Publications

A recent study looked at 24 month outcomes when treatment includes 18 months of follow-up telephone counseling.  Alcohol dependent patients (252) – half of which were also cocaine dependent – completed 3 months of intensive outpatient treatment. Participants were then randomly placed in three groups: treatment as usual (TAU), TAU plus telephone monitoring and feedback (TM), or TAU plus telephone monitoring and feedback plus counseling (TMC).

TM participants received brief phone calls for up to 18 months (5-10 minute calls for 8 weeks, every other week for 10 months, and once per month for the last 6 months). Each call included a 10 item progress assessment covering current use and other risk and prevention factors. The call to the TMC group was the same as the TM but also included current goals and objectives, and coping responses to risky situations were rehearsed. Alcohol use was measured in “percentage of days drinking” and “any heavy drinking”.

Results showed that TM did not improve outcomes over TAU for males. However, adding TMC to standard care improved drinking outcomes for 18 months but effects on drinking did not persist beyond that point. Overall significant effects favoring TMC and TM over TAU were seen for women. TMC was found to be superior to TAU for patients with ”social support for drinking, low readiness for change, and previous alcohol treatments”.

Since none of these benefits persisted after the end of the 18 month treatment duration or remained significant after 24 months these findings suggest that benefits of telephone counseling as an adjunct to out-patient treatment only helps certain subgroups and may be limited in duration.

(McKay, JR, Van Horn, D, Oslin, DW, Ivey, M, Drapkin, ML, Coviello, DM, Yu, QIN, Lynch, KG,: Extended telephone-based continuing care for alcohol dependence” 24 month outcomes and subgroup analyses. Addcition, 106: 1760-1769, 2011.)

 Naltrexone is a medication that reportedly reduces the craving for alcohol, one of the symptoms of alcohol dependence (alcoholism). However, past research has suggested that naltrexone’s benefits may be limited to less-severe alcohol dependence and only reduce heavy drinking rather than support abstinence.  The current study examined the effectiveness of once a month, injectable, extended-release naltrexone (XR-NTX) in patients with higher severity alcohol dependence. This method of administering the medication also addresses the problem of adherence – the degree to which a patient correctly follows medical advice.

This study recruited 624 adult men and women with a diagnosis of alcohol dependence who had at least 2 episodes per week of heavy drinking. Half received either XR-NTX or placebo every 4 weeks for 24 weeks. All received low intensity counseling.

Higher severity alcohol-dependent patients receiving XR-NTX showed an average reduction of 37.3% in heavy-drinking days compared with 27.4% for placebo-treated patients.  Among those who had detoxification just prior to randomization, these reductions were 48.9% XR-NTX vs. 30.9% placebo. The study also supported earlier research findings that patients with at least 4 days of lead-in abstinence experienced significantly better maintenance of initial and 6-month abstinence.

These findings showing efficacy of XR-NTX among the more severely alcohol-dependent patients challenges previous research suggesting that naltrexone only benefits lower severity alcohol-dependent patients. (Oral naltrexone was used in the previous studies, which may be one reason for the differences in outcomes). This study, using injectable, longer lasting XR-NTX was effective in relatively higher severity alcohol dependence resulting in both reduction in heavy drinking and maintenance of abstinence and has implications for the role of adherence in pharmacotherapy.

(Pettinati, HM, Silverman, BL, Battisti, JJ, Forman, R, Schweizer, E, Gastfriend,  Efficacy of extended-release naltrexone in patients with relatively higher severity of alcohol dependence. Alcoholism: Clinical and Experimental Research, 35: 1804-1811, 2011.)

Current data show that drinking usually begins in the teen years. By 12th grade 86% have consumed alcohol and 55% have had at least one drink in the last 30 days. Previous research also indicates that many teen drinkers experience some signs of alcohol dependence without a prior diagnosis of alcohol abuse. Further studies have shown that an early age of drinking onset (14 and under) considerably increases the likelihood of experiencing alcohol dependence in adulthood. This current study at Wesleyan University sought to assess the prevalence of alcohol dependence diagnosis in a representative sample (N=9490) of recent onset adolescent drinkers drawn from the National Survey of Drug Use and Health (NSDUH) and to determine whether the level of alcohol use and dependence was similar for different socio-demographic groups (i.e., gender, age, ethnicity, family income, substance use). Alcohol dependence was defined as three or more positive responses to the following criteria: withdrawal, tolerance, using more than intended, unsuccessful efforts to quit or cut down, a great deal of time spent to obtain, and drinking despite physical or psychological problems.
The study identified important differences in the rates of alcohol dependence in adolescent recent onset drinkers. Female adolescents were found to be more likely to be alcohol dependent, to use alcohol for a longer period than intended, and report drinking in spite of physical and psychological problems.

Compared to non-Hispanic White youth, Native Americans/Alaskans were more likely to experience withdrawal and to report unsuccessful efforts to quit or cut down whereas Pacific Islanders were more likely to report tolerance. Together it appears that adolescents of all these demographic groups may experience alcohol dependence more quickly after beginning to drink and in the case of younger members, at lower levels of use.

The study found that alcohol dependence symptoms were experienced by a substantial proportion of this population even at lower levels of drinking (only a few drinking days per month). Most notably, more than 20% of adolescents who reported only drinking one day a month reported having unsuccessful efforts to quit or cut down. This, according to the researchers, contradicts the widespread belief among adolescents that only those who drink heavily for a long period of time are at risk for dependence and that they are invulnerable to this risk if they only drink occasionally.
(Chien-Ti Lee, Rose, JS, Engel-Rebitzer, Selya, A, Dierker, l: Alcohol dependence symptoms among recent onset adolescent drinkers. Addictive Behaviors 36: 1160-1167, 2011.)

Jerry Moe, Vice President and National Director of Betty Ford Children’s Programs, is a contributor to a newly released book, Children of Substance-Abusing Parents: Dynamics and Treatment.

“Children of Substance-Abusing Parents: Dynamics and Treatment” is a necessary reference for all mental health professionals and students who need to understand and treat this population. It offers an invaluable look at treatment options and programmatic interventions across the life span and fills an important gap in the current literature. The contributors include a wide range of experts who provide up-to-date evidence-based clinical and programmatic strategies for working with children of alcohol and other substance-abusing parents of any age and in almost any practice setting.

“This highly recommended book is a valuable resource for all practitioners and students concerned about this very large, but often hidden group of individuals and families.”
- Sis Wenger
President/CEO, National Association for Children of Alcoholics

Parental drug abuse and alcoholism have an enormously detrimental impact on children and adolescents. Children whose parents suffer from drug abuse or alcoholism often face multiple physical, mental, and behavioral issues. They are at a greater risk for depression, anxiety, low self esteem, and addiction, and also are known to have poor school attendance, difficulty concentrating, and lower IQ scores.

This book offers health care practitioners proactive programs and innovative strategies to use with this vulnerable population. Taking a comprehensive, life course approach, the authors discuss the implications and interventions at the prenatal stage, through childhood, adolescence, young adulthood, and adulthood. With this book, social workers and health care practitioners can help assess and intervene with children of substance abusing parents.

Key topics:

•Dynamics in families with substance abusing parents and treatment implications
•Issues across the life span of children of substance abusing parents
•Prevention and early intervention programs for pregnant women who abuse substances
•Programs for young children, adolescents, college students, and children with incarcerated parents

Professionals facilitating support groups realize that one factor in having a successful group experience is their ability to create a safe environment.  There are a variety of ways to do this, but one of the most important when working with elementary school-age children is to establish age-appropriate rules and consistently enforce them.  Why, then, is this often the most difficult thing for counselors and facilitators to do?  Anyone who has worked with kids or has their own children can testify to the fact that sometimes it isn’t as easy as it sounds!

When a problem is going on in a family, whether it’s addiction, death, divorce or major life changes, children are frequently placed in adult roles or begin to worry about adult problems.  It is not uncommon for kids to feel like it’s their job to fix things.  They feel uncertain and scared about what is happening in their families.  Sometimes rules are not consistently enforced at home. In the midst of crisis, it can be unclear who is supposed to be in charge. Due to this, rules are especially important.  Kids often report that one of the places they feel safest is at school.  Why is that?  Because they know what to expect, what their role is, and who is in charge.  Part of doing so is providing rules and consistently enforcing them.  It is giving children what they need in the developmental stage that they are at. It is your job to provide this type of safe environment when facilitating group. 

Here are some DO’s and DONT’s for creating group rules for elementary age children:

DO establish ownership of rules and consequences.

Children follow rules that make logical, concrete sense to them and are framed in a simple way.   Having kids identify and discuss why rules are important will allow them to have more ownership of the group rules.  When reviewing rules on the first day, begin by asking the group why rules are important.  You will notice that hands fly up into the air, as kids are eager to give input.  Common comments you will hear from children are: “Rules are important so things don’t get crazy!”, “Rules are so nobody gets hurt.”, “Rules are there to keep us safe.”  Once you’ve had the discussion, stress to the group that the main reason we have rules is that everyone stays safe and has a good time. 

DO create rules that tell them what TO do, instead of what NOT to do.

Children respond better to rules that clearly state the desired behavior.  In the Children’s Program at Betty Ford we use rules that are framed in the positive and cover many things, even though there are only five of them:

1. One Person Talks At a Time
2. You Can Pass
3. Respect Each Other
4. Put-Ups Only
5. What We Say Here, Stays Here 

DO review the rules frequently.

Group rules should be reviewed each group session and displayed in a prominent place in the room.  This is especially true for younger children or kids who have trouble with attention or distractibility.  It is unrealistic to expect a seven, eight, or even nine-year-old to come to group once every one or two weeks and remember the rules from the last time.  It is also a set-up for failure.  In the children’s program, we have the luxury of seeing the kids each day for three or four days in a row.  Regardless, we still review the rules daily.  When kids are processing emotional issues, it is too much to ask that that they be required to remember rules from one day to the next.

DO make the rules relevant to their own lives.

As much as possible, have the kids read and describe what they mean. This again allows for ownership. Start with asking a child to read the rule, then ask the group why that rule is important.  Spend a bit of time really discussing rules in kid-friendly language, especially during the first group session. 

DO enforce rules with simple but clear consequences.

You cannot have rules without making clear what the consequences are when a rule gets broken.  It is also important to keep these simple and clear.  In the Children’s Program we have three consequences:  Strike One – A Warning, Strike Two – Ten Minute Time Out, and Strike Three – Parent Conference.  The third strike is basically when a child does not come back to group.    Although the third strike may sound harsh, it’s one that kids really understand.  Almost every group I’ve worked with has shared their frustration with that one student in class who always breaks the rules and then the whole class gets punished.  We tell kids that this does not happen in our program.  One person will not be allowed to ruin it for everyone else.  In my twelve years of group work with children using these consequences, I can count on my hand how many kids have actually reached a strike three.

DO follow-through from the beginning.

The biggest mistake a facilitator can make is not giving consequences, if needed, starting on the first day of group.  Don’t wait until the 5th session when things are out of control to start enforcing the rules.  By then, you have set the tone for the group.  It’s much easier to be “strict” at the beginning than it is to backtrack toward the end.   Being lenient and inconsistent at first is a recipe for disaster.  By the time you try to re-establish the rules, it won’t matter, because you’ve already lost trust and credibility.  

DON’T get stuck with too many rules.

There should never be any more than 5 rules in a kids group.  More than that is too much to expect kids to remember.  Too many times I have seen facilitators come up with a long list of 10-12 rules and then continue to add to them when issues arise.  Remember that some rules cover many things.  If you notice that the group is distracted by cell phones or other electronics, don’t add a rule about this.  Simply remind them of the “Respect Each Other” rule.  Being distracted by other things while their peers are sharing is not respectful.  Another frequent issue that comes up is that of personal space.  We’ve all worked with kids who may touch or poke at others when it is not appropriate.  Keeping your hands to yourself is also about respecting others.  Don’t get bogged done with rule saturation!  It’s too confusing for everybody.

DON’T reinforce bad behavior by processing consequences with a child.

Every new group facilitator has made the mistake of giving a consequence for a rule break, seeing a child’s reaction to it, and then immediately going over to console them or explain why they received the consequence.  A consequence, or strike, is given quickly, calmly, with limited discussion, no shaming and no judgment.  If a child doesn’t understand why they received the consequence, take them aside after the session, but DO NOT get into a debate or discussion in the moment.  98% of the time children know exactly why they have received it.  If you review the rules regularly and display them prominently, children understand them.  For some kids, acting out is the way they get attention.  If a counselor sits and talks with them during their ten minute time out, not only did they get the attention while they were acting out, but now they get one-on-one time with the counselor.  The danger in this is that frequently the children who get the most attention or are identified as having the most issues in group are the ones that are acting out.  The quiet, people-pleasing kids, who have just as many issues and needs, are often the ones that we forget about. 

DON’T take back a consequence!

It is natural and developmentally appropriate for elementary age children to “test” facilitators.  They want to know if you mean what you say and if you will follow through.  If you give a consequence but then take it back, you’ve lost all credibility.  It quickly becomes clear that the adult is not the person in charge.  As much as they may protest, kids DO NOT want to be in charge – it’s not their job.  Additionally, if you take back a consequence, you’ve also proven to the group that the rules don’t matter, and that you won’t stand up for the group to make it a safe place.  Children become annoyed when their needs aren’t being met because one group member is continually breaking rules.  They won’t trust you as a facilitator, and be less likely to share.  Enforcing rules is non-negotiable.

Each Day a New Beginning!

Consequences or strikes should not carry over from one day to the next.  Give children a chance to start out with a fresh, clean slate each group session.  Do not start the next session talking about the rule-breaks from the last one, or saving a consequence until the next session.  A consequence needs to occur in the immediate moment, not a week later.  Kids will not remember why they are receiving it and it becomes ineffective.  Additionally, if a child receives a consequence do not then take it to the parent at the end of the session, informing them of the bad behavior.  If you’ve dealt with it in group, it is done.  Rehashing the issue with the parent only sets the child up for a repeat consequence and can also be shaming.  Unless the behavior has reached the point of “Strike Three” or it is a safety issue, parent intervention is not warranted.

Counselors new to facilitating kids’ groups can find it difficult to enforce rules or manage behavior. Some kids come into our group having had many difficulties in their young lives.  I have heard facilitators say, “But I feel so badly for these kids.  It’s hard to give a consequence.  I don’t want to hurt their feelings.  They’ve been through so much already.” Remember, facilitating kids support groups is very different than providing one-on-one therapy to children.  In therapy, it is appropriate to focus on one child and help them regulate their own behavior, or recognize the issue behind their behavior. This is not conducive to group facilitation.  Having high expectations of kids in an environment facilitated by a safe, supportive adult fosters resiliency in children.  If you treat them like they are incapable of following the rules, they will prove you correct.  They will also not have a positive group experience, and neither will the group.  Children deserve to be in an environment that allows them to play, learn, and have fun in a safe way without the responsibility of being “in charge”.  In other words, let them be kids!

 Peggy McGillicuddy is a counselor and group facilitator, having provided advocacy and support services for young children impacted by addiction since 2000.  She currently serves as a consultant and trainer for the Betty Ford Institute Children’s Program Training Academy. Peggy particularly enjoys training and teaching others to work effectively with children from a strength-based perspective.  She has made all of the mistakes listed above and then some!  Stay tuned for a follow-up article in the next edition of Planting Seeds.  

An Interview with Pat Schafer, Brighton Hospital

One in four children is affected by a loved one’s addiction to alcohol and/or other drugs.  More than 8.3 million children live with at least one parent who abuses or is addicted to alcohol or other drugs (National Household Survey on Drug Abuse [NHSDA], 2007). Because of their circumstances and genetic predisposition, these kids are at a higher risk of addiction as adults.

 The Betty Ford Children’s Program provides services for these children in three different states: California, Texas and Colorado.  The success of the Children’s Program in those locations has prompted numerous requests for services from other agencies, professionals and programs around the country.

 But, without expanding our program further, what could we do? In 2009, the Center took on an exciting new endeavor and created a way to partner with agencies, organizations and treatment centers to encourage, train and support them in providing their own programs for children of alcoholics and addicts. We created the Children’s Program Training Academy (CPTA).

Our first partner in this endeavor was Brighton Hospital. Located in Brighton, Michigan just outside of Detroit, the hospital is one of the oldest and most reputable addiction treatment facilities in the country.  After almost five months of intensive training, in July of 2009 Brighton Hospital held their first children’s program.  The process of developing a new program has not always been an easy one, but Betty Ford CPTA staff traveled frequently to Brighton, providing group facilitation, training, assistance with fundraising and marketing, and ongoing clinical support. 

 Pat Schafer, LMSW, was chosen to lead the program as the coordinator.  She was given the daunting task of facilitating the groups and providing marketing and outreach.  I spent some time talking with Pat recently, as she reviewed the program’s growth. Coming into the process with over 20 years of experience with kids, Pat jumped in eagerly.  She shared with me what the experience has been like for her.

Having started a Children’s Program at Brighton Hospital from scratch, what would you say has been your biggest challenge?

The biggest challenge has been trying to get enough kids in the groups. It takes many hours, breaking through parent’s denial, guilt and shame by educating them that their kids know much more about what is going on than they think, and that they need education and support. It is critical to address the misconceptions parents and grandparents have regarding the purpose and design of the program and how very important it is for family recovery.

 I often hear statements like:  

“My kid is already in therapy.”

“They have had the Dare Program in school.”

“They do not know about my use/addiction.”

“They are way too young for the program.”

“My kid is a straight A student. She will not get into anything like drugs.”

 “I don’t want them to miss school.”

“I don’t want to drag my brother into this. He has gone through enough.”

At the beginning of the process, did you have any expectations (of yourself, families, kids, etc.) that you needed to change as you went along?

 I expected to be able to get more kids in each program by now, and after two years I thought it would be much easier filling two groups every month. I also thought being part of an inpatient and outpatient treatment program, it would be much easier getting referrals.

It is difficult to have full groups, and for just one person to do everything for the program. It is necessary to educate staff that this is not just another treatment program. Parents are entrusting you with their children! Clinicians need at least 6-9 months of doing the program consistently before they are fully trained. This is difficult for supervisors to understand. There are so many details that have to be learned.

What advice would you give to other professionals wanting to start a similar program?

Don’t expect the program to be full right away. Be gentle with yourself and do not take the low numbers personally, thinking, ‘I have not done a good enough job’. It takes at least two years to build a program. The facilitators of the program must do the marketing. They know the program best. It gives a face to the program and establishes trust. It takes two full time counselors to do the marketing, which should be the majority of their job when they are not facilitating groups.

Do not charge a fee initially. It’s hard enough to get families signed up!  Instead, think about collecting a deposit, which not only will secure their place in the program, but also provide an incentive to follow through. Once your program is established and you are getting consistent referrals, then charge, with the philosophy that ‘no family will be turned away due to financial hardship’.

And lastly, you have now been facilitating Children’s Programs at Brighton for almost two and a half years.  What has been the most rewarding part of the process for you?

Coordinating and facilitating this program has been rewarding in so many ways.

I have been amazed at how open and honest the children and caregivers can be when they feel safe. It has been wonderful getting to know the kids and families and realizing how resilient they are! It is rewarding to recognize that you are truly making a difference in these kids’ lives, and witnessing the progress made throughout the four days. The parents are so grateful for the staff and the program. I am always amazed at how great this program is and I feel fortunate and blessed to be part of it.

Brighton Hospital continues to move forward. At the 18 month mark, the program appeared to have found its niche.  The Brighton Hospital Children’s Program provided two sessions a month, serving full groups of children and parents, throughout the summer of 2011.  They are now looking at ways to expand further.  For more information about the Brighton Hospital Children’s Program, contact Pat Schafer at (810) 220-1807 or check out their website at http://www.brightonhospital.org. 

 Author Peggy McGillicuddy is a counselor and group facilitator, having provided advocacy and support services for young children impacted by addiction since 2000.  She currently serves as a consultant and trainer for the Betty Ford Institute Children’s Program Training Academy. 

By David Meggitt, M.A. Candidate

The Betty Ford Children’s Programs are an excellent resource for families struggling with addiction and learning about recovery.  While our primary focus is on providing excellent, age-appropriate information and skill building to children who have lived or are living with an addicted loved one, we are able to observe children for an extended period over several days. This allows us to provide much more to the families we serve. 

Our program is an opportunity to observe children socially, emotionally, physically and developmentally.  Within the last year we have had two children, in particular, who really benefitted from this aspect of the process.  One child, a nine-year-old girl, was lagging in physical development, specifically, fine-motor control and hand-eye coordination, which was detected during an activity called the Ultimate Koosh Challenge.  Her parents had noticed this prior to the program; but, when they approached their school, the school was not willing to investigate the issue.  So when we brought it up during the parent continuing care meeting on Sunday, both parents were relieved to hear the assessment and confirm their own thoughts.  We then followed it up with a letter to the parents recommending their daughter be assessed.  After she was assessed, she was referred to an occupational therapist and is receiving the help she needs. 

The other example was a twelve-year-old boy. We noticed peculiar behavior which aligned with Asperger’s syndrome, and we referred the family to see a psychologist and get an evaluation.  After some time, the family was finally able to get their son in to see a psychologist and after a six hour evaluation, our suspicion was confirmed.  The young man did have Asperger’s and Mom was relieved and very grateful for the referral.  She and her son would be able to address the impact that Asperger’s had been having in their lives and looked forward to understanding each other better as a result.

While not all of our referral meetings have the impact as the examples above, observation is an important aspect of our groups.  We at the Betty Ford Center believe addiction is a family disease. Thus, we do not believe in treating just the addicted person, but the family as a whole.  Likewise, when working with children, we do not believe in just educating them on what addiction is, but we desire to look at the whole child and examine not only their understanding of addiction, but where they are socially, emotionally, physically and developmentally, so that proper referrals may be made when necessary.

We are delighted to share the news that on September 10, 2011, the Television Academy gave a nod to a very important video program.  “Nick News With Linda Ellerbee: Under the Influence: Kids of Alcoholics” received the award for Best Children’s Nonfiction Reality or Reality-Competition Program in the Creative Arts portion of the 63rd Annual Primetime Emmy Awards.

This is not the first award received by the special that features Jerry Moe, National Director, Betty Ford Children’s Program, as the subject matter expert.  Earlier this year, the 15th Annual PRISM Awards recognized the program, with the award for Children or Teen Television Program. The PRISM Awards honor actors, movies, music, media and television’s top shows that accurately depict and bring attention to substance abuse and mental health issues.

More than a year in the making, the program premiered in November 2010 in a prime-time slot, and was aired again last February to recognize Children of Alcoholics Week.  “Under the Influence: Kids of Alcoholics” tells the story of 5 kids who live with alcoholic parents and the challenges they face because of it.  This program features five youth from across the US, including an alum from the Colorado children’s program, who openly and honestly share their experience, strength and hope.

Although the program shows how sad and scary it can be for children living with alcoholism, it also delivers a message of hope. It lets kids know that they are not alone and that there are things they can do to stay safe and cope with the problem.

“This is a great resource for introducing a very sensitive topic to a diverse group of kids,” states Jerry Moe, “particularly in a school setting.” With Linda Ellerbee’s blessing, Jerry Moe has developed a lesson plan to coincide with the program. The objectives of the lesson plan include teaching students about the common problems and feelings of kids living in families hurt by alcoholism, as well as important messages and strategies to empower these children to positively cope with the many challenges they face. Additionally, students will learn how a friend can help.

The video program remains available at no charge in DVD format through the Betty Ford Institute to professionals who work with kids. It may also be downloaded as a free podcast on iTunes. The lesson plan is available now in the Publications at www.bettyfordinstitute.org and will be available soon on Nick’s online resource for teachers.

Get the lesson plan

Download the video program

of the program

In addition to providing support and education to children affected by a loved one’s addiction, the Five Star Kids program has undertaken the initiative to advocate for this population by providing education to other community agencies and among professionals. Five Star Kids counselors provide lectures and opportunities for discussion with patients and their family members in both residential and outpatient treatment centers such as Pine Street, Grapevine Valley Hope and the Right Step. These lectures offer insight into the family dynamics of addiction as well as provide the Children’s Program as a resource. The Five Star Kids staff frequently presents information on children’s perspective of addiction at various community agencies.

For example, this summer counselors gave presentations to staff members of Hope’s Door, a domestic violence agency, and teachers at Frisco ISD’s in-service. This is done in the hope that a deeper understanding of the dynamics of addiction and its effects on children will empower professionals in other fields to provide more comprehensive services. Finally, each season the Five Star Kids program hosts low-cost trainings for professionals as part of the Betty Ford Center Training Series. The most recent training focused on the use of resiliency with mental health clients as presented by Dr. Carolyn Kern, Associate Professor in Counselor Education at the University of North Texas. The next training has a limited number of seats available in order to accommodate this hands-on learning experience focused on the facilitation of art therapy with traumatized children by Julie Espey, LMSW and Registered Art Therapist. To learn more or register, please contact Lance Hughes at .

On October 5^th, we held our annual “Thank You Luncheon” at the Cool River Cafe in the Denver Tech Center for 35 people.  Each year we are pleased to be able to host a luncheon to let our supporters, referents and friends know how we are doing, and how much we appreciate their support.

Last month, David Meggitt made a presentation for professionals at the Third Annual Colorado DEC Conference in Colorado Springs.  There were about 100 people in attendance for his presentation on “Risk and Resilience.”

Phoenix Multisport,  whose mission is to build  sober, active communities through  pursuits such as climbing, hiking, cycling and social events, received a grant to collaborate with the Betty Ford Children’s Program to provide members of their community an opportunity to have their children participate in our four-day program.  The grant makes it possible for Phoenix Multisport families to participate in a 1/2 day “Parenting in Recovery” workshop and the four-day group session for kids between the ages of 7-12. Additionally, all participants will be invited to Stage II and Stage III Betty Ford Children’s Programs as well as the Annual Betty Ford Colorado Children’s Celebration.

Heads up! Betty Ford Colorado Children’s Program will start a weekly aftercare program in late January or early February, 2012.  Stay tuned for more details.

With the school year in full swing, the California Children’s staff is facilitating four-day programs in our elementary schools.  We are happy to work so closely with the Desert Sands Unified School District and their Student Assistance Program to provide preventative education to children that would otherwise not have the ability to attend our programs on the Betty Ford campus.  We plan on serving nine schools for the 2011-2012 school year.  We truly appreciate the support we receive from the school principals and counselors. 

 In addition to our community and school programs, we are looking forward to welcoming many of our Children’s Program Alumni and their families back to celebrate the annual Betty Ford Center Alumni Celebration, November 11-13th.  Each year, children come back to enjoy two days of fun, learning and creative activities that reinforce the messages they learned from the four-day program; you are not alone, find safe people to talk to and that their number one job is to be a kid!  Staff has been working hard the past few months to ensure that every child attending has a great time.

Religious affiliation is known to play a role in decreasing alcohol use, and the specific type of church involvement has also been shown to be important. This VA study looked at whether childhood religious experience might also impact adult drinking behavior. The 931 participants were males born between 1939 and 1957, who served in the military during the Viet Nam era (1965-1975) and who completed a lifetime drinking history. Their religious affiliation during childhood was obtained from spouses or partners. These affiliations were divided into four categories: non-religious, accommodating (more accepting of mainstream social norms regarding drinking), differentiating (likely to have more restrictive beliefs about alcohol use), and Catholic.

Data were collected via interview in phases to provide the participants’ alcohol use history for every year of their drinking. Lifetime alcohol abstinence, ever drinking regularly, current alcohol dependence (AD), and several other alcohol use variables were calculated for each of the four religious affiliation categories. Among the study’s findings were: significant differences were found among the groups for abstinence, regular drinking, and current quantity/frequency of drinking (QFI) scores. Participants from differentiating denominations (Baptist, Mormon, and fundamentalist protestant) had the highest rates of abstinence and non-regular drinking, and the lowest QFI scores. The non-religious group had more alcohol use than any of the other groups. The accommodating (United Church of Christ, Lutheran, Methodist, and Presbyterian) and Catholic fell in between. Childhood religious affiliation appeared most associated with preventative influences such as avoiding, delaying, and minimizing alcohol use and most prominently influenced variables that occur in childhood and adolescence, such as first drink.

The effect of childhood religion on alcohol consumption was consistent across time and continued to influence adult alcohol use rather than decreasing it as expected. The findings confirmed the frequently reported association between religion and alcohol use.

(Koenig, LB, Haber, JR, Jacob, T: Childhood religious affiliation and alcohol use and abuse across the lifespan of alcohol-dependent men. Psychology of Addictive Behaviors 25: 381-389, 2011)

Research supports the contention that the cost of substance use disorder (SUD) treatment is more than offset by other savings in areas like health care and criminal justice. This study by researchers at the Stanford University Medical Center explores the question, “Why haven’t health care system managers rushed to expand treatment?”

The researchers looked at national data from 1998 to 2006 when over 3 million patients in the Veterans Affairs (VA) health care system were diagnosed with alcohol use disorder (AUD).  These databases were used to determine the net effect on VA medical centers as they expanded or reduced SUD treatment. During the period 1998 to 2001 the annual number of SUD patients were around 345,000 per year and then increased to 426,000 by 2006. Cost data were collected by department (SUD, psychiatric, and general medicine). No individual medical center increased SUD spending each year and none decreased each year. The study found no evidence that a medical center saves money at that facility by investing in SUD treatment. Offering SUD outpatient or inpatient treatment resulted in costs that were not offset by savings in other medical departments. However, the study emphasizes that SUD treatment may cost VA medical center additional money but it saves money for other stakeholders such as the criminal justice system, child protective services, and unemployment and welfare agencies. Thus a VA medical Center’s investment in SUD care may pay off well for others but not for itself. This study also acknowledges advocates who argue that the need to prove that the money spent for SUD treatment must generate offsetting cost reductions is a “testimony to the stigma attached to the endeavor. “  They further point out that “virtually no other health care activity is held to such a high fiscal standard.”

(Humphreys, K, Wagner, TH, Gage, M: If substance use disorder treatment more than offsets its costs, why don’t more medical centers want to provide it? A budget impact analysis in the Veterans Health Administration. Journal of Substance Abuse Treatment 41: 243-251, 2011.)

A recent national survey found that nearly one third of women drank alcohol at some time during their pregnancy. Heavy alcohol consumption during pregnancy is the cause of fetal alcohol syndrome (FAS), a cluster of birth defects. However, most women who drink while pregnant are light to moderate users who quit or reduce alcohol use by mid-pregnancy, producing fewer and less severe effects. This study evaluated the association between prenatal alcohol exposure and conduct disorder (CD) in adolescent offspring. Two study groups were selected from a screening of 1360 women interviewed at a prenatal clinic during the fourth month of their pregnancy. One group was selected to study the effects of prenatal alcohol exposure on development and included women who drank an average of three or more drinks a week. A second group was selected to study the effects of marijuana.  Both groups included women who abstained from substance use during pregnancy.

The women were interviewed at their fourth and seventh month of pregnancy and with their children at birth, 8 and 18 months, and 3, 8, 10, and 14 years. Offspring and their mothers or caretakers were interviewed again at age 16 when current and lifetime psychiatric disorders in both the mothers and offspring were diagnosed. Over half of the mothers met the criteria for a lifetime diagnosis, including CD (9.5%), antisocial personality disorder (5.8%) or a substance use disorder (SUD; 27). Among the adolescent offspring (48% male) the lifetime prevalence of CD was 11.5%. Adolescents exposed to an average of one or more drinks per day in the first trimester were three times more likely to meet the criteria for a diagnosis of CD than adolescents whose mothers drank less than that or abstained. The study also found that youth who rated their parents as more strict and involved were less likely to have CD. Exposure to binge drinking, marijuana, cocaine, and other illicit drugs during pregnancy did not increase the risk for CD in offspring. 

The effects of alcohol exposure during the first trimester remained constant even after controlling for other variables such as environment, or a mother’s psychopathology. The researchers did not have information about the psychiatric status of the father and so were unable to control for that variable. The study showed that first trimester alcohol consumption above the level of 1 drink per day predicts later conduct disorders in exposed offspring.

(Larkby, CA, Goldschmidt, L, Hanusa, BH, Day, NL: Prenatal alcohol exposure is associated with conduct disorder in adolescence: findings in a birth cohort.  Journal of the American Academy of Child & Adolescent Psychiatry 50:  262-271, 2011)

Garrett O’Connor, MD, recently received an award on the opening evening of the California Society of Addiction Medicine’s (CSAM’s) State of the Art Conference at the Hyatt Regency in Long Beach, California, to honor the profound contributions that he has made to the field of addiction medicine.

The California Society of Addiction Medicine (CSAM) recognized Garrett O’Connor, MD, of the Betty Ford Institute, for a lifetime of achievement in addiction medicine. At the ceremony held at CSAM’s State of the Art Conference in Long Beach, CA, Karen Miotto, MD, presented Dr. O’Connor with a stunning glass statue commemorating his ceaseless efforts to give voice to those who have been silenced by the disease of addiction. The inscription read “Garrett O’Connor, MD, who speaks for the ‘invisible people’ and inspires us to do the same.”

O’Connor took the stage accompanied by his wife, Fionnula Flanagan, and told the tale of his life, weaving in notes about the evolution of CSAM over the past four decades. Anybody who has experienced a Garrett O’Connor speech knows there is no way to describe the impact he is able to achieve through spoken word. With his signature mix of honesty, wit, tenderness, and humor, he covered everything from biography and genetics to the ravage of addiction and the promise of fellowship. Dr. O’Connor’s riveting presentation was followed by tributes from long time CSAM colleagues, friends, and leaders. One by one, Peter Banys, MD, Gail Shultz, MD, Timmen Cermak, MD, Jeffery Wilkins, MD, Gail Jara, Tom McLellan, and Karen Miotto, MD, shared the ways in which Dr. O’Connor had personally and deeply moved them and influenced the practice of addiction medicine. CSAM presented him with a stunning glass statue commemorating his ceaseless efforts to give voice to those who have been silenced by their disease. The inscription read “Garrett O’Connor, MD, who speaks for the ‘invisible people’ and inspires us to do the same.”

CSAM is the California organization of physicians who specialize in addiction medicine, the medical specialty that provides care and treatment for millions of Americans with alcoholism and other substance use disorders. Addiction medicine includes both pharmaceutical and behavioral treatments and aligns with other specialties including public health, psychiatry and internal medicine. CSAM is dedicated to education of physicians and other health professionals about substance use disorders, and promoting research, prevention and implementation of evidence-based treatment.

Garrett O'Connor, MD, of the Betty Ford Institute, was surrounded by colleagues from the California Society of Addiction Medicine after receiving an award honoring him for the profound contributions he has made to the field of addiction medicine. Pictured from left back row are: Timmen Cermak, MD, CSAM President, Jeffrey Wilkins, MD, CSAM President-elect, Kerry Parker, CAE, CSAM Executive Director; front row from left: Dr. O'Connor's wife Fionnula Flanagan, and Dr. O'Connor standing between Karen Miotto, MD and Jean Marsters, MD, both are members of members of the CSAM Executive Council.

Availability and utilization of alcohol treatment has historically fluctuated with changes in public policy, particularly the organization and financing of the U.S. healthcare system. During the 1980s, private sector alcohol treatment services expanded. This expansion resulted from the federal government’s emphasis on privatization, deregulation, and federalism, and new state mandates for minimum insurance coverage for alcohol services. However, concerns about the rising cost of health care led to policies aimed at reducing costs. The 1990’s brought a clear shift away from long-term residential services to less expensive, shorter term outpatient services for treatment. In line with this trend the private sector diverted three fourths of the insurance coverage for substance abuse and mental health care to control of the managed care industry. This study in the journal Alcoholism: Clinical and Experimental Research looked at changes in the use of alcohol services over the decade from 1991/92 to 2001/02 among U.S. whites, blacks, and Hispanics. Data were taken from two household surveys of the U.S. adult population in which face-to-face interviews were conducted with a combined (85,955) sample of individuals 18 years of age and older. Findings suggested that changes in the organization and financing of alcohol services in the 1990s affected rates of treatment use for whites, blacks, and Hispanics in the general population.

There was a substantial increase in treatment utilization in the 1980’s while significant decreases occurred from 1991-1992 to 2001-2002 for individuals with alcohol use disorders (AUDs). Drinkers in this period also showed increasing emergency room and human services care for alcohol problems.  These changes between survey years impacted all ethnic groups equally. However, the effect of ethnicity on utilization varied by level of severity. Blacks and Hispanics at higher levels of severity were less likely to ever seek treatment or to use any alcohol treatment services compared to whites. The researchers pointed out that these utilization trends for blacks and Hispanics may reflect underlying disparities in healthcare access for minority groups, and language and logistical barriers. The findings emphasize the need to identify barriers to treatment for these high-risk groups, as well as policy solutions for improving treatment utilization across white, black, and Hispanic ethnicities.

(Chartier, KG, Caetano, R: Trends in alcohol services utilization fro 1991-1912 to 2001-2002: ethnic group differences in the U.S. populations. Alcoholism: Clinical and Experimental Research 35: 1485-1497, 2011)

Marijuana is the illicit drug most used by adolescents and young adults but has been rarely studied in older adults. The drug is known to cause short term memory deficits and difficulties with concentration. Consequently, compared to non-users, adolescent and college users report poorer academic performance, less time studying, and increased absence from classes. Opportunities to initiate use of marijuana are common in teen years and continue throughout college and into adulthood. The results of a recent study showed that both parental and peer influence play a role in late adolescence and young adulthood decision making about marijuana.

Data were taken from the College Life Study, a large study of students at a public mid-Atlantic University. All those attending new student orientation were invited to complete a screening survey. A sample of 1253 students was selected and assessed annually for four years. Race and gender were considered to ensure diversity. Follow-on surveys found that more than a third of the students had already used marijuana once before college and 25% more  started using after entering college. Of the 360 non-prior users, 74% were offered marijuana in college and as a result 54% started using. Notably, not all users used frequently.  Only 32.8% of the sample used marijuana 12 or more times at least once over 4 years.

The survey included questions about parental monitoring and supervision during the student’s senior year in high school. The findings showed that a high level of parental monitoring and establishing of boundaries appeared to be two of the most protective factors across the entire developmental stages. However, once exposure occurred, the survey indicated that the decision to use or not to use was more the result of peer influence. 

 The study provides strong evidence of the continuity of marijuana use from high school to college and the risk of exposure and use remains high through college. Since initiation seldom occurs after 2 years of college the researchers suggest that prevention efforts should be aimed at first and second year college students as a continuation of prevention activities beginning before high school.

(Pinchevsky, GM, Arria, AM, Caldeira, KM, Garnier-Dykstra, KB, Vincent, KB, O’Grady, KE: Marijuana exposure opportunity and initiation during college: parental and peer influences: Prevention Science, Society for Prevention Research 2011 10.1007/s11121-011-90243-4).

Healthy People is a government sponsored program to provide science-based, 10-year national objectives for improving the health of all Americans. For over thirty years Healthy People has established benchmarks to measure the impact of prevention efforts and to guide individuals toward making informed health decisions. One of the objectives of Healthy People 2020 is to increase the number of elementary, middle, and high schools that provide comprehensive health education in the areas of injury, violence, suicide, tobacco, alcohol and other drug use, unintended pregnancy, HIV/Aids, unhealthy diet, and inadequate physical activity.  The premise is that these problems can be partially addressed by providing health education. A recent review article in the American Journal of Preventive Medicine identified evidence-based, peer reviewed programs, strategies, and resources to meet these objectives and recommended evidence based implementation strategies to help achieve these goals. National health education standards have been developed to guide prevention programs.

The article states that alcohol and drug use are associated with many serious problems, including violence, injury, and HIV infection. It cites the 2007 Youth Risk Survey which found that 45% of high school students reported drinking alcohol in the previous 30 days and that those 12-20 years old drank 11% of all the alcohol consumed in the U.S. The report identifies 5 evidence-based substance abuse prevention programs all aimed at reduction of alcohol and drug use by school aged young people: Protecting you/ Protecting Me, Life Skills Training, CASATART, Class Action/Project Northland, and Project Alert.

 Online resources for identifying such evidence-based prevention resources are: The Substance Abuse and Mental Health Services Administration (SAMSHA) nrepp.sanshsa.gov/, Blue Prints for Violence Prevention www.colorado.edu/cspv/blueprints/, The Office of Juvenile Justice and Delinquency Prevention www.ojjdp.ncjrs.gov/mpg/, The Collaborative for Academic, Social, and Emotional Learning (CASEL) www.casel.org/programs/selecting.php, and CDC Division Of Adolescent and School Health (DASH) www.cdc.gov/healthyyouth/index.htm.  The authors caution that “without following the developer’s guidelines and ensuring fidelity of the program an evidence-based program will not produce the intended results”.

 (Inman, D D,  Bakergem, K M,  LaRosa, A C,  Garr, D R: Evidence-based health promotion programs for schools and communities. American Journal of Preventive Medicine 2011, 40:207-219.)

 Jerry Moe’s keynote speech at the September 2011 NAADAC conference has been covered in this article in Joined Together.

Patrick Haggerson’s narrative about positive effects of “The Honour of All” documentary is featured in Counselor Magazine.

To accompany a group showing of the special video report: “Nick News with Linda Ellerbee – Under the Influence: Kids of Alcoholics”

In November 2010, a special edition of Nick News with Linda Ellerbee brought attention to a problem that approximately 11 million kids in the U.S. have been suffering silently for too long. “Under the Influence: Kids of Alcoholics” tells the story of 5 kids who live with alcoholic parents and the challenges they face because of it. Jerry Moe, National Director, Betty Ford Children’s Program, is featured as the subject matter expert in the program. 

Although the program shows how sad and scary it can be for children living with alcoholism, it also delivers a message of hope. It lets kids know that they are not alone and that there are things they can do to stay safe and cope with the problem.

The objectives for the lesson plan include teaching students about the common problems and feelings of kids living in families hurt by alcoholism, as well as important messages and strategies to empower children of alcoholics to positively cope with the many challenges they face. Additionally, students will learn how a friend can help.

Get the lesson plan

Download the video program

of the program

A recent study at the Massachusetts General Hospital and Harvard Medical School examined the relationships between AA, spirituality/religiousness (SR), and alcohol use, and tested whether better outcomes can be explained by spiritual changes. According to these researchers, “increasingly rigorous research conducted in the last 15 years supports the notion that AA participation is associated with better short- and long-term outcomes and may be a cost-effective treatment adjunct.”  AA claims it aids recovery through “spiritual” practices and beliefs but much skepticism and contentiousness surrounds such claims. Many previous studies suggest that AA works through increasing self confidence, enhancing coping and motivation, and by mobilizing changes in social networks. Spirituality and religiousness (S/R) has experienced growing interest, but never been subjected to rigorous scientific investigation.

Adults (1,726) participating in a trial of various treatments for alcohol use disorder (Project MATCH) were assessed at treatment intake, and 3, 6, 9, 12, and 15 months on their AA attendance, S/R and alcohol use outcomes. The assessments found that attending AA was independently associated with increases in spiritual practices over and above their level of S/R prior to starting the study and other variables such as age and ethnicity. This was especially true for those initially low on these practices before entering the study. Results also revealed that AA was consistently associated with better subsequent alcohol outcomes, which the researchers state was partially the consequence of increases in spirituality. These mediational effects were found to be very consistently demonstrated across both outpatient and aftercare samples and on both alcohol outcomes (percent days abstinent and drinks per drinking day).

The study findings suggest that ”AA leads to better alcohol use outcomes, in part, by enhancing individuals’ spiritual practices and provides support for AA’s own emphasis on increasing spiritual practices to facilitate recovery.”

(Kelly, JF, Stout, RL, Magill, M, Tonigan, JS, Pagano, M: Spirituality in recovery: a lagged meditational analysis of alcoholics anonymous’ principal theoretical mechanism of behavior change. Alcoholism: Clinical and Experimental Research 35, 3, 454-463, 2011.)

Researchers at Loyola Marymount University in Los Angeles examined the questions, “Do parents accurately perceive the attitudes of other parents about their college students’ use of alcohol?” and, “What is the effect of these perceptions on the alcohol related attitudes of their own college student’s drinking?”  Recent research indicated that parents still have significant impact on their college student’s alcohol use. Parental influences such as permissiveness or parental monitoring were found to impact alcohol use. It had also been shown that parental disapproval of high-risk drinking reduced such behavior in students. This current study sought to understand to what extent parents of college students accurately perceive the alcohol use approval levels of other parents and examine the effect of those misperceptions on both parent and child attitudes about drinking.  

Participants were 270 college student-parent pairs who completed an online questionnaire. Average student age was 19 years and parents averaged 50.9 years. Analysis showed that “parents significantly overestimated other parent’s approval of alcohol use by their child and, further, that these misperceptions strongly influenced parental attitudes toward their own child’s drinking”. This strong link between parental attitudes about drinking and their student’s attitudes suggest a need to provide parents with accurate and credible information about what typical parents feel about risky drinking.

The study offers “unique insights into how parental attitudes relate to child attitudes and thus to a child’s drinking while in college”. It is the first study to document parental overestimation of other parent’s attitudes. This research underscores the need to approach the problem of risky college age drinking beyond just the college environment and concludes that these findings have significant implications for the content and use of parent-based interventions.

(LaBrie, W, Hummer, JF, Lac, A, Ehret, P: Parents know best, but are they accurate? Parental normative misperceptions and their relationship to students’ alcohol-related outcomes. Journal on Studies of Alcohol and Drugs, 72,521-529, 2011).

Only 10% of the estimated 1.4 million teens with an alcohol or drug problem are receiving treatment, compared to 20% of adults. Alcoholics Anonymous and Narcotics Anonymous (AA/NA) are now deemed an effective adjunct to substance abuse treatment for adults. However, little is known about the effectiveness of these programs for teens. This review article looks at teen involvement in Alcoholics Anonymous/Narcotics Anonymous (AA/NA), and at studies of formal teen treatment programs that used an AA/NA model. The article also provides data on the effects of AA/NA attendance on abstinence, which youth tend to become involved in AA/NA, and the benefits of AA/NA participation.

 Approximately two thirds of formal inpatient and outpatient treatments for teens are considered to be, at least in part, based on the 12 Step principles. Unfortunately, there is little research on teen involvement in informal community-based 12 Step programs. These programs are convenient and free and provide sober peer support.  Yet, at present, only about 11% of AA members and 14% of NA members are 21-30 years old and only 2% are under 21.

The author reviewed 19 studies that had investigated the effects of AA/NA on teen drug use. Only formal 12-step oriented programs mentioned any evaluation of youth alcohol/drug use. Levels of abstinence averaged 30%-40% across the studies and time points. Eleven of the studies found that AA/NA attendance increased   abstinence by two to three-fold over non-participants. A wide range of reasons was found for why teens attended meetings: feeling hopeless, motivated for abstinence, drug-free friends, a history of previous treatment, having experienced severe alcohol or drug problems, need to feel connected to others, and desire for a more spiritual orientation to life.

Possible reasons cited for limited teen participation in AA/NA were difficulty in admitting powerlessness, the shorter duration of their problem, a teen’s need to test limits, higher probability of being in treatment involuntarily, discouragement by older members, and structural barriers such as transportation.

The author suggests several means to increase teen involvement in AA/NA, such as AA pamphlets and a variety of other literature designed for teens and their parents. There are 12-Step groups designed for teens to help teens, as well as 12-Step chat rooms and forums. Novel ideas such as “sober schools” have been developed to provide treatment without interrupting education. The review states that treatment for teens is superior to no treatment, and that participation in AA/NA results in enhanced alcohol/drug use outcomes, but concludes that much can be done to increase teen participation.

(Sussman, S,: A review of alcoholics anonymous/narcotics anonymous programs for teens.  Evaluations and the Health Professions 33: 26-55, 2010

According to a recent article, accredited residency programs in addiction are only available for psychiatrists specializing in addiction psychiatry (ADP).  Of the 40 accredited ADP residency programs in the United States, only 7 offer training to non-psychiatrist physicians. The 2008 National Survey of Drug Use and Health found that over 23 million people in the USA need treatment for drug or alcohol use of whom 20.8 million receive no specialized care. To meet this gap in treatment this study examines the need to expand office-based treatment by training both primary care physicians and addiction specialty physicians. They note that “currently addiction medicine (ADM) is rarely taught as a formal discipline in any of the nation’s 132 medical schools”.

Historically, the American Society of Addiction Medicine (ASAM), originally founded in 1954,  was established in 1988 as a national medical specialty society.  ASAM has provided professional certification in addiction medicine to 4514 physicians. Certification is based on completion of a one year fellowship program or 1950 hours of clinical practice and completion of a 250 item written exam.

Concurrently, the American Academy of Addiction Psychiatry (AAAP), founded in 1985, achieved formal recognition from the American Board of Medical Specialties (ABMS) for a sub-specialty of addiction psychiatry. So at present in the US, only psychiatrists have access to an accredited residency program in addiction medicine. Thus non-psychiatrists might receive ADP training yet not be granted a certificate of completion of accredited training.

The authors suggest the next step in the advancement of addiction medicine is to develop a residency that meets uniform standards for certification. However, several medical specialties – family medicine, internal medicine as well as psychiatry – were involved in the evolution of addiction medicine so it doesn’t fit neatly into a single specialty. And comprehensive information is lacking about the characteristics of existing ADM programs. One objective of this study was to compile such information for use in applying to the American Board of Medical Specialties (ABMS) for formal recognition of ADM as a specialty or sub-specialty.

A one page survey was sent to leaders of 133 medical schools and 37 independent teaching hospitals. Completed questionnaires from 117 medical schools and 24 teaching hospitals revealed 15 ADM programs. A contact person from these 15 programs was sent a second more detailed survey. Results showed 26 addiction medicine fellowships. Direct contact with these program directors revealed only 17 positions for accredited addiction psychiatry residency programs that train non-psychiatrists. To remedy this disparity, the authors suggest a number of steps that would allow addiction medicine to “enter the existing structure of medical education and board certification within organized medicine in the United States.”

(Tontchev, GV, Housel, TR, Callahan JF, Kunz, KB, Miller, MM, Blondell, RD: Specialized training on addictions for physicians in the United States. Substance Abuse 32:84-92, 2011)

“The global war on drugs has failed, with devastating consequences for individuals and societies around the world…fundamental reforms in national and global drug control policies are urgently needed.”  So states the June 2011 report by the Global Commission on Drug Policy, a 19-member commission including former U.N. Secretary-General Kofi Annan, former U.S. official George P. Schultz, former U.S. Federal Reserve chairman Paul Volcker, former presidents of Mexico, Brazil and Colombia, the current prime minister of Greece  and other notable figures. The purpose of the Global Commission on Drug Policy is “to bring to the international level an informed, science-based discussion about humane and effective ways to reduce the harm caused by drugs to people and societies”. They urge nations to “Break the taboo on debate and reform”.

Citing the United Nations estimates of annual drug consumption increases from 1998 to 2008 (cannabis 147.4 million to 160 million, cocaine 13.4 million to 17 million, and opiates 12.9 million 17.35 million) the commission places part of the blame on policymakers reinforcing the idea that all people who use drugs are ‘amoral addicts’, and all those involved in drug markets are ruthless criminal masterminds. The reality according to the report is much more complex.

The commission’s goals are to: review the basic assumptions, effectiveness and consequences of the ‘war on drugs ‘approach, evaluate the risks and benefits of different national responses to the drug problem, and develop actionable, evidence-based recommendations for constructive legal and policy steps. Of particular note the commission recommends that “ Instead of punishing users who the report says “do no harm to others,” they argue that governments should end criminalization of drug use, experiment with legal models that would undermine organized crime syndicates and offer health and treatment services for drug-users in need.” The report  emphasizes, “the time for action is now.”

www.globalcommissionondrugs.org June 2011

The International Society of Addiction Medicine (ISAM) was founded in 1999 to advance knowledge of addiction as a treatable disease, enhance the creditability of physicians involved in its treatment, and develop educational activities and consensus guidelines. As an increasing number of physicians dedicate a major portion of their practice to this specialty, raising their credibility and validating their practice through certification became a major goal of ISAM.

This Canadian lead study describes the growing consensus about the core competencies required of any physician who treats abusing or addicted patients: Screening, Brief Intervention and Referral for Treatment options including mutual help (SBIRT). The authors stress that, by comparison, the competencies for an addiction medicine specialty are far more extensive and understandably less defined. The first such certification exam in the United States was held in 1983 by the California Society of Addiction Medicine followed b y the first national exam in 1986 under the auspices of the American Society on Alcoholism and Other Drug Dependencies, which was changed to the American Society of Addiction Medicine (ASAM) in 1989. In 2003, in Amsterdam, the Board of ISAM set the goal of developing comparable, affordable and creditable international certification.

The ISAM certification exam was based on three existing textbooks judged to be a repository of current knowledge in the field – texts backed by 150 peer reviewed journals in the addiction field. To enhance access to the exam an extensive list of prior education, experience, and references were recommended. Since 2005 the examination has been held 8 times. Candidates were from Canada (20), Egypt (37), and Saudi Arabia (37) and Hong Kong, Iceland, Kuwait, and Sudan as well.  The pass rate was 81%. The study concludes that international certification of addiction medicine is possible, the examination has performed well, and areas of improvement have been identified. Funding, standardized review courses, translation to additional languages, and complimenting the exam with an objective locally administered clinical examination are viewed as the next steps.

(e-Guebaly, N, Violoto,C,: The international certification of addiction medicine: validating clinical knowledge across borders. Substance Abuse, 32:77-83, 2011)

BFI Executive Council member, Carl Erickson, discusses the progress of addiction science over the last 20 years.
http://www.statesman.com/opinion/insight/texas-expert-addiction-science-has-taken-giant-steps-1642154.html?viewAsSinglePage=true
Dr. Erickson, professor of Pharmacology/Toxicology at The University of Texas at Austin, has been studying addiction for the past 30 years. He is the author of more than 260 peer-reviewed and professional publications, including two sole-authored books: The Science of Addiction: From Neurobiology to Treatment (W.W. Norton, New York, 2007) and a new book titled Addiction Essentials: The Go-To Guide for Clinicians and Patients (W.W. Norton, New York, 2011.)

Betty Ford Institute, whose inaugural conference, “What is Recovery? A Working Definition” tackled a fundamental issue in the addiction treatment field of how recovery is defined and measured, is supporting a new research program which aims to further refine the term.

The term ‘recovery’ is widely used in addiction research literature. It also appears in NIAAA’s strategic plan, and in the title of one of its divisions. Recovery is a goal of alcohol and drug abuse treatment. Addicts and alcoholics who no longer drink or use who are trying to pursue an improved way of living say that they are ‘in recovery.’ Yet with its frequent use, there is no agreed-upon definition of the term recovery. For instance:
• Does recovery require abstinence?
• Can someone be “in recovery” if they are still drinking or using?
• Is recovery more than just being clean and sober? If so, how is that defined?

Scientists at the Alcohol Research Group (ARG) want to answer these questions and are working with partners such as Betty Ford Institute to connect with people who used to have a problem with alcohol or drugs. ARG has asked Betty Ford Institute to help recruit people to take an anonymous online survey. To be eligible, participants must be at least age 18 and consider themselves to be ‘in recovery’ from an alcohol or drug problem.

The goal of the research is to develop a way of measuring recovery that will illustrate the constructive personal and social ways of being that are associated with recovery. Additionally, it will provide a framework for educating the public and policymakers about what recovery from alcohol and drug dependence entails.

Betty Ford Institute will participate in other parts of the study as well, which will include further surveys, telephone interviews and the development of a comprehensive scale of the qualities associated with recovery.

“What Is Recovery” is a research project of the ARG which conducts and disseminates high-quality research in epidemiology of alcohol consumption and problems, alcohol health services research, and alcohol policies, while also training future generations of alcohol researchers. The study, funded by the National Institutes of Health, is directed by Dr. Lee Ann Kaskutas, a Senior Scientist at the ARG, which is part of the Public Health Institute (PHI).

Jerry Moe, Vice President and National Director of Betty Ford Children’s Programs, is a contributor to a newly released book, Children of Substance-Abusing Parents: Dynamics and Treatment.

“Children of Substance-Abusing Parents: Dynamics and Treatment is a necessary reference for all mental health professionals and students who need to understand and treat this population. It offers an invaluable look at treatment options and programmatic interventions across the life span and fills an important gap in the current literature. The contributors include a wide range of experts who provide up-to-date evidence-based clinical and programmatic strategies for working with children of alcohol and other substance-abusing parents of any age and in almost any practice setting.

“This highly recommended book is a valuable resource for all practitioners and students concerned about this very large, but often hidden group of individuals and families.”
- Sis Wenger
President/CEO, National Association for Children of Alcoholics

Parental drug abuse and alcoholism have an enormously detrimental impact on children and adolescents. Children whose parents suffer from drug abuse or alcoholism often face multiple physical, mental, and behavioral issues. They are at a greater risk for depression, anxiety, low self esteem, and addiction, and also are known to have poor school attendance, difficulty concentrating, and lower IQ scores.

This book offers health care practitioners proactive programs and innovative strategies to use with this vulnerable population. Taking a comprehensive, life course approach, the authors discuss the implications and interventions at the prenatal stage, through childhood, adolescence, young adulthood, and adulthood. With this book, social workers and health care practitioners can help assess and intervene with children of substance abusing parents.

Key topics:

• Dynamics in families with substance abusing parents and treatment implications
• Issues across the life span of children of substance abusing parents
• Prevention and early intervention programs for pregnant women who abuse substances
• Programs for young children, adolescents, college students, and children with incarcerated parents

http://www.springerpub.com/product/9780826165077

“The Truth About Drugs and Alcohol” is an informational guide developed by Premier Agendas, Inc. in conjunction with Betty Ford Center for students in middle grades. The brochure is a supplement to agenda-style calendar books created by Premier Agendas, Inc. that is used daily by students to record their assignments. The goal of the publication is to dispel myths and provide facts about drugs and alcohol in an age-appropriate manner and to give students information about what to do if they encounter the problem themselves.

Used with permission of Premier Agendas, Inc. Full reproduction is prohibited. For authorization to reprint, or additional copies, please contact: 800-221-1165 or email

Drug and Alcohol Prevention Supplement_Premier

The Betty Ford Institute has been fortunate to have benefited from the vision and wisdom of First Lady Betty Ford. Over several decades, her pioneering spirit and honest dialogue has contributed to hope and healing.

In 1975, Mrs. Ford took her first step into history by going public with her breast cancer, thereby saving the lives of hundreds of thousands of women by emphasizing early detection.

Seven years later, in 1982, Mrs. Ford took her next step into history by sharing the truth about her alcoholism and other drug dependence with the nation, and by co-founding the Betty Ford Center with Leonard Firestone.

