Brain imaging shows there may be a cognitive difference in people with addictions

Scientists have for the first time identified brain sites that fire up more when people make impulsive decisions.

In a study comparing brain activity of sober alcoholics and non-addicted people making financial decisions, the group of sober alcoholics showed significantly more "impulsive" neural activity.

The researchers also discovered that a specific gene mutation boosted activity in these brain regions when people made impulsive choices. The mutation was already known to reduce brain levels of the neurotransmitter dopamine. The newly found link involving the gene, impulsive behavior and brain activity suggests that raising dopamine levels may be an effective treatment for addiction, the scientists say.

The research is reported in the Dec. 26, 2007 issue of the "Journal of Neuroscience."

Lead scientist is Charlotte Boettiger, PhD, assistant professor of psychology at the University of North Carolina at Chapel Hill. Boettiger led the research as a scientist at UCSF's Ernest Gallo Clinic and Research Center. Senior author is Howard Fields, MD, PhD, a UCSF professor of neurology and an investigator in the Gallo Center. He also serves as director of the UCSF Wheeler Center for the Neurobiology of Addiction.

"Our data suggest there may be a cognitive difference in people with addictions," Boettiger said. "Their brains may not fully process the long-term consequences of their choices. They may compute information less efficiently."

"What's exciting about this study is that it suggests a new approach to therapy. We might prescribe medications, such as those used to treat Parkinson's or early Alzheimer's disease, or tailor cognitive therapy to improve executive function" she added.

"I am very excited about these results because of their clinical implications," Fields said. "The genetic findings raise the hopeful possibility that treatments aimed at raising dopamine levels could be effective treatments for some individuals with addictive disorders."

The scientists used functional magnetic resonance imaging, or fMRI, to image brain activity while subjects were faced with a hypothetical scenario: choose less money now, or more money later.

Boettiger recruited 24 subjects:19 provided fMRI data, 9 were recovering alcoholics in abstinence and 10 had no history of substance abuse. Another five were included in the genotyping analysis.

At the fMRI research facility at the University of California, Berkeley, financial decision tasks measured rational thinking and impulsivity. Sober alcoholics chose the "now" reward almost three times more often than the control group, reflecting more impulsive behavior.

While decisions were being made, the imaging detected activity in the posterior parietal cortex, the dorsal prefrontal cortex, the anterior temporal lobe and the orbital frontal cortex. People who sustain damage to the orbital frontal cortex generally suffer impaired judgment, manage money poorly and act impulsively, the scientists noted.

The study revealed reduced activity in the orbital frontal cortex in the brains of subjects who preferred "now" over "later," most of whom had a history of alcoholism.

The orbital frontal cortex activity may be a neural equivalent of long-term consequences, Fields said.

"Think of the orbital frontal cortex as the brakes," Boettiger explained. "With the brakes on, people choose for the future. Without the brakes they choose for the short-term gain."

The dorsal prefrontal cortex and the parietal cortex often form cooperative circuits, and this study found that high activity in both is associated with a bias toward choosing immediate rewards.

The frontal and parietal cortexes are also involved in working memory - being able to hold data in mind over a short delay. When asked to choose between $18 now or $20 in a month, the subjects had to calculate how much that $18 (or what it could buy now) would be worth in a month and then compare it to $20 and decide whether it would be worth the wait.

The parietal cortex and the dorsal prefrontal cortex were much more active in people unwilling to wait. This could mean, Boettiger said, that the area is working less efficiently in those people.

The researchers also focused on a variant of a gene called COMT. The mutation is associated with lower dopamine levels, and the study showed that people with two copies of this allele (resulting in the lowest dopamine levels) had significantly higher frontal and parietal activity and chose "now" over "later" significantly more often.

"We have a lot to learn," Boettiger said. "But the data takes a significant step toward being able to identify subtypes of alcoholics, which could help tailor treatments, and may provide earlier intervention for people who are at risk for developing addictions."

The bigger picture, she added, is that her study provides more evidence that addiction is a disease, something even some of her peers don't yet believe.

"It's not unlike chronic diseases, such as diabetes," she said. "There are underlying genetic and other biological factors, but the disease is triggered by the choices people make."

"It wasn't that long ago that we believed schizophrenia was caused by bad mothers and depression wasn't a disease. Hopefully, in 10 years, we'll look back and it will seem silly that we didn't think addiction was a disease, too."

source: http://www.ucsf.edu/

Genetic link to alcoholism looks likelier

SAN MATEO, Calif. — Bay Area researchers probing the brain for genetic factors behind alcoholism found one more piece in the complex puzzle of the condition, according to a study published last week in a leading neurology journal.
Scientists with a research center run by the University of California-San Francisco found that a genetic variation, which produces lower-than-normal levels of the feel-good brain chemical dopamine, were strongly linked to impulsivity — one of the hallmarks of alcoholism.

"That's the major finding of this study," said Dr. Howard Fields, a neurologist and one of the study authors.
Fields works at the Ernest Gallo Clinic and Research Center, focused on the biological basis of alcohol and substance abuse. The article was published Wednesday in the Journal of Neuroscience.
"With this gene variation, you have almost double the chances of being impulsive," Fields said.

Dopamine is a neurotransmitter that induces pleasurable feelings, and is sometimes called "the courier of addiction," since many disorders, such as alcoholism and narcotics abuse, are linked to a powerful urge to create a "dopamine rush" by imbibing or injecting.

With this finding, neurologists can keep refining their targets for developing drugs that might ultimately help alcoholics kick the habit, Fields said.
"There won't be a pill that can cure alcoholism," Fields predicted. "But there will be a pill you can take that, in combination with psycho-social strategies (like Alcoholics Anonymous), will make alcoholism much more manageable."
But Stanton Peele, a New Jersey-based social psychologist and author of the 2007 book, "Addiction Proof Your Child," among several other books on addiction, noted that researchers have long sought in vain for an effective treatment for alcoholism and have few tools in their arsenal.

The paucity, he believes, is because value systems, not biological factors that lend themselves to medical treatment, largely determine why some people drink so heavily as to disrupt their lives.

source: Arizona Daily Star

'Sometimes after a hard week in court I still think, God, I'd love a drink'

Australians' relationship with alcohol has never been under more scrutiny than now. It is one of life's pleasures, a social lubricant - but it is also a major cause of violence and misery. In the first of a series on the role alcohol plays in our lives, Julie Szego meets a prominent reformed alcoholic.

