placebo group was the primary comparison; the group that received buprenorphine alone served as an active control. All statistical tests were performed as two-sided tests with an alpha level of significance of 0.05.The base-line characteristics of the groups were compared with the use of the following tests: the Kruskal–Wallis test for the duration of opiate use and household income; the Cochran–Mantel–Haenszel test, stratified according to site, for race, sex, any past enrollment in a methadone or levomethadyl acetate maintenance program, employment status, and living arrangement; and a two-factor (group and site) analysis of variance for other variables. Adverse effects were compared among groups with the use of Fisher's exact test.The percentage distribution of opiate-negative urine samples was analyzed with a two-factor (site and group) analysis of variance. Least-squares means analysis was used for each of the three pairwise comparisons. No adjustments were made for multiple comparisons. Participants provided a maximum of 11 or 12 urine samples, depending on the day of the week on which treatment was initiated. According to the most conservative approach, missing samples (including those from subjects who did not complete the trial) were considered “not negative” for opiates. The percentage of negative urine samples for each subject was based on the expected number of samples (11 or 12).Opiate-craving scores and subject- and clinician-rated impressions of overall status were analyzed as four weekly averages by a three-factor (site, group, and week), repeated-measures analysis of covariance (for craving) or analysis of variance (for global impressions).

Results

Double-Blind Trial

The data and safety monitoring board and the Human Rights Committee of the Veterans Affairs Cooperative Studies Program Coordinating Center recommended termination of the double-blind trial because buprenorphine alone and the combination of buprenorphine and naloxone had been found to have greater efficacy than placebo. At the time the study was terminated, 451 persons had been screened, 326 had been enrolled and assigned to a study group, 323 had received at least one dose of study medication, and 243 had completed the trial. The three subjects (one in each group) who had not received study medication after randomization were excluded from the analyses. Of the 323 subjects who had received at least one dose, 109 received the combination of buprenorphine and naloxone, 105 received buprenorphine alone, and 109 received placebo. Of the 27 subjects who had not completed the double-blind trial when it was stopped, 11 had begun receiving the combined treatment, 4 had begun receiving buprenorphine alone, and 12 had begun receiving placebo. After termination of the study, all 27 subjects were enrolled in the open-label phase. For the 296 subjects who were not affected by the early termination, 243 (82 percent) completed the trial (82 in the combined-treatment group, 86 in the buprenorphine-only group, and 75 in the placebo group); the differences among the groups in the proportion of subjects who completed the trial were not significant. Overall, the subjects received medication for 90 percent of the days that they remained in the study.Base-line demographic data were similar in all three treatment groups (Table 1Table 1Base-Line Demographic Characteristics of the Subjects in the Double-Blind Trial and of Those Who Constituted the Group in Whom Safety Was Assessed.). Both of the buprenorphine-based treatments reduced opiate use; the percentages of urine tests that were opiate-negative were 17.8 percent in the combined-treatment group and 20.7 percent in the buprenorphine group, as compared with 5.8 percent in the placebo group (P<0.001 for both comparisons). There was a significant site effect (P<0.001), but there was no significant site-by-group interaction; that is, the effect of treatment was about the same at all sites.Both of the buprenorphine-based treatments also reduced the craving for opiates (Figure 1AFigure 1Mean (±SD) Scores for Opiate Craving and Subjects' and Clinicians' Impression of Overall Status.). During each of the four study weeks, the mean craving scores in the combined-treatment and buprenorphine groups were significantly lower than those in the placebo group (P<0.001 for both comparisons). The effects of the site (P=0.03), group (P<0.001), and week of treatment (P<0.001) on craving scores were significant; there was also a significant group-by-week interaction (P<0.001), indicating that the effects of treatment varied from week to week during the trial.The overall health and well-being of the subjects in the combined-treatment and buprenorphine-only groups improved to a significantly greater extent than they did in the placebo group, as measured by a global-impression rating scale with which the subjects assessed their own status each week relative to their status at the start of the study (Figure 1B) (P<0.001 for both buprenorphine-based groups vs. placebo at all assessments). In all the groups, subjects' self-assessments of their overall status relative to the previous assessment also showed improvements, but these improvements were not statistically significant. Each week, those who received either the combined treatment or buprenorphine alone had significantly higher scores than those who received placebo (P<0.001) (data not shown).The clinicians' ratings of their impressions of the subjects' status relative to the start of the study were generally lower than the subjects' own ratings but showed similar improvements (Figure 1C). Each week, subjects who received either the combined treatment or buprenorphine alone had higher scores than those who received placebo (P<0.001 for both comparisons). The improvements in clinicians' ratings relative to the previous assessment were similar to the improvements relative to the start of the study, except that scores in the group that received buprenorphine alone were significantly higher than those in the placebo group only at week 1 (P<0.001) and week 2 (P=0.002).The drug (other than opiates) most commonly detected in the urine in all three groups was cocaine; the frequency of cocaine-positive samples did not differ significantly among the groups (45 percent in the combined-treatment group, 44 percent in the group that received buprenorphine alone, and 40 percent in the placebo group). Overall, benzodiazepines were detected in 83 of 813 samples (10 percent), and amphetamines, barbiturates, and methadone were each detected in less than 5 percent of the samples. There was no appreciable increase or decrease in the use of any of these drugs during the four-week study period in any of the groups.Buprenorphine was well tolerated when given alone or in combination with naloxone. The overall rate of adverse events did not differ significantly among the groups (78 percent in the combined-treatment group, 85 percent in the buprenorphine-only group, and 80 percent in the placebo group), and there were few differences among the groups in the rates of specific adverse events (Table 2Table 2Adverse Events Reported by at Least 5 Percent of the Subjects in Any Treatment Group during the Double-Blind Trial.). Fourteen serious adverse events (four in the combined-treatment group, three in the buprenorphine-only group, and seven in the placebo group) were reported in 13 subjects. Inpatient detoxification treatment was the most common (in five subjects), and suicidal ideation or a suicide attempt was reported by two subjects, both in the buprenorphine-only group. Treatment with the combination of buprenorphine and naloxone or with buprenorphine alone did not result in appreciable electrocardiographic changes. Changes from base line in clinical (chemical and hematologic) values were small and not clinically relevant.

Open-Label Study

A total of 461 subjects (268 of whom had participated in the double-blind trial) took part in the open-label safety study. These 461 subjects and an additional 11 subjects who had participated only in the double-blind trial constituted the group in whom safety was assessed (Table 1). Of these 472 subjects, 385 received at least eight weeks and 261 received at least six months of treatment consisting of buprenorphine and naloxone in combination. There were a total of 92,930 subject-days of exposure to this medication. Fourteen subjects discontinued therapy because of adverse events, of which detoxification or withdrawal symptoms (for example, rhinitis and diarrhea) were the most common. Eight subjects discontinued therapy because of medical conditions considered unrelated to the study medication, and two subjects discontinued therapy because of conditions possibly related to it.Eighty-one serious adverse events were reported. The most common (in 10 subjects) were increases in hepatic alanine or aspartate aminotransferase or lactate dehydrogenase levels that were judged to be not related (in 3 cases), possibly related (in 6 cases), or probably related (in 1 case) to the study medication. In 8 of these 10 cases, serologic evidence of hepatitis B or hepatitis C infection was present at base line. Nonserious adverse events reported by at least 20 percent of the subjects were headache, pain, withdrawal syndrome, infection, insomnia, back pain, and constipation. There were no clinically important changes from base line in the results of clinical (chemical and hematologic) tests or in the findings on electrocardiography.The percentages of urine samples negative for opiates, cocaine, and benzodiazepines are shown in Figure 2Figure 2Percentage of Urine Samples Negative for Opiates, Cocaine, or Benzodiazepines among Subjects Who Received Combination Treatment with Buprenorphine and Naloxone.. The percentage of opiate-negative urine samples ranged from 35.2 percent to 67.4 percent in multiple assessments. The overall rate of opiate use was lower than that in the double-blind trial, whereas the use of cocaine or benzodiazepines remained relatively constant.

Discussion

This two-part study demonstrated the efficacy and safety of a novel sublingual-tablet formulation of buprenorphine and naloxone in combination. The superiority of buprenorphine over placebo has been previously reported,23,28 but the efficacy of buprenorphine or of this medication in combination with naloxone has not been previously evaluated in an office-based setting. The subjects in the double-blind trial were examined and given medication daily in an office setting. Medication was provided for at-home use on weekends and clinic holidays during the double-blind trial and for up to 10 days during the open-label phase. The Drug Addiction Treatment Act of 2000,17 which allows the use of schedule III, IV, and V narcotic medications for the treatment of opiate addiction, and the approval by the Food and Drug Administration in October 2002 of buprenorphine and buprenorphine and naloxone in combination permit office-based treatment with these medications.Approximately half of the subjects enrolled in the study reported having received no prior opiate-substitution treatment, either by choice or because of regulatory ineligibility for such treatment. The remainder had discontinued methadone or levomethadyl acetate pharmacotherapy; no direct induction from either of these medications was undertaken in this study. These results support the use of a sublingual tablet consisting of a combination of buprenorphine and naloxone as a first-line, office-based treatment for opiate addiction. The results also extend treatment options for persons who have previously undergone opiate-substitution pharmacotherapy.The inclusion of naloxone in the sublingual-tablet formulation is not intended to increase the efficacy of treatment but, rather, to help deter the possible diversion of buprenorphine to misuse by the parenteral route. Combinations of buprenorphine and naloxone have been shown to precipitate withdrawal signs and symptoms when administered intravenously to opiate-dependent persons.18-20 According to published data,30 the buprenorphine–naloxone combination would not be expected to precipitate opiate withdrawal in persons whose condition had stabilized with the use of a therapeutic dose of buprenorphine. Although this study was not intended to compare the two active-treatment groups, the absence of an apparent difference in efficacy between them supports the idea that naloxone does not reduce the efficacy of buprenorphine.The percentages of opiate-negative urine samples in both active-treatment groups were significantly greater than those in the placebo group during the double-blind trial. Although the percentages, averaged over four weeks, may appear low, this finding was neither unexpected nor indicative of a poor treatment response. The trial was designed to show efficacy by the four-week point, not the achievement of a full clinical effect. As a conservative approach, all the missing urine samples, including those missing because of early termination of the study, were coded as “not negative.” Thus, it is likely that the actual percentage of negative samples was higher than that estimated. The pattern of results is similar to that observed in the initiation of treatment with other therapies currently approved for persons with opiate addiction.31 In addition, other factors probably negatively affected the outcome of treatment. These factors include the fixed-dosing design, which did not permit individual dose titration; the blinding of clinicians to the results of urine testing, which are typically used to tailor individual treatment plans; and the absence of concomitant behavioral treatment. The percentages of urine samples negative for opiates during the open-label phase (generally between 50 percent and 60 percent) exceeded those in the double-blind trial and more closely resembled those reported in studies in which therapeutic dosages of buprenorphine, methadone, and levomethadyl acetate were used.31-33 The strengths of this study include the placebo-controlled design, the inclusion of both women and men, and the consistency of the findings among multiple outcome measures. Its limitations include a potentially restricted capacity for generalization to the population of opiate-addicted persons, because the criteria for enrollment excluded some persons, primarily for reasons related to safety. In addition, the expertise of the investigators and the resources available to them in the clinics may exceed those available in some office-based settings.No unexpected safety issues emerged during the study, and the reported adverse events were those known to be generally associated with opiate-agonist treatment. We conclude that both buprenorphine alone and buprenorphine and naloxone in combination provide safe and effective treatment of opiate-addicted persons in an office-based setting.

Supported by the National Institute on Drug Abuse through the Department of Veterans Affairs Cooperative Studies Program (Interagency Agreement no. 3YO1-DA-30011-04).Presented in part at the 60th Annual Scientific Meeting of the Committee on Problems of Drug Dependence, Scottsdale, Ariz., June 15, 1998.

Source Information

From the Veterans Affairs (VA) Medical Center, University of Pennsylvania School of Medicine, Philadelphia (P.J.F., L.M.); the Division of Treatment Research and Development, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Md. (T.P.B., S.H., C.N.C.); the VA Cooperative Studies Program Coordinating Center, Perry Point, Md. (W.O.W., K.J., J.C.); the Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore (W.O.W., J.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, University of New Mexico, Albuquerque (D.R.); the VA Medical Center, New York Harbor Health Care System, New York University Medical School, New York (P.C.); the VA Medical Center, Cincinnati (R.J.G.); the VA Medical Center, West Los Angeles (W.L.); the VA Medical Center, Hines, Ill. (U.M.); the VA Boston Healthcare System, Boston University School of Medicine, Boston (J.R.); the VA Medical Center, West Haven, Conn. (S.S.); and the VA Medical Center, University of California at San Francisco, San Francisco (D.T.).Address reprint requests to Dr. Fudala at the Psychiatry Service, Ward 7E (116-7E), VA Medical Center, University and Woodland Aves., Philadelphia, PA 19104.

We are indebted to James Hosking, Ph.D., Karen Kook, Pharm.D., John Mendelson, M.D., J. Thomas Payte, M.D., Paolo B. Petrillo, M.D., and Eric Strain, M.D., for invaluable guidance and insight as members of the data and safety monitoring board; and to Frank Vocci, Ph.D., director of the Division of Treatment Research and Development, National Institute on Drug Abuse, National Institutes of Health, for leadership and support of this project.

Appendix

Other members of the Buprenorphine/Naloxone Collaborative Study Group were as follows: Principal investigators in the open-label study — R. Douyon, the Veterans Affairs Medical Center, Miami; M. Fe-Bornstein, the Veterans Affairs Medical Center, New Orleans; J.G. Liberto, the Veterans Affairs Medical Center, Baltimore; and E. Santos, the Veterans Affairs Medical Center, San Juan, Puerto Rico; other members of the study group — K. Ajir, K. Annon, J.M. Buckelew, K. Conley, B.L. Curtis, T. Doane, D. Gaughan, L.D. Gorgon, C. Haakenson, M. Hanrahan-Boshes, R.L. Hawks, J. Hill, P. Lane, J. Leal, D. Leiderman, D. Lokhorst, P. Manning, F. McSherry, D. Preston, M. Sather, S. Scott, E. Somoza, S. Stinnett, K.B. Thomas, D. Wagner, J. Wagner, and R. Walsh.

How to Find the Best Drug and Alcohol Rehabilitation Center

2010-08-16T17:45:00.000-07:00

One of the truths with the addicts of drug or alcohol is that before getting treatment they need to accept that they have a disease and they need the treatment.