Mrs. Ford’s third step into history took place in 2006 when she established the Betty Ford Institute (BFI). The mission of the BFI is to conduct and support collaborative programs of research, prevention, education and advocacy to reduce the devastating impact of addictive disease on individuals, families, organizations and communities.

Author William L. White, America’s most distinguished addiction historian and a member of the BFI Executive Council, describes the important work of Betty Ford Institute, “No other institution in America dealing with alcohol and other drug problems combines such an integrated focus on personal, family and community resilience/recovery, nor places such an emphasis on the resilience and recovery needs of families, women and children.”

It is Mrs. Ford’s courage, vision and pioneering fortitude that has made it possible for the Betty Ford Institute to forge ahead with programs of hope and healing; and for this, we are eternally grateful.

Substance use disorders (SUDs) are thought to have roots in childhood.  According to this recent Massachusetts General Hospital study, psychiatric disorders have been observed in up to 85% of adolescents with SUDs. Previous research has shown that childhood attention-deficit/hyperactivity disorder (ADHD) persists into adolescence in 75% of cases.  However, long-term research on predictors of SUD in children with ADHD has been limited.  This study’s aims were to identify “clinically meaningful characteristics of children that predicted the future development of SUDs and to see whether the role of these characteristics varied by sex”.

A number of male and female participants were recruited from pediatric and psychiatric clinics (280 with ADHD and 240 without). Subjects in the ADHD group met the full diagnostic criteria for the disorder and had active symptoms when recruited. Approximately 70% of the girls and over 80% of the boys were reassessed at the 10-11 year mark.  At follow-up, females with ADHD at recruitment were 3.49 times more likely to have an alcohol or drug use disorder. Male subjects with ADHD at recruitment were 3.1 times more likely to develop an alcohol or drug use disorder.  The study found that familial ADHD did not increase risk for SUD and, in fact, offered a protective effect against later alcohol-use disorder in the youth with ADHD. No clinically significant associations were found for any social or family environmental factors and there were few gender-specific effects. One of the major factors noted was that ADHD children with co-occurring conduct or oppositional disorders at baseline assessment were at significantly higher risk for developing substance use disorders 10 years later compared to those without those disorders. The study concludes that “the findings support the hypothesis that ADHD is a risk for subsequent SUD”.

(Wilens,TE, Martelon, M, Gagan, J, Batemen, C, Fried, R, Petty, C, Biederman, J: Does adhd predict substance-use disorders? A ten-year follow-up study of young adults with adhd. Journal of the American Academy of Child and Adolescent Psychiatry. 2011, 50: 543-53.)

Fourteen US states have legalized medical marijuana, and 12 states are considering doing so. This widespread availability of medical marijuana raises concerns about its impact on adolescents through increased availability, altered perceptions of harmfulness, and changed social norms surrounding its use –all factors known to impact adolescent marijuana use and relapse after treatment.  This University of Colorado-Denver study evaluated the prevalence of marijuana diversion into the hands of adolescents in treatment and explored the hypothesis that adolescents exposed to medical marijuana – compared with those with less exposure – would report greater availability, less perceived harmfulness, less peer disapproval, more frequent use, and more drug-related problems.

Eighty outpatients in a Denver treatment program ages 15-19, all with a history of marijuana use, completed a medical marijuana questionnaire created for the study. Questions concerned access, perceived harmfulness, and social norms. Participants were told that neither therapists nor parents would know the results. Thirty-nine (48.8%) reported having received marijuana from someone with a medical marijuana license. These teens were “significantly” more likely to report very easy marijuana access, no peer disapproval of regular use, having used marijuana 20 or more times per month during the past year, more substance-related problems and more general health problems.

The researchers conclude that diversion of medical marijuana to teens in treatment is commonplace and that medical marijuana exposure in an adolescent’s life may lead to more marijuana use and more overall problems. They recommend similar research be done in states and communities that have distinct medical marijuana systems.

(Thurstone, C, Lieberman, Ss, Schmiege, SJ: Medical marijuana diversion and associated problems in adolescent substance treatment. Drug and Alcohol Dependence. , doi:10:1016/jdrugalcdep.2011.03.031)

According to the Substance Abuse and Mental Health Services Administration  (SAMSHA), 13.6% of all children ages 3-5 live in a home where one or more parents have a past year diagnosis of drug abuse or dependence. Parental drug abuse increases risk of conduct problems in their children. The pre-school period and transition to elementary school is particularly important because that is when the onset of life-course-persistent problems occurs. This innovative study at the Center for Addiction Research, the University of Arkansas, consisting of homework, class sessions, and a novel incentive program resulted in reductions in children’s’ behavioral problems.

Forty-seven mothers – most of whom were in residential substance abuse treatment with their children during the period of the study – were randomly assigned to parent training plus incentives (PTI) or parent training without incentives (PT). Participating children were 55% male, ages 2-7. The intervention employed a pre-existing training program proven to enhance parenting skills and reduce childhood conduct problems. The mothers were paid $25 for completing questionnaires before and after treatment. All families participated in a twelve-week 2hrs/week training session. However, the PTI group also received financial incentives based on treatment compliance that involved opportunities to draw for gift certificates ranging from $1 to $100.

Data were analyzed using traditional intent-to-treat analysis, plus complier average causal effects (CACE) – a novel statistical technique that identifies predictors of compliance with treatment in a randomized trial. All mothers were asked to make daily calls to a voice response tracking system to rate their own parenting and their child’s conduct. Analysis showed that rates of attendance and homework completion did not differ significantly between the PTI and PT groups. However, PTI mothers made an average of 41% of possible calls versus 21% for PT mothers. Also, children of those mothers who received the added incentives showed a greater reduction in behavior problems. Overall, analysis showed significant positive effects on PTI parents’ abilities to parent, and their children’s behavior and emotional management skills.

 The researchers suggest that this study provides support for the need to augment parent training with their novel incentive program to boost parenting outcomes among substance abusing parents and as a prevention strategy for children at risk from their parent’s substance abuse or dependence.

(Stanger C, Ryan SR, Fu H, Budney, AJ: Parent training plus contingency management for substance abusing families: a complier average causal effects (CACE) analysis.  Drug and Alcohol Dependence.  , doi:10.1016/j.drugalcdep.2011.03.007.)

We welcome Josie Warren, a native Coloradan to our staff.  She brings with her a lot of enthusiasm and hope for the children with whom we work.  She received her Psychology and Human Development Bachelor of Arts degrees from Eckerd College in Florida.  Josie started in our program as a volunteer in July of 2010.  She joined us as a per diem staff in January. The addition of Josie to our team was also when our program here in Colorado became independent of support from the California and Texas program staff.

The California Children’s Program strives to help in educating families about the disease of addiction in many different ways.  We are dedicated to serving families that come to our Children’s Program on our main campus; however, a large amount of time is utilized throughout our community.

We will continue to have two programs a month on the main campus during the summer.  In addition, many of our staff will participate in the International Doctors and Dentists in Alcoholics Anonymous (IDAA) Conference in August.  Staff will travel to Arizona to host several children’s groups simultaneously in an effort to help change the family legacy.

Efforts will also be focused on presenting material to other professionals and patients alike.  Already this season we have visited the Riverside County Department of Mental Health MOMS program; The Ranch Recovery Centers, Hacienda Valdez; Torres-Martinez Tribal TANF (temporary assistance for needy families) and New Found Life Family Forum in Long Beach.  We look forward to visiting Cedar House on June 6th and many others as the summer progresses.

EMDR Workshop Successful
On April 29th, Renee Lozano, LCSW presented as part of the Betty Ford Center Five Star Kids Training Series on Eye Movement Desensitization and Reprocessing (EMDR). EMDR is a technique used in therapeutic work with those who have experienced trauma and continue to experience strong emotional reactions long after a difficult event has passed. Participants received an excellent example of this therapeutic process as Ms. Lozano performed EMDR with two volunteers who had been under the care of Ms. Lozano prior to the training. Participants reported that observing the process first hand added significantly to their understanding and appreciation for this more novel approach to trauma work. Learn more about Renee Lozano’s work at http://www.heritage-behavioral.com/index.html

Register to Learn About Resiliency
The next presentation in the Five Star Kids Training Series discusses the topic of resiliency. So often, mental health interventions focus intently on the problems and setbacks a client has experienced. However, clinicians may also benefit from a reminder of those factors which contribute to success and perseverance, despite the difficulties a client may have experienced. Dr. Carolyn Kern, Assistant Professor of Counseling for the Department of Counseling and Higher Education at the University of North Texas will facilitate a training on this topic October 7, 2011 at the Five Star Kids offices in Irving, TX. Contact us now to save your spot! E-mail or call 972-751-0363.

“Tools for the Journey” is a one-day workshop offered by Betty Ford Children’s Program for professionals interested in helping children from addicted homes. 

The session provides training on how to work with children and families in achieving these goals:
1. Introduce children to healing from addiction in their family;
2. Empower adults with parenting skills; and
3. Heal the parent/child relationship.

The first half of the day is spent understanding addiction and resilience.  Addiction is presented as a multigenerational disease which thrives on the “Family Laws of Addiction:  Don’t Talk, Don’t Trust and Don’t Feel” (Claudia Black).  Resilience is that quality which allows a person to successfully adapt despite risk. Resilience is embedded in the Betty Ford Children’s Program model of discovery/recovery:  “Learning About Addiction,” “Feelings,” “Self-Care” and “Celebration” and the tools used to illustrate those concepts. By giving children age-appropriate tools that build upon already present strengths, children are able to deepen their strengths, skills and supports to overcome the adversity in their life caused by addiction. 

The afternoon session of the “Tools for the Journey” workshop is spent demonstrating experiential activities with the participants.  By using experiential activities, children (and adults) are able to use more than one mode of learning (visual, auditory and kinesthetic) and thereby connect to the material presented for deeper levels of insight and understanding.  Activities presented include:  “The Bicycle,” “Stuffed Problems, Feelings and Secrets,” “Addiction Man,” “Safe People Map,”  “Alphabet Soup,” “High Risk Me,” “Jeopardy Game,” and “Self-Care Bag.”  Each activity covers one or more aspects of addiction and recovery and is modifiable to meet the needs of different age ranges.

People who have attended past workshops include: social workers, teachers, school psychologists, therapists, professionals from government agencies, prevention programs and treatment programs, people who work with children at the elementary, middle and high school levels, parents, recovery community members and more.  Tools for the Journey may be tailored to meet the needs of those in attendance by addressing specific questions and concerns of the participants.
 
The workshop provides an opportunity for participants to earn continuing education units (CEU’s). It has been offered at the Betty Ford Center in Rancho Mirage and on location in Denver, but is portable to other locations as well. For more information or to inquire about the next workshop opportunity, contact any Betty Ford Children’s Program staff.

For those of us who run educational support groups for school-age children, having an amazing activity with an incredible message doesn’t always mean that kids will be interested or that they will “get” it.  The key to a successful activity is more in the delivery than anything else.

Anyone who has ever worked with elementary age children knows that it is not as easy as it sounds.  The best laid plans can easily fall apart, and before you know it, you’re a group facilitator that has lost the group.  Needless to say, it can feel frustrating to look around at a roomful of people who only come up to your chin, who haven’t yet passed the third grade, and realize that with all of your wisdom and experience with facilitation, the kids are running the show!

In my work with kids ages seven to twelve in the Children’s Program, my job title may be “counselor” but I am also an educator.  In addition to offering kids a supportive environment where they feel safe to share feelings, I am also teaching “lessons” on self-care and problem solving.  As a teacher of my group, it’s my responsibility to create the best environment for learning that I can.  This can be a challenge, but remembering some key points about how children learn can help along the way:

Children learn best when they are excited and motivated to listen and learn.
At the beginning of each activity, get kids excited about what they will be learning! Grab their attention and create anticipation of what is in store.  Use of body language, tone of voice and energy level all set the stage for the rest of the activity. Speaking too softly or with no energy can create an environment that is non-engaging.  As adults, how many of us enjoy listening to a 45-minute lecture given by a speaker, reading the material, in a monotone voice?

Children learn best when they have the opportunity for success.
It is important for children to feel empowered and successful.  Create an environment where kids succeed.  Ask questions that you know they will be able to answer in front of the group.  Modify questions to meet the developmental needs of kids.  Children ages seven to twelve are concrete in their thinking, though kids in the upper age range are slowly moving toward abstract thinking skills.  If a younger child struggles to answer an open-ended question, reframe with a closed one.  Speak to children in a way that conveys confidence in their ability.  Give them options that allow for success.

Children learn best when the activity has an element of surprise.
The lesson should not be laid out in front of them, children should experience it as they go.  Too many times adults over-explain things to kids, boring them and guaranteeing that by the time the activity starts, interest is lost.  The worst thing to do is to tell children exactly what they will be learning at the beginning of the activity.  By allowing them to experience it, their comprehension of the material is enhanced.

Children learn best when the activity is tangible and active.
Children need something to hold, see or experience. Because they are active by nature, children tend not to respond well to learning experiences in which they have little to do.  Create activities and lessons that accommodate for all learning styles; kinesthetic, auditory and visual. 

Children learn best when an activity has a beginning, middle and an end.
Every activity should have a clear beginning, middle and end.  The beginning is the introduction, the part of the lesson where the facilitator creates excitement.  This can also be a time where the facilitator refers back to a previous activity, linking the anticipated lesson with one they have already learned.  The middle is the core of the activity, where children are actively engaged in the process.  The end is often a summary of what was learned, or a quick review of the important points.  Some activities come to a close on their own. 

Children learn best when the activity is relevant to their own lives.
This is true for adults as well.  Make the activity relevant to them.  Feel free to use examples that kids may have already brought up. Connect the mind with the heart and make the activity meaningful to the group as a whole.
 
Children learn best when the facilitator provides open-ended questions.
Open-ended questions encourage dialogue and discussion.  These types of questions are more objective and less leading than close-ended questions, which encourage “yes” or “no” answers.  They typically begin with “Why” or “How” or “Tell me about that…”  Older children in a group respond very well to these types of questions, and group facilitators can gain more information about a child’s life or perspective. 

Children learn best when the facilitator understands that there needs to be the freedom to change the activity in the middle whenever it is appropriate.
I cannot stress this point enough!  When working with kids, be prepared and flexible.  A great way to tell if it’s time to change an activity mid-gear is by observing the group.  Have “chair acrobats” started?  Are kids wriggling around?  Are kids excited, or are they not responding to questions?  You may see that the group is no longer engaged, but you think to yourself, “I still have important points to teach.”  Keep in mind that children can only listen to a certain point.  If you have lost the group, no matter how important or relevant the rest of the information, it is time to move on. 

Children learn best when the facilitator understands the audience, and makes adjustments when needed.
Be aware of the personality of the group as a whole.  Some groups are very reflective, needing a good deal of time for processing in an activity.  Some groups are very active, moving through the activity quickly and energetically and need less time to talk.  Tailor your delivery to the needs of your audience.  Is there a recurring theme in the group? It is perfectly appropriate to incorporate these issues into the activity.  By doing so, you demonstrate to the group that you have been listening to their concerns, and you also make the activity relevant to their own lives.

A skilled kids’ group facilitator should be able to keep the activity moving along, following the plan, but with the flexibility and adaptability to change it if it is not meeting the needs of the group.  The best activity can fall flat on its face if it is not delivered in an engaging, age-appropriate manner.  My hat goes off to all professionals who create an environment of safety, support and discovery, whether it’s for a weekly one-hour educational support group, or an intensive all day process.  By reflecting on how children learn, we can take steps to engage kids, enhance comprehension, and have fun while doing it!

Peggy McGillicuddy is a counselor and group facilitator, having provided advocacy and support services for young children impacted by addiction since 2000.  She currently serves as a consultant and trainer for the Betty Ford Institute Children’s Program Training Academy. Peggy particularly enjoys training and teaching others to work effectively with children from a strength-based perspective.

On April 6th, Elizabeth Devine, Clinical Coordinator for the Betty Ford Center Five Star Kids presented “Children’s Perspectives on Addiction in the Home: Considerations for Professionals” via webinar for the National Alliance for Drug Endangered Children. Over 500 professionals from across the nation tuned in to see the artwork and writings of children that exemplify the experience of growing up in a home with familial addiction. The PowerPoint for this presentation, full-length webinars and other resources are available free of charge at http://www.nationaldec.org/training/trainingdownloads.html.

In the webinar, Elizabeth Devine offers insight regarding the mental and emotional perspective of children growing up with alcohol or drug addicted caregivers. Children within such a family system take on several different roles to cope and share many common characteristics and challenges. Additionally, ideas are presented on how to work with this population in a way that fosters resiliency.

The webinar is provided by the National Alliance for Drug Endangered Children. The mission of the National Alliance for Drug Endangered Children (National DEC) is to break the cycle of abuse and neglect by empowering practitioners who work to transform the lives of children and families living in drug and alcohol environments. National DEC provides these webinars at no charge to professionals working to improve the lives of children living in drug environments.

On April 28th, the 15th Annual PRISM Awards recognized Lucky Duck Productions’ special program, “Nick News with Linda Ellerbee – “Under the Influence: Kids of Alcoholics”” with the award for Children or Teen Television Program. The special tells the story of 5 kids who live with alcoholic parents and the challenges they face because of it.

Although the program shows how sad and scary it can be for children living with alcoholism, it also delivers a message of hope. Jerry Moe, National Director, Betty Ford Children’s Program, who is featured in the show as the subject matter expert, explains, “It lets kids know that they are not alone and that there are things they can do to stay safe and cope with the problem.”

Special kudos to Matthew, and alumnus of the Colorado Betty Ford Children’s Program, who was featured on the show and clearly demonstrated both his strengths and resilience.

The show can be viewed on iTunes or downloaded as a free podcast at: http://itunes.apple.com/us/podcast/under-influence-kids-alcoholics/id400203724?i=89045827

The PRISM Awards, produced by the Entertainment Industries Council, Inc. (EIC), in collaboration with the Substance Abuse and Mental Health Services Administration (SAMHSA) and FX Network, honor actors, movies, music, media and television’s top shows that accurately depict and bring attention to substance abuse and mental health issues.

Five percent of US pregnant women use illicit drugs. Substance-abusing pregnant and/or parenting women have great need for medical, mental health, and other social support services. Studies show that, compared with substance-abusing men, women are more likely to have psychiatric problems, lower self-esteem, and histories of traumatic abuse events. Most of these women have limited education, are unemployed, and rely on public assistance and/or crime as sources of income. Treatment can change their lives by promoting family unification and long-term recovery.

This UCLA study looked at mothers who were pregnant or parenting and who were admitted to women only (WO) versus mixed group MG) substance abuse treatment programs.  Long term outcomes were derived from administrative records of 1000 such mothers.  Analysis was accomplished using propensity-matching. (Propensity-matching is a method that estimates the effect of treatment when random assignment of subjects is not feasible.) This study is expected to fill some of the knowledge gap concerning appropriate services for this understudied population because it included a large and diverse sample of pregnant and parenting substance-abusing mothers, it involved multiple treatment sites and examined a diversity of treatment settings.

The findings indicated some positive impacts of WO programs for this population of women. Women treated in WO programs had lower levels of arrest, reduced mental health service use, and less drug treatment during the first year after initial treatment. The WO program participants also had lower incarceration rates during the third year post treatment. The findings provide evidence of the positive short-term impact of WO programs.

The study concludes that substance abuse treatment can be a significant turning point in the life of these women but understanding the specific treatment and support needs for women is crucial to achieving long term effects.

Hser YI, Evans E, Huang D, Messina N J: Long-term outcomes among drug-dependent mothers treated in women-only versus mixed-gender programs. Subst Abuse Treat 2011 Apr 4. [Epub ahead of print]

Pregaming is an urban slang term that has found its way into the mainstream vernacular. Pregaming is the practice of drinking alcohol prior to attending parties, sporting events or social gatherings. There have been studies of this practice in the college setting but little is known about the prevalence of this behavior in high school students. This study examined how gender, age, alcohol expectancies, motivations for drinking, and engagement in other risky alcohol use were associated with high school pregaming.

 The prevalence of this behavior was derived from a parent approved questionnaire that identified 233 students who had current alcohol use and 111 of which had a history of pregaming activity. Participants reported that they were likely to pregame before night sporting events, overnight school trips, proms and other parties. Through a variety of questionnaires and survey instruments, the researchers looked at drinking motives, alcohol expectancies, and drinking in social contexts.  Results indicated that being older, having high levels of risky alcohol use, and participating in drinking games (DG) predicted increased likelihood of pregaming.  Being male and reporting high levels of hazardous alcohol use was associated with increased frequency of pregaming.  A large number of pregamers said they pregamed before parties (82%), night sporting events (66%), prom nights (24%), and overnight school trips (6%). None of the other variables were predictors.

The study points to serious implications for students going on to college since drinking patterns developed in high school are generally maintained in the first year of college. Those not going to colleges are also at risk since continued pregaming is strongly related to hazardous alcohol use.

These findings show that “pregaming is prevalent among high school students particularly among boys and older students and it is associated with risky alcohol use and DG (drinking games) participation.”  The researchers suggest that these findings point to a need to address pregaming in high school hazardous alcohol use prevention programs

(Zamboanga BL, Borsari B, Ham LS, Olthuis JV, Van Tyne K, Casner HG: Pregaming in high school students: relevance to risky drinking practices, alcohol cognitions, and the social drinking context. Psychol Addict Behav. 2011 Mar 28. [Epub ahead of print] advanced online doi: 10.1037/a0022252.)

            Nearly half of 8th-grade youth have used alcohol. By the end of high school almost three-fourths have initiated use. Alcohol is a key contributor to the causes of death among those 10 to 24 years—motor-vehicle mortality, suicide, and unintentional injuries. Alcohol continues to be the drug of choice among adolescents but consumption has shifted from beer to liquor. Yet, few studies have examined the effects of beverage-specific alcohol use, particularly hard liquor.   

            Specific types of alcohol may be associated with different levels of consumption and the potential harmful consequences. More importantly, many prevention strategies to reduce underage drinking are beverage-specific .This study by the University of Florida; College of Medicine examined the effect of specific types of alcoholic beverages on 731 urban youths who reported drinking alcohol in 7^th grade. This research addressed three questions: What is the most prevalent type of beverage? What are the effects of beverage-specific use on alcohol behaviors 1 year later? .What are the primary sources for each type of beverage?

Sixty-one public schools in Chicago participated (29 schools assigned to the

intervention, 32 to the comparison group). The students completed self-report questionnaires while in 6th through 8th grades answering questions about their drinking history, quantity, the kind of beverage, and the source of the beverage. The responses enabled the researchers to analyze beverage types, drinking behaviors, sources, trends and demographics.

Analysis showed that hard liquor use in 7^th grade increases the risk of drunkenness and recent alcohol use. Hard liquor was also associated with increased heavy drinking. In general, drinking in 7^th grade led to increased alcohol problems in 8^th grade and drinking hard liquor in 7^th grade led to even higher 8th grade risks. Findings also suggest that sources of alcohol among early adolescents did not vary by beverage type. Parents were the primary source for each specific beverage, with the exception of hard liquor in which case parents and someone under 21 supplied liquor at similar levels.

The study has important implications for researchers and policy makers since strategies to reduce underage drinking are beverage-specific. Participants in this study reported consuming a range of beverages: wine 40%, beer 35%, hard liquor 32%, flavored drinks 23%, and malt beverage 28%. .Interestingly, only 3% was obtained from commercial sources. Understanding specifically what underage youth are drinking, the sources, and the consequences should prove valuable in further research, in countering alcoholic beverage advertising and marketing aimed at youth, and in developing  prevention programs and public policy.

(Maldonado-Molina, MM, Reingle, JM, Tobler, A,l, Komro, Ka: Effects of beverage-specific alcohol consumption on drinking behaviors among urban youth. J. Drug Education, V40(3) 265-280,2010.)

A long-held tenet in the treatment and recovery worlds is that alcoholism and other drug addictions are a family disease. Everyone in the family, including children, gets hurt by this cunning, powerful, and baffling illness. All too often it becomes a family legacy that gets passed from generation to generation. Where does it stop?

Children’s programs provide a unique opportunity to interrupt the multigenerational transmission of addiction. They can teach youth important life skills, empower adults with parenting strategies that they can include in their recovery process, and heal and strengthen the parent/child relationship. Help, hope, and healing are the possibilities of the day.

No Way, No How

“There’s absolutely no way that’s ever going to happen,” she blurted out in an angry tone. I could clearly hear the emotion building in her voice. The mere suggestion, delivered in a careful, gentle manner, that her son might have been affected by her problem drinking was too much for her to hear. Sitting across from me was a bright, attractive 34-year-old physician who wanted to be anywhere else in the world besides my office. She was intent on setting me straight that her oldest child had not only never been affected, but also would never be participating in a kids’ program. “Sammy has absolutely no clue because I would only drink at night while he was asleep in bed,” she asserted. “I don’t want you to be filling his head with a bunch of ideas. He’s only eight.” She glared at me and declared, “I am a good mom.” I shook my head affirmatively as she bolted out the door.

The last vestige of denial is admitting the disease you never asked for has not only hurt you, but has hurt your loved ones as well, especially the children. What person in their right mind would ever hurt their children? This is such a painful place to go, yet perhaps the denial was slowly cracking for this proud, caring mother. About five days after our initial encounter, she watched the kids from the children’s program coming back from swimming. They had smiles plastered all over their faces as they were laughing and giggling about “throwing” me into the pool that particular afternoon. Even she couldn’t hide the smile as she witnessed me dripping from head to toe. These were awesome boys and girls, full of strengths, hopes, and dreams. Something touched her as she watched them parade by. “Can we meet again?” she asked as I passed by. “How about at 4?” I suggested. “I should be fairly dry by then.”

Small Steps

Her mood and tone had softened considerably. She began by stating, “Don’t you think eight is awfully young? He really doesn’t know about any of this.” I knew she was genuine as her face was filled with emotion.

“Where does your son think you are right now?” I asked.
She quickly teared up upon hearing these words and offered, “He thinks I’m working.” She paused, but before I could get a word in edgewise she continued, “But I’ve never been gone this long.” Sadness quickly enveloped her as she was looking at this situation in a brand-new light.

“Did you grow up in an addicted family?” I asked thoughtfully.

“Yes, but it was so different with my mom and her drinking. There was yelling and fighting and she never had any time for me.” She was starting to get all worked up as she asserted, “I am not like that in any way. There’s no yelling, and I spend lots of time with my children.”

I purposely interrupted by offering, “Could you have benefited from a program like this when you were eight? Could your life have been better at such a young age?”

This stopped her in her tracks and was met with stone-cold silence. “I gotta go now,” was her only reply.

Sammy’s dad had agreed with his wife that the children’s program wasn’t a good idea — until his son brought home a note from his third-grade teacher one Friday afternoon. She was very concerned about Sammy because he didn’t seem like himself at school. He was so sad, withdrawn, and distracted. This caring teacher wanted to know if anything was happening at home that was troubling this bright boy. As Dad read the note he knew it was time to immediately take action. Once the two younger ones were put to bed, Dad explained to Sammy, “Mom isn’t away working right now. I just didn’t know how to tell you. She drinks wine after you go to bed at night. Sometimes she drinks too much and it makes her sick. She’s at a special place getting help. I’ll take you to see her on Sunday.”

Sammy wouldn’t say a word and his face looked expressionless. After many moments of awkward silence he softly uttered, “Dad, I’m going to bed now.”

Bringing Mom Home

Dad was awakened early the next morning at about 5:30, as he heard a loud commotion downstairs in the kitchen — cabinets opening, doors slamming, someone talking to himself. What could this be so early on a Saturday morning? When he entered the kitchen he found Sammy fully dressed. He even had the hood on from his sweatshirt. Sammy had a flashlight in his right hand and a handful of Fruit Roll-Ups in his left.

“What in the world are you doing?” Dad asked him. “Sammy, it’s the middle of the night!”

Sammy turned toward Dad and shared, “Dad, I’m going to get Mom now and bring her back home.”

Dad was startled by his son’s words. With tears streaming down his face, Sammy said, “Oh Dad, I’m sorry. I didn’t mean to tell Mom I hated her when she wouldn’t let me go to my friend’s house. I’ll do better in reading and I’ll clean up all the dog poop and won’t fight with my sisters anymore. I just want to tell Mom I’m sorry I stress her out and make her drink.” Dad held his son and they both cried.

Later that day, during their phone call, Dad told his wife all about what Sammy had done. This touched her in a very deep and tender place. When I got to work on Monday morning, this mom was anxiously standing by my office waiting for me to arrive.

“I want to sign my son up for the next program,” she declared.

“Absolutely,” I excitedly replied. “You are giving your son the gift you so desperately needed as a child. You’re changing the family legacy.”

“I just love my kids so much,” she shared.

“Yeah, I knew that from the moment I first met you.”

The Betty Ford Children’s Program is for seven- through 12-year-olds who come from families hurt by alcoholism and other drug addiction. With locations in Southern California, the Dallas/Fort Worth Metroplex, and Denver, Colorado, no child is ever turned away due to an inability to pay.

This article is adapted from Understanding Addiction and Recovery Through a Child’s Eyes by Jerry Moe, 2007; and reposted from http://recoveryview.com/2011/04/changing-the-family-legacy/.

In recent years there has been an international effort in the addictions field to identify treatments and therapies that have been proven to work.  However, evidence-based practices have rarely identified practices that don’t work.  This two-stage study involved a panel of 75 experts who examined a list of 65 treatments currently practiced in addiction medicine. They rated them on a continuum from “not at all discredited” to “certainly discredited.” A Delphi methodology was used to achieve a professional consensus on discredited treatments.  (Delphi employs structured group communications in which experts develop a consensus by mail rather than gathering in-person for discussion.) An initial questionnaire began with the request to “rate the extent to which you view the treatment as discredited from ‘not at all discredited’ to ‘certainly discredited’ ” and included various criteria by which a treatment could be deemed discredited. Replies were pooled with those of the other experts. A second similar questionnaire was then sent, including the first round responses from the panel as a whole.  Anonymity was maintained throughout the process.

The experts considered 11 treatments as “certainly discredited” ranging from electrical stimulation of the head to use of stimulant medications. At the other end of the continuum, 5 treatments were considered “unlikely to be discredited.” These included Alcoholics Anonymous and Antabuse. The researchers raise a number of cautions in interpreting these findings. For example, a treatment for one purpose might be discredited for another (e.g., benzodiazepines effective for withdrawal but not for treatment), and all the experts hailed only from the United States.

Still the researchers believe that, “this study offers a cogent, positive first step in consensually identifying the “dark side” or “soft underbelly” of modern addiction treatment. As a counterbalance to the Evidence-Based Practice (EBP) movement that demonstrates effective treatments, they suggest an emphasis on the field discouraging discredited treatments.

(Norcross, JC, Koocher, GP, Fala, NC, Wexler, HK: 2010. What does not work? Expert consensus on discredited treatments in the addictions. Journal of Addiction Medicine 4: 174-180.)

Of historical interest, the practice of partying before events (tailgating) is associated with American football but it traces its origins to the 1861 Civil war Battle of Bull Run. Supporters of the Union showed up in their wagons with baskets of food and enthusiastically cheered for the Union soldiers.

This modern day study measured alcohol consumption by students and non-students tailgating prior to football games at one southeastern university (School 1) and one Midwestern university (School 2). Approximately 75 % of those approached agreed to participate. Researchers did not notice any pattern to those who refused with regard to age, ethnicity, or signs of drinking. However, participants were mostly male, non-Hispanic white/Caucasian and non-students. Participants (466) completed a short interview and provided a breathalyzer sample during the tailgating time period (150 min prior to 10 min after kickoff). The researchers found that a plurality of participants engaged in heavy episodic drinking, 48.5% at School 1 and 58.8% at School 2. Eleven percent at both sites abstained from alcohol. Breath samples over the legal driving limit were found at both School I (40.2%) and School 2 (31.9%). Heavy episodic drinking was self-reported by younger ages, males, and non-students at School I and younger ages and non-game attendance at School 2. At both schools heavy drinking and higher blood alcohol levels were associated with younger ages although 92.7% of those sampled had reached the legal drinking age.

Tailgating might seem to be student dominated. However, the sample represented in this study – in which more than half the participants are non-students – and other research, shows that this is not true at football games. Likewise the expectation that heavy drinking would be a predominantly male behavior was true at School I but not at School 2.

Consistent with previous research, heavy episodic drinking prior to American football tailgating can be a hazardous activity, particularly in the case of the over 25% who do not attend the game and are likely to be driving under the influence. The involvement of both students and non-students points to a need for both on and off campus prevention programs to reduce heavy episodic drinking at football games. The authors recommend extending such efforts to include other sports events.

Parents’ use of alcohol is a recognized factor in alcohol use and dependence in their offspring.  Current estimates are that 40-60% of alcohol dependence can be attributed to genetics. The remaining risk factors include an individual’s family background, socialization, and psychological makeup. There is a known relationship between alcohol use and depression and anxiety disorders.  This New York University School of Medicine study looked for a possible pathway from parental use of alcohol during their child’s adolescence and the appearance of psychological symptoms in young adulthood.

Participants (1330) came from grades 7-10 in the East Harlem neighborhood of New York City and were African American or Puerto Rican. At the first year (T1) the students took self-administered questionnaires reporting their own and parent’s use of alcohol.  Follow-up took place at 5 years (T2) and 10 years (T3) with structured individual interviews. The following significant pathways were among those observed:  (1) Parent’s use of alcohol at T1 was positively associated with the frequency of their offspring’s alcohol use. (2) Youth alcohol use at T1 showed a positive path to psychological problems at T2. (3) Adolescent psychological symptoms at T2 had a positive path to psychological problems at T3. (4) Males drank significantly more at T2 and displayed more psychological symptoms than females.  The research also showed support for the presence of a pathway from parental alcohol use at T1 to young adult psychological symptoms at T3.

The study suggests pathways from parental use of alcohol to early adolescent alcohol use leading to late adolescent alcohol use, and from late adolescent alcohol use to psychological symptoms in late adolescence.  This in turn predicts young adult psychological problems. The findings point to the parent’s alcohol use as a necessary focus in prevention and treatment of psychological problems in late adolescents and young adults.

(Brook, JS, Balka, EB, Crossman, AM, Dermatis, H, Galanter, M, Brook, DW: 2010. The relationship between parental alcohol use, early and late adolescent alcohol use, and young adult psychological symptoms: a longitudinal study. The American Journal on Addictions 19:534-542.)

Adults in recovery face many day-to-day challenges, and for those who are parents, maintaining good relationships with children can be both rewarding and daunting at the same time. Addressing parenting issues during various stages of recovery can lead to enhanced quality of the parent-child relationship, especially during adolescence.  Research has shown that effective parenting is one of the most critical influences on healthy adolescent development – and for parents in recovery, parenting might be an even more critical factor given children’s heightened risk for problems with substance use.

Parenting issues that appear to be especially relevant to parents in recovery are:

• Overindulgence as a coping mechanism for guilt: Parents in recovery, just like all parents, should be encouraged to set limits, monitor and supervise activities and friends, and provide a structured environment that encourages responsible behavior.
• Discipline issues: All parents find it difficult to balance warm and supportive parenting with having to hold a child responsible for his/her behavior.  But parents must realize that age appropriate rule-setting and positive discipline are necessary and will most likely lead to better child outcomes in the long-term.
• Preoccupation with maintaining recovery:  Despite the importance of occasionally making major life changes, parents in recovery should work to ensure sure that changes are handled with care and monitored to make sure children are adjusting well. Moreover, day-to-day issues like arranging for alternative activities for children during the times that a parent attends recovery support services or NA/AA/Al-Anon meetings can sometimes be stressful if not planned carefully. Drawing on help and support from trusted neighbors, extended family members and community support networks is another strategy.
• Parental absence: There is no one best strategy for confronting the sensitive topic of past parental absences during the time when the parent was in the active stage of addiction.   Many families find counseling helpful to overcome these issues.  Ongoing open and honest discussions between parents and children can help as well. Parents need to keep in mind that children differ in their responses to such stressful life events, with some being much more sensitive than others. Also, as children grow older, their capacity for processing information and having discussions about such past events might improve.
• Rebuilding trust between parent and child: This process can take a lot of time and work for both parent and child, the latter needing reassurance a parent can be relied upon to be responsible when it comes to caring for a child.  Even the smallest demonstration can make a difference, such as being on time to pick up a child from a friend’s house or prompt attendance at a sports or school event.  Encouragement from family members, significant others and family friends can help.
• Overcoming stigma: From a clinical point of view, there appear to be no clear strategies for helping a child – or recovering parent – overcome the stigma of drug or alcohol abuse.  Recovering parents should expect to have to deal with the challenge and focus on the positive aspects of their recovery (for themselves as well as their children) and the new behavior patterns they have or are trying to establish.

Adapted from an article in Counseling Magazine by Amelia Arria, Ph.D. ¹ , Jerry Moe ² and Ken C. Winters, Ph.D. ¹, written  for the Betty Ford Institute.  Click here to view the entire article.

1. Parents Translational Research Center at the Treatment Research Institute
2. Betty Ford Center

BY: William L. White, M.A.

 SUMMARY:  Models of addiction treatment that view the sources and solutions to severe alcohol and other drug (AOD) problems as rooted within the vulnerability and resiliency of each individual stand in marked contrast to models that focus on the ecology of AOD problem development and resolution via complex interactions between individuals, families, and communities. An integration of the latter model into mainstream addiction treatment would necessitate a reconstruction of the treatment-community relationship and new approaches to community resource development and mobilization. Such an integration would redefine core addiction treatment services and to whom, by whom, when, where, and for how long such services are delivered. This article draws on historical and contemporary events in the history of addiction treatment and recovery in the United States to illuminate the relationship between recovery and community. Principles and strategies that could guide the development and mobilization of community resources to support the long-term recovery of individuals and families are identified.
Mobilization of community resources to support recovery

BY: Robert L. DuPont, M.D., A. Thomas McLellan, Ph.D., William L. White, M.A., Lisa J. Merlo, Ph.D., Mark S. Gold, M.D.

 SUMMARY: A sample of 904 physicians consecutively admitted to 16 state Physicians’ Health Programs (PHPs) was studied for 5 years or longer to characterize the outcomes of this episode of care and to explore the elements of these programs that could improve the care of other addicted populations. The study consisted of two phases: the first characterized the PHPs and their system of care management, while the second described the outcomes of the study sample as revealed in the PHP records. The programs were abstinence-based, requiring physicians to abstain from any use of alcohol or other drugs of abuse as assessed by frequent random tests typically lasting for 5 years. Tests rapidly identified any return to substance use, leading to swift and significant consequences. Remarkably, 78% of participants had no positive test for either alcohol or drugs over the 5-year period of intensive monitoring. At post-treatment follow-up 72% of the physicians were continuing to practice medicine. The unique PHP care management included close linkages to the 12-step program of Alcoholics Anonymous and Narcotics Anonymous and the use of residential and outpatient treatment programs that were selected for their excellence.
Setting the Standards for recovery

BY: James R. McKay, Ph.D. and Deni Carise, Ph.D.

SUMMARY: The second Betty Ford Institute conference took place on October 3 and 4, 2007. The topic of this conference was continuing care and recovery management for substance use disorders. The goals of the conference were to review evidence for the effectiveness of various approaches to continuing care, discuss new approaches to the long-term management of these disorders, and develop an agenda for future research. As was the case in the first Betty Ford Institute conference, the overarching purpose of this conference was for the participants to arrive at agreement about position statements-this time regarding what is known about effective continuing care and where additional research is needed.
State of the science

 BY: James R. McKay, Deni Carise, Michael L. Dennis, Robert Dupont, Keith Humphreys, Jack Kemp, Debra Reynolds, William White, Ron Annstrong, Mady Chalk, Beverly Haberle, Thomas McLellan, Garret O’Connor, Barton Pakull, John Schwarzlose

SUMMARY: One of the primary goals of the conference was to arrive at position statements regarding continuing care. By the end of the conference, the participants produced position statements concerning three issues: (a) what is currently known about the components of effective continuing care, (b) factors that are likely to  improve continuing care, and (C) key questions that require-additional research.
Extending the benefits of addiction treatment

AUTHOR: James R. McKay, Ph.D.

 SUMMARY: In the field of addiction treatment, the term continuing care has been used to indicate the stage of treatment that follows an initial episode of more intensive care. This article reviews controlled studies of continuing care conducted over the prior 20 years. The results indicate that continuing care interventions were more likely to produce positive treatment effects when they had a longer planned duration, made more active efforts to deliver treatment to patients, and were studied more recently. However, there was considerable variability in patient response and room for improvements in participation rates and effectiveness. It is possible that the effectiveness of continuing care interventions could be further improved by the use of adaptive algorithms, which adjust treatment over time based on changes in patients’ symptoms and status. The use of alternative service delivery methods and care settings may also lead to greater engagement and retention in continuing care, particularly among the large numbers of individuals who do not want traditional, clinic-based specialty care.
Continuing care research

Betty Ford Institute concluded the selection process for the 2011 Summer Institute for Medical Students program this week. From 271 applications received, 112 students were selected to receive full scholarships to attend the intensive experiential learning program about the treatment of addiction.

To be considered for a scholarship, students submitted letters of recommendations from their professors and personal essays about what they were hoping to learn from the training. Selected students will participate in one of seven week-long sessions from May through August.

Donations from generous supporters underwrite the scholarships so that students do not incur costs of travel, accommodations, meals and program fees.

Students applied from medical schools representing all areas of the United States and many countries around the world. In addition to the US, students will come to the SIMS program from Canada, Poland, India, England, Ireland, and Samoa.

Students, whether accepted, rejected or listed as alternate participants, were notified this week of their status. The first program begins on May 23, 2011.

White, W., Arria, A. & Moe, J. (2011). Parenting in the context of addiction recovery: Critical research questions. Posted at www.williamwhitepapers.com and www.facesandvoicesofrecovery.com

COMMENTARY

Parenting in the Context of Addiction Recovery: Critical Research Questions

William L. White, MA, Amelia Arria, PhD, and Jerry Moe, MA

Abstract

The emergence of recovery as an organizing paradigm in the addictions field is spurring calls for the development of a national recovery research agenda. This article identifies research questions of great concern to parents in recovery, parents of recovering adolescents, addiction professionals, and recovery support specialists seeking to include parent-focused interventions within the treatment and post-treatment recovery support process. Effectively addressing parenting as a treatment and recovery support issue will require mobilizing people in recovery to help shape a recovery research agenda that includes parenting as a prominent focus of research activity.

Research related to alcohol and other drug (AOD) problems has evolved topically through three organizing paradigms: 1) a pathology paradigm (studies of the etiology, epidemiology, personal course, and social costs of AOD problems), 2) an intervention paradigm (studies to evaluate the effectiveness of prevention, early intervention, and treatment approaches), and 3) an emerging resilience and recovery paradigm (studies to elucidate resistance to and resolution of AOD problems; White, 2005, 2008). Research studies flowing from the first two of these governing paradigms have produced an impressive body of knowledge about the causes and consequences of AOD problems and the relative effectiveness of various professional interventions to address these problems. In spite of such advances, we as a professional field and a country know surprisingly little about people with substantial personal and environmental risk factors for developing severe AOD problems but who do not develop such problems. Moreover, we know very little about the prevalence and natural history of recovery in the general population. Finally, there is a scarcity of data regarding the frameworks used to describe recovery (e.g., secular, spiritual, religious; natural, professionally-assisted, peer-assisted) and the patterns and processes of long-term personal and family recovery from severe AOD problems (Laudet, 2008).
The purpose of this article, the fifth in a series of papers advocating the development of a national recovery research agenda (Erickson & White, 2009; White & Chaney, 2008; White & Godley, 2007; White & Schulstad, 2009), is to identify research questions of great concern to parents in recovery, parents of recovering adolescents, and addiction professionals and recovery support specialists interested in parent-focused interventions within the treatment and post-treatment recovery support process.

Parents in Recovery

Parental AOD problems can exert a potentially profound influence on family health and the developmental trajectory of children (Brook et al., 2010; Brown & Lewis, 1999; Chassin, Flora, & King, 2004; Eiden, Colder, Edwards, & Leonard, 2009; Hussong, Flora, Curran, Chassin, & Zucker, 2008; Keller, Cummings, Davies, & Mitchell, 2008; King et al., 2009; Marmorstein, Iacono, & McGue, 2009; White & Savage, 2005). Children raised by parents with such problems manifest widely diverse responses, with some revealing remarkable resilience under the worst circumstances while others exhibit significant problems in their development. The harmful influence of parental AOD problems is thought to be exerted through such mechanisms as pre- and post-natal AOD exposure, inadequate bonding and nurturing, disruption of family rituals, family conflict, inadequate monitoring and supervision, and physical and emotional neglect/abandonment (Arria, Moe, & Winters, 2010a).
While the pathology literature (studies of the effects of parental addiction on child development) is voluminous (for recent representative literature, see Bijttebier, Goethals, & Ansoms, 2006; Coyer, 2003; El-Sheikh & Flanagan, 2001; Johnson & Leff, 1999; McLaughlin et al., 2010), few studies have been conducted to explore the effects of parental recovery on child development and more specifically, the effects of parenting style on the prevalence and severity of AOD problems in children of recovering parents (Smith & Hall, 2008). While there are studies that are cause for optimism on these and related issues (Andreas & O’Farrell, 2007; Andreas, O’Farrell, & Fals-Stewart, 2006; Koning, van den Eijnden, Engels, Verdurmen, & Vollebergh, 2011; Mares, van der Vorst, Engels, & Lichtwarck-Aschoff, 2011; Moos & Billings, 1982; Reimuller, Shadur, & Hussong, 2011), definitive answers have yet to be formulated for numerous questions raised by parents in recovery. Because of the authors’ tenure in the addictions field and our known interest in parenting and children’s issues, we are frequently presented with questions like the following.

Assessing Vulnerability
• Are my children at increased vulnerability for the development of AOD problems because of my addiction?
• Does the vulnerability of children vary by the type of parental addiction (e.g., alcoholism versus heroin addiction)?
• Is the source of this vulnerability fixed (beyond parental, peer, or professional influence) or fluid (amenable to parental, peer, or professional influence over time)?
• Are there indicators that would tell me which of my children might be at greatest vulnerability and in need of special support? Should I be more vigilant during particular periods of development, such as during adolescence?
• Does my recovery status or my spouse/partner’s recovery status influence my child’s vulnerability or potential prognosis for recovery?

Understanding Parenting in Context of Recovery
• What changes in my family and my children should I anticipate following initiation of my recovery?
• At what stage of recovery are the problems that developed in my relationships with my children during my addiction likely to dissipate? When will things get better?
• How do parenting concerns differ across the stages of recovery and across the developmental ages of children?
• What are the most common parenting mistakes made by parents in recovery?
• Are there special parenting issues for fathers in recovery?
• Should parents who abandoned their children during their active addiction seek to re-establish contact with their children? (Will this harm or benefit the child?) If so, when and how?

Communicating with Children about a Parent’s Recovery

• Should I talk about my recovery to my children? If so, when and how?
• When my children hear that addiction is a “chronically relapsing disease,” they fear I will return to using. What should I tell them?
• I was in recovery before any of my children were born. Do I need to tell them about my addiction/recovery history?
• How can I best prevent embarrassment of my children potentially resulting from my addiction/recovery history?
• My children sometimes resent the amount of time I am not available to them due to my recovery support meetings and recovery service work. How is such resentment best avoided or managed?
• My children did not live with me during the later stages of my addiction, and I am now trying to rebuild these relationships. What actions on my part will be most effective in this process?

Reducing Vulnerability and Enhancing Resiliency
• Are there any parenting interventions that can lower this vulnerability or that could enhance prognosis for early and full recovery if my child would develop an AOD problem?
• How should I respond to early alcohol or drug use by my children?
• There is a history of severe AOD problems in my family going back at least four generations. What can I do as a parent to help break this intergenerational cycle?
• My child has been diagnosed with ADHD and prescribed stimulants. Given the family history of addiction, will this increase his/her risk of developing a drug problem?
• Should I let my children’s physician know that I am concerned about their heightened risk for addiction?

Scientific studies exist that shed light on some of these questions, yet for others, the research is sparse or non-existent. Even in the former case, existing studies have not been synthesized and communicated in venues that are accessible and conveyed in a language understandable to parents in recovery.

Parents with a Child in Recovery

Parenting concerns also extend to parents who are themselves not in recovery but who have a child in recovery. Some of the more common questions we are presented with in this situation include the following.

Understanding Adolescent Recovery and Related Risks
• Are there predictable stages of recovery for adolescents and young adults?
• I have four children, the oldest of whom is now in recovery. Are my younger children at risk for similar problems because of their older sibling’s addiction/recovery status?
• My child just completed adolescent addiction treatment. What is her risk of relapse?
• When, if ever, will the risk of relapse for my child end or at least subside?
• Will my son have to go to AA/NA or other recovery support meetings for the rest of his life?
• I worry that my child’s addiction/recovery history could be a cause for discrimination and limit her potential in later life due to the stigma and misconceptions attached to addiction. Is this a legitimate concern?
• Will the legal problems my child has experienced hurt his/her chances for later success? Employment?

Parenting a Recovering Child
• What are the common experiences (problems, pitfalls, and opportunities) of parenting a child entering and progressing through these stages of recovery?
• What actions can I take as a parent to lower this risk? Should alcohol now be removed from our home?
• I live in a community with few recovery support meetings and no young people’s meetings. Are there other recovery supports that can help my child?
• It has been suggested that my 16-year-old son might need a recovery coach or live for a while in a recovery home after he completes treatment. Is there research proving that these will enhance my son’s recovery chances? How do I as a parent know what kinds of support will be best for my son?
• Is there a danger that the amount of attention required by my recovering daughter could negatively affect my other children? If so, how can I avoid such dangers?
• My child has been in recovery less than a year, is doing very well, and is now planning to go to college. How can I as a parent best support my son’s recovery as he enters what is clearly an abstinence-hostile environment? I have heard that some colleges and universities have campus-based recovery programs. Do students in these programs have better recovery rates and better academic achievement than students in recovery entering an educational setting without such special support?

Professional Concerns about Parenting

Addiction professionals, child welfare professionals, and a broad spectrum of other helping professionals (psychologists, social workers, mental health counselors, pastoral counselors) have also asked us how they can best address parenting issues within their helping role. Their questions include the following:

Models for Parenting Support
• Are there models for integrating parent-focused interventions that have been proven to improve recovery outcomes, family health, parent-child relationships, or child health?
• Which strategies are more effective in achieving the above outcomes: parenting skills trainings or programs focusing on parent-child relationship development? Individual versus group formats? Professional versus peer delivery formats?
• What is the ideal time duration of parental support interventions? Weeks? Months? Years? How long is parent-focused program support needed?
• Will clients in treatment voluntarily participate in parenting-focused treatment and recovery support activities?
• To what extent should parent-focused programs differ across cultural contexts?
• What is the most effective setting in which to deliver parent-focused recovery support: treatment setting, recovery community organization, school, etc.?
• What evidence-based models are available for peer-based support for parents in recovery, e.g., parenting guides/sponsors?

Financing Models
• What financing models are available for parent-focused interventions as part of addiction treatment or recovery support services?

Effects of Parenting Supports
• Does engagement of key community institutions in support of parents in recovery enhance recovery, parent-child relationship, and child health outcomes?
• Does engagement of extended family and kinship networks, including key elders, in support of recovering parents enhance these outcomes?

What has struck us in our attempts to respond to these questions is how few scientific studies exist that can inform our efforts to answer these questions.

Toward a Parenting-Focused Research Agenda

The Betty Ford Institute hosted a two-day Critical Issues Conference September 29-October 1, 2010 in Washington, DC on Breaking Intergenerational Cycles of Addiction: Parent-Focused Strategies. The Conference brought together more than 50 policy specialists, federal officials, addiction researchers, addiction treatment professionals, parents in recovery, recovery advocates, and child advocates to discuss what we know, need to know, and need to do as a field to address the kinds of concerns we have raised in this paper.
Many recommendations were formulated at this meeting, but one of the most pervasive themes of the discussions was the desperate need for scientifically grounded answers to parenting-related questions as well as scientifically grounded strategies to address parenting as a treatment and recovery support issue. Children affected by parental addiction and recovery and young people in recovery and their parents could be mobilized to help set this research agenda and to help forge a body of experiential knowledge that would collectively help answer some of the critical questions posed in this paper. Fulfilling that agenda once it is created will take sustained consciousness of its importance and a period of dedicated private and public funding. The stakes involved in these questions warrant such a commitment.

About the Authors: William White is a Senior Research Consultant at Chestnut Health Systems. Amelia Arria is a Senior Scientist at the Treatment Research Institute. Jerry Moe is the National Director of Children’s Programs for the Betty Ford Center.

Acknowledgment: Work on this paper was supported in part by SAMHSA contract HHSS28320070006I, Westat Subcontract s8440, Recovery Supports for Adolescents and Families, the National Institute on Drug Abuse (P50-DA02784 and R01-DA14845), and the Betty Ford Institute. The views expressed in this paper are those of the authors and do not necessarily reflect the views or policies of the Department of Health and Human Services.

References

Andreas, J. B., & O’Farrell, T. J. (2007). Longitudinal associations between fathers’ heavy drinking patterns and children’s psychosocial adjustment. Journal of Abnormal Child Psychology, 35(1), 1-16.

Andreas, J. B., O’Farrell, T. J., & Fals-Stewart, W. (2006). Does individual treatment for alcoholic fathers benefit their children? A longitudinal assessment. Journal of Consulting and Clinical Psychology, 74(1), 191-198.

Arria, A. M., Moe, J., & Winters, K. C. (2010a). Parenting challenges in recovery: Implications for addiction professionals. Counselor, 11(6), 10-17.

Arria, A. M., Moe, J., & Winters, K. C. (2010b). Stages of recovery and impact on parenting. Retrieved February 15, 2011 from

http://addictioninfamily.com/family-issues/stages-of-recovery-impact-on-parenting/

Bijttebier, P., Goethals, E., & Ansoms, S. (2006). Parental drinking as a risk factor for children’s maladjustment: The mediating role of family environment. Psychology of Addictive Behaviors, 20(2), 126-130.

Brook J. S., Balka, E. B., Crossman, A. M., Dermatis, H., Galanter, M., & Brook, D. W. (2010). The relationship between parental alcohol use, early and late adolescent alcohol use, and young adult psychological symptoms: A longitudinal study. American Journal on Addictions, 19(6), 534-542.
Brown, S., & Lewis, V. (1999). The alcoholic family in recovery: A developmental model. New York & London: Guilford Press.

Chassin, L., Flora, D. B., & King, K. M. (2004). Trajectories of alcohol and drug use and dependence from adolescence to adulthood: The effects of familial alcoholism and personality. Journal of Abnormal Psychology, 113, 483–498.

Coyer, S. (2003). Women in recovery discuss parenting while addicted to cocaine. American Journal of Maternal Child Nursing, 28(1), 45-49.

Eiden, R. D., Colder, C., Edwards, E. P., & Leonard, K. E. (2009). A longitudinal study of social competence among children of alcoholic and non-alcoholic parents: Role of parental psychopathology, parental warmth, and self-regulation. Psychology of Addictive Behaviors, 23(1), 36-46.

El-Sheikh, M., & Flanagan, E. (2001). Parental problem drinking and children’s adjustment: Family conflict and parental depression as mediators and moderators of risk. Journal of Abnormal Child Psychology, 29(5), 417-432.

Erickson, C. K., & White, W. L. (2009). Commentary: The neurobiology of addiction recovery. Alcoholism Treatment Quarterly, 27(3), 338-341.

Hussong, A. M., Flora, D. B., Curran, P. J., Chassin, L. A., & Zucker, R. A. (2008). Defining risk heterogeneity for internalizing symptoms among children of alcoholic parents. Development and Psychopathology, 20, 165-193.
Johnson, J. L., & Leff, M. (1999). Children of substance abusers: Overview of research findings. Pediatrics, 103, 1085-1099.
Keller, P. S., Cummings, E. M., Davies, P. T., & Mitchell, P. M. (2008). Longitudinal relations between parental drinking problems, family functioning, and child adjustment. Development and Psychopathology, 20, 195-212.

King, S. M., Keyes, M., Malone, S. M., Elkins, I., Legrand, L. N., Iacono, W. G., & McGue, M. (2009). Parental alcohol dependence and the transmission of adolescent behavioral disinhibition: A study of adoptive and non-adoptive families. Addiction, 104, 578–586.

Koning, I. M., van den Eijnden, R.J., Engels, R. C., Verdurmen, J. E., & Vollebergh, W. W. (2011). Why target early adolescents and parents in alcohol prevention? The mediating effects of self-control, rules and attitudes about alcohol use. Addiction, 106(3), 538-546.

Laudet. A. (2008, May). Building the science of recovery. Presentation at Aligning Concepts, Practice and Context to Promote Long-Term Recovery: An Action Plan. Philadelphia Recovery Symposium, Philadelphia, PA. Retrieved from http://www.williamwhitepapers.com/friends_favorites/

Mares, S. H. W., van der Vorst, H., Engels, R., & Lichtwarck-Aschoff, A. (2011). Parental alcohol use, alcohol-related problems, and alcohol-specific attitudes, alcohol-specific communication, and adolescent excessive alcohol use and alcohol-related problems: An indirect path model. Addictive Behaviors, 36, 209-216.

Marmorstein, N. R., Iacono, W. G., & McGue, M. (2009). Alcohol and illicit drug dependence among parents: Associations with offspring externalizing disorders. Psychological Medicine, 39, 149-155.

McLaughlin, K. A., Green, J. G., Gruber, M. J., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2010). Childhood adversities and adult psychiatric disorders in the national comorbidity survey replication II: Associations with persistence of DSM-IV disorders. Archives of General Psychiatry, 67(2), 124-132.
Moos, R. H., & Billings, A. G. (1982). Children of alcoholics during the recovery process: Alcoholic and matched control families. Addictive Behaviors, 7(2), 155-163.

Reimuller, A., Shadur, J., & Hussong, A. M. (2011). Parental social support as a moderator of self-medication in adolescents. Addictive Behaviors, 36, 203-208.

Smith, D. C., & Hall, J. A. (2008). Parenting style and adolescent clinical severity: Findings from two substance abuse treatment studies. Journal of Social Work in the Addictions, 8(4), 440-463.

White, W., & Savage, B. (2005). All in the family: Alcohol and other drug problems, recovery, advocacy. Alcoholism Treatment Quarterly, 23(4), 3-37.