PETER Faris, QC, once chairman of the National Crime Authority, frequent media commentator and constant flame-thrower, recently published an anecdote on his blog that takes the piss out of his pissed colleagues. He tells of hearing a "strident call" while walking down the street one day: "Faris, you're a c---!"

"Turning quickly I recognised the species, 'barrister inebriatus', commonly known as the 'fuzzy-eyed advocate'," Mr Faris writes. "I think that, when his time comes, the (Victorian) bar should bury him in a tomb in the foyer of Owen Dixon Chambers with an eternal flame, fuelled by whisky … the Tomb of the Unknown Barrister."

The vitriolic tone of both the incident and blog entry make sense when you remember that Mr Faris is the silk who claimed in May that cocaine had almost replaced alcohol as the drug of choice in some legal circles. Note, for present purposes, the word "almost".

Barristers, especially those who practise in the high-stakes world of criminal law, are famously heavy drinkers. Mr Faris, 67, used to put it away with the best of them before going dry more than 30 years ago. For this maverick lawyer, his status as a teetotaller helps underscore his disposition as a loner.

He blames his predicament partly on genes. His father, a bank clerk, was an alcoholic, "never violent, but often cruel". His affliction made life chaotic and unsettling. "No money, nothing. The bailiff at the door — my father spent the money on the grog. Usual story, " Mr Faris says.

"Alcohol was never on display at home — there were no bottles in the fridge or freezer. But it was always underneath, it was this massive undercurrent." Only once he turned 16 did he realise that grog was responsible for his old man's choppy moods.

Mr Faris was initiated into drink while doing his articles, a kind of apprenticeship year for young lawyers. For 14 years, from age 22 to 36, every week night was spent cultivating the next day's hangover.

"You'd go to, say, (Carlton bar) Jimmy Watson's with a bottle of red and then you'd go to the pub and drink beers till it shut, and then you'd go to a party or something, and then drive home.

"I didn't like the taste of it — it's not like chocolate or camembert. But what I did like was the hit I got; that warm feeling with the first couple of glasses of wine when all of a sudden your worries are gone."

Each night he set out to the pub with good intentions: three drinks, maximum. "So then I had three drinks and thought 'f--- it, I'll have 30'." The booze was controlling him, not vice versa. As this knowledge sunk in, so did depression.

Then one night his mate had offered to drive a girl home and, being drunk, ended up killing her. Summoned to the police station in the dead of night, it fell to Mr Faris, who knew the girl, to tell her family of the tragedy.

But even as he waded through alcohol's wreckage, he delayed putting the brakes on his own drinking. What made him change? It's hard to say. He took up jogging and hiking. His mother died. "I'm not sure about the relationship between the two things. Maybe you can work it out." Maybe the thought of years dissolving in a drunken haze was starting to terrify him.

Mr Faris resolved to go cold turkey: "On 30th June, 1976. Midnight." Out of loyalty to his mates, he returned to the pub on his first grog-free day to sip lemon squash. But the camaraderie he had once felt so intensely now soured into disdain.

"I realised all the people I had thought of as so witty, intelligent and fun to be with were the most boring, second-rate people, and we were supposed to stand around this hotel, with its carpet covered in glass and vomit, having ebullient conversations.

"I lost all my friends in one go."

They speak highly of him too, of course. Matters of personality and even ideology (Mr Faris tends to be alone among his colleagues in supporting tough anti-terror laws) explain his shortage of friends in the legal fraternity. He is now taking briefs independently from the bar and the bar's ethics committee is in turn investigating whether his comments about cocaine brought the profession into disrepute. But Mr Faris believes his non-drinking helps reinforce a perception of him as aloof and unfriendly.

"And, look, sometimes after a hard week in court I still think, 'God, I'd love a drink'. But I know I would lose so much self-respect."

His reward for abstinence comes in the form of more time for his wife and children and more clarity for intellectual pursuits. And more emotional fortitude, you could say, although inner-strength does have its downsides.

"I suppose the way I see it is that life is pretty hard — there's no soft edges. You don't get to have a couple of drinks and soften the edges.

"And that's difficult, but to use the cliche, it's character-building. I feel that I've lived every day at a time, rather than escaped."

source: http://www.theage.com.au/

When road to recovery goes through campus

James Jones developed a drinking problem in high school that became so severe he ended up forgoing a college scholarship at West Virginia University and entered a treatment program. He now counsels other young people struggling with addictions.

James Jones' first shot at college ended before it began.

In August 2004, days after his freshman orientation at West Virginia University, he went into treatment for a drinking problem that had grown so all consuming he walked away from an engineering scholarship without taking a single class.

An even lower point came months later as the young man, by then in an orange jumpsuit and shackles, was escorted into a courtroom in his hometown of Weirton, W.Va. Arrested for petty larceny, he locked eyes briefly with his sobbing mother, from whom he'd stolen his late grandmother's diamond to feed his addiction.

"I couldn't bring myself to say anything, so I just walked past her," said Mr. Jones, then 18. "I had used up all the 'I'm sorrys.' "

His downward spiral, it turns out, was short-lived. Now sober and earning solid grades almost halfway to a bachelor's degree at Penn State University's Beaver campus, Mr. Jones is part of a largely invisible group of college students often left out of the discussion of campus drinking.

By some estimates, at least 25,000 college students nationwide are in the early stage of recovery from alcoholism. Many thousands more, including Mr. Jones, whose last drink was in January 2005, have made it even further, reaching their second year of sobriety and beyond.

For them, pursuing a degree means a daily test of resolve in a setting where making friends often revolves around getting drunk.

"They're in one of the toughest environments you could imagine to stay sober, and yet they're succeeding," said Amanda Baker, an assistant director of the Center for the Study of Addiction and Recovery at Texas Tech University. "It can be a very lonely existence because the way you socialize is different, and yet you're forced to keep one foot in that environment."

Mr. Jones, who is now 21, said it's unrealistic to wall himself off from campus peers who drink, so he occasionally attends parties and accompanies friends to off-campus clubs. But he also knows he can never drink himself. He learned that lesson painfully when, after an initial attempt to get sober, he started drinking in moderation and relapsed within a month.

"I know how fast I can fall," he said.

At his worst, he was downing a fifth of liquor a day, and, when the high wasn't strong enough, he supplemented it with 80 milligram tablets of the painkiller OxyContin.