After realizing, they need cures from drug or alcohol addiction. Before joining any drug and alcohol rehabilitation center, they or their relatives, friends must survey the drug and alcohol rehabilitation centers around their locality.
So the first thing people need to know about the drug and alcohol rehabilitation center is where to join. It is very necessary to know the procedures the drug and alcohol rehabilitation center is using. They must keep in mind that they are ill and they need the best treatment to leave their drug or alcohol addiction.

Here are some facts to be known which should be kept carefully in the mind before getting into a drug and alcohol rehabilitation center.

1. At first before searching the drug and alcoholic rehabilitation centers in the surrounding area, people need to know if it is essential for them to be tested for a drug or alcoholic addiction.

2. They must see if they are capable to analyze the need of your treatment level. At the same time they should also see if the experts in rehabilitation center are able to understand the need of drugs to be used in the treatment.

3. They must be able to visit the drug and alcohol rehabilitation center as many times as they ask to visit. They should ask the professionals in that drug and alcohol rehabilitation center how much time it will take to overcome the problem.

4. They must check if the cost of the treatment is up to their budget. May be it is costly so they need to produce a budget for the cure.

5. It is also necessary to know if they need to leave their job, so they must ask about it at the drug and alcohol rehabilitation center. This will help them plan everything accordingly.

Finally, those who are taking drug or alcohol in any way must accept that they are drug or alcohol addicts and need some treatment. Once they make up their mindPsychology Articles, the best drug and alcohol rehabilitation centers in their surroundings are there to get the best result of drug or alcohol rehabilitation program.

ABOUT THE AUTHOR

Serenity Manor East is leading alcohol and drug rehabilitation center in New York. We exist to provide a safe, nurturing, and effective course of alcohol and drug treatment, in a serene, high end environment, that will empower all who walk through our doors to go on to live a productive and happy life.

Marijuana Arrests Fuel Increase in Teen Drug Treatment Numbers

2009-10-06T09:04:00.000-07:00

The number of American teenagers in drug treatment increased dramatically during the 1990s, but that jump was fueled almost entirely by teen marijuana users arrested and ordered into treatment by the courts. According to a study released earlier this fall by the Substance Abuse and Mental Health Services Administration (SAMHSA), the number of youth aged 12 to 17 placed in drug treatment programs rose from 95,000 in 1993 to 138,000 in 1998, an increase of 46% in five years. But the study, "Coerced Treatment Among Youths: 1993-1998," reported that "the increase was largely driven by marijuana-involved admissions referred through the criminal justice system."

"What an incredible waste," said retired American University law professor Arnold Trebach, founder of the Drug Policy Foundation and currently head of the Trebach Institute (http://www.trebach.org). "The idea that every teenage pot-smoker needs treatment is absurd," he told DRCNet. "I'm opposed to kids smoking pot," he added. "That could lead to tobacco use, which could be dangerous, but the notion that they need treatment is a reflection of how messed up our drug policy is at its core."

The study, which relied on data from SAMHSA's Drug and Alcohol Services Information System's Treatment Episode Data Set (TEDS), a nationwide compilation of treatment episodes in centers receiving federal funding, found that teen drug treatment referrals from other sources remained stable over the five-year period. Teens referred to drug treatment by schools have declined slightly to about 15,000 after peaking at about 20,000 in 1995. Self-referrals, where either the teen or a friend or family member arranged the intervention, hovered at about 20,000 in 1998, down slightly from the mid-1990s. All other referrals, which include health care providers and community, government or religious social service providers, increased from 20,000 to 30,000 between 1993 and 1995, but have remained at that level since then.

Criminal justice system referrals, either for marijuana alone or for marijuana and alcohol, have gone through the roof, however, increasing from about 37,000 in 1993 to more than 60,000 in 1998. According to the study, by 1998 almost half (49%) of all teen drug treatment admissions came through the courts, and people admitted for marijuana alone or marijuana and alcohol combined constituted three-quarters of all admissions. (Over the five-year period, alcohol alone and marijuana alone switched positions. In 1993, alcohol alone was named in 24.4% of admissions and marijuana alone in 11.9%. By 1998, alcohol alone had dropped to 9.3%, while marijuana alone had increased to 24.9%. Marijuana and alcohol combined grew slightly from 45.4% in 1993 to 51.2% in 1998.)

During the five-year period, in the midst of rapidly rising marijuana arrests during the Clinton administration, the number of teens forced into drug treatment by the criminal justice system increased 73%.

Despite the increases in overall marijuana arrests and in teens sent to drug treatment by courts, "there is very little evidence of a teen pot problem," said Trebach. "I just checked the data on child deaths from drug abuse from 1996-1999," he explained. "There are roughly a hundred per year, for all drugs. Kids are fairly sensible about this," said Trebach. "There is no great need for treatment [for teenagers], but there is a real need for getting honest information to the kids. Some kids do get in trouble with drugs, and they could use the help, but it has to be intelligent help, not the harsh regimen they often find in drug treatment today."

Visit http://www.samhsa.gov/OAS/coercedTX.pdf to read the study in full.

Everything You Need to Know About CARE Addiction Recovery

2009-09-29T09:00:00.000-07:00

Author: Kausik Dutta

Acknowledging that you have a problem with drugs or alcohol can be stressful and upsetting. However, it’s the first step to recovering from your addiction and learning to live a fulfilling and sober life.

The next step can be frustrating as well: choosing which recovery or rehabilitation center to enroll in. There are many different options out there, and you want to find the one that will be the best for you. For many different reasons, CARE is a wonderful place for you to recover from your addiction.

CARE offers a wide variety of programs and treatments for you to participate in. This center understands that each person is different and strives to individualize each treatment program so that it will best treat the addict on a specific and individual basis. CARE also has a low client to therapist ratio, so you’re sure to get the attention and help that you need through this difficult time. The center realizes that they are not treating only an addiction—they are treating a human being as well. Therefore, each program is customized, taking into consideration your special needs, histories and reasons for becoming an addict. Each drug is different, too, and CARE takes this into consideration. Some drugs affect our bodies differently than others, and the combination of a specific drug and an individual personality can be complex to treat. This is why CARE approaches each patient with respect, care and concern. Their number one goal is to aid you to recovery.

While CARE uses a modified 12-step program such as those used through Alcoholics Anonymous and Narcotics Anonymous, the center takes it a step further and incorporates holistic healing, pain management, and the treatment and acknowledgement of underlying psychological factors that some patients may have. There are many specialty programs available such as alternative medicine, massage therapy, nutrition counseling, and herbal therapy. The combination of these alternative practices with tradition detox and recovery programs help to make CARE the successful addiction recovery center that it is.

If you or something you know has a problem with drugs or alcohol, contact CARE Addiction Treatment. The staff will do all they can to help you down the bumpy road of rehabilitation and recovery.

Author Information:
CARE Addiction Treatment is the premier source for finding information about drug rehab Florida centers. Source: http://u.article99.com.com/rkweb-solution/

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Signs of an Addiction

2009-09-22T08:55:00.000-07:00

Addictions come in many forms. It's important to recognize the signs of addictions in order to seek out help before the problem becomes to large.

Some different types of Addictions are: Caffeine addiction, nicotine addiction, drug addiction, Alcohol addictions, and gambling addictions.

Like mentioned above it's very important to recognize the symptoms of addictions in order to be able to recognize and treat an addiction before it becomes to serious. There are several different symptoms, some vary on type of addiction, and others are age and gender specific. Here is a look at some of the most common symptoms:

Uncontrolled Craving and Desires – This symptom can be general to all types of addictions. For example: food/drink cravings, gambling cravings

Fatigue – Often times addictions will result in both physical and mental fatigue, as your body will often be working over time, and not resting properly.

Obsessive thoughts – Can you not get a thought out of your mind, is it starting to take over and effect the way you think?

Change in Behavior – Do you suspect that your behavior has changed? Are you more moody, or easily frightened?

Hyperactivity – Do you seem to be excessively active, but not getting a lot done? Do you fidget more then usual? Do you have problem sitting still for any length of time?

These are just a few of several signs that can indicate the development or indication of an already existing addiction. If you are experiencing any of these signs, and it is unusual for you, I would recommend seeking out further existence either by a medical or mental professional.

Be smart with your health and body. Your only given one chance with it!

Feel free to reprint this article as long as you keep the following caption and author biography in tact with all hyperlinks.

Ryan Fyfe is the owner and operator of Addiction Area. Which is a great web directory and information center for Addiction and related topics like Rehabilitation.

Source: healingsteps.com

When Alcohol Abuse Changes to Alcoholism

2009-09-15T08:48:00.000-07:00

By Dennis Soinski

Changing a Person's Drinking Behavior

Thousands of articles have been written and countless research studies have been undertaken regarding alcoholism. In spite of this, the one finding that has apparently failed to reverberate throughout the alcohol abuse and alcoholism academic and medical communities is the emphasis on the fact that alcohol addiction has its roots in alcohol abuse. While this fact has many ramifications, perhaps the key upshot of this fact is that millions of non-alcoholic individuals in our society and throughout the world who engage in abusive drinking can address their drinking consumption and make healthy and positive changes in their drinking behavior before they become alcohol dependent.

One school of thought sees alcohol abuse in the following way: alcohol abuse takes place whenever an individual's drinking causes a problem in any aspect of his or her life.

The areas of a person's life where alcohol abuse commonly leads to problems includes the following:

· relationships
· employment
· school
· finances
· health
· the law (for instance, a DUI).

The Need for Positive and Healthy Change

Now that we are aware of the problems that are usually associated with alcohol abuse, it can be seen that in order to overcome these difficulties and issues it is important for the alcohol abuser to look in the mirror and honestly ask himself or herself if alcohol is causing a problem in any facet of his or her life.

As an additional component in the quest for healthy and positive change, problem drinkers need to understand that continued, repetitive, and heavy drinking can and does turn into alcohol addiction. Stated differently, millions of non-alcoholics in our society who have a drinking problem will, at some point in their lives, experience a transition from alcohol abuse to alcohol dependency. When this happens, it must be emphasized, the person will no longer simply be an alcohol abuser. Indeed, at this point, the person will be an alcohol abuser and an alcoholic.

Signs of Alcohol Addiction

How can a person tell if he or she is alcohol dependent? First, the experience of alcohol withdrawal symptoms when an individual suddenly stops drinking is one sign that alcoholism has reared its ugly head.

Second, repetitive and out-of-control drinking behavior is another indication that a person has become an alcoholic. What this usually means is that after consuming the first drink, the individual lacks control over stopping his or her drinking and therefore continues to drink until he or she becomes inebriated.

Alcohol Addiction Has Its Roots in Alcohol Abuse

Perhaps the key in all of this is the following: most, if not all instances of alcohol addiction get their start from alcohol abuse. Stated another way, it is highly unlikely that a non-drinker will become alcohol dependent simply by having one drink or that a non-drinker will become an alcoholic by getting drunk once. Indeed, alcoholism does not result from infrequent and sporadic drinking but rather from continuous, excessive, and repeated drinking. The point: alcoholism doesn't take place in a vacuum. In short, the roots of alcoholism are found in alcohol abuse.

Knowing this and letting this "fact" influence an individual's drinking behavior in a positive and healthy manner is perhaps the single most important health-related bit of information that a problem drinker can learn and implement in his or her life.

Why is this so important? Research shows that alcoholics are masters of denial, deception, dishonesty, and manipulation and often blame their alcohol-related problems on situations and people outside themselves. Alcoholics also exhibit out-of-control and irresponsible drinking behavior. Not only this, but most alcoholics will lie, cheat, and steal in order to get their next drink. Why would an alcohol abuser who is not yet an alcoholic want to face such a dreary and destructive set of circumstances?

Part One of Two

This article is part one of a two-part article. See the "About the Author" section below for the website address of the complete article.

About The Author:

Denny Soinski writes about alcohol abuse, alcoholism, drug abuse, and drug addiction. The above article is part one of a two-part article. To see the full version of this article, please go to the following website: When Alcohol Abuse Changes to Alcoholism.

Copyright 2009 - Denny M. Soinski. All Rights Reserved Worldwide. Reprint Rights: You may reprint this article as long as you leave all of the links active, do not edit the article in any way, and give the author name credit.

Article Source: http://EzineArticles.com/?expert=Dennis_Soinski

Cocaine Use by College Students and Celebrities

2009-09-08T08:45:00.000-07:00

Cocaine Use Increases

An article entitled "Cocaine Epidemic Feared As Cocaine Deaths Nearly Double In Florida Over Past 5 Years" was featured on the "Medical News Today" website on October 21, 2006. Not surprisingly, the information contained in this article was quite disconcerting. For instance, one of the key points in the article was that cocaine use is on the rise among college students with disposable income and also among high-profile celebrities. Perhaps of more importance, however, are two facts that are associated with the escalation in cocaine use: the increased cocaine-related emergency room visits and the rising cocaine-related fatalities. In fact, according to Florida drug authorities, cocaine-related deaths in Florida have almost doubled from 2000 to 2005.

Why People Use Cocaine

Why do various individuals use cocaine? Cocaine gives a person a feeling of euphoria, energy, and at times, an unbelievable, almost superhuman sense of control and mastery. For instance, some people who have taken cocaine have been known to leap out of windows or off rooftops, thinking that they could fly or that they could jump dozens of feet without getting injured. There is, however, a physiological reason why people continue to use cocaine after their first encounter. Cocaine exhausts the "feel-good" neurotransmitter dopamine, thus causing a need for even more use. In short, and from a physiological perspective, cocaine use perpetuates more cocaine use.

Fatalities and Cocaine Use

To gain a better understanding of the ultimate danger inherent in cocaine use, namely death, one needs to focus on the timeframe regarding its life-threatening effects. To accomplish this, cocaine use will be compared with prescription drug abuse.

The abuse of prescription drugs such as Oxycontin, Vicodin, and Adderall can trigger abrupt cardiac or respiratory arrest at the time of abuse. Thus the critical and fatal timeframe when abusing prescription drugs is mostly "short-term." Conversely, due to the snowballing effects of cocaine, especially regarding the blood vessel damage that increases the risk of stroke or heart attack as a person ages, users can suddenly die years after their cocaine abuse started. Therefore, the critical and fatal timeframe for cocaine use, unlike the same measure for prescription drug abuse, is typically "long term."

Why the Rise in Cocaine Use?

Why is cocaine use increasing? One of the reasons is that celebrities who are addicted to cocaine have become "walking cocaine advertisements" and, as a result, have been able to adversely influence others, such as students, who have access to relatively large amounts of disposable income.