White, W. L. (2005). Recovery: Its history and renaissance as an organizing construct concerning alcohol and other drug problems. Alcoholism Treatment Quarterly, 23(1), 3-15.

White, W. L. (2008). Recovery: Old wine, flavor of the month or new organizing paradigm? Substance Use and Misuse, 43(12&13), 1987-2000.

White, W. L., & Chaney, R. A. (2008). Intergenerational patterns of resistance and recovery within families with histories of alcohol and other drug problems: What we need to know. Posted at www.facesandvoicesofrecovery.org

White, W. L., & Godley, S. H. (2007). Adolescent recovery: What we need to know. Student Assistance Journal, 19(2), 20-25.

White, W. L., & Schulstad, M. (2009). Relapse following prolonged addiction recovery: Time for answers to critical questions. Counselor, 10(4), 36-3

Click here to view the report.

The 1^st Annual Professional Development and Training on Indigenous Prevention Strategies on Substance Use and Other Behavioral Issues conference was held March 28 through April 1, 2011 at the Marriott Hotel in Albuquerque, New Mexico. As part of its ongoing support of addiction recovery for Native communities in North America, Betty Ford Institute co-sponsored the training event.

Patrick Haggerson, M.A., I.C.A.D.C. Program Director of Ethno Cultural Activities for Betty Ford Institute, was an active participant in the six-day event, which featured more than 20 day-long classes.  The instruction was conducted by a cadre of national experts with demonstrated teaching experience on health and substance abuse issues faced by Native people. According to Haggerson, practitioners from across the country attended the event to gain inspiration while earning up to 40 CE (Continuing Education) contact hours.

Haggerson is pictured here with Native American Training Institute, Inc. President Patrick Trujillo and Institute Vice President Marie Kirk.

“One thing I see happening to front line workers on reservations is that they often don’t have much peer support or administrative support in their work,” said Haggerson.  “Some have to attend AA meetings that their clients attend because that is the only option. As a result, the front line workers are prone to higher than normal rates of burn-out. This conference offered an opportunity to do some personal recovery work that isn’t possible back home. It is also a source of burn-out prevention for attendees.”

Haggerson and tribal elder Arthur Dick of Alkali Lake co-facilitated a workshop on “Grief Recovery: The Use of Traditional Ceremonies” for over 30 people. They offered both didactic and experiential teaching strategies, including a “Talking Circle” in which a number of participants shared unresolved grief they have been carrying related to their jobs as therapists, i.e. working with suicides, murders, accidents and loss of child custody because of their clients’ drinking and drugging.

David Meggitt, Program Coordinator for the Denver Children’s Program, presented a day-long workshop entitled “Tools for the Journey:  Helping Children Who Live with Addiction.”

Although the event is titled the “1^st Annual”, this conference is now operated by the Native American Training Institute, Inc. which has taken over from  American Indian Training Institute and continues the history of delivering skill-development training in alcohol and other drug prevention, treatment and aftercare services to those providers who work in Indian and First Nations communities. Some of the staff, the history and experience which offered the school for the past 33 years continues.

The mission of Betty Ford Institute is to conduct and support collaborative programs of research, prevention and education that will lead to a reduction of the devastating impact of addictive disease on individuals, families and communities. The initial prevention focus is on families and children at risk for alcohol and other drug problems. For more information about Betty Ford Institute, visit www.bettyfordinstitute.org.

The second annual University Day organized by Glucksman Ireland House at NYU will take place on Saturday April 16th.

The event, entitled, “Who Do We Think We Are? The Irish Family” will focus on Irish family issues.

Dr. Garrett O’Connor will deliver the keynote lecture, “Resilience, Shame, Alcohol and Survival: The Tragic and Triumphant Alchemy of Irish Cultural History,” which will explore the complex elements of the Irish historical experience with alcohol, and how that experience illuminates contemporary family life in Ireland. For the past 20 years, Dr. O’Connor has striven to clarify the role of malignant shame that can arise from extreme cultural and familial trauma and the ways in which this destructive form of shame may be transmitted unconsciously to future generations as well as the transformative qualities of healthy shame that can motivate positive change.

Born in Dublin, Dr O’Connor graduated from the Royal College of Surgeons in 1960 to train in Psychiatry at the Johns Hopkins University School of Medicine. Later, he introduced innovative experiential teaching methods for medical students at UCLA and pioneered successful community models of addiction treatment in Los Angeles. In December 2010, Dr. O’Connor delivered the prestigious annual Michael Littleton Lecture on RTE Radio in Ireland on ‘The Role of Alcohol and Malignant Shame in the Unprecedented Economic and Social Collapse of Ireland in 2010.’

Also speaking at the event are Colm Tóibín, Booker prize-winning Irish author; Patricia Harty, co-founder and editor of Irish America Magazine; Pete Hamill, former NYC mayoral candidate, newspaper editor, journalist and prominent author; Peter Quinn, best-selling novelist and formerly chief speech-writer for President Reagan; actress Fionnula Flanagan; and professors Marion Casey, Linda Dowling Almeida and Miriam Nyhan.

University Day welcomes the public to the NYU campus to connect with the academic work being done, and invites them to engage with writers and other scholars for an accessible and relevant intellectual experience, bridging the gap between the university and the community.

Glucksman Ireland House is the center for Irish and Irish-American Studies at New York University providing access to Irish and Irish-American culture and fosters excellence in the study of Ireland, Irish America, and the global Irish Diaspora.

The event takes place in the Silverstein Lounge at NYU’s Silver Building, located at 100 Washington Square East. For more visit Irelandhouse.as.nyu.edu or call (212) 998-3950.

# # #

The mission of Betty Ford Institute is to conduct and support collaborative programs of research, prevention and education that will lead to a reduction of the devastating impact of addictive disease on individuals, families and communities. The initial prevention focus is on families and children at risk for alcohol and other drug problems. For more information about Betty Ford Institute visit www.bettyfordinstitute.org.

In October, 2007, the conference “Extending the Benefits of Addiction Treatment; Practical Strategies for Continuing Care and Recovery” was held in Los Angeles.
One of the primary goals of the conference was to arrive at position statements regarding continuing care. By the end of the conference, participants produced position statements concerning three issues: (a) what is currently known about the components of effective continuing care, (b) factors that are likely to improve continuing care, and (c) key questions that require additional research.
Conclusions and recommendations were published in the Journal of Substance Abuse Treatment, October, 2008

Conference Papers

An editorial by John T. O’Neill

As a science writer, research has always seemed to me a rather sporting endeavor. One group arrives at new, perhaps exciting, findings and then their peers take swings at it. Someone once said, “Science is the antidote for the poison of enthusiasm”.  In other fields such antagonism would be thought as competiveness. But researchers seem to view others tweaking their work as brotherly/sisterly collaborators on the pathway to truth.  A current example of this kind of synergistic interaction is a commentary by Moos and Finney on the findings presented in the above report titled Encouraging Report about Remission from Dependence.

These two scientists, while acknowledging the contribution described in the report, provide insights about how epidemiologist’s and clinicians’ ” illusions” about the prevalence and stability of remission from alcohol and/or drug dependence could alter findings. They suggest that these “illusions” can be countered by identifying the psycho-social mechanisms that underlie remission and relapse. 

They point out that clinicians are likely to deal with severe cases with a tendency to relapse and are unlikely to continue seeing individuals in sustained remission. They term this “clinicians illusion”. On the other hand, epidemiologist’s surveys are likely to include data from individuals with less severe disorders, a higher likelihood of remission, and not include those who refuse to participate due to homelessness, institutionalization or death. They term this “epidemiologists’ illusion”. They suggest that integration of epidemiologists’ and clinicians’ perspectives would promote a better understanding of the processes of remission and relapse.

Moo and Finney point to their own work that found that 43% of those who obtained help and achieved remission were relapsed at a 15 year follow-up while 61% of those who achieved remission without obtaining help were relapsed at the 16 year follow-up…a less optimistic picture than that in the study.  Their commentary suggests a need for longitudinal studies over a specified time period if stable remission is to be identified. The good news is that both the study and the commentary reveal that significant numbers of individuals experiencing alcohol dependence do achieve and maintain long term recovery. So I say, “Keep on swingin’”  

Remission (cessation of disease symptoms) from dependence on nicotine, alcohol, cannabis, and cocaine is an observable occurrence, but how often does it occur and to whom?  Are there discernable patterns and predictors of remission that could aid in developing timely prevention and treatment?  A new study sought to estimate the specific probability of remission for each of those substances and to determine whether race or ethnicity played a role. The National Epidemiological Survey of Alcohol and Related Conditions (NESARC) provided a database of individuals who at some point in their lives had been diagnosed as dependent on nicotine (6937), alcohol (4781), cannabis (530), or cocaine (408). Interviews of these subjects were conducted by professional interviewers from the US Census Bureau. The data included race, ethnic background, gender, age, nativity, education level, income, and marital status. Age of dependence onset was defined as the age at which the respondent first met the diagnostic criteria for dependence on that substance.  

A key question was, “’about how old were you when you finally stopped having any of these (dependence) experiences with (name of the drug)?”  Questioning also revealed that “approximately 80% of those with a history of dependence on nicotine and alcohol and almost all with dependence on cannabis or cocaine had a diagnosis of another psychiatric disorder at some time in their lives.”  About a third of the nicotine or alcohol dependent individuals had at some time been diagnosed with a mood, anxiety, or personality disorder.  Two thirds of the entire respondent pool had a family history of substance use.

In its detail the study explored how race, ethnicity, gender, the specific drug, and other variables influenced when and under what circumstances remission took place.  The study estimated that the lifetime probability of remission was 83.7% for nicotine, 90.6% for alcohol, 90.6% for alcohol, 97.2% for cannabis, and 99.2% for cocaine. These findings demonstrate that in a large nationally representative sample of US adults, the vast majority of individuals experiencing dependence on one or more of these four substances will remit at some time in their lives. The author’s emphasize the role that early intervention and treatment can play in facilitating remission.

 (Lopez-Quintero, C, Hasin, DS, de los Cabos, JP, Pines, A, Wang, S, Grant, BF, Blanco, C, (2011) Probability and predictors of remission from life-time nicotine, alcohol, cannabis or cocaine dependence: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Addiction, 106:, 657-669.)

 The number of 50+ year-old Americans with a substance use disorder is expected to reach 5.7 million by 2020. A recent report by Duke University Medical Center researchers reviews epidemiological findings focused on illicit drug use disorders and nonmedical use of prescription drugs by older adults. Alcohol abuse and dependence are excluded in order to isolate the “hidden” emerging problem of drug use in the over-50 population. The review states that the number of adults age 50 to 59 is growing, as large numbers of baby boomers reach 50 years or older. Surveys show that this “baby boomer cohort” uses more illicit or nonmedical drugs than older adults. Marijuana and cocaine are the most commonly used illicit drugs and opioid analgesics (pain killers) are the prescription drugs most commonly used for nonmedical purposes.   

This review found that adults age 50-64 were more likely than those over 65 to use marijuana (3.9% vs.0.7%) and cocaine (0.7% vs. 0.04%) while rates of inhalants, hallucinogens, methamphetamine, and heroin were very low (less than 0.2%). Nonmedical prescription use of prescription opioids (1.4% among adults 50+ years) was more prevalent than nonmedical use of prescription sedatives (0.14%), tranquilizers (0.46%) and stimulants (0.16%).    

In articles related to this subject published between 1990 and 2010, the reviewers identified a number of reasons why drug problems in this cohort are increasing and becoming more problematic: older Americans in this age group have been exposed to a society in which drug use became more prevalent and are less likely to perceive a problem or use treatment services.  Age-related physiological problems may increase sensitivity to these drugs. Chronic medical or psychological problems can be worsened by drug use.  And – because these drugs work by altering neurotransmission in the brain – age-related changes in the brain can lead to adverse consequences. Drug abuse can also be difficult to diagnose in older individuals because the diagnostic criteria were developed for young and middle-aged persons.

The review points to a national study of projections for substance use disorder revealing that the number of 50+ year-olds with substance use disorders is expected to increase for all gender, racial, and ethnic groups.  Because of projected increases in the growth of the population size and the use of substances, the number of older adults with a substance use disorder will at least double by 2020. The article concludes with recommendations to examine and revise diagnostic criteria to make it more relevant to this population and highlights the requirement for age-appropriate intervention and treatment models, including the recruitment of counselors who are trained and motivated to work with older adults.

Wu, LT, Blazer, DG: Illicit and non-medical drug use among older adults: a review. Journal of Aging and Health, published online 17 Nov 2010

Next week, Betty Ford Children’s Program Clinical Coordinator, Elizabeth Devine, will present an important online workshop for any counseling professional who has encountered addiction in family situations. The webinar, titled, “Children’s Perspectives on Addiction in the Home: Considerations for Professionals,” is scheduled for April 6, 2011 at 11:30 AM Mountain Time.

Using children’s artwork and writings, this webinar will provide participants with insight regarding the mental and emotional perspective of children growing up with alcohol or drug addicted caregivers. Children within such a family system take on several different roles to cope and share many common characteristics and challenges. This will be discussed as well as ideas for how to work with this population in a way that fosters resiliency.

In three locations in the US, the Betty Ford Children’s Program provides support and education to children who have been affected by a loved one’s addiction to drugs or alcohol. As a Licensed Professional Counselor, Elizabeth Devine serves as the Clinical Coordinator for the Five Star Kids program in Texas. In addition to this role, her clinical experience includes providing counseling to both victims and perpetrators of domestic violence, children in the foster system and a private practice focused on a variety of mental health issues. She has spoken nationally on issues related to therapeutic work with children, domestic violence and addiction. Prevention is a key function in the mission of the Betty Ford Institute with training programs and resources for professionals about the disease of addiction.

The webinar is provided by the National Alliance for Drug Endangered Children. The mission of the National Alliance for Drug Endangered Children (National DEC) is to break the cycle of abuse and neglect by empowering practitioners who work to transform the lives of children and families living in drug environments. National DEC provides these webinars at no charge to professionals working to improve the lives of children living in drug environments.

There is no charge to attend, but space is limited. Reservations for the webinar are being taken at: https://www1.gotomeeting.com/register/894157545.

North-American Interfraternity Conference

Posted by Ben Pendry , March 22, 2011

 INDIANAPOLIS (3/22/11) – Alpha Tau Omega, Sigma Chi, and the University of Alabama Fraternity Community along with President Dr. Robert E Witt will be honored with the 2011 North-American Interfraternity Conference (NIC) Laurel Wreath Award for their industry leading initiatives that have advanced the fraternal movement.  The awards will be presented at the NIC Annual Meeting in Washington, DC on April 10, 2011.

 Alpha Tau Omega implemented Congress – LIVE at their most recent national convention.  Utilizing state-of-the-art technology they were able to present large portions of their ATO Congress to their entire fraternity via live streaming on the internet.  Fraternity members were able to tune in from across the world and be a part of the event.  Several undergraduate members who were either deployed or otherwise unable to attend were able to join in as their chapter was recognized with fraternity awards.

 Sigma Chi Fraternity, through the work of dedicated alumni, forged a partnership with the Betty Ford Center.  The Sigma Chi / Betty Ford Alliance is reshaping how the organization is educating undergraduate chapters and alumni about the effects of alcohol and substance abuse.  The Alliance also offers a Professional-in-Residence program which allows a number of alumni to go through training on-site at the Center.  Through the relationship, the fraternity has developed a resource for chapter education and is in the process of developing additional educational programs for use throughout the organization.

 The University of Alabama Fraternity Community along with President Dr. Robert E Witt are an example of how institutional commitment to building relationships with stakeholders has led to unprecedented growth and a higher functioning fraternity community.  President Witt has motivated undergraduate chapters and mobilized large groups of alumni to reengage with the university through housing campaigns and enhanced resources to fraternity life.

 Among the other honors presented at the NIC Annual Meeting are the NIC Gold and Silver Medal, and the NIC Awards of Distinction.  For more information regarding NIC recognition efforts please visit www.nicindy.org/programs/recognition.

Film Production Manager of “the Honour of All” Will be Plenary Speaker

 As part of its ongoing support of addiction recovery for Native communities in North America, Betty Ford Institute will co-sponsor a training for professionals in Albuquerque, New Mexico. The 1^st Annual Professional Development and Training on Indigenous Prevention Strategies on Substance Use and Other Behavioral Health Issues will take place on March 28th through April 1^st.

Although titled the “1^st Annual”, this conference is operated by the renowned American Indian Training Institute that has a 34-year history of delivering skill-development training in alcohol and other drug prevention, treatment and aftercare services to those providers who work in Indian and First Nations communities.

Betty Ford Institute is sponsoring the participation of Arthur Dick from Alkali Lake as the Wednesday morning plenary session speaker. Arthur will talk about his experience as “production manager” in the making of the classic film, “The Honour of All” in 1985. He will be joined by Betty Ford Institute’s Ethno Cultural Activities Program Director, Patrick Haggerson, who will provide guidelines on how to use the film as a treatment tool.

“The Honour of All” is a film about the true story of the sobriety movement which began in the First Nation community of Alkali Lake, British Columbia. In the late 1970’s, the level of alcoholism in the tribe was at virtually 100% among the teenagers and adults. Then, one brave child stood up to her parents’ drinking. That action sparked a change for the entire community.

Betty Ford Institute will take an active role in presentations throughout the conference. Arthur Dick and Patrick Haggerson will co-facilitate a session on the use of music as a tool in developing cultural awareness. Patrick Haggerson will facilitate a six-hour family program entitled, “Families Need Help Too: Working with the Addictive Family System.”  Also, David Meggitt, Colorado Program Manager of the Betty Ford Children’s Program, will facilitate a six-hour workshop entitled, “Tools for the Journey: Helping Children Who Live with Addiction.”

The Betty Ford Institute is offering its support to the 1^st Annual Professional Development and Training on Indigenous Prevention Strategies on Substance Use and Other Behavioral Health Issues by fully sponsoring the participation of Patrick Haggerson, M.A., ICADC, David Meggitt, BA and co-sponsoring Arthur Dick from Alkali Lake.

The mission of Betty Ford Institute is to conduct and support collaborative programs of research, prevention and education that will lead to a reduction of the devastating impact of addictive disease on individuals, families and communities. The initial prevention focus is on families and children at risk for alcohol and other drug problems.

The American Indian Training Institute, Inc., (AITI) a nonprofit corporation, was founded in 1974.  Its mission is to reduce the incidence and prevalence of alcohol and other drug related issues among Indian tribes, organizations, and families through education and community organization. AITI is a highly regarded, cutting edge training and consulting organization dedicated to delivering skill-development training, in AOD prevention, treatment and aftercare services to Indian and First Nations countries.

Since 1978, AITI has convened the Annual Indian School on Alcohol and Other Drug Related Issues. This six day training event features over 20 informative and interactive, day long classes, designed to enhance professional development and personal wellness. The instruction is conducted by a cadre of national experts with demonstrated teaching experience on health and substance abuse issues faced by Native people. Practitioners nationwide attend the annual event to gain inspiration while earning valuable continuing education hours. Up to 30 CE contact hours are available to those completing the required courses.

 For more information, contact Patrick Haggerson by phone at (760) 773-4295 or by e-mail at .

(Application Deadline for Summer Program is Approaching!)

Is it true that most medical students become licensed as physicians without having been taught to recognize an addict when they see one in their practice?

Unfortunately, the reality is that medical students still have few opportunities to learn in school about diagnosing and treating addiction. This dearth of educational opportunities led to the creation of the Summer Institute for Medical Students (SIMS) in 1988 at the Betty Ford Center under the leadership of James West, M.D. Since then, more than 2,500 students have participated in this unique, week-long experiential learning program that gives first and second year medical students an opportunity to gain first-hand knowledge about addiction and how to treat it.

This year, the Betty Ford Institute will once again conduct the program that is offered at no-cost to accepted students. By working diligently for donations to underwrite this important educational program, the organization expects to award 115 students with scholarships – which include tuition, travel and accommodations – to participate this summer.

Mara Schwarzlose, Coordinator of the SIMS Program, said the main objective of the program is to provide medical students with the knowledge that addiction is a treatable family disease. “In most cases, our medical students come to us with very little understanding about the disease of addiction,” she said. “Their lack of knowledge about the disease is a basic misconception about addiction. Too often, students report being coached by their physician mentors to spend as little time as possible with addicts because ‘there is little that can be done to help them.’ What the students learn here is that addicts do respond to help and can lead long and productive lives managing their disease.”
At the core of the SIMS Program is the experiential interaction with patients in treatment at the Betty Ford Center. Students participate with patients in small group therapy sessions and learn directly from them and their family members about how addiction has devastated the lives of all concerned. As one medical student stated, “This time with the patients allows me to put a face to the disease. As a result, I feel compassion and a desire to help the person who is suffering from it.”

Throughout the week the students are provided presentations from nationally known and respected medical staff at the Betty Ford Center about the physiological nature of the disease, making a diagnosis, talking about addiction with patients, and working with patients in recovery.

The deadline for students to apply for the 2011 summer program is Friday, March 18th at 4:00 pm PST. More information about Summer Institute for Medical Students and the online application may be found here:

http://www.bettyfordinstitute.org/education/summer-institute-for-medical-students.php

Alcohol is a teratogen (a substance capable of interfering with the development of organ systems, including the central nervous system). Alcohol use by pregnant women 18-44 years old is a leading cause of birth defects and developmental disabilities in the US. Yet, fetal alcohol spectrum disorders (FASD) are entirely preventable as long as pregnant women do not drink alcohol.  According to this recent report sponsored by the Centers for Disease Control and Prevention (CDC), alcohol use prior to pregnancy is a strong predictor of use during pregnancy. Previously reported data determined that approximately 50% of non-pregnant women consumed some alcohol during the previous month. This current study points out that many women are not aware of pregnancy for four to six weeks and thus may drink prior to recognition.

A systematic review of earlier studies comparing various screening tools for alcohol use showed that most focused on heavy drinking, abuse, or dependence, and tended to include mostly males. In spite of sometimes differing findings the study found that ”both men and women benefit from brief interventions.” The researchers also cite a history of efforts to identify better ways to intervene specifically in the use of alcohol by women of childbearing age. They conclude that these more recently developed brief intervention tools have proven effective enough to recommend that at-risk women be screened and receive brief advice and counseling. Consequently the study encourages health care professionals to include evidence-based screening in their routine assessment of all women of childbearing age to protect current and future pregnancies.

(Floyd, RL, Weber, MK, Denny, C, O’Connor, MJ: Prevention of fetal alcohol spectrum disorders. Developmental Disabilities Research Reviews, 2009, 15:193-199)

Serotonin (5-HT) is a chemical found naturally in the human brain. The serotonergic system is known to temper mood and emotion and is implicated in the control of many behavioral and physiological functions, including alcohol drinking. The serotonin transporter (5-HTT) is a protein that transports serotonin from synaptic spaces into the nerve cells that released it, which is one of the mechanisms for terminating serotonin’s action. Because serotonin is known to be a regulator of the severity of alcohol drinking, medications that affect the function of the 5-HTT seem promising. Ondansetron is one such drug.

Based on earlier genetic research on the serotonergic system, the authors of this paper hypothesized that genetic variants of the 5-HTT might lead to different individual reactions to the drug ondansetron. In other words, genotype might offer a clue to whether a drug like ondansetron would be useful in treating a specific type of alcoholism.

Participants in this study were 283 individuals seeking treatment for alcoholism. DNA was extracted from the blood of each patient. The patients were then randomly selected to receive either treatment (ondansetron twice daily) or placebo. All received cognitive behavioral therapy and underwent weekly assessments of their alcohol use.

The study found that drinkers with one particular genotype of the 5-HTT (designated LL) had a lower number of drinks per day and a higher percentage of days abstinent days than the other participants. The findings show that “ondansetron is a promising therapeutic agent for the treatment of severe drinking among alcohol-dependent individuals with the LL genotype.” When those with the LL genotype also possessed the TT genotype (another variant in the 3′-untranslated region of the 5-HTT), the effects were even greater for ondansetron to decrease severe drinking and promote abstinence. These findings present “a new pharmacogenetic approach using ondansetron to treat severe drinking and improve abstinence in alcoholics.”

(Johnson BA, Ait-Daoud N, Seneviratne C, Roache JD, Javors MA, Wang XQ, Liu L, Penberthy JK, DiClemente CC, Li MD: Pharmacogenetic approach at the serotonin transporter gene as a method of reducing the severity of alcohol drinking.  American Journal of Psychiatry, 2011, Jan 19. [Epub ahead of print]) (doi: 10.1176/appi.ajp.2010.10050755)

Healthy People 2020 are a government-sponsored program to provide science-based 10-year objectives for improving the health of all Americans. One objective is to “Increase the proportion of elementary, middle, and senior high schools that provide comprehensive school health education to prevent health problems.” A University of North Carolina at Charlotte and Medical University of South Carolina study examined the role of education in this effort and identified evidence-based, peer-reviewed programs, strategies, and resources. The results were organized in the categories of sexual health, mental and emotional health, injury prevention, tobacco and substance abuse, and exercise and healthy eating.
In the discussion of substance abuse the authors pointed out that 11% of the alcohol in the US is consumed by those 12-20 years of age, the use of illicit drugs usually begins in that age group, and is associated with problems like violence, injury, and HIV infection. Five evidence-based substance abuse prevention programs were indentified: Protecting You/Protecting Me, Life Skills Training, CASASTART, Class Action/Project Northland, and Project Alert. The Centers for Disease Control and Prevention (CDC) has created the Health Education Curriculum Analysis Tool (HECAT) to aid schools in choosing health education programs. Additional resources can be found in The Substance Abuse and Mental Health Services Administration (SAMHSA) National Registry of Evidence-based Programs and Practices (NREPP) www.nrepp.samhsa.gov/.
The study concludes that evidence-based strategies for implementing prevention programs are often a “missing link” crucial to prevention program success.
(Inman, DD, van Bekergem, KM, LaRosa, MD, Garr, DR: Evidence-based health promotion programs for schools and communities. American Journal of Preventive Medicine, 2011, 40: 207-219.)

Alcoholics Anonymous (AA) has grown from an initial membership of less than 100 in the mid 1930’s to more than 1.2 million members meeting in 55,000 meetings in the US alone.  Evidence supports the fact that AA can play a valuable role in recovery from alcoholism.  Rigorous research over the last 15 years shows also that AA is a cost effective treatment adjunct.  A recent study from the Center for Addiction Medicine, Massachusetts General Hospital, and Harvard Medical School hypothesized that AA attendance is associated with positive alcohol use outcomes as well as enhanced spirituality/religiousness (S/R), that AA increases S/R more for those initially low on this variable at treatment intake, that greater S/R is associated with positive alcohol outcomes, and that the effect of AA on subsequent alcohol use is partially the consequence of enhanced S/R.

Participants (1,726), already engaged in a study of psychosocial treatments for alcohol use disorders (project MATCH), were assessed on their AA attendance, spiritual/religious practices and alcohol use at treatment intake, and at 3, 6, 9, and 15 months after treatment.  Analyses showed that AA attendance was associated with an increase in spiritual practices and better alcohol use outcomes. This effect was observed in outpatient and inpatient samples and in both abstinent days and drinks per drinking day.  The findings suggest that “AA leads to better alcohol use outcomes, in part, by enhancing individuals’ spiritual practices, and provides empirical support for AA’s emphasis on increasing spiritual practices to facilitate recovery from alcoholism.”

The researchers comment that spiritual concepts and practices persistently play a role in treatment for addictions even though in this age of neuroscience they can seem “archaic and odd.”  But they conclude that,” participation in groups like AA is not only likely to produce changes in spirituality, but also coping, abstinence self-efficacy, motivation, negative affect, social networks, and at the neurobiological level.”

Kelly, JF, Stout, RL, Magill, M, Tonigan, JS, Pagano, ME:  Spirituality in recovery: a lagged meditational analysis of alcoholics anonymous’ principal theoretical mechanism of behavior change.  Alcohol Clinical & Experimental Research, 2011, 35: 1-10.)

Research has shown that relapse rates are high when clients in outpatient programs have to live in situations that are not supportive of recovery.  This is especially true in high crime areas and where heavy drinking and drug use is common. In addition, treating homeless persons with addictions is especially challenging because they must deal with survival, health, and safety as well as staying sober. Earlier research showed that when clients received housing as part of their out-patient treatment, they had better retention and achievement of treatment milestones than those who made their own living arrangements.  Sober Living Houses (SLH) have been suggested as one possible solution to the housing problems faced by clients attending outpatient treatment. SLH’s are alcohol and drug free living environments for people trying to abstain from alcohol and drugs. Usually they do not provide treatment but require or at least encourage residents to attend self-help groups such as AA.   SLH’s differ from conventional half-way houses because they are financially self supporting and clients can stay as long as they follow the house rules.

The objective of this California study was to measure treatment outcomes over an 18 month period from a sample of patients (55) who were provided SLH lodging as part of their outpatient treatment. Participants were male, mean age 43 years, 59% African American, 30% white, 11% other. A fourth were criminal justice referrals. A third were either homeless or lived in a shelter. Residents were dependent on cocaine (60%), alcohol (55%), marijuana (18%), heroin (15%), and amphetamines (12%).  Participants were interviewed at intake and at 6, 12, and 18 months. Cash incentives and eliciting extensive contact information produced high follow-up rates of 86% at 6 months, 76% at 12 months and 71% at 18 months.

The study found that the SLH clients experienced significant improvements in measures of alcohol and drug use, arrests, and days worked.  Involvement in 12-step groups was the strongest predictor of reductions in alcohol and drug use. These outcomes did not vary by demographics such as age, race, and education. The study concludes that “lack of a living environment that  supports sustained recovery is a major obstacle to successful treatment of substance abuse disorders in out-patient programs and SLH’s should  be considered as an adjunct to outpatient treatment for clients who have access to limited financial resources or reside in destructive living environments.”

 (Polcin, DL, Korcha, R, Bond, J, Galloway, G: Eighteen month outcomes for clients receiving combined outpatient treatment and sober living houses. Journal of Substance Use 2010, 15:352-366.)

This study at Columbia University looked at the risk and protective factors surrounding alcohol and drug use by young girls. According to the study, adolescent girls are surpassing boys in their use of alcohol and other drugs. The objective was to learn more about gender-specific risk and protective factors – knowledge that might be useful in the design of prevention programs. Mother-daughter pairs (781) were recruited via ads, signs in buses, and a radio station serving the greater New York City. Three-fourths of the girls sampled were African American or Latina. Participants were given usernames and passwords to access and respond to an online survey asking previously validated questions on adolescent substance use.

Analysis of the data suggested that, “where adolescent girls go after school, how they view and think about themselves, who their friends are, what their mothers know about their comings and goings and whether their families articulate non-use messages are all associated with girls use of alcohol, prescription drugs, and inhalants “. The known influence of best friends in choices about substance use is underscored in the findings.  Mother’s single-parent status had little influence but a mother’s use of alcohol and knowledge (or lack of knowledge) about a daughter’s whereabouts, companions and accessibility helped explain a girl’s substance use. Families who expressed appropriate messages about substance use and parents who set rules about non-use were found to be key factors in a girl’s choice regarding substance use.

The researchers conclude that this is a profitable area for future research to investigate and prevent substance abuse among adolescent girls and improve prevention programming.

(Schinke, SP, Fang, L, Cole, KC: Substance use among early adolescent girls: risk and protective factors. Journal of Adolescent Health 2008, 43: 191-194.)

(Ages 7 and up)
From the book Discovery . . . Finding the Buried Treasure by Jerry Moe
This activity goes beyond helping youngsters understand that family addiction is not their fault.  While this game helps children know in their hearts that they are not responsible for their parents’ problems, it also guides them in learning how they can take good care of themselves.  Youngsters come to realize that self-care is ultimately their most important responsibility. DESCRIPTION The facilitator distributes the updated ‘Alphabet Soup Revisited’ sheets (see example at the end of this activity) to group members.  One by one, youngsters volunteer to read one of the Seven C’s.  The children briefly discuss the meaning of each C and share how it applies to their lives before moving on to the next C.  The facilitator then explains that the Seven C’s can actually be divided into two parts, things you are not responsible for (the first three C’s) and things you are (the final four C’s).  A discussion follows in which the group differentiates between these two categories.  The facilitator reiterates that children can’t make their parents’ problems better but that they can learn to take care of themselves.
Now youngsters can either color their Alphabet Soup Revisited sheet with crayons and markers or draw a picture on the back of the sheet.  The pictures can either illustrate how family addiction really isn’t the children’s fault or show a new way children can take good care of themselves.  Another option, if time permits, is to divide the Seven C’s among group members and have them make collages illustrating the message of each C.  Youngsters paste the pictures and words they cut out of magazines onto large poster boards.  During group discussion, children look at the various collages and guess which C each one represents. EXAMPLE Frankie had difficulty playing Alphabet Soup Revisited.  He told the group facilitator that he was very angry he had to do a collage about CELEBRATE me.  “It’s not fair.  Why can’t I do one on can’t CONTROL or can’t CURE?” this twelve-year-old bluntly asked the facilitator.  Not getting the response he wanted, Frankie sat in a     corner and stared off into space.  After a few minutes had passed, the facilitator approached Frankie and validated his anger.  “It’s real hard for you to let go of Mom’s problems and just focus on yourself,” the facilitator gently offered.  Tears quickly welled up in Frankie’s eyes as he nodded affirmatively.  Even though he never completed the collage, he clearly got the point of this exercise. AFFIRMATIONS

• “It’s important to take good care of myself.”
• “I can let go of my parents’ problems.”
• “I’m learning about what I’m responsible for and what I’m not.”

COMMENTS Whether children draw pictures or make collages, hang the artwork on the walls during subsequent sessions.  It will serve as a powerful visual reminder of exactly what youngsters can and can’t do in their daily lives.
It’s often necessary, particularly with younger children, for the facilitator to provide extra assistance and support as the group members work on their drawings and/or collages.  Simply roaming the room and checking in with each child can make a big difference. MATERIALS (The last four items are for the collage option)

• Alphabet Soup Revisited sheets
• Crayons and markers
• Poster board
• Magazines
• Scissors
• Glue

The Evolution of an Activity The 7 C’s actually started out quite humbly as the 4 C’s.  They are featured in the 1989 book Kids’ Power: Healing Games for Children of Alcoholics by Jerry Moe and Dan Pohlman.  They are included in an activity named Alphabet Soup.
The 4 C’s

• I didn’t CAUSE the alcoholism.
• I can’t CONTROL it.
• I can’t CURE it.
• But I can learn how to COPE with it.

The Betty Ford Children’s Program prides itself on always making programs fit children and not making children fit programs.  It became clear to me that youth had some difficulty in understanding what COPE means.  Somehow it needed to be more clearly and thoroughly delineated.  The other limitation here is that the 4 C’s, which really impart important and essential information, only tell children what they can’t do.  The addition of the extra C’s lets kids know what they can do.
Remember that the children are the experts.  They continuously help make all the activities here better and more meaningful.  We encourage you to modify and adapt all the activities here to best meet the needs of the children and families you serve.
Elizabeth Devine is the Clinical Coordinator of Five Star Kids, the Betty Ford Children’s Program in Texas.  Take a good look at how she has adapted the 7 C’s activity to make it more meaningful and engaging for kids. 7 C’s Game Purpose:  To address the concept of the Serenity Prayer in a child-friendly way. To explain to the children what they can and can’t control. To help the children learn practical ways of focusing more on themselves than their loved ones with an addiction. To combat the common misguided beliefs of children of addicted parents. Making the bracelets allows for a kinesthetic experience and lets the children go away with a fun and tangible reminder of what they’ve learned. The children also are given a chance to diffuse their energy and emotions after the review of the 7 C’s.

• Either cover the C words on the posters or write out the 7 C’s and create blanks for where the C words go. Create a word bank where the C words are listed in a jumbled order.
• Explain to the kids that they are all on the same team, and that they will together try to fill in all 7 blanks. For each blank that they fill in, they will receive a “C” bead to be used for the bracelet they will get a chance to make. Show the children a pre-made 7 C’s bracelet.
• Once a child is chosen, have them fill in the blank using the word bank. If a child is stuck, they can call on someone else on their team who has their hand raised. After the child has filled in the blank, discuss each 7 C statement.
  1. I didn’t CAUSE it. Another person’s addiction can never be a kid’s fault.
     1. I want you to pretend that you go to school and you get in a fight with another kid and go to the principal’s office. When you get home you have a report card waiting for you and it is not good. You then go and pour yourself some milk and spill it all over the table. That person in your family comes in, sees the milk, yells at you and then guzzles a beer. Was that person’s drinking your fault? No. Did you put that alcohol in their mouth? No. We talked about how addiction is a disease. Did you give them a disease? No.
  2. I can’t CONTROL it. They choose to use or not to use.
     1. Ask the kids if they have ever tried to keep someone in their family from using. Allow them to share times they may have hid, poured out or destroyed their parents’ drugs or alcohol. Also talk about how sometimes kids try to be perfect so that they won’t upset their parents or stress them out. Sometimes kids beg or they police their parents. Point out that if a person with addiction decides they are going to use that day, there is nothing anyone can do to stop them, especially not a kid. Point out that the kids are off the hook. It is not their job to try to stop them.
  3. I can’t CURE it. It’s a disease and can come back, but people do get better.
     1. Ask the kids if they have the cure for cancer. What about for diabetes? Well, do they know how to treat cancer or diabetes? No. There are people who are specially trained to help people with the disease of addiction, but that is not a kid’s job. Also, talk about how a person with addiction will always have it, but that they can get better. That once a person learns how to stay away from drugs and alcohol, they can be just as healthy and happy as anyone without a disease.
     2. Personal Story: My dad didn’t drink anything for 8 years. Was he still an alcoholic? What do you think would have happened if after 8 years he thought he would have just one beer? He would relapse. My dad actually relapsed several times but eventually he figured out how to stay healthy through T&R (Treatment and Recovery). If you would have met him, you would have no idea he had the disease of addiction. He was fun to be around.
     3. Think of it like this, let’s pretend addiction is this little monster that lives inside. What does it eat and drink? Drugs and alcohol or whatever that person may be addicted to. So the more drugs and alcohol you feed it, the bigger and crazier it gets. The person is making bad choices and getting sicker and sicker and wants more and more. But, if that person can ask for help and stop doing drugs or drinking alcohol it gets weaker and weaker, and finally it gets so weak that it’s like its sleeping. It’s always there but it’s not really bothering anyone.
  4. But, I can help take CARE of myself. My #1 job is to be a kid!
     1. Ask the kids if they have ever felt like they were the adult in the home. A lot of times, kids find themselves taking care of their siblings, feeding others in the family or even parenting the adults in the house. Ask the children what a kid’s job should be. A kid’s job is to learn about the world around them and have fun! Let the kids know that kids are able to help take care of themselves. They know they will get stinky if they don’t take a shower or how to pick out their clothes, but a kid should always have an adult there to help them and watch out for them no matter what. It is also never a kid’s job to take care of an adult. If an adult needs help, a kid needs to find another adult to help out.
     2. To illustrate: What would you do if you came in and saw the person you care about who has addiction lying on the couch? You try to get them up, but they want you to leave them alone. You’re pretty sure they haven’t eaten or showered in a long time and you’re afraid that your brothers and sisters are going to need some food and someone to take care of them. What should you do? Sometimes the kids will brainstorm ways they could handle the situation. Keep listening to the kids’ ideas until one figures out that it would be best to call a safe person.
  5. I can COMMUNICATE my feelings, by talking, drawing and writing.
     1. Ask the kids what two ways we have done this so far. (Talking and drawing.) Mention how sometimes writing can help and that can be poetry, journaling or just writing your story. Talk with the kids about other ways to let their rocks out too. (i.e., crying, hitting or screaming into a pillow, tearing or scribbling on paper, running to get out your energy, listening to music.) You may also want to mention here the ways to let your anger out, but mention that it is not okay to hurt themselves or anyone else with your words or actions. It is also not okay to destroy anything that is important or valuable.
     2. To illustrate: Let’s say you’re super, super angry and you go home and rip up yesterday’s newspaper. Is that ok? Sure. You’re so very mad that you walk in your room and punch the wall. Is that ok? No. You hurt yourself and damaged something valuable. You’re super, duper mad and you go home, grab your pillow, scream into it and then hit it really hard. Is that ok? Sure. You’re so crazy angry that you go home and kick the dog. Is that ok? NO!
  6. I can make healthy CHOICES by choosing not to use drugs or alcohol.
     1. Talk to the kids about how it is important to have a plan if someone offers them drugs or alcohol and ask them various ways to say no. (i. e., I’ve got a lot of homework. I’m allergic. I’ve got to get to my baseball game…) Also remind them that they are at a greater risk of becoming addicted when someone in their family has addiction, but that addiction can never get them if they never try drugs or alcohol.
  7. I can CELEBRATE myself. I am special! I can _________________.
     1. Share with the kids that a lot of times when there are family problems about addiction, kids can start to feel down about themselves, and it is important to remember the things that make them special. Ask the kids what they are proud of or enjoy doing.
• You can finish this activity by pointing out how it is like the Serenity Prayer. The things in red (the first 3 C’s) are the things we can’t control. The things in green (the last 4 C’s) are the things we can. Explain what serenity means.
• Pass out bracelet cord and colored beads to each child. It can create a more fun atmosphere if you put on fun, kid-friendly music. Provide these guidelines:
  1. Must use all 7 C’s
  2. Has to be a bracelet
  3. Everyone gets to make one 7 C’s bracelet and, if facilitator approves, they can make an additional one without C beads.

Once again the Five Star Kids sponsored a toy drive for the families and agencies that we partner with.  The donations come primarily from tenants in our office building.  As in years past there were an abundance of toys, bikes, games, art supplies and plush animals to distribute to our kids.

Elizabeth Devine, clinical coordinator, spearheaded the distribution.  We were able to provide assistance to approximately 30 families that we had directly served.  We also partnered with one of our Irving school sites and donated some of the toys to help with their toy drive.  This school’s student population is in great need of services, and the counselors there made sure that everything went to families in need.

We also had a very generous donation from Michael Huff, #24 for the Oakland Raiders.  He donated 24 pair of Nike Air Jordan’s and 24 sets of sweat suits that matched.  Huff was born in Irving, Texas and attended a local high school.  He played at the University of Texas and was on the Longhorn National Championship team.

We are very grateful for the generosity of the tenants in our building, as well as Mr. Huff.  Without their support we could not have provided such awesome gifts to our families.

Upcoming Events:

12th Annual Reunion Roundup
Sunday, February 20, 2011
12 noon – 2:30 p.m.
Eddie Deen’s Ranch
Downtown Dallas

 Professional Workshop:
April 29

 The one book we consistently recommend to the parents, foster parents and grandparents who go through our children’s programs is Positive Discipline for Parenting in Recovery.  Written by Jane Nelsen, Riki Intner and Lynn Lott, and recently updated in 2007, this powerful book focuses on mending the broken bond between parent and child.

With an emphasis on solutions, this book helps grown-ups take charge of their lives and make positive changes to bring healing, health and wellness to the whole family.  Parents in recovery learn one step at a time how to create consistency and order in their relationships with their children.

Positive Discipline for Parenting in Recovery shows families how to build toward a positive future.  The book focuses on such topics as:

• Start where you are and keep it simple
• Build closeness and trust through emotional honesty
• Connect with outside support groups
• Break old patters of co-dependence
• Establish routines and structures
• Set limits and follow through
• Learn healthy communication skills

This book is a treasure in helping recovering folks let go of their guilt and shame in healthy ways so it doesn’t interfere with their relationship with their kids and the important task of parenting.

Positive Discipline for Parenting in Recovery, Jane Nelson, Riki Intner and Lynn Lott, Empowering People Books, 2007.

For printed books please visit: http://www.empoweringpeople.com

For e-books and downloadable audio files please visit: http://www.focusingonsolutions.com

NICK NEWS WITH LINDA ELLERBEE – UNDER THE INFLUENCE: KIDS OF ALCOHOLICS

Eleven million American kids live in a family with a parent suffering from alcoholism. Countless others deal with the havoc, trauma and chaos of this family disease but aren’t currently living with the alcoholic. We are talking about one out of every four kids in the U.S.

Five of these kids share their experiences dealing with parents who are struggling with alcoholism in the Nick News with Linda Ellerbee special, “Under the Influence: Kids of Alcoholics,” which will re-air on TeenNick during National Children of Alcoholics Week on Tuesday, February 15, 2011 at 6:00pm, EST.

Betty Ford Children’s Program staff supported the effort to create the program. Jerry Moe was interviewed as a subject matter expert and Children’s Program staff worked with the production crew to help identify kids who could share their stories.

“It was like I was the mother,” says Kate, age 12, from New Mexico. “I have lost some of my childhood…I know things some kids my age don’t know — like maybe should not know.”

“I love my mom but she loves drinking more than me,” says Brittany, age 15, from Mattituck, NY.  “I’ve tried to help my mom not to drink. I yelled and cried and begged her to stop. I have one tip.  If you want the alcoholic not to drink, don’t dump the alcohol down the drain. That’s just going to make them more angry.”

 “I would worry a lot about my dad,” says Matthew, age 10 from Westminster CO.  “My grades were suffering because I couldn’t focus.”

Then there’s Rian, 13, from Westwego, LA. “One day (my mom) wouldn’t wake up,” Rian says. “And I started crying because I thought she was dead.”

The poignant stories told by the children in the special allow viewers to connect with the depth of the problem. Jerry Moe acknowledges it’s difficult for kids growing up in homes where there’s alcoholism because they never know what’s going to happen next. But he also says kids can cope, “by having safe people that you can talk to about what’s going on at home – by learning problem solving skills, ways to stay safe.” 

The program also tells the story of hope; that alcoholics can get better. “I wondered, ‘What’s wrong with my dad?  Is he sick?” says Sam, age 13, from Palm Beach Gardens, FL. Yes, his father was sick. He suffered from alcoholism, but agreed to go to rehab after an intervention. “My dad went into rehab, and I saw this place, almost surreal like. It was a place that would take in broken people, and basically taught them skills so they wouldn’t drink anymore and would stay sober.  Not all the time it would work, but it worked for my dad and that’s all that matters to me.”

 The Betty Ford Children’s Program is grateful to Linda Ellerbee, Nickelodeon and Lucky Duck Productions for telling this important story to kids across the country, and for permission to share the program. If you would like to receive a DVD copy of the program, please contact one of our Children’s Program offices.

Continuing care is an essential ingredient to the recovery process for alcoholics, addicts and their families.  This is also very true when it comes to the children.  Continuing care allows kids and families to stay connected, receive valuable reminders of the tools they learned during the program, as well as the opportunity to practice and deepen these emerging skills.

Continuing care activities take different forms and shapes in our three children’s programs.  This is a reflection of the various communities we serve, as well as what best works in each locale.

California

Wednesday night is Kids’ Night at the Children’s Program at the Betty Ford Center.  Kids participate in a one-hour group with other alumni children their same ages.  We offer an Alateen group for our teen alumni of the kids’ program, as well as a closed Al-Anon group for all the parents and grandparents.  An interesting phenomenon has recently developed here.

In speaking with one of the dads on a Wednesday evening, he stated that he was so grateful to the children’s program in so many ways.  He found support for himself and all of his children as well as “friends” who understand completely what he has gone through and is going through.  Their parent group has gotten very tight and support each other completely.  They recognized that in order to utilize everything they had learned during the children’s program that they needed to keep balance in their lives.  They all had work and meetings but needed to “play.”  Their collective decision was to have a family get-together on Friday evenings.  All are invited to bring a dish to share, and they barbeque and watch movies or play games, kids and parents all together.  What great recovery!

Texas

Our Five Star Kids Program in Texas utilizes Focused Continuing Care (FCC) as one of their highly effective ongoing tools.  Counselors contact the parents/grandparents of the children who have come through the program every three months for one year.  A sense of belonging and connectedness gets reinforced, as well as the program’s major messages.  Most importantly, the children and families are reminded about how much we care.  Here are some recent comments from the grown-ups.

Everything is going great with the kids!  They are both doing really well in school.  Both the kids have been seeing a counselor for about a month now and they have really gotten a lot out of it.  The kids still to this day talk about how much they enjoyed the Five Star Kids program.

Thanks so much for your email.  My son got SO MUCH out of the program!  He talked about it a bunch when he got home and shared about the “rocks in the bag” concept, so you guys did a great job!

From a School Counselor at our program in December:  “BTW, a young girl came to school today carrying her Alanon book.  She asked if she could wait in my office so she could read before she went to class.  She said “Miss, I just can’t put this down.  I love this book!”

Colorado

The Colorado Children’s Program recently offered a Stage II program in Denver.  This is a continuing care process which has been used quite effectively in all three of our programs.  Here alumni youngsters spend a weekend with a focus on problem solving, safe people and staying safe.

During the Stage II we had 15 children attend the weekend event.  The children learn the S.T.O.P. method for problem-solving, as well as identifying safe people who can help them solve their problems when issues arise. 

The S.T.O.P. method is outlined below:

S:  Stop and name the problem; a kid cannot solve a problem if he/she does not identify the problem.

T: Think: What can I do?  The kids will brainstorm a few ideas about how to solve the problem.

O: Outcome: What can happen when I pick each of the solutions listed above?

P: Proceed or Plan:  Pick the safest plan or solution and use it.  If it does not work go to another solution or start the S.T.O.P. method over. 

On Sunday of this program we had a 12-year-old boy and his 10-year-old sister come in and share that when Dad got them home on Saturday their mother had been drinking.  The ten-year-old walked us through how she used S.T.O.P. and came up with a safe solution.  This is what she shared:

 “I picked the third option and it turned out to be the best solution as my dad, brother and I, with our dog, had a great time in the park and Mom was safe, too.”

The children left the three-day program with some new tools, some of which they were able to use even before the end of the program.  We were able to catch up with the children and what was going on in their lives and all of them were quick to open up about the good stuff and the hard stuff that has been happening since the last time we saw them.

Our staff is growing to meet the demands in Colorado.  Please welcome Josie Warren as our new children’s counselor.  A native Coloradan, Josie grew up in the Eastern Plains and started off in our group as a volunteer.  Her enthusiasm and desire to help children from addicted homes has shown through and played a major role in her being hired for the position.

Upcoming Events: David Meggitt, manager of the Colorado Children’s Program, will be presenting at the 37th Annual Psychotherapy Associates Annual Advanced Winter Symposium.  On Thursday, February 3, David will be presenting “Helping Children from Addicted Families:  The Betty Ford Children’s Program.”  For more information about the symposium, please go to www.ggforrest.com.  David will also be working with Lorie Obernauer, Alumni Coordinator from CeDAR, to present a parenting workshop March 5 and March 26 at CeDAR.  The Colorado Children’s Program staff will be also be presenting two Tools for the Journey workshops in May.  The first will be held in Grand Junction (location to be determined) on May 5; the second workshop will be held at the Doubletree Southeast in Aurora, just off the I-225 and Iliff.

The California Children’s Program kicked off the holiday season with our 28th Annual Alumni Reunion.  Children from across the country joined together to celebrate their family’s continued recovery.  Staff from our Texas and Colorado Children’s Programs joined with California to help make the event special and fun for the kids.  In addition, the Children’s Program provided a Holiday Hotline for our alumni children to call.  For the twelfth year, an 800 number was provided so that kids could reach out to a familiar voice in their time of need.

Over the next several months staff anticipates reaching out to more community members in an effort to share our program information.  We are in the process of planning in-services for our surrounding treatment centers and children’s out-reach programs such as MOMS, Cedar House, Desert Strength Academy and others.  We look forward to working with many of you soon.

This recent University of Chicago study looked at the relationship between the socioeconomic status (SES) of adolescents and their substance use in early adulthood. Much of the earlier research in this area focused on substance abuse in lower SES populations.  However, growing evidence shows that teens from high SES backgrounds are also at high risk. This study analyzed the relationship between adolescent SES (measured by parental education and income) and their adult substance use. The data came from The National Longitudinal Survey of Adolescent Health (AddHealth) a nationally representative study originally designed to examine how social contexts (such as families, friends, peers, schools, neighborhoods, and communities) influence teens’ health and risk behaviors. The survey is now also examining how health changes over the course of early adulthood. The objective of this particular study was to see if wealthier adolescents are more likely than those from a lower SES to engage in substance use in early adulthood.   

This analysis found that higher parental education is associated with higher rates of binge drinking and marijuana and cocaine use in early adulthood. Also, it found that higher parental income was associated with binge drinking and marijuana use. No significant results were seen for crystal meth or other drug use. The results were consistent for white non-Hispanics but not for non-whites perhaps because of the smaller sample size of non-whites. The study findings offer evidence that wealthier students may be at risk for substance use problems in the future.  The authors speculate that this can inform teachers, parents, school administrators, and program officials of the need for addressing drug abuse prevention in this population of students.

The study also suggests that students with more spending money might be more likely to engage in substance use. Thus, closer monitoring of allowances and other forms of spending money might be appropriate for parents concerned about an adolescent’s possible substance use.

(Humensky, JL: Are adolescents with high socioeconomic status more likely to engage in alcohol and illicit drug use in early childhood? Substance Abuse Treatment, Prevention, and Policy (2010) 5:19)

The goal of this study was to estimate the relationship between lifetime drinking experiences (life course patterns) and the risk of diabetes, heart problems, and hypertension. This study states that previous studies of both the protective and harmful effects of alcohol consumption on heart disease and related conditions are inconclusive because of poor alcohol-intake measurement, rarely including current drinking, lack of lifetime drinking assessment, not differentiating former drinkers from lifetime abstainers, and inconsistent and incomplete controls.

For this work, data were collected from 6919 respondents from all 50 states and the District of Columbia. Participants were placed in categories based on whether they had consumed any alcoholic beverages during their entire lifetime.  In addition, they gave answers to questions about the number of times they had consumed five or more drinks on a single occasion during their 20s, 30s, and 40’s. Current drinking status was based on the frequency of drinking five or more drinks on one occasion during the last 12 months. Three health conditions were examined: any heart or coronary problem, diabetes, and hypertension (high blood pressure). A major difference between this and previous studies on heart risk was the inclusion of former drinkers in the life course group rather than as abstainers.  A technique called propensity-score matching was used to arrive at probabilities and to control for potential confounders such as demographics, socioeconomics, and other health risks.

Among the study’s findings:

• Lifetime abstainers were found to be at risk of diabetes compared with both lifetime and current moderate drinkers.
• Ex-drinkers were found to be at increased risk of diabetes, heart disease, and hypertension.
• Higher volume drinkers (30 or more drinks per month) were found to be at reduced risk of diabetes relative to moderate current drinkers.
• Heavy-occasion drinkers were found to be at risk of hypertension. 
• Regular low quantity alcohol intake may be protective against adult onset diabetes.
• No evidence was found that lifetime heavy drinkers had increased risk of heart problems.
• No evidence was found that lifetime moderate drinking offered protection from heart disease or hypertension.

These findings are contrary to many previous studies showing protective effects of moderate drinking on coronary heart disease. The researchers conclude with “hope that this perspective on life-course drinking classification will be considered in the design of future studies so that causal relationships between alcohol consumption and heart problems can be clearly established or rejected.”

 (Kerr, WC, Ye, Y: Relationship of life-course drinking patterns to diabetes, heart problems, and hypertension among those 40 and older in the 2005 U.S. national alcohol survey. Journal of Studies on Alcohol and Drugs (2010) 71:515-25.)

Surveys show that initiation of teen substance use increases rapidly during middle and high school grades. This study points to a lack of evidence-based drug prevention programs in high schools. Researchers identified eight prevention programs recognized as evidence-based and classified as “model” or effective” based on the following criteria: (1) they target substance use; (2) they are intended for all students; (3) they are designed for use in high school; and (4) they are classified as effective by either the Substance Abuse and Mental Health Services Administration (SAMHSA) or the Center for the Study and Prevention of Violence. The researchers also provided a response option for locally-developed and other drug prevention programs.

The substance use prevention curricula employed in 1392 school districts nationally were identified via a 40-45 minute questionnaire using a secure web site. The responding school districts were provided with a list of the eight programs considered model or effective as well as an option to indicate locally developed curricula. An intense data collection strategy yielded a response rate of nearly 85%.

The study found that, while 56.5% of school districts with high schools reported some kind of prevention curricula, only 10.3% reported using any of the eight evidence-based programs. It was found that larger districts were more likely to sponsor some kind of program and were more likely to have an evidence-based program. This is some improvement over studies done 7 years earlier when virtually no high schools used evidence-based programs.

Even so, according to the researchers, “it appears that the nation’s high schools are making scant progress towards the implementation of evidence-based substance use prevention criteria.”

(Ringwalt, C, Hanley, S, Vincus, AA, Ennett, ST, Rohrbach, LA, Bowling, JM: The prevalence of effective substance use prevention curricula in the nation’s high schools. Journal of Primary Prevention (2008) 29:479-488)

Substance use disorders create an enormous burden of medical, behavioral, and social problems and pose a major and costly public health challenge. Despite the high prevalence of substance use and its consequences, physicians often do not recognize these conditions and, as a result, provide inadequate patient care. At the center of this failure is insufficient training for physicians about substance use disorders.

To address this deficit, the Betty Ford Institute convened a meeting of experts who developed the following 5 recommendations focused on improving training in substance abuse in primary care residency programs in internal medicine and family medicine: 1) integrating substance abuse competencies into training, 2) assigning substance abuse teaching the same priority as teaching about other chronic diseases, 3) enhancing faculty development, 4) creating addiction medicine divisions or programs in academic medical centers, and 5) making substance abuse screening and management routine care in new models of primary care practice. This enhanced primary care residency training should represent a major step forward in improving patient care.

Full article authored by Patrick G. O’Connor, MD, MPH; Julie G. Nyquist, PhD; and A. Thomas McLellan, PhD
http://annals.org/content/154/1/56.full

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This genetic analysis suggests that the way commonly used and misused drugs affect an individual may be inherited. Also, the way genetics and environment influence the effects of one drug may impact the effects of other drugs. According to this University of Colorado study, the sometime-in-a-lifetime use of the most commonly used psychoactive drugs are alcohol 91.6%, tobacco, 73.6% and marijuana 42.4%. Since the same brain pathways are used by psychoactive drugs, the way one affects an individual may indicate how the pathways will respond to others. The researchers looked at possible interactions, positive and negative, among the subjective effects of alcohol, tobacco, and marijuana.

Data were collected from 1299 adolescents and young adults. The subjective effects of these three drugs were assessed using a 13 item questionnaire. The effects of tobacco were recorded only if tobacco was used every day for 30 days. Data on alcohol and marijuana use were taken from subjects who used these drugs more than six times in 30 days. For each drug the question was asked,” in the period shortly after you used (the drug’s name), did it make you feel (a drug sensation)”?