It drove this once high-achieving high school senior off Weir High School's baseball team the year it took the state championship. It even put him on the streets briefly after his mother said she would not tolerate his behavior in her house and he walked out.

These days, as he strolls the Penn State campus, a baseball cap turned backward, it's hard to envision him as once so desperate he pawned a family heirloom -- his mother's necklace set with the wedding diamond worn by his late grandmother.

Now studying psychology, Mr. Jones completed treatment at Gateway Rehabilitation Center, and the center later hired him part-time to help counsel young people facing similar addictions.

He said he hopes that by speaking openly he can show others "that your life isn't over. Things do get better." He said he feels gratitude both for the opportunity to touch other people's lives and for his own second chance.

"The way I look at it is I went through a rough period," he said. "I'm not ashamed of who I am."

His mother, Gale Jones, a nurse at Children's Hospital in Pittsburgh, said she and his stepfather feel blessed by their son's rebound. "I'm so very proud of him," she said.

Fighting for recognition

Experts say that for all the focus on alcohol in college and all the emphasis on combating binge drinking, relatively little is known about student alcoholics who are in recovery. Though some schools are showing more interest in their needs, very few campuses offer dedicated programs such as recovery housing for students.

Rutgers University pioneered the concept of recovery housing two decades ago, experts say. Today, a handful of others offer it and about 15 campuses have full-blown recovery programs.

The small number of schools is due partly to a reluctance to commit funding and partly to the difficulty gauging demand, since students in recovery won't necessarily approach the campus counseling center or even acknowledge their situation to peers.

An institution's image also comes into play, said Andrew Finch, executive director of the Association of Recovery Schools, a group whose members have dedicated recovery programs for alcohol and drug abusers.

It's one thing for a college to tell parents their child can live in a dorm where everyone pledges to abstain or to help Alcoholics Anonymous hold campus meetings. It's another thing for a college to openly market itself as an institution with specialized programs for alcoholics.

"I've even been told by a college administrator that there was some hesitancy among his administration to build programs for recovering students because the image would be 'Oh, you must really have a problem,' " said Dr. Finch, a Vanderbilt University professor.

That's a shame, he and other advocates say, because problem drinking is everywhere.

In fact, one in five full-time college students nationally, ages 18 to 22, needs treatment for alcohol abuse or dependency, according to a special analysis of data conducted this month for the Pittsburgh Post-Gazette by the federal government's Substance Abuse and Mental Health Services Administration. The finding is based on 2004-2006 surveys of 16,000 of the estimated 8.2 million full-time college students in that age group.

Many of those were facing a problem long before they arrived on campus. In fact, nearly 6 percent of individuals ages 12 to 17 ought to be in treatment for an alcohol problem, the federal agency says.

Ms. Baker said her center's estimate of 25,000 students in early recovery is likely a conservative one. Even so, the government said most who need help aren't seeking it.

Neil Capretto, medical director at Gateway, said those who do undergo treatment need support, including peers who can insulate them from temptation.

"Most relapses happen in the first year," he said. "Of those, most happen in the first 90 days. And of those, most happen in the first 30 days."

For Gary Mahoney, 27, sober since 2002 and working on a bachelor's degree at the University of Virginia, pressure these days has less to do with alcohol's allure than with whether and how to tell others on campus he is in recovery. One time he tried in class.

"I got really uncomfortable," he said. "The second it came out of my mouth it felt like I was from Mars."

At large social gatherings, he tries to have at least one person with him who knows he's in recovery, helping him to avoid the sort of pressure he felt when classmates and a professor at an end-of-semester reception unwittingly kept urging him to toast with champagne.

He benefits from a group of students, staff and faculty who meet twice monthly to discuss their recovery, but he wishes colleges did more to raise awareness that people like him are part of the campus population.

"It might remove some of the stigma," he said. "Maybe people would be more likely to seek and receive the help they need."

Sinking to the bottom

Sitting in the campus library at Penn State Beaver, Mr. Jones talked about his new career goal of counseling young people. He said some of those with whom he works at Gateway remind him of himself, struggling with image problems, in denial about their addictions and, in some cases, trying to get back into school.

"You can actually see these kids change, from the time they get there," he said of those in treatment. "Some of them change for the worse once they're there, but the majority of them, you can just see their outlook improve. It's an awesome feeling."

He reassures them by using a most striking example -- his own.

He was 5 years old when his father, a steel mill foreman who also had a drinking problem, died of a pulmonary embolism linked to alcohol use. James' mother watched helplessly years later as alcohol began to claim a second family member, a bright teenager who for most of his high school career brought home A's and B's and earned admission offers from WVU, Pitt and other schools.

Mr. Jones said his drinking at first seemed like a normal high school diversion, something he and friends did on certain weekends. But he began to crave the feeling of acceptance it provided.

By his senior year, he was drinking daily and in growing quantities, switching from beer to rum. He smoked marijuana. He abused prescription pills.

And he changed friends.

"We would get drunk before school, or use drugs before school, or leave early and get alcohol, one or the other," he said. "I got to a point where I felt -- and this is horrible -- that I had to be high or drunk to go to school."

Some mornings, he'd awake feeling so sick and achy from the previous day's binge that he'd swig alcohol from a bottle hidden in his room.

And his grades fell. He bombed physics and calculus. His mother later learned that he wasn't showing up for class. She said she underestimated the problem.

"I was alert to alcohol," she said. "I really didn't know a lot about drugs."

His baseball coach at Weir High, Bob Rosnick, said the trouble involving James didn't square with the polite teenager he had known since middle school. "I didn't see it coming," he said.

When James came home drunk or got high in the house, his mother would lay down the rules, finally telling him to leave after he ignored her warnings about getting high in her home.

"I was going crazy. I was sick. I was losing weight," she said. "I was beating myself up, saying 'What did I do wrong?'"

The teenager was anguishing, too. He wanted to believe things would improve once he got to college. But instead of joining peers on campus, he entered 133 days of residential treatment at Gateway weeks after graduating high school.

He came out clean, but started using again and in less than a month was consuming so much he went into his mother's bedroom one day looking for something to pawn. Mrs. Jones said the hardest decision she made was pressing a charge of petty larceny after confronting her son about the stolen necklace and other jewelry.

"James," she told him. "That was grandma's wedding ring."

He went into rehab at Gateway a second time, and now says he's grateful his mother loved him enough to be tough on him when he needed it.