The Need For Intervention and Education

Florida drug experts stress that additional drug education and intervention need to take place in schools, colleges, and in local communities nationwide to help prevent a full-blown cocaine epidemic. I agree, but to be effective, I assert that the intervention and educational strategy has to include facts that challenge the lifestyles of the cocaine-using celebrities. Let me explain. Students need to be aware that they are observing a "snapshot in time" that does not reveal "the rest of the story" as Paul Harvey would say. Stated differently, college students who are impressed by cocaine-using high rollers need to learn how to see through the VIPs' facade and realize that they are getting "sold" faulty goods by the cocaine-using rich and famous.

Many celebrities are at or approaching middle age. As a result, most, if not all, of the high-profile chronic cocaine have learned first-hand about the consequences of their drug-related lifestyles. On the other hand, most "traditional" college students are either teenagers or very young adults. Due to the cumulative effects of cocaine use, however, college students who continue to use cocaine are essentially playing Russian roulette with their near and long-term future.

The Rest of the Story

College students must be made aware of the fact that the cocaine-using celebrities that they are impressed with are really loose cannons that may explode into oblivion at any time because of their drug-related lifestyles. This "ultimate" and fatal consequence, however, does not tell the whole story. Indeed, the "rest of the story" also focuses on both the short-term and the long-term health consequences of cocaine use.

Short and Long-Term Effects of Cocaine Use

What the impressionable students have not seen are the friends of celebrities who have died from cocaine-related cardiac arrest, seizures, strokes, and respiratory failure. In addition, the vulnerable students have not been told about the "coke crash" that certainly has left some of the rich and famous depressed, irritable, and fatigued.

Not only this, but the easily influenced students have not been informed about the loss of smell, problems with swallowing, and the nosebleeds experienced by some of the rich and famous who got their cocaine "buzz" via snorting. Moreover, the "receptive" students have not been notified about the bizarre, unpredictable, and at times violent behavior of many high rollers who took increasingly larger doses of cocaine in order to experience the desired high.

Additionally, the suggestible students were not informed about the abdominal pain and nausea experienced by some of the cocaine-using celebrities. In a similar manner, the impressionable students were not told about the paranoid psychosis and auditory hallucinations experienced by various VIPs who experimented with binge cocaine use, i.e., taking more frequent AND higher doses of the drug at the same time.

Moreover, the vulnerable students were not told about the fever, convulsions, blurred vision, muscle spasms, and comas experienced by some of the cocaine-using VIPs or by some of their friends who "party" with them. Similarly, the impressionable students were not told about the major weight loss, malnourishment, and loss of appetite experienced by numerous celebrities who have been chronic cocaine users. And finally, the susceptible students were not informed about the severe chest pains, coughing, shortness of breath, and bleeding in the lungs experienced by some of the celebrities who got their cocaine "buzz" via smoking.

Conclusion

College students need to become knowledgeable of the immediate and the long-term health problems that virtually all chronic cocaine users, even celebrities, eventually experience. In addition, they need to become aware of their vulnerability to cocaine use due to the fact that, statistically speaking, the 18 to 25-year-old age group currently has the highest rate of cocaine use compared to other age groups. Until college students can "see" the contradictions and damaging effects inherent in the questionable lifestyles of cocaine-using VIPs, however, some of them will continue to follow the destructive paths of the high-profile cocaine-using celebrities.

Copyright 2007 - Denny Soinski. All Rights Reserved Worldwide. Reprint Rights: You may reprint this article as long as you leave all of the links active, do not edit the article in any way, and give the author credit.

Denny Soinski, Ph.D, writes about alcohol abuse intervention, alcohol addiction, alcohol testing, alcohol use and binge drinking, alcoholism, alcohol recovery, alcohol treatment, and alcohol rehab. For more information, please visit college and teen alcoholics right away!

Careful treatment of alcohol dependency is necessary for a swift recovery by Andrew Regan

2009-09-03T01:11:00.000-07:00

For many people in the UK, the consumption of alcohol is merely an everyday habit. Whether it's two or three beers in the pub after work, or a few glasses of wine with your dinner, drinking alcohol is, to many, a basic social gesture. And while many individuals may binge drink to their detriment every weekend, it's important to establish the difference between people who often drink more than is good for them and those that are alcohol dependent.

If you suffer from alcohol dependency, it means that you feel the need to have a drink to help you with certain situations. For instance, if the thought of socialising without having a few drinks first fills you with dread and anxiety, then you're likely to be alcohol dependent. Alcohol dependency isn't quite the same as alcoholism; alcoholics need alcohol to handle every situation, while alcohol dependents rely on alcohol to get them through only certain situations. But, alcohol dependency does require treatment, and may in turn develop into alcoholism if left unchecked.

In contrast to opiate dependency, alcohol withdrawal may often present a risk to life; and acute withdrawal of alcohol in chronic alcohol dependency may lead to Delirium Tremens. Delirium Tremens is characterised by acute confusion, disorientation, vivid visual hallucinations, paranoia, marked tremors and other various symptoms and signs of alcohol withdrawal. If left untreated, Delirium Tremens can lead to a 10 per cent mortality rate, and therefore requires urgent medical admission.

Additionally, alcohol withdrawal seizures often present a risk to life and, if observed, should be treated with a bolus of parenteral or per rectal diazepam. However, in most cases, alcohol dependent patients will not need prescriptions. Instead, following advice to cut down drinking at a gradual pace will be sufficient to manage most acute presentations of alcohol dependency. Nevertheless, it's important to keep in mind that a patient with a clear history of withdrawal seizures, who claims to have no access to alcohol supplies, may be labelled as appropriate to commence a community detoxification with chlordiazepoxide immediately - but this course of action should be avoided wherever possible.

If you suffer from alcohol dependency, or are close to someone who does, and are looking for alcohol treatment, you might find that private residential alcohol treatment is preferable to community treatment. This method of alcohol treatment is beneficial because it allows the patient to choose their own location in which they'd like to treat their alcohol dependency. But wherever you choose to undertake a course of alcohol treatment, it's important to always keep basic alcohol treatment guidelines in order to ensure a swift and effective recovery.

Andrew Regan is an online, freelance journalist.

Article Source: http://www.a1-articledirectory.com

Issues for DSM-V: Internet Addiction

2009-09-01T07:53:00.000-07:00

Jerald J. Block, M.D.

Internet addiction appears to be a common disorder that meritsinclusion in DSM-V. Conceptually, the diagnosis is a compulsive-impulsivespectrum disorder that involves online and/or offline computerusage (1, 2) and consists of at least three subtypes: excessivegaming, sexual preoccupations, and e-mail/text messaging (3).All of the variants share the following four components: 1)excessive use, often associated with a loss of sense of timeor a neglect of basic drives, 2) withdrawal, including feelingsof anger, tension, and/or depression when the computer is inaccessible,3) tolerance, including the need for better computer equipment,more software, or more hours of use, and 4) negative repercussions,including arguments, lying, poor achievement, social isolation,and fatigue (3, 4).

Some of the most interesting research on Internet addictionhas been published in South Korea. After a series of 10 cardiopulmonary-relateddeaths in Internet cafés (5) and a game-related murder(6), South Korea considers Internet addiction one of its mostserious public health issues (7). Using data from 2006, theSouth Korean government estimates that approximately 210,000South Korean children (2.1%; ages 6–19) are afflictedand require treatment (5). About 80% of those needing treatmentmay need psychotropic medications, and perhaps 20% to 24% requirehospitalization (7).

Since the average South Korean high school student spends about23 hours each week gaming (8), another 1.2 million are believedto be at risk for addiction and to require basic counseling.In particular, therapists worry about the increasing numberof individuals dropping out from school or work to spend timeon computers (5). As of June 2007, South Korea has trained 1,043counselors in the treatment of Internet addiction and enlistedover 190 hospitals and treatment centers (7). Preventive measuresare now being introduced into schools (9).

China is also greatly concerned about the disorder. At a recentconference, Tao Ran, Ph.D., Director of Addiction Medicine atBeijing Military Region Central Hospital, reported 13.7% ofChinese adolescent Internet users meet Internet addiction diagnosticcriteria—about 10 million teenagers. As a result, in 2007China began restricting computer game use; current laws nowdiscourage more than 3 hours of daily game use (10).

In the United States, accurate estimates of the prevalence ofthe disorder are lacking (11, 12). Unlike in Asia, where Internetcafés are frequently used, in the United States gamesand virtual sex are accessed from the home. Attempts to measurethe phenomenon are clouded by shame, denial, and minimization(3). The issue is further complicated by comorbidity. About86% of Internet addiction cases have some other DSM-IV diagnosispresent. In one study, the average patient had 1.5 other diagnoses(7). In the United States, patients generally present only forthe comorbid condition(s). Thus, unless the therapist is specificallylooking for Internet addiction, it is unlikely to be detected(3). In Asia, however, therapists are taught to screen for it.

Despite the cultural differences, our case descriptions areremarkably similar to those of our Asian colleagues (8, 13–15),and we appear to be dealing with the same issue. Unfortunately,Internet addiction is resistant to treatment, entails significantrisks (16), and has high relapse rates. Moreover, it also makescomorbid disorders less responsive to therapy (3).

Footnotes
Address correspondence and reprint requests to Dr. Block, 1314Northwest Irving St., Suite 508, Portland, OR 97209; jblock@aracnet.com(e-mail). Editorial accepted for publication November 2007 (doi:10.1176/appi.ajp.2007.07101556).

Dr. Block owns a patent on technology that can be used to restrictcomputer access. Dr. Freedman has reviewed this editorial andfound no evidence of influence from this relationship.

Editorials discussing other DSM-V issues can be submitted tothe Journal at http://mc.manuscriptcentral.com/appi-ajp. Submissionsshould not exceed 500 words.

References

TOP References

Dell’Osso B, Altamura AC, Allen A, Marazziti D, Hollander E: Epidemiologic and clinical updates on impulse control disorders: a critical review. Eur Arch Psychiatry Clin Neurosci 2006; 256:464–475[CrossRef][Medline]

Hollander E, Stein DJ (eds): Clinical Manual of Impulse-Control Disorders. Arlington, Va, American Psychiatric Publishing, 2006

Block JJ: Pathological computer use in the USA, in 2007 International Symposium on the Counseling and Treatment of Youth Internet Addiction. Seoul, Korea, National Youth Commission, 2007, p 433

Beard KW, Wolf EM: Modification in the proposed diagnostic criteria for Internet addiction. Cyberpsychol Behav 2001; 4:377–383[CrossRef][Medline]

Choi YH: Advancement of IT and seriousness of youth Internet addiction, in 2007 International Symposium on the Counseling and Treatment of Youth Internet Addiction. Seoul, Korea, National Youth Commission, 2007, p 20

Koh YS: Development and application of K-Scale as diagnostic scale for Korean Internet addiction, in 2007 International Symposium on the Counseling and Treatment of Youth Internet Addiction. Seoul, Korea, National Youth Commission, 2007, p 294

Ahn DH: Korean policy on treatment and rehabilitation for adolescents’ Internet addiction, in 2007 International Symposium on the Counseling and Treatment of Youth Internet Addiction. Seoul, Korea, National Youth Commission, 2007, p 49

Kim BN: From Internet to "family-net": Internet addict vs. digital leader, in 2007 International Symposium on the Counseling and Treatment of Youth Internet Addiction. Seoul, Korea, National Youth Commission, 2007, p 196

Ju YA: School-based programs for Internet addiction prevention and intervention, in 2007 International Symposium on the Counseling and Treatment of Youth Internet Addiction. Seoul, Korea, National Youth Commission, 2007, p 243

The more they play, the more they lose. People’s Daily Online, April 10, 2007

Aboujaoude E, Koran LM, Gamel N, Large MD, Serpe RT: Potential markers for problematic Internet use: a telephone survey of 2,513 adults. CNS Spectr 2006; 11:750–755[Medline]

Block JJ: Prevalence underestimated in problematic Internet use study (letter). CNS Spectr 2007; 12:14[Medline]

Lee HC: Internet addiction treatment model: cognitive and behavioral approach, in 2007 International Symposium on the Counseling and Treatment of Youth Internet Addiction. Seoul, Korea, National Youth Commission, 2007, p 138

Block JJ: Pathological computer game use. Psychiatric Times, March 1, 2007, p 49

Ko CH: The case of online gaming addiction without other comorbid psychiatric disorders, in 2007 International Symposium on the Counseling and Treatment of Youth Internet Addiction, Seoul, Korea, National Youth Commission, 2007, p 401

Block JJ: Lessons from Columbine: virtual and real rage. Am J Forensic Psychiatry 2007; 28:5–33

Source: ajp.psychiatryonline.org

How To Find The Right Drug and Alcohol Rehab Center

2009-08-31T08:18:00.000-07:00

By: Jon Arnold

When you, a family member or loved one is battling against the demons associated with drug and/or alcohol abuse, rehabilitation is needed to get back on a healthy track. Turning to the healing properties of a drug rehab or alcohol rehab center can bring about the lifestyle and behavioral changes associated with leaving negative influences to the wayside.

There are numerous drug and alcohol rehab centers across the United States. Sometimes, a patient may even choose treatment outside of the country. Rehabilitation is a very emotional and a mental roller coaster that takes every ounce of restraint and focus. It is the responsibility of alcohol and drug rehab centers to find the medium and motivation for each patient to embrace recovery. Each and every individual that walks through the door of a clinic or enters a program is unique.

Different Clinic and Program Approaches

Since no two patients are alike, drug and alcohol rehab programs and procedures differ. While some rely heavily on prescription drugs and other medical techniques, there are other methods of treatment that utilize holistic or natural approaches. When evaluating a potential drug or alcohol rehab center, there are several different types of treatment programs to consider. Substance abuse is a delicate issue and each drug of choice is dealt with in a different manner. For instance, sleeping pill addiction will not be treated in the same way as crystal meth addiction.

One of the main decisions regarding the type of alcohol or drug rehab center to consider is the length of necessary treatment. With short-term rehab clinics, a patient may become a resident and undergo various medical approaches for several weeks. They may also receive drug-free outpatient services. When longer-term care is needed, several outpatient treatments are available as well. A patient may also choose to live in a residential community treatment center to ensure continue drug-free success. Some residents may choose or need to spend years at these types of facilities.

The issue of medication and other drug treatment options come into play when choosing a drug rehab clinic, as seen through what is called maintenance treatment. For example, a heroin addict may receive an oral dose of methadone to help block the effects of their abused drug of choice. The methadone helps to eliminate the cravings that many addicts encounter through physiological demands on their body. Some people are leery of methadone treatments because this drug in itself can be addicting.

When it comes time to locate the best drug rehab and alcohol rehab centers within your grasp, doctors and other health professionals will give you what is called a referral. You may receive one or two to choose from, but they are usually the most viable options of treatment for you to consider. When budget is of no concern, some people will look into treatment options both near and wide. Some drug and alcohol rehab centers are more private than others, offering certain luxuries that state officials cannot afford. There are numerous brochures and websites to scan when you are able to pay more for your treatment options.