Analysis of these responses showed that inherited influences contribute moderately to both positive and negative effects of all three drugs. There were no differences between males and females. Genetic modeling showed that the felt effects of alcohol, tobacco, and marijuana share a common inherited origin and that drug-specific genetic influences also make important contributions to individual response to these drugs.    

The study concluded “that the subjective effects to these commonly used and misused drugs are heritable and that genetic and environmental influences on effects to one drug also influences subjective effects to other drugs”.

 ( Haberstick,BC, Zeiger, JS, Corley, RP, Hopfer, CJ, Stallings, MC, Rhee, SH, Hewitt, JK,: Common and drug-specific genetic influences on subjective effects to alcohol, tobacco and marijuana use. Addiction. 2010 Oct 19. doi: 10.1111/j.1360-0443.2010.03129.x. [Epub ahead of print])

S = 3   V = 3   O = 4

Research has linked entertainment media with aggressive behavior, smoking, and sexual behavior. But less is known about the relationship between movies and alcohol use. This Dartmouth Medical School study looked at how parental restrictions on R-movie viewing influenced the risk of early-onset alcohol use. Participants were 3577 New England middle school youths (grades 5-8) who had reported never drinking. The question was asked, “How often do your parents let you watch R-rated movies or videos?”

Follow-up was conducted 13-36 months later using a computer assisted telephone system. Students responded via touch-tone responses. Outcome was determined by asking, “Have you ever drunk beer, wine, or other alcoholic drink that your parents did not know about?” Overall, 14.8% of the participants reported drinking without their parent’s knowledge during the survey period. A friend’s drinking played a powerful role in the choice to drink. Only 2.9% of those without a drinking friend chose to drink, while 27.8% with a peer who drank did drink. Yet – after controlling for covariates like a friend’s drinking, authoritative parenting style (how the adolescent viewed his/her parents in terms of warmth and limit setting), parent education and income, and personality characteristics of the adolescent – parental restrictions on R-movie viewing still predicted future use of alcohol.

The study showed that some of the influence of R-rated movie restrictions was due to reduced exposure to movie alcohol depictions, but some of it was “direct,” meaning that it was probably also a marker for parents who restrict other media venues with alcohol, such as television programming. In summary, children whose parents restricted access to adult media had lower likelihood of alcohol use. The researchers stated “that his study confirms a plausible causal pathway, from restrictions, to lower exposure to movies and movie alcohol depictions, to lower risk of alcohol use”.

(Tanski, SE, Cin, SD, Stoolmiller, M, Sargent, JD: Parental R rated movie restriction and early-onset alcohol use. Journal of Studies on Alcohol and Drugs 71, 452-459, 2010)

S = 4   V = 3   O = 4

A recent study by the National Institute on Drug Abuse (NIDA) examined gender differences in rates of substance abuse and dependence among young people. Earlier research has shown that males appear to be at greater risk than females for substance use problems. (In 2008 males comprised 60% of the 20 million youthful illicit drug users, and more than 2/3 of those in drug abuse treatment.) However, these studies provided only limited insight into gender differences in drug use or drug consequences. The objective of this NIDA study was to determine whether rates of substance use disorders among users differed between males and females on a national scale. The focus was on youths (12-17 years) and young adults (18-25 years) and on alcohol, marijuana, cocaine, and non-medical use of prescription drugs. Data were drawn from the National Survey on Drug Use and Health (NSDUH), which is conducted annually and samples the civilian, non-institutionalized population 12 years or older of the 50 states. Data from 271,000 responses were analyzed with gender evenly distributed and race representative of the US population.
Alcohol, marijuana, and psychotherapeutics used non-medically (including pain relievers, sedatives, stimulants, and tranquilizers) were the most common substances reported. Overall use rates of these substances were higher for males, who also exceeded females in meeting criteria for abuse, except in the case of cocaine where there was no gender difference. In the case of dependence, females exceeded males for dependence on cocaine and psychotherapeutics, while males exceeded females for alcohol and marijuana. The study describes numerous other patterns of use, abuse, or dependence, which differ by gender, age group, and drug, and concludes that all these variables play a role in the patterns of drug use, abuse, and dependence. Because gender influences who becomes dependent on which drugs, it should be taken into account when designing prevention and treatment interventions.

(Cotto, JH, Davis, E, Dowling, GJ, Elcano, JC, Staton, AB, Weiss, SR: Gender effects on drug use, abuse, and dependence: A special analysis of results from the national survey on drug use and health. Gender Medicine 7: 402-13, 2010 )

S = 4 V = 4 O = 3

Categories: Families, Adolescents, Young adults, Abused drugs, Prescription drugs, Women

On December 2, 2010, in a ceremony scaled down due to extremely adverse weather conditions, the Chancellor of the National University of Ireland, Dublin, conferred honorary doctorate degrees on actor, Brendan Gleeson; nuclear physicist Professor Richard Milner and Dr. Garrett O’Connor, President of the Betty Ford Institute.
Honorary degrees are awarded by the university to individuals who have contributed significantly to public life, the betterment of society, and the interests of humanity in Ireland, Europe or elsewhere. It is an honor of the highest level given to those whose academic distinction is linked in some way to the culture, scholarship, traditions and values of the National University of Ireland.
Born in Dublin, Dr O’Connor graduated from the Royal College of Surgeons in 1960 to train in Psychiatry at the Johns Hopkins University School of Medicine. Later, he introduced innovative experiential teaching methods for medical students at UCLA, and pioneered successful community models of addiction treatment in Los Angeles. For the past 20 years, Dr. O’Connor has striven to clarify the role of malignant shame that can arise from extreme cultural and familial trauma, as well as the ways in which this destructive form of shame may be transmitted unconsciously to future generations.
The topic of addressing malignant shame was the impetus for an invitation from Irish public broadcast RTE Radio to Dr. O’Connor to deliver the 2010 Michael Littleton Memorial Lecture, a prestigious annual public lecture. On December 7, 2010, Dr. O’Connor will address a studio audience about “Malignant Shame in Ireland and its role in the rise and fall of the Celtic Tiger.” The lecture will be broadcast nationwide later in the month.
As President of the Betty Ford Institute, Dr. O’Connor is dedicated to the mission of supporting collaborative programs of prevention, education and research that will lead to a reduction in the devastating effects of addictive disease on individuals, families and communities. He has written and spoken on numerous occasions on the topic of shame and addiction.
Links to two of Dr. O’Connor’s articles are below. The first is an overview of shame and addiction. The second is an analysis of malignant shame and the Irish condition.
“To Understand Shame Is To Understand Addiction And Maybe Even Life Itself”

http://www.bettyfordinstitute.org/publications/bfi-staff-publications/to-understand-shame-is-to-understand-addiction-and-maybe-even-life-itself.php

“Recognising and Healing Malignant Shame”

http://www.zonezero.com/magazine/essays/distant/zreco2.html

Drinking patterns and alcohol problems change with age but few studies have spanned the history of an individual’s alcohol use and/or alcohol use disorders (AUD) from early adulthood to middle age. An AUD at any age points to recurring alcohol problems and risks for illness and early death. Thus it is useful to understand the predictors of such problems. A long running study by the Department of Psychiatry, University of California, San Diego reports results of their 25 year observation of AUDs observed in 373 relatively well educated Caucasian men originally recruited between 1978 and 1988 when they were 18- to 25-years-old. All had experience with alcohol but none met the criteria for AUDs. Baseline data was collected via face to face interviews at age 20. Follow-up interviews were conducted every 5 years. Based on these reports the men were placed in 4 groups: no alcohol use disorder (62.5%), chronic AUD at age 30 (17.2%), onset of AUD at age 30 with no recovery (6.7%), and AUD onset at age 30 with 5 years remission before the 25 year follow-up.     Schuckit and Gold, 1988 M.A. Schuckit and E.O. Gold, A simultaneous evaluation of multiple markers of ethanol/placebo challenges in sons of alcoholics and controls, Arch. Gen. Psychiatry 45 (1988), pp. 211–216. View Record in Scopus | Cited By in Scopus (89)

Ninety nine percent of the participants were located and interviewed at year ten (T-10). Further follow-up interviews took place at the 15, 20 and 25 year mark. Among the 373 participants, 140 met the criteria for alcohol abuse or dependence during the 25 year follow-up. The study determined that a low level of response (LR) to alcohol, family history of AUDs, and higher novelty seeking at age 20 predicted AUDs with onset before age 30 but among these only LR predicted later onset (mean age 38) as well. Additional predictors of AUDs included demography (lower education), and greater involvement with alcohol, drugs, and nicotine prior to year ten (T-10).  Sustained remission from AUDs among alcoholics was predicted by lower T1 and T10 drinking frequencies, a trend for higher Reward Dependence .and being separated or divorced at T10, The study concludes that information available in the late teens to early twenties can help predict the future onset and course of AUDs. This underscores the importance of longitudinal studies in substance use disorders.

(Schuckit, M, Smith, T,: Onset and course of alcoholism over 25 years in middle class men. Drug and Alcohol Dependence (2010),doi; 10.1016/j.drugaldep.2010.06.017)

A recent study by University of Maryland researchers looked at the difference between children’s self-perceptions of their risk of alcohol use versus their perceptions of risk of alcohol use for other children, and whether these discrepancies predicted children’s future alcohol use. They cite research indicating that 58% of U.S. children have had at least minimal experience with alcohol before the age of 12 years and that recent evidence shows those children’s perceptions about alcohol risk is a predictor of early-onset alcohol use.

This study examined 277 children ages 9 to 13 years (fifth and sixth graders) recruited from schools, libraries, and Boys and Girls Clubs from a large metropolitan area in the northeastern U.S. Follow-up consisted of two waves of assessment separated by one year. At onset children were asked how risky they thought it would be for them to use alcohol. They were also asked how risky alcohol use was for children their own age. Riskiness was defined as the chance of getting hurt or of getting in trouble with authority figures.

The study led to two main findings.  First, the group who used alcohol the least had perceived that the risk of alcohol use was high for both themselves and others the same age. Second, the group with the highest alcohol use had perceived a low risk of alcohol use for themselves and a high risk for their peers. The researchers suggest that these discrepancies between children’s perceptions versus actual risk of alcohol use can be helpful in predicting children’s alcohol use outcomes.

(De Los Reyes, A, Reynolds, E, Wang, F, MacPherson, L, Lejuez, C: Discrepancy between how children perceive their own alcohol risk and how they perceive alcohol risk for other children longitudinally predicts alcohol use. Addictive Behaviors 35: 1061-1066, 2010.)

Treatment for addictions based on the Twelve Step teachings and traditional practices of Alcoholics Anonymous is the prevalent clinical model in the U.S.  A primary objective of this model is to connect the recovering person to a community-based AA affiliation. Several studies have shown the beneficial relationship between AA attendance and increased abstinence. Other studies have shown the positive relationship between the social support of AA and substance use reductions. Encouragement to acquire an AA sponsor is common practice and is seen as an important means of increasing the benefits of the social support provided by AA participation.  This study states the role of AA sponsor as, “to guide a junior member through the prescribed Twelve Steps: a role identified in approved AA literature”.
Much is known about the prevalence, practice and benefit of AA sponsorship. The researchers cite work showing that 75% of adults in Twelve-Step based treatment had a sponsor in the first 3 months after treatment. This is consistent with the 2007 Triennial AA Survey that reported 73% of new AA members acquire a sponsor within the first 90 days. However, this tends to decay over the course of 12 months; one study showed only one in five participants had a sponsor at 9 month follow-up.
This study investigated the “direct and specific effects of AA sponsorship on later substance use”.  Participants (235) were recruited from AA and outpatient treatment. Intake and follow-up interviews included questionnaires, interviews, and drug testing. Overall reductions in alcohol, marijuana, and cocaine use were found over 12 months.  Results showed that having an AA sponsor predicted increased alcohol abstinence. During early AA affiliation – but not later- the study showed that having a sponsor predicted increased alcohol, marijuana, and cocaine abstinence. Having an AA sponsor was found to be “significantly and positively predictive of later abstinence regardless of whether the abstinence did or did not consider the use of illicit drugs.” For example: participants with sponsors at 3 months were almost three times as likely to be abstinent from alcohol at 6 months as AA attendees who had no sponsor. Although the researchers point out that there is wide variation on how sponsorship is structured and experienced, the findings provide strong support for the benefits of having an AA sponsor during early AA affiliation.

(Tonigan, J, Rice, S,: Is it beneficial to have an Alcoholics Anonymous sponsor? : Psychology of Addictive Behaviors 24: 397-403, 2010)

The Betty Ford Institute is pleased to share with you a video that beautifully and eloquently explains how addiction is a disease.  “Pleasure Unwoven: A Personal Journey About Addiction” is presented by The Institute for Addiction Study, written by Kevin McCauley, cinematography by Norman Bosworth and produced by Jim Clegg.

The most important question about addiction is: “Is it really a “disease?” In this video essay, filmed in high-definition, Kevin McCauley explores the arguments for and against this vital debate, reviewing the latest neuroscientific research about addiction along the way. Using the spectacular landscape of Utah’s State and National Parks to describe the brain areas involved in addiction, Dr. McCauley turns complex neuroscientific concepts into easy-to-understand visual images that will help people in recovery feel better understood, and their families and friends feel hope that recovery is possible.

“The quality of the Pleasure Unwoven as an educational product on this issue is unprecedented and has enormous potential for professional and public education… Pleasure Unwoven may prove to be one of the most effective educational tools ever developed on addiction and will serve as an invaluable aid in the treatment of individuals and families affected by addiction.”

- William L. White, MA

Chestnut Health Systems

To learn more or purchase a copy of the DVD, click here: http://www.instituteforaddictionstudy.com/index.html

To see a preview, click here

Shame, as the conductor of the affective orchestra in humans, is a powerful, elusive and tricky emotion that can protect or destroy the organism – depending on the circumstances. Often referred to as the pathological affect of abandonment, indignity, alienation and failure, the healthy function of shame, which is to protect and motivate the self to move in a positive direction by deeply disturbing it, goes largely unrecognized. This protection, however, comes with a high premium in pain and suffering for alcoholics and other addicts who, because of their frequently shameful lifestyles and bio-psycho-social-spiritual make-up, tend to exist in a more or less chronic state of permanent and immutable malignant shame.

Shame must be differentiated from guilt, although both affects often work in concert with each other.  Guilt is about action and behavior, while shame is about identity and self. Guilt involves a violation of an external rule or standard that can be redressed by restitution or an apology. Shame, on the other hand, slices uninvited through the ego boundary to inflict a deep wound on the self that is experienced as an “inner torment” or a sickness of the soul. Shame patrols the boundary between our public and private lives.

Malignant shame, the core affect of addiction, can be treacherous, dangerous and even lethal to the addict as well as to family members and others when it is expressed as rage, fear, anxiety or despair. Paradoxically, healthy shame, which motivates the alcoholic or addict not to drink or use drugs, kicks in at the moment when the addict hits bottom, and continues to function as the healing force that energizes the hard, but joyous, work of authentic suffering, surrender, forgiveness and service to others that is so essential to the attainment of stable and sustained sobriety. Shame can be paired with hope as well as with despair.

Fundamentally, the healing approach for the disease of addiction is based on caring rather than curing (Kurtz.).  Shame-based, traumatized addicts need care, while at the same time they must be held accountable for whatever physical, emotional or spiritual damage they may have caused through their frequently anti-social behavior. Although the treatment of shame-based disorders can be considered from a number of different perspectives, the 12-Step approach, which has been shown to meet all scientific criteria for psychotherapy, is a highly effective shame reduction modality for alcoholics and other addicts in that it challenges and modifies the narcissistic self-centeredness of the addict in an environment of spiritually-protected public exposure. Thus unencumbered by selfish narcissism, and newly liberated from the prison of malignant shame, the alcoholic or drug addict can maintain sobriety by being of service to other suffering alcoholics and drug addicts so that they too may achieve sobriety.

          On Sunday, November 14, 2010, a special edition of Nick News with Linda Ellerbee will bring attention to a problem that approximately 11 million kids in the U.S. have been suffering with silently for too long. “Under the Influence: Kids of Alcoholics” tells the story of 5 kids who live with alcoholic parents and the challenges they face because of it.

“It was like I was the mother,” says Kate, 12, from New Mexico. “I have lost some of my childhood…I know things some kids my age don’t know — like maybe should not know.”

“What children of alcoholics do need to know,” says Ellerbee, “is that it’s not their fault, they didn’t cause it and they can’t fix it. Most of all they need to know they’re not alone.”

“I love my mom but she loves drinking more than me,” says Brittany, 15, from Mattituck, N.Y.  “I’ve tried to help my mom not to drink. I yelled and cried and begged her to stop. I have one tip.  If you want the alcoholic not to drink, don’t dump the alcohol down the drain. That’s just going to make them more angry.”

You’ll hear from Matthew, 10, AGE, from Westminster, Colo. “I would worry a lot about my dad,” he says.  “My grades were suffering because I couldn’t focus.”

Then there’s Rian, 13, from Westwego, La. “One day (my mom) wouldn’t wake up,” Rian says. “And I started crying because I thought she was dead.”

Although the program shows how sad and scary it can be for children living with alcoholism, it also delivers a message of hope. It lets kids know that they are not alone and that there are things they can do to stay safe and cope with the problem.

Jerry Moe, National Director, Betty Ford Children’s Program, acknowledges it’s difficult for kids growing up in homes where there’s alcoholism because they never know what’s going to happen next. But he also says kids can cope, “by having safe people that you can talk to about what’s going on at home. By learning problem solving skills, ways to stay safe.” 

The good news is that alcoholics can get better.  “I wondered, ‘What’s wrong with my dad?  Is he sick?” says Sam, 13, from Palm Beach Gardens, Fla. Yes, his father was sick. He suffered from a disease called alcoholism, but agreed to go to rehab after an intervention. “My dad went into rehab, and I saw this place, almost surreal like. It was a place that would take in broken people, and basically taught them skills so they wouldn’t drink anymore and would stay sober.  Not all the time it would work, but it worked for my dad and that’s all that matters to me.”

Tune in this weekend to the Nick News with Linda Ellerbee special, “Under the Influence: Kids of Alcoholics,” premiering Sunday, Nov. 14, from 9:00 to 9:30 p.m. (ET/PT) on Nickelodeon.

Jerry Moe, National Director of the Betty Ford Children’s Program, received the California Society of Addiction Medicine (CSAM) 2010 Community Service Award during the organization’s recent Addiction Medicine Review Course in Newport Beach.

An internationally known author, lecturer and trainer, Jerry’s passionate advocacy for, and work with, children of alcoholics and addicts has significantly improved thousands of lives.  Jerry has been developing programs and facilitating groups for children from addicted families since 1978.

His books include: Understanding Addiction and Recovery Through a Child’s Eyes, Kids’ Power: Healing Games for Children of Alcoholics; Conducting Support Groups for Elementary Children; Discovery … Finding the Buried Treasure; Kids’ Power Too: Words to Grow By; The Children’s Place … At the Heart of Recovery and the Beamer series.

During his career, Jerry has received a number of acknowledgments for his work with children, including the 1993 Marty Mann Award and the 2005 American Honors Recovery Award.

The Community Service Award was established by CSAM’s Executive Council in August 1985 as the Achievement Award or Merit Award to honor “someone outside the health professions.”  Over time it came to be called the Community Service Award.  Past recipients include Betty Ford, Stephanie Brown and Joan Kroc.

Helping recovering parents prevent their children from developing drug abuse or dependence was the subject of a September 29 through October 1 Conference sponsored by Betty Ford Institute (BFI) in Washington, D.C.  

“Breaking Intergenerational Cycles of Addiction: Parent-Focused Strategies” brought together researchers, policy makers, practitioners and recovering parents to discuss and promote the need for including parenting skills education as a standard part of addiction treatment.  Sponsors included SAMHSA/CSAT, Legacy, and the Norlien Foundation of Calgary, Canada.

Transmission of alcohol or other drug dependence from one generation to the next is all too common in this country and worldwide. Moreover, according to SAMHSA, an estimated 8.3 million children in the U. S. currently live with a parent who meets criteria for a substance use disorder and countless other children who are not currently living with their parents.  No estimates exist for the number of children who are living with a parent in recovery.    

But despite evidence that addiction is a multigenerational disorder, and that effective parenting practices can reduce the risk of adolescent alcohol or other substance use, the September 29 conference was the first to address parent-child relationship issues during treatment of adults for drug or alcohol addiction. The issue has been little-studied, and a pre-Conference survey of addiction treatment centers in the U. S. conducted by the Betty Ford Institute revealed that formal parenting skills education is infrequently offered as part of substance abuse treatment.

Presentations at this historic Conference included:
• Seeing addiction and recovery from a child’s perspective;
• Family dynamics that are frequently manifested during addiction and recovery;
• Consideration of cultural and financing issues in launching parent skills education; and
• Raising awareness among addiction professionals of the importance of addressing parenting issues that arise during recovery. 

One panel composed exclusively of parents in recovery discussed the degree to which adult recovery is affected by parenting challenges. Other presentations described model programs now in existence, with follow-up discussion of what types of models may be best and for what populations of recovering parents.

“Parenting skills education and other parent-focused services should be a fixture in the treatment of alcohol or other drug addiction,” said Garrett O’Connor, M.D., President of BFI and Conference Co-Director.  “Unfortunately these services are still the exception in out-patient and in-patient substance abuse treatment programs for adults.”

“Effective parenting is probably one of the best and most available strategies for breaking intergenerational cycles of addiction,” said Amelia Arria, Ph.D., BFI Director of Prevention and Conference Co-Director.  “Helping mothers and fathers use effective parenting skills throughout their children’s lives helps the children themselves and removes a major stressor on the parents’ own recovery,” she said.  Arria is a Senior Scientist at the Treatment Research Institute and faculty member at the University of Maryland School of Public Health.

Next steps include advocating for more research to understand and evaluate best practices for parents, a review of existing parenting skills education strategies used in drug treatment, and development of tools and resources for parents in recovery.

The mission of Betty Ford Institute is to conduct and support collaborative programs of research, prevention and education that will lead to a reduction of the devastating impact of addictive disease on individuals, families and communities. The initial prevention focus is on families and children at risk for alcohol and other drug problems.

The Texas Children’s Program hosted a day long workshop on September 24th on the topic of Reactive Attachment Disorder. Nancy Kolo, a local therapist specializing in the disorder, presented the information along with a panel of parents who have adopted children with RAD. Fifty professionals were in attendance and the evaluations were excellent. One of the attendees drove from Houston to attend the workshop. She told us that she cannot get this level of training for the price anywhere in her area. Lance Hughes, coordinator for the Professional Training Series is to be commended for his work on this and other educational efforts provided by the Texas Children’s Program.

Restricting access to alcohol is thought to reduce underage drinking. Community policies such as strict enforcement of underage drinking laws and responsible beverage server training have proven effective.  Research has also shown an association between geographic availability of alcohol and consumption. A recent study by the Pacific Institute for Research and Evaluation examined whether the frequently advocated strategy of limiting the number or density of alcohol purveyors in a neighborhood further reduces underage drinking.  The study focused on adolescents from 50 California zip codes with varying numbers of alcohol outlets, a range of household income, and where at least 200 14-16 year olds resided.  Only off-premise retail outlets were considered, since few people this young drink in bars, pubs, or restaurants.

The researchers examined whether greater alcohol outlet density is associated with higher levels of youth drinking, elevated levels of excessive youth drinking, and/or encourages the growth of youth drinking. Data were collected via three waves of computer assisted phone interviews in Spanish and English, conducted approximately one year apart. About 300 interviews were completed in each zip code. Off-premise outlet density was determined from license data acquired from the state. In each annual follow-up survey, participants who reported drinking during the previous year were asked about both the frequency of their drinking and any excessive drinking.  They provided the names of five friends who were asked about the participant’s reported drinking.  Individual variables also considered in the analysis were personal income, access to auto, parent drinking, gender, age, and race/ethnicity. Rates of past year drinking were 31%, 45%, and 55% at waves 1, 2, and 3, while 19%, 27%, and 36% reported ever being drunk during those periods. When multi-level analysis considered only zip code area incomes and alcohol density, no significant relationship was found. However, when individual variables were considered, higher levels of drinking and excess drinking were observed in the zip codes with greater alcohol outlet densities. The study suggests that outlet density may play a role in initiation of teenage drinking.

(Chen, M-J, Grube, JW, Gruenewald, PJ: Community alcohol outlet density and underage drinking. Addiction, 105, 270-278, 2010)

Efforts to translate advances in science into clinical practice are occurring throughout the range of health care. This concept of “evidence-based practice” (EBP) produces consistency in practice, improved accountability, increased cost-effectiveness, and enhanced treatment effectiveness, and raises the overall quality of patient care. A recent review conducted by the Integrated Substance Abuse Programs at the University of California, Los Angeles examined the concept of EBP, and looked at how EBP is evaluated and applied in the addictions field.  The scope of the review involved a literature search of publications about this topic over the past 10 years and current documents concerning EBP use in addiction treatment, both within and outside the United States. The use of medications was not considered in this review, which was limited to psychosocial treatments.

Early studies had pointed out the disparity between patient care and research-validated clinical practices. These findings led to EBP being defined as: “the integration of best research evidence with clinical expertise and patient values”. The authors of this review state that the most debated parts of this definition are “best research evidence” and “clinical expertise”.

Best research evidence can be derived from a variety of sources, all of which are subject to some level of bias. Yet there is a recognized hierarchy of evidence ranging from randomized controlled trials (RCT) – which are considered to be the least subject to bias – to systematic reviews employing meta-analysis. A number of constituencies have produced criteria for how a specific clinical practice is to be established as evidence-based. For example, the American Psychological Association introduced the term “empirically supported treatments” making a distinction between efficacy (demonstrated by controlled research) and effectiveness (observed in a clinical setting). Efficacy is considered paramount. This approach is not without critics; nonetheless, the reviewers state that there is an emerging body of evidence supporting psychotherapy approaches based on efficacy research alone.

Clinical expertise can encompass a variety of background and skills, including scientific knowledge, patient awareness and interpersonal abilities, awareness of one’s own limitations, and decision-making. Standards, regulations, and training influence how an individual clinician may demonstrate these characteristics. The reviewers state that in a recent study of 31 states, only one state mandated course work in research. Interpersonal skills are also recognized as critical components in treatment outcome. To reach desired levels of clinical expertise, the reviewers recommend more rigorous certification/ licensing requirements, plus education and training aimed at a limited set of EBP core principles and skills. In addition to identifying organizational and workplace barriers to EBP implementation, the review also provides an extensive list of addiction treatment techniques that have been proven to not work.

The authors conclude with the following recommendations for evidence-based skills training and strategies to encourage transfer of research based clinical practices: involve stakeholders in the consensus process that designates a practice as evidence based, train clinicians to use easily learned and widely adaptable EBPs, implement EBPs using established methods, adopt changes in the light of organizational readiness, increase access to training and information resources, and increase clinician and organizational exposure to EBPs.

(Glasner-Edwards, S, Rawson, R: Evidence-based practices in addiction treatment: review and recommendations for public policy. Health Policy 97: 93-104, 2010.)

Key words:

In 2006 there were nearly 20,000 emergency department (ED) visits by patients aged 15 to 24 years. These ED visits are an opportunity for intervention efforts to reach adolescents not attending school, who lack a primary care MD, or who are otherwise outside mainstream medical care. A recent study conducted at the Hurley Medical Center in Flint, Michigan looked at whether therapist and computer interventions could be effective in reducing adolescent violence and alcohol misuse. Over a 3-year period (2006-2009) 3,338 patients 14-18 years old completed a 15-minute computerized survey. Those reporting alcohol use or aggression were recruited for further testing. Participants were randomized and received either a therapist brief intervention or a computer-based brief intervention, or were assigned to a control group.

The SafERteens brief interventions used in the study were based on motivational interviewing but included alcohol refusal and conflict resolution skills practice. The therapist and computer interventions had similar content and were culturally relevant for urban youth. The content sections included “goals, personalized feedback for alcohol, violence, and weapon carriage, decisional balance exercise for the potential benefit of staying away from drinking and fighting, 5 tailored role plays (e.g., anger management, conflict resolution, alcohol refusals, not drinking and driving), and referral.” The computer intervention was an interactive animated program with touch screens and audio. Both the computer and therapist interventions were consistent with motivational interviewing but it was not possible for the computer to provide the complex interpersonal responses of a skilled therapist. Follow-up consisted of self-administered computerized assessments 3 and 6 months after the ED intervention.

Results indicated that brief intervention with adolescent patients in an urban ED shows promise. The findings show that a therapist brief intervention (with computerized feedback and structure) decreases the occurrence of peer violence in the 3 months following an ED visit. In addition, both the therapist and the computer brief interventions were effective at reducing alcohol consequences over 6 months. The researchers point out that a leading cause of mortality and morbidity in this age group is violence. Thus a reduction in severe violence following a single-session brief intervention is clinically meaningful. (Walton M, Chermack, S, Shope, J, Bingham, R, Zimmerman, M, Blow, F, Cunningham, R: Effects of a brief intervention for reducing violence and alcohol misuse among adolescents. J. Amer. Med. Assoc. 304:527-535, 2010

You have the right to be yourself.

You have the right to ask for help.

You have a right to your own opinions.

You have the right to make mistakes.

You have the right to your own feelings.

You have the right to share your feelings with safe people.

You have the right to think good thoughts about yourself.

You have the right to expect a safe home.

You have the right to dislike someone else’s behaviors.

You have the right to choose your own behaviors.

You have the right to grow at your own pace.

You have the right to know that you are not responsible for the drinking or drug problem in your home.

 You have the right to be a kid!

A Tool to Address Stuffed Problems and Feelings
(Ages 7 and up)

This experiential exercise helps children to kinesthetically understand the consequences of holding problems and feelings inside. In a fun way, it also introduces them to the recovery process of identifying problems and expressing feelings.  Youngsters actually experience freedom by initiating this process for themselves.

Description: With the children sitting in a circle, the group facilitator places a tote bag in the middle.  Unbeknownst to the kids the bag is full of brightly colored rocks, each with a problem (such as addiction, fighting, abuse, and secrets) or a feeling (such as anger, scared, hurt, shame, guilty, and sad) painted on it.  The facilitator describes how everyone who comes to a recovery center has been carrying around such a bag inside.  One by one youngsters pick up the bag and attempt to walk around the room carrying it.  The facilitator asks such questions as, “How does it feel carrying all this stuff?”, “When you carry such a heavy load what are you always thinking about?”, and “Can you be free to be a kid and laugh and play when you’ve always got that bag with you?”

After a brief discussion, the bag is returned to the middle of the circle and the facilitator opens it up and explores its contents. One by one the children reach into the bag, take out a rock, and read the problem or feeling on it. When the addiction rock comes out the facilitator asks how many kids have addiction problems in their families.  Many hands are raised.  The facilitator acknowledges the children and states, “We’ll learn lots about addiction this week, especially that it’s not the kids’ fault.”  When a feeling rock gets pulled out the facilitator asks how many children have felt this way, and kids have a chance to share feelings.  Before long the bag is empty and everyone has the chance to carry it around again.  All are amazed at how much lighter the bag is because they talked about their problems and feelings.

Example: Jordan, age 7, could barely lift the full bag off the floor and had to drag it across the room.  He especially enjoyed how much lighter it felt after the sharing session.   At the end of the discussion he uttered, “I want to get rid of some rocks about Mom’s divorce.  I feel sad and scared.”

Affirmations: “I can share my problems and feelings with people who care.” “All my feelings are okay.”

Comments: This is an excellent introductory activity to get the group rolling.

As youngsters share problems and express feelings during the week, celebrate their progress by acknowledging “You let go of a couple more rocks today. Hooray!”

Materials:
-tote bag
-10-12 rocks, each painted with an individual feeling or problem

The Stuffed Problems and Feelings Game (Bag of Rocks) can be found in the book, “Discovery:  Finding the Buried Treasure,” by Jerry Moe.  Published by ImaginWorks, 1992.

From ‘12 Steps for Parents’ by Dr. Patricia O’Gorman and Philip Diaz, MSW

 It is important to remember that parenting is always a struggle between love and fear. As parents, we try to control our children in an attempt to protect them from any painful experiences. The best you can do as a parent is be an example and encourage your children to their fullest by being all that you can be. As a recovering parent you will need to take responsibility for learning about your children and developing new parenting strategies so that you may open new avenues of communication and self respect in your families. Following the 12 Steps of Recovery, Revised for Parents, can bring sanity, order and fulfillment to the parenting process: Step 1: Admit powerlessness over your ability to protect your children from pain and become willing to surrender to your love and not your control. Step 2: Find hope in the belief that recovery is possible through faith and a willingness to work on yourself. Step 3: Reach out for help and acknowledge that you are not alone. Step 4: Take stock in yourself as a parent. Step 5: Learn to share your parenting issues with others without self-recrimination. Step 6: Become ready to change by giving up the demand to be perfect. Step 7: Make conscious changes in your parenting by identifying specific strategies for healthy parenting. Step 8: Take responsibility for the effect your parenting has had on your children and learn self-forgiveness. Step 9: Make amends to your children through healthy parenting without over compensating. Step 10: Model being honest with yourself and your children and create acceptance in your family for imperfection. Step 11: Learn to accept your limits in life and find your true spiritual path while allowing your children theirs. Step 12: Reach out to other parents in the spirit of giving and community.

excerpted from:
“The Lowdown on Families Who Get High” – - Child & Family Press (July 2004)
“Breaking the Cycle of Addiction”- – Health Communications (1987)
reprinted with permission from the authors

Lost Childhood: Growing Up In An Alcoholic Family is a half-hour program told in three parts. The first part begins in 1986 at a summer camp retreat for young children of alcoholics. The children speak about their experiences with an honesty and wisdom beyond their years. Many of these children know they are at high risk of becoming alcoholics themselves.

Part two takes place 17 years later as we follow up with two of the children from 1986 who are now adults. Through their experiences, we explore the long-term impacts of living with alcoholism in the family.

The third part takes us back to the summer camp retreat where our story first began. We visit the newest generation of children of alcoholics. We talk to the same counselor who helped our 1986 children and learn that while the core issues remain the same for today’s children, the vast majority of children of alcoholics are still not getting any help. Many face additional burdens of broken homes, poverty and hard core drug use.

The video is available online at www.nacoa.org

Staff to Present at National Drug Endangered Children Conference

The 2010 National DEC Conference is being held in partnership with the Texas Alliance for Drug Endangered Children and the Greater Dallas Council on Alcohol and Drug Abuse. The Texas Alliance for Drug Endangered Children is supported by the Children’s Justice Act through the Texas Center for the Judiciary. Betty Ford Five Star Kids played a key role in the formation of the Texas Alliance.  www.texasdec.org

Elizabeth Devine, Clinical Coordinator and Pam Newton, Director, will present two workshops at the conference this year.

November 9 – 11, 2010 
Dallas/Addison Marriott Quorum by the Galleria
14901 Dallas Parkway
Dallas, TX 75254

For more information about the conference,   http://www.nadec-conf.org/

David Meggitt, Colorado Children’s Counselor, made a presentation for The Coalition for the Prevention of Child Abuse and Neglect (CPCAN) Forum on September 17th, 2010.  The focus of the talk was hands-on practical suggestions for teachers and other people working directly with children affected by a loved one’s substance abuse.  Topics covered included how to identify children in this population; the dos and don’ts of working with these children; and how to build some resilience skills in these children.

The California Children’s staff maintained a steady presence in the community this summer.  In addition to facilitating our four-day programs on the Betty Ford Center campus twice a month, we dedicated much time to providing tools to children, families and professionals.

For the third year, staff from the Children’s Program visited the James O. Jessie Desert Highland Unity Center.  The Highland Center serves children year round, offering after-school activities and summer sessions in the north Palm Springs area.  In June, we facilitated the last of our ten one-hour sessions for the fiscal year, offering addiction education, problem-solving and self-care skills to kids in kindergarten through 8^th grade.

Betty Ford Center hosted the annual East & West Network Luncheon in June.  Over 70 professionals from the valley attended, sharing ideas for helping children and families in our community.  Helene Photias, California Children’s Program Supervisor, presented at the event.  Helene also had the opportunity to lead a mini workshop for the Riverside County CASA meeting.  Over 20 Court Appointed Special Advocates were present to learn of the correlation between foster children and drug or alcohol addiction.  Tools were provided to volunteers so that they could help guide foster parents in better helping their children.  Staff also presented Changing the Family Legacy at the Eisenhower Medical Center Junior Volunteer’s Luncheon.

In August, staff from the California program joined counselors from Texas and Colorado to facilitate a program for nearly 50 kids at the annual International Doctors in Alcoholics Anonymous (IDAA) in Buffalo, New York.  We also led a Family Communications workshop at the Desert Strength Academy for the Riverside County Probation Department.  Once a year, the Academy holds a week long character building camp for at-risk youth, and provides useful tools to kids that need guidance.

Staff continues to provide early preventative education and recovery awareness in the community, joining others in the Coachella Valley Health Initiative Forum and volunteering with Celebrate Healthy Families, a recovery event planned for October 2, 2010.  Such community events pursue a common goal of helping children and families live happy, healthy lives free from drugs and alcohol.

Welcome to our new newsletter for professionals, Planting Seeds.

All of the Children’s Program staff, whether we’re in Texas, Colorado or California, consider ourselves farmers.  Each and every day, in our work with children and families hurt by the insidious disease of alcoholism and other drug addiction, we sow seeds that we hope will take root.  Some of the seeds may wash away; others may lie dormant for some time.  Every once in a while one of those seeds will grow in a child’s heart – in that small fertile patch that hasn’t been affected by a family member’s addiction.  And every so often, a seed will be planted in the heart of a parent or grandparent, the courageous adult who so lovingly brings their “little ones” to the kids’ program for help, hope and healing.

 From there, a blossoming begins.  Before long the harvest starts to take shape and form.  We see ourselves, and you, too, as itinerant farmers.  We work so hard at sowing seeds, working the “soil,” and praying for sufficient sunshine and rain.  Often we don’t see the harvest—the fruits of our labor.  We get busy throwing more and more seeds as so many people desperately need our help. 

 We ask you to join us in sowing these seeds of help, hope and healing.  It’s together that we truly make a difference.  May we all, from time to time, experience a bountiful harvest.   Keep throwing seeds.

Jerry Moe
Vice-President & National Director
Betty Ford Children’s Program

 The first five-day Professionals in Residence (PIR): Focus on Children program – tailored specifically for those who work with children or are interested in developing children’s services – was recently held on the Betty Ford Center’s Rancho Mirage campus.

Jerry Moe, National Director of the Betty Ford Children’s Program and Training Academy, and trainer/counselor Peggy McGillicuddy co-facilitated the pilot program.

“One of the goals of the Children’s Program Training Academy is to teach others in this field how to create their own program,” said Jerry. “In this fashion, we are able to help more children around the country; in fact, around the world.”

As the work of the Institute’s Children’s Program became more acknowledged over the past decade, interest in emulating it grew.

This first session was by invitation only and included nine participants from Bermuda, Canada, Kansas, North Carolina and Arizona. Each of those who attended had expressed interest in this sort of training “if it ever happened,” and Jerry promises that the success of this event will prompt the scheduling of more in the future.

He added that one of the challenges in creating the program was to do it in a ‘kid-less way’ – the participants didn’t spend any time observing a children’s program but learned general principles and strategies found effective in helping kids from addicted families.

Each participant was provided with a daily schedule, not knowing what was planned for the next day, and thus “lived in the now” each day. Jerry said that several elements of the “classic Children’s Program” were included to make the experience even more unique.

Following are a few comments from the evaluations:

• “Peggy has a very strong, steady, calming presence. She has such great passion for this work. She is a gifted teacher.”

• “Jerry Moe is amazing. He is very engaging, compassionate and energetic. He cares so much and believes strongly in what he is doing …”

• “The program exceeded all my expectations – having a children’s program will enhance our treatment immeasurably. It’s given me new enthusiasm for my work.”

• “This has changed my perspective on what a Children of Alcoholics program should look like, who should be involved in facilitating it and how it affects child and family.”

• “[receiving] the information as it is used with the children in the program [was] far better than learning from lectures or reading. This may be the most impactful training in my career.”

If you are interested in participating in a future session of this new offering, please contact the Children’s Program at (800) 854-9211, ext 4291.

          What is the Children’s Program FCC?  Our children’s counselors contact parents of the children who have come through our program every three months for one year.  This is a way for children and families to still feel connected and to receive valuable reminders of tools they learned during the program.

 “We miss being there and being surrounded by love.  Thank you for your unending tenderness with my babies.  You were there for them at one of the lowest and most confusing spots of their lives.  I hope they’ll always have someone to trust.  If not me, then someone like you.”

 “It’s been a remarkable blessing in our lives. I am grateful every day to you and your team for the healing and the joy in our lives today.”

 “I want to thank you all for the great work that you do.   It certainly has made a huge difference in our lives.  All three of us are in a much, much better place than we were just a year ago.  It is a lot of hard work, but I am so happy to see the results.  We appreciate your help, guidance and continued contacts over the past year.  Your program is terrific and you guys are great!  I tell other families about it every chance I get.”

 “I thank God everyday for placing you and your staff in our lives.  We have and continue to learn so much from you all. Thank you from the bottom of my heart for helping.  Because of what you do I am a better mom.”

 “Whenever anyone asks me how we are doing, I say that while I wish our family never had to experience the pain of living with an addicted family member, the best thing that we experienced was your program….and that my girls have a foundation that few others have that will serve them well in their challenging teenage years and beyond.  THANK YOU for that!!”

 “I am so grateful for all your support and help.  I feel I can continue on with the kids and I feel I’m not alone.”

 “(My child) seems to have a level of peace that she didn’t have prior.  So thank you for what you and the team do.”

 “We have been using the tools we brought back from Camp Betty. Wow, what a difference. I have one word for our week out there, amazing. You were so wonderful, thank you for your patience and dedication to kids. God bless us all.”

 “I am grateful for all the support and love that you and your agency has given to us.  I will forever embrace our experience at BFC and think of you all on a regular basis.  Her experience there made a big impact on her life as well.  Since then she is becoming an awesome, healthy child.  I am proud to be her mom.  Thank you for everything you have taught her.  You are a blessing to us and I will forever be grateful for your help.  Even though this is a struggle at times, I know that (she) is going to be okay. Thank you and thank the BFC for everything.”

 “Thank you for all of your help and support. The children’s program has been a valuable part of our family’s recovery.”

 “Our family is well and we are all working on our recovery.  Thanks for all your help and support. I’m glad the kids want to keep in touch with you. It’s a good, safe connection for them to have as well.”

In most Western societies, alcohol use is widespread among adolescents and young adults. In the U.S., the average adolescent drinks his first alcoholic beverage at the age of 13. Typically, alcohol use increases during adolescence and young adulthood but stabilizes or decreases at the age of approximately 25.  Family, twin and adoption studies suggest that there are genetic risk factors for alcoholism.  Different versions of a gene are called alleles and different alleles have different effects. Serotonin or 5-hydroxytryptamine (5-HT) is a neurotransmitter found in the central nervous system of humans and animals. It is a well-known contributor to feelings of well-being and contributes to many physiological functions. The 5-HT system has been one of the key targets in examining the genetic bases for alcohol use and dependence.  Although the exact role of 5-HT in alcohol use and abuse remains unclear, evidence exists that 5-HT deficits in the brain result in alcohol-seeking behavior in humans and animals.  5-HT availability in the brain is influenced by the serotonin transporter (5-HTT). A polymorphism (5-HTTLPR) located in a region of 5-HTT  has been a prime candidate for genetic association studies on alcohol abuse risk. (Polymorphism in nature simply means something exists in different forms.)
Scientists at Radboud University in the Netherlands examined the association between the 5-HTTLPR and the progression of alcohol use throughout adolescence and young adulthood. Non-regular drinkers (n=202) were selected from a Dutch nationwide sample of adolescents (mean age 13.4). Initially the presence or absence of the 5-HTTLPR polymorphism was determined by standard genotyping analysis. The participant’s alcohol use was then assessed annually across five years by means of self-reported responses to four questions: ‘How many alcoholic drinks did you consume in the past week at home on weekdays?’, ‘How many alcoholic drinks did you consume in the past week at home during the weekend?’, ‘How many alcoholic drinks did you consume in the past week when you were out on weekdays?’, and ‘How many alcoholic drinks did you consume in the past week when you were out during the weekend?’. Asking about these four specific situations forces respondents to actively ‘search’ their memory, which is supposed to increase the reliability of their response. The four answers equaled the amount of alcohol consumed in the past week. This method has been used frequently and reliably in other studies.
The 5-HTTLPR “short” allele was observed to predict an adolescent’s progressive use of alcohol use over time.  Adolescents with the 5-HTTLPR short allele showed a larger increase in alcohol consumption than those without the 5-HTTLPR short allele. This first multi-wave longitudinal study adds further insight into the role of genetic determination of adolescent alcohol use.

(van der Zwaluw, CS, Engels, RCME, Vermulst, AA, Rose, RRJ, Verkes, RJ, Buitelaar, J, Franke, B, Scholte, RHJ,: A serotonin transporter polymorphism (5-HTTLPR) predicts the development of adolescent alcohol use. Drug and Alcohol Dependence, epub (July 1, 2010) doi:10.1016/j.drugalcdep.2010.06.001

Alcohol and drug use disorders are among the most prevalent chronic illnesses.  Family members of individuals with alcohol and other drug (AOD) disorders have higher medical costs than those with other chronic diseases, such as diabetes and asthma and have more medical and psychiatric conditions than families without AOD disorders. Past studies provided evidence of reduced family medical costs following AOD treatment but most were based on alcohol-based treatment, did not match patients or families with non-AOD affected families (controls), or consider the AOD patient’s treatment outcome.
A 2009 study by the Division of Research, Kaiser Permanente and Department of Psychiatry, University of California at San Francisco asked whether positive AOD treatment results in reduced family medical costs. Using the databases of Northern California Kaiser Permanente, a private, integrated health plan, they matched AOD treatment patients and their families with health plan member families without AOD disorders. The AOD patients included patients with both alcohol and/or other drug disorders. AOD patients were matched by age and gender to non-AOD patients, and their treatment outcome at one year was measured, along with age, gender, geography, and family size.

The study then looked at differences in average medical cost per member month for five years between family members of abstinent and non-abstinent AOD patients and controls. Consistent with other research, family members of both abstinent and non-abstinent AOD patients had significantly higher costs than controls prior to treatment. Average medical costs for family members of non-abstinent AOD patients continued upwards for 5 years and were significantly higher than for control family members. However, at 2–5 years after intake, each year family members of AOD patients who were abstinent at one year had average per member medical costs similar to the non-AOD families.

The study design is useful for shaping health plan policy because – instead of comparing family members of abstinent to non-abstinent AOD patients directly, both of whom may have higher costs than family members of non-AOD patients – the researchers compared these two groups to a sample of families with no AOD. The findings strongly support the business case for earlier and better treatment for AOD individuals and their families.

(Weisner, C, Parthasarathy, S, Moore, C, Mertens, JR: Individuals receiving addiction treatment: are medical costs of their family members reduced?, Addiction, 105, 1226-1234, 2009)

The prevalence of nicotine dependence among those suffering from alcohol dependence is as high as 50%. In fact, smokers with a long history of alcohol dependence are more likely to die of smoking-related diseases rather than alcohol-related diseases. Past research also shows an association between nicotine dependence, addictive diseases, and psychiatric disorders. This large scale study examined the socio-demographic factors and mental disorders associated with nicotine dependence among alcohol dependent persons.
From a US national survey of 43,000 adults, responses were examined from 4782 subjects with lifetime alcohol dependence. Comparisons were made between those with and those without nicotine dependence. Mood and anxiety disorders included in the survey were panic disorder, agoraphobia, specific phobia, social phobia, generalized anxiety disorder, major depressive episode, and manic episode.

Nicotine dependence was found to be associated with a higher risk of almost every assessed mental and addictive disorder.  This finding is in line with previous studies suggesting that antisocial personality disorder, depression, and other drug dependencies are associated with alcohol and tobacco dependence. However this new research differs in three main aspects. First, the size of the sample of alcohol-dependent subjects is about four times more than previous work.  Second, a nationally representative sample was used, whereas previous work surveyed only alcohol-dependent outpatients or families. Third, the association of nicotine dependence with 20 psychiatric and addictive diagnoses among alcohol-dependent subjects showed that nicotine dependence is associated with a broader spectrum of disorders ranging from anxiety to mood disorders, and from antisocial to addictive disorders.

These findings are of interest since comorbidities are associated with a less favorable prognosis. Thus, patients suffering from alcohol and nicotine dependence should be carefully assessed for accompanying psychiatric and other addictive disorders. The researchers concluded that nicotine dependence represents a general marker of psychiatric and particularly of addictive comorbidity and can be used as a screening measure for psychiatric diagnoses in clinical practice.

(Le Strat,Y, Ramoz,N, Gorwood, P, : In alcohol dependent drinkers, what does the presence of nicotine dependence tell us about psychiatric and addictive disorders comorbidity? Alcohol and Alcoholism 45: 167-172, 2010)

Patrick Haggerson, MA, CADC-II, ICADC,  first visited Alkali Lake in British Columbia in 1999 as a guest speaker at the community’s annual recovery celebration event.  He continued to make these annual trips for many years, and what began with his participation in this annual event evolved into a strong bond between the community and the Betty Ford Center.

When the community’s therapist retired in 2005, Patrick took on that role and continues to make monthly trips to Alkali Lake.  In addition to individual therapy sessions, he offers family workshops; art therapy groups; a week-long men’s workshop and teaches Native flute music as a vehicle of alcohol and drug use prevention.

In his words, Patrick says, “My experience at Alkali Lake has changed me in a professional as well as personal sense.  I am grateful to the people of Alkali Lake who have been very patient with me as I learned to love and respect their culture and their ways.  I’ve learned that through loving and respecting First Nations’ invidiuals, families and whole communities, I can be helpful …in ways I wouldn’t have thought important prior to my cultural sensitization.  At times, just being present to help out in any way needed was adequate.”
The full article can be read here:  August 2010 issue of Counselor magazine.

Despite the widespread use of 12-Step approaches and numerous referrals to Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) by youth-service providers, there is little “hard scientific evidence” showing that these groups can improve outcomes among youth who are in recovery. Part of the issue is that mutual-help organizations like AA and NA are community organizations based on anonymity, and cannot be directly controlled by researchers. This study examined how helpful AA and NA may be for adolescents in their transition to young adulthood who were initially enrolled in treatment that was based on a 12-Step model.

Researchers recruited 160 adolescent inpatients (96 males, 64 females) with an average age of 16 years. All of the adolescents were enrolled at two treatment centers in California that had a focus on abstinence and were based on a 12-Step model. The study participants’ length of stay ranged from four to six weeks, after which they were re-assessed on a number of clinical variables at six months, and then one, two, four, six, and eight years following treatment.

Results indicated many youth initially attended AA/NA meetings intensively, but during the eight-year period following treatment, their attendance declined sharply and steadily. Those patients with severe addiction problems, and those who believed they could not use alcohol/drugs in moderation, attended the most meetings. Despite the decline in attendance, greater early participation was associated with better long-term outcomes. On average, each AA/NA meeting attended was associated with two days of subsequent abstinence. The study authors recommend AA and NA as a “buffer” against relapse during this particularly high risk developmental period into young adulthood, and especially among those youth who have more severe substance-use issues.

(Kelly, JF, Brown, SA, Abrantes, A, Kahler, CW, Myers, M: Social recovery model: An 8-year investigation of adolescent 12-step group involvement following inpatient treatment. Alcoholism: Clinical and Experimental Research 32:1468-78, 2008.)

“Doctors’ role in the prescription abuse crisis” is the subject of an article by Garrett O’Connor, MD, President of the Betty Ford Institute, in the July/August 2010 issue of Addiction Professional magazine.
Dr. O’Connor says that as a consequence of inadequate education about addiction in medical school and residency training, a significant majority of physicians in the U.S. wittingly or unwittingly contribute to the prescription drug epidemic because they lack the skill, knowledge and training to diagnose and treat addictive disease.  These deficiencies are exacerbated by prejudice against addicts, radical changes in patterns of clinical practice, substandard reimbursement and a nihilistic attitude about treatment’s efficacy.
There are currently approximately 780,000 licensed physicians in the U.S. with about 15,000 new graduates joining their ranks each year.  A survey conducted by the National Center on Addiction and Substance Abuse (CASA) found that 57% of doctors believe it is their primary responsibility for preventing prescription drug diversion and abuse.  However, two-thirds of these physicians report they only received two hours of less of training in prescription drug diversion in medical school, residency or continuing medical education.  Since only one-third of these physicians feel their training is inadequate, it’s reasonable to assume the other two-thirds (520,000) of the U.S. physicians currently in practice lack the knowledge and skills to diagnose and manage addictive disease.  These undertrained physicians will thus proceed to treat the symptoms of the disease but not the disease itself.

Anabolic-androgenic steroids (AAS) are a group of hormones that include natural testosterone and numerous synthetic testosterone-like substances. When taken in very large doses and combined with strenuous exercise and proper nutrition, AAS can cause users to gain muscle and lose fat. In the United States alone the number of those who have used AAS has surpassed 2 million. The great majority of AAS users are men because women rarely aspire to becoming extremely muscular. Evidence is showing that AAS can cause dependence wherein individuals will use these drugs for years despite harmful effects. Demand for treatment of AAS abuse is expected to increase because illicit AAS use only became widespread in the 1980s. Thus, those who used AAS as youths in the 1980s are just now reaching middle age and entering the age of risk for cardiac complications and hormonal fluctuations affecting their behavior sufficient to motivate them to seek treatment.

Growing evidence suggests that classical drugs of abuse cause addiction via a common neural reward pathway, leading some to lose cognitive control. AAS, on the other hand, produce few immediate intoxicating effects and thus probably induce dependence via more complex pathways. This review of current research addresses the question, “Will AAS patients seek treatment?” and suggests at least three mechanisms by which AAS dependence might develop and that treatment should address: a body image mechanism,  an androgenic mechanism, and an hedonic mechanism.

Most people take AAS for their anabolic effects – to gain muscle and lose fat. AAS use may be involved with disorders of body image in which individuals see themselves as small and weak even though they are large and muscular: a kind of “reverse anorexia nervosa”. These body image concerns may stimulate escalating use in some individuals, leading to dependence.

AAS may cause male users to experience decreased production of testosterone, other important hormones, and reduced sperm. This can cause a number of adverse physiological impacts including loss of muscle and increased fat. Studies also show that AAS withdrawal may induce major depression. Treatment for these androgenic related effects should therefore treat both the sexual dysfunction and any AAS induced depression.

Though not considered intoxicating, AAS may produce increased self-confidence and aggressiveness.  These hedonic effects may vary with the type of AAS used and be impacted by alcohol and stimulants. Both animal and human studies show the same kind of reinforcement of the brain’s reward center as occurs with the classical addictive drugs. Evidence suggests that pharmacological and psychosocial treatments effective for substance dependence in general and opioid dependence in particular might be beneficial in cases of AAS dependence.

This review concludes that, unlike conventional addictive drugs, AAS may induce dependence via three separate paths – the anabolic, the androgenic, and the hedonic. Evolving understanding of these mechanisms indicates that clinicians should be prepared to treat these three conditions: underlying body image disorders, AAS induced sexual dysfunctions, and possible major depression, and co-existing dependence on alcohol and the classical addictive drugs.

(Kanayama, G, Brower, K, Wood, R, Hudson, J, Pope,H: Treatment of anabolic-androgenic steroid dependence: Emerging evidence and its implications. Drug and Alcohol Dependence 109: 6-13, 2009)

Since their introduction in 1987, the energy drink market has grown exponentially. The main ingredient of energy drinks is caffeine. For comparison, the caffeine content in a 6 oz. cup of coffee varies from 77 to 150 milligrams, while in energy drinks caffeine can range from 50 to 500 mgs per can or bottle.  Energy drinks, depending on the brand, may also contain substances such as taurine, riboflavin, pyridoxine, nicotinamide, B vitamins, and various herbal derivatives. The effects of excessive and long-term use of these additives alone and in combination with caffeine are not fully known. This review by scientists at Johns Hopkins University suggests that these drinks may serve as gateways to other forms of drug dependence, have the potential for adverse health consequences, and may be cause for regulation.
Energy drinks are promoted for their stimulant effects. Advertising claims include increased attention, endurance, performance, and weight loss. Most of these claims have as yet to be proven. Some performance enhancement has been shown from caffeine but this may be counteracted by caffeine withdrawal. The review cites three hazards associated with the use of these drinks: caffeine intoxication, caffeine dependence, and caffeine withdrawal. Features of caffeine intoxication include nervousness, anxiety, restlessness, insomnia, gastrointestinal upset, tremors, tachycardia, agitation, and in rare cases death. While there is debate surrounding the issue of caffeine dependence, there is compelling evidence that caffeine can produce a substance dependence syndrome in some users. Symptoms of caffeine withdrawal have been in the medical literature for over a century.

Mixing energy drinks with alcohol may increase the potential for adverse consequences. One well-known U.S. beer company has stopped the sale of caffeinated alcoholic beverages. Studies have also shown that lifetime caffeine use, toxicity, and dependence are significantly associated with various psychiatric disorders.

The lack of any regulatory oversight has allowed aggressive marketing of energy drinks aimed primarily at young males. The reviewers suggest it would be prudent to require product labels to fully disclose the amount of caffeine and other contents, and state the risks of combining these drinks with alcohol. They further recommend that in view of the increasing use of these drinks, clinicians become familiar with the features of caffeine intoxication, withdrawal, and dependence.

(Reissig, C, Strain, E, Griffiths, R: Caffeinated energy drinks – a growing problem. Drug and Alcohol Dependence 99:1-10, 2009)

College students are likely to be more vulnerable to alcohol related traffic risk behavior because they have less driving experience.  Also, binge drinking and other risky alcohol-related behavior are highly prevalent in that population. Alcohol consumption and alcohol impaired driving appear to be common even before college.  Almost half of high school seniors report having used alcohol in the past 30 days, and 28%
have been drunk. Past month drinking and driving by high school seniors is estimated to be about 15%. This investigation looked at changes in traffic risk behavior as students progressed through their college years.

National studies show that 25% of college students have driven while intoxicated in the past month. Even more admit to driving after drinking some alcohol and/or riding with an intoxicated driver. That means over two million college students engage in such behavior.  To determine whether these behaviors changed over time, 1,253 first year students at a large mid-Atlantic university were interviewed annually for 4 years. Age-related changes in prevalence and frequency of driving while intoxicated (DWI), driving after drinking (DAD), and riding with an intoxicated driver (RWID) were evaluated.