He said friends of people abusing alcohol or drugs have a similar obligation not to look the other way, even if it's an uncomfortable thing to raise.

"Anyone can drag somebody to a car and drop them off at their apartment, but you're enabling them by helping them not get into trouble so they can do it again," he said. "You definitely have a responsibility to say something ... something like, 'I don't know if you remember what happened last night, but it's definitely not OK.'"

source: Pittsburgh Post-Gazette

Social theory leads to trial of possible anti-cocaine tool

LITTLE ROCK, Ark. — Cocaine users often chase away the taste in their throat or level off the high with beer or liquor, so researchers at the University of Arkansas for Medical Sciences thought small doses of a drug that targets alcoholics might help.

It didn't.

"We actually found the lower doses ... will exacerbate cocaine use," said Dr. Alison Oliveto, head of the study. "It will make cocaine use worse."

Oliveto and researchers are conducting a second study to examine the drug disulfiram's effect on cocaine and habitual opiate users, convinced by prior studies that something about the 1940s alcohol treatment may work at a metabolic level. But it was cultural experience, rather than empirical research, that first led doctors to think it might work.

Disulfiram, known as Antabuse in its brand-name form, has been used to help treat chronic alcoholics since its discovery. The drug requires patients to remain utterly abstinent from alcohol, even in its common forms.

"If you ingest alcohol in any form, we're even talking about wearing perfume, it can set up a pretty nasty reaction," Oliveto said. "We're talking about vomiting, flushing, increases in blood pressure, nausea — just really kind of nasty. Obviously, it's sort of a negative reinforcement approach."

It wasn't until 50 years after the drug's discovery that doctors began looking at disulfiram as a means to wean cocaine users from their habit. Instead of attacking cocaine use itself, a doctor looked at what users did on the periphery of their cocaine use.

Oliveto said doctors determined that many drank liquor to accompany the drug, to smooth out their high while cutting back on the drug's harsh aftertaste.

"It was very indirect and really very behavioral," she said. "It's very novel."

Previous studies suggested that disulfiram, coupled with therapy, helped wean cocaine users away from the drug by increasing the unpleasant effects of the drug, including anxiety. Armed with that information, Oliveto began a clinical trial that used half or less of the drug's maximum dose on chronic cocaine and opiate abusers. Researchers drew blood from test participants, wanting to see how disulfiram affected patients' dopamine levels.

Cocaine interferes with the absorption of dopamine, building up the neurotransmitters in the brain to cause the drug's high. The idea, Oliveto said, was that maybe the disulfiram was stopping that buildup.

"It's not that we're making it up, it's sort of like we're putting the cart before the horse," she said. "Now we're trying to explain the mechanism."

But in the weakened dose, men, those with a certain lowered dopamine level and those who haven't abused alcohol in the past did more cocaine during the study, Oliveto said. She cited the fact the study included those who also abused opiates, more often than not prescription pain pills like Percodan or Hydrocodone. When she began the study in Connecticut while at Yale, most of the patients she ran into used heroin, while those in Arkansas used the pain pills.

Oliveto said a second study under way will include higher doses of the drug, as well as the potential of having just cocaine users take part. The tests will include genome typing as well to see if the different users have a genetic makeup making them more likely to respond to the disulfiram.

Despite the study's findings so far, Oliveto remains certain that disulfiram could provide chronic cocaine users a means to escape the habit.

"I think part of the issue is people seem to be very afraid of (disulfiram). I'm not sure I understand why and I'm genuinely perplexed. It's been around for 60 years," Oliveto said.

JON GAMBRELL
Associated Press Writer
source: http://www.thecabin.net/

Can a drug cure an addict?

Researchers are working on a vaccine that could neuter the effects of narcotics like cocaine. Some experts warn this magic bullet could backfire

A man is at a downtown loft party. He knows he shouldn't be there, but a friend convinced him it would be a good time, one not to miss.

The music, the short skirts and familiar faces set off an urge he has been fighting for six months. It's been that long since he last cut cocaine. And he swore to stay clean.

But tonight, the pull is too strong. In a bathroom, after a quick exchange, he gets his fix.

He waits a few minutes. Yet the euphoria does not come. The vaccine worked – it stopped the cocaine molecules swirling in his blood from reaching his brain – and the man, even after giving in to temptation, does not spiral back into addiction.

The man in this scenario does not exist. But in as few as five years, this experience could be very real for the hundreds of thousands of people in North America who struggle with cocaine addiction.

In an ever-widening search to treat addiction, scientists have homed in on vaccines as a way to help people kick their habits for good. They say the powerful technology holds promise as an innovative way to treat drugs of abuse, including cocaine, methamphetamine, and even nicotine.

Human trials for the nicotine and cocaine vaccines are already well under way and have yielded good results. The National Institute for Drug Abuse in the U.S. has put $15 million toward research.

The promise of a magic bullet, a quick fix that would tear people away from drug dependency, is enticing to researchers, clinicians and addicts alike. But even as the technology is being perfected in laboratories, experts doubt that a single type of treatment will be able to solve addiction, a complex puzzle that affects dozens of brain processes and arises from myriad environmental, economic and social situations.

Anti-addiction vaccines also come with a host of ethical dilemmas: Should parents be allowed to inoculate their children against cocaine and nicotine?

Should convicted drug offenders have to be vaccinated against their illegal habit before entering prison? Should a vaccine be forced upon people, whether a person with mental illness or a pregnant mother, to protect their health?

Despite these concerns, proponents say vaccines, if and when they are shown to be safe and effective, will hold an important niche in addiction treatment and therapy.

There needs to be a wide variety of options since people respond differently to different treatments, says Margaret Haney, an associate professor of clinical neuroscience at Columbia University who studies medications, including a vaccine, to treat cocaine dependence.

Right now, she says, there are not enough medications available to treat most types of drugs of abuse, particularly cocaine.

"A vaccine is not going to cure cocaine addiction," she says.

"But there is a subset of people who will benefit from this approach ... There is a great call out there among people who are dependent, and from their family members, for something to help."

Anti-addiction vaccines employ immunotherapy and work by setting the body's immune system against drug molecules floating in the blood.

Normally, cocaine and nicotine molecules are too small for the body to recognize and easily pass from the bloodstream into the brain, where they set off pleasure receptors and produce a high.

To create a vaccine, scientists pair drug molecules with proteins to increase their overall size.