What to Expect With Treatment

Very rarely do you see drug rehabilitation without some sort of approach towards psychological repair. Even though drugs can be purged from the physical parts of the patient, it is the mental barriers and breakdowns that continue the vicious cycle of drug abuse. Most drug rehab and alcohol rehab programs will treat the mind, body and soul of a patient. This is the best approach towards increasing the success rate for when patients are released onto the world.

It is also much healthier for the patient to receive well-rounded treatment so that they may achieve stronger, more positive outcomes. It is the goal of rehab centers to make sure patients equip themselves with the tools and strength needed to resist temptation and face the threat of relapse.

While at a drug or alcohol rehab center, you will encounter a trained professional who knows the ins and outs of drug addictions. Physicians and therapists become important fixtures on the road to recovery. They will ask you many different questions and may even perform a series of medical tests. This will assist in the accurate assessment of your personal characteristics. It will aid in deciding on the appropriate drug rehabilitation program that you will benefit the most from. You could face inpatient, outpatient, residential, and/or short-stay treatment.

Helping Rehabilitated Patients Succeed

It is the responsibility of the newly rehabilitated patient to take control over the things that affect their life. Surrounding themselves with positive influences and adhering to outpatient counseling and programs is a must. Family and friends should be supportive and aware that the potential of relapse is never too far behind. A circle of support and encouragement is crucial to long term success.

For a newly released drug or alcohol rehab patient, one day at a time never made more since than now. Each morning should be greeted with individual care and concern. They may need a lot of help to continue their success. Love, understanding, and support is all friends and family can give; the rest is up to the rehabbed individual.

Article Source: http://www.afroarticles.com/article-dashboard

Jon Arnold is a computer engineer who maintains many websites to pass along his knowledge and findings. You can read more about Drug and Alchohol Rehab at his web site at www.rehab-alcohol-drug.com/

About Drug Rehabilitation Centers in New Jersey

2009-08-27T05:38:00.000-07:00

New Jersey drug rehabilitation centers assist substance abusers with detoxification and recovery from drug addiction. The term "drug" is defined here as any addictive chemical including alcohol, tobacco, prescription pharmaceuticals and illegal narcotics. The New Jersey Division of Addiction Services (DAS), a division of the Department of Human Services and the central organization for addiction recovery in the state, defines addiction as "a chronic, progressive, and often fatal disease characterized by irrational thoughts and habitual behaviors," but the DAS recognizes that the disease is treatable.

Features

Drug rehabilitation centers in New Jersey are as varied in scope and focus as our universities and hospitals. Facilities may specialize in substance abuse and recovery, or they may treat cases in conjunction with broader mental and behavioral health services. Many offer clinical and emotional support, while others provide only detoxification and medical attention. Treatment facilities are religious, like Catholic Charities in East Brunswick, or secular. Some centers are associated with local hospitals such as Raritan Bay Medical Center Behavior Services in Perth Amboy, but most are independent organizations providing customized recovery care.

Function

In addition to standard detox and recovery, New Jersey treatment facilities provide drug abuse education, occupational and life skills training, emotional and psychological support, and community reintegration. Rehab centers help patients recover physically and emotionally from the ravages of addiction, and then prepare them for a clean, productive life as fully functioning members of society. Addiction issues are approached differently based on the type of care and rehabilitation required.

Types

The DAS identifies 12 types of drug and alcohol abuse treatment. They are:

1. Hospital-based detoxification--Detox services administered and managed by a licensed general or specialized hospital. Service providers are associated with a local hospital, and may offer in-patient or out-patient detoxification.

2. Non-hospital-based detoxification--Detox services administered and monitored in a licensed residential (non-hospital) treatment facility. Service providers are not associated with a hospital, but are licensed by the state and capable of providing in-patient as well as out-patient detoxification.

3. Residential short-term--A licensed non-hospital facility that provides a structured recovery environment and professional clinical services that address addiction and lifestyle issues for recovering addicts.

4. Residential long-term or therapeutic community--A licensed non-hospital facility that provides a structured recovery environment and professional clinical services that address addiction and lifestyle issues for recovering addicts. This program utilizes the structure of a community to reintegrate the patient into society with specific focus on education and vocational skills.

5. Extended care--A licensed non-hospital facility that provides room and board for 60 days or more. The structured environment addresses addiction, interpersonal skills and emotional development with an emphasis on work therapy.

6. Partial hospitalization--A licensed freestanding, non-hospital and non-residential facility providing a structured environment 20 hours per week over a minimum of four separate occasions. Services include substance abuse counseling, education and community support.

7. Intensive out-patient--A licensed, non-residential facility providing clinically intensive programs. Services include individual, group and family counseling, and education for a minimum of nine hours per week.

8. Out-patient--A licensed, non-residential facility providing scheduled individual, group and family counseling for less than nine hours per week. Patients have access to medical and support services.

9. Methadone maintenance--Also referred to as opioid pharmacotherapy. A licensed facility utilizing methadone, LAAM2 or other approved pharmaceutical to maintain patients addicted to heroin or similar opiates. These facilities also provide medical monitoring, lab testing, clinical assessment and intervention.

10. Out-patient detoxification--Planned withdrawal implemented by gradually decreasing doses of the problem drug.

11. Halfway house--Licensed facility providing six months or more of room, board and support services. Treatment is intended to assist patients with adjusting to regular patterns of life via education, vocation and independent self-monitoring.

12. Group recovery homes--Not licensed by the state. Facilities are also referred to as transitional homes or three-quarter Houses. Patients rent living space and offer each other support services. A boarder must abstain from drugs and alcohol to remain a resident. Oxford House is the recommended provider in New Jersey. For a list by county of

Benefits

Rehab facilities are conveniently located, with multiple centers in each of New Jersey's 21 counties. Most licensed centers receive state and county funding from the DAS to offset costs and reduce rates. Payment methods and funding resources include:

* Private health insurance
* Military insurance (VA,TRICARE, etc.)
* Medicaid
* Medicare
* Self pay/sliding scale
* Payment assistance
* South Jersey Initiative (SJI)
* NJ Access Initiative (NJAI)
* Drug Court (DC)
* DUI Initiative (DUII)
* Work First New Jersey (WFNJ)
* Dept. of Youth & Family Services (DYFS)
* MAP Program

Considerations

The Division of Addiction Services evaluates, regulates and licenses drug rehabilitation treatments, programs and facilities throughout New Jersey to ensure hygienic, professional care. Before beginning any treatment program, make sure the facility is licensed and current with the DAS.

Written by John Farley

Source: essortment.com

The "Rock Bottom" Myth - Learn How to Raise the Bottom

2009-08-27T01:03:00.000-07:00

The "Rock Bottom" Myth - Learn How to Raise the Bottom
This whole idea of "hitting bottom" is out of date. Some people will wait years-even decades-for their friend to reach this mythical point in their alcohol and drug use. But why wait for them to "hit bottom"? Why not help them by raising their bottom?

Ezine Articles by Joe Herzanek

EEG Spectral Changes in Treatment Naïve Active Alcoholics

2009-08-25T07:27:00.000-07:00

G. Fein, Ph.D and J. Allen, B.A

Neurobehavioral Research, Inc., Corte Madera, CA

Address reprint request and correspondence to: Dr. George Fein, Neurobehavioral Research, Inc., 201 Tamal Vista Boulevard, Corte Madera, CA 94925, Tel: 415.927.7676, Fax: 415.924.2903, Email:george@nbresearch.com

Abstract

Background

The present study examines the EEG spectra of actively drinking treatment naïve alcoholics (TxNA).

Methods

EEGs were gathered on 51 TxNA’s and age and sex-matched controls during eyes-closed conditions. Participants were excluded for lifetime diagnoses of psychiatric or substance abuse disorders. Power for the theta to high beta bands was examined across midline electrodes.

Results

The TxNA sample exhibited a nexus of disinhibited traits associated with the vulnerability to alcoholism, and had developed alcohol dependence, but no other diagnosable psychiatric or substance abuse disorders. The TxNA subjects evidenced higher power for all EEG bands compared to controls. The magnitude and anterior-posterior extent of the group differences varied across bands. Within the TxNA group, EEG power was negatively correlated with average and peak alcohol drinking duration and average and peak alcohol dose.

Conclusions

Increased EEG power across the theta to high beta bands distinguishes TxNAs without comorbid diagnoses from controls. These effects varied across bands in their magnitude and spatial extent, suggesting that there are different effects for the different EEG spectral generators. We hypothesize the increased power in these individuals is a trait difference associated with the inherited nexus of disinhibited traits and its manifestation in alcoholism.

Based on the strong negative correlations with alcohol use variables, we speculate that decreases in EEG power are a morbid effect of long-term alcohol abuse. We acknowledge that this hypothesized effect of alcohol abuse on EEG power is opposite to the increased EEG power we hypothesize is associated with alcoholism and its inherited nexus of disinhibited traits. An implication of this model is that with continuing alcohol abuse, the increased EEG power in TxNAs will eventually be overpowered by the effects of long-term severe alcohol abuse. This model predicts that in very long-term alcoholics EEG power would be equal to or lower than that of age and sex comparable controls.

Keywords: Resting EEG, power spectra, alcoholism, treatment naïve, aging

INTRODUCTION

Given the EEG’s high heritability and its dramatic response to alcohol intoxication, the EEG has been studied extensively as a trait marker for the genetic vulnerability to alcoholism. Many studies have reported increased slow alpha activity as a response to ethanol ingestion in both men and women (Cohen et al., 1993; Ehlers et al., 1989; Lukas et al., 1986; Lukas et al., 1989), and some have revealed changes in theta, and fast alpha activity as well (Ehlers et al., 1989; Lukas et al., 1986; Volavka et al., 1985). The background EEG is highly heritable (e.g., (Van Baal et al., 1996), as is alcoholism (Begleiter and Porjesz, 1999; Foroud et al., 1998; Foroud et al., 2000; Reich et al., 1998). Moreover, the heritability of the EEG recorded post alcohol administration is even higher than that recorded under resting conditions (Propping, 1977; Sorbel et al., 1996). In alcohol challenge studies, Ehlers and Shuckit reported elevated beta in FHP (family history positive) vs. FHN (family history negative) men 90 minutes post ethanol (Ehlers and Schuckit, 1990) and a decrease in fast alpha post-ethanol in FHN, but not FHP subjects (Ehlers and Schuckit, 1991).

Several studies have examined EEG power as a trait marker for alcoholism, comparing individuals at high vs. low risk for developing alcoholism, with varying results. In a recent study, Rangaswamy et al. found increased beta power in FHP individuals (Rangaswamy et al., 2004). Pollock et al. (Pollock et al., 1995) reported increased beta power in older FHP subjects compared to age- and gender-matched controls. Ehlers and Shuckit found elevated baseline fast alpha in FHP subjects (Ehlers and Schuckit, 1991). In contrast, Finn and Justus found that the offspring of alcoholics showed reduced alpha power and elevated beta power compared to FHN controls (Finn and Justus, 1999). Finally, Cohen et al. found no alpha or beta EEG power differences between FHP vs. FHN samples (Cohen et al., 1991).

Compared to the studies of high-risk samples, there have been relatively few studies of alcoholic samples. Rangaswamy et al. found increased theta power in alcoholics (Rangaswamy et al., 2003), as well as increased low beta power in male alcoholics, and increased mid beta power in female alcoholics (Rangaswamy et al., 2002). Pollock et al. examined the EEG spectra (delta through beta), and found increased theta amplitude for recovered alcoholics, but no differences for any other band (Pollock et al., 1992). These EEG spectral studies included large numbers of participants with comorbid substance abuse disorders, antisocial personality disorder, and depression, all factors independently associated with abnormal EEG power (Bauer and Hesselbrock, 1993; Costa and Bauer, 1997; Knott et al., 2001; Newton et al., 2003; Petersen et al., 1982).

Finn et al. (Finn et al., 2000) reported that social deviance proneness and excitement/pleasure seeking account for a significant portion of the relationship between a positive family history of alcoholism and later alcohol abuse. Current theories propose that disinhibition is a fundamental mediator of the inherited predisposition toward alcohol dependency (Begleiter and Porjesz, 1999; Cloninger, 1987; Sher et al., 1991; Tartar et al., 1985). It has been proposed that behavioral phenomena such as psychopathy, antisocial and impulsive traits, and alcoholism, should be viewed as variable expressions of a generalized disinhibitory complex (Gorenstein and Newman, 1980). Several studies have reported that EEG power in externalizing disorder samples is similar to that seen in FHP samples. Excessive theta activity has been associated with a number of indicators of disinhibited personality, such as antisocial personality (Mednick et al., 1981), attention-deficit/hyperactivity disorder (Barry et al., 2003), borderline personality disorder (Russ et al., 1999), and criminality (Petersen et al., 1982; Raine et al., 1990). Excessive theta activity is thought to indicate cortical underarousal and has been associated with measures of low autonomic arousal (Raine et al., 1990). Some theorize that excessive theta reflects delayed cortical maturation and poor behavioral control that often leads to disinhibited behavioral syndromes such as antisocial personality and substance abuse (Ishikawa and Raine, 2002). Alpha power has been reported to be increased in persons with extroverted personality traits (Wall et al., 1990).

The current study examines eyes-closed resting EEG power in treatment naïve actively drinking alcoholics (TxNA) compared to age- and gender-matched controls. This study excludes participants with lifetime diagnoses of comorbid psychiatric or substance abuse disorders. Participants were currently drinking, met current DSM-IV-R criteria for alcohol dependence, and had never sought treatment for alcoholism; in fact none of the TxNA participants self identified as alcoholics. This sample is more representative of alcoholic dependent individuals in the general population than are treated samples. We have shown that they come from a different population than treated samples, with less severe drinking histories in the first four to five years after meeting criteria for heavy drinking (Fein and Landman, in press). During this period, long-term abstinent alcoholic men and women drank an average of 210 and 134 drinks per month while TxNA men and women drank an average of 165 and 98 drinks per month. In the current study, we examine the TxNA sample’s EEG spectra, and its association with age and drinking variables.

METHODS

Participants

All participants were recruited from respondents to postings, mailings, newspaper ads, ads on an Internet site, and referrals from other participants. The study involved a sample of treatment naïve, actively drinking, alcohol dependent (TxNA) individuals, and a control sample (C) matched on a one-to-one basis on gender and age with the TxNA sample. The TxNA group was recruited by advertising for ‘heavy social drinkers’ or ‘men and women who have a high tolerance for alcohol’. None of the TxNA participants labeled themselves alcoholics, and we never used the word alcoholism in referring to these participants, either in our advertisements or in their assessment procedures.