This study found that drinking frequency increased significantly every year from age 19-22.  All three risky driving behaviors increased with age, notably at age 21, the legal drinking age.  At age 19, 17% of students drove while intoxicated, 42% drove after some drinking, and 38% rode with an intoxicated driver. At age 21, 25% of the 21 year olds drove while intoxicated sometime during the past year, 63% said they had driven after drinking some alcohol, and 49% said they had ridden with an intoxicated driver. Overall, males were found to be more likely to engage in these behaviors than females. Further analysis revealed that, while drinking frequency increased every year, the frequency of drunkenness was stable for females but increased for males.

The researchers concluded that alcohol-related traffic risk behaviors are quite common among college students and take a notable upturn at the age of 21. They pointed to a need for aggressive law enforcement and early identification of individuals at high risk and noted that sobriety checkpoints have proven to be effective deterrents to drinking and driving by elevating the perceived risk of arrest.

(Beck, K, Kasperski, S, Caldeira, K, Vincent, K, O’Grady, K, Arria, A, Trends in alcohol-related traffic risk behaviors among college students. Alcoholism: Clinical and Experimental Research, Early View DOI: 10.1111/j.1530-0277.2010.01232.x

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CHAPTER I: INTRODUCTION

The Betty Ford Institute was created as the result of a planning process begun in 2005. Upon succeeding her mother in the Chair of the Betty Ford Center Board, one of Susan Ford Bales’ first actions was to appoint a Vision 2015 Task Force to consider the long term future development of the Center and its programs. This Task Force addressed the opportunities and challenges that might be expected for the Center. Its recommendations called for the creation of a new organization – the Betty Ford Institute – to be separately focused on broadly based programs of research, education and prevention related to addictive disease.

The recommendations of the Vision 2015 Task Force were approved by the BFC Board in early 2006. An Institute Task Force, made up of invited national experts and BFC Board and management representatives, was appointed to oversee the early developmental planning of the new Institute. The Institute Task Force recognized the ultimate need for a Strategic Plan for the new Institute and that this Plan should be developed separately for the Institute. The Task Force also considered and recommended formal statements of Values, Vision and Mission for the Institute which were adopted by the BFC Board. These formal statements represent the foundation of this Strategic Plan and are included in Chapter II. In formulating these statements, the Institute Task Force considered various roles that the Institute might come to play and their deliberations were used as a valuable resource and input in developing the Strategic Plan.

In early 2007, the BFC Board took a major step in actually creating the Institute by appointing an Executive Council to oversee the program development, management and operations of the Institute. This Executive Council held its first meeting in March, 2007, and met a total of three times during the year. One of its most important accomplishments is represented by this Strategic Plan. The Executive Council, having based its plan on the previously adopted statements of Values, Vision and Mission, formulated carefully delineated Goals, Objectives and Strategies for the Institute’s early growth and development over the next two to three years. These are the real “meat” of this Plan and can be found in Chapter III.

The following persons contributed to the development of this plan:

• Original Institute Task Force: BFC Board members – Susan Ford Bales; Geoff Mason; Mary Pattiz; James West, M.D.; and Chris Wrather. Chairman’s Council Members – Maria Bradley; Carolyn Cochener; Gail Shultz, M.D.; and Mary Pat Woodard.
• Executive Council Members: Susan Ford Bales (ex officio); Carlton Erickson, Ph.D.; Herb Kleber, M.D.; Carol McDaid; Geoff Mason; Mary Pattiz; Gail Shultz, M.D.; William White, M.A.; and Chris Wrather.
• Management Staff and Consultants: John Schwarzlose; Mike Neatherton; Garrett O’Connor, M.D.; Tom McLellan, Ph.D.; Amelia Arria, Ph.D., and Merlin Olson.

CHAPTER II: VALUES, VISION AND MISSION

Statement of Values – “What are the “drivers” of the Betty Ford Institute?”

What we care about, what really matters, what we truly believe – these are the values that provide the foundation on which our Center and our Institute are built. Values shape an organization’s vision and mission while prescribing acceptable behavior for everyone associated with the organization.

The statement of Values of the Betty Ford Institute describes strongly held beliefs that guide all that we do. We believe…

• Addictive disease is a chronic relapsing disease requiring a comprehensive and compassionate response.
• Recovery from addictive disease is a continuous commitment, for the addict and family, to a transformation of body, mind, spirit and relationships with others.
• Addictive disease is widely misunderstood. New understanding of it effects will lead to improved prevention and treatment of the disease.
• New understanding of addictive disease is best developed collaboratively, open-mindedly and rigorously, and should be shared openly.
• The opportunity for recovery and healing should be shared and accessible to all.

The last several decades have witnessed unparalleled advancements in our scientific understanding of addiction, but social stigma and lack of public understanding remain rampant. The Institute strongly believes that one key to reversing social stigma lies in the successful translation and dissemination of research findings. Therefore, the Institute will commit resources to facilitate mechanisms for debate and discussions about some of the most significant issues facing the addiction treatment field today. Through these mechanisms, combined with actively communicating and disseminating the results of this work to wider audiences, it will be possible not only to promote a more informed public view of addiction, but also to foster and shape future research agendas. It is only through collaborative discussion and debate that we can fill critical knowledge gaps in our understanding of the complexity of addiction, its etiology, its course, and its consequences.

Statement of Vision – “What might we look like in 2015?”

The mental picture of an organization’s desired future is the guiding force of all its activity and the source of its energy. A Vision is a dream that beckons; an inspiration that motivates people to action. The Vision Statement for the Institute is intended to be compelling, so that it might inspire us to greatness.

We envision that the Betty Ford Institute will always reflect the high ideals, standards, quality and reputation of the Betty Ford Center at Eisenhower. The Institute will be recognized as an innovative leader in all of its endeavors and will devote itself to the following initiatives:

• Convene carefully constructed panels of professionals to review, compile and synthesize recent research findings in addictive disease, and communicate these findings to a wider audience in such a way as to set the agenda for additional research and clinical applications.
• Translate recent research findings into effective treatment practices, in collaboration with the nation’s highest quality research centers.
• Perform rigorous scientific validation studies of prevention and treatment practices, some which may be controversial.
• Advance and expand the care and treatment of children and families affected by addictive disease.
• Educate health care professionals, especially primary care physicians, in addiction medicine, treatment and recovery.
• Advocate the accessibility of treatment and prevention.
• Serve as an important focal point for the public and professional understanding of addictive disease.
• After its first decade of work, it will be apparent that the Betty Ford Institute, in conjunction with others, will have performed an intervention on the nation and raised the awareness and understanding of the hidden undertow of alcohol and other drugs on all Americans.

Statement of Mission – “Why do we exist?”

A formal mission statement is the platform for all organizational planning. An organizational mission statement asserts clearly and firmly why the organization exists and whom it serves. The Betty Ford Institute’s mission statement is:

To conduct and support collaborative programs of research, prevention, education and policy development that will lead to a reduction of the devastating effects of addictive disease on individuals, families, organizations and communities.

CHAPTER III:  GOALS, OBJECTIVES AND STRATEGIES

PROGRAM FOCUS: PREVENTION

Drug problems can develop in different individuals in different ways – sometimes obviously, but in many more cases, silently and insidiously. A great deal of scientific knowledge has accumulated to explain these complex pathways of alcohol and other drug addictions. We know, for instance, that early warning signs are apparent for some in early childhood and that adolescence carries with it new drug use opportunities and additional challenges. The Institute is committed to using this wealth of knowledge as a foundation to develop, design and test bold innovative strategies to prevent alcohol and other drug problems, and to intervene at the very earliest stages possible.

The Institute is keenly aware of the multiple targets for drug prevention and has chosen to sharply focus its resources on improving the lives of families at high risk for addiction. We define a high-risk family as a family where at least one caregiver has an active alcohol or drug problem or is in recovery from addiction. Despite the well-known observation that children of alcoholic or other drug-dependent parents are at high risk for developing drug problems themselves, surprisingly little attention has focused on specific strategies to reduce risk for these children. It is conservatively estimated that, in any given year, more than 6 million (or almost one in ten children) live with at least one parent who meets DSM-IV-TR criteria for an active substance use disorder. Because the Betty Ford Center has decades of clinical experience with understanding the interpersonal dynamics of high-risk families and the special needs of children living in such families, the Institute is uniquely poised to contribute to the development of strategies to reduce a child’s risk of developing alcohol or other drug problems given that they have been exposed to this kind of family environment.

Potential targets for intervention include (a), improving the parenting skills of parents in recovery; (b), increasing the family’s ability to recognize and assess early childhood problems in the areas of emotional and behavioral regulation; and (c), better understanding of environmental factors that interact with the family environment to produce adverse outcomes such as witnessing and experiencing domestic violence, and promoting particular resiliencies of children of parents in recovery.

PREVENTION

Goal I: To provide and disseminate practical, effective prevention solutions to families with children at high risk for alcohol and other drug problems, with a particular emphasis on children of parents in recovery.

Objectives and Strategies

• • By December 2008, to assemble, integrate and synthesize existing knowledge regarding vulnerabilities and risk management strategies that are particularly relevant to high-risk families.

1.1.1. Conduct a systematic review of peer-reviewed articles.

1.1.2. Analyze new or existing data related to children growing up in families of substance users to improve our current knowledge reflected in the peer-reviewed literature.

1.1.3. Conduct research that focuses on how family history of substance use problems might contribute to high risk drinking and illicit drug use among college students and other young adults.

1.1.4. Hold structured discussions with clinicians involved in family-based treatment regarding their perspectives on addictive disease.

1.1.5. Hold focus groups with three groups of children and young adults (ages 7-12, 13-18, and 18-25, respectively) who have experience growing up in a family with an alcohol or other drug-dependent parent.

1.1.6. Develop a comprehensive communication and dissemination plan that at least involves writing two manuscripts for publication which consolidate the findings from our work.

1.1.7. Disseminate the knowledge to a variety of stakeholders by sponsoring a conference and using the Parents Resource Center of the Partnership for Drug Free America as another possible dissemination vehicle.

• • Design a Children’s Program Training Academy to begin in Fiscal Year 2009.

1.2.1. Assist BFC Children’s Program staff in developing a curriculum for the Training Academy. Create selection criteria for potential students of the Academy.

1.2.2. Begin to develop a list of potential candidate agencies to be included in the first group for training. Work in consultation with the Betty Ford Foundation to underwrite specific communities to be involved with the training.

1.3. To develop and test at least two practical prevention solutions targeted for high-risk families which build on the knowledge identified through the processes outlined in 1.1.

1.3.1. Convene a panel of experts to generate ideas regarding design elements and procedures for a prevention solution that seeks to reduce alcohol and other drug risk in children of parents in recovery.

1.3.2. Convene leaders of philanthropic organizations and other individuals interested in developing prevention solutions for children of parents in recovery as a way to increase awareness of BFI activities.

1.3.3. Commission a design team to develop prototypes for at least two prevention solutions.

1.3.4. Explore opportunities for funding a pilot study to validate, refine and test the effectiveness of at least one prevention program for parents in recovery, which could then be used to design a larger-sale initiative based on the pilot study results.

PROGRAM FOCUS: MEDICAL EDUCATION

Traditionally, there has never been an emphasis on teaching about addictive disease and its treatment in U.S. medical schools (nor in other health sciences schools such as dentistry, pharmacy, nursing or allied health). There is no standard or accepted curriculum for addiction topics in medicine. Although a few medical schools teach some addiction medicine information, these are often elective lectures – frequently limited to one hour – or perhaps covered in grand rounds.

Likewise, there is no standardized approach for including information on addictive disease in training programs for residents or continuing education of practicing physicians in primary care specialties (family medicine, internal medicine, OB/GYN and pediatrics)

The Betty Ford Institute plans to collaborate with other interested parties to design a model curriculum for medical schools to include teaching on addictive disease. The career teacher program that was established and funded by NIMH in medical schools in the late 1970’s is one example of a promising format. However, funding for this program evaporated and nothing has taken its place.

The Betty Ford Institute will evaluate the success of current training programs for medical students, residents, and practicing physicians. The Institute’s exploration will include education programs conducted by the Betty Ford Center (e.g. the Summer Institute for Medical Students, the Medical Clerkship Program, and the Professionals-in-Residence Program) as well as the program developed by the Medical Education and Research Foundation – MERF (affiliated with the California Society of Addiction Medicine – CSAM).

The initial exploratory meeting with MERF representatives and BFI staff and consultants was held on January 3 and 4, 2008, at Rancho Mirage.

GOAL 2: To facilitate improvement in medical education regarding addictive disease in order to equip medical students, residents and practicing physicians with tools to diagnose and manage patients with addictive disease at all levels of practice.

Objectives and Strategies

2.1. To develop a model addiction medicine curriculum for residents in internal medicine, pediatrics, OB/GYN, and family medicine specialties with specific training in addiction medicine.

2.1.1. Identify a minimum of 10 U.S. medical schools/teaching hospitals with current didactic training for residents in addictive disease, and obtain copies of their curricula.

2.1.2. Review the curricula to determine common topics and educational materials.

2.1.3. Add unique topics (e.g., 12-Step principles, neurobiology, DSM terminology) to be included in the “model curriculum” to target residents in internal medicine, pediatrics, OB/GYN, and family medicine students.

2.1.4. Determine a mechanism for writing the complete curriculum in different formats (e.g., slide format, 6-hour vs. 12-hour format, web-interactive).

2.1.5. Study progress of the American Society of Addiction Medicine in its efforts to gain recognition for Addiction Medicine as a specialty by the American Board of Medical Specialists (ABMS).

2.1.6. Identify the barriers to curriculum implementation in graduate medical education by medical schools/teaching hospitals.

2.1.7. Design the model curriculum in such a manner that it also serves as a template and basis for questions written and incorporated into physician Board and Specialty Qualification exams.

2.2. To explore the possibility of collaborating on the design of the “model” curriculum with the Medical Education and Research Foundation – MERF (sister organization to CSAM).

2.2.1. Analyze perceived deficiencies in current medical education curricula and benefits identified by physician graduates of MERF, BFC’s Summer Institute for Medical Students and Professionals in Residence programs; review with medical faculty and deans; summarize in a white paper.

2.2.2. Collaborate with MERF to seek additional funding to allow the program to expand.

2.2.3. Affiliate BFC’s Professionals-in-Residence Program opportunities with other MERF training.

2.2.4. Evaluate effectiveness of SIMS program. Seek ways to duplicate SIMS at other sites.

2.2.5. Study expansion of Medical Clerkship opportunities at BFC.

2.2.6. Explore collaboration with MERF around BFI-sponsored fellowships in addiction medicine and addiction psychiatry, and explore the concept of mentorship for students and residents.

PROGRAM FOCUS: TRANSLATION OF RESEARCH FINDINGS

The earliest thinking behind the development of a Betty Ford Institute reflected a need for it to “act as a convener, synthesizer, and facilitator to bring together the findings and expertise of others and to measure the value and interpret the important applications of these findings.”  The last several decades have witnessed unparalleled advancements in our scientific understanding of addiction, but social stigma and lack of public understanding remain rampant. The Institute strongly believes that one key to reversing social stigma lies in the successful translation and dissemination of research findings. Therefore, the Institute will commit resources to facilitate mechanisms for debate and discussions about some of the most significant issues facing the addiction treatment field today. Through these mechanisms, combined with actively communicating and disseminating the results of this work to wider audiences, it will be possible not only to promote a more informed public view of addiction, but also to foster and shape future research agendas. It is only through collaborative discussion and debate that we can fill critical knowledge gaps in our understanding of the complexity of addiction, its etiology,  its course, and its consequences.

GOAL 3: To translate and disseminate quality empirical research findings to targeted audiences.

Objectives and Strategies

3.1. To identify, by June 2008, at least two key research topics in the addiction field  for which the Institute could play a major role in advancing understanding by the scientific community and/or policy makers.

3.1.1. Review the existing literature on potential topics of interest to the Institute in an effort to identify significant gaps in existing knowledge.

3.1.2. Hold teleconferences between Institute staff and outside experts to decide on the specific topics, relevant audiences, presenters, and mechanisms of dissemination of information.

3.2. To discuss and disseminate information about at least one key topic in the addiction field by December 2008.

3.2.1. To invite key stakeholders with an interest and expertise in the topic to a conference at the Institute.

3.2.2. To have the invitees of the conference prepare manuscripts for subsequent peer review and publication in a scientific journal.

3.3. By June 2008, establish a mechanism for real-time dissemination of Institute-related documents and materials, including peer-reviewed scientific publications resulting from conferences.

3.3.1. To create an Institute website as a repository and dissemination vehicle for Institute-related materials.

PROGRAM FOCUS: ETHNO-CULTURAL CONCOMITANTS OF ADDICTIVE DISEASE

In the U.S., disadvantaged ethnic populations tend to suffer disproportionately with individual, family, and community complications of addictive disease. Most notably, these populations comprise Native North-Americans and African-Americans, both of whom share cultural histories of oppression, including genocidal colonization and slavery. The Betty Ford Institute will initiate programs of research, prevention and education designed to further understand the biological, psychological, social, spiritual and cultural factors by which severe and chronic addictive disease is transmitted down through many generations of Native-North American and other ethnic populations that have been victimized and stigmatized by neglect and discrimination for racial, political, or economic reasons.

Implementation of this strategy will build on a variety of training and treatment activities initiated by BFC in 1999 with the Alkali Lake Band of Indians in British Columbia. In addition, relationships between BFC and the Morongo Band of Indians in the Coachella Valley have been on-going, and more recently, a training contract was signed with the St Francis Mission on the Rosebud Reservation in South Dakota (Lakota Band of Indians). It goes without saying that the BFI project will rely heavily on these relationships, as well as the pioneering work of Bill White and Don Coyhis in their recently published, and widely acclaimed, five-year study of how Native North American Nations resisted the efforts of three governments (British, French and United States) to supply them with weapons-grade alcohol for aggressive political, military and economic purposes over a span of several centuries.

GOAL 4: To enhance and improve culturally sensitive approaches to prevention and treatment of addictive disease in disadvantaged populations.

4.1. To identify and articulate by June 2009 the origins and cultural manifestations of alcohol and other drug addictions that continue to ravage vulnerable ethnic communities.

4.1.1. Invite a small focus group of prominent and relevant representatives of ethnic groups meeting the above criteria to participate in a three-day retreat.

4.1.2. With consultation and advice from the retreat participants derived from their personal experience and first-hand knowledge of their particular ethnic and social circumstances, recommend culture-appropriate research, prevention, education, and treatment initiatives

4.1.3. Following the retreat, create an appropriately structured ethno-cultural Advisory Council to collaborate with BFI about how best to promote and implement these initiatives.

CHAPTER IV: GOVERNANCE AND MANAGEMENT

Executive Council

The current members of the Institute Executive Council were appointed by Chairman Susan Ford Bales and the BFC Board in January 2007 to an 18 month term extending through the end of FY 2008 (June 2008). The Board will consider the continuing roles of the Executive Council and the reappointment of current members and/or the appointment of new members for future fiscal years. The Institute CEO will make his formal recommendations to the BFC Board in advance of the Board’s Spring Planning Retreat scheduled for May 2008.

When the BFC Board approved the creation of the Institute, they reviewed four options for governance and organization. The Board selected an option which calls for a single governing Board (the existing BFC Board) for both the Center and the Institute. In order to promote the concept of “cooperative independence,” this option called for the appointment of a subordinate body to oversee the operations of the Institute and to advise the governing Board in matters relating to the Institute. This body is composed of experts in addictive disease, the majority of whom will be from outside BFC. This subordinate body is called the BFI Executive Council. The Board also accepted the Task Force’s recommendation that the Chief Executive Officer of the Institute should report to John Schwarzlose, rather than to either the BFC Board or the BFI Executive Council.

1. A. The Task Force Co-Chairmen recommended that the initial membership of the BFI Executive Council should be appointed by the BFC Board at its January, 2007 meeting.
2. Delegation of Powers – The BFC Board delegated significant powers and functions to the Executive Council including the following tasks related to Institute operations:
   1. Formulation of Institute strategy and program policy;
   2. Coordination of Institute external communications;
   3. Oversight of Institute programs, quality and safety;
   4. Oversight of an annual operating budget recommended by the Executive Council and Institute management, and approved by the BFC Board;
   5. Review and approval of the job description of the Institute’s Chief Executive Officer (as recommended by the Office of the BFC President); and
   6. Other functions as may be determined from time to time by the BFC Board.
3. The BFC Board defined the Executive Council size and composition as follows:
   • The initial membership of the Executive Council will be relatively small. It will consist of a majority of external members (persons having no current formal connection with the BFC); and a minority of internal members (representing the BFC Board and Chairman’s Council).
   • Over time, the size of the Executive Council may be expanded, but the majority will remain external members.
   • All initial members, both external and internal, were appointed for a term of one year, commencing with the first meeting of the Executive Council.
   • External members of the Executive Council serve at the pleasure of the BFC Board; after the completion of the first one year term, external members will be considered for possible reappointment to staggered terms (the length and number of terms to be determined by the BFC Board).
   • Internal members will serve at the pleasure of the BFC Board and will be reviewed for reappointment annually; there is no limit to the number of consecutive years that internal members may serve.
   • The Executive Council will be staffed by the Office of the BFC President and BFI CEO, including staff and consultants that both executives may designate. None of the BFC or BFI staff members are formal members of the Executive Council.
4. Council Meetings – The BFI Executive Council shall meet four times per year, three times in person, and once via teleconference. At least one of the three in-person meetings will be held in Rancho Mirage. In-person meetings may be scheduled to occur in coincidence with a BFI conference. The one teleconference meeting each year will occur during the summer months.
5. Potential Candidates for Membership
   • The appointment of the Executive Council’s external members is intended to bring to the Institute experience and expertise that the BFC Board does not have among its members.
   • External members of the Executive Council should be selected to include persons with particular experience and expertise in one (or more) of the Institute’s four mission components: Research, Education, Prevention and Policy related to addictive disease.

Institute Convenes Inaugural Conference September 18-20, 2006;

Experts in Addiction Field Assemble in Rancho Mirage, California;

Topic: “Defining & Measuring Recovery”
Rancho Mirage, CA, September 14, 2006 – Former First Lady Betty Ford, Co-founder of the Betty Ford Center, announced today the establishment of the Betty Ford Institute. It will operate independently of the non-profit licensed addiction treatment hospital. Seventy-five thousand women and men addicted to alcohol and/or other drugs and their affected family members have received treatment since the Center was established in 1982.

“As we approach our 25th anniversary,” says Mrs. Ford, “we feel it is an appropriate time to take this initiative. Although we have been involved as a leader in education and training in addictive disease and its treatment, as well as in public policy efforts, the establishment of our Institute will allow us to devote more resources to these areas.”

Mrs. Ford also announced the Betty Ford Institute’s inaugural “Consensus Conference” will be held September 18-20, 2006 in Rancho Mirage, California. At these “Consensus Conferences,” leading experts from various fields involving the disease of addiction will gather for intensive discussion of selected topics.

In addition to convening carefully constructed panels of professionals (and disseminating their findings), the Betty Ford Institute will also:

1. Translate recent research findings into effective treatment practices, in collaboration with the nation’s leading treatment providers;
2. Educate health care professionals about the nature of addictive disease;
3. Advocate access to treatment and the importance of prevention;
4. Serve as a global focal point for public and professional understanding of the disease of addiction to alcohol and other drugs, the role of treatment, and the promise of recovery.

The first “Consensus Conference,” Defining and Measuring Recovery, will be held September 18-20, 2006.  Erica Goode, Health Editor of The New York Times’ Science Times will moderate.

According to John Schwarzlose, President and CEO of the Betty Ford Center, “We feel `recovery’ is exactly the right subject to tackle during the first Betty Ford Institute conference. The addiction treatment field seems to be struggling with defining recovery, as are federal agencies and others involved in the alcohol and drug arena. It is our goal with this and future topics to have a diversity of viewpoints represented, even if they do not concur with the philosophy of the Betty Ford Center.”

Inaugural conference participants include:

1. Charlene Belleau, Former Chief, Alkali Lake Band of Indians, British Columbia
2. Robert L. DuPont, M.D., President, Institute for Behavioral Health, former White House Drug Czar
3. Carl Erickson, PhD, Director, Addiction Science Research & Education Center, University of Texas, Austin
4. Marc Galanter, M.D., Professor of Psychiatry and Director, Division of Alcoholism and Drug Abuse, New York University School of Medicine
5. Mark Gold, M.D., Chair, McKnight Brain Institute, University of Florida School of Medicine
6. Tom McLellan, PhD, CEO, Treatment Research Institute
7. Jon Morgenstern, PhD, Professor of Clinical Psychology in Psychiatry, Columbia University Medical Center
8. William White, Senior Research Consultant, Chestnut Health Systems

Several of the above have written research reports expressly for the conference; they are being distributed in advance to all participants, and will form the basis for much of the discussion.

Among sensitive questions on the table for the inaugural conference:

1. What exactly is recovery?
2. Is treatment necessary for long-term recovery to work?
3. Is there a role for medications during recovery?
4. Is ongoing 12-step meeting attendance key to long-term recovery?
5. How do we measure “success” vis-à-vis recovery?
6. Is it possible to translate the concept of recovery into numbers?

It is expected a document summarizing the discussions and presenting the “consensus” on recovery will be prepared and available after this first Betty Ford Institute-convened conference concludes.

According to Susan Ford Bales, Chairman of the Betty Ford Center, the Center has long been involved in many activities which the Institute will now conduct and/or sponsor. “But,” she says, “it is time now to formalize and focus our research, education and public policy initiatives.”

As an example of existing programs, Ms. Bales referenced the Center’s Summer Institute for Medical Students (SIMS), which welcomes 100 students every year from medical schools throughout the U.S. They spend two weeks among patients and clinicians, observing how state-of-the-art treatment works.

Press contact:
Russ Patrick
310 385-9401

A significant percentage of recent marijuana using high school seniors wish to reduce or stop their use. This conclusion is based on analysis of data collected by the Monitoring the Future Study (MFS), an ongoing study of the behaviors, attitudes, and values of American secondary school students, college students, and young adults. Each year, a total of approximately 50,000 8th, 10th and 12th grade students are surveyed (might want to explain why no 9^th grade data).  The MFS is conducted by the Survey Research Center in the Institute for Social Research at the University of Michigan. Drawing data from the MFS, the Institute for Social Research at that university looked at students’ perceived need to reduce or stop marijuana use, likelihood of use in the next 12 months, reasons for abstaining or quitting, and present use. Gender and race/ethnicity were also examined.

Earlier studies showed a strong decrease in marijuana use from the late 1970s through the early 1990s followed by an upsurge in the mid 1990s with some decrease in the 2000’s. During that period the percentage of seniors who felt they should stop or reduce their use increased from about 44% in the late 1970s to above 50% in the late 1980s. Since the early 1990s, rates have remained relatively stable at just below 50%.

This 2008 analysis showed that 50% of users reported feeling they should reduce or stop their use. Sixty percent worried about possible psychological or physical damage. Nearly the same number cited a concern about parental disapproval. Less than a quarter had concerns about either expense or a bad trip and, interestingly, only 7 % seven percent said that lack of availability was a reason for feeling they should abstain or quit. Concern for psychological or physical harm had been top reasons in the late 1980s but decreased sharply as of the early 2000s. Parental disapproval remained constant while concern about arrest rose significantly and is now at more than 50%. Expense and availability have remained low.

Ethnically, Black and Hispanic seniors were most likely to report having never used marijuana (67%). White seniors appear to be a harder–to-reach group for marijuana use reduction, with a higher percentage of continued users and a lower percentage seeing such use as a problem. This article clearly shows that a significant number of U.S. high school seniors who are using marijuana wish to stop or reduce that use – valuable information for those engaged in programs aimed at reinforcing the desire to stop or reduce marijuana use.

(Terry-McElrath, Y, O’Malley, P, Johnston, L: Saying no to marijuana: why American youth report quitting or abstaining. Journal of Studies on Alcohol and Drugs 69:796-805, 2008)

Ed. Note – Latest MTF (2009) is available at http://www.nida.nih.gov/newsroom/09/NR12-14.html

Alcohol, tobacco, and illegal drugs are responsible for illness and death around the globe. The World Health Organization has estimated that 91 million people are affected by alcohol use disorders and 15 million by drug use disorders. Yet, current world-wide data on the extent and severity of these issues has been lacking. This study is the work of researchers from every continent employing data from the first 17 countries participating in the World Health Organization’s (WHO’s) World Mental Health (WMH) Survey Initiative. Eighteen surveys were carried out in 17 countries in the Americas, Europe, the Middle East, Africa, Asia, plus separate surveys in the People’s Republic of China, and New Zealand. All interviews were carried out face-to-face by trained lay interviewers. Participants were asked if they had ever used alcohol, tobacco, cannabis, and/or cocaine.

The researchers found that in the Americas, Europe, Japan, and New Zealand, alcohol is used by the vast majority of survey participants, compared to smaller proportions in the Middle East, Africa, and China. The global distribution of illegal drug use is unevenly distributed, with the US having the highest levels of both legal and illegal drug use among all countries surveyed. Reduced levels were observed in lower income countries in Africa and the Middle East and in the Asian locales studied. Globally, drug use was not simply related to drug policy. Countries with stringent illegal drug policies did not have lower levels of use than countries with liberal ones. Males were more likely than females to have used all drug types. Younger adults were more likely than older adults to have used any of the drugs. Higher income was related to drug use of all kinds. Marital status was found to be linked to illegal drug use—the use of cocaine and cannabis is more likely in people who have never been married or were previously married. Gender differences were consistently observed but were noted to be decreasing in younger persons who also had higher levels of illegal drug use.

These comprehensive findings on the patterns of drug use in all regions of the world should be useful to government and health organizations in developing more effective policies to combat these problems.

(Degenhardt, L, Chiu, W-T, Sampson, N, Kessler, RC, Anthony, JC, et al.  Toward a global view of alcohol, tobacco, cannabis, and cocaine use: Findings from the WHO World Mental Health Surveys.  PLoS Medicine 5:1053 – 1067, 2008.

S = 4, V = 4, O = 3

Considerable research has examined the psychological, social, and behavioral aspects of relapse after treatment for alcohol dependence. However, recent advances in brain imaging devices have enabled scientists to pursue biochemical clues to why some return to drinking and others seem able to abstain.   Metabolism involves the breakdown of chemicals into simpler molecules. A metabolite is the result of that process and some may serve as markers of the “health” of different types of cells in the brain. Scientists believe that the levels certain brain metabolites in the human reward system may assist in explaining some of the biological factors that contributing to relapse in those afflicted with alcohol and drug  dependence. The brain reward system is involved in reasoning, planning, judgment, impulse control, and anticipation and processing of pleasure. A recent study at the San Francisco Veterans Administration Medical Center employed brain scans to compare metabolite levels in the brain reward system of persons who remained abstinent against those who resumed drinking after treatment for alcohol dependence. Magnetic resonance spectroscopic imaging (MRSI) is a non-invasive neuro-imaging technique that makes possible the examination of brain metabolites/chemicals associated with mood, cognition, and behavior. In this study 51 treatment seeking alcohol dependent persons who had been abstinent for 7 days, and 26 light drinking controls completed MRS imaging. Baseline metabolite levels were obtained from the several regions that make up the brain reward system. The alcohol dependent participants were followed over a 12 month period. Eighteen remained abstinent (“abstainers”), while 33 resumed hazardous levels of drinking (“resumers”) after treatment.

When the baseline metabolite levels – measured at the beginning treatment – were compared, resumers showed significantly lower concentrations of two brain chemicals – N-acetylaspartate (NAA – a marker for neural integrity), and CHO (a marker of cell membrane health) than the abstainers and light drinking controls. These findings point to abnormalities and compromised neural integrity in the brain reward system in the resumers. Since normal functioning of the brain reward system is required for accurately weighing the pros and cons of a person’s actions and then changing behavior based on the consequences, the lower levels of NAA and CHO in resumers suggest they may have difficulty with controlling their impulses and behavior, particularly for alcohol use.  The results also highlight the importance of functional brain reward system in maintaining abstinence.

( Durazzo, T, Pathak, V,  Gazdzinski, S, Mon, A, Meyerhoff, D: Metabolite levels in the brain reward pathway discriminate those who remain abstinent from those who resume hazardous alcohol consumption after treatment for alcohol dependence. Journal of Studies on Alcohol and Drugs 71: 278-89, 2010.)

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The first Consensus Conference held by the Betty Ford Institute took place on September 18-20, 2006 and tackled a fundamental issue in the addiction treatment field: How is recovery defined and measured?

Sensitive questions considered at the inaugural conference included:

• What exactly is recovery?
• Is professional treatment necessary for long-term recovery to work?
• Is there a role for psychotropic and/or other medications during recovery?
• Is ongoing 12-step meeting attendance key to long-term recovery?
• How do we measure “success” vis-à-vis recovery?
• Is it possible to translate the concept of recovery into numbers?

Conference Papers

Resources

The Betty Ford Institute is now in the second year of partnering with Loma Linda University School of Medicine in the two-week Clerkship PIR Program.  The 4^th year medical students attend the family program their first week and spend their second week in the Residential Day Treatment program. Without exception the students have reported that their experiences have enlightened them about the disease in such a way that they understand it is a treatable disease and they have a responsibility to their patient.  In addition to spending the majority of their time with the family members and patients, they also attend an Al-Anon meeting and an AA meeting.  The students also meet with our physicians for the didactic component of their education.  Students report that they will use their prescription pads in the future to prescribe AA and Al-Anon, encourage sponsorship, and monitor patients who are addicts with a sense of partnership in their recovery process.

College campuses across America have suffered many alcohol and drug related tragedies.  Our alliance with Sigma Chi is one of our most enduring PIR Programs. The Sigma Chi alumni who attend the program not only learn about the disease – they also learn how to remove the stigma that is often associated with alcoholism so that they can address the subject with ease. College students are more responsive and willing to engage honestly with the alumni who are able to talk candidly about alcoholism and drug addiction.  The men who have attended the Sigma Chi PIR Program have continued to receive further training and been invited by many universities to provide presentations.  The response of the student body has been positive and far-reaching.  They are touching lives and making a difference.

Anabolic-androgenic steroids (AAS) are a family of hormones, including the natural male hormone testosterone, that possess “muscle building” and “masculinizing” properties. AAS allow users to greatly increase muscle strength and athletic performance, often well beyond what is possible through natural means. While problems associated with AAS abuse have recently caught public attention, most AAS abusers are not elite or competitive athletes.

This review examined the long-term psychiatric and medical consequences of AAS abuse, specifically looking at the population of ordinary – meaning non-athlete – AAS users that began to emerge in the early 1980s. The senior members of this population are now entering middle age, and they represent the leading wave of a new type of aging former substance abusers, with specific medical and psychiatric risks.

Analysis revealed that long-term use of AAS may cause irreversible cardiovascular toxicity, especially atherosclerotic effects and cardiomyopathy. In other organ systems, evidence of persistent toxicity is more modest, and there is little evidence of an increased risk of prostate cancer. However, high concentrations of AAS, likely sustained by many AAS abusers, produce harmful effects on various cell types, including neuronal cells – raising the specter of possibly irreversible neuropsychiatric toxicity. Finally, AAS abuse appears to be associated with a range of potentially prolonged psychiatric effects, including dependence syndromes, mood syndromes, and progression to other forms of substance abuse. In summary, given that the prevalence and severity of these various effects remain poorly understood, the authors recommended additional research in order to obtain more systematic data on the long-term psychiatric and medical consequences of AAS abuse.

(Kanayama, G, Hud-son, JI, Pope, HG: Long-term psychiatric and medical consequences of anabolic-androgenic steroid abuse: A looming public health concern? Drug and Alcohol Dependence 98:1-12, 2008.)

The presence or absence of music in a bar setting, its fast or slow tempo, and style have all been found to influence the level of alcohol consumption. However, the effect of sound levels of music in bars remains in question. In this French study 40 bar patrons, aged 18-25, were unknowingly aware that they were being observed at random in two bars located in a medium-sized city. The bars were famous as hangouts for young people of the town. Only patrons drinking draft beer were considered as “participants.” Draft beer was generally served in 8 oz. glasses making it possible to observe consumption with the same product and capacity.

The researchers looked at the number of drinks ordered by each patron, the amount of time spent drinking each glass, and the number of gulps. It appeared that a higher level of music than normal was associated with increased consumption. A high level of sound led to increased drinking speed. Interestingly, the number of gulps needed to consume the glass of beer remained the same. The authors hypothesize that increased drinking is due to arousal caused by the louder music. They also suggested that loud music inhibits conversation and socializing which might lead to more consumption. These findings along with other research point to the sound level, style and tempo of music in a drinking environment as a factor in increased drinking. In France more than 70,000 persons die each year because of chronic alcohol consumption and alcohol is involved in the majority of fatal car wrecks. Music as an influence on how much people drink is a factor that has implications for both sides of the bar.

(Gueguen, N, Jacob, C, Le Guellec, H, Morineau, T, Lourel, M: Sound level of environmental music and drinking behavior: A field experiment with beer drinkers: Alcoholism: Clinical and Experimental Research 32: 1795-98, 2008.)

Despite the widespread use of 12-Step approaches and numerous referrals to Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) by youth-service providers, there is little “hard scientific evidence” showing that these groups can improve outcomes among youth who are in recovery. Part of the issue is that mutual-help organizations like AA and NA are community organizations based on anonymity, and cannot be directly controlled by researchers. This study examined how helpful AA and NA may be for adolescents in their transition to young adulthood who were initially enrolled in treatment that was based on a 12-Step model.

Researchers recruited 160 adolescent inpatients (96 males, 64 females) with an average age of 16 years. All of the adolescents were enrolled at two treatment centers in California that had a focus on abstinence and were based on a 12-Step model. The study participants’ length of stay ranged from four to six weeks, after which they were re-assessed on a number of clinical variables at six months, and then one, two, four, six, and eight years following treatment.

Results indicated many youth initially attended AA/NA meetings intensively, but during the eight-year period following treatment, their attendance declined sharply and steadily. Those patients with severe addiction problems, and those who believed they could not use alcohol/drugs in moderation, attended the most meetings. Despite the decline in attendance, greater early participation was associated with better long-term outcomes. On average, each AA/NA meeting attended was associated with two days of subsequent abstinence. The study authors recommend AA and NA as a “buffer” against relapse during this particularly high risk developmental period into young adulthood, and especially among those youth who have more severe substance-use issues.

(Kelly, JF, Brown, SA, Abrantes, A, Kahler, CW, Myers, M: Social recovery model: An 8-year investigation of adolescent 12-step group involvement following inpatient treatment. Alcoholism: Clinical and Experimental Research 32:1468-78, 2008.)

While “tail-gating parties” and “throwing back a few at the game” are traditions for many sports fans, the reality is that drinking alcohol before, during and/or after sporting events can increase the chances of traffic accidents and injuries before, during, and after professional sporting events. Illegal alcohol sales at these events may be one contributing factor to such alcohol-related incidents. This first-of-its-kind study looked at the likelihood of alcohol sales to underage youth and intoxicated patrons at professional sports stadiums across the U.S., and what factors may facilitate these illegal sales.

Researchers had young persons who appeared younger than 21 years old, the legal U.S. drinking age, and actors feigning intoxication attempt to purchase alcohol in the stands and at concession booths at 16 sports stadiums (for professional hockey, basketball, baseball, and football) in five U.S. states. In total, they conducted 159 pseudo-underage and 159 pseudo-intoxicated purchase attempts. Researchers also collected seller, purchase-attempt, and event characteristics.

Results showed that the individuals who appeared underage or obviously intoxicated had a relatively easy time purchasing alcohol at the professional sports events examined. The overall sales rate to the pseudo-underage buyers was 18 percent, and to the pseudo-intoxicated buyers was 74 percent. The best predictor for either type of illegal sale was location of the purchase attempt: the odds of a sale to a pseudo-underage buyer and a pseudo-intoxicated buyer in the stands were 2.9 larger than the odds of a sale at the concession booths. Study authors recommended that stadiums do more to help vendors check for proof of age and sobriety, particularly those who sell alcohol in the stands, given that they are likely under pressure to work faster to avoid blocking other fans’ view of the game and are less likely to be monitored by managers.

(Toomey, TL, Erickson, DJ, Lenk, KM, Kilian, GR: Likelihood of illegal alcohol sales at professional sport stadiums. Alcoholism: Clinical and Experimental Research 32: 1859-64, 2008.)

Amphetamine abuse and dependence may not be in the public eye as much as cocaine and heroin abuse, but it represents a major public-health problem with considerable psychiatric, social, and economic consequences. In Sweden, particularly, amphetamines are the most commonly abused substance after marijuana and alcohol. Currently, no approved pharmacotherapy treatment for amphetamine dependence exists. Recent human research suggests that naltrexone – an opioid antagonist use to treat alcohol dependence – may also decrease some of the reinforcing effects of amphetamines. This study compared the effectiveness of naltrexone with a placebo in reducing relapse among amphetamine-dependent patients.

Researchers recruited 80 amphetamine-dependent individuals (62 males, 18 females), 20 to 65 years of age, from the Stockholm area. Participants were randomized to 12 weeks of treatment with either naltrexone (50 mg) or placebo, and were required to visit the clinic twice weekly to receive medication and relapse-prevention therapy, and to leave urine samples for analysis.

Of the 80 original patients, 55 completed the trial study (29 in the naltrexone group, and 26 in the placebo group). Results showed that the naltrexone group had a significantly higher number of amphetamine-negative urine samples compared with the placebo group; the naltrexone group also performed better on the “continuous abstinence” measure, reduction in craving levels, and self-reported consumption of amphetamine. Furthermore, naltrexone appeared to be well-tolerated in this group. The authors contend that naltrexone holds promise as a treatment for amphetamine dependence.

(Jayaram-Lindström, N, Hammarberg, A, Beck, O, Franck, J: Naltrexone for the treatment of amphetamine dependence: A randomized, placebo-controlled trial. American Journal of Psychiatry 165:1442-48, 2008.)

Editors Ratings: S=4, V=3, O=4

Patients in chemical dependency (CD) treatment have high rates of medical diseases that often precede steps toward recovery. There is evidence to suggest that heavy drinkers, especially older individuals, quit drinking or reduce consumption in response to health problems. This study looked at whether the existence of medical problems predicts better long term CD treatment outcomes, and the role played by primary care services in this process. In a sample of 598 CD patients in a private health plan, researchers examined whether substance abuse-related medical conditions, integrated medical care (within CD treatment), and on-going primary care predicted remission of CD problems at the five-year point.

The study found that those with substance abuse-related medical but not psychiatric conditions did have a higher likelihood of remission. More severe pre-existing medical problems at the time of admission were also related to higher levels of remission at five-year follow-up. Primary care visits were related to positive outcomes; those with 2-10 visits were more likely to be remitted than those with fewer than 2 visits. Further, the researchers noted that receiving medical care as an integral part of CD treatment also predicted better five-year outcomes. This study highlights the important role of medical services in the long-term treatment of alcohol and drug disorders and points toward a disease management approach to CD treatment similar to that used with other chronic diseases: specialty care when the disease is severe followed by primary care when the disease is stabilized.

(Mertens, JR, Flisher, AJ, Satre, DD, Weisner, CM: The role of medical conditions and primary care services in 5-year substance use outcomes among chemical dependency treatment patients. Drug and Alcohol Dependence 98: 45-53, 2008)

California is the largest alcohol market in the United States. In 2005 alone Californians consumed 14 billion alcohol drinks. This study is the first comprehensive estimate of the cost of alcohol use in an individual state. Alcohol contributes to illnesses such as cirrhosis, esophageal cancer, pancreatitis, and epilepsy. It plays a role in violent crimes such as sexual assaults, domestic violence, and child abuse. This study analyzed the costs of alcohol-related health problems, alcohol-attributable illness, fetal alcohol syndrome, high risk sex, alcohol dependence and abuse, non-motor vehicle accidents, self inflicted injuries, crime, and traffic injuries and fatalities. Both the economic and quality of life costs were examined. Alcohol use in California in 2005 led to 9,439 deaths and 921,929 alcohol related problems such as crime and injuries. The economic cost of these problems is estimated to be between $35 billion and $42 billion. The economic cost of these deaths and non-fatal incidents accounted for an economic cost of $38 billion.

This economic cost amounts to $1,000 per resident of California. In addition, alcohol is responsible for severe reductions in an individual’s quality of life. The researchers estimated that the disability caused by injuries, personal anguish of violent crime victims, and the life-years lost to fatalities were enormous. The estimated value of this reduced quality of life is between $30 billion and $60 billion. The authors suggest that the methodology developed for this study can be useful in studying the economic and quality of life costs of alcohol related problems in other states.

(Rosen, SM, Miller, TR, Simon, M: The cost of alcohol in California. Alcoholism: Clinical and Experimental Research 32: 1925-36, 2008.)

Amphetamine abuse is a global problem, with estimates of 35 million people worldwide abusing amphetamine-type stimulants in 2004. Closer to home, the 2005 National Survey on Drug Use and Health reported 19.1 million Americans had used an illicit or prescription-type stimulant non-medically at least once in their lifetimes. Reports in 2007 indicate that methamphetamine abuse may be on the increase in some major metropolitan U.S. cities. While cocaine is recognized as a contributor to acute myocardial infarction (AMI) no population-based studies have looked at an association between amphetamine abuse and heart attacks. This Texas study looked at patients hospitalized for amphetamine abuse to see if they were more likely to have an AMI, and if this association differed by public-health regions in the state.

Researchers examined 3,148,165 discharges during 2000-2003 from Texas hospitals covered by a state quality-of-care reporting law. They identified 11,011 AMIs among persons aged 18 – 44 years of age while controlling for well-established risk factors for AMI such as cocaine abuse, alcohol abuse, tobacco use, hypertension, diabetes mellitus, lipid disorders, obesity, congenital defects, and coagulation defects.

Results showed that not only was amphetamine abuse modestly but significantly associated with AMI, but also that the rate of AMIs among amphetamine abusers increased significantly from 2000 to 2003. The data indicated that amphetamine abuse was responsible for 0.2 percent of AMIs in the state of Texas, varying by region, with prevalence highest in the North Texas and Panhandle regions of Texas.

(Westover, AN, Nakonezny, PA, Haley, RW: Acute myocardial infarction in young adults who abuse amphetamines. Drug and Alcohol Dependence 96:49-56, 2008.)

Research has shown conclusively that family alcoholism risk is in part genetic and not just the result of family environment. Studies in recent years have confirmed that identical twins, who share the same genes, are about twice as likely as fraternal twins – who share on average 50 percent of their genes – to resemble each other in their risk of alcoholism. Recent research also reports that 50 to 60 percent of the risk for alcoholism is genetically determined, for both men and women. Genes alone do not preordain that someone will be alcoholic; features in the environment along with gene–environment interactions account for the remainder of the risk.

Addiction is based in the brain so memory, motivation, and emotional state have thus been logical targets for the search for genes that underlie risk for alcoholism. Genetic technology now permits scientists to delete or inactivate specific genes, or alternatively, to increase the expression of specific genes, and watch the effects in living animals. These techniques can provide important clues to functions of the addicted brain.

Scientists now have methods for locating alcohol–related genes and gene locations and only then determining how the genes function, an approach known as reverse genetics. Gene locations have been identified for alcohol sensitivity, alcohol preference, and withdrawal severity. Scientists also can scan the genome to identify genes whose activity differs among animals that respond differently to alcohol. Knowledge gained from animal studies has assisted scientists in identifying the genes underlying brain chemistry in humans.

The drug naltrexone has been shown to help some, but not all, alcohol–dependent patients reduce their drinking. Preliminary studies show that alcoholic patients with different variations in the gene for a receptor on which naltrexone is known to act responded differently to treatment with the drug. This demonstrates how genetic typing may be helpful in customizing treatment for alcoholism to each individual.

NIAAA’s Collaborative Study on the Genetics of Alcoholism (COGA) is searching for alcohol–related genes through studies of families with multiple generations of alcoholism. They have found “hotspots” for alcoholism risk on five chromosomes and a protective area on one chromosome. They have also examined patterns of brain waves measured by electroencephalogram and found that reduced amplitude of one wave that characteristically occurs after a stimulus correlates with alcohol dependence.

Genetic research promises to help researchers identify markers of alcoholism risk and ultimately, suggest ways to identify those at risk and to treat the disease pharmacologically.

Adapted from NIAAA Alcohol Alert No. 60: The Genetics of Alcoholism

A 2001/2002 survey by the World Health Organization found that about 80 percent of young people began drinking before they were16 years old. Furthermore, the average age of drinking for the first time was 12 years. Boys reported drinking for the first time at an average age of 12.3 years and girls at an average of 12 years. As in many other countries Dutch adolescents establish a drinking pattern early in life. This University of Amsterdam study looked at the contribution of genes and environment to the initiation of alcohol use and frequency of drinking among early adolescents in The Netherlands.

The researchers used data collected through the Netherlands Twin Register to identify 694 twin pairs 12 to 15 years of age during survey years 1993, 1995, 1997 and 2000. Of these pairs, 125 were identical males, 89 were fraternal males, 183 were identical females, 106 were fraternal females, and 191 were fraternal of the opposite sex (in total, 619 males, and 769 females). The study authors analyzed the initiation and frequency of drinking as a function of three influences: genetic effects, common environmental effects, and unique environmental effects.

Results showed that genetic factors were the most important influence in early initiation of alcohol use. Common environmental factors explained most of the variation in frequency of drinking once alcohol use had been initiated. While it is often assumed that initiation of alcohol use is mainly predicted by social factors like peer pressure, family norms, and cultural attitudes toward alcohol use, these findings suggest that genetic factors may play a significant role in early initiation of some adolescent children to alcohol.

(Poelen, EAP, Derks, EM, Engels, RCME, van Leeuwe, JFJ, Scholte, RHJ, Willemsen, G, Boomsma, DI: The relative contribution of genes and environment to alcohol use in early adolescents: Are similar factors related to initiation of alcohol use and frequency of drinking? Alcoholism: Clinical & Experimental Research 32:975-982, 2008.)

Alcohol has a reputation – recorded in history and popularized in movies and writing – of having both anesthetic and analgesic properties. Yet few studies have systematically looked at alcohol’s ability to suppress pain within a controlled laboratory setting. This study investigated whether two groups of people – those with a strong positive family history for alcoholism (FHP), and healthy individuals with a negative family history of alcoholism (FHN) – have different sensitivities to the analgesic (pain reducing) effects of alcohol.

Researchers exposed 19 FHP subjects (11 males, 8 females) and 41 FHN subjects (21 males, 20 females) to three separate test days at least three days apart in a randomized order under double-blind conditions. Each test day included an alcohol infusion through a computerized pump either at a high alcohol concentration, a low alcohol concentration or as a placebo. Participants were given electrical stimulations, progressively increased until pain reports reached five or higher on an 11-point scale.

Alcohol appeared to increase pain tolerance among study subjects, but had no effect on pain thresholds. There were no gender differences in pain tolerance or threshold. Furthermore, despite an initial hypothesis that FHP individuals would be more sensitive than FHN individuals to the analgesic effects of alcohol, no discernible differences were found between the two groups.

(Perrino Jr, AC, Ralevski, E, Acampora, G, Edgecombe, J, Limoncelli, D, Petrakis, IL: Ethanol and pain sensitivity: Effects in healthy subjects using an acute pain paradigm. Alcoholism: Clinical & Experimental Research 32:952-958, 2008.)

Legal gambling in the U.S. is a multi-billion dollar business with over 100% increases in revenue over the past decade. Gambling opportunities range from spectator sports to casinos, to government sponsored lotteries, and many more options. Disagreement has grown over how to classify and regulate this industry. Along with this has come the realization that gambling can be highly addictive and disabling for some participants. The American Psychiatric Association estimates that 2.5 million Americans are pathological gamblers and another 3 million are problem gamblers. One potential risk factor for gambling problems is alcohol, whose use is associated with impaired judgment and greater risk taking. Earlier studies have shown that alcohol can influence gambler’s choices, making them more likely to play, or continue to play, and increase the amount they are willing to risk.

University of Miami researchers examined data from the National Epidemiological Survey on Alcohol and Related Conditions NESARC). The NESARC interviewed over 40,000 respondents and included questions about gambling and gambling-related problems. Three Percent (1203) people reported gambling related problems. Twenty four percent (9050) reported drinking to intoxication and 8.5% met the diagnostic criteria for alcohol abuse or dependence. Analysis determined that alcohol consumption was associated with the likelihood of experiencing gambling-related problems and with the number of problems. This association became larger as drinking increased. The researchers concluded that there is strong evidence that problematic gambling and alcohol consumption are complimentary activities.

(French, M.T., Maclean, Johana, C., Drinkers and bettors: investigating the complimentary of alcohol consumption and problem gambling: Drug and Alcohol Dependence 96 (2008) 155-164)

Asthma, an often chronic lung condition, affects approximately 20 million U.S. residents (roughly 8% of the general population). Some 40 million prescriptions were dispensed in the U.S. for asthma inhalers in 2006. The pharmacological actions of albuterol/salbutamol inhalers include increased heart rate and blood pressure. While some case studies have reported misuse/abuse, few investigations have systematically looked at the prevalence, patterns, correlates or consequences of asthma-inhaler abuse. This survey looked at asthma-inhaler abuse among a group of antisocial youth.

Researchers examined data collected from a 2003 survey of 723 (629 boys, 94 girls) adolescents, with mean age of 15.5 years, living in a Missouri Division of Youth Services facility (an alternative sentencing option for youthful offenders). Voluntary, face-to-face interviews queried the youth about their substance abuse, psychiatric symptoms, and antisocial behaviors.

Results showed that asthma-inhaler misuse for the purposes of getting high was prevalent among the youth examined, and co-occurred with other psychiatric and substance-use problems. More specifically, roughly 26 percent (193) of the youth were diagnosed with asthma (a rate twice that of comparably aged youth in the general population), and 93.2 percent had received a prescription for an inhaler. More than half of the youth (373) reported using a prescribed or non-prescribed asthma inhaler; and of these, 23.6 percent (n=88) reported using an inhaler to get high. Asthma-inhaler abusers had an earlier onset of antisocial conduct, greater levels of psychiatric distress, higher levels of volatile-solvent and other substance-use problems as well as significantly higher levels of temperamental impulsivity and fearlessness than did non-users or proper users of inhalers.

Findings also indicated that asthma-inhaler abusers were significantly more likely to report euphoria, memory problems, slurred speech, blurred vision, confusion, dizziness, and a variety of other acute reactions not reported by those who used the inhalers properly.

(Perron, BE, Howard, MO: Endemic asthma inhaler abuse among antisocial adolescents. Drug and Alcohol Dependence 96:22-29, 2008)

Chronic alcoholism (ALC) is associated with cognitive and emotional dysfunction, which may be due to brain damage, particularly in the right hemisphere of the brain.

More specifically, ALC can lead to Reward Deficiency Syndrome by changing brain neurotransmitters that control both positive reward and negative punishment. This study used magnetic resonance imaging (MRI) to examine the integrity of white-matter tracts that are critical for the operation of the reward circuitry regions of the brain. (The brain’s white matter is one of the main components of the central nervous system. It consists of the nerve-cell’s fibers that connect various areas of the brain by carrying nerve impulses between the cells.)

Researchers used MRI to scan white-matter integrity in two groups of men: 15 long-term ALC men who were abstinent and 15 non-ALC men matched on demographics. The findings showed white-matter microstructure deficits among the abstinent ALC men in several right-hemisphere tracts that connect the prefrontal and limbic systems, which are integral to the processing of memory, emotion, and reward functions. These findings support three propositions about ALC that have been reported elsewhere in the literature. One, white matter is damaged at the micro-structural level in ALC. Two, the reward circuitry becomes damaged in the brains of ALC individuals. Three, ALC selectively affects the integrity of the right hemisphere of the brain.

This study helps to understand how long-term chronic drinking can cause damage to brain regions that comprise a system that is essential for normal emotional functioning and for modulating the effectiveness of positive and negative reinforcement in human behavior.

(Harris, GJ, Jaffin, SK, Hodge, SM, Kennedy, D, Caviness, VS, Marinkovic, K, Papadimitriou, GM, Makris, N, Oscar-Berman, M: Frontal white matter and cingulum diffusion tensor imaging deficits in alcoholism. Alcoholism: Clinical & Experimental Research 32:1001-1013, 2008.)

“Religion” is generally thought of as an organized social system of beliefs and practices, whereby “spirituality” refers to a person’s unique and subjective perspectives, sense of meaning, and/or experiences. Past research has shown that religiousness and spirituality are consistently associated with lower rates of drinking and fewer alcohol-related problems. However, there is little understanding of the specifics of why they do so. This study identified several mechanisms by which religiousness and spirituality could influence alcohol use and problems.

Researchers recruited 512 college students (315 females, 197 males) who were predominantly Christian (80% self identified) to answer a questionnaire for $15 each. The questions addressed their drinking and/or problems, as well as other measures: their religious/spiritual involvement, search for meaning, spiritual well-being, religious struggle, motives for drinking, negative beliefs about alcohol, and social influences.

Results showed that negative beliefs about alcohol, social influences, spiritual well-being and motives for drinking appeared to be among the mechanisms or links between religiousness/spirituality (R/S) and alcohol use and problems. Analysis showed that the bulk of the effects of R/S on alcohol use occurred through the impact of R/S on social influences. This and related studies seem to indicate that part of why R/S can reduce drinking and associated problems is related to the positive and supportive social networking and/or socialization that such organizations and groups provide. The researchers recommended that future efforts address the schism that still seems to exist between clergy who typically lack training and information about substance-use disorders, and mental-health professionals who often do not recognize the potential value of or share the same commitment to R/S as their clients.

(Johnson, TJ, Sheets, VL, Kristeller, JL: Identifying mediators of the relationship between religiousness/spirituality and alcohol use. Journal of Studies on Alcohol and Drugs 69:160-170, 2008.)

The non-medical use of prescription opioids – taking someone else’s prescription medication or taking it for the wrong reasons – is increasing in the United States. Inappropriate use of prescription medications has been associated with medical and psychiatric symptoms. Not only does this misuse have fundamental health risks associated with it but these “legal” drugs have the potential of becoming a substance-use disorder (SUD) leading to job problems, arrest, even the risk of death. This Yale University School of Medicine study was designed to examine the demographic and clinical attributes of people who misuse prescription opioids, as well as what psychiatric, medical, and substance-abuse characteristics people who abuse or are dependent on prescription opioids may have.