This forces the body to recognize them and to start producing antibodies against them.

After several inoculations, a patient who tries to use drugs will have enough antibodies in their blood to fight the new drug molecules, which are then prevented from reaching the brain.

The antibodies are excreted with no lasting effects.

Since vaccines target drugs before they reach the brain, scientists predict patients should experience fewer side effects.

Most other medications used to treat addiction work by changing neural pathways in the brain that mediate the effects of a particular drug.

At Columbia, in 2003, Haney tested a cocaine vaccine on 10 people who had no plans to quit using the drug.

After a course of four vaccines injected over a 12-week period, half of the people produced sufficient levels of cocaine antibodies and reported a substantial decrease, up to a 70 per cent drop, in their dependence.

Haney says the results are exciting.

One of the concerns with a cocaine vaccine is that once inoculated against a cocaine high, determined users will seek other drugs. But Haney's subjects did not do that.

"On the outside, they were using less cocaine. They just stopped. None of them switched to another drug of abuse."

A 2005 Yale University clinical trial of 18 cocaine addicts in early treatment found that cocaine antibodies persisted in the blood six months after inoculation, and subjects reported the usual euphoric effect of cocaine had diminished.

Clinical trials of nicotine vaccines have also met with success and experts say one of these vaccines will likely hit the market in as little as three years.

A 2005 clinical trial out of the University of Minnesota looked at NicVAX, a vaccine produced by Nabi Biopharmaceuticals based in Boca Raton, Fla. It found 38 per cent of smokers who received a higher dose of the vaccine quit smoking for one month, compared with 9 per cent of the placebo group.

"This is proof of principle that this (vaccine) can help people quit smoking," says study author Dorothy Hatsukami, the Forster family professor in cancer prevention at the University of Minnesota.

She sees the vaccine as a tool to help determined quitters from relapsing.

"Nothing is going to be a miracle cure," she says.

"Cigarette smoking is about more than just the drug itself. It includes a lot of things, the social environment, the pleasure sensory of smoking, using it to deal with stress. There are a lot of factors associated with smoking that people still need to deal with ... It (quitting) will still be a struggle, but it's always good to have something to help with the struggle."

Scientists who are working on anti-addiction vaccines see both the promise and the challenges that lay ahead.

Before the nicotine or cocaine vaccines can get to market, scientists have to figure out how to make them more effective, says Paul Pentel, professor of medicine and pharmacology at the University of Minnesota and a pioneer in the field.

It is clear, he says, from the three nicotine and one cocaine clinical trials that the more antibodies a person can produce, the better their chance of not using the drug. The clinical trials have also shown that not everybody who gets the vaccine will produce enough antibodies. Scientists don't yet exactly know why this happens.

"It needs to be improved to be generally useful and to get the most out of it," says Pentel.

Experts also say the mounting excitement over anti-addiction vaccines has to be tempered. Many people think of vaccines as a cure-all. And in most cases that is true; a shot against, say, measles, will prevent the disease from striking.

But anti-addiction vaccines work more like medication, says Pentel. People will likely need multiple doses over many months or years. Vaccines won't curb cravings or deal with the underlying reasons for addiction. And, in their current form, they certainly will not stop people from seeking drugs in the first place.

Haney at Columbia is adamant that people are not vaccinated against their will.

"If parents want to vaccinate their kids, I feel very strongly that that will be a disaster," she says. "The only appropriate use is for somebody who is very motivated to quit."

Tony George, a professor and chair in addiction psychiatry at the University of Toronto, says anti-addiction vaccines will be used in treatment programs once they are proven to be safe and effective. Clinicians are always looking to have more tools to help clients stay clean for good.

"This will be a bonus to our armoury," he says. "It just increases our repertoire and our chances of success."

source: The Toronto Star
Megan Ogilvie
Health Reporter

Holidays can be blue for LGBT people

Addictions to alcohol, drugs can spiral out of
control as year ends

The holidays often bring joy, but they also can bring misery for people whose addictions spiral out of control during the final days of the year, according to alcohol and drug addiction counselors.

That can be especially true for gay and lesbian people, said Franky Smith, director of the Pride Institute of Texas at Millwood Hospital in Arlington, a 10-year-old drug and alcohol rehabilitation center serving the LGBT community.
“Sometimes the holidays can exacerbate an addiction because of shame or homophobia,” Smith said. “The LGBT person is often ostracized by their families of origin. Because of that the depression sets in or the addiction takes a stronger hold.”
Smith said there usually is an increase in the number of people seeking treatment for addictions after the first of the year because alcoholics and drug addicts become more aware of their substance abuse.

Sometimes, the addicts come to realize they have a problem because family members or friends notice it, or they may come to the realization on their own, he said.

“They are around their support systems,” Smith said. “Their families start noticing things or if they are not with their families of origin, their families of choice might bring things to their attention. Then the realization is, ‘Maybe, I do have a problem.’”

Randy Martin, the former director of the Pride Institute who now has a private counseling practice in Dallas, said he sees an increase in his private practice after the first of the year. People who are having trouble dealing with new issues or even old ones that arise during the holidays seek help when the holidays are over, he said.

Frequently, those problems have involved excessive drinking or drug abuse, Martin said.
“People who have patterns of compulsive drinking … often engage in even more excessive drinking during the holidays as a way of dealing with the depression and anxiety that is going on,” Martin said. “Whether they call it a New Year’s resolution or just a general cry for help, a lot of new appointments surface in January or early February.”

Martin said he frequently refers people who are having problems with alcohol or other substance abuse to the Pride Institute.

Smith said that most of the people admitted to the Pride Institute come in on a voluntary basis.

“That means that their physician or psychologist has said, ‘This problem is serious enough that you need help,’ or they have realized it on their own,” he said.
Treatment in rehabilitation centers is based on the 12-step programs of Alcoholics Anonymous and Narcotics Anonymous. It also includes individual and group cognitive behavioral therapy.

The therapy begins after the patient goes through detoxification. That process often involves medical care so the patient can cope emotionally and physically with the withdrawal symptoms.

Smith said many people are often not aware how dangerous withdrawal from alcohol can be. Alcohol is legal and easily acquired so people are unaware of its powerful effect on the brain and other parts of the body, he noted.

The length of time that is required for detoxification varies from person to person, Smith said. People usually being to feel better after three or four days, unless they are addicted to heroin or some other opiate, he said.