The TxNA group (n= 51) was comprised of 20 women and 31 men between the ages of 19 and 50 (mean = 31.9, SD = 8.0). Table 1 presents subject demographics, alcoholism family history measures, and alcohol use variables and a measure of the number of symptoms of externalizing disorders and two personality measures of deviance proneness, the CPI (California Psychological Inventory Socialization Scale (Gough, 1994)), and MMPI-2 Pd (Minnesota Multiphasic Personality Inventory 2 Psychopathic Deviance Scale (Hathaway, 1989)).

Table 1

Characteristics of Participant Groups

The inclusion criteria for the TxNA group was that they meet lifetime DSM-IV-R (American Psychiatric Association, 2000) criteria for alcohol dependence, that they were currently drinking, and that they have never sought treatment for alcoholism. DSM-IV criteria for alcohol dependence were assessed from an initial phone interview with the subjects. Participants were asked a series of questions taken from the DSM-IV-R criteria for alcohol abuse and dependence. If a subject answered “yes” to three or more of these questions at any time in the same twelve-month period, he/she met criteria for alcohol dependence. Similar questions were asked for all other drugs used more than experimentally to exclude individuals who met criteria for abuse or dependence on other drugs. Inclusion criteria for the C group was a lifetime drinking average of less than 30 alcohol containing drinks per month, and never having exceeded 60 drinks per month (a standard drink was defined as 12oz. beer, 1.5 oz. liquor, or 5 oz. of wine).

All participants were given a computerized psychiatric diagnostic evaluation (Computerized Diagnostic Interview Schedule (Robins, 1998)) and psychological assessments. Separate lifetime use data was gathered for alcohol and all drugs used more than experimentally (using the timeline follow-back methodology of the Lifetime Drinking History Questionnaire (Skinner and Sheu, 1982; Sobell and Sobell, 1992)). Participants also had their medical history reviewed, had a blood draw to test liver function, and completed the Family Drinking History Questionnaire, based on the Family Tree Questionnaire by Mann et al., (Mann et al., 1985). We derived two measures from the Family Drinking History Questionnaire: the number of first degree relatives that were identified by the participant as problem drinkers, and the proportion of first degree relatives that were identified as problem drinkers. Post-alcohol withdrawal hyper-excitability (PAWH) was implemented partway through the study, after which it was administered to all TxNA subjects (n=28). PAWH was measured using a self-report questionnaire where subjects estimated (on a 0 to10 point scale) the frequency and distress caused by physical and psychological symptoms experienced during alcohol withdrawal. For the frequency estimate, a 0 meant never, 1 corresponded to 10 % of the times one ceased drinking, up to a 10 which indicated the symptom was experienced 100% of the time one ceased drinking. For the degree of distress caused by the presence of the symptom, a 0 meant not at all distressing, a score of 5 meant somewhat distressing, and a 10 meant “unbearable.” The symptoms were compiled from the Diagnostic Interview Schedule (DIS) (Robins, 1998), the alcohol dependence scale (Skinner and Allen, 1982), and SSAGA interviews (Bucholz et al., 1994). We computed the average frequency and intensity over eight symptoms that measure PAWH: i) shakes (hands tremble, shake inside); ii) feel tense, nervous or anxious; iii) feel fidgety or restless; iv) have trouble concentrating v) heart pound or beat rapidly; vi) feel hypersensitive to stimuli (e.g. light, sound, touch); vii) have difficulty sleeping; and viii) have memory problems.

Exclusion criteria for both groups were: 1) history or presence of an Axis I diagnosis on the DIS, 2) history of stroke, diabetes, or hypertension that required medical intervention, 3) significant history of head trauma or cranial surgery, 4) clinical or laboratory evidence of active hepatic disease, 5) Wernickes-Korsakoff syndrome, 6) a history of drug dependence other then caffeine or nicotine, or 7) current substance abuse other then alcohol (aside from caffeine and nicotine). As noted above, substance abuse and dependence were determined from the phone interviews where follow-up questions were asked for all drugs (other than caffeine or nicotine) where the subject acknowledged more than experimental use.

Each subject was informed as to the nature of the study and procedures and signed a consent form prior to their participation. Participants were to complete a total of four sessions that included clinical, neuropsychological, electrophysiological and neuroimaging assessments. All participants were to abstain from drinking for 24 hours prior to each lab visit, and a Breathalyzer was administered before each session. No participants in the current study had positive Breathalyzer results (>.000) on any of their study sessions. Other drugs of abuse were not tested for. For the purposes of this study, we are examining only the data during the eyes closed resting portion of the EEG session, which took place on the third visit. All participants who completed a session were paid for the session and any travel expenses. Participants also received a completion bonus if they completed all four sessions of the study.

EEG Recording and Artifact Reduction

As noted above, participants were given a Breathalyzer upon arrival at the EEG lab; a 0.000 Breathalyzer result was required to continue the session. Participants were seated comfortably in a sound attenuated room. The computer screen, used in presenting stimuli for other EEG/ERP experiments, was turned off. The participants were asked to relax with their eyes closed for five minutes. Over the course of the study, two EEG acquisition systems were used, a 40-channel system (n = 87) and a 64-channel (n = 15). Only the midline electrodes, which were common to both systems, were examined for this study. Reference was the right ear for all recordings, and ground was 4 cm above the nasion for 40-channel caps and 8 cm above the nasion for 64-channel caps. EEG data was acquired using the NuAmps (NuAmp, Neuroscan, Inc.) single-ended 40 channel amplifier and Scan 4.2 Acquisition Software (Neurosoft, Inc.) for the 40-channel recordings. The NuAmps amplifier had a fixed range of ±130 μV sampled with a 22 bit A/D converter where the least significant bit was 0.062 μV. For the 64-channel recordings, EEG data was acquired using the SynAmps2 (SynAmps2, Neuroscan, Inc.) amplifier and Scan 4.3 Acquisition Software (Neurosoft, Inc.). The SynAmps2 amplifier had a fixed range of ± 333 μV sampled with a 24 bit A/D converter where the least significant bit was 0.019 μV. Electrode impedances were maintained below 10 kΩ. The sampling rate was 250 samples per second, and activity was recorded for 5 minutes. Data from control subjects whose data was collected using the different amplifier systems (NuAmps, SynAmps2) were examined, and revealed no differences associated with the different acquisition amplifiers. Vertical eye movements were recorded by electrodes above and below the left eye for later reduction of ocular artifact.

Raw data were processed offline using the Edit Program in Scan 4.3 (Neurosoft, Inc.). Data from the first and last minute were discarded and the analysis was performed on the middle three minutes of recordings. Ocular artifacts were removed using the ocular artifact reduction algorithm (ARTCOR) implemented in Scan4.3 (Neuroscan, 2003). Data were then bandpass filtered between 0.5 and 30Hz at 48 dB/Octave. Power spectra was computed using the Scan4.3 AVERAGE procedure which computes a standard power spectrum adapted from the Cooley-Tukey method, on 512 sample epochs (2.044 seconds in duration) using a 10% cosine taper. Average power spectra were then aggregated for six frequency bands: theta (3 to 7.5 Hz), low alpha (7.51 to 10 Hz), high alpha (10.01 to 12 Hz), low beta (12.01 to 16 Hz), mid beta (16.01 to 20 Hz), and high beta (20.01 to 28 Hz). A natural log transformation was applied to the absolute power data to normalize the distributions.

Statistical Analysis

This paper only examines the midline recordings common to all participants (Fz, FCz, Cz, CPz, Pz, Oz). Repeated measures ANOVA was carried out on the log power dependent variables using the General Linear Models procedure in the Statistical Analysis System (SAS Institute, 1990), with age, group and gender as between-subject effects and EEG band and electrode as repeated measures. The association of band power with age and alcohol use variables was analyzed using Spearman correlations. Because alcohol use duration is partially confounded with age (older participants have had a longer life in which to drink), associations of EEG measures with alcohol use duration and with age were examined using partial correlation analysis (i.e., association of EEG measures and age with alcohol use duration partialled out, and association of EEG measures and alcohol use duration with age partialled out).

RESULTS

Group Differences in Demographic and Subject Variables

Table 1 presents the demographic, alcohol use and subject variables for men and women in each group. As noted above, the TxNA group and controls were matched for age and gender with age ranging from 19 to 50 years. The groups were also similar in education. The TxNA group had more first degree relatives who were problem drinkers (F₁,₉₈ = 6.72, p < .02), but this effect was not very large, with group membership accounting for only 6.2% of the variance of the number of first degree relatives who were problem drinkers. As expected, the groups differed on alcohol use measures (group membership accounted for 5.2% of the variation in duration of active drinking, 64.1% of the variance of average lifetime drinking dose, 59.8% of the peak dose variance, and 58.7% of the variance of the drinking dose in the 6 months immediately prior to the study. The TxNA group compared to Controls had a larger number of externalizing symptoms (the sum of Antisocial Personality Disorder and Conduct Disorder symptoms on the DIS (Robins, 1998)), with group membership accounting for 8.5% of the symptom count variance (F₁,₉₈ = 9.96, p<.003). They also showed more evidence of deviance proneness on both the California Psychological Inventory (CPI) socialization scale (Group accounting for 21.7% of the variance (F₁,₉₈ = 27.85, p < .0001) and the MMPI Psychopathic Deviance (PD) scale (Group accounting for 9.5% of the variance (F₁,₉₈ = 10.31, p < .002).

As described above, PAWH was measured using a self-report questionnaire where participants estimated (on a 10 point scale) first, the frequency and then, the distress level of physical and psychological symptoms experienced during alcohol withdrawal. The TxNA’s mean score (± sd) for the frequency of withdrawal symptoms was 2.46 ± 1.6, meaning that, on average they experienced withdrawal symptoms after drinking 24.6% of the time. On the distress level scale (10 point scale), a zero indicated that the withdrawal symptoms bothered the participant “not at all”, a three indicated that the symptoms were “a little bothersome” and five indicated that the symptoms were “somewhat bothersome”. The mean score for distress was 2.91 ± 1.89, indicating that the participants typically found the distress of withdrawal symptoms less then “a little bothersome”. There were no significant associations between EEG power and withdrawal measures.

EEG Power

Analysis of between-group effects (between subject variance)

In the between subjects analysis (power averaged across bands and electrodes), group membership accounted for 4.0 % of the log power variance (F_1,93 = 4.4, p < r =" −.22,">1,93 = 5.1, p <>1,93 = 3.0, p < .09), with men having lower EEG power than women.

Analysis of repeated measures effects

The analysis of repeated measures indicated the well known large differences in power between the EEG bands (accounting for 33.3% of the within-subject across band variance, F_5,465 = 51.43, p < .0001), and across electrode sites (accounting for 6.9% of the within-subject across electrode variance, F_5,465 = 8.34, p < .0001). There were also electrode by group interactions (accounting for 5.6% of the within-subject across electrode variance, F_5,465= 6.75, p < .0005), and band by electrode by group interactions (accounting for 2.5% of the within-subject across bands and electrodes variance, F_25,2325 = 2.63, p < .02); both of these effects indicate that differences in power between the groups varied across bands and electrodes. Figure 1

presents this data. The strongest group differences were observed for low alpha and mid beta, where the TxNA group had higher power at all midline electrode locations except the most frontal (Fz). The TxNA group showed higher power at the central-posterior sites (CPz, Pz, Oz) for high beta. For theta, high alpha, and low beta the TxNA group had higher power at CPz and Oz, with a trend towards higher power at Pz.

Fig. 1

Displays group differences in EEG power for each band at each midline electrode location. For presentation purposes the inverse of log (power) has been used to show the results as power on a natural log scale. *, **, ***: p < .05, p < (more ...)

There were band by age interactions, electrode by age interactions, and group by band by electrode by age interactions (all F_5,465 > 4.88, p < .002) indicating that the correlations with age differ across groups, bands, and electrodes. In order to better understand this data, we computed age correlations for each group at each electrode within each band. Table 2. presents these associations. In the controls, there were only a few age associations. For high alpha, there was a negative association at Fz, as well as trends for negative associations at FCz and Oz. For low beta, a positive association with age was observed at CPz, with a trend at Cz. Similarly, positive associations between age and power were observed at these same electrode locations for mid and high beta.

Table 2

Association of EEG Power with Age and Lifetime Drinking Duration

Within the TxNA group, the age associations were consistently negative, and showed strong patterns across electrodes within specific bands. Strong negative correlations with age were observed at all midline electrode sites for theta, high alpha, and low beta power. For mid-beta power, negative associations were observed only at Oz, and for low alpha and mid beta power only a trend for a negative correlation at Oz was observed.

Since age may potentially be confounded with lifetime drinking duration (older participants may have had a longer time to drink), we examined the association between lifetime drinking duration and power measures in the TxNA group. There were strong negative associations between power and lifetime drinking duration for theta, high alpha, and low beta at all electrode sites, and for low alpha power and mid beta power at Oz, with a trend for high beta at Oz (see Table 2). Within the TxNA group, we next examined the associations between age and power with lifetime drinking duration partialled out. These partial correlations were close to zero (see Table 2). Because negative associations with age were not seen in controls, the simplest explanation for this pattern of results is that these negative associations in the TxNA group of age with EEG power are a consequence of the negative association of abusive drinking with power.

In a search for additional evidence supporting this hypothesis, we examined the association between lifetime drinking dose (drinks/month) and the power measures within the TxNA group. Table 3 presents these associations. There were strong negative associations at all electrode sites of the alcohol dose variables with low beta, mid beta, and high beta, as well as negative associations with low alpha power at Fz, FCz, Cz, and CPz, with a trend for an association at Pz. Negative associations were also evident for high alpha power at the frontal electrodes, with a trend for a negative association for theta power at Pz and Oz. These negative associations between alcohol dose and power measures is consistent with the hypothesis that the negative associations of power measures with age and with lifetime duration of drinking in the TxNA group are a consequence of abusive drinking rather than of age per se.

Table 3

EEG Power Associations with Lifetime Drinking Dose (Average Drinks/Month)

The few associations observed between power and lifetime drinking dose in the controls were more sporadic, weaker, and positive rather then negative. These positive associations and trends were seen for theta power at CPz, low alpha power at Cz, CPz, Pz, and Oz, and mid beta power at Oz. It is of interest that in the controls, the effects of moderate or light drinking may have the opposite effect to that seen in the alcohol dependent sample, with alcohol use actually increasing EEG power.

In the TxNA group, the measures of alcohol use over the six months prior to study were very highly correlated with the average lifetime dose measures (r = 0.93). For this reason, we did not examine the associations of recent alcohol dose with EEG measures since the results would have been entirely redundant with the results for average dose. Finally, we found no associations of the power measures with either of the family history of alcoholism measures (number of first degree relatives with alcohol problems and percent of first degree relatives with alcohol problems) all r’s < |.22|, p > 0.12.