Researchers analyzed the 2002-2004 National Survey on Drug Use and Health (NSDUH), an annual cross-sectional survey of the civilian, non-institutionalized population 12 years and older. The NSDUH is designed to collect information on the prevalence of substance use and co-existing psychiatric conditions. For this particular study, data for 91,823 respondents aged 18 years and older were analyzed.

Results indicated that non-medical use of prescription opioids is common. Of the population surveyed, 4.5 percent had engaged in their non-medical use during the preceding year, while nearly 13 percent of these individuals met criteria for abuse/dependence. Results showed that younger age (18-21), unemployment, phobic symptoms, past year alcohol abuse/dependence, were among the characteristics associated with past-year non-medical use of prescription opioids. Based on their findings, the researchers recommended that clinicians screen for non-medical use of prescription opioids when patients present with panic, social phobia, and agoraphobia, low self-rated health status, and other substance misuse. They also suggested that future research examine how many of those with non-medical use began taking an opioid for a legitimate medical condition and then transitioned into problematic use.

(Becker, WC, Sullivan, LE, Tetrault, JM, Desai, RA, Fiellin, DA: Non-medical use, abuse and dependence on prescription opioids among U.S. adults: Psychiatric, medical and substance use correlates. Drug and Alcohol Dependence 94:38-47, 2008.)

“Legal coercion” essentially means using the law to force someone to do something they do not want to do… in this case, entering substance-abuse treatment. As the criminal-justice system in the United States has adopted the disease model of addiction, “drug courts” have popularized the practice of legal coercion in order to address the increasing number of criminal acts that are related to substance use. Such coercion by the courts reflects society’s disillusionment with incarceration as a means of dealing with criminal acts by addicted persons. This study looked at whether or not this practice is effective.

Researchers examined the influence of legal coercion on retention in substance-abuse treatment, using data from a national survey of programs in the public-care sector, with a focus on three treatment modalities: short-term residential (n=756), long-term residential (n=757), and outpatient treatment (n=1,181).

The study revealed that legal coercion significantly reduced the risk of dropout from treatment for all three kinds of programs. However, the results were not equal across the board. Specifically, short-term residential treatment showed the greatest effects, followed by long-term residential treatment, while outpatient treatment showed the smallest effects. The researchers recommend that types of treatment be carefully considered when using legal coercion to place people into treatment.

(Perron, BE, Bright, CL: The influence of legal coercion on dropout from substance abuse treatment: Results from a national survey. Drug and Alcohol Dependence 92:123-131, 2008.)

Key words –

Getting along with other people is a critical ingredient for a full and happy life. Yet building and maintaining healthy relationships requires the ability to correctly read and express emotional facial expressions (EFE), an ability that alcohol-dependent individuals tend to lack. It has been observed that alcoholic subjects overestimate the intensity of EFE, misinterpret EFE, and are unaware of this impairment. This study explored why people with alcohol dependence (AD) have deficits in emotional facial expression (EFE): Is it because of fundamental emotional problems, or because of a more general impairment in visual and/or facial processing?

Researchers asked 18 AD patients (9 women, 9 men), during their third week at a detoxification treatment center, and 18 age/gender/education-matched healthy “control” volunteers, to perform several tasks. These tasks evaluated: one, basic ability to process visual-spatial and facial-identity information; two, simple reaction times; and three, complex facial-features identification (specifically, age, emotion, gender, and race). All of the participants’ accuracy and reaction times were recorded and compared.

The AD patients did not appear to have deficits in basic visual-spatial and facial-identity processing, although their reaction times were slower in comparison to the controls. However, when the age, gender and race aspects of the third task were controlled for, the AD patients continued to show deficits when identifying emotions. This means that EFE-processing deficits that are often witnessed among persons with chronic alcoholism are specifically due to an impaired ability to decode emotions. These findings may have implications for future efforts that address helping AD individuals build healthy relationships with family, friends and work colleagues.

(Maurage, P, Campanella, S, Philippot, P, Martin, S, de Timary, P: Face processing in chronic alcoholism: A specific deficit for emotional features. Alcoholism: Clinical and Experimental Research 32:600-606, 2008.)

Topiramate is normally an anticonvulsant medication, but it has also shown promise in treating alcohol dependence, reportedly by reducing both drinking amounts and craving. Given that its use is still relatively new, its levels of effective dosage and the mechanisms or means by which it works remain relatively unclear. This study systematically looked at the effects of specific doses of topiramate within a laboratory setting, and also examined the means by which it may reduce drinking.

Researchers recruited 61 heavy drinkers (39 males, 22 females), of which 14 percent met Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM-IV) criteria for alcohol abuse, while 46 percent met DSM-IV criteria for alcohol dependence. Participants were randomly assigned to one of three medication groups: placebo (n=20), 200 mg (n=20) or 300 mg (n=21). After 32 days of medication adjustment (this period of time is referred to as “titration”), participants reached their target doses, and then were stabilized for approximately one week. During this time they were tested in a laboratory setting for their reactions to the sight and smell of alcohol, as well as their subjective responses to a moderate dose of alcohol.

Both doses of topiramate reduced the frequency of heavy drinking during the titration period as compared to the placebo. The 200 mg dose of topiramate also reduced the stimulating effects of alcohol as compared to the placebo. However, topiramate did not appear to have an effect on self-reported craving at any time during the experiment. These results suggest that while topiramate may not reduce the likelihood that an individual may drink, it appears to hold promise for reducing the likelihood that he/she will drink heavily.

(Miranda, R, MacKillop, J, Monti, PM, Rohsenow, DJ, Tidey, J, Gwaltney, C, Swift, R, Ray, L, McGeary, J: Effects of topiramate on urge to drink and the subjective effects of alcohol: A preliminary laboratory study. Alcoholism: Clinical and Experimental Research 32:489-497, 2008.)

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Motor-vehicle crashes that are alcohol-related kill approximately 17,000 Americans per year. Injury from these accidents is the leading cause of death among Americans under 34 years of age. Drinking and 
driving is also costly, causing more than $51 billion in related damages in the year 2000. Many policy-makers assume impaired drivers are heavy drinkers or alcohol-dependent. This study looked more closely at the issue, asking: “Who are these alcohol-impaired (AI) individuals who are making American roads so unsafe?”

Researchers analyzed data from the 2006 Behavioral Risk Factor Surveillance System. The BRFSS is a state-based cross-sectional telephone survey of US adults for drinking patterns and self-reported alcohol-impaired (AI) driving among U.S. adults 18 years and older conducted by the Center for Disease Control and Prevention (CDC). Drinking was divided into four categories: non-binge/non-heavy, non-binge/heavy, binge/non-heavy, and binge/heavy. (Binge drinking was defined as 5 or more drinks for men or 4 or more drinks for women on one or more occasions in the previous month. Heavy drinking was defined as more than 2 drinks per day for men or more than 1 drink per day for women.)

Binge drinking accounted for more episodes and was more predictive of AI driving than heavy drinking. Approximately 84 percent of AI drivers were binge drinkers, and 88 percent of AI-driving episodes involved binge drinkers. Study authors called for more effective interventions to reduce binge drinking and its negative effects on public health and safety, such as increased taxes, and better enforcement of laws to prevent sales to intoxicated patrons or underage persons.

(Flowers, NT, Naimi, TS, Brewer, RD, Elder, RW, Shults, RA, Jiles, R: Patterns of alcohol consumption and alcohol-impaired driving in the United States. Alcoholism: Clinical and Experimental Research 32:639-644, 2008)

A third of the 140 million employed persons in the US report past month alcohol use. From 13% to 31% of the workforce experience alcohol-related problems yet do not meet the criteria for alcohol abuse or alcohol dependence. Brief intervention for at-risk drinking has been shown to reduce health, occupational, and social problems. Workplace studies have shown that Brief Interventions (BI) have been effective in reducing negative drinking consequences even when implemented by facilitators who do not specialize in addiction. Employee Assistance Programs (EAP) offer counseling to employees who seek or are referred for help, usually for personal problems affecting their attendance, performance, or behavior on the job. This Rand Corporation study looked at the value of screening for alcohol-related problems using brief interventions in the Employee Assistance Program setting.

In this study, 107 clients entering the EAP for mental health services were screened and met criteria for at-risk drinking. EAP therapists were randomly assigned to two groups to provide either brief intervention (BI) plus EAP or services as usual (SAU).The final analysis consisted of 44 BI plus SAU and 30 SAU only with a three month follow-up.

Results indicated that participants in the BI plus SAU group had significant reductions in peak blood alcohol consumption, peak alcohol quantity, and alcohol-related adverse consequences compared with the SAU group. These findings provide evidence to support the use of alcohol screening and BI as a low-cost way to intervene with clients with at-risk drinking in the context of their EAP presenting problem.

(Osilla, K., Zellmer, SP, Larimer, ME, Neighbors, C, Marlatt, GA: A brief intervention for at-risk drinking in an employee assistance program. Journal of Studies on Alcohol and Drugs 69:14-20, 2008)

Despite the success of pharmacotherapies for alcohol and drug disorders a significant number of treatment providers and programs have been slow to adopt these new medications. This study examined how the structural variations of private treatment centers may affect their adoption of naltrexone (Revia) – an opiate antagonist used in the treatment of both opiate and alcohol dependence.

Researchers analyzed information gathered on 165 private Substance Abuse (SA)treatment centers by the National Treatment Center Study, which currently contains four waves of data collected between 1994 and 2003. Specifically, they looked at the impact of culture, leadership characteristics, internal structure, and external characteristics on the likelihood of naltrexone being adopted as part of the treatment protocols.

Results showed that the majority of the private treatment facilities were based on a 12-Step philosophy (93%) and also held 12-Step meetings on their premises (80%). In a multivariate model those programs employing a 12-Step model were less likely to adopt naltrexone. The researchers noted that AA recommends that members follow their physician’s advice and be medication compliant. Nonetheless, these structural characteristics clearly had an impact on openness to innovative practices. In addition those organizations utilizing a 12-Step model and those employing more experienced administrators were significantly less likely to adopt naltrexone. Conversely, those that used prescription drugs, possessed an employee handbook, were accredited, and operated on a for-profit basis were significantly more likely to adopt naltrexone over time.

(Oser, CB, Roman, PM: Organizational-level predictors of adoption across time: Naltrexone in private substance-use disorders treatment centers. Journal of Studies on Alcohol and Drugs 68:852-861, 2007.)

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The past decade has produced research on relationships between neighborhood characteristics and health but few studies have specifically looked at how a neighborhood may play a role in shaping alcohol use and misuse. This study looked at the impact of the “urban built” environment – a reference to not only all the buildings of a neighborhood, but also the streets, parks, and public spaces within it – on recent alcohol use.

Researchers recruited 1,355 respondents through a random digit-dial survey of New York City (NYC) residents, using structured interviews to both assess their alcohol consumption and determine their neighborhood of residence. Study authors then used archival sources to compile data on the “internal and external built” environments in the pertinent 59 NYC neighborhoods. A neighborhood’s “built environment” can be thought of as everything in the neighborhood but the people who live there. “Internal built” environment is defined as the internal characteristics of individual homes – such as the condition of plumbing, painting, kitchen equipment, water leakage, heating, etc. “External built” environment is defined as characteristics of the façade or structure of the home – walls, window frames, cracks, missing stairways, poor original construction, etc.

Results support a link between heavy alcohol use and the urban built environment. More specifically, people who lived in neighborhoods characterized by poorly built environments were up to 150 percent more likely to report recent heavy drinking than similar respondents in neighborhoods with better built environments. This study of the complex relationship between neighborhood characteristics and alcohol use points to the need for further examination. The study did conclude that the quality of a neighborhood’s built environment may be associated with heavy drinking in urban populations independent of individual characteristics.

(Bernstein, KT, Galea, S, Ahern, J, Tracy, M, Vlahov, D: The built environment and alcohol consumption in urban neighborhoods. Drug and Alcohol Dependence 91:244-252, 2007).

Prior research has shown that as the cost of alcohol, tobacco and illicit drugs decrease, their abuse increases… and vice versa. This study wanted to see if the same principle applies to prescribed medications: specifically, if the introduction of generic products in the U.S. increased the therapeutic use and illicit abuse of oxycodone products, generally prescribed as pain medication, and the fentanyl patch, used for chronic pain management.

Researchers began with abuse data that they already possessed and then purchased corresponding prescription data by ZIP code: from 2003 to 2006 for oxycodone products and the latter part of 2006 for the fentanyl patch. Study authors also gathered analysis and commentary from a network of 351 drug-abuse experts – predominantly treatment specialists – with a history of being able to identify abuse of branded drugs as they become available.

Results showed that reduced drug costs alone do not increase the overall likelihood that a prescription opioid analgesic will be used more therapeutically or abused even at cost savings of over 45% in the case of fentanyl. The introduction of generic versions of oxycodone and fentanyl products saw a dramatic drop in sales of the branded products with a compensating increase in generic sales. Yet the branded oxycodone and fentanyl products remained the “drugs of choice” for abuse for at least two more years.

The results did not support the hypothesis that overall abuse of opiod analgesics would rise significantly with the availability of cheaper generics as had been previously observed for alcohol and illicit drugs.

(Cicero, TJ, Inciardi, JA, Surratt, H: Trends in the use and abuse of branded and generic extended-release oxycodone and fentanyl products in the United States. Drug and Alcohol Dependence 91:115-120, 2007.)

ey words –

Several tools have been developed in recent years to diagnose a variety of psychiatric disorders, including alcohol and drug dependence. Researchers at the University of Connecticut Health Center used individual criteria from the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM-IV) to assess the  diagnostic reliability of a relatively diagnostic instrument – the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA).

The SSADDA is a comprehensive series of psychiatric interviews that assesses the physical, psychological, social, and psychiatric manifestations of alcohol and other drug abuse and dependence as well as a variety of psychiatric disorders in adults.

The researchers recruited 293 subjects in total: 159 from substance-abuse treatment facilities, 59 from inpatient and outpatient psychiatric services, and 75 respondents from the community. The participant total contained just slightly more women (52.2%) than men. Participants were predominantly European American (46.8%), followed by African American (38.2%), and then Hispanic (7.5%). All of the subjects were interviewed twice during a two-week period. The researchers examined inter-rater reliability (will the same test given by different interviewers produce the same results?) and test-retest reliability (will responses of later interviews correspond to earlier responses to the same interviewer?) for dependence on nicotine, alcohol, cocaine, opioids, cannabis, stimulants and sedatives.

Results indicate that the SSADDA can be used reliably to assess substance dependence. The authors contend that – given its reliable assessment of both individual criteria and diagnoses, its poly-diagnostic nature, its ability to be administered by non-clinicians, and its computer-assisted format (which includes internal consistency checks) – the SSADDA can be a useful diagnostic instrument for a variety of applications – including genetic and family studies of substance dependence.

(Pierucci-Lagha, A, Gelernter, J, Chan, G, Arias, A, Cubells, JF, Farrer, L, Kranzler, HR: Reliability of DSM-IV diagnostic criteria using the semi-structured assessment for drug dependence and alcoholism (SSADDA). Drug and Alcohol Dependence 91:85-90, 2007.)

OxyContin is a sustained-release oxycodone preparation that can provide safe and effective relief from chronic pain for 12 hours. During the latter part of the 1990s, the practice of crushing OxyContin tablets – thereby “jumpstarting” the release of the contained opioid – and then inhaling or dissolving and injecting the powder became popular for its pronounced “high.” Several scientific studies found that the role of OxyContin is minimal in the use and abuse of pharmaceutical opioids. A very different characterization of the increase in pharmaceutical opioid use is found in popular media. Some went so far as to call it a plague. Many of these media reports characterized most of those who became dependent as innocent, drug-naïve individuals who became addicted after unnecessary prescribed use. To scientifically scrutinize this characterization, this study looked at pharmaceutical opioid addiction among patients in substance-abuse treatment.

Researchers examined data gathered from 27,816 patients (64% male, 36% female; 42% white, 42% black) who were admitted to 157 treatment programs in the U.S. from 2001 through 2004. Collected information included: lifetime and past 30-day use of OxyContin and other drugs prior to admission, any chronic medical problems, source of drug supply, and prior treatment history.

Only approximately five percent of the observed population reported any prior use of the drug OxyContin. Nearly 80% of the patients who did report OxyContin use stated the drug had not been prescribed for any medical reason, that they used the drug to get a “high” or “buzz” and had prior treatment for a substance use disorder.

Thus, contrary to media reports, the OxyContin was most frequently obtained from non-medical sources as part of a broader and longer-term pattern of multiple substance abuse.

(Carise, D, Dugosh, K, McLellan, A, Camilleri, A, Woody, G, Lynch, K: Prescription oxycontin abuse among patients entering addiction treatment. American Journal of Psychiatry 164:1750-1756)

Many people may be confused by what appears to be contradictory findings regarding the effects of alcohol consumption on cardiovascular health or, more specifically, Ischemic Heart Disease (IHD) mortality. Previous studies of data from 74 countries found that the relationship between alcohol and heart disease differed based on drinking patterns. Interestingly, unlike most western countries, U.S. drinking patterns include a high rate of abstention from alcohol – currently around 35 percent of the population – while the percentage of drinkers, after peaking in 1981 at more than 70 percent, has remained around 65 percent ever since. This study looked at both the protective and harmful effects of U.S. drinking at an aggregate (population) level.

Researchers gathered and analyzed U.S. population-level data from 1950 to 2002 that pertained to: IHD mortality rates, per capita consumption of alcoholic beverages, cirrhosis mortality rates, cigarettes, and sugar-sweetened soda.

Results show that alcohol has a complex relationship with IHD. Similar to previous individual-level studies, this population study found protective effects from moderate drinking and harmful effects from heavy drinking. The authors contend that these findings underscore the importance of considering drinking patterns when discussing alcohol-related health outcomes. The negative health effects of cigarette smoking and drinking regular soda were also confirmed. The clearest finding of the study is that cigarette smoking has been a substantial contributor to IHD in the U.S.

(Kerr, WC, Ye, Y: Population-level relationships between alcohol consumption measures and ischemic heart disease mortality in U.S. time-series. Alcoholism: Clinical and Experimental Research 31:1913-1919, 2007.)

Key words –

Auto accidents are a leading cause of death among teens and young adults. A substantial number of these fatalities result from driving after drinking or using drugs. Efforts to reduce driving after drinking have met some success but little is known about the extent of youth driving after use of marijuana or other illicit drugs. The National Study on Drug Use and Health reported in 2002 that 15%-18% of persons 18-21 years old drove after drinking or using illicit drugs in the previous year. Clearly a considerable amount of driving after illicit drug use is occurring. However, little is known about the psychosocial aspects of this driving or riding in the vehicle.

This University of Michigan study found that driving or riding after drinking or using illicit drugs was widespread among US high school seniors. Of seniors in classes 2001-2006 who reported driving under the influence in the prior two weeks, 14.2% had been drinking alcohol while 13.1% had used marijuana. The most striking finding was the sheer numbers of high school seniors who put themselves at this sizeable risk. In 2006 30% of high school seniors reported that during the prior two weeks they had either driven after drinking heavily or using drugs, or ridden in a car in which the driver had been drinking heavily or using illicit drugs.

There is some belief that driving after smoking marijuana is not as dangerous as driving after drinking alcohol. Of note, these researchers found that individuals who reported driving after marijuana use and having an accident in the prior 12 months was just about as frequent as those having accidents after heavy drinking. Variations by population density were not significant and variations by region were not great. Living with both parents seemed to provide some protection while higher socioeconomic status did not. Compared with white students, Hispanics were much less likely to drive after using marijuana while black students were less likely to drive after heavy drinking.

As might be expected, lifestyle factors such as high religiosity, good grades, few absences, and infrequent fun nights out resulted in less risk. The study concluded that impaired driving by youth needs serious attention in spite of some recent progress.

(O’Malley, P, Johnston, L: Drugs and driving by American high school seniors, 2001-2006. Journal of Studies on Alcohol and Drugs 68: 834-832,2007)

Much is known about the damaging effects of alcoholism on the cognitive (thinking) function of the brain. There is also a growing body of knowledge on how much recovery occurs with abstinence.
However, there is little research available on cognitive functioning in very long term abstinent alcoholics, especially the elderly.

This research examined 91 elderly abstinent alcoholics (EAA) (49 men and 42 women) with an average age of 67.3 years and who were abstinent for an average of 14.8 years. They were compared to a comparable light/non-drinking control group. The EAA group was divided into three subgroups: abstinent before age 50 (EAA1), between 50 and 60 (EAA2), and after age 60 (EAA3). They were assessed for cognitive functions such as attention, verbal skills, cognitive flexibility, immediate and delayed memory, reaction time, and auditory working memory. EAA1 was the only group to perform worse than the controls and this was only in the one category of auditory working memory. Since this group had fewer years of education and auditory working memory is associated with education, this finding should be interpreted with caution. The EAA1 group had the highest family history density for alcoholism and the earliest onset of alcoholism which may have contributed to impairments in auditory working memory. Surprisingly, groups EAA2 and EAA3 performed better than controls in a number of cognitive functions.

The study concluded that these elderly alcoholics, even if they drank late into life but had at least 6 months of abstinence, exhibited normal cognitive brain function.

However, the researchers point out that approximately 75,000 deaths each year are attributed to either excessive or risky drinking, making alcohol the third leading actual cause of death. It may be that cognitively healthier alcoholics with more reserve brain capacity are more likely to survive with relatively intact cognition into their 60s, 70s, or 80s and be more likely to volunteer for studies such as this. Thus these findings, though positive, hopefully do not imply that all elderly alcoholics with long term abstinence will retain normal cognition.

(Fein, G, McGillivray, S: Cognitive performance in long-term abstinent alcoholics. Alcoholism: Clinical and Experimental Research31:1788-1789)

Women are underrepresented in most alcohol and drug treatment programs. They also often have special accompanying issues, such as child-care responsibilities and past trauma. These issues may be overlooked or discounted in a mixed-gender setting. In fact, many women with substance-use disorders (SUDs) report that all-female groups provide a safer and more comfortable treatment environment. This study tested a treatment program that is women-focused and women-only in design.

Researchers recruited patients with SUD from local hospital programs, clinician referrals, etc. Participants were then randomly assigned to either women-focused group therapy (n=16) called the Women’s Recovery Group (WRG), or a mixed-gender (n=7) Group Drug Counseling (GDC). The WRG is a new 12-session relapse-prevention group therapy that utilizes a cognitive-behavioral approach; the GDC is known to be an effective treatment for SUDs.

During the 12 weeks of treatment, there were no significant differences in substance-use outcomes between the WRG and GDC groups. However, during the six-month follow-up, WRG members showed a pattern of continuous reductions in substance use, while GDC members did not. Furthermore, WRG members with alcohol dependence had significantly greater reductions in average drinks per drinking day than GDC members. The results suggest that women-focused and women-only treatment groups have long-term positive outcomes.

(Greenfield, SF, Trucco, EM, McHugh, RK, Lincoln, M, Gallop, RJ: The Women’s Recovery Group study: A Stage 1 trial of women-focused group therapy for substance use disorders versus mixed-gender group drug counseling. Drug and Alcohol Dependence 90:39-47, 2007.)

Researchers in this study highlighted a particular case in the Russian town of Izhevsk in which surrogate alcohol consumption was the underlying cause of death in 30% of men aged 25 to 54.

Surrogate alcohol is homemade beverages and non-beverage alcohol not intended for consumption, such as aftershaves, antifreeze, and the like. Surrogate alcohol is defined as both non-beverage alcohol and illegally produced or homemade alcohol. There is little research on diseases and mortality rates due to the consumption of these products.

Surrogate alcohol use is common in many countries. In the U.S., “moonshine” has historically been produced in automobile radiators or copper tubes sealed with solder. Leaching of lead from these methods can result in lead poisoning. Other chemicals such as arsenic, copper, and zinc have also been found in significant quantities in homemade alcoholic beverages. Illegally produced beverages in the U.S. and other countries have been found to contain toxic levels of methanol and volatile substances. The most common form of toxicity associated with surrogate alcohol is accidental poisoning. Poisoning can occur slowly over time with lead toxicity or acutely with compounds like methanol. Methanol occurs naturally in legally produced alcohol without causing harm. However, illicit drinks and non-beverage substances such as chemicals for photocopy machines contain high levels of methanol, which can cause severe illness and death.

Despite improvement in treatment, methanol poisoning still has a high mortality rate. In the U.S. between 1993 and 1998, 13,524 cases of poisoning were attributed to methanol, and windshield wiper fluid was involved in 61% of the cases. Ingestion of high levels of methanol leads to organ damage, damage to the central nervous system, and liver, retinal, and renal damage. High levels of lead have been linked to damage of the central nervous system, the peripheral nervous system, and the hematopoietic (blood), renal, and gastrointestinal systems.

Researchers recommend prevention strategies to prevent consumption of surrogate alcohol, including the global abolition of methanol in “denatured” alcohol. Bittering agents that make non-beverage alcohol such as medicinal alcohol and technical/automobile products undrinkable are preferable as only low amounts are necessary to render a product undrinkable. The sale of large container sizes could also be regulated globally to curb the consumption of medicinal alcohol.

Further research is needed to better understand who buys surrogate alcohol, under what circumstances, and for what reasons.

(Lachenmeier, DW, Rehm, J, Gmel, G: Surrogate alcohol: What do we know and where do we go? Alcoholism: Clinical and Experimental Research 31: 1613–1624, 2007.)

New evidence suggests that spiritual orientation may play a role in recovery. Previous studies offer evidence that spirituality increases after recovery, that greater spirituality is associated with longer recovery, and that those who reported a spiritual awakening during participation in a 12-Step program were much more likely to report total abstinence after 3 years than were those who never experienced a spiritual awakening.

Researchers sought to more precisely determine the role of spiritual change in patients in recovery by examining the relationship between 12-Step involvement, spiritual change, and reduction in alcohol and drug use. Specifically, the study was designed to identify whether the recovery benefits of spiritual change might simply be an unrelated side effect of 12-Step involvement, whether spiritual change helps drive the benefits of 12-Step involvement, or whether spiritual change has a beneficial effect independent of 12-Step involvement.

The study followed 733 patients admitted for treatment. A questionnaire was administered at intake, and again after 12 months. Seventy-three percent of the original group, or 537 patients, were successfully followed through 12 months. The questionnaire measured spirituality through the Religious Background and Behaviors scale (RBB), as well as a single question regarding spiritual awakening or conversion. At the conclusion of the study participants were also asked if they had been abstinent from alcohol and drugs for the past 30 days.

The study found that 61% of participants achieved 30-day abstinence after 12 months. Further, 27% reported a spiritual awakening at study onset, and another 22% reported a spiritual awakening during treatment. Abstinence rates among those who experienced a spiritual awakening during treatment were significantly higher than those who experienced no change (82% versus 55%). Level of spirituality at study outset had no association with treatment outcomes.

A similar benefit was found for those who increased their involvement in the 12-Step program over the course of treatment as compared to those who decreased or had no change in involvement (72% versus 47%). Significantly, an increase in 12-Step involvement was associated with higher RBB scores and higher odds of a spiritual awakening. Further analyses suggested that the effects of 12-Step involvement on treatment outcomes were partially due to the effects of 12-Step involvement on spirituality.

The author concludes that spiritual change helps explain the relationship between increases in 12-Step involvement and better treatment outcomes while also confirming that baseline religiosity is a poor predictor of treatment outcomes.

(Zemore, SE: A role for spiritual change in the benefits of 12-Step involvement. Alcoholism: Clinical and Experimental Research 31: 76S–79S, 2007.)

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More than 10 years ago, the 1990-1992 National Comorbidity Survey (NCS) looked at the use of “extra-medical” drugs: alcohol, tobacco, psychoactive prescription drugs used outside of the prescribed purpose, and illegal drugs.

This study revisits that issue, analyzing more recent data from the 2001-2003 NCS-Replication (NCS-R). The face-to-face household survey collected responses from 5,692 English-speaking respondents who were 18 years of age or older (3,310 men, 2,382 women), using the World Health Organization Composite International Diagnostic Interview.

Despite a decade-plus span dividing the two surveys, the similarities of drug use are noteworthy. Alcohol use was the same for both the NCS and NCS-R, at 92%. Tobacco use was at 76% (NCS) and 74% (NCS-R). Extra-medical use of psychoactive drugs was at 51% (NCS) and 45% (NCS-R). Marijuana use was at 46% (NCS) and 43% (NCS-R). Finally, cocaine use was at 16% for both the NCS and NCS-R.

Statistically notable associations were seen among all types of drug use and age, sex, income, employment, education, marital status, geography, religious affiliation and religiosity. Here  are a few examples: 46% of the 1947-1957 age cohort reported having used marijuana as compared to 6% of the 1904-1942 group. Non-Hispanic Whites were most likely to engage in extra-medical use of other drugs compared to other race-ethnicity groups. Blacks were less likely than non-Hispanic Whites to have started smoking. Persons who had not attended college were most likely to have started tobacco use while less likely to have used alcohol or marijuana. Those who had never married were less likely to have started smoking, drinking or using extra-medical drugs. Those with high incomes were most likely to have engaged in extra-medical use of all drug types except cocaine. Residents of rural areas were just as likely to smoke and drink as city dwellers but less likely to use other drugs. Those for whom religion was less important were more likely to have used all drug types.

The authors note that, while these findings lead to no firm cause-and-effect interpretations, they do provide a foundation for further research into drug use across decades and birth populations.

(Degenhardt, L, Chiu, WT, Sampson, N, Kessler, RC, Anthony, JC: Epidemiological patterns of extra-medical drug use in the United States: Evidence from the National Comorbidity Survey Replication, 2001-2003. Drug and Alcohol Dependence 90:210-223, 2007.)

Increasing evidence suggests modulating effects of cannabinoids on time of onset, severity, and outcome of schizophrenia. Two recent large-scale studies have found that people who use marijuana have a two-fold risk of later developing schizophrenia, depending on when they started using and how often. If schizophrenia does develop, marijuana-using patients seem to experience more severe symptoms and suffer more frequent relapses. There is a known flushing response to niacin and a relationship between the severity of this flushing and long term marijuana use. This study looked at the relationship between marijuana’s delta-9-tetrahydrocannabinol (THC) and niacin sensitivity as a potential marker of lipid-arachidonic alterations, possible indication of a genetic vulnerability for developing schizophrenia.

Participants comprised 64 (19 women, 45 men) patients who met Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition criteria for paranoid schizophrenia. Of these, 35 (5 women, 30 men) had used marijuana on a regular basis before admission; 29 had not. Researchers also recruited 53 (14 women, 39 men) healthy “controls” from the community for comparison; of these, 22 (3 women, 19 men) had used marijuana previously, 31 had not. Study authors tested participants for niacin response by applying niacin patches in three concentrations onto the forearm skin and then assessing flush response in three-minute intervals during a 15-minute span.

The observed differences in flush response showed a definite impact of long-term marijuana use on lipid-arachidonic acid pathways. Given the preexisting vulnerability of lipid metabolism in schizophrenia, these results support the theory that marijuana use is involved in the underlying gene/environment factors associated with schizophrenia.

(Smesny, S, Rosburg, T, Baur, K, Rudolph, N, Sauer, H: Cannabinoids influence lipid-arachidonic acid pathways in schizophrenia. Neuropsychopharmacology 32:2067-2073, 2007.)

Participation in 12-Step self-help groups has been shown to both reduce post-treatment relapse and the need to repeat treatment. A recent VA study compared two different kinds of 12-Step referral: standard and intensive.
For standard referral, patients received a schedule for local 12-Step meetings and were encouraged to attend. For intensive referral, counselors linked patients with 12-Step volunteers and encouraged the use of journals to record 12-Step meeting attendance. Study participants (n=345) – patients in a 28-day treatment program – were randomly assigned to one or the other and subsequently asked to self-report on their 12-Step meeting attendance and involvement, as well as their substance use at baseline, six months and one year later. Patients who received intensive referral fared better than patients who received standard referral. More specifically, these individuals were more likely to attend and be involved with 12-Step groups at both six months and one year after beginning and also improved more on their alcohol and drug-use outcomes for the year. Study authors call intensive-referral intervention both brief and feasible and recommend its use by primary-care physicians, employee-assistance programs, and members of the clergy.

(Timko, C, DeBenedetti, A: A randomized controlled trial of intensive referral to 12-Step self-help groups: One-year outcomes. Drug and Alcohol Dependence 90:270-279, 2007.)

Prescription drugs – for pain, sedation, anxiety, and stimulation clearly have a legitimate medical use. Just ask those people who suffer from acute and chronic pain, insomnia, anxiety, attention-deficit hyperactivity disorder, and other psychiatric disorders. Unfortunately, these medications also have great potential for misuse, abuse, and dependence. This study examined changes in the prevalence of non-medical prescription drug use and disorders for the periods of 1991/1992 and 2001/2002.

Researchers examined two large national surveys conducted 10 years apart: the 1991-1992 National Longitudinal Alcohol Epidemiologic Survey and the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions. Respondents (n=42,862 and n=43,093, respectively) were asked about past-year non-medical prescription drug use and drug-use disorders.

From 1991-1992 to 2001-2002 the prevalence of non-medical use of prescription drugs increased by 53%. Among their findings the researchers noted that misuse decreased with age, was significantly greater among women in the 1991-1992 period but not in the 2001-2002 period, and individuals with some college were less likely to abuse these drugs. In total, the results indicate alarming increases in the prevalence of both prescription drug non-medical use as well as prescription-drug disorders. The study authors recommend urgent action to find better means of balancing legitimate need for prescription drugs against this proven potential for abuse and dependence.

(Blanco, C, Alderson, D, Ogburn, E, Grant, BF, Nunes, EV, Hatzenbuehler, ML, Hasin, DS: Changes in the prevalence of non-medical prescription drug use and drug use disorders in the United States: 1991-1992 and 2001-2002. Drug and Alcohol Dependence 90:252-260, 2007.)

(A person’s deoxyribonucleic acid (DNA) is his/her personal blueprint, a complex database of chemical information that ensures the production of proteins that a cell needs to survive. The body has trillions of cells, each of which has 46 chromosomes, each of which is made up of 50 to 250 million bases. The DNA in each chromosome contains thousands of genes. Genes usually code for a particular protein, such as an enzyme. A single gene can also have multiple alternative forms called alleles. Humans, and most animals, have two alleles for any given gene.)

The enzyme mitochondrial aldehyde dehydrogenase 2 (ALDH2) is crucial for the metabolism or oxidation of acetaldehyde that is generated during alcohol consumption. Acetaldehyde is far more toxic than alcohol itself. People with genetic mutations of this enzyme tend to experience a very unpleasant flushing and nausea when they drink. This means the mutation may actually reduce a person’s risk of developing alcohol dependence. Jews have fewer alcohol-related problems compared with other Caucasian groups. It is unclear whether cultural, religious, or biological factors are responsible. This study examined the effects of two variants of ALDH2 alleles (*A and *G) on reactions to alcohol among Jewish individuals.

ALDH2 genotyping was performed on 53 Jewish college students (29 women, 24 men) from a Midwestern university and 76 Jewish individuals (40 women, 36 men) from a large Midwestern city, all of Ashkenazi or Eastern European descent. Researchers examined associations between ALDH2*A and ALDH2*G alleles and self-reported alcohol consumption and responses to alcohol.

The study discovered that Jewish persons with the ALDH2*A allele drank fewer drinks per occasion, and reported feeling drowsy after a smaller number of drinks, but interestingly did not drink significantly less frequently than individuals without the ALDH2*A allele. The study does suggest that ALDH*2 status correlates with variations in alcohol drinking among Jewish populations.

(Fischer, M, Flury Wetherill, L, Carr, LG, You, M, Crabb, DW: Association of the aldehyde dehydrogenase 2 promoter polymorphism with alcohol consumption and reactions in an American Jewish population. Alcoholism: Clinical and Experimental Research 31:1654-1659, 2007.)

Despite the high prevalence of both alcohol and illegal substance use, little research has been conducted on concurrent and simultaneous use of alcohol and drugs. Concurrent use is defined as the use of alcohol and other drugs during the same time period, while simultaneous use is the use of alcohol and other drugs at the same time.

Using data from the 2000 National Alcohol Survey, researchers looked at the prevalence of concurrent and simultaneous use of alcohol with marijuana, cocaine/crack, uppers, downers, heroin/opiates, hallucinogens, and painkillers in the general U.S. population. Researchers also examined the role of gender, age, ethnicity, income, educational level, and marital/relationship status in concurrent and simultaneous alcohol and drug use. Furthermore, researchers wanted to learn whether concurrent or simultaneous users differ from drinkers who do not also use drugs in terms of alcohol-related problems, alcohol dependence, and depression.

The data were gathered from telephone interviews with 7,612 respondents from all 50 states and Washington D.C. Analyses revealed that approximately 10% of current drinkers also reported using marijuana in the past 12 months. Simultaneous use was reported by 7%, and 3.3% used marijuana and alcohol during the same time period (concurrent use). The prevalence rates for simultaneous use of alcohol with marijuana were much higher than those of alcohol with other drugs. Only 1.7% of current drinkers reported using alcohol and other drugs simultaneously.

The study revealed that being younger, having less than a high school education, not having a regular partner, and having heavier drinking patterns were associated with simultaneous use of marijuana and alcohol. Unsurprisingly, the simultaneous use of other drugs and alcohol was significantly associated with adverse social consequences, alcohol dependence, and depression.

These findings underscore the need for prevention and treatment programs targeting both alcohol and drug use. Prevention programs, particularly those for adolescents, should focus on motivational and environmental factors surrounding polydrug use.

(Midanik, LT, Tam, TW, Weisner, C: Concurrent and simultaneous drug and alcohol use: Results of the 2000 National Alcohol Survey. Drug and Alcohol Dependence 90: 72–80, 2007.)

Key words –

Medications for alcohol and drug dependence have been developed, tested and available for some time in the U.S. Yet their rate of adoption by American treatment organizations appears to be slow. This study is one of the few to examine the availability and use of pharmacotherapies in various treatment settings.

Researchers gathered data from 403 privately funded, and 363 publicly funded, treatment centers in the U.S. They analyzed the availability of agonist medications such as methadone and buprenorphine, used mainly for people dependent on opioids (an agonist is a medication that binds to a receptor in the brain and triggers a specific result); naltrexone and disulfiram, used for alcohol, cocaine, and opioid dependence (naltrexone is an opioid receptor antagonist used primarily in the management of alcohol and opioid dependence; an antagonist is a medication that binds to a receptor and prevents an agonist from working on the receptor); disulfiram (Antabuse) is a drug used to aid in the treatment of chronic alcoholism by producing an acute sensitivity to alcohol; and selective serotonin reuptake inhibitors (SSRIs), commonly used to treat depression but which also have potential to facilitate compliance with taking naltrexone.

The study determined there to be considerable variation in the use of mediations across publicly-funded nonprofit, government-owned, privately-funded non-profit, and for-profit treatment centers. Some of these differences were affected by organizational factors such as accreditation, the availability of staff physicians, and the availability of detoxification. However, the authors suggest that the availability of staff physicians may be key to the greater use of pharmacotherapies (medications) for substance abuse.

(Knudsen, HK, Ducharme, LJ, Roman, PM: The adoption of medications in substance abuse treatment: Associations with organizational characteristics and technology clusters. Drug and Alcohol Dependence 87:164-174, 2007.)

Most research on drug abuse and dependence has looked at possible gender differences in “risk of first use” and “persistence of dependence.” So this study looked at male-female differences in their progression from first use to clinical dependence upon marijuana, cocaine, and alcohol.

Researchers analyzed a sample of non-institutionalized men and women 15 to 44 years of age in the U.S. (3558 marijuana users, 1337 cocaine users, and 6149 alcohol drinkers.) All had reported using their drug on at least one occasion.

Results showed notable male-female differences in the risk of becoming marijuana-dependent during the first several years after first use, less-pronounced male-female differences for alcohol, and even smaller male-female differences for cocaine. In general, however, first use risk was greater for young men and greater for alcohol than marijuana and cocaine; and highest risk of first use of marijuana and alcohol was between 18 and 19 years of age, and 21 to 22 years of age for cocaine.

The risk of cannabis dependence among male cannabis users was 1% in the first year after first use, and reached a peak at 4% two years later.

The estimated risk of cannabis dependence among female users remained at 1% per year for three years, without the peak.

For both male and female cocaine users, the estimated risk for developing cocaine dependence was 5% to 6% within the first year after first use. Thereafter, the estimated risk declined from the peak value, with a somewhat faster decline for females in the three years after first use.

For alcohol, the estimated risk period extended for many years after the first drink, with female drinkers becoming alcohol dependent at a rate of about 1% per year.

For both male and female drinkers, the period of risk for developing alcohol dependence extended for a span of more than 20 years since first use.

(Wagner, FA, Anthony, JC: Male-female differences in the risk of progression from first use to dependence upon cannabis, cocaine, and alcohol. Drug and Alcohol Dependence 86:191-198, 2007.)

A great deal of scientific study has focused on the relationship between alcohol use and factors such as age, gender, education, income, and others. An area of increasing interest among researchers is the association between religion and alcohol use. Religious beliefs and practices vary among the many faiths and even within denominations so its influence is difficult to measure and quantify. In a recent study, researchers looked at the relationship between religion and alcohol use by defining three variables: religious preference, religiosity, and proscription of alcohol use by a given religion. They also considered eight demographic variables: gender, ethnicity, education, income, marital status, age, geographic region of the U.S., and employment. One goal of the study was to learn whether religion variables are more significant than demographic variables and to what extent these variables, independently and in combination, predict abstention, moderate drinking, and heavy drinking.

As expected, after reviewing data from the most recent National Alcohol Survey of the year 2000, researchers found diverse patterns of drinking among religious affiliations. For example, being Mormon, Muslim, Church of God, Pentecostal, Protestant, or Baptist was associated with abstinence, while Jehovah’s Witness, Lutheran, and Catholic were associated with heavy drinking. The adherents of the European Free Church or Judaism were found to be moderate drinkers. Those with the highest rates of frequent heavy drinking were Catholics and those who espoused No Religion (agnostics and atheists). An unusual finding was that 18.9% of those who espoused No Religion nevertheless responded that religion was important to them, indicating that it is possible to be spiritual without affiliating with a particular religious practice. Analyses showed that religiosity and proscription work together to increase rates of abstention.

In heavy versus moderate drinking, religion was a factor, but secondary to the demographic variables of gender and age. Men were found less likely to be religious and abstaining than women, and were more likely to be heavy drinkers. Younger adults in the 18-29 age groups also are more likely to be heavy drinkers. A significant and positive finding was that the current abstention rate in the U.S. has steadily increased over the years 1984 through 2000. The data revealed a strong correlation between religion and these increases.

(Michalak, L, Trocki, K, Bond, J: Religion and alcohol in the U.S. National Alcohol Survey: How important is religion for abstention and drinking? Drug and Alcohol Dependence 87: 268–280, 2007.)

While it is well known that psychiatric disorders often co-occur with substance-abuse disorders – called co-morbidity – it is often unclear which symptoms are a result of which disorder. Most studies only measure psychiatric illnesses severe enough that they meet diagnostic thresholds. This study proposes a “sub-diagnostic” approach, measuring psychiatric co-morbidity among alcoholics along a continuum of symptoms.

Researchers examined two groups recruited from the community: 48 (25 men, 23 women) long-term abstinent alcoholics, and 48 age- and gender-matched light or non-drinking “controls.” Continuous measures of pathology were used, such as symptom counts and psychological assessments, in the domains of anxiety, mood, and externalizing pathology.

Using this broader range of criteria, the psychiatric symptom counts and psychological pathology were found to be greater among the alcoholics than among the controls. The authors contend that, unlike the use of diagnostic criteria, employing continuous measures of psychiatric symptomatology and psychological abnormality yields a much more accurate picture of co-occurring psychiatric illnesses among alcoholics.

(Fein, G, Di Sclafani, V, Finn, P, Scheiner, DL: Sub-diagnostic comorbidity in alcoholics. Drug and Alcohol Dependence 87:139-145, 2007.)

Between 50 and 90 percent of persons who seek alcoholism treatment in North America are chronic smokers. Previous studies have shown that patterns of neurocognitive dysfunction (loss of the ability to concentrate, remember things, process information, learn, speak, and understand) among heavy smokers are very similar to those observed in alcoholics. This study looked at neurocognitive recovery among abstinent 
alcoholics who continued to smoke heavily.

Researchers gathered three groups for long-term study: 13 nonsmoking alcoholics in recovery (12 men, 1 woman), 12 actively smoking alcoholics in recovery (11 men, 1 woman), and for comparison’s sake, 22 nonsmoking and light-drinking individuals (20 men, 2 women) known as “controls.” Study authors examined what neurocognitive changes occurred among the two alcoholic groups in recovery during six to nine months of alcohol abstinence, comparing their performance with that of the controls.

Heavy smoking appears to interfere with brain recovery among abstinent alcoholics. More specifically, nonsmoking alcoholics in recovery showed greater improvement in several domains of neurocognitive function. The nonsmokers were superior to smokers on measures of auditory/verbal learning, auditory-verbal memory, cognitive efficiency, executive skills, processing speed, and working memory.

(Durazzo, TC, Rothlind, JC, Gazdzinski, S, Banys, P, Meyerhoff, DJ: Chronic smoking is associated with differential neurocognitive recovery in abstinent alcoholics: A preliminary investigation. Alcoholism: Clinical & Experimental Research 31:1114-1127, 2007.)

The suicide rate among patients with substance-use disorders (SUDs) prior to treatment may be as high as 45%. Little is known, however, about suicide risk factors during treatment and after discharge. To improve treatment options for those with potential for self harm, researchers in a recent study compared rates of suicide attempts of patients in the year prior to treatment versus the year following discharge. Treatment setting (outpatient and residential), length of treatment, availability and use of psychiatric treatment were also examined. The goal of the study was to identify aspects of treatment that may be important in preventing suicide attempts.

Participants in the study were men and women, most of whom had sought treatment for either alcohol and/or cocaine use. There were 31 outpatient programs and 23 residential programs involved, with the length of treatment averaging two months. Patients were interviewed at intake prior to treatment, when discharged, and one year after discharge. Twenty-six percent of 3,733 participants reported a suicide attempt during their lifetime and nine percent reported a suicide attempt within the twelve months prior to treatment.

At intake 67% of those who had attempted suicide reported that the attempts involved alcohol or drug use. These patients were more likely to be female and in treatment for problems with alcohol, cocaine, or more than one substance. Two percent of the patients reported suicide attempts during treatment and four percent reported an attempt in the year following discharge. Of these, 74% reported that their attempts were the result of drugs or alcohol.

Researchers found that suicide attempts during treatment were approximately three times as prevalent in outpatient programs as with residential programs. Patients involved in lengthier treatment programs had lower rates of attempts in the year following treatment. They suggest that a combination of residential treatment and follow-on treatment is appropriate for patients at high risk for suicide.

(Ilgen, MA, Jain, A, Lucas, E, Moos, RH: Substance use disorder treatment and a decline in attempted suicide during and after treatment. Journal of Studies on Alcohol and Drugs 68: 503–509, 2007.)

Key words –

The term “dually diagnosed” refers to patients with drug problems and co-occurring psychiatric disorders. Although previous research has shown that dually diagnosed individuals attend and benefit from 12-Step programs, the specifics of what may work or not work remains unclear. Existing data suggest that nonspecific change mechanisms (self-efficacy, social support) are similar to those described in general AA literature. This report is based on a review of 83 publications that addressed 12-Step programs serving patients with both addictions and psychiatric disorders.

The review shows that dually diagnosed individuals attend 12-Step programs at about the same rates as the non-dually diagnosed, although attendance is somewhat lower for those with psychotic disorders. Dually diagnosed individuals seem to improve in 12-Step programs just as much as in cognitive behavioral treatment. Specialized 12-Step programs for the dually diagnosed – such as “Double Trouble in Recovery” and “Dual Recovery Anonymous” – have potential benefits over and above those seen in traditional 12-Step programs because they address factors related to mental illness that play a significant role in recovery. However, availability of these specialized programs is still limited. The author recommends further work to identify the mechanisms of 12-Step recovery in the dually diagnosed.

(Bogenschutz, MP: 12-Step approaches for the dually diagnosed: Mechanisms of change. Alcoholism: Clinical & Experimental Change 31:64S-66S, 2007.)

Prior to this study, researchers already knew that stress and “alcohol cues” – reminders of drinking – could produce craving, and possibly relapse, in alcoholics. This study investigated how stress and alcohol cues may work on the brain to produce craving.

Researchers exposed 20 (18 males, 2 females) treatment-seeking alcoholics to a brief five-minute guided imagery procedure that involved three conditions: a recent personal, stressful situation; a personal alcohol-cue-related situation; and a neutral, relaxing situation. One image per session was presented in random order. The scientists also measured and compared alcohol craving, anxiety and emotion ratings, cardiovascular levels, and salivary assessments of the stress hormone cortisol across the three conditions.

Although both stress and alcohol cues appear able to produce increases in anxiety associated with alcohol craving, the specific psychobiology associated with each appears to be different. Stress-related craving was significantly correlated with increases in sadness, anger, and anxiety. Cue-induced craving was associated with decreases in joy and relaxed state, as well as increases in anxiety and fear. Also, while stress exposure increased blood-pressure responses, only alcohol cues increased salivary cortisol. These differences suggest that learning to recognize the different effects of stress and alcohol cues on craving may improve an alcoholic’s chances of avoiding relapse.

(Fox, HC, Bergquist, KL, Hong, K-I, Sinha, R: Stress-induced and alcohol cue-induced craving in recently abstinent alcohol-dependent individuals. Alcoholism: Clinical & Experimental Research 31:395-403, 2007.)

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Most alcohol-prevention projects are large, community-wide efforts with the intent of reducing alcohol-related problems such as assaults, automobile accidents, and other injuries. While these programs are effective in communities at large, certain neighborhoods within a larger community may benefit from more targeted strategies. For example, prior studies have shown that neighborhoods with a high density of alcohol outlets have more alcohol-related problems such as violence and drunk driving. Thus prevention efforts on the neighborhood level would benefit not only the neighborhood, but the larger community as well.

The Sacramento Neighborhood Alcohol Prevention Project (SNAPP) was implemented in two problem neighborhoods in Sacramento. The primary goal of SNAPP was to reduce youth and young-adult (ages 15 through 29) access to alcohol, risky drinking and its associated problems, particularly in low-income, ethnically diverse neighborhoods. Both the North and South neighborhoods had higher rates of crime and assaults than the community at large and also had higher concentrations of bars and other alcohol outlets per roadway mile.

Committees consisting of local law enforcement officers, medical service providers, alcohol beverage control agents, community activists, parents, youth, and members of community organizations were formed to design intervention strategies tailored to the needs of the two neighborhoods. Presentations of research findings on alcohol and local statistics were given to community groups, and informational flyers and brochures on underage drinking were distributed at meetings and door-to-door within the neighborhoods. Additionally, local law enforcement conducted sting operations in alcohol outlets in an effort to curb alcohol sales to minors and intoxicated individuals, and a Responsible Beverage Service program was implemented to help retailers train staff in complying with alcohol policies.
Analysis of the SNAPP project showed declines in sales to minors in both neighborhoods. Efforts to reduce sales to intoxicated patrons were less successful, perhaps in part due to the fact that clearly defined laws against selling to intoxicated persons do not exist. The most positive finding of the SNAPP project was the significant reduction in assaults as reported by police and EMS officers in both the North and South sites. The program costs appear to be justified given the reductions in medical treatment, lost wages, pain and suffering, and other costs associated with assaults, as well as in reductions in sales to minors.

(Treno, AJ, Gruenewald, PJ, Lee, JP, Remer, LG: The Sacramento neighborhood alcohol prevention project: Outcomes from a community prevention trial. Journal of Studies on Alcohol and Drugs 68: 197–207, 2007.)

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Many people believe that spirituality and/or religiousness (S/R) are important, if not crucial, components of successful recovery from alcohol dependence. This study attempted to quantify changes in S/R, and to see if those changes may have contributed to recovery.

Researchers collected longitudinal survey information from 123 outpatients (81 males, 42 females) with alcohol-use disorders at treatment entry and then again six months later. Study participants were asked about 10 measures of S/R, as well as their drinking habits.

Results indicate that half of the S/R variables changed significantly from treatment entry to six months later, particularly on the Daily Spiritual Experiences, Purpose in Life, S/R practices, Forgiveness, and Positive Religious Coping scales. There were also statistically significant decreases in alcohol use.

The results of this study support the perspective of many clinicians and recovering individuals that changes in spirituality and religion occur in recovery and are important to sobriety. Study authors contend that these results suggest that spiritual change in specific dimensions – particularly daily spiritual activities and a sense of purpose in life – may be particularly important in early recovery.

(Robinson, EAR, Cranford, JA, Webb, JR, Brower, KJ: Six-month changes in spirituality, religiousness, and heavy drinking in a treatment-seeking sample. Journal of Studies on Alcohol and Drugs 68:282-290, 2007.)

New medicines and advances in behavioral therapies have led to economic pressures to identify which of these interventions are the most efficacious and also the most cost effective. Even though alcoholism has costs – on personal, social, and health care levels – there have been few studies on how best to measure either the economic burden or the effect of treatment on economic outcomes. This study used the Economic Form 90, designed to measure changes in key economic outcomes following treatment for alcohol dependence. The objective was to examine the cost-effectiveness and cost-benefits of treatment. The Economic Form 90 can detect significant differences – across a range of dependence-severity levels – for the economic impact of inpatient medical care, emergency-department medical care, behavioral health care, being on parole or probation, and missed workdays if employed. Researchers used baseline data from the Combining Medications and Behavioral Interventions Study (a three-year study of 1,383 of alcohol dependent patients in treatment) to see if the Economic Form 90 can detect such differences.

Results indicate that the Economic Form 90 can be a useful tool in assessing the impact of recent economic events and for detecting changes in economic outcomes following treatment. More specifically, it can detect significant differences across a range of dependence-severity levels for the economic outcomes of inpatient medical care, emergency-department medical care, behavioral health care, being on parole or probation, and missed work days. The researchers did not find any significant cost differences across dependence severity for employment status, outpatient medical care, criminal justice involvement, or motor vehicle accidents. These findings may help identify therapies that not only work but are also cost-effective.

(Bray, JW, Zarkin, GA, Miller, WR, Mitra, D, Kivlahan, DR, Martin, DJ, Couper, DJ, Cisler, RA: Measuring economic outcomes of alcohol treatment using the Economic Form 90. Journal of Studies on Alcohol and Drugs 68:248-255, 2007.)

Beverage manufacturers spend billions on advertising, particularly at the point-of-purchase in stores. Such alcohol advertising includes special displays, in-store circulars, signs, and price discounts. In 2001, beer sales in supermarkets increased between 2.9% and 17% when point-of-purchase advertising was used.

There is a concern that in-store promotions of alcoholic beverages may lead to an increase in consumption. This study examined the sale of standard alcoholic beer, malt liquor, and nonalcoholic beer, available in 40-oz bottles, 6-packs, 12-packs, and cases (24-packs) from supermarkets in 64 retail market areas of the U.S. from 1995 through 1999. Demographics of the retail market such as age, race/ethnicity, and economic level were determined based on population, income, and economic data from federal agencies.
Researchers found that in-store promotions of beer were more prevalent during April-June and July-September. Larger package sizes (larger than 72 oz) tended to be more heavily promoted than smaller package sizes. Malt liquor and nonalcoholic beer were less likely to be promoted. During the years studied, the highest-selling beer brand, Budweiser, was also the most heavily promoted.

Marketing research has found that larger package sizes encourage more sales in a given period than smaller packages. This may lead to higher consumption of beer than would promotions of smaller package sizes. Other studies have also shown that greater beer promotions in large size packaging was also associated with heavy episodic drinking among college students. One positive finding was that the in-store beer promotions did not appear to target youths or racial and ethnic minorities.

(Bray, JW, Loomis, B, Engelen, M: Correlates of in-store promotions for beer: Differential effects of market and product characteristics. Journal of Studies on Alcohol and Drugs 68: 220–227, 2007.)

“Medication compliance” is defined as the extent to which a patient takes his/her medication according to a healthcare provider’s instructions. Pharmacotherapy trials of alcoholism have shown that compliance is equal to, or more important than, other areas of medicine. This study uses two different compliance methods to evaluate naltrexone’s efficacy in treating alcoholism as well as the impact of compliance on its effects. (Naltrexone is a drug used in the treatment of opioid or alcohol dependence. It is used after the patient has stopped taking drugs or alcohol and works by blocking the effects of narcotics or by decreasing the craving for alcohol. Naltrexone has been shown to be of value in preventing relapse.)

Of 160 alcohol-dependent patients (121 males, 39 females), 137 completed 12 weeks (84 days) of naltrexone or placebo and cognitive behavioral therapy (CBT) or motivational enhancement therapy (MET). Researchers simultaneously used urine riboflavin and the medication event monitoring system (MEMS) to measure compliance. [MEMS uses a medication bottle cap fitted with a microprocessor to capture the timing (date and time) of each medication-taking.]

Results indicate that using either method of compliance yields a greater treatment effect than not using a compliance measurement. The authors recommend that greater attention be given to ways of enhancing compliance during alcoholism treatment. (Ed. Note: Another name for “compliance” is “adherence.”)

(Baros, AM, Latham, PK, Moak, DH, Voronin, K, Anton, RF: What role does measuring medication compliance play in evaluating the efficacy of naltrexone? Alcoholism: Clinical & Experimental Research 31:596-603, 2007.)

The Alcohol Use Disorders Identification Test (AUDIT) was designed by the World Health Organization to screen for harmful drinking in various cultural settings. The test has been extensively researched to determine its capability to accurately and practically screen for alcohol problems. Since the 2002 review of the performance of the AUDIT by these same researchers, a large number of new studies has been published. This review is one of the very latest re-examinations of the AUDIT’s effectiveness. It summarized new findings and integrated them with previous research.

The review found that a growing body of evidence supports the validity of the English version of the AUDIT as a screening instrument for alcohol dependence as well as less severe alcohol problems. Its sensitivity and specificity are comparable to or exceed those of other alcohol screening methods. The test is brief, easy to score, relatively free of cultural bias and available without a royalty fee.

Research supports the continued use of AUDIT as a means of screening for a spectrum of alcohol-use disorders in various settings and with diverse populations. There is little evidence that the accuracy of the AUDIT varies with ethnicity. One study found that with modification of three items the AUDIT might also be appropriate for adolescents. In its present form the AUDIT did not seem particularly useful in evaluating alcohol problems in the elderly. Surprisingly, it seems the AUDIT is effective in evaluating possible accompanying alcohol problems in those suffering from severe and persistent mental illnesses.