“It depends on how long a person has been drinking and how much they have been drinking over a period of time,” Smith said.

Smith said there is a major advantage to a gay and lesbian person seeking help from the Pride Institute, which has the capacity for 10 patients at a time, as opposed to other rehabilitation centers.

“Being gay is not an issue at Pride,” Smith said. “At another program that is geared for the general population, some who is gay may not feel as free to discuss their issues.”
Smith said honesty is essential to the recovery process, and gay and lesbian people sometimes cannot bring themselves to discuss their sexual orientation with straight people.

Martin called the Pride Institute a “gold mine” in terms of specialty services to Dallas’ LGBT community.

“So many people are still not aware of what is right in our back yard,” Martin said. “Often times they wind up going into mental health facilities for help not realizing there is that specialized treatment there.”

Martin said he hears stories from patients who complain about stays in rehabilitation centers that were not gay friendly and not sensitive to LGBT issues.

“And just a few miles down the road is this hospital that has that specialty program,” Martin said. “I’m very confident of the program. They try to provide the most sensitive, affirming environment for the LGBT patient so I pretty regularly refer there.”

The length of treatment at the Pride Institute depends on the individual. Some stay a week or less, while others remain in treatment for as long as 28 days.

Involvement in treatment is completely anonymous to the outside world, Smith said.
“Our information is very guarded here,” Smith said. “I can’t even tell your partner if you haven’t put them on your contact list. It’s the same for employers.”

The first step is an evaluation to determine if the patient needs treatment.
“I would encourage someone who even thinks they have a problem to please have it checked out,” Smith said. “If you are having a hard time coping with life on life’s terms, call us.”

Generally, the treatment program requires that patients have insurance benefits, Medicare or the cash to fund their treatment.

But the rehabilitation center also makes referrals to public health facilities for anyone who does not have resources, Smith said.

“They should give us a call because we can get them somewhere they can get some help if we can’t help them,” Smith said.

source: http://www.dallasvoice.com/
By David Webb Staff Writer
Last Updated: Dec 21st, 2007 - 11:44:02

Children are victims of parents' drinking

When life with alcoholic parents became too much for a 10-year-old girl to handle, she sought the help of a trusted counselor and found a way to manage what previously had gotten out of hand.

The support she received from that counselor and from the Alateen program she subsequently attended molded her into the successful adult she is today.

She has asked to use the name Lanie to maintain anonymity.

“Tell your story,” she advised others who may be in a similar position today. “It’s not a secret that you have to keep. It’s nothing to be ashamed of. It is a disease that can be treated and managed.”

Lanie grew up with two alcoholic parents and, while they were not physically abusive, life was not easy for the child, and the holiday season was worse.

“With alcoholism, there’s always the unpredictability of every day, not knowing what each day is going to hold,” she said. “Then when you add the holidays to that, when things should be good, I think it makes things even worse. I think it’s overwhelming. ... They do have the expectations that holidays will be a wonderful time.”

And for some, it is, she added. Occasionally alcoholics make the effort to behave better during the holidays. They are more likely to go to church or attend Alcoholics Anonymous meetings because of the season.

For most, though, the holidays are a struggle, often because of balancing the cost of Christmas with finances already tight from feeding the alcoholism.

“It can make for a very difficult time,” Lanie said.

And while her parents did not abuse her and her younger sister, siblings of both her mother and father also were alcoholics, which exacerbated their family get-togethers.

“I still remember an incident,” she said, describing a Christmas celebration when her father and his brother got into an argument.

“(The uncle) ended up putting his fist through a window and knocking over a Christmas tree,” Lanie said. “I remember thinking, ‘This is not normal. This is not the way holidays should be.’”

Because both parents were busy with alcohol, some of the responsibility of tracking finances rested on Lanie’s shoulders. She tried to monitor money and make sure the bills had been paid, with enough left over for Christmas. During the season, it seemed, her father tended to drink even more and money was tight.

“It’s real hard for two kids to live with two alcoholics living together,” she recalled. “It was always like, ‘Who’s the parent here?’”

Finally, the girl decided she needed to talk to someone about the problems at home.

“When I finally talked to my school counselor at the time, that’s what finally got my mom to treatment,” Lanie said.

She had gone to counselor Robbie Hill for advice, and Hill had called in Lanie’s mother.

“It wasn’t a good confrontation,” Lanie said of the meeting. No one threatened to take the children away, but Hill made it clear that the environment was not good for the children and something had to be done.

The result eventually was worth the effort.

“(Hill) is a big supporter of Alateen,” Lanie said. “She’s definitely one of those people that’s easy to talk to and is a big support for families.”

So Lanie, at 10, began going to Alateen meetings.

“I would really, really encourage kids to seek out Alateen,” Lanie said. “That was my saving grace through my childhood.”

She could not leave her year-old sister at home to be taken care of by her alcoholic parents while she attended meetings, though.

“If I wanted to go to an Alateen meeting, I had to take her with me,” Lanie said. “ ... She learned to read from Alateen books.”

Lanie began to learn, too, and by the time she was in her teens, she became a speaker for the organization.

“Alateen really, honestly, provided me with so many opportunities. I’ve been to 48 states and seven countries as an Alateen speaker,” she said.

It was not unusual for her to speak to crowds of up to 10,000 youths, all children of alcoholics going through much of the same life she had experienced.

“One thing I think was really helpful as a kid was trying to keep in mind that it wasn’t because of me and it wasn’t about me,” she said. “Even though it was affecting me, it was nothing I could control.”

As a teen, Lanie also served as one of a seven-member national Alateen committee that created literature, bylaws, and similar guidelines for the organization.

Lanie maintained that connection to Alateen until, at 20, she aged out of the program and began going to Al-Anon. Though she still goes to meetings, she doesn’t attend as frequently as she did the Alateen group.

“It really defined my life and me as a person,” she said. “The traveling alone gave me so many experiences, and then to be able to be part of an organization and a planning committee like that, I think really enabled me to be part of the business world. ...

“I know I definitely wouldn’t be who I am today if I didn’t have parents who were alcoholics and if I didn’t have Alateen.”

Lanie’s mother got into recovery and started attending AA meetings when the girl was 14. Her parents divorced, and her father continued to drink, though he made seven failed attempts at treatment.

“I learned how to love him and have a relationship with him in the context (of alcoholism). I was okay with that,” Lanie said. “I think it taught me, especially with my dad, never to give up hope.”