DISCUSSION

Central Findings

The central finding in this study was that TxNA alcoholics evidence higher power than controls across the theta to high beta bands, with the magnitude and anterior-posterior extent of these effects varying across bands. The largest and most widespread effects were for the low alpha and mid beta bands, where the effects were present for all electrodes posterior to Fz. For the other bands, the effects did not extend as anteriorly and were of smaller magnitude. These differences in the effects across bands indicate that the effects are not a simple global increase in EEG power, but rather are specific and different effects for the various bands. Given that we asked all subjects to abstain from alcohol for 24 hours prior to the EEG session, no subjects had positive breathalyzer tests on the day of their EEG study, and that on average our TxNA subjects reported experiencing withdrawal symptoms only about one quarter of the time, we believe it is highly unlikely that their EEG results reflect the effects of post alcohol withdrawal hyperexcitability.

In the introduction, we reviewed the literature showing that there is a nexus of disinhibitory traits, deviance proneness, externalizing symptoms, and a positive family history for alcoholism that often appear together and are strongly associated with alcoholism and other substance abuse. In its more severe manifestations, this nexus is represented in alcoholics with comorbid psychiatric, other substance abuse, and antisocial diagnoses. In addition, a relatively common set of EEG characteristics has been associated with the various aspects of this nexus.

The population studied here is unique with regard to this nexus discussed above. All participants met criteria for alcohol dependence (alcoholism), yet they had at most a minimally greater family history for alcoholism than controls. Individuals with comorbid antisocial personality disorder, conduct disorder, depression, anxiety, or other substance abuse disorders were excluded. The TxNA sample came from a population with a history of early abusive drinking (in the first five years immediately after meeting criteria for heavy alcohol consumption) that was 30–40 % less in average and peak dose than treated samples (Fein and Landmann, in press). They had an increased rate of externalizing symptoms and psychological evidence of deviance proneness compared to controls, although these rates were markedly less than those of treated samples (Fein et al., 2004). Our hypothesis is that the population studied is composed of individuals with less severe manifestations of the nexus described above who have gone on to develop alcohol dependence but no other diagnosable psychiatric or substance abuse disorders. We believe our results show that this select population is characterized by increased EEG power across the theta to high beta bands.

While the sample studied (TxNA) was advantageous in that it is more representative of alcoholics in the general population in that it is an untreated sample free of comorbid disorders, there were limitations inherent in studying this sample. We did not examine severe active alcoholics, and although it is possible that our sample represents severe alcoholics in the relatively early stages of their alcoholism, previous examination of this population suggests that this is in fact a different population from alcoholics typically studied. Furthermore, the sample studied reported experiencing relatively minor withdrawal symptoms. Although it is beneficial to be able to show that it is highly unlikely that our results are associated with alcohol withdrawal, our results are silent on the EEG effects of more severe withdrawal that may be present in samples with greater alcoholism severity.

There are other limitations to the current study. In hindsight, we should have assessed for caffeine or nicotine dependence or recent caffeine or nicotine use to determine the degree to which such use or dependence could have influenced our EEG results. Finally, since our TxNA sample is almost by definition in denial about their alcoholism, it is also highly likely that they would be in denial with regard to alcohol problems in their first degree relatives. Their data regarding the family history of alcoholism assessment is highly suspect and may be a gross underreporting of alcohol problems in their extended families. Therefore, the negative findings regarding the association of the EEG power measures with the family history of alcoholism should be discounted.

Our data support the hypothesis that an effect of long-term alcohol abuse is to negatively impact the substrate underlying EEG power. Negative associations between EEG power and alcohol use variables (both dose and duration), suggests that a reduction in EEG power is a morbid effect of accumulating alcohol abuse. We acknowledge that this hypothesized effect of alcohol abuse is opposite to the increased EEG power effect that we hypothesize is associated with the inherited nexus of disinhibited traits that conveys a vulnerability to alcoholism. The current subjects were studied at the relatively early stages of this process, before these morbid effects of chronic alcohol abuse can overpower the trait-related increased EEG power present in this sample of alcoholics.

With continuing alcohol abuse, we would expect to see the trait of increased EEG power in alcoholics overpowered by the effects of long-term severe alcohol abuse. In other words, in longer term and more severe alcoholics, we hypothesize that we would not see the increased EEG power observed in the current study. In the most severe and longest-term alcoholics, we hypothesize that we would see an actual reduction in EEG power. We have been studying a sample of long-term abstinent treated alcoholics in whom we can test these hypotheses.

Footnotes

This work was supported by Grants AA11311 (GF) and AA13659 (GF), both from the National Institute of Alcoholism and Alcohol Abuse. We also express our appreciation to the NRI recruitment and assessment staff, and to each of our volunteer research participants.

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The NARCONON™ drug education curriculum for high school students: A non-randomized, controlled prevention trial

2009-08-25T01:47:00.000-07:00

Richard D Lennox
Psychometrics Technologies, Incorporated, 2404 Western Park Lane, Hillsborough, NC 27278, USA

and

Marie A CecchiniIndependent Research Consultant, 10841 Wescott Avenue, Sunland, CA 91040, USA

Background

An estimated 13 million youths aged 12 to 17 become involved with alcohol, tobacco and other drugs annually. The number of 12- to 17-year olds abusing controlled prescription drugs increased an alarming 212 percent between 1992 and 2003. For many youths, substance abuse precedes academic and health problems including lower grades, higher truancy, drop out decisions, delayed or damaged physical, cognitive, and emotional development, or a variety of other costly consequences. For thirty years the Narconon program has worked with schools and community groups providing single educational modules aimed at supplementing existing classroom-based prevention activities. In 2004, Narconon International developed a multi-module, universal prevention curriculum for high school ages based on drug abuse etiology, program quality management data, prevention theory and best practices. We review the curriculum and its rationale and test its ability to change drug use behavior, perceptions of risk/benefits, and general knowledge.

Methods

After informed parental consent, approximately 1000 Oklahoma and Hawai'i high school students completed a modified Center for Substance Abuse Prevention (CSAP) Participant Outcome Measures for Discretionary Programs survey at three testing points: baseline, one month later, and six month follow-up. Schools assigned to experimental conditions scheduled the Narconon curriculum between the baseline and one-month follow-up test; schools in control conditions received drug education after the six-month follow-up. Student responses were analyzed controlling for baseline differences using analysis of covariance.

Results

At six month follow-up, youths who received the Narconon drug education curriculum showed reduced drug use compared with controls across all drug categories tested. The strongest effects were seen in all tobacco products and cigarette frequency followed by marijuana. There were also significant reductions measured for alcohol and amphetamines. The program also produced changes in knowledge, attitudes and perception of risk.

Conclusion

The eight-module Narconon curriculum has thorough grounding in substance abuse etiology and prevention theory. Incorporating several historically successful prevention strategies this curriculum reduced drug use among youths.

Background

Effective education is needed to address today's burgeoning substance abuse problem

Although the annual, benchmark study, Monitoring the Future (MTF) [1], has measured small declines in drug use during the past few survey years, the estimated 13 million youths aged 12–17 in the U.S. who become involved with alcohol, tobacco and other drugs annually remains high compared with the declining trend seen during the 1980's which ended in 1992 [2].

Problem areas include the estimated $22.5 billion that underage consumers spent on alcohol in 1999 (of $116.2 billion total) [3]; an alarming 212 percent increase in the number of 12- to 17-year olds abusing controlled prescription drugs between 1992 and 2003; and youth initiation of pain relievers estimated at 1,124,000 in 2001, second only to marijuana initiation at 1,741,000 [2]. Controlled prescription drugs (including OxyContin, Valium and Ritalin) are now the fourth most abused substances in America behind only marijuana, alcohol and tobacco.

When prevention efforts fail it is not at small cost. In 2005, lifetime prevalence rates for any drug use were 21%, 38%, and 50% in grades 8, 10, and 12, respectively [1]. Although it can be argued that not all students who try drugs will develop problems, in 2002 the alcohol abuse and dependence-related costs for lost productivity, health care, criminal justice, and social welfare were estimated at $180.9 billion [4].

For many youths, substance abuse precedes academic problems such as lower grades, higher truancy, lower expectations, and drop out decisions [5]. In fact, the more a student uses cigarettes, alcohol, marijuana, cocaine and other drugs, the more likely they will perform poorly in school, drop out [6,7] or not continue on to higher education [8].

Consistent with the goals and public health agenda of the Office of National Drug Control Policy (ONDCP) and the Department of Education, the Narconon program's ultimate goal is to prevent and eliminate drug abuse in society. Research has shown that preventing or delaying initiation of alcohol or other drug use during early adolescence can reduce or prevent substance abuse and other risk behaviors later in adolescence and into adulthood [9,10]. However, there is still much discussion regarding what policy and strategies to employ toward this goal.

For the past 30-years, Narconon drug prevention specialists have delivered seminars aimed at supplementing existing prevention efforts by further illustrating materials covered in school curricula. In 2004, Narconon International developed an eight-module drug education curriculum for high school ages based on the research and writings of L. Ron Hubbard as incorporated into the secular Narconon drug rehabilitation methodologies. Program developers analyzed post-program student feedback, surveys collected as a quality management practice that has been in place since program inception and continues today, in light of evidence-based practices and prevention theory to create a stand-alone, universal (all youths) drug education curriculum for high school ages aimed at addressing key problem areas.

The eight module Narconon drug education curriculum for high school ages incorporates a unique combination of prevention strategies with content addressing tobacco, alcohol, marijuana and common "hard drugs." Health motivation, social skills, social influence recognition and knowledge-developing activities address a number of risk and protective factors in the etiology of substance abuse and addiction. The aim of this study was to assess the program's ability to change drug use behavior, attitudes and knowledge among youths and evaluate the components of the Narconon drug prevention curriculum against prevention theory.

Methods

Description of the sample

The Narconon program recruited 14 schools from two states. Schools were assigned to education or control groups based on similarity of school size, community size and general ethnicity. Schools also agreed to complete three testing points: Baseline, approximately one month later, and a six month follow-up. The full Narconon drug education curriculum was implemented either after completion of the baseline survey (education condition) or after completion of the final six month survey (control condition). Fidelity of curriculum delivery was verified by facilitator report.

After obtaining parental consent, there were 236 control group and 244 experimental group students in Oklahoma, with 295 control group and 220 experimental group students in Hawai'i. Voluntary assent and confidentiality were explained to the students. After the baseline survey, one charter school of 26 participants withdrew from the study for scheduling reasons. No provision was made to adjust representation by gender or potentially interesting ethnic or risk groups.

The study protocol and consent forms were reviewed and approved by Copernicus Group IRB (Protocol HI001). Human participant protections certified survey staff assigned each student a unique identification number based on a classroom roster. For confidentiality, students marked their answers on standard bubble answer forms labeled only with their unique identification number. The roster and identification code was used to give students the same identification number at each survey point, thus permitting comparison of answers given on each measurement occasion – a sampling strategy that provided the necessary statistical power to identify differences in tested variables among a universal classroom population, where the majority of youths do not use drugs. Completed answer forms were placed by each student into a security envelope, sealed, and returned to survey staff for mailing to the Principal Investigator for scanned data entry, data management, and statistical analysis.

Drug education intervention

The study design called for each of the schools recruited to the experimental conditions to receive the complete drug education curriculum. Professionally trained facilitators followed a codified delivery manual and completed a daily compliance report. Codified Narconon drug prevention curriculum materials help the facilitator implement the program according to specific standards, maintaining program fidelity.

Outcome measures

The primary outcome measure was last 30-day substance use using the Center for Substance Abuse Prevention (CSAP) Participant Outcome Measures for Discretionary Programs designed for outcomes evaluation in CSAP funded substance abuse prevention programs which is recommended for use in a pre-test/post-test design. (Form OMB No. 0930-0208 Expiration Date12/31/2005) [11]. Questions were directed to frequency of use of twenty two drugs of abuse including twelve questions from the Monitoring the Future Survey [1].

Secondary outcomes assessed by the CSAP instrument included perception of risk, attitudes and decisions about drug use including five questions from the Monitoring the Future Survey that ask about perceived harm from substance use; and four questions from the Student Survey of Risk and Protective Factors [11] that ask about drug use attitudes. In addition to calculating change in behavior and beliefs among individuals, these questions permit comparisons to state and national norms.

Additionally, the program developers recommended 25 questions that were appended to the CSAP survey for the purpose of assessing whether drug education concepts covered by the Narconon program are correctly understood by each program recipient, to what extent they are retained at follow-up points, and whether or not students could apply key program concepts. The program developer questions were designed to examine proximal effects including the ability of the program to educate by examining recall of program material, as well as give an impression of student capacity to apply program skills such as self-reported ability to communicate their beliefs on substance use, recognize and resist pressures to use substances, and make decisions.

Statistical analysis

The non-randomized design – where it cannot be assumed that groups assigned to experimental and control conditions will be equal – calls for a conservative analysis. For this reason the study utilized Analysis of Covariance (ANCOVA) of the change scores from baseline, controlling for initial drug use as well as changes in the school populations as covariates. The autocorrelation among the classroom clusters was statistically accommodated through use of a nested treatment effect, in which the treatment effect was nested within the classroom effect. Type III sum of squares deviations between the baseline characteristics of both groups were used in all post-treatment statistical comparisons of the treatment and control group, thus statistically controlling for any differences existing at baseline and removing any effects caused by pre-existing differences between the two test conditions that might confound the results. In this way, the analysis is aimed at establishing the statistical strength and reliability of assigning any measured differences at the six-month post-treatment follow-up to the drug education received by the experimental group rather than any attempt to quantify those changes.

Results

Evaluation of Narconon curriculum components

Table 1 outlines the eight curriculum sessions against key constructs used by many drug prevention programs. The interactive curriculum imparts science-based information from fields as diverse as toxicology, forensic science, nutrition, marketing, pharmacology, and many others. Program materials include audiovisual support and clear lesson plans that are to be delivered in their entirety combined with quality management tools such as anonymous student questionnaires for each session and a facilitator's log sheet to list any session problems and/or questions. Facilitator training emphasizes the importance of effective communication as well as creating an environment in which students may ask questions, discuss personal situations, and actively participate.

Table 1. Constructs in the Narconon Drug Education Curriculum for high school students.

Tests for selection bias: Demographic representation and drug use characteristics of groups at baseline

A total of 995 students out of a possible 1106 were recruited based on informed parental consent. Of these 726 completed both the baseline assessment and the six-month follow-up. The main sources of attrition were students not available on the day of survey and students no longer enrolled at the study school at the six month follow up.