(Reinert, DF, Allen, JP: The Alcohol Use Disorders Identification Test: An update of research findings. Alcoholism: Clinical & Experimental Research 31:185-199, 2007.)

Counseling in a medical setting for alcohol use is of proven value. It is also known that general health-care disparities clearly exist in the United States based on race, gender, and age as well as other characteristics. This medical center study sought to determine if disparities exist in physician counseling for alcohol use, and if so, based on what characteristics.

Researchers analyzed data collected through a telephone survey, the 1999 Behavioral Risk Factor Surveillance System. More specifically, they examined participant-reported physician counseling for alcohol use among 15,498 adults in five U.S. states. Participants reported their usual alcohol intake, risky drinking (intake of 5 or more drinks in one occasion, greater than 60 drinks a month, or driving after drinking), and whether a doctor had spoken to them about alcohol use.

The study concluded that clear racial and ethnic differences exist in physician counseling for alcohol use among both problem drinkers and abstainers: Black and Hispanic adults reported two-fold higher odds of having received counseling than Whites. Interestingly, no such disparity was noted for general diet counseling by physicians.

(Mukamal, KJ: Impact of race and ethnicity on counseling for alcohol consumption: A population-based, cross-sectional survey. Alcoholism: Clinical & Experimental Research 31:452-457, 2007.)

Cigarette smoking and alcohol use disorders (AUD) have been closely linked. Yet it is not clear whether higher rates of AUD among smokers are due to heavier drinking or whether smokers are more vulnerable to AUD than non-smokers who drink the same heavier amounts. Using data from the U.S. National Survey on Drug Use and Health, researchers looked at a representative sample of U.S adolescents and young adults to analyze the relationship between smoking and AUD.

Nearly 75,000 non-institutionalized 12-20 year olds from the civilian population were studied for current diagnosis of alcohol abuse or dependence, number of drinks in the past year, and past year smoking, defined as having more than 100 cigarettes in their lifetime and having smoked during the past year.

Researchers found that past year smokers drank higher quantities than never-smokers and were at an elevated risk for AUD – even when compared to never-smokers who drank the same higher quantities. This effect was seen across all age groups but more so among younger adolescents. The results suggest a higher vulnerability to AUD among smokers unrelated to the quantity consumed.

(Grucza, R, Bierut, L,: Cigarette smoking and the risk for alcohol use disorders among adolescent drinkers. Alcoholism: Clinical & Experimental Research 30:2046-2054,2006)

Alcohol can initially help people fall asleep, but leads to poor-quality sleep later during the night. Increased drinking in order to help sleep can possibly lead to alcoholism in vulnerable drinkers. This study evaluates both subjective and objective measures of poor sleep among alcoholic insomniacs; it also examines which measures may predict future drinking.
Researchers examined 18 individuals with insomnia (9 males, 9 females) in early recovery from alcohol dependence. Each participant underwent sleep lab testing –polysomnography (PSG) for two nights, three weeks apart. Participants also provided morning estimates of sleep onset latency (SOL) or the time it takes to fall asleep, wake time after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE), a measure of sleep continuity. After complete PSG results were recorded, participants were asked to give information about their drinking habits during two consecutive six-week follow-up periods.

Most of the alcoholic insomniacs overestimated SOL and underestimated the amount of wakefulness they experienced in sleep (WASO). Those individuals with inaccurate sleep perceptions were also more likely to return to drinking. This suggests that inaccurate sleep perceptions among alcoholics in early recovery may predict relapse to drinking.

(Conroy, DA, Arnedt, JT, Brower, KJ, Strobbe, S, Consens, F, Hoffmann, R, Armitage, R: Perception of sleep in recovering alcohol dependent patients with insomnia: Relationship to future drinking. Alcoholism: Clinical & Experimental Research 30:1992-1999, 2006.)

The “gateway hypothesis” is the theory that using drugs of abuse likely progresses through several discrete stages. For example, consumption of beer or wine may lead to hard liquor; use of tobacco may lead to marijuana and then harder drugs. This study examined the accuracy of the gateway hypothesis and sequencing as they pertain to use of tobacco, alcohol and marijuana. It also investigated if any transitions are determined by particular risk factors.

Researchers examined three groups of males from ages 10/12 to 22 years of age: those who consumed licit (legal) drugs only (n=99); those who consumed licit drugs before transitioning to marijuana ( illegal) use (n=97), called “gateway sequencing;” and those who used marijuana before using licit substances (n=28), called “alternative sequencing.” Study authors compared the three groups across 35 variables that measured psychological, family, peer, school, and neighborhood characteristics.

Results indicate that “proneness to deviancy” and “drug availability in the neighborhood” promote marijuana use. The authors conclude that when illicit-drug use first occurs, it is likely due to the opportunities provided by a neighborhood environment combined with low parental supervision.
(Tarter, RE, Vanyukov, M, Kirisci, L, Reynolds, M, Clark, DB: Predictors of marijuana use in adolescents before and after licit drug use: Examination of the gateway hypothesis. American Journal of Psychiatry 163:2134-2140, 2006.)

The hippocampus is a brain structure vital for learning and memory. It also appears to be vulnerable to damage from chronic, heavy alcohol consumption. This study attempts to measure damage to the hippocampus by assessing its total volume.

Researchers compared hippocampus volumes from both alcohol-dependent (n=8) and non-alcohol-dependent (n=8) adult male veterans, using magnetic resonance imaging (MRI) scan data. All of the alcohol-dependent subjects had long, heavy drinking careers and were still drinking heavily at the time of the study. Control subjects were matched to the alcohol-dependent subjects by age and ethnicity.

Findings indicate a reduction in total hippocampus volume among alcoholics, suggesting that heavy drinking exerts significant and injurious effects on the hippocampus, likely reflecting a loss of hippocampal tissue substance.

(Beresford, TP, Arciniegas, DB, Alfers, J, Clapp, L, Martin, B, Liu, YDD, Shen, D, Davatzikos, C: Hippocampus volume loss due to chronic heavy drinking. Alcoholism: Clinical & Experimental Research 30:1866-1870, 2006.)

“Self-efficacy” is a fancy term for what is essentially known as “believing in yourself.” This study applies the term to the field of addictions research in an effort to examine the relationship between substance-abuse treatment and abstinence self-efficacy.

Researchers assessed 2,350 clients (99% male) who received treatment at 88 community residential facilities across the United States, both at treatment entry and again one year later. Treatment providers were also asked to report on the patients’ engagement/participation in specific components of treatment.

After controlling for patient factors such as more years of education, lower baseline substance-related problems, and higher baseline confidence in abstinence … results indicate that patients who were more engaged in skills-training activities and who inspired providers’ confidence in their ability to remain abstinent had higher one-year self-efficacy. The authors conclude that abstinence success is driven not only by what a patient brings to treatment, but also by the activities a patient engages in during treatment.

(Ilgen, M, McKellar, J, Moos, R: Personal and treatment-related predictors of abstinence self-efficacy. Journal of Studies on Alcohol 68:126-132, 2007.)
Editor’s Ratings: S=4, V=4, O=4

Higher levels of health risks in racial and ethnic neighborhoods have been observed in the cases of toxic waste, pollution, and the locating of industrial sites. This condition is referred to as environmental injustice. Another example is evident in the density of liquor stores and bars in non-white urban neighborhoods. There are no data available on a national scale showing that alcohol retail presence is greater in high-minority and lower-income minority neighborhoods. It is not clear if previous local area studies reflect a general pattern. For example, in one New Jersey city the highest alcohol density was found in one of the wealthiest neighborhoods. A Chicago study found such disparities; however, the city council there has passed one of the nation’s toughest anti-alcohol billboard ordinances because of a perceived disparity.
                Using census data, a recent national study by the Rand Corporation looked at the association between residential socioeconomic characteristics and alcohol outlet density in over 9000 urban zip codes. Results showed that blacks faced higher density of liquor stores than did whites. The density of liquor stores and bars is greater among non-whites in lower income areas than among whites in either lower or higher-income areas or non-whites in higher income areas.
                The study concludes that mismatches between alcohol demand and the supply of liquor stores within urban neighborhoods constitute an environmental injustice for minorities and lower income persons, with potential adverse consequences for drinking behavior and other social ills.

(Romney, J, Cohen, D, Ringel, J, Sturm, R, Alcohol and environmental justice: The density of liquor stores and bars in urban neighborhoods in the United States. Journal of Studies on Alcohol & Drugs 68: 48-55, 2007)

Editor’s Ratings: S=4, V=3, O=3

Although a number of studies have shown a significant relationship between drinking and depression, there have been some contradictory findings, and sometimes the relationship appears stronger for women than for men. This study explores if some of these inconsistent findings may be partially due to the types of measures used for both drinking and depression.

Researchers conducted a general population telephone survey of 6,009 male and 8,054 female Canadian residents aged 18 to 76 years. They used four types of alcohol measures for both the previous year and the week prior to the survey: frequency of drinking, usual and maximum quantity per occasion, overall volume, and heavy episodic drinking. Also used were two types of depression measures: meeting criteria for a clinical diagnosis of major depression, and recent feelings of depression.

Results indicate that drinking and depression have a complicated relationship, and that measurement and gender are key factors. More specifically: depression is primarily linked to binge drinking. The relationship between major clinical depression 
and alcohol consumption appears to be stronger for women than it is for men; however, there is no gender difference in the relationship between drinking and depression when depression is measured as recent feelings of depression or unhappiness.

(Graham, K, Massak, A, Demers, A, Rehm, J:  Does the association between alcohol consumption and depression depend on how they are measured? Alcoholism: Clinical & Experimental Research 31:78-88, 2007.)
Editors Ratings: S=3, V=3, O=3

Alcohol research is not an exact science. Although accurate estimates of alcohol use and intoxication are clearly important in many areas of the law and in alcohol research, there exists considerable inconsistency in the reporting and interpretation of alcohol-test results across studies. For example, in a recent study a drink was defined as either one ounce of distilled spirits, six ounces of wine or 12 ounces of beer. However, the actual measure of alcohol in these drinks can vary widely depending on the percentage of alcohol in each and if standardized pharmacological principles are correctly applied. This study examined three topics: calculating alcohol equivalents, dosing methodologies, and alcohol-test results. It presents formulas designed to take these factors into account.

Based on his review, the author derives 20 mathematical calculations in alcohol pharmacokinetics and pharmacology, providing examples of how each calculation works. The formulas, he writes, will “enable researchers to calculate accurately and systematically the amount of alcohol in any beverage and estimate the blood alcohol concentration in a range of persons with individual characteristics and drinking patterns.”

(Brick, J: Standardization of alcohol calculations in research. Alcoholism: Clinical & Experimental Research 30:1276-1287, 2006.)
Editors Ratings: S=4 V=4 O=4

Research has found that college students tend to greatly overestimate the percentage of their peers who drink heavily. Prevention experts worry that such a distorted view of subjective drinking norms might actually drive up student alcohol consumption. In response, “social norms marketing” (SNM) campaigns have been designed to correct misperceptions of subjective drinking norms, hopefully driving down alcohol consumption. This study of SNM campaigns is the most rigorous evaluation conducted to date.

Researchers carried out their study at 18 institutions of higher education–reflecting all four U.S. census regions– that were randomly assigned to treatment or control groups. The treatment institutions ran SNM campaigns for three academic years (Fall 2000 to Spring 2003), delivering school-specific, data-driven messages through a mix of campus media venues. Students from all 18 institutions were surveyed for their “alcohol norms and behavior” both at baseline and post-test.

Results indicate that students attending institutions that had implemented an SNM campaign had a lower relative risk of alcohol consumption than students attending institutions that had not.

(DeJong, W, Kessel Schneider, S, Gomberg Towvim, L, Murphy, MJ, Doerr, EE, Simonsen, NR, Mason, KE, Scribner, RA: A multisite randomized trial of social norms marketing campaigns to reduce college student drinking. Journal of Studies on Alcohol 67:868-879, 2006.)
Editors Ratings: S=4 V=3 O=4

There are certain high-risk groups on college campuses that have a reputation for heavy alcohol consumption: student-athletes, for example. This study examined the impact of a social norms intervention designed to reduce alcohol misuse among athletes by changing their misperceptions of the levels of peer drinking.

Researchers targeted student-athletes at an undergraduate college with a comprehensive set of interventions. These interventions communicated accurate local norms regarding alcohol use through multiple venues. Accurate information about how much fellow students actually drank was communicated by campus newspaper ads, posters, e-mail messages, computer kiosks, and interactive multi-media programs, peer educators, and interactive CD’s.

An anonymous survey of all student-athletes was conducted annually for three years (2001, n=414; 2002, n=373; 2003, n=353). In addition, a pre/post comparison of student-athletes was conducted separately for both new and ongoing athletes at each time point in order to isolate any general time-period effects from the program’s effects.

The social-norms intervention method used in this study proved highly effective in reducing alcohol misuse in the target high-risk college subpopulation.

(Perkins, HW, Craig, DW: A successful social norms campaign to reduce alcohol misuse among college student-athletes. Journal of Studies on Alcohol 67:880-889, 2006.)
Editors Ratings: S=4 V=3 O=4

Prior research has shown a link between chronic alcoholism and a number of deficits in odor judgment, odor identification, odor sensitivity, and the ability to qualitatively discriminate between odors. This new study indicates that these olfactory deficits among alcoholics are also associated with impairments in the functions of the prefrontal lobe.

Study participants included 32 alcoholics (18 males, 14 females) and 30 healthy “controls” (16 males, 14 females) that were matched on age, gender and smoking status. Researchers assessed three areas for all of the participants: olfactory functions (detection threshold, quality discrimination, identification), executive function (using the Wisconsin Card Sorting Test), and memory (using the German version of the California Verbal Learning Test).

When compared to the controls, alcoholic patients were impaired in all three domains: olfactory functions, executive function, and memory. Deficits in olfactory functions among alcoholics appear to be indicative of greater problems than the inconvenience of a lessened capability of smell.

(Rupp, CI, Fleischhacker WW, Drexler, A, Hausmann, A, Hinterhuber, H, Kurz, M: Executive function and memory in relation to olfactory deficits in alcohol-dependent patients. Alcoholism: Clinical & Experimental Research 30:1355-1362, 2006.)
Editors Ratings: S=3 V=3 O=4

Previous research has shown that alcohol taxes or prices affect total alcohol consumption, and that aggregate alcohol consumption affects cirrhosis mortality rates. Other evidence suggests that heavy drinkers, who are most at risk for liver disease, are less responsive to price than other drinkers. This study investigated the impact that alcohol taxes – for distilled spirits, wine and beer – may have on cirrhosis mortality.

Researchers examined 30 U.S. states that require alcohol licensing, from 1971 to 1998; they also reviewed each state’s cirrhosis mortality rates, age distribution, religion, race, health-care availability, urbanity, tourism, and local bans on alcohol sales.

Cirrhosis rates were found to be significantly related to taxes on distilled spirits but not to taxation on wine and beer. Consistent with prior research, and based upon correlation with taxation, the results confirm that cirrhosis mortality in the U.S. is more closely linked to consumption of distilled spirits than it is with other alcoholic beverages.

(Ponicki, WR, Gruenewald, PJ: The impact of alcohol taxation on liver cirrhosis mortality. Journal of Studies on Alcohol 67:934-938, 2006.)
Editors Ratings: S=4 V=3 O=4

Alcohol’s damage to the brain’s cognitive functions was reported by scientists as early as the 1880s. Available data show the tremendous neuropsychological problems exhibited in alcoholics entering treatment and in early abstinence. However, there is evidence of significant recovery of these faculties over the first year of abstinence. Current research reflects a developing understanding of the time it takes to recover from such deficits and examines the many factors that may influence their presence and severity. This study by neurobehavioral researchers compared cognitive abilities in long term abstinent alcoholics (LTAA) versus an equal number of age and gender comparable normal controls (NC). Various cognitive skills such as abstraction, attention, memory, spatial processing, reaction time and verbal skills were tested. Long term abstinent alcoholics performed similarly to NC, except for spatial processing deficits.

The “eyes look but the brain sees,” meaning that the brain must process what the eyes sense in order to bring meaning to what is viewed. A person with spatial processing problems may have 20/20 vision but still have difficulties discriminating foreground from background, forms, size, and position in space. The person may be unable to synthesize and analyze visually presented information accurately or fast enough. The researchers cautioned that there was no strong statistical evidence of spatial processing deficits but this finding is among the impairments reported by abstinent alcoholics. Other investigators have reported that these deficits may not resolve even with long term sobriety. In all other cognitive skills LTAA compared favorably with NC. It was observed that older alcoholics showed more severe cognitive deficits and less recovery in early recovery. This and other studies indicate that most reversal of cognitive deficits occurs within the first year of recovery.

(Fein, G, Torres, J, Price, l, Di Sciafani, V: Cognitive performance in long term
abstinent alcohol individuals. Alcoholism: Clinical and Experimental Research 30: 1538-1544, 2006.)
Editors Rating: S=4 V=2 O=3

Short-term alcoholism mortality studies have limited applications for longterm, comprehensive treatment program planning. There was a need for longer-term research. This San Antonio study followed alcoholics for more than 33 years after they were discharged from treatment in order to examine how, when, and why they died.

Researchers followed 500 alcoholics – admitted in five groups of 100 in 1963, 1964, 1967, 1970 and 1972 to community-based treatment – for 33 to 42 years. Their deaths were tracked and case-fatality and cause-specific mortality rates were calculated. Although whites generally tended to live longer, all three racial/ethnic groups died either from lifestyle behaviors (including accidents, homicide, suicide and trauma of all sorts) at young ages, early in the followup period, or at older ages from cancer and diseases of the lung. Study authors recommend that comprehensive treatment programs address lifestyle issues soon after discharge and the prevention of organ diseases later in life.

(Costello,RM: Long-term mortality from alcoholism: a descriptive analysis. Journal of Studies on Alcohol 67:694-699, 2006.)

Approximately 80 percent of individuals with alcohol-use disorders are also chronic smokers. Although numerous studies have reported associations between chronic cigarette smoking and lower cerebral perfusion – which translates into lower blood flow to tissue. These same perfusion abnormalities are observed among alcohol-dependent individuals. It remains unclear, however, if chronic alcohol and tobacco use together have greater adverse effects.

For this study, researchers used magnetic resonance imaging (MRI) to measure cerebral perfusion among 29 alcohol-dependent individuals in treatment who had been abstinent for one week: 19 smokers and 10 nonsmokers. Researchers also used MRI to scan 19 healthy light drinkers who were also nonsmokers. Preliminary results indicate that chronic cigarette smoking adversely affects cerebral perfusion in the frontal and parietal gray matter of one-week-abstinent alcohol-dependent individuals.

In fact, results suggest that chronic cigarette smoking compounds the detrimental effects of alcohol dependence on brain neurobiology.

(Gazdzinski, S, Durazzo, TC, Jahng, G-H, Ezekiel, F, Banys, P, Meyerhoff, DJ: Effects of chronic alcohol dependence and chronic cigarette smoking on cerebral perfusion: A preliminary magnetic resonance study. Alcoholism: Clinical & Experimental Research 30:947-958, 2006.)

Despite the existence of a minimum drinking age of 21 years in most states, young people continue to have ready access to alcohol. This study attempted to measure the harm this may cause. The researchers estimated the magnitude and costs of problems from underage drinking by category – traffic crashes, violence, property crime, suicide, burns, drowning, fetal alcohol syndrome, high-risk sex, poisonings, psychoses, and dependency treatment – and comparing those costs with associated alcohol sales. For each category of alcohol-related problems, researchers estimated fatal and nonfatal cases that were attributable to underage alcohol use. They then multiplied alcohol-attributable cases by estimated costs per case to obtain total costs for each problem.

Results indicate that underage drinking merits just as much attention as use of illicit drugs and tobacco by youth. Specifically, underage drinking accounted for at least 16 percent of alcohol sales in 2001, led to 3,170 deaths, and caused an estimated bill of $61.9 billion, including $5.4 billion in medical costs, $14.9 billion in work loss plus other quality-of-life costs. Even leaving aside these quality-of-life costs, which are very difficult to measure, societal harm of $1 per drink consumed by an underage drinker exceeded the 90 cents in average purchase price of an average drink.

(Miller, TR, Levy, DT, Spicer, RS, Taylor, DM: Societal costs of underage drinking. Journal of Studies on Alcohol 67:519-528, 2006.)

Surveys indicate that 8% of American drinkers eventually become alcohol-dependent. Treatment providers endeavor to match those who seek treatment with the program most appropriate for their needs. There are two basic models of treatment programs: one is spiritually based such as Alcoholics Anonymous (AA), and the other is a more clinical model without a spiritual component. Past research has shown that spirituality facilitates recovery from alcoholism. Positive outcomes have been reported for AA attendance, length of sobriety, and a general sense of purpose in life. However, some individuals may be uncomfortable with a spiritually-based treatment program and thus such treatment may be less effective – or ineffective. It would seem reasonable to expect that a patient placed in a program that corresponds to his or her own level of spirituality would be more receptive to treatment, less likely to terminate treatment prematurely, and be less likely to report a continuing desire to drink at the end of the treatment program.

In a study to test this hypothesis, volunteers were placed in two treatment facilities; one of the programs was based on the 12- step philosophy with spirituality at its core. The program includes individual and group therapy sessions, individual counseling by chaplains, and required weekly healing sessions or nondenominational spirituality presentations. Patients were asked to complete a series of questionnaires concerning the severity of their alcohol addiction and levels of spirituality. The other treatment program adhered to a medical model of addiction where spirituality was not a core feature, although patients were encouraged to attend 12-step meetings.

Both programs included patients who tested with a broad range of spirituality levels. Surprisingly, researchers found that an incompatible match between the patient’s level of spirituality and the spiritual orientation of the program did not result in premature termination of treatment. Nor did incompatibility negatively affect abstinence rates.

However, patients in the non-spiritual program who were found to have a low level of spirituality did have poorest end-of-treatment outcomes. An encouraging finding was that less spiritual patients who were placed in the spiritual treatment program had satisfactory end-of-treatment outcomes.  Researchers conclude that regardless of the individual’s belief system, exposure to spirituality in a treatment program seems to contribute to optimal treatment outcomes.

(Sterling, RC, Weinstein, S, Hill, P, Gottheil, E, Gordon, SM, Shorie, K: Levels of spirituality and treatment outcome: A preliminary examination. Journal of Studies on Alcohol 67: 600-606, 2006.)

Prenatal exposure to alcohol causes birth defects, as well as abnormal development in attention and memory, executive functioning, motor skills, learning, and judgment. This study examined how psychiatric problems might also be linked to prenatal alcohol exposure. Beginning with a longitudinal study of 1,529 pregnant women, researchers chose a group of 500 newborns who were most heavily exposed to alcohol, plus a sampling of newborns with exposures varying from total abstinence to heavy drinking. Years later, at an average age of 25.7 years, 400 members of the newborn group were administered clinical assessments for psychiatric disorders.

Results indicate that prenatal exposure to alcohol may be a risk factor for specific psychiatric disorders and traits in early adulthood. Specifically, the odds of appearance of one or more of six psychiatric disorders and traits were more or more binge-drinking episodes during pregnancy.

(Barr, HM, Bookstein, FL, O’Malley, KD, Connor, PD, Huggins, JE, Streissguth, AP: Binge drinking during pregnancy as a predictor of psychiatric disorders on the Structured Clinical Interview for DSM-IV in young adult offspring. American Journal of Psychiatry 163:1061-1065, 2006.)

Despite the fact that it is illegal for alcohol establishments to sell alcohol to an obviously intoxicated individual, the practice continues and likely contributes to the many problems linked to high-risk drinking. This study examined the influence of alcohol establishment policies/practices on the likelihood of sales to intoxicated patrons. Researchers hired 14 professional actors (7 males, 7 females) to feign intoxication while attempting to purchase alcohol at 231 Midwestern on-premise establishments (bars and restaurants), and conducted a phone survey of owners/managers at each establishment.

Other variables included policies/practices of the establishments, as well as characteristics of the buyers/servers and establishments. Interestingly, those establishments that held staff meetings at least once a month were less likely to sell to obviously intoxicated patrons. Establishments with beer- and/or wine-only licenses, as well as those with managers who had at least one year of employment, were more likely to sell to obviously intoxicated patrons. These findings suggest more research is needed to determine the best types of intervention to prevent serving patrons who have obviously had enough.

(Lenk, KM, Toomey, TL, Erickson, DJ: Propensity of alcohol establishments to sell to obviously intoxicated patrons. Alcoholism: Clinical & Experimental Research 30:1194-1199, 2006.)

Three national drug-use monitoring studies have cited significant increases in prescription opioid use over the past 5 years, particularly among young people. The causes for this increase are unknown; however, the leadership of the National Institute on Drug Abuse and the White House Office of National Drug Control Policy have both expressed concern that online pharmacies selling medications without prescriptions may be playing a role. Very little is known about these “no-prescription websites” (NPWs), their characteristics, or the degree to which they contribute to drug abuse.

Forty-seven Internet searches were conducted with a variety of opioid medication terms, including “codeine,” “no prescription Vicodin,” and “OxyContin.” The resulting links were coded as NPWs if they offered to sell opioid medications without prescriptions. In searches using terms such as, “no prescription codeine” and “Vicodin,” over 50 percent of the links obtained were coded as NPWs. The proportion of links yielding NPWs was greater when the phrase “no prescription” was added to the opioid term. More than 300 opioid NPWs were identified and entered into a database. The emergence of NPWs introduces a new source for unregulated access to opioids. Young people – the heaviest users of the Internet – appear to now have an unsupervised means of obtaining opioid medications. Uncontrolled access to non- prescription opioids has broad implications for law enforcement, health care delivery, and drug policy.

(Forman, RF, Woody, GE, McLellan, T, Lynch, KG: The availability of web sites offering to sell opioid medications without prescriptions. American Journal of Psychiatry 163:1233-1238, 2006)

Alcohol is the drug of choice for youth in the United States. By 8th grade, more than 40 percent of youth have used alcohol; by 12th grade, almost 80 percent have done so. Many of these young people began drinking at early ages. On average, boys start drinking earlier than girls, and whites and Native Americans start drinking earlier than other races/ethnicities. With alcohol consumption such a prevalent behavior among young people, it is crucial to understand the initiation of drinking as well as possible causes so as to facilitate interventions to delay this behavior.

This study 1) examined whether the age of drinking initiation has changed over time and 2) evaluated trends in the percentages of young people who started drinking by various grades. Multiple years of data from three national surveys were analyzed to further understand the start of drinking: Monitoring the Future, the National Household Survey on Drug Abuse, and the Youth Risk Behavior Surveillance System.

Simultaneous examination of data from the three surveys indicates that 7th and 8^th grades (ages 13-14) are peak years for the initiation of drinking. Further, the present analysis shows that although the percentage of youth who start drinking early (before age 13) has declined, the average age of initiation for these very early starters did not change over the period 1991 to 1998. This study also identified a group of young people who are still starting to drink very early (at age ten or younger) and represent a high-risk group that should be intervened with early.

Research showed that certain interventions work well for youth who have not started consuming alcohol, but are much less effective with youth who have already begun drinking. Early initiation of drinking is also associated with heavier alcohol use throughout adolescence and early adulthood. At a minimum, youth who postpone drinking also postpone the risk of acute negative alcohol-related consequences.

(Faden, VB: Trends in initiation of alcohol use in the United States 1975 to 2003. Alcoholism: Clinical and Experimental Research 30, Vol 306: 1011-1022, 2006)

There has been a growing public concern about women’s drinking habits because current research in women’s health issues point to links between alcohol consumption and breast cancer, higher risk of alcohol-related liver problems as compared with men, and the risks of fetal alcohol syndrome. There is also a fear that alcohol may pose an increased risk of physical assault. Given women’s role changes over the past several decades, stresses due to employment, and college and university environments in which heavy drinking occurs, it seems reasonable to expect that more and more women are drinking over time. However, research has supported no such trend.

As part of the National Study of Health and Life Experience of Women, researchers analyzed data gathered in three surveys conducted by the National Opinion Research center. Women 21 years and older from all U.S. states but Alaska and Hawaii were surveyed three times over a period of 20 years: baseline in 1981, and follow-ups in 1991 and 2001. Face-to-face interviews averaging 75-90 minutes in length included questions about drinking behavior (including lifetime histories and abstinence), drinking-related problems, and possible antecedents and consequences. Participants were also asked about heavy episodic drinking, defined as drinking six or more drinks per day. From the data gathered, researchers computed the prevalence of drinking and abstinence patterns in six age groups of women (from the 20s through the 70s and older). Ethnicity, marital status, and education were also studied.

Results of the study did not support the expectation that more and more women are drinking. On the contrary, the data suggest that U.S. women tend to quit drinking as they grow older—a pattern that has received little attention in recent research. Researchers also analyzed abstinence rates and found that 30-day abstinence rates increased sharply between 1981 and 2001, a finding inconsistent with media alarms about women’s drinking. The findings also do not support the expectation of an historical increase in heavy episodic drinking; analysis showed a decline from 1981 to 2001, particularly among women in the 21-30 age group who had initially reported the highest prevalence for heavy episodic drinking. The prevalence of intoxication consistently declined with advancing age.

(Wilsnack, RW, Kristjanson, AF, Wilsnack, SC, Crosby, RD.: Are U.S. women drinking less (or more)? Historical and aging trends, 1981–2001. Journal of Studies on Alcohol 67: 341–348, 2006.)

The behavior of chronic drug users often seems erratic and even dangerous to the observer. This is because their decision-making abilities – a complex process that involves the integration of emotional information with higher level cognitive processing – have likely been compromised by their substance use. This study examines linkages between decision-making impairments and frontal lobe dysfunction.

Researchers used functional neuroimaging to compare four groups during performance of the Cambridge Risk Task (which presents an unlikely high-reward option as well as a likely low-reward option). The groups were: chronic amphetamine users, chronic opiate users, ex-drug users abstinent for at least one year, and matched “controls,” healthy individuals without drug issues.

Results indicate that both current and prior amphetamine and opiate abuse may disrupt the ability of the prefrontal cortex to properly regulate the decision-making process. During the risk task, control participants showed relatively greater activation in the right dorsolateral prefrontal cortex, whereas participants with current, or even a prior history of drug use showed relatively greater activation in the left orbitofrontal cortex. This different brain activation observed in both the current and former drug users may reflect long-lasting changes in brain function caused by chronic drug use, or it may reflect a pre-existing abnormality that could have been exacerbated by chronic drug use.

(Ersche, KD, Fletcher, PC, Lewis, SJG, Clark, L, Stocks-Gee, G, London, M, Deakin, JB, Robbins, TW, Sahakian, BJ: Abnormal frontal activations related to decision-making in current and former amphetamine and opiate dependent individuals. Psychopharmacology 180:612-623, 2005.)

It has been suggested so-called energy drinks might reduce the intensity of the depressant effects of alcohol. Users who combine alcohol with an energy drink frequently report a reduction in sleeplessness and an increase in pleasure when these drinks are combined. However, there is little scientific evidence to support this hypothesis.

A recent study in Brazil evaluated the effects of the simultaneous ingestion of an alcohol (vodka) and an energy drink (Red Bull) compared with those who ingested an alcohol or an energy drink alone. Twenty-six healthy volunteers in their early twenties were randomly assigned to two groups that received 0.6 or 1.0 g/kg alcohol respectively. They all completed three experimental sessions in random order that were seven days apart: alcohol alone, energy drink alone, or alcohol plus energy drink.

When compared with the ingestion of alcohol alone, the ingestion of alcohol plus energy drink significantly reduced the subjects’ perception of headache, weakness, dry mouth, and impairment of motor coordination. However, the ingestion of the energy drink did not significantly reduce the deficits caused by alcohol on objective motor coordination and visual reaction time. In addition, the ingestion of the energy drink did not alter the breath alcohol concentration in either group.

Even though the subjective perceptions of some symptoms of alcohol intoxication were less intense after the combined ingestion of the alcohol plus energy drink, these effects were not detected in objective measures of motor coordination and visual reaction time, as well as on the breath alcohol concentration.

The increase in alcohol tolerance reported by many users of energy drinks could lead young people toward a higher consumption of alcoholic beverages. For this reason, knowledge about the effects of this interaction between alcohol and energy drinks may be relevant to prevention programs.

(Ferreira, SE, Tulio de Mello, M, Pompéia, S, Souza-Formigoni, MO.: Effects of energy drink ingestion on alcohol intoxication. Alcoholism: Clinical and Experimental Research 30: 598-605, 2006)

Most clinical studies examine individuals either during or immediately following formal treatment. However, individuals who are willing to acknowledge their alcohol-use problems actually choose self-help groups, such as Alcoholics Anonymous (A.A.), and/or treatment, or sometimes nothing at all. This study tracks individuals for 16 years who chose one of these three options, comparing their success rates and/or life changes.

Researchers surveyed 461 individuals (232 females, 229 males) who had initial contact with an alcoholism treatment system for their alcohol-use disorder. Study participants were asked about their subsequent participation in A.A., further treatment or any other kind of assistance – as well as their alcohol-related functioning, life context and coping responses – at baseline (initial contact) and then again at one, three, eight and 16 years later.

Whether or not the individuals obtained help, study results indicate that their alcohol-related functioning, life context, and coping improved. However, those individuals who obtained help either through A.A. or treatment during the first year improved more, and were more likely to achieve stable remission than those who obtained no help at all.

(Moos, RH, Moos, BS: Sixteen-year changes and stable remission among treated and untreated individuals with alcohol use disorders. Drug and Alcohol Dependence 80:337-347, 2005.)

Disulfiram, naltrexone and acamprosate are the only treatment medications currently approved for the management of alcohol dependence. Oxcarbazepine (OXC) is a new antiepileptic drug that reduces glutamatergic transmission at corticostriatal synapses. Given that acamprosate (ACP) also slows transmission between glutamate nerve cells, this pilot study compares the efficacy and safety of OXC with ACP in recently withdrawn alcohol-dependent patients.

Researchers conducted a 24-week study of 30 alcohol-dependent patients seeking outpatient treatment for alcohol-relapse prevention. Patients were evenly divided between OXC (n=15) and ACP (n=15) using a randomized, parallel-group, open-label, clinical design. After the initial three-month treatment period, medication was stopped and patients were observed for another three months without receiving anticraving drugs or any other medication. Researchers assessed time to first severe relapse and first drink, used biological markers to evaluate safety, and recorded side effects in order to establish tolerability.

Results indicate that OXC is comparable to ACP in terms of “time to severe relapse” and “time to first consumption of any alcohol.”

(Croissant, B, Diehl, A, Klein, O, Zambrano, S, Nakovics, H, Heinz, A, Mann, K: A pilot study of oxcarbazepine versus acamprosate in alcohol-dependent patients. Alcoholism: Clinical and Experimental Research 30:630-635, 2006.)

Congreve wrote in 1697, “Music has Charms to sooth a savage Breast, to soften Rocks, or bend a knotted Oak.” Research seems to show that this famous adage is not valid in our day, especially if it is the music popular with American youth. Prior research suggests that there are connections between preferences for certain music genres and risky behaviors. Studies have concluded that rap music, the predominant genre of hip-hop culture, more than any other genre, encourages risky behaviors and may have some influence on youth. Many rap musicians have promoted alcoholic beverages, especially malt liquor, deemed “the gangsta drink of choice, the brew of alienation.”

In a recent study, 1,056 central California community college students aged 25 and younger completed questionnaires regarding music preferences, alcohol and drug use, and aggressive behaviors. Students also responded to questions regarding “sensation seeking” behaviors such as doing “crazy” things for fun, going to wild parties, and the like.

Among the sample of students who listened to music daily, rap music was the most popular music genre (69%) followed by alternative (65%), R&B (57%), rock (51%), top 40/hot-100 (37%), techno-house (32%), country (31%), punk (28%), and heavy metal (22%). Less than 20% of those who listened to music daily preferred Latin/salsa, reggae, classical, jazz, world, or Christian music.

Researchers found that for this sample of students, rap music was consistently related to general alcohol use, malt liquor use, potential alcohol-use disorder, drug use, and aggression. Asian students, who were just as likely as others to listen to rap music, reported the lowest levels of substance use and abuse. Black students reported significantly more aggressive behaviors, and students of all racial/ethnic groups who reported higher levels of sensation- seeking were more likely to listen to rap and other genres associated with substance use and aggression.

(Chen, M-J, Miller, BA, Grube, JW, Waiters, ED: Music, substance abuse, and aggression. Journal of Studies on Alcohol 67: 373–381, 2006.)

Illicit injection drug use is associated with a wide array of problems, not the least of which are new cases of HIV and hepatitis C infection. “Assisted injection” is a common practice among injection-drug users, yet little is known about individuals who assist with injections.

Researchers interviewed 704 (295 females, 409 males) participants enrolled in the Vancouver Injection Drug User Study. Of the total, 27.4 percent or 193 (85 females, 108 males) had provided others with help injecting drugs during the previous six months. The study found that assisted injections were associated with various high-risk behaviors: lending one’s own syringe, frequent heroin injection, unstable housing, binge drug use, frequent cocaine injection, and frequent use of crack cocaine. The authors suggest a need for education about sterility as well as consideration of safer injection facilities.

(Fairbairn, N, Wood, E, Small, W, Stoltz, J-A, Li, K, Kerr, T: Risk profile of individuals who provide assistance with illicit drug injections. Drug and Alcohol Dependence 82:41-46, 2006.)

Mexico – especially its 2,000-mile-long border with the United States – has long been regarded as a passageway for drugs to enter North America from South America. In the past decade, however, the northern border of Mexico has itself become vulnerable to substance abuse, particularly injection drug use. This review examined opium production in Mexico, recent trends in drug use, and the Mexican response.

Mexico is not only a major source of marijuana; it has cultivated opium poppy since before the 1900s, is a major supplier of heroin to the U.S. as well as its own consumer markets, has become more involved in the production of high-quality, low-priced methamphetamine, and continues to facilitate the passage of an estimated 70 percent of all South America-derived cocaine to the U.S.

Coffee crops in some parts of Mexico have given way to poppy farming. The resulting opium is often refined into less-bulky and easier-to-conceal forms of heroin such as “black tar,” a poorly refined product that is typically injected. Also the increase in the production of heroin powder has raised concerns about a greater chance of blood-borne viruses since heroin powder for injection does not require heating. By 2002, heroin was the primary reason for seeking treatment for almost a third of drug users at treatment facilities in Tijuana. Anecdotal reports suggest that heroin use is on the rise in border towns, where a heroin fix can cost as little as $2.00.

Although HIV prevalence among injection-drug users in Mexico is relatively low when compared to cases in the other Americas, the Mexican prison population and sex workers – especially in Mexican border cities where prostitution is legally tolerated – may be at especially high risk. Like other Latin American countries, there is low tolerance for illicit drug use in Mexico and the response to the problem has emphasized legal sanctions rather than “harm reduction,” or prevention activities aimed at drug users.

This study documents that both Mexico and the U.S. continue to be challenged by this growing cross border drug problem.

(Bucardo, J, Brouwer, KC, Magis-Rodríguez, C, Ramos, R, Fraga, M, Perez, SG, Patterson, TL, Strathdee, SA: Historical trends in the production and consumption of illicit drugs in Mexico: Implications for the prevention of blood borne infections. Drug & Alcohol Dependence 79: 281-293, 2005.)

Little is known about the relationship between viewing alcohol drinking in movies and the early onset of alcohol use in adolescents. A recent study sponsored by the National Cancer Institute and the National Institute on Alcohol Abuse and Alcoholism sought to fill that serious gap in our understanding of one of the social influences of the entertainment industry. This study assessed drinking in a sample of popular contemporary movies and examined the association of exposure to movie alcohol use with early drinking in a large adolescent sample. The methods used had been previously validated by studies of the relationship between movie smoking and cigarette use.

Researchers identified a sample of 4655 adolescents ages 10-14 years old recruited from 15 New Hampshire and Vermont schools. A confidential survey was administered to students during class time. Students were surveyed and interviewed by telephone 13-26 months later.

Screen depictions of alcohol drinking were timed for each of 601 popular contemporary movies. Each adolescent was asked if he/she had seen any of a list of 50 movie titles randomly selected from the larger pool. Movie alcohol screen time was totaled for movies which the adolescent had actually seen and scaled up to reflect exposure to the 601 movies. Ninety-two percent of the movies in the sample depicted drinking. The median screen time for movie alcohol use was 2.5 minutes. The typical adolescent had been exposed to eight hours of movie alcohol use, but exposure varied from less than one hour to over fourteen hours.

Of 2406 never drinkers who were followed up 13-26 months later, 14.8% had tried drinking. Drinking rates at follow up were highly dependent on movie alcohol exposure at baseline, with low-exposure adolescents having drinking rates of less than 5% while high-exposure adolescents had drinking rates of 20% or more. This relation held even after controlling for many other risk variables including gender, age, parental education, peer drinking and personality characteristics that lead to risky behavior.

The study shows that adolescents are frequently exposed to alcohol use in movies and that higher exposure is associated with higher prevalence and incidence rate of early teen drinking.

(Sargent, JD, Wills, TA, Stoolmiller, M, Gibson, J, Gibbons, FX: Alcohol use in motion pictures and its relation with early-onset teen drinking. Journal of Studies on Alcohol: 67: 54-65, 2006.)

Both genetic and environmental factors, such as stress, are believed to play a role in the development of alcoholism. Evidence also indicates that biological systems that are affected by both alcohol and stress – such as the beta-endorphin system – may have an impact on alcohol consumption. This study looked at the response of the beta endorphin system to stress as related to an individual’s family history of alcohol problems.

Four groups of individuals participated in this study: social and heavy drinkers with a family history of alcoholism (considered “high risk”) and social and heavy drinkers without a family history of alcoholism (considered “low risk”). Each participant was given either a placebo or alcohol (0.50g alcohol/kg) drink. Researchers then measured their pituitary beta – endorphin responses to the drinks as well as to a stress test (arithmetic computations, and a competition for monetary reward) performed 30 minutes after ingestion.

Results indicated that there are indeed differences in both the beta-endorphin levels as well as the response of the beta-endorphin system to stress in those with family history of alcohol problems. More specifically, in high-risk individuals, dysfunction in the activity of the pituitary beta-endorphin system predates the development of alcoholism; while in low-risk individuals, dysfunction develops following alcohol dependence.

(Dai, X, Thavundayil, J, Gianoulakis, C: Differences in the peripheral levels of B-endorphin in response to alcohol and stress as a function of alcohol dependence and family history of alcoholism. Alcoholism: Clinical & Experimental Research 29: 1965-1975, 2005.)

A low level of response (LR) to alcohol is one of several genetically influenced indicators of an elevated risk for heavy-drinking and alcoholism. In other words, if you have a family history of alcoholism and have a “hollow leg” chances are you will develop problems with alcohol in the future. This study compared responses to alcohol among similarly aged subjects across generations.

Between 1978 and 1988, 453 18-to-25-year-old nonalcoholic Caucasian male drinkers participated in the San Diego Prospective Study. They were given several “alcohol challenges,” and their LR to alcohol was determined through self reports on feelings of “high” and “intoxication,” as well as measures of changes in body sway. About 20 years later, 40 of the 18-to-29-year-old offspring of 25 of the original subjects were tested using similar methods.

Despite the passage of two decades between laboratory sessions, those (father) subjects with a positive family history for alcoholism still demonstrated low level response (LR) after alcohol consumption similar to that reported 20 years earlier. Their sons and daughters subjected to the same alcohol challenges produced similar subjective feelings of intoxication and body sway results. These similarities, while not proving heritability, are consistent with previous research that has established an association between genetic influences and LR to alcohol.

(Schuckit, MA, Smith, TL, Kalmijn, J, Danko GP: A cross-generational comparison of alcohol challenges at about age 20 in 40 father-offspring pairs. Alcoholism: Clinical & Experimental Research 29: 1921-1927, 2005.)

A recent study in England found substantial reductions in criminal convictions for drug users who under- went treatment for drug dependence problems. These results replicated previously reported findings demonstrating that treatment reduces criminal activity.

Researchers investigated changes in criminal convictions among 1075 patients admitted to 54 drug misuse centers across England. Convictions data were collected by personal interviews during the year prior to treatment, and at 1 year, 2 years, and 5 years after treatment. During the year prior to treatment, 34% of the subjects had been convicted of at least one offense. Most of these actions involved the acquisition of drugs for personal use.

The study found that conviction rates at all of these follow-up points were significantly lower than at intake. At 1-year follow-up, the percentage of the sample convicted for that year had fallen to 28%. During the year prior to the five-year follow-up, 18 % of the subjects had been convicted of only one offense. Statistically significant reductions were also found in the total number of convicted offenses between treatment and five-year follow-up.

Reductions in convictions were observed for both acquiring and selling drugs as well as commission of violent crimes. The study reinforces the belief that treatment for drug problems reduces crime among drug misusers and produces positive changes in behavior, as well as significant personal and social benefits.

(Gossop, M, Trakada, K, Stewart, D, Witton, J: Relations in criminal conviction after addiction treatment: 5-year follow-up. Drug & Alcohol Dependence 79: 295-302, 2005.)

Three medications are currently approved in the United States for the treatment of alcohol dependence (disulfiram, naltrexone and acamprosate), yet these medications are not widely prescribed. Alcoholism treatment remains predominantly psychosocial in nature. A symposium at the June 2005 Research Society on Alcoholism meeting in Santa Barbara reviewed the current state of pharmacotherapy for alcoholism and made recommendations for future research.

Development of alcoholism is associated with neuroadaptive changes in specific motivational systems in the extended amygdala (a brain region associated with emotional memory) that persist during protracted abstinence, and convey a vulnerability to relapse. This is an area of promising medications research.

In addition to the three medications listed above, three others – long-lasting naltrexone, topiramate and aripiprazole – are also in development.

Despite a relatively slow rate of adoption of pharmacotherapies for alcoholism, patient attitudes seem to be moving toward openness to pharmacotherapy.

Several challenges will need to be addressed prior to a greater adoption of pharmacotherapies for alcoholism: a demonstration that the medications can be highly effective; more positive patient and clinician attitudes; improved clinician knowledge and skills; and improved third-party reimbursement policies.

The prevailing perception is that these medications have poor efficacy and a high cost. Yet there is abundant evidence supporting their use for the treatment of alcohol dependence. The symposium concluded that more research is needed to convince physicians to recommend these medications for alcohol-dependent patients.

(Kranzler, HR, Koob, G, Gastfriend, DR, Swift, RM, Willenbring, ML: Advances in pharmacotherapy of alcoholism: Challenging misconceptions. Alcoholism: Clinical & Experimental Research 30: 272-281, 2006.)

Surveys have found that most people have little idea of the amount of wine, beer, spirits, or alcohol content in a given glass. Preliminary pilot studies confirmed that asking subjects the size of their wine or spirit drinks was unreliable.

In a recent study, a sample of 310 drinkers from the 2000 National Alcohol Survey were re-contacted to participate in a telephone survey with specific questions about the drinks they consumed. Subjects were instructed to prepare their usual drink at home and to measure the alcoholic beverage and other ingredients with a provided beaker. Information on the brand or type of each beverage was used to specify the percentage of alcohol.

The weighted mean alcohol content of respondent’s drinks was found to be 0.67 ounces overall. The largest average alcohol content for spirits was found to be 0.89 ounces – 48.3% larger than a so-called standard drink. Wine drinks had the second highest mean alcohol content at 0.66 ounces, 10% larger than a standard drink. Beer drinks were found to contain the least alcohol with a mean of 0.56 ounces, 6.7% less alcohol than the standard.

While the 0.6-ounce of alcohol drink standard appears to be a reasonable single standard, it cannot capture the substantial variations evident in this sample and it probably underestimates average wine and spirits ethanol content. The study concludes that, although drinks of a certain type could contain this weighted mean amount of alcohol, it is not necessarily an accurate description of the drinks actually consumed by Americans.

(Kerr, WC, Greenfield, TK, Tujaque, J, Brown, SE: A drink is a drink? Variation in the amount of alcohol contained in beer, wine and spirits drinks in a US methodological sample. Alcoholism: Clinical & Experimental Research 29: 2015-2021, 2005.)

Alcoholics Anonymous (AA) is the most widely used resource for alcohol problems and alcoholism, but little is known about patterns of AA involvement over time and how this relates to abstinence. In a recent study, researchers recruited 349 dependent drinkers when they entered treatment. Patients who reported that they had attended AA were re-interviewed one, three, and five years later. The researchers found four classes of AA “careers” over five years low, medium, high, and declining. The low AA attended only a handful of meetings during the 12 months following treatment. The medium group maintained modest but steady attendance. The high group attended many meetings and stayed with it over time. The declining group attended many meetings but only for a short period of time.

Specifically, the medium and high groups reported stable attendance at the second and third follow-ups (about 60 meetings a year for the medium group and over 200 meetings per year for the high group.) Such high rates of attendance may be the norm, but could reflect the higher proportion of newcomers in AA. For example those with longer time in the program may attend fewer meetings but spend more time with people in recovery outside of meetings or simply disengage somewhat after many years of intense involvement. By year five, there were slight increases for the medium group and slight decreases for the high group. The declining AA group doubled its meeting attendance to almost 200 meetings a year following treatment entry, but by year five, they were only attending about six meetings on average. Not surprisingly, there was a strong parallel between AA meeting attendance and abstinence rates at all follow-ups. (Rates of abstinence by year five were 43% for the low AA group, 73% for the medium group, 79% for the high group and 61% for the declining group).

Notably, only one demographic difference was uncovered by the study; non-high school graduates were overrepresented in the low AA career group. This supports earlier analysis which reported a moderate relationship between AA affiliation and education level.

The prototypical AA careers derived from this study are consistent with anecdotal data about AA meetings: some never connect; some connect but briefly; and others maintain stable and sometimes quite high rates of AA attendance. The authors note that contrary to AA lore, in this study many who connected only for a little while did well afterwards.

(Kaskutas, LA, Ammon, L, Delucchi, K, Room, R, Bond, J, Weisner, C: Alcoholics anonymous careers: Patterns of AA involvement five years after treatment entry. Alcoholism: Clinical & Experimental Research 29: 1983-1990, 2005.)

To date, research on the addiction likelihood of different drugs has been conducted alongside research on individual user risk for addiction. The authors of this study attempted to bridge that work by examining the relationship between length of time between onset of abuse and dependence (LOTAD) and the addiction potential of different drugs. The expectation was that the shorter the LOTAD, the greater the addictive liability.

Researchers reanalyzed data gathered by the American Psychiatric Association Substance Use Disorders Work Group from 1,226 participants between 1990 and 1994 at five U.S. sites. Participants were recruited from both community and clinical settings.

The shortest LOTADs were observed for disorders related to cocaine and opiates, followed by marijuana and then alcohol. Women and early initiators of drug use had shorter LOTADs compared to men and other initiators of drug use.

(Ridenour, TA, Maldonado-Molina, M, Compton, WM, Spitznagel, EL, Cottler, LB: Factors associated with the transition from abuse to dependence among substance abusers: Implications for a measure of addictive liability. Drug and Alcohol Dependence 80:1-14, 2005.)

In Germany and many other European countries, alcohol-treatment rehabilitation programs have traditionally focused almost exclusively on inpatient treatment. The costs are considerable. This study investigated the effectiveness of a highly structured outpatient treatment program, and also looked at predictors for relapse after three years.

Researchers consecutively recruited 103 alcohol-dependent patients who enrolled in a two-phase treatment program: a 12-week motivational phase, followed by an eight-month rehabilitation phase. Patients were interviewed at entry to, as well as exit from, the program; and also six, 12, 24 and 36 months after the end of treatment.

 The strong predictors for relapse after treatment were found to be: dropping out of treatment, being female, and having fewer positive life events prior to treatment. Of the original 103, 74 patients completed the program: 44 (43%) were abstinent and 46 (45%) had relapsed. The authors note that an abstinence rate of 43 percent for the total follow-up period of three years is considered favorable.

(Bottlender, M, Soyka, M: Outpatient alcoholism treatment: Predictors of outcome after 3 years. Drug and Alcohol Dependence 80:83-89, 2005.)

Over the past ten years, researchers have learned a great deal about cannabinoid (marijuana-like) and opioid (morphine-like) drugs and their interactions. The main psychoactive ingredient in marijuana is THC (delta-9-tetrahydrocannibinol). It produces its behavioral effects by binding to cannabinoid receptors in the brain. Similarly, the main ingredient in opium, morphine, produces its behavioral effects by binding to opioid receptors. Studies have shown that both THC and morphine interact with these receptors to produce, among other effects, an increase in appetite and food consumption in both animals and humans. The findings of these studies have led researchers to investigate the therapeutic value of THC and morphine. Recently, cannabis was approved for cancer and HIV patients, to reduce pain and increase appetite. Just as THC and morphine bind with receptors and increase appetite, other chemicals called antagonists block the effects of THC and morphine and thus suppress appetite and reduce food intake. The antagonist drug rimonabant, which blocks the effects of THC, has been proposed as a medication for the treatment of obesity.

In a recent study, researchers investigated the effects of THC, morphine, rimonabant, and naltrexone (or naloxone) on appetite and food reinforced behavior in rats. They also studied the influence of the interactions between the cannabinoid and opioid receptor systems on food-reinforced behavior. As in prior studies, researchers found that THC and morphine significantly increased the motivation in rats to respond for food, while the antagonists rimonabant and naloxone significantly reduced such motivation. A new finding from the study was that the cannabinoid and opioid systems are interdependent. Researchers discovered that naloxone (the morphine antagonist) reversed the appetite response effects of THC and similarly, rimonabant (the THC antagonist) reversed those effects of morphine. Thus, the effects of THC appeared to be dependent upon the secondary activation of opioid systems and the effects of morphine appeared to be dependent on cannabinoid systems. The findings support the therapeutic use of THC for the treatment of severely reduced food consumption associated with chemotherapy and HIV and the use of antagonists such as rimonabant for the treatment of obesity.

(Solinas, M, Goldberg, SR.: Motivational effects of cannabinoids and opioids on food reinforcement depend on simultaneous activation of cannabinoid and opioid systems. Neuropsychopharmacology 30: 2035–2045, 2005.)

Alcohol use among all adolescents has always been an area of concern. In recent years, the rates of alcohol use among very young female adolescents have been of special interest, and have been increasing as well. This study examines the prevalence of alcohol use, accompanying sociodemographic factors, expectancies, and future intentions among girls eight to 10 years of age.

Researchers examined data taken from the ongoing Pittsburgh Girls Study, in which alcohol-use behaviors and attitudes were assessed annually during a three-year period among a community sample of preadolescent girls. For this study of 2,451 age-eligible girls, data were collected during separate parent and child interviews conducted in the participants’ homes.

The prevalence of alcohol use without parental permission was less than three percent in any given year between the ages of eight and 10. Most of the girls reported sipping only and there was little continuity of use across assessments. Alcohol-related expectancies (expectations to drink) were predominantly negative during this period and decreased with age but expectancies increased particularly among white girls. This increase in positive expectancies from age nine onward may signal girls’ increasing readiness to initiate alcohol use that may, in turn, require prevention programs to begin earlier, during the elementary school years.

                (Hipwell, AE, White, HR, Loeber, R, Stouthamer-Loeber, M, Chung, T, Sembower, MA: Young girls’ expectancies about the effects of alcohol, future intentions and patterns of use. Journal of Studies on Alcohol 66:630-639, 2005.)

In a survey conducted by researchers of the Bureau of Justice Statistics in 2002, more than two-thirds of jail inmates were classified as alcohol or drug dependent or abusers. Fifty-three percent of inmates were dependent on or abused drugs, as opposed to 47% for alcohol. Surprisingly, almost two-thirds of inmates who met the criteria for dependence or abuse had participated in a substance abuse treatment program in the past, and most while under correctional supervision.

Some important results of the survey are given below:

• White and middle-aged inmates had higher rates of substance dependence or abuse.
• Half of all jail inmates aged 35-44 were alcohol or drug dependent, and women and white inmates were more likely to have used drugs at the time of their offense.
• Younger inmates had higher drug dependence or abuse, while middle-aged inmates had higher alcohol dependence or abuse.
• Over half of those convicted for drug, robbery, or burglary offenses were under the influence at the time of the offense. About one-fourth of property and drug offenders reported that they committed their crime to get money for drugs.
• Half of all inmates who met the conditions for substance dependence or abuse had a family member who had served time, most often a father or brother.
• Inmates who were dependent on or abused substances were more likely to have had a prior criminal record.
• Substance dependent and abusing inmates were also more likely to have been homeless in the year prior to admission to jail and were twice as likely to have lived in a foster home, agency, or institution. Over a fifth of these inmates reported physical or sexual abuse in the past.
• Treatment while under correctional supervision rose between 1996 and 2002. One in six inmates who used alcohol at the time of the offense and one in five who used drugs participated in treatment or other programs after admission.

(Karberg, JC, James, DJ: Bureau of justice statistics special report: Substance dependence, abuse, and treatment of jail inmates, 2002. Department of Justice, Office of Justice Programs, July 2005, NCJ 209588)

Common hypotheses among researchers in the field of alcohol studies are that a set of symptoms associated with alcohol-use disorders progress in a sequential pattern and that there is a systematic progression from alcohol abuse to alcohol dependence. But is there evidence that symptoms of alcohol use develop in an orderly fashion? Does the presence of a certain symptom indicate how far the disease has progressed?

In a recent study of older, community-residing problem drinkers, researchers identified possible sequences of symptoms based on the average age of symptom onset, the average number of years from drinking initiation to symptom onset, and the prevalence of symptoms. Symptom orders experienced by individuals were compared with the statistics based on the group as a whole. Researchers also assessed whether individuals progress from alcohol abuse to alcohol dependence. The sample of participants included 192 women and 486 men whose average age was 69 years. Data on drinking histories was gathered as part of a larger, 10-year longitudinal study.

                Using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), researchers analyzed data from individual participants to see how well they matched with expected progression from early to middle to late symptoms and looked for evidence of a systematic progression from abuse to dependence.

Researchers found that the order of symptoms experienced by individuals did not follow the expected order based on group data. Also, alcohol abuse symptoms did not appear to be a necessary precursor to symptoms of alcohol dependence. In fact, a substantial number of participants developed three dependence symptoms (the minimum for dependence diagnosis) prior to their first abuse symptom. Although findings of the study did not support a disease-progression model, the data on age of symptom onset, years to symptom onset, and prevalence of symptoms, are nevertheless useful. For example, women were more likely than men to continue drinking despite health problems and less likely to engage in hazardous use and experience social problems due to drinking. These findings may explain why women were more likely than men to experience dependence symptoms prior to any abuse symptoms.