Two years ago, unexpectedly, her father began going to AA meetings and has been sober since.

“His health has improved considerably. He’s just really become a nice guy. It’s been a nice opportunity for him to be a parent and a grandparent,” she said.

The end of her uncle’s story was not so happy. He and his wife divorced, and several years later, he died in a motel room out-of-state. It was several days before anyone found his body.

“In AA they say it’s a cunning, baffling disease, and that is so true,” Lanie said. “ ... You just never know what’s going to happen. There’s definitely some power greater than us that makes those decisions.”

source: The Emporia Gazette

Addicted Doctors Are Allowed to Practice

SAN FRANCISCO -- Troubling cases in which doctors were accused of botching operations while undergoing treatment for drugs or alcohol have led to criticism of rehab programs that allow thousands of U.S. physicians to keep their addictions hidden from their patients.

Nearly all states have confidential rehab programs that let doctors continue practicing as long as they stick with the treatment regimen. Nationwide, as many as 8,000 doctors may be in such programs, by one estimate.

These arrangements largely escaped public scrutiny until last summer, when California's medical board outraged physicians across the country by abolishing its 27-year-old program. A review concluded that the system failed to protect patients or help addicted doctors get better.

Opponents of such programs say the medical establishment uses confidential treatment to protect dangerous physicians.

"Patients have no way to protect themselves from these doctors," said Julie Fellmeth, who heads the University of San Diego's Center for Public Interest Law and led the opposition to California's so-called diversion program.

Most addiction specialists favor allowing doctors to continue practicing while in confidential treatment, as does the American Medical Association.

Supporters of such programs say that cases in which patients are harmed by doctors in treatment are extremely rare, and would pale next to the havoc that could result if physicians had no such option.

"If you don't have confidential participation, you don't get people into the program," said Sandra Bressler, the California Medical Association's senior director for medical board affairs.

California's program ends June 30. If no alternative program is adopted, the rules could revert back to the zero-tolerance policy in place before 1980, when doctors who were found by the medical board to have drug or alcohol problems were immediately stripped of their licenses.

No other state has followed California's lead. But the president of California's medical board, Dr. Richard Fantozzi, said that behind the scenes, regulators nationwide share his ambivalence toward such programs.

"To hide something from consumers, something so blatant ... it's unconscionable today," Fantozzi said.

Between 10 percent and 15 percent of physicians nationwide will have a substance abuse problem at some point in their lives, a rate similar to that of the general population, according to widespread estimates. An estimated 7,500 to 8,000 practicing doctors are probably in confidential treatment, or about 1 percent of all physicians practicing in the U.S., said Dr. Greg Skipper, head of Alabama's program and a leader of an upcoming study on the issue.

Opponents of such programs are unable to cite any documented cases in which doctors who were confidentially undergoing treatment botched operations while drunk or high. But they say the very secrecy of the programs makes it hard to assess the risks.

Nevertheless, some doctors have been accused of harming patients while they were in treatment.

In Montana, a patient accused a doctor enrolled in the state's treatment program of not following up on her abnormal test results, delaying her cancer diagnosis by more than a year. Montana revoked Dr. Robert Schure's license last year after he flunked out of treatment six times since 1994, according to board documents. The patient's suit was settled for an undisclosed sum.

A North Carolina surgeon enrolled in the state's program for alcoholism charged patients for one type of gastric bypass and then performed a shortcut procedure that led to serious complications, including stomach ulcers and vomiting, according to patients and a medical board investigation.

It wasn't until Dr. Steven Olchowski lost his license in 2005, years after many of the incidents occurred, that his participation in North Carolina's program became publicly known.

Opponents of California's program have focused on the case of Dr. Brian West, a Long Beach plastic surgeon who has been accused of negligence by the state medical board and is fighting to keep his license.

In 1999, West performed a double mastectomy and breast reconstruction surgery on Becky Anderson. The procedure left her with gaping, infected wounds that wouldn't close and, ultimately, a grotesque lump the size of a melon caused by organs spilling through an unhealed hole in her abdomen.

Weeks before performing his final, futile procedure on her, West was arrested for a drunken-driving accident.

After his conviction, West entered the diversion program for alcoholism. A year later he performed a tummy tuck on a 37-year-old woman that also healed poorly.

West ultimately flunked out of the treatment program after investigators uncovered a pattern of relapses, binge drinking and doctored urine tests that "demonstrate that he is a physician who has been long and chronically impaired by alcohol," according to a 2005 medical board complaint.

West's supporters say he has been made a scapegoat, asserting that he is not to blame for his patients' complications and that the severity of his drinking problem has been exaggerated by investigators. "I have no information from any of my investigations that Dr. West has ever cared for patients while under the influence of alcohol," said his attorney, Dominique Pollara.

West admitted no fault in settling Anderson's malpractice lawsuit for $250,000, Pollara said. The tummy-tuck patient lost her malpractice case.

Without the assurance of confidentiality, some say, addicted doctors will go underground and continue to practice without getting any treatment at all.

Jim Conway, a Venice, Calif., drug and alcohol counselor, said that before confidential treatment programs, doctors would do whatever they could to hide their addiction for fear they would lose their licenses.

At a Pomona hospital where Conway worked, an alcoholic obstetrician came to work and delivered a baby while "dead drunk," he said. In the process, the doctor severed the newborn's spine.

"And that's how it will be if they just do a punitive approach," Conway said.

Dr. Jason Giles, a Malibu physician, completed California's program in 2004 after five years in treatment for alcoholism and addiction to prescription drugs.

"I was never intoxicated taking care of patients. It didn't get to that _ but would have if I didn't avail myself of that rope dropped from the helicopter," he said.

His experience in rehab was so transformative, he said, that he quit practicing anesthesiology and opened the drug treatment center he now runs.

Giles said allowing physicians to continue to practice while in rehabilitation is crucial to the success of the treatment.

"Working actually helps them get better," he said.

source: By MARCUS WOHLSEN
The Associated Press
Wednesday, December 19, 2007; 7:31 AM

The People Joins Xmas Ambulance Crews

Her face is smeared with vomit, her skirt has ridden up to show her knickers and her stockings are round her knees.

The pretty 21-year-old lies slumped in the back of the crowded ambulance whimpering and flailing her limbs as paramedic Brian Hayes tries to get a drip in her arm.