Although selection of sites for "no treatment" attempted to match the demographic composition at intervention sites with respect to residence state, age, and general economic group, this strategy does not guarantee that the two types of sites are free from selection bias. Table 2 presents demographics composition of the control and treatment groups. Students frequently indicated several ethnic categories. The ethnic make-up of this group is particularly interesting as the evaluation includes a number of typically under-represented groups; however, the size and scope of this study do not make analysis of individual ethnic groups feasible.

Table 2. Demographics.

The drug use portion of this questionnaire determines general usage levels for the various drugs (except for cigarettes and smokeless tobacco). For example, "On how many occasions during the last 30 days have you used marijuana ..." is answered on the scale: "1" = 0 occasions, "2" = 1–2 occasions, "3" = 3–5 occasions, "4" = 6–9 occasions, "5" = 10–19 occasions, "6" = 20–39 occasions, and "7" = 40 or more occasions. From this, Table 3 shows the means for both groups to be slightly higher than 1 or "0 occasions", indicating some degree of drug use but a high proportion of individuals not using substances, or that substance.

Table 3. Drug use at baseline: Comparison of means between treatment and control groups.

Comparison of the means on the drug use measures between the treatment and control groups prior to receiving any drug education, as seen in Table 3, show that the two groups do not differ significantly on any of the drug abuse measures, suggesting that any difference seen at follow-up was unlikely to be caused by pre-existing differences.

Effects of the Narconon drug education curriculum on drug use compared with sites that have not yet received the curriculum

At follow-up, as shown in Table 4, students in the drug education program, but not the control group, had moved toward less drug use for virtually all of the drug use types. Given the similarities of group drug use behavior measured at baseline, this pattern alone supports the reliability of the differences created by the drug education curriculum.

Table 4. Drug use at six month follow-up: Comparison of means between treatment and control groups.

A number of drug use reductions achieve statistical significance. Characteristics of the specific tests indicate the effectiveness of the program. The areas of alcohol, tobacco and marijuana use in the past 30 days are particularly relevant to high school populations: Amount of cigarette use showed the strongest effect (F = 3.89, df = 11, p < f =" 3.39," df =" 11," f =" 3.35," df =" 11," f =" 2.28," df =" 11," p =" 0.010" f =" 2.12," df =" 11," p =" 0.017," f =" 1.87," df =" 11," p =" 0.040" f =" 169," df =" 11," p =" 0.073,">

Among the "hard drugs," use of amphetamines was somewhat prevalent among these youths and was significantly reduced by the curriculum (F = 2.35, df = 11, p = 0.008). Reduction in use of amphetamines without a prescription approached significance (F = 1.59, df = 11, p = 0.098).

The differences between the drug education and control groups are consistent with the literature on universal, classroom-based types of intervention [12] where drug use data is obtained by self-report and levels of substance use are high among only a small subgroup of youths [13].

Influence of the Narconon drug education curriculum on perception of risk and attitudes about drugs or drug use compared with sites that have not yet received the curriculum

Survey questions for decisions regarding drug use, changes in perceptions of risk and attitudes regarding drug use and means of the answers for each group at follow-up along with the significance values are presented in Table 5. Corresponding percents of students answering in an anti-drug fashion are presented for each question in Tables 6, 7 and 8.

Table 5. Means of attitudes and beliefs responses at six month follow-up.

Table 6. Decisions regarding drug Use: Percent of students in each group who gave a "drug free" answer.

Table 7. Perception of "harmfulness" of drugs: Percent of students in each group who answered "great risk."

Table 8. Disapproval of drug use: Percent of students in each group who answered "wrong" or "very wrong."

Six months after participating in the program, controlling for baseline differences, there was a much greater tendency for the control group to plan to get drunk in the year following the six-month follow-up compared with the drug education program group (F = 1.65, df = 11, p = 0.003) as well as a stronger decision to smoke cigarettes among the control group. (F = 1.33, df = 11, p = 0.008) In comparison, the drug education treatment group stated a stronger commitment to a drug free lifestyle than the control group (F = 1.82, df = 11, p = 0.048).

At six month follow-up, four out of five questions assessing risk of harm were statistically significant. Significantly more students in the drug education group indicated great risk to the question "how much do people risk harming themselves (physically or in other ways) if they try marijuana once or twice (F = 6.55, df = 11, p < f =" 9.41," df =" 11," f =" 1.91," df =" 11," p =" 0.035).

Although a greater percent of students who received the Narconon drug education curriculum indicated great risk of harm from smoking one or more packs of cigarettes per day, and having one or two drinks each day, the mean answer for that group indicated slightly less risk than answered by the control group (F = 5.79, df = 11, p < f =" 2.27," df =" 11," p =" 0.010">

Among the questions assessing whether students believed drug use was "wrong" or "very wrong" for someone their age, the drug treatment group felt that dinking liquor, smoking cigarettes, and using LSD, etc., were more wrong at follow-up than did the control group (F = 3.15, df = 11, p < f =" 4.12," df =" 11," f =" 3.96," df =" 11,">

Competency in absorbing the material covered in the Narconon drug education curriculum compared with sites that have not yet received the curriculum

The ability of the intervention to impart knowledge was tested by examining students' ability to correctly answer nineteen items designed to assess assimilation of program content and six questions assessing their ability to apply program messages to drug use decisions and behaviors.

As shown in Table 9, six-months after receiving the drug education program, significantly more students who received the drug education curriculum were able to give answers consistent with the program content for all nineteen items, controlling for differences at baseline. Of interest, students in the drug education program improved their understanding that alcohol is a drug (F = 6.03, df = 11, p < f =" 4.24," df =" 11," f =" 8.79," df =" 11," f =" 3.53," df =" 11," f =" 5.73," df =" 11,">

Table 9. Percent of students who gave a correct answer to program content questions.

However, "addiction only happens once you can't stop," was scored "true" more often among the control group than among the treatment group (F = 2.95, df = 11, p <>

Of the six questions assessing student decisions and behaviors, three produced significant change. Students in the drug prevention group were more likely to indicate that they knew enough about drugs to make decisions (F = 2.77, df = 11, p = 0.002,). Interestingly, recipients of drug prevention indicated a greater current ability to resist pressures to take drugs (F = 2.77, df = 11, p = 0.002) although the question assessing past resistance to drug use pressures was answered similarly between both groups at all time points. There was also a larger shift in the number of students who indicated "false" to the statement "drugs aren't really that bad" (F = 1.91, df = 11, p = 0.035).

Because a rather large percent of students in both groups answered the questions correctly at baseline, no further analysis was done to separate groups based on competency.

Discussion

The purpose of this study was to evaluate the capacity of the Narconon drug education program to produce a long-term impact on students' drug use behaviors in a universal (all student) classroom setting. To a large degree, baseline survey responses were similar to drug use patterns seen in large national surveys. After controlling for pretest levels of use, at six months after receiving the drug prevention curriculum students in the drug education group had lower levels of current drug use than students in the comparison group. Significant reductions were observed for alcohol, tobacco, and marijuana – important categories of drug abuse for this population – as well as certain categories of "hard drugs" including controlled prescription drugs, cocaine, and ecstasy. The results in Table 4 show a clear and reliable tendency among every category tested for the drug education program to produce reductions in drug use behavior.

This is encouraging in light of the evaluation being designed to provide a "real world" test of the Narconon program under the normal conditions of operating a classroom based intervention. Inherent barriers to administering the program and evaluation while schools were in session, including assessing its effectiveness with self-report questionnaires, leads to modest measurable differences between the drug education groups and the control groups with relatively large error terms.

The use of the CSAT survey methodology does not make quantifying the reductions in drug use possible and that was not an aim of this evaluation. Importantly, by testing a universal audience, rather than selecting groups of high risk students, the mathematical differences between student responses in each category remained modest due to the majority of students indicating no drug use at baseline.

The CSAP questions testing the hypothesis that changes in attitudes and beliefs would be modified by the drug education program, argue for a mediating effect on substance use. Interestingly, the questions aimed at discerning whether new knowledge was obtained and retained over time, although indicating an overall pre-existing acquaintance with the data, nonetheless categorically produced the most statistically significant changes.

Primarily an education strategy (Center for Substance Abuse Treatment classification [14]), the Narconon program includes approaches that align with key prevention theories. Throughout the curriculum, persuasive communication is emphasized as the means to impart each component [15]. Competency enhancement is accomplished through student interaction [16] and after-school personal inspection of media and other environmental influences aimed at addressing social influences. Science based information is presented, and students complete exercises aimed at developing their ability to assess the correctness of messages presented as information from a variety of sources.

Originally researched on cigarette use by Evans and colleagues in 1976, social influence theory was one of the first strategies to produce an impact on drug use behavior. This theory posits that alcohol and other drug use among young people is primarily a social behavior strongly influenced by social motives, a complex and reciprocal interaction between both personal and environmental factors including both overt and covert pressure from friends and others to conform to what is depicted as the group norm. A major departure from previous approaches to tobacco, alcohol, and other drug abuse prevention; Evans work emphasized increasing awareness of the various social pressures promoting drug use, including media influences [17,18].

One well-popularized aspect of today's social influences model is the focus on social resistance skills training. However, programs based primarily on resistance training have shown mixed results [19,20]. While this is not a focus of the Narconon program, students who received the curriculum were more likely to say they could now resist pressures to use drugs compared with those who did not receive this program. Interestingly, both groups answered similarly about their ability to resist pressures in the past.

Instead of directly practicing resistance skills, the Narconon drug education curriculum provides an opportunity for youth to inspect a myriad of positive, negative and often conflicting messages regarding drugs and their abuse, messages that often include incorrect and conflicting information about drugs and their effects. Program developers believe that prevention effectiveness is currently compromised by the pervasiveness of conflicting messages, including popular prevention approaches that do not communicate a consistent message.

Attempts to promote abstinence contrast with other messages heard in and out of school. For example, the notion that "everyone will experiment" has lead to various, sometimes controversial, practices aimed at reducing harm [21]. Goodstadt argues that dichotomies such as "licit" versus "illicit" drugs, or simply "good" versus "bad" drugs, result in ambiguities and problems [22]. Petosa adds that legal definitions designating certain recreational drug as "licit" for adults but "illicit" for adolescents may encourage young people to use those drugs to demonstrate their transition to adulthood [23]. The current prevalence of media advertising for prescription medications sends another powerful message [24], one complicated by the fact that commonly prescribed medications are too often used in ways substantially inconsistent with diagnostic guidelines [25,26].

Although students may "know" a certain datum about drugs, conflicting messages such as these may cause that datum to be minimized or rejected entirely unless placed in correct context or inspected relative to other information. To address this, the program teaches about the often subtle pro-drug advertising and other environmental messages aimed at increasing tobacco, alcohol and other drug consumption; contrasting these pro-drug messages with true scientific facts about drug effects on the body, mind, emotions, and enjoyment.

Program facilitators purposefully encourage students to arrive at their own conclusions regarding the data presented based on each student's own observation of the topic under discussion. Facilitators do not tell students what to think, rather, they teach students how to observe.

Another environmental influence addressed by the Narconon program includes more accurate awareness of family and peer drug use patterns. The program includes modules to review and discuss personal observations and provide opportunity for youth to work out what are correct and pro-survival norms.

Media, family, peer and other environmental influences become the subject of competency enhancement activities included in the Narconon curriculum. Competency to observe is applied during after-school practicals and becomes subject of the subsequent group discussion. These take home assignments and classroom activities are also aimed at developing broader personal and social skills with peers, family and community members. Research supports the use of activities that improve interpersonal relations, self esteem, communication, and other skills as directly applicable to substance use as well as many other adolescent problems. Such activities appear to generally enhance program effects [27,28].

With respect to the importance of knowledge, while many early prevention programs gave individuals accurate facts about the harmful effects of alcohol and other drugs, theorizing that those individuals would reduce or avoid drug use because it was in their own best interest to do so, studies of this generic information-only or awareness model have led to one of the very few universally agreed-upon facts in the prevention field: That is, for the vast majority of individuals, simple awareness through passive receipt of health information is not enough to lead them to alter their present behavior or reduce their present or future use of drugs [29,30].

According to Botvin and Botvin [12,16]., inclusion of information remains a necessary component of substance abuse education, although information alone is not sufficient to reduce or prevent use. Evans stresses the importance of attention and comprehension of the contents of the message [15]. Narconon program developers posit that true information correctly communicated can lead to changed behavior by changing the perceived value or social acceptance of that information.

Since inception, Narconon prevention training materials have emphasized correct communication of information and interaction with the communicator. Facilitator training aligns with the five component communication persuasion model described by McGuire [31]. According to this theory, to be effective an educator must get and hold the listeners' attention, must be understandable (comprehension), must elicit acceptance on the part of the person exposed to the message (yielding), the acceptance must be retained over time (retention), and thereby be translated into action in appropriate situations. Testing the ability to choose a correct answer only begins to answer the question of the perceived value and usefulness of that information. To that end, the incorporation of persuasive communication into facilitator training and multi-media program components is suggestive. In theory, the communication of science-based information regarding the nature and effects of drugs can assist students in developing judgment and awareness, but only to the extent that the message sent is very real to youths and delivered in a way that students respect and can appreciate. Measurements of student satisfaction that include affective reactions (e.g. enjoyment, content value) should be further explored as they may reveal important shifts in perceptions about the information itself that would not be detected in simple "true/false" questions.

This theory is supported by a previous evaluation of 1045 post-program student surveys, published in 1995, with findings that the Narconon program format was engaging and appreciated by youths [32]. Participants also reported heightened perceptions of risk – including a shift in attitude among the borderline group of students who held the view that they might use drugs in the future. Eighty six percent of the students in this category stated that the session they had attended changed their mind; most stating that they were now more concerned about the effects of drugs or that they had not realized that drugs were so damaging.

In addition to analyzing elements of content and implementation, a recent synthesis of characteristics common to exemplary prevention programs by Winters, et al. [33] raises the issue of management structure and sustainability. Narconon International's corporate and regional offices provide centralized management and assistance to ensure that local prevention offices receive meaningful attention and support. In addition to the questionnaire used in this study, Narconon program staff continued to collect their own feedback evaluations for ongoing quality management. Staff interaction with teachers and community members helped the schools further reinforce the prevention messages.

The report by Winters, et al. [33] points out the broad lack of programs aimed at high school years and, interestingly, the need for multiple sessions in future years to reinforce the message. The Narconon high school curriculum helps fill this need. Existing materials for younger ages should also be developed into an age appropriate curriculum to provide a continuum of educational resources. As the program further develops its training materials for professional facilitators it may consider also making them appropriate for peer leader groups who may particularly benefit through improved communication skills. The program should also develop appropriate universal booster sessions and provide educator consultation.