Researchers conclude that applying a disease-progression model is inappropriate for the study of the complex personal and social criteria contributing to alcohol-use disorders. The results also suggest a need for reexamination of the DSM-IV abuse and dependence diagnoses and the assignment of symptoms within each category.

(Lemke, S, Schutte, KK, Brennan, PL, Moos, RH: Sequencing the lifetime onset of alcohol-related symptoms in older adults: Is there evidence of disease progression? Journal of Studies on Alcohol 66: 756–765, 2005.)

Given the complex and highly individualized nature of alcohol dependence, there does not appear to be one “right” treatment for alcoholism. Some people choose Alcoholics Anonymous (AA) and some undergo professional treatment. A new study has found that people who become involved in both AA and treatment fare better than those who obtain only treatment.

Researchers surveyed 362 individuals (193 females, 169 males) who had initial contact with an alcoholism treatment system for their alcohol-use disorder. Study participants were surveyed at baseline (initial contact) and then again at one, three, eight and 16 years later.

Compared with those who participated only in professional treatment in the first year after initial contact for help, those who participated in professional treatment and AA together were more likely to achieve remission, whereas individuals who entered treatment only and delayed participation in AA did not appear to obtain any additional benefits from AA.

(Moos, RH, Moos, BS: Paths of entry into Alcoholics Anonymous: Consequences for participation and remission. Alcoholism: Clinical & Experimental Research 29:1858-1868, 2005).

Poor job performance and occupational injury have been associated with drug and alcohol use in the workplace, posing a health and safety risk not only to the user but also to other employees. Within some occupations (such as the transportation industry) operating under the influence is especially risky. Peer intervention programs were created so that coworkers could identify and intervene with problem workers and to change attitudes leading to a drug- and alcohol-free workplace.

One such program, PeerCare, was adopted in 1987 by a major interstate transportation company and a study was conducted to evaluate the impact of the program on occupational injuries. The results of the study showed that injury rates declined steadily after the implementation of the program until 1989 and then leveled off. Researchers also found a correlation between the percentage of employees covered under the PeerCare contract and injury rates. By June 1996, when 86% of the workforce was covered under PeerCare, injury rates had declined by an average of 14% per month. Before random drug and alcohol testing, the impact of the PeerCare program was greatest. Random drug and alcohol testing was implemented in 1990 and further reduced injuries.

Researchers concluded that programs such as PeerCare do achieve the hoped for decrease in workplace injuries by discouraging (and thereby reducing) impairment due to on-the-job alcohol or drug use. Their findings support the economic and human resources value of peer-focused prevention and early intervention programs.

(Spicer, RS, Miller, TR: Impact of a workplace peer-focused substance abuse prevention and early intervention program. Alcoholism: Clinical & Experimental

Research 29: 609–611, 2005.)

Between 1980 and 2002 America’s prison population quadrupled from 500,000 to 2,000,000, largely due to drug-related crime and drug abuse. This analysis estimates that 82% of state prison inmates are involved with alcohol and drugs and 69% have used illegal drugs regularly (51% were under the influence of alcohol or drugs at the time of their crime). Yet relatively few inmates received treatment.

Available treatment was either too limited (12 Step programs or education) or too extensive and costly (long term residential programs). Researchers from the University of Pennsylvania have developed a framework for estimating the actual levels of treatment needed. They estimate that one-third of the male and half of the female inmates need residential treatment, but that half of the males and one-third of the females may need no treatment or short-term intervention.

Their study states that treatment capacity in state prisons is quite inadequate and improvements in assessment, treatment matching, and incentives are needed. The researcher’s suggested framework matches an individual’s treatment with specific needs by taking into account the severity of drug use, drug-related behavioral consequences, and the existence of other health and social problems. Inmates usually present an array of health and social problems beyond just their alcohol and drug issues. Other research has shown a high rate of mental health conditions among inmates as well. Drug-involved offenders frequently also have educational deficits and sporadic work histories that complicate their transition back into their communities.

A number of studies have shown that matching services to these specific client needs positively affects treatment outcomes. This study concludes that, although the initial funding would be considerable, increasing access to different levels of treatment matched to inmate needs would result in substantial long-term social and economic benefits from reduced recidivism, easier transition to the community, and reduced drug use.

(Benko, S, Peugh, J: Estimating drug treatment needs among state prison inmates. Drug and Alcohol Dependence 77: 269-281, 2005)

Researchers already know that alcoholism can develop differently and produce differing consequences in women than in men. Few studies utilizing brain-imaging techniques, however, have looked at these gender differences. This German study used computed tomography (CT) to examine brain atrophy in female and male alcoholics, building upon a prior hypothesis that women develop alcoholic brain damage more readily than men.

Researchers examined 158 subjects: 76 women (42 patients, 34 healthy “controls”), and 82 age-matched men (34 patients, 48 healthy “controls”). All of the alcoholics were recruited from a six-week inpatient treatment program, and met DSM-IV and International Classification of Diseases 10 (ICD-10) criteria for alcohol dependence. Control subjects were recruited by advertisement. CT scans were performed twice among the patients – at the beginning and end of their six-week program – and once among the controls.

The findings indicate that women seem to develop alcohol dependence faster than men. This supports what is called a “telescoping effect” among women, in which a later onset and more rapid development of dependence appears to occur. Findings also indicate that brain atrophy seems to develop faster in women.

(Mann, K, Ackermann, K, Croissant, B, Mundle, G, Nakovics, H, Diehl, A: Neuroimaging of gender differences in alcohol dependence: Are women more vulnerable? Alcoholism: Clinical & Experimental Research 29:896-901, 2005.)

Antidepressants are commonly used with substance abusers to treat co-occurring depression. In addition, these medications positively affect some of the underlying mechanisms of addiction, particularly for alcohol, cocaine and nicotine dependence. This review systematically analyzed the scientific literature to examine the effectiveness of antidepressant drugs in individuals with alcohol and other drug-abuse disorders (alcohol, cocaine, nicotine and opioids) who may or may not have co-occurring depression.

The authors examined all studies listed on the PubMed database from 1966 to May 2004 in English, French and Spanish. Additional research was gleaned from the bibliographies of the initial studies, and abstracts from medical meetings were also included in the meta-analysis. Results do not support the use of antidepressants for the treatment of alcoholism alone; however, antidepressants do seem to help treat nicotine dependence. For dually diagnosed individuals, analysis reveals that improvement of depressive symptoms as a result of treatment with antidepressant drugs is not necessarily accompanied by an improvement in drug use. The authors recommend that dually diagnosed patients need treatment for both disorders – depression and substance dependence – in conjunction with one another.

(Torrens, M, Fonseca, F, Mateu, G, Farré M: Efficacy of antidepressants in substance use disorders with and without comorbid depression: A systematic review and metaanalysis. Drug and Alcohol Dependence 78:1-22, 2005.)

A respectable amount of data has been collected on predictors of recovery following treatment of individuals with alcohol-use disorders (AUDs). However, most of that information has been either retrospective or looked at only short-term recovery. This study looked at the role of psychological and social factors in a sample of alcoholics and their partners as predictors of recovery during a nine year period.

For nine years, researchers assessed and monitored “life functioning” of 134 community-based, coupled men. (Participants were identified from an ongoing study of families at high risk for AUDs who had met Diagnostic and Statistical Manual criteria for AUDs, i.e. abuse and dependence.) Their partners were also assessed. Predictors of recovery included treatment experiences, education, partner’s AUD status, amount of AA participation, non-smoking, and the partner’s social support network. Interestingly the alcoholic’s initial severity of drinking did not predict long-term outcome.

Results demonstrated the importance of interpersonal factors in both maintaining AUDs or promoting recovery. The researchers contend that consideration of partner characteristics and marital context as factors in the recovery process is essential.

(McAweeney, MJ, Zucker, RA, Fitzgerald, HE, Puttler, LI, Wong, MM: Individual and partner predictors of recovery from alcohol-use disorder over a nine-year interval: Findings from a community sample of alcoholic married men. Journal of Studies on Alcohol 66:220-228, 2005.)

None of the medications currently used to treat alcohol-related problems are universally effective. All have side effects that may limit their usefulness as well as reduce individual adherence to the prescribed dosage. Previous research has shown that an extract of an herbal plant called Pueraria lobata (kudzu), which contains isoflavones, can reduce alcohol consumption in rats and hamsters. Kudzu is a frequent ingredient in Chinese herbal medicine. This study tested kudzu’s effectiveness on alcohol consumption among heavy human drinkers.

Researchers recruited 14 (11 males, 3 females) self-reported “heavy” drinkers to participate in this study. “Heavy” alcohol consumption was defined as an average of nearly 26 drinks per week. Participants were given either a placebo or kudzu extract for seven days, and then given an opportunity to drink their preferred brand of beer while seated in a simulated natural environment that nonetheless allowed for observation and measurement.

Kudzu treatment resulted in a significant reduction in the number of beers consumed. This overall reduction was paralleled by an increase in the number of sips, an increase in the time to consume each beer, and a decrease in the volume of each sip. Furthermore, there were no reported side effects.

(Lukas, SE, Penetar, D, Berko, J, Vicens, L, Palmer, C, Mallya, G, Macklin, EA, Lee, DY-W: An extract of the Chinese herbal root kudzu reduces alcohol drinking by heavy drinkers in a naturalistic setting. Alcoholism: Clinical & Experimental Research 29:756-762, 2005.)

Prior research has demonstrated that relapse rates for alcohol-dependent patients with co-occurring anxiety disorders are higher than for alcohol dependent patients without a co-occurring anxiety disorder. Dutch researchers looked at whether or not the relapse rates in dually diagnosed patients could be reduced if they were given additional treatment for the co-occurring anxiety disorder.

Researchers conducted a 32-week long randomized, controlled study of 96 (65 males, 31 females) abstinent patients with a primary diagnosis of alcohol dependence as well as a co-occurring anxiety disorder (agoraphobia or social anxiety). Forty-nine patients were randomly assigned to an intensive psychosocial relapse-prevention program. Forty-seven patients received a combination anxiety-treatment program that also included cognitive behavioral therapy and/or pharmacotherapy. The study sought to identify the percentage of patients who suffered an alcohol relapse during the study. Also measured were the secondary outcome measures of total abstinence, reduction in the days of heavy drinking, and less severe anxiety symptoms.

Results indicate that, although anxiety treatment for alcohol-dependent patients with a co-occurring  anxiety disorder can help to alleviate anxiety symptoms, it seems to have no significant effect on the outcome of alcohol treatment.

(Schadé, A, Marquenie, LA, van Balkom, AJLM, Koeter, MWJ, de Beurs, E, van den Brink, W, van Dyck, R: The effectiveness of anxiety treatment on alcohol-dependent patients with a comorbid phobic disorder: A randomized controlled trial. Alcoholism: Clinical & Experimental Research 29:794- 800, 2005.)

 In 2002, a report of the U.S. Surgeon General identified nicotine dependence as an impediment to smokers who wish to stop smoking. Since the early 1980s, studies have shown that treatment with nicotine replacement therapy (NRT) increases success in smoking cessation among heavy smokers (those who smoke more than 15 cigarettes per day).

More recent research studied the efficacy of NRT among light smokers. In the trial, 917 participants who were identified as light smokers (those who smoked fewer than 15 cigarettes per day) were given either a low (2 mg) dose nicotine lozenge or a placebo lozenge. Participants identified as heavy smokers received a higher (4 mg) dose nicotine lozenge or a placebo. Participants were provided with a six-month supply of lozenges and lozenge use was recorded daily. Abstinence rates were recorded after six weeks and again at one year.

Analysis of the data showed that the light smokers who received the 2 mg nicotine lozenge had significantly higher abstinence rates as compared to those who received the placebo, both at six weeks and at one year. When abstinence rates of light versus heavy smokers were compared, researchers found that the efficacy of nicotine lozenges in both groups was similar. The study found that light smokers used fewer lozenges than heavy smokers, indicating less need for nicotine among the light smokers. Not surprisingly, light smokers used fewer lozenges than heavy smokers but both benefited equally from appropriate doses.

 (Shiffman, S: Nicotine lozenge efficacy in light smokers. Drug and Alcohol Dependence 77: 311–314, 2005.)

Treatment of older adults – particularly older women – for alcohol dependence has received little research attention. This study, led by Dr. Derek Satre of UCSF, examined the clinical characteristics and treatment outcomes of older alcohol-dependent men and women at a mixed-age, private outpatient chemical dependency program.

Researchers drew data from two randomized studies conducted at the Kaiser Permanente Chemical Dependency Recovery Program in Sacramento between 1994 and 1996, and 1997 and 1998, gathering a final sample of 92 patients (63 males, 29 females), ages 55 to 77 years. Researchers collected information on demographic characteristics, measures of alcohol and drug use and dependence, drinking history, health status, psychiatric symptoms, length of stay in treatment, use of Alcoholics Anonymous, and six-month treatment outcomes.

Results indicate that following treatment for alcohol dependence, older women have better outcomes when compared with older men. Specifically, women had greater lengths of stay in treatment and better AA attendance, which are associated with good treatment outcomes. They were more likely than men to report total abstinence from both alcohol and drugs six months after treatment. Among those who were not abstinent, the older women reported greater elimination of heavy drinking than did men.

(Satre, DD, Mertens, JR, Weisner, C: Gender differences in treatment outcomes for alcohol dependence among older adults. Journal of Studies on Alcohol 65:638-642, 2004.)

Many studies have identified a strong correlation between cigarette smoking and alcohol use. Yet there has been some reluctance to treat tobacco dependence concurrently with alcohol and drug dependence for fear of jeopardizing drinking treatment outcomes. Recently, University of Minnesota researchers conducted an extensive study to compare concurrent treatment for alcohol and tobacco dependencies with separate delayed treatment for tobacco dependencies.

Four hundred ninety-nine smokers were enrolled and randomly assigned to either concurrent alcohol and tobacco treatment or delayed (six months later) treatment for tobacco. Participants in the concurrent treatment group were found likelier to accept tobacco treatment than those offered help at a later date. There was no difference between the two groups’ smoking cessation success rates at the end of 18 months. However, it is significant that members of the concurrent group had a harder time achieving both one and six months of alcohol abstinence compared to the group who initiated tobacco treatment separately.

The study concluded that patients in alcohol treatment are willing to participate in smoking cessation, and demonstrate some success with recovery from tobacco addiction; but there is no benefit to concurrent treatment when alcohol is the primary addiction.

The findings suggest that smoking cessation efforts should be delayed until after intensive alcohol treatment. A significant finding was that drinking outcomes were worse with concurrent tobacco treatment. These results are not consistent with the existing research literature and require further replication.

(Joseph, AM, Willenbring, ML, Nugent, SM, Nelson, DB: A randomized trial of concurrent versus delayed smoking intervention for patients in alcohol dependence treatment: Journal of Studies on Alcohol 65:681-691, 2004)

Determining the amount an individual user spends on illicit drugs can produce useful estimates of the individual financial burden, the level of drug-related crime, and the challenges to providing treatment in a specific market. In 2000, the Arrestee Drug Abuse Monitoring (ADAM) program introduced an advanced questionnaire designed to more accurately determine the financial aspects of illegal drug use in Manhattan. Many impoverished drug users resort to crime to support their habit. The expense of drugs is an indicator of how much drug-related crime may occur in a given area. The ADAM effort surveyed Manhattan arrestees and the questionnaire asked very specific questions like, “How much cash did you spend for crack the last time you bought it?” In a 30-day period infrequent marijuana users spent as little as $5 while daily marijuana users spent about $600. Arrestees that used both heroin and cocaine spent over $1000 a day.

Since only a third of the arrestees reported holding full time jobs, it is likely they engaged in a significant amount of money-producing crime. The new drug market questions used in the ADAM questionnaire obtained more extensive information about drug market transactions and may prove useful in analyzing the social and economic cost of illegal drug use in other geographic areas.

(Golub, A, Johnson, BD: How much do Manhattan arrestees spend on drugs? Drug and Alcohol Dependence: 76, 235-246)

Detoxified alcoholics consistently demonstrate visuospatial and visuoperceptual deficits. Such deficits are characterized by difficulty in such tasks as putting pieces of a puzzle together and map reading. Impairment severity, however, can vary with test and task type. This study seeks to understand why some tasks are more compromised than others and, further, to specify which parts of the brain may be particularly vulnerable to alcoholism.

Researchers examined visuoperception and perceptual learning with a picture-fragment identification task in 51 recently detoxified alcoholic men (ages 29 to 66 years) compared with 63 “normal,” control men (ages 21 to 70 years). Executive function and explicit declarative memory were also assessed.

Results indicate that “controls” invoke basic visuospatial processes to perform a perceptual learning task, whereas alcoholics invoke higher-order cognitive processes (such as frontal executive systems) to perform the same task at normal levels. The use of more demanding cognitive systems by the alcoholics may be less efficient, and more costly to brain processing capacity, than those invoked by the controls. The study authors also found that as time elapses from original learning, in the alcoholics – but not the controls – age becomes predictive of perceptual learning performance. Older alcoholics are even more challenged than younger alcoholics in learning visuospatial material than are controls of similar ages.

(Fama, R, Pfefferbaum, A, Sullivan, EV: Contributions from explicit memory, executive function, and age. Alcoholism: Clinical & Experimental Research 28:1657-1665, 2004.)

A recent Brown University Medical School study confirmed the long-held belief that recovering alcoholics who help other alcoholics are better able to stay sober themselves.

Alcoholics Anonymous is the largest mutual help organization for alcoholics in the world. Yet little research has been done on its specific mechanisms that enable behavior change. This study, involving 1726 patients, showed that those who were sponsoring others or otherwise doing 12 Step work were more successful at not taking the first drink during the year following treatment. The researchers found no demographic differences in regard to helping others except age. Those who were helping other alcoholics were, on the average, 3 years older than those who were not. The ability to help others was not impacted by educational level, gender, race, socioeconomic status, or severity of past drinking behavior. Those who were helping were significantly more likely to stay sober than those who didn’t, independent of the number of meetings attended. The findings support the AA literature that encourages newcomers in recovery to get involved in helping others. The research warrants further study to determine which other elements of AA participation contribute to positive alcohol use outcomes several years after treatment.

(Pagano, ME, Friend, KB, Tonigan, JS, Stout, RL: Helping other alcoholics in Alcoholics Anonymous and drinking outcomes: Findings from Project MATCH: Journal of Studies On Alcohol 65:766-773, 2004)

Alcohol and drug use by teenagers creates major health and policy issues. The sheer size of this group – today’s adolescents make up the largest generation in American history – illuminates the need for substance-use treatment services. This study looks at the effects of a reduction in the copayment amount by a large self-insured state employer on utilization of adolescent services. Specifically, does the number of adolescent users of substance-use outpatient services increase if there is a resultant reduction in cost-sharing arrangements?

Researchers analyzed 31,585 records on utilization of mental health and substance-abuse services by members of a state-indemnity plan from July 1998 through December 2001, equaling 36 months of pre-treatment data and six months of post-treatment data. Monthly data were analyzed from both before and after copayment changes were implemented.

Results suggest that a reduction in adolescents’ substance-use service copayment requirements to a level that is equal to that for general medical services may help assure full parity between these types of services. Specifically, analysis revealed a significant increase in the number of independent adolescent users of substance-use services in the month following the change in copayment requirements.

(Ciemins, EL: The effect of parity-induced copayment reductions on adolescent utilization of substance use services. Journal of Studies on Alcohol 65:731-735, 2004.)

Alcohol use is associated with a variety of personal, health, and social problems. Considerable research has looked at identifying demographic, clinical, and motivational variables that might predict that a person would enter alcohol treatment. Still the question remains: What profile of clinical features of alcohol dependence are associated with entry into treatment? The study addresses this gap by identifying clinical features associated with receiving or not receiving alcohol treatment.

In 1998, the National Survey on Drug Use and Health gathered information from 25,500 respondents aged 12 years and older. Of 18,772 adults (ages 18 years or older), 12,437 (66%) reported use of alcohol in the preceding year. These respondents constitute the sample of “recent drinkers” that is analyzed for this study. The clinical features that were assessed included: health problems, conspicuous drinking problems, use of alcohol more than intended, increased tolerance for alcohol, a reduction in important activities, emotional problems, and inability to cut down.

Individuals who received treatment reported all seven clinical features more often than drinkers who did not receive treatment, particularly alcohol-related emotional problems and health problems. The study speaks to the importance of treatment providers recognizing and addressing, in the early stages of treatment, those clinical problems (or features) that bring alcohol drinkers into treatment.

(Lloyd, JJ, Chen, C-Y, Storr, CL, Anthony, JC: Clinical features associated with receipt of alcohol treatment. Journal of Studies on Alcohol 65:750-757, 2004.)

Key words – alcohol use, alcohol dependence, clinical features, health problems, conspicuous drinking problems, use of alcohol more than intended, increased tolerance for alcohol, reduction in important activities, emotional problems, inability to cut down, National Survey on Drug Use and Health

According to previous research, the illicit use of prescription pain medication has increased significantly among college students during the past decade, reaching a historic high point in 2002. This University of Michigan study assesses the characteristics of undergraduate college students who illicitly use prescription pain medication.

Researchers secured a random sample of 19,378 full-time undergraduate students from the Registrar’s Office at a large Midwestern university in the United States, e-mailing each of them an invitation to self-administer the Student Life Survey via the internet. The response rate was 47.3 percent, or 9,161.

Results indicate that the illicit use of prescription pain medication was second only to marijuana as the most commonly used illicit drug on a college campus. Reported usage was for recreational purposes and self-medication for pain. The majority of students obtained prescription pain medication for illicit use from their peers, and secondly from family members; those who reported obtaining the medication from their peers also reported significantly higher rates of other substance use than those who obtained the medication from family members. The authors also report that although undergraduate women were more likely than men to use prescription pain medication, undergraduate men were significantly more likely to be approached to divert their prescription pain medication to their contemporaries.

(McCabe, SE, Teter, CJ, Boyd, CJ: Illicit use of prescription pain medication among college students. Drug and Alcohol Dependence 77:37-47, 2005.)

An estimated 80 percent of alcohol-dependent individuals smoke regularly. Although brain structure, brain metabolism, and neurocognition are known to be adversely affected by chronic, heavy alcohol consumption, little research has examined the independent effects of cigarette smoking or its potentially compounding effects on alcohol-related brain damage. This Veterans Administration study examined the effects of chronic cigarette smoking on common brain metabolites and neurocognition in recovering alcoholics (RAs) and healthy controls.

Researchers compared 24 one-week-abstinent RAs (14 smokers, 10 nonsmokers) in treatment with 26 light-drinking “controls” (7 smokers, 19 nonsmokers) on magnetic resonance spectroscopic imaging (MRSI) measures of common brain metabolites in the gray and white matter of multiple brain regions, with emphasis on those areas effected by chronic alcoholism. Researchers also compared measures of neurocognitive functioning, as well as laboratory markers of drinking severity and nutritional status.

The MRSI results indicate that cigarette smoking exacerbates chronic alcohol-induced neuronal injury and cell membrane damage in the frontal lobes of RAs. In addition, cigarette smoking – independent of alcohol consumption – has adverse effects on neuronal integrity and cell membrane synthesis in the midbrain and on cell membrane synthesis in the the cerebellar vermis. Higher smoking levels among the RAs are also associated with abnormal metabolite concentrations in select subcortical structures, and lower neurocognitive functioning correlates with greater neuronal injury in the cerebellar vermis. These findings provide preliminary evidence that chronic smoking and excessive alcohol use each independently cause brain damage and that that damage is worsened when they are combined.

(Durazzo, TC, Gazdzinski, S, Banys, P, Meyerhoff, DJ: Cigarette smoking exacerbates chronic alcohol-induced brain damage. A preliminary metabolite imaging study. Alcoholism: Clinical & Experimental Research 28:1849-1860, 2004.)

Mental-health disorders often co-exist. Substance-use disorders, for example, may co-occur with major depression (MD) and with antisocial personality disorder (ASPD) which may, in turn, indicate common risk factors that are shared by these conditions. This study looked at those genetic effects that are associated with ASPD and which may contribute to the co-occurrence of major depression and substance-use disorders.

Researchers accessed data contained in the Vietnam Era Twin Registry, a general population registry of male veteran twins culled from Department of Defense files as well as other sources. A telephone diagnostic interview was administered to eligible twins. Of a total 5,150 twin pairs, 3,360 pairs (1,868 identical, 1,492 fraternal) were included in the final sample for analysis. All provided the pertinent diagnostic information required by the Diagnostic and Statistical Manual of Mental Disorders – Third Edition for ASPD, MD, alcohol dependence (AD) and marijuana dependence (MJD).

The shared genetic risk between MD and both AD and MJD was largely explained by genetic effects on ASPD which, in turn, was associated with increased risk of each of the other disorders. In short, and at least in men, this study confirms that genetic risk for ASPD is a major determinant of risk of substance dependence.

(Fu, Q, Heath, AC, Bucholz, KK, Nelson, E, Goldberg, J, Lyons, MJ, True, WR, Jacob, T, Tsuang, MT, Eisen, SA: Shared genetic risk of major depression, alcohol dependence, and marijuana dependence. Archives of General Psychiatry 59:1125-1132, 2002.)

Alcohol and drug dependence treatment outcomes of older alcoholics, particularly women, have been largely ignored. This study examined clinical characteristics and treatment outcomes among older alcoholics in a mixed-age, private outpatient, chemical dependency program.

Researchers examined 92 patients, 55 to 77 years of age (63 males, 29 females) for their demographic characteristics, alcohol and drug use/dependence, drinking history, health status, psychiatric symptoms, length of stay in treatment, use of Alcoholics Anonymous, and six-month treatment outcomes.

The women reported later onset of heavy drinking (5+ drinks per occasion) than the men, but had similar drinking levels at the treatment-intake interview. However, at the six-month follow-up, 79% of the women reported abstinence from alcohol and drugs in the prior 30 days, versus 54% of the men. These findings suggest that older women may have better treatment outcomes, after treatment for alcohol dependence, than with older men.

(Satre, DD, Mertens, JR, Weisner, C: Gender differences in treatment outcomes for alcohol dependence among older adults. Journal of Studies on Alcohol 65:638-642, 2004.)

The 2002 National Survey on Drug Use and Health found that 50% of young adults assessed with illicit drug disorders (abuse and dependence) also met the criteria for an alcohol use disorder. However, among those assessed with an alcohol use disorder (abuse and dependence), only one-third also met the criteria for an illicit drug disorder.

Prior research had identified several factors contributing to the crossover between alcohol and other substance abuse and dependence. In adults, antisocial personality disorder, manic depressive disease and schizophrenia have been associated with an increased risk for both alcohol and illicit drug disorders.

Genetic predisposition for alcohol use and dependence has also been widely documented. For example, a low level of physical response to alcohol has been observed as a high risk for alcoholism in children of alcoholics and in some Native Americans. Living in neighborhoods where drugs are easily obtained, where poor educational and job-training opportunities exist, and where poverty and dysfunctional families predominate also contribute to increased risk for both alcohol and substance disorders. For this reason, many studies on alcohol and drug abuse and dependence have used subjects from less well-educated and lower socioeconomic levels.

This study, however, involved subjects who were white, well-educated, middle-class men from stable families and young adult sons of alcoholics and controls. Two hundred forty-nine young men were evaluated 20 years ago with follow-up interviews 10, 15 and 20 years later. The men were divided into two groups. Group 1 included those diagnosed without illicit substance use. Group 2 included those diagnosed with illicit substance use. Of the 249 men, 61.8% had a parent or a sibling who met the criteria for alcohol abuse or dependence and 21.7% had at least one relative with abuse of or dependence on an illicit drug. Over the 20-year study period, 72.7% of the men had used an illicit substance.

Researchers found that the men in Group 2 (those diagnosed with illicit substance use) were almost three times more likely to be smokers and were more likely than those in Group 1 to have had a parent or sibling who met the criteria for manic depressive disease. Most importantly, the subjects in Group 2 were more likely to have co-occurring alcohol abuse or dependence. The predictors of alcohol abuse and dependence (a family history of alcoholism and a low response to alcohol) did not predict dependence or abuse on illicit drugs (such as marijuana).

The key finding in this study is that a family history of alcoholism does not indicate a high risk for dependence on or abuse of illicit drugs in this group unless that family also has individuals with dependence on drugs other than alcohol. Thus, family histories of illicit substance abuse or dependence predicted those disorders in offspring.

(Schuckit, MA, Danko, GP, and Smith, TL: Patterns of drug-related disorders in a prospective study of men chosen for their family history of alcoholism. Journal of Studies on Alcohol 65: 613–620, 2004.)

This University of Vermont study examined animal laboratory research, as well as human laboratory and clinical studies, to report on the validity and significance of “marijuana withdrawal syndrome.”

Results indicate that a withdrawal syndrome reliably follows discontinuation of chronic heavy use of cannabis or tetrahydrocannabinol (THC) – the active ingredient in marijuana. Commonly reported symptoms are primarily emotional and behavioral; however, appetite change, weight loss, and physical discomfort have also been frequently reported. The onset and time course of these symptoms appear similar to those of other substance-withdrawal syndromes. Furthermore, the magnitude and severity of these symptoms appear substantial, which suggests that the syndrome has clinical importance.

The authors recommend that “cannabis withdrawal syndrome” be included in the next revision of the Diagnostic and Statistical Manual.

(Budney, AJ, Hughes, JR, Moore, BA, Vandrey, R: Review of the validity and significance of cannabis withdrawal syndrome. American Journal of Psychiatry 161:1967-1977, 2004.)

Although Native Americans, as a group, have the highest alcohol-related death rates of all ethnic groups in the United States, tribes differ in their use and/or abuse of alcohol. This study examined the order of appearance and the progression of alcohol-related life events in a sample of reservation-dwelling Mission Indians.

Each of the 407 study participants completed an interview with the Semi-Structured Assessment for the Genetics of Alcoholism, which was used to gather demographic information and to make a lifetime diagnosis of alcohol dependence according to DSM-III-R criteria. Findings were compared with published data from the Collaborative Study on the Genetics of Alcoholism (COGA).

A high degree of similarity in the type and progression of alcohol-related life events was found between Mission Indians of both genders and alcoholics examined by COGA. This would support the belief that alcoholism has a distinct temporal course that does not appreciably differ between subgroups or by ethnic heritage. However, the age at onset of alcohol dependence occurred earlier in life (at 20 years of age) and the course progressed more rapidly (6 years) than what has been described in other large studies of alcoholics, which implies a “telescoping” of the course of alcoholism. Understanding these similarities and differences can help to guide the development of prevention and treatment programs in this population.

(Ehlers, CL, Wall, TL, Betancourt, M, Gilder, DA: The clinical course of alcoholism in 243 Mission Indians. American Journal of Psychiatry 161:1204-1210, 2004.)

Since a high percentage of offenders convicted of driving while impaired (DWI) suffer from alcohol abuse or dependence, many courts require DWI offenders to undergo assessments of their drinking. These screenings, however, are often inaccurate due to under-reporting. Offenders under-report their alcohol use out of concern for legal and social consequences. They may be ashamed and thus defensive about their alcohol use. And, offenders must pay for the screening and subsequent treatment so they falsify information to avoid the costs.

To identify the extent of this under-reporting, researchers compared the diagnoses of alcohol abuse or dependence of DWI offenders during earlier court-ordered screening with diagnoses from self-reported information five years later during a voluntary second interview. In the second interview, 583 women and 495 men were asked to provide information concerning current alcohol use. They were also asked to recall their experience five years earlier during the initial screening and diagnosis and were asked how accurately they reported their alcohol use at that time.

During the initial screening, 16.8% of offenders were diagnosed with alcohol abuse and 20.1% with dependence. Five years later, the diagnoses for these offenders increased significantly: 19.9% were diagnosed with alcohol abuse and 60.1% with dependence. In other words, over half (59%) of the offenders received a less severe diagnosis at the initial screening than at the 5-year second interview. The rate of under-reporting alcohol use in the initial screening was greatest among non-Hispanic whites (62.4%). Native Americans were least likely (46.1%) to underreport their alcohol use. Surprisingly, 61.1% of the offenders who were diagnosed as alcohol-dependent during the second interview responded that they “very accurately” reported their alcohol use during the initial screening.

Researchers concluded that, despite a comprehensive and rigorous screening program, 59% of offenders underreported alcohol abuse or dependence. Under-reporting leads to inaccurate diagnoses and missed treatment opportunities. The researchers suggest longer screening interviews and motivational approaches to encourage more accurate reporting and provide screeners with easy access to driving and criminal records. A more radical approach would be to eliminate screening and require universal treatment, during which there would be more time to evaluate and diagnose offenders. However, some providers feel that universal treatment for all offenders is neither in the offenders’ nor the public’s best interests.

(Lapham, SC, C’de Gaca, J, McMillan, G, and Hunt, WC: Accuracy of alcohol diagnosis among DWI offenders referred for screening. Drug and Alcohol Dependence 76: 135–141, 2004.)

In 2004, the U.S. Preventive Task Force recommended brief counseling for patients who drink too much. The World Health Organization also found that as little as five minutes of advice from a primary care provider was as effective as longer counseling. Nevertheless, research has shown that many of those patients who would benefit from such counseling do not receive it.

In a recent study of seven Veterans Affairs (VA) primary care facilities, researchers examined whether patients assessed with alcohol misuse were advised to drink less or to abstain. Prior to the study, researchers hypothesized that patients who tested with severe alcohol problems, who suffer from medical and psychosocial problems, and who fall within a certain sociodemographic profile (namely male, nonwhite, unmarried, lower socioeconomic status, and those who smoke) would be more likely to receive alcohol counseling. Researchers also hypothesized that the likelihood of counseling would vary among primary care providers (physicians, nurse practitioners, physician assistants, and others) based on attitudes, training, and local screening practices. And finally, researchers expected that most patients who screen positive for alcohol misuse report only mild drinking, which would lead the provider to advise a reduction in drinking rather than abstinence.

Of the 5,191 patients who reported alcohol misuse, only 1,554 patients (30%) reported receiving advice. The odds of counseling were higher in patients with more severe alcohol problems, prior alcohol treatment, and who suffered from medical conditions associated with alcohol. The proportion of patients who reported advice ranged from 27% to 34% across the seven VA primary care facilities. However, the likelihood of receiving advice was slightly higher among patients who had female providers and among nurse practitioners (94% of whom were women) rather than MD providers. Contrary to expectations, most patients who received alcohol-related advice were advised to abstain from alcohol rather than just reduce their consumption.

The researchers suggest that separate primary care visits devoted to alcohol use, programs linking primary care providers and specialists, and even financial incentives could be highly effective in increasing the likelihood of patients receiving alcohol-related advice.

(Burman, ML, Kivlahan, D, Buchbinder, M, Broglio, K, Zhou, XH, Merrill, JO, McDonell, MB, Fihn, S D., and Bradley, K A.: Alcohol-related advice for Veterans Affairs primary care patients: Who gets it? Who gives it? Journal of Studies on Alcohol 65: 621–630, 2004.)

The Incentive-Sensitization theory of addiction proposed by Robinson and Berridge in 1993 is of particular note because recovered addicts consistently affirm that it accurately describes their addiction experience. The theory proposed that the neurobiological changes that produce the experience of “liking” the drug experience can occur independently of the sensitization that results in “wanting” or craving the drug.

The theory proposed that:

1. Addictive drugs share the ability to enhance the activities of the neurotransmitter dopamine in the pleasure center of the brain.
2. This same neural system has the capability to attribute “incentive salience” or “wanting” to a perception or experience that stimulates that system.
3. In some individuals the repeated use of addictive drugs produces adaptations in this neural system making it increasingly and perhaps permanently sensitized to drugs and drug-associated stimuli.

They further suggested that this sensitization can produce compulsive drug-seeking and taking even if the expectation of drug pleasure is diminished by the potential discomfort of withdrawal or serious adverse consequences including the loss of reputation, job, home and family. This would explain why drugs can become more and more “wanted” as they come to be less and less “liked.”

The study points out the weaknesses of two other popular theories of addiction – Negative Reinforcement or “relief of withdrawal,” and Positive Reinforcement or “pleasure seeking.” Neither, according to these scientists, explains relapse after long periods of abstinence, why craving can increase after taking the drug, continued use in spite of negative consequences or relapse triggered by external cues. They refer to animal research supporting their hypotheses. The work points out how this theory that “liking” drugs and “wanting” drugs employ different neural pathways answers the critical questions of addiction: why the drug is craved, why addicts continue to use in the face of harmful results, and how “liking” the drug can be neurochemically different and occur independently from “wanting” the drug.

(Robinson, T.E., Berridge, K.C., The neural basis of drug craving: An incentive-sensitization theory of addiction. Brain Research Reviews 18: 247-291, 1993.)

This landmark study in 1981 conducted in Sweden by Cloninger and associates from the U.S. concluded that alcoholism runs in families but cannot be explained by either genetic or environmental factors alone. Rather, specific combinations of predisposing genetic factors and environmental factors appear to interact before alcoholism develops in most persons. In an attempt to disentangle these gene-environment interactions, children separated at an early age by adoption from their biological parents and reared by unrelated foster parents were studied. Three questions were pursued:

1. What characteristics of the biological parents influence the risk of alcoholism in the adoptee?
2. What characteristics of the adoption experience and the foster parents influence the risk?
3. How do genetic and environmental factors interact to influence the risk of alcoholism?

The availability of extensive social and medical records made Sweden an ideal place to study these questions. The sample consisted of 862 adopted men.

(Ed note: One difficulty in summarizing the results of historic studies in the alcohol and drug field is the earlier practice of interchanging the terms alcohol abuse and alcoholism. Since this study is referring to degrees of impaired control over alcohol we are using the term alcoholism.)

By examining complex mixes of alcoholic biological parents versus non-alcoholic parents and the interaction of those factors with environmental stressors the researchers identified two subtypes of alcoholism: moderate and severe. In general the study concluded that having a biological alcoholic parent, in particular the father, played a significant role in the development of the severe type of alcoholism in the son even when the child was raised in a non-alcoholic foster family. Further, even when alcohol abuse was present in the adoptive home it did not influence the likelihood of alcoholism in the adopted child when there was no history of an alcoholic biological parent.

This elegant and highly sophisticated study also looked at several of the possible interactions of genetics and environment in the onset and severity of alcoholism. The researchers did pioneer work in designing ways to separate genes from environment in the study of addictive diseases. There was still much work to be done: the role of genetics in addiction to other drugs, societal influences, conducting similar research on women, etc. Nonetheless this was ground-breaking work that clearly demonstrated that genetics plays a significant role in vulnerability to impaired control over alcohol use.

(Cloninger, C.R., Bohman, M., Sigvardsson, S., Inheritance of alcohol abuse: Cross-fostering analysis of adopted men. Archives of General Psychiatry 38: 861-868, 1981.)

This 1974 study at the University Of Kentucky College Of Medicine was an early effort to define in a more objective and scientific manner the phenomenon of craving – the longing for alcohol in its absence and loss of control over its use as reported by alcoholics. The hypothesis was that the internal and external cues that seem to be associated with “taking the first drink” could be replicated under controlled and measurable conditions. If that were possible, they reasoned that much could be learned of value in preventing relapse.

Twenty-four volunteer subjects were given both high and low doses of alcohol under a variety of environmental circumstances. A “Craving Meter” was devised that allowed subjects to report subjectively the level of craving they were experiencing. In addition, behavioral responses, physiological changes, and neurophysiologic (brain wave) readings were taken. The findings supported the hypothesis that both alcohol drinking and situational variables contribute to the experience of craving.  In addition, their combined interaction exerts the most profound effect. (A real life example would be taking the first drink following a severe fight with one’s spouse.)

This was a complex research effort resulting in a number of suggestions for further research. However the following findings are of particular note:

1. The study lends credence to the injunction of Alcoholics Anonymous to avoid the first drink, especially in situations or settings associated with prior drinking or conducive to further drinking.
2.  The conversion from abstinence to alcohol-seeking behavior was induced equally by both low and high doses of alcohol.
3. Any therapeutic approach that does not recognize the powerful effects of both internal and external stimuli on craving and alcohol-seeking behavior and that neglects to provide techniques for modifying the strength of these effects will likely be destined to failure.

(Ludwig, A.M., Wikler, A., Stark, L.H., The first drink: Psychobiological aspects of craving. Archives of General Psychiatry 30: 539-547, 1974.)

Neuroimaging studies have consistently shown that recently detoxified alcoholics have significant and widespread loss of brain cells, a shrinking of the brain’s surface, and a reduction in the size of ventricles that contain spinal fluid. This 1995 study used Magnetic Resonance Imaging (MRI) to measure these changes in 58 chronic alcoholics over the course of seven months after they had received 30 days of treatment. The first MRI showed significant deficiencies in brain cells (gray matter and white matter) in the cortex (the “thinking” outside portion of the brain) in the alcoholics versus a control group of non-alcoholics. Rescanning was done over a 3-12 month period.

Over a short period (30 days) of abstinence the alcoholics showed significant changes toward normalization. Older alcoholics showed greater initial damage and reversal was slower. Resumption of drinking after a short period of abstinence produced a reversal in most of the improved areas. The study also suggested that the extent of previous alcohol consumption predicts the degree of the brain’s vulnerability to the adverse effects of resumed drinking. This research additionally produced noteworthy findings regarding the influence of age and drinking history on the degree of brain damage and the rate and amount of recovery. However, the most important value of this work is that it demonstrates that a good deal of what is termed “recovery” involves the restoration of brain cells and brain function as a consequence of abstinence.

(Pfefferbaum, A., Sullivan, E.V., Mathalon, D.H., Shear, P.K., Rosenbloom, M.J., Lim, K.O., Longitudinal changes in magnetic resonance imaging brain volumes in abstinent and relapsed alcoholics. Alcoholism: Clinical & Experimental Research 19:1177-1191, 1995.)

Animal models are useful to investigate aspects of human alcoholism since the addiction process seems to occur in the primitive parts of the brain that humans share with other animals. However, animals will not voluntarily consume sufficient alcohol to produce intoxication. This fact had limited the use of animals in addiction research. A 1984 review by Holman clearly defined the criteria needed for an animal model of voluntary consumption:

1. oral ingestion of alcohol without food deprivation
2. substantial alcohol intake even when other liquids are available
3. blood alcohol levels high enough to produce intoxication
4. work performed, even in the face of adversity, to obtain alcohol
5. long-term intoxication
6. withdrawal symptoms and physical dependence
7. after abstinence, a return to drinking to intoxication.

The researchers pointed out how animal models up to that time had failed to meet one or more of those criteria and thus the research results were questionable. However, their conclusions provided useful guidelines for subsequent development of animal models, which have produced important findings about the interaction of alcohol and drugs with brain chemistry. Such knowledge led to the development of alcohol-preferring and alcohol nonpreferring mice and rats that are in use today. 

(Holman, R.B., The pharmacology of alcohol-seeking behaviour in animals. In: Pharmacological Treatments for Alcoholism. Edwards, G. and Littleton, J. (eds), Croom Helm, London, 1984.)

A most significant breakthrough in unraveling the medical mystery of alcoholism was a 1992 study published by the Yale University School of Medicine reporting the positive results of clinical testing of the drug naltrexone. The drug proved superior to placebo in measures of amount of drinking, abstinence rates, relapse, and severity of alcohol-related problems. (Ed. Note: This was one of two articles published in the same journal showing the value of naltrexone.)

Previous work had shown that naltrexone, an opioid antagonist, might be effective as pharmacological treatment for alcoholism. Opioid systems occurring naturally (endorphins) in the brain had been shown to be involved in the alcohol intake of alcohol-preferring rats. A 1990 human study by Volpicelli had demonstrated that naltrexone, when used along with psychotherapy, resulted in fewer drinking days, less craving, and lower rates of relapse.

This more extensive later research by O’Malley and coworkers was undertaken to replicate and expand earlier findings. They examined whether naltrexone used in combination with coping skills treatment would enhance treatment outcome. The 12 week study involving 58 subjects concluded that naltrexone, accompanied by adjunctive behavioral therapy, reduced craving, increased abstinence rates and prevented or limited relapse.

This study on naltrexone demonstrated that at least some forms of alcohol dependence involved the human opioid systems and added further evidence that alcoholism is a pathological brain chemistry disorder – a disease.

(O’Malley, S.S., Jaffe, A.J., Chang, G., Schottenfeld, R.S., Meyer, R.E., Rounsaville, B., Naltrexone and coping skills therapy for alcohol dependence. Archives of General Psychiatry 49: 881-887, 1992.)

It is a scientific way to describe a means to understand the complex neurobiological mechanisms of addiction by integrating neuroscience with social psychology, experimental psychology, and psychiatry. In other words it provides a framework to identify the range of factors that produce vulnerability to addiction and relapse. A 1997 Science article by Koob and Le Moal termed addiction as Hedonic Homeostatic Dysregulation. They coined the term to define the “cycle of spiraling dysregulation of brain reward systems that progressively increases, resulting in compulsive drug use.”

They point out the need to distinguish between drug and alcohol abuse and drug and alcohol dependence, suggesting that more complex neurobiological mechanisms are involved in the pathological dysregulation of the reward center of the brain that results in dependence – impaired control over the use of a substance. This model provides the structure for studying the role of brain systems and mechanisms in processes such as social psychology, self-regulation, positive and negative reinforcement, and other changes that are observed in the transition from drug use to abuse to dependence. Most important, this suggests there is a neurobiological basis for a number of sites in the brain for intervention and treatment. Finally, the authors point out that dysregulation of hedonic homeostasis can be seen in the similar spiraling cycles of pathological gambling, binge eating, compulsive exercise, compulsive sex, and others.

(Koob, G.F., Le Moal, M., Drug abuse: Hedonic homeostatic dysregulation. Science 278: 52-58, 1997.)

Neuropathological damage in the brains of chronic alcoholics has been reported for many years. However it was widely believed that this damage was the result of the malnutrition that usually accompanied such consumption. Nonetheless brain damage has been noted in alcoholics with no history of malnutrition. Previous studies had shown that long-term alcohol exposure in laboratory rats (3 to 7 months) results in residual impairment in a variety of behavioral tasks.

This 1980 study at the University Of Florida College of Medicine clearly showed that 5 months of ethanol intake results in significant loss of brain cells (16-20%) in the area of the brain responsible for learning and memory. This was the case even though the animals were given adequate nutrition throughout the period.

(Walker, D.W., Barnes, D.E., Zornetzer, S.F., Hunter, B.E., Kubanis, P., Neuronal loss in hippocampus induced by prolonged ethanol consumption in rats. Science 209: 711-713, 1980.)

Most approaches to intervention with an alcoholic assume that the motivation to cooperate with recovery must emanate primarily from within the drinker. (Perhaps reflecting the old notion that an alcoholic had to “bottom out” before they would accept help). Treatment failures were largely attributed to lack of motivation, resistance or denial – flaws in the individual’s personality. In 1983 W.R. Miller at the University of New Mexico developed a process of motivational interviewing which emphasized that motivation for change can be facilitated by the interviewing techniques of the therapist. This was an early effort to define and demonstrate an intervention model that combined known principles of psychology to assist the drinker to progress through the internal changes needed to change behavior. Thus, rather than giving advice, labeling, moralizing, or warning of consequences, the therapist led the client toward self-evaluation and motivation to change. A variety of techniques for affirmation, awareness building, and alternative choice-making were employed. The goal was not “treatment” but moving the individual from unmotivated to a readiness to change.

This innovative interviewing strategy was an important development because it offered a testable alternative to the traditional model that saw lack of motivation and denial as client personality traits. Motivational interviewing suggested that properly trained therapists could elicit positive change in a client and intervene earlier in the progress of his/her drinking problem.

(Miller, W.R., Motivational interviewing with problem drinkers. Behavioral Psychotherapy 11: 147-172, 1983,)

Heavy episodic drinking by college students has been associated with numerous adverse consequences. Alcohol poisoning and serious injuries are of particular concern. However, neither the incidence nor the demographic and clinical characteristics of these health consequences has been clearly defined. In this study the medical records of college students who sought treatment at a university medical center emergency department were examined.

A total of 1,529 records were viewed by the researchers. Of these 193 (13%) had alcohol use as a contributing factor. Five percent of these students required hospitalization as a result of alcohol related serious injuries such as closed head trauma, fractures requiring surgical repair, and attempted suicide.

Most of the injuries were unintentional injuries or falls, and assaults or fights contributed to 16% of the cases. There were nearly twice as many males than females among patients requiring emergency care for alcohol related conditions.

Notably, the researchers pointed out that an unpublished survey conducted on their own campus found that 55% of undergraduates engaged in heavy drinking episodes at least once every 2 weeks. Fourth year students, most of whom reached 21 years of age during their senior year, reported a higher rate of heavy episodic drinking.

The researchers admit that a limitation of this study is that students may have sought emergency care outside the university system or toughed-out their problem with no medical help. Alcohol related conditions requiring emergency care when the student was off the campus during the summer break would also not be reported. Nonetheless this study supports the commonly held opinion that a significant number of college students engage in harmful use of alcohol leading to serious health consequences.

(Turner, JC, Jianfen S,: Serious health consequences associated with alcohol use among college students. Journal of Studies on Alcohol 65: 179-183, 2004.)

Prenatal exposure to legal and illegal drugs is one of the single most preventable causes of developmental problems in North American children today. Large-scale investigations indicate that children who are born to mothers who abused drugs during pregnancy have an increased risk of substance abuse or addictive behaviors.

This review summarizes the experimental animal research that investigated the role of drug exposure in utero on the development of specific brain circuits that are involved in the reinforcing effects of addictive drugs, and on the behaviors that are controlled by these brain-reward systems. Identification of distinct aspects of animal behavior, the researchers reasoned, could be used as a “starting point” for human studies.

Findings of the animal research thus far indicate that the following four distinctions about animal behavior can produce new knowledge about the lasting effect of these drugs on the developing brain and later behavior. One concerns “self administration” or the “acquisition or willingness to work to obtain drugs.” The second is the “rewarding effect of those drugs” – that is, how brain-reward circuitry may encourage the pursuit/use of drugs. The third concerns “contextual associations” such as setting or environment and how those “cues” may influence craving or sensitivity. The fourth relates to “locomotor stimulation” and sensitization – that is, the “drug activation” itself.

The summary concludes that the neurobehavioral and neuropharmacological changes seen in animal research of prenatal drug exposure has yeilded insights into the basic workings of the brain reward systems involved with addictive drugs and later behavioral development. Scientists hope that these efforts will launch human studies leading to therapeutic interventions that will improve the outcome of drug exposed children.

(Malanga, CJ, Kosofsky, BE: Does drug abuse beget drug abuse? Behavioral analysis of addiction liability in animal models of prenatal drug exposure. Developmental Brain Research 147:47-57, 2003)

In recent years, there have been increasing media reports of aggressive driving and highway violence, often referred to as “road rage.” One 1999 police survey indicated alcohol involvement in 25.5% of road rage incidents. Although there is no precise scientific definition of road rage, the term generally refers to an incident in which a driver or passenger attempts to intimidate, injure, or kill another driver, passenger, or pedestrian; or an incident in which there is a threat or attempt to damage another person’s vehicle.

Scientific studies exploring the causes of road rage are few. Fewer still are studies concerning the relationship between alcohol use and road rage. Since aggressive and violent behavior has been linked to alcohol consumption, it is plausible that alcohol consumption may be a causal factor of road rage as well.

Researchers in Ontario, Canada, gathered information on road rage and alcohol use from the Centre for Addiction and Mental Health Monitor, a telephone survey of Canadian adults. Alcohol consumption, dependence, and problems were assessed by standard questions from the Alcohol Use Disorders Identification Test (AUDIT). In order to identify both victims and perpetrators of road rage, researchers devised six questions. Participants were asked whether 1) someone shouted, cursed, or made gestures, 2) someone threatened to hurt the participant or damage his or her vehicle, 3) someone attempted to or did injure the participant or damage the vehicle, 4) the participant shouted, cursed, or made gestures at someone, 5) the participant threatened to hurt someone or damage another’s vehicle, and 6) the participant attempted to or actually did hurt someone or damage another’s vehicle. Demographic measures such as gender, age, geographic region, income, education, and marital status were also included in the analyses.

In general, nearly half of the respondents were shouted at, cursed at, or had rude gestures directed at them in the past year; however, only 6% were threatened with damage to their vehicle or personal injury. Nearly a third of respondents admitted shouting, cursing or making rude gestures but only 1.7% threatened to hurt someone or damage their vehicle.

Researchers found that frequency and volume of alcohol consumption measured as high scores on the AUDIT scale were associated with both verbal perpetration as well as attempts to injure someone or damage another vehicle. Alcohol problems were associated with five of the six measures including the most serious measure, attempts to injure or damage.

(Mann, RE, Smart, RG, Stoduto, G, Adlaf, EM, and Ialomiteanu, A: Alcohol consumption and problems among road rage victims and perpetrators. Journal of Studies on Alcohol 65: 161–168, 2004.)

Dual diagnosis patients (those with both substance abuse and psychiatric problems) often require intensive treatment. This study looked at the value of less intensive, more informal services such as self-help programs to supplement acute care. To compare treatment outcomes of dual diagnosis patients admitted to both high-intensity and low-intensity care programs and the efficacy of self-help group attendance, researchers evaluated 230 patients admitted to 14 different residential treatment programs located throughout the U.S. Seven of these programs were affiliated with the Department of Veterans Affairs (VA), and seven were community programs with VA contracts to provide treatment services to veterans and non-veterans. The high-intensity programs offered different types of substance abuse treatments – formal psychiatric care, counseling and rehabilitation services, as well as social-recreational services. Patients were evaluated at intake and, depending upon the severity of substance use, psychiatric condition and family/social problems, were placed either in a high-intensity or a low-intensity treatment program. Both programs included 12-step meeting attendance as a component of treatment. Patients were evaluated at the end of the treatment program and again one year following discharge.

As might be expected, high-intensity programs combined with more attendance at 12-step meetings during and following treatment were associated with better improvement outcomes. High-intensity services were particularly associated with better outcomes for substance use and family/social problems both at discharge and after one year. Depending upon the intensity of services, patients with more attendance at 12-step group meetings showed greater improvement in substance use and psychiatric outcomes, both during and following treatment. Those in low-intensity programs who attended more 12-step programs during treatment and in the year following had better substance use outcomes as well as better psychiatric and family/social functioning. These findings concur with previous studies suggesting that 12-step programs should be integrated with acute treatment for greater benefit to dual diagnosis patients.

(Timko, C, and Sempel, JM: Intensity of Acute services, self-help attendance and one-year outcomes among dual diagnosis patients. Journal of Studies on Alcohol 65: 274–282, 2004.)

To determine trends in drinking patterns of men and women aged 60 and older, researchers analyzed five years of alcohol consumption data from the National Health Institute Surveys (NIHS). Previous studies of older drinkers measured the average number of drinks per day in order to examine the association of alcohol and health. In this study, quantity and frequency were measured separately so that researchers might find associations between these two separate measures and certain medical conditions. For example, two studies found that frequency of drinking was associated with the reduced risk of heart attacks and Type II diabetes even when quantity was low. Another study found a positive association between quantity (but not frequency) and blood pressure, while others have found a strong correlation between quantity and alcohol-related injuries.

In this recent study of 8,136 men and 8,710 women drinkers aged 60 years and older, researchers found strikingly different patterns with respect to quantity and frequency. In terms of quantity, both men and women participants showed a trend toward lower volume with increasing age. Heavy episodic drinking (the number of days in which five or more drinks were consumed) decreased with age. The proportions of men and women who drank less than 12 days per year increased with age, and those who drank 260–365 days per year also increased.

This study suggests that composite analysis (in this case looking at the combined effect of quantity and frequency rather than examining the individual effects of each) may result in missing important findings. Particular attention to the separate measures of frequency and quantity of drinking is necessary as these measures may suggest health-related associations with each unique to older individuals.

(Breslow, RA, and Smothers, B: Drinking patterns of older americans: National Health Interview Surveys, 1997–2001. Journal of Studies on Alcohol 65: 232–240, 2004.)

Chronic alcohol consumption leads to numerous structural, functional and bio-chemical alterations in the heart, liver and skeletal muscle. One such alteration is a decreased protein content, caused in part by diminished rates of protein metabolism. This study examined how long alcohol’s adverse effects on protein synthesis persist after withdrawal.

Researchers first exposed rats to a chronic diet of alcohol for 16 weeks, and then examined the effects of removing alcohol from their diets for a period of 72 hours.

Withdrawing alcohol from the rats’ diets led to a restoration of protein synthesis in the heart and skeletal muscle comparable to levels found in those rats not exposed to a chronic diet of alcohol. The organ weight and protein content per muscle was not affected by withdrawing alcohol from the diet. In summary, changes in protein metabolism observed during chronic alcohol intake appear to be reversible and do not, at this stage, seem to represent an irreversible change in cardiac or skeletal muscle.

(Vary, TC, Nairn, AC, Lang, CH: Restoration of protein synthesis in heart and skeletal muscle after withdrawal of alcohol. Alcoholism: Clinical & Experimental Research 28:517-525, 2004.)

August 31, 2004

Researchers already know that some adults with sleep problems later develop alcohol-use disorders. No long term research, however, has studied the relationship between sleep problems (overtiredness and difficulty sleeping) during childhood and subsequent alcohol use during adolescence. This study examined whether sleep problems in early childhood predict the onset of alcohol and other drug use in adolescence, and also if such a relationship is affected by other known predictors of early onset alcohol use and problems, such as attention problems, anxiety/depression, and aggression.

Researchers examined 257 boys drawn from a community sample of high-risk families (as part of an ongoing longitudinal study of the development of risk for alcohol and other substance-use disorders). All families were Caucasian. Early childhood (3 to 5 years of age) sleep problems were rated by the boys’ mothers; late childhood (9 to 11 years of age) attention problems, anxiety/depression, and aggression were also rated by the boys’ mothers; and early adolescent (12 to 14 years of age) substance use was assessed through self-report questionnaires.

The mothers’ ratings of their children’s sleep problems at ages three to five significantly predicted the onset of any use of alcohol, marijuana, cigarettes and illicit drugs by 12 to 14 years of age. Although sleep problems in early childhood also predicted attention problems and anxiety/depression in later childhood, these problems did not mediate the sleep problems/onset of substance use relationship. Since onset of substance use during the early adolescent period is known to be predictive of subsequent alcohol and drug problems and later alcohol-use disorders, such a “sleep-problem marker” has great potential to indicate risk for alcohol problems very early in life.

(Wong, MM, Brower, KJ, Fitzgerald, HE, Zucker, RA: Sleep problems in early childhood and early onset of alcohol and other drug use in adolescence. Alcoholism: Clinical & Experimental Research 28:578-587, 2004.)