Brian shakes his head wearily and says: "She's totally out of it. God knows how much she's had or where her friends have gone.

"She could have been raped and wouldn't have known a thing."

Fellow paramedic Phil Guthrie tries to hold a sick bowl under her chin while propping up a semiconscious man called Dave and trying to bandage the bleeding head of a paralytic OAP who's just lost control of his bowels.

Welcome to the front line of boozed-up Britain - and another night of battle for our 999 heroes. It's 2.30am in central London on Friday - the biggest night of the year for office parties.

Brian, Phil and 999 team-mate Kevin Carroll are dealing with their Eleventh drunk in seven hours - and will treat another Nine before dawn.

Across the capital, dozens more crews have been picking up the battered casualties of the UK's most deadly weapon - alcohol.

In the two years since 24-hour drinking was launched, London has seen a 12 per cent rise in booze-related calls.

Alcohol admissions to hospitals have Tripled.

And across the country, A&Es are regularly clogged up with drunks, costing taxpayers £500 Million a year.

Brian, 37, said: "The level of drunkenness is ridiculous. "I fear we are fighting a losing battle and will soon reach breaking point.

"Every time an ambulance is called out it costs £167.

"Between November last year and this September we answered 38,849 alcohol-related calls - that's £6.5million of taxpayers' money.

"And while we are mopping up sick and dealing with obnoxious or violent drunks, we hear calls coming over the radio to real life threatening emergencies.

"How would you feel if your dad had a heart attack and we could not get to him because we were dealing with a p***ed-up teenager?"

Brian has pioneered London's first "Booze Bus" ambulance which targets alcohol-related calls at peak periods to free up other crews for genuine emergencies.

He said: "More and more kids are getting paralytic.

"That's setting a time bomb for a surge in liver disease and health problems in the next decade."

And fellow ambulance man Michael Taylor, 42, warned drunk girls are easy targets for sex attackers. He said: "They match lads drink for drink then go off to the toilets, collapse in a cubicle and wake up an hour later with their knickers round their ankles, no idea where they are and terrified they've been sexually assaulted.

"Their friends say, 'Someone must have spiked her drink'. But when they sober up may they admit how much they drunk. Yet an expert told me there's not one proven case of Rohypnol or GHB date-rape drugs being used in the UK."

On Friday, the Booze Bus got its first call at 7.15 to a drunk who had collapsed in a Euston garden after an office bash.

Brian and Phil took him to University College Hospital - where he turned nasty and was arrested. Next was a call to a 49-year-old man slumped semi-conscious on a wall in Trafalgar Square.

The ambulance was diverted to Vauxhall Bridge Road, where a 48-year-old man had smashed his head open when he fell while trying to swig from a bottle of vodka.

Next they picked up Jim, a 40-year-old chartered surveyor who collapsed at a Chinatown eaterie after a party.

Pals had tied him to a chair for safety before dialling 999.

They also picked up 18-year-old Dan who was wandering shirtless round Leicester Square with his face covered in blood.

Next was Lisa, a pretty 25-year-old hit in the face by a flying glass at her office party in Aldwych.

They then headed to Soho where drunken designer Lars, 30, had tried to jump a 5ft railing for a pee - and bust his ankle.

Brian said: "It should be agony but he can barely feel it."

He also treated a man slumped on a nearby bench.

At 1.45am the crew collected a pensioner who hit his head in Holborn - then raced to a club off Regent Street to treat drunken Dave and the 21-year-old girl.

Brian said: "She'll come round in hospital scared, ashamed and feeling like s**t." And he told how medics were regularly attacked by drunks.

He said: "I've been thumped, kicked and bitten and had to have tests for HIV and hepatitis.

"I don't know what's happened to our society."

Alcohol Concern said: "We must crack down on irresponsible pubs and clubs which sell very cheap booze then leave the emergency services to clean up the mess."

I was on a drip... Mum was terrified

Tv Researcher Lisa, 31, of London, is single and tells of her nightmare binge that ended in hospital last Christmas.

I would never have called myself a big drinker but at our work lunch I started on champagne, then red wine, then Baileys. By 6pm I was drunk but we went to a pub, then a club.

We had shots of Sambuca and I staggered to the toilets - pals came looking but I'd stumbled outside without my coat in the freezing cold.

A passer-by found me lying semi-conscious covered in vomit. I'd lost control of my other bodily functions too.

This good Samaritan, whom I never found, rang an ambulance. The first thing I can remember is being slapped in the face by a nurse trying to rouse me.

I was on a drip and vomited for another three hours. My mum was called and said I was Homer Simpson yellow.

She was terrified my liver was failing. I couldn't stop crying and felt disgusted I'd tied up an ambulance.

I was off work for two days but later started a diet and exercise regime which I've stuck to. I'm terrified of getting drunk again.

source: People

Al-Anon can help you cope with alcoholics in your life

Margie and her husband go to one of those churches that frown on drinking, but her husband of 30 years drinks anyway.

Margie had an alcoholic father, an alcoholic uncle and an alcoholic brother. Her husband is an alcoholic. “I’ve had it all my life and I’m tired of dealing with it. I am a Christian and I always felt that with the Lord’s help, I could do this.”

But she can’t talk to her church friends about her husband’s drinking. They don’t know he drinks. “My husband is a closet alcoholic,” Margie said. “He doesn’t drink in bars. He doesn’t drink where anyone can see him. He drinks at home, but not when I’m there.”

Margie works a professional job. Her husband, now retired, is a functioning alcoholic, she said. Trouble is, he becomes unpleasant and verbally abusive to her when he drinks.

“You never know when you come home what you’re going to find,” she said, adding that her husband isn’t physically abusive. “Just nasty things coming out of his mouth, not cussing, but mean things.”

In August, a friend took Margie to Al-Anon, a 12-step program for people who have a loved one who abuses alcohol or drugs or has an eating disorder. The friend’s parents were alcoholic and she had gone until they died. For years, she encouraged Margie to go.

“You get wisdom from people who have gone through this,” Margie said. “Last night we talked about trying to find the blessings in other situations and not to concentrate on the alcoholic.”

The week before, people had talked about the three C’s: “You can’t cure it, you didn’t cause it, you can’t control it.” She added another three. “But with Christ, you can cope and have compassion.”

She has more peace now. She hopes her husband won’t drink so much, but he won’t have the excuse anymore that she is nagging him. “Now he doesn’t get the harassment from me. I have learned that this isn’