Project findings may have policy implications regarding both setting goals and objectives for prevention programs as well as evaluating their success. For example, the Safe and Drug-Free Schools and Communities act of 1994 includes "slow recently increasing rates of alcohol and drug use among school-aged children by 2000" among the six performance indicators chosen for assessing program accomplishments. It also expects prevention to "realize continuous improvement in the percentage of students reporting negative attitudes toward drug and alcohol use between now and 2002". Further, this act is subject to requirements of the Government Performance and Results Act of 1993 (GPRA) in requiring local and state education agencies to monitor program effectiveness, for which the CSAT instrument is a recommended tool sanctioned by the National Institute on Drug Abuse (NIDA), and the Substance Abuse and Mental health Services Administration (SAMHSA). Unfortunately, the instrument is unable to quantify change in drug use and does not assess completely the factors that might lead to such a change, factors that may include change in knowledge and the perceived value of that knowledge.

As current youth drug use levels remain high, it is clear that much more remains to be learned regarding effective drug abuse prevention. What works best; what goals additional to reduction in youth drug use – if achieved – constitute an effective program; how to measure achievement and the extent to which a school-based implementation strategy can counter other influences remains under discussion.

Conclusion

As an intensive, eight-module, educational curriculum, the Narconon program has thorough grounding in theory and substance abuse etiology, incorporating several important and historically successful prevention components. This supports the prediction that participants in this classroom-based program would change their behavior regarding drugs of abuse. Further, the Narconon network provides a strong organizational structure to foster sustainable and high fidelity program implementation.

In this evaluation, the Narconon drug education curriculum produced reliable reductions in drug use a full six months after completion of the drug education program and in every category of drug use tested. A third of these questions – those assessing the drugs most commonly used by youths; alcohol, tobacco and marijuana as well as "hard drugs" – showed statistically significant reductions in use. The reductions achieved with both amphetamines and non-prescription use of amphetamines are important given recent increases in availability and initiation of these drugs. The reliability of the reductions measured in drug abuse behavior provide the most relevant support for the Narconon drug education curriculum.

The program's ability to produce reductions in drug use behavior appears to be through correcting prevalent but false messages while empowering youth to observe, draw their own conclusions, and potentially also improves interpersonal skills contributing to the development of appropriate group norms. These changes may result in shifts in perception of risk and corrected attitudes as individuals and as a group. However, the mechanisms of action for this program should be further explored using sensitive instruments and analyses designed to test this hypothesis. Although the CSAP questionnaire underwent an extensive development process, isolating effective components of drug prevention programs may require a more robust methodology, particularly in light of the theory constructs of this program.

The Narconon drug education curriculum for high school grades shows clearly positive results and sends an important and powerful message promoting abstinence. Given the significant reductions in drug use behavior, the scientific content and social influence theory underlying the program materials and their implementation, and the strong, centralized management by Narconon International, this program is very promising and fills a vital need in substance abuse prevention.

Competing interests

M Cecchini wishes to disclose that between 2000–2002 she was the Executive Director of a Narconon center engaged in delivering substance abuse prevention programs; familiarity with program operations made it possible to coordinate independent field data collection with ongoing prevention efforts and assisted in describing the history and development of the program.

Authors' contributions

RL is Principal Investigator and developed the study design, statistical analysis and interpretation, and drafted sections of the manuscript.

MC coordinated the independent field data collection staff with scheduled drug education program delivery, ensured compliance with procedures to protect human subjects, and drafted sections of the manuscript.

Both authors read and approved the final manuscript.

Please send all reprint/proof correspondence to Marie Cecchini, 10841 Wescott Avenue, Sunland CA 91040.

Acknowledgements

The authors acknowledge the Association for Better Living and Education, Narconon International, Narconon of Hawai'i and Narconon of Oklahoma for project support.

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What To Expect In Detox

2009-08-24T08:11:00.000-07:00

By: Joe Gardener

Detoxification is ridding the body of sustained drug and/or alcohol addiction. It is most often the first step in getting your life back on track. There are people who have had to go through detox alone but that should not have to be the case. Drug detox and alcohol detox can be done in a caring and supportive environment with people who either have been through the process themselves or are trained in detoxification. For alcohol and most drug addictions, there is also medication that can help ease the symptoms of withdrawal.

While in detox, people are able not only to rid their bodies of the harmful drugs but also to discover what triggered the addiction in the first place. Ridding your body of the drugs or alcohol will be useless if you return to the same lifestyle as before you entered detox, so you must learn to change your behaviors. At first, none of it may make sense, but that is the affects of the drugs and alcohol. It does begin to make perfect sense and you see that by changing your behaviors you can get your life back on track.

With alcohol detox as well as drug detox, your body is likely going to go through withdrawal symptoms that can range from mild to severe. This is why there are often medications to help ease the discomfort of withdrawal. The most effective detox centers will incorporate several methods to help your mind and body recover from alcohol and/or drug addiction. Holistic treatment centers offer detox that helps physically, mentally and spiritually to help you gain control over your addictions and your life.

Most people fear the worse about detox but the process has come a long way over the years. There is so much known now about addictions and detoxification that just wasn’t known in the past. Medication use in detox used to be unheard of as well but now it is commonly used. While no one says it will be easy, it probably is not what you imagine it to be. There are many people leading happy lives now that they have rid their bodies and minds of drugs and/or alcohol. You can be one of them. Years of addiction take a toll on a person’s body and their mind. Only once you are rid of the addiction can you see the affects it has had on your life and the lives of others. Detox is a necessary part of obtaining a better life.

By talking to a professional at a detox center, you can gain more detailed information. Since no two people are alike, it is impossible to say exactly what your detox experience will be. The fear of detox, however, is often more frightening than the actual detox experience. This is part of the addiction; scaring yourself into not getting the help you need to rid yourself of drugs and alcohol. Detox should be done in a caring and professional environment with all of the tools available to help you overcome your addiction.

Article Source: http://www.bigfreearticles.com

Detoxification is ridding the body of sustained drug and/or alcohol addiction It is most often the first step in getting your life back on track

About the Author:
Joe Gardner has years of experience working with Alcohol Detox and Drug Detox. Visit his site to learn more.

Drug Rehabilitation Does It Really Works

2009-08-20T00:54:00.001-07:00

Drug rehabilitation is not an easy task for the patient but it really works. It can transform one’s life. Drug rehabilitation programs can really help an individual to start a new life. Patient starts the rehabilitation program by going under a series of tests. The patient has to answer various questions each and every day. The goal of a rehabilitation center is to make the person free from addiction.

Everything starts from commitment. The treatment does not work if the patient is unable to recognize his problem. The patient should have desire to change his life. Many times the patient is forced to go under the treatment procedure. But the true healing starts from the patient’s mind.
The first step of the treatment is most difficult. First of all the physician have to deal with the drug remains ion the body. This step is known as detoxification. Withdrawal symptoms are also seen during this step of treatment.

As the detoxification step precedes the patient have to work with different types of counselors. The counselors try to find out the reason for taking the drug. The family should regularly visit some of the counseling sessions. According to some reports and statistics the patients with a supportive family recover fast as compared to others.

The patient should have detailed information about each and every step of the treatment before the program starts. This will help the patient to prepare himself before the initiation of the program. Patient should visit the physician regularly. It is a good idea to discuss all the doubts, fears and expectations.

The job of the family members is to find the best rehabilitation center. A center should have a skilled staff with a 24 hour emergency service. You should find lot of information related to the drug and alcohol rehabilitation programs. There are several sources of information which provide useful details. One of the useful forms of information is internet. It is a good idea to spend some time on the internet. You can go through the websites of the centers. This will help you to compare the facilities and cost of the programs they are offering.

If you want to know more about Alcohol Treatment then it is a good idea to visit Drug Treatment .

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TREATMENT

2009-08-18T00:55:00.000-07:00

Treatment, in this context, means active participation in the process of recovery from alcohol or drug abuse. Drug and alcohol treatment is the therapeutic and educational process which is usually the first step in recovery from alcohol or substance abuse.

Drug and alcohol treatment covers a wide range of options and variables.

Drug or alcohol treatment is a general term for the processes of medical and/or psychotherapeutic rehabilitation for dependency on alcohol or drugs. The intent of treatment is to enable the patient to cease using alcohol and or mood altering substances. Most people are steered into treatment as the result of some psychological, legal, financial, social, and physical consequences that their drinking or drug use has caused.

Through treatment tailored to individual needs, people with alcohol and drug abuse can recover and lead productive lives.

Scope of treatment

In today's recovery world treatment is very broad term. The overall scope of alcohol and drug treatment is two-fold:

Teaching the individual about alcohol and or drug abuse and what lifestyle changes will be necessary to maintain long term abstinence.

Behavior modification

Goal of treatment

the primary goal of treatment is achieving lasting abstinence from alcohol and or drug use. The immediate goals are to reduce physical and psychological abuse, improve the patient's ability to function and minimize the medical and social complications. Like people with other life threatening diseases such as diabetes or heart disease, people in treatment and recovery will also need to change their behavior to adopt a more healthful lifestyle.

Effective Treatment Approaches

Medication and behavioral therapy alone or in combination are aspects of an overall therapeutic process that begins with detoxification. It is followed by treatment and relapse prevention. Easing withdrawal symptoms is important in the initiation of treatment. Relapse prevention is necessary. And sometimes, as with other chronic conditions, episodes of relapse may require a return to prior treatment components. A continuum of care that includes a customized treatment regimen, addressing all aspects of an individual's life, including medical and mental health services, and follow-up options (e.g., community- or family-based recovery support systems) can be crucial to a person's success in achieving and maintaining an alcohol, drug-free lifestyle.

Medication and Treatment

Medications can be used to help re-establish normal brain function and to prevent relapse and diminish cravings throughout the treatment process. Currently, we have medications for opioid (heroin, morphine) and tobacco (nicotine) addiction, and are developing others for treating stimulant (cocaine, methamphetamine) and cannabis (marijuana) addiction.

Behavioral Treatment

Behavioral cognitive therapies help patients engage in the treatment process, modify their attitudes and behaviors related to drug abuse, and increase healthy life skills. Behavioral treatments can also enhance the effectiveness of medications and help people stay in treatment longer.

Buprenorphine treatment

Buprenorphine is a relatively new and important treatment medication. NIDA-supported basic and clinical research led to its development (Subutex or, in combination with naloxone, Suboxone), and demonstrated it to be a safe and acceptable addiction treatment. While these products were being developed in concert with industry partners, Congress passed the Drug Addiction Treatment Act (DATA 2000), permitting qualified physicians to prescribe narcotic medications (Schedules III to V) for the treatment of opioid addiction. This legislation created a major paradigm shift by allowing access to opiate treatment in a medical setting rather than limiting it to specialized drug treatment clinics. To date, nearly 10,000 physicians have taken the training needed to prescribe these two medications, and nearly 7,000 have registered as potential providers.

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Drug And Alcohol Rehabilitation: The Facts

2009-08-17T08:01:00.000-07:00

Drug rehab is a term that refers to psychotherapeutic and medical treatment for substance abuse, or a dependence on a harmful substance. These harmful substances include not only illegal street drugs like cocaine, heroine, or other amphetamines, but also prescription drugs and alcohol. Since the abuse of drugs and alcohol can have far-reaching consequences - social, physical, mental, legal, and financial - the main aim of drug and alcohol rehab is to break that dependency and to enable the patient to cease using the substances and to find a new drug-free way of life.

What does rehab do?

Drug and alcohol rehab tends to focus on the dual nature of substance abuse and dependency, which is both physical and psychological. Dealing with the physical dependency can result in severe withdrawal symptoms, so rehab centres help clients go through what is known as a 'detoxification' process to help cope with the physical withdrawal from drugs and / or alcohol.

Dealing with the psychological aspect of drug and alcohol abuse is also a major part of the rehabilitation process, and it generally focuses on helping an individual learn how to interact and react to situations and stresses on a daily basis, in a drug-free environment. Patients are encouraged to make changes to their life, which may include changing their group of friends, particularly those who are still using drugs or alcohol. In early recovery this can be an important factor in relapse prevention. Certain rehab programs take the client through a 'twelve-step programme', which challenges addicts and alcoholics to accept that they need help from others in order to beat their addiction, that they must make changes to their life in order to recover, and that they must lead a life which is based upon total honesty with themselves and others.

Often, rehab centres will recommend complete abstinence from legal substances, such as alcohol. Quitting the substance completely is the preferable option, even in cases where alcohol had not been a perceivable problem for the client before. This is because of the fact that most addicts, if their drug of choice is removed, will turn to another drug instead. Alcohol is a mind-altering drug, which will soon become a dependence in people who have been addicted to other drugs in the past.

What forms of rehab are there?

Other than the general treatment centres and twelve-step programmes that are available for substance abusers, a variety of alternative drug and alcohol rehab programmes have emerged over the past few decades. Programmes include residential treatment, extended care centres, sober living houses and local support groups.

Sometimes antidepressants are prescribed for rehab clients in the early stages of treatment, as a temporary measure, as they can be used as part of the detoxification process. However, This must be closely monitored to ensure the client does not develop another addiction to the prescribed substance. In most cases, however, when the client stops using drugs and alcohol, symptoms of depression will diminish and disappear over time. This is because symptoms of the addictive disorder very closely mirror those of clinical depression, with individuals suffering low moods, mood swings, irritability, restlessness, malaise, trouble sleeping and changes in appetite, as a direct result of their drug use. Many addicts are surprised and heartened to find that this is the case as they continue with their recovery.

While in most cases clients will check themselves into drug or alcohol rehab, often attendance and treatment at a rehab centre is ordered by the criminal justice system. Those who are convicted of minor drug or alcohol offences are often referred to a drug and alcohol rehabilitation centre instead of prison, and offenders who have a dependence upon alcohol are sometimes ordered to attend a number of Alcoholics Anonymous meetings to help overcome their addiction.

While traditional rehab treatment is based on counselling, a number of studies have shown that there are many occasions where individuals who suffer from addiction have a chemical imbalance that needs to be addressed along side physchological issues. Chemical imbalances can be helped through making changes to diet, other nutritional supplements, and working toward a healthy lifestyle, which helps to correct the imbalance and also releases the patient from the grip of drug or alcohol addiction.

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Comparison of opiate-primary treatment seekers with and without alcohol use disorder

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Methods

Protocol

Enhancement of Compliance

Counseling

Screening and Eligibility Criteria

Outcomes

Statistical Analysis

Results

Discussion

Source Information

Appendix

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Procedures

Measures of Treatment Efficacy

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Results

Double-Blind Trial

Open-Label Study

Discussion

Source Information

Appendix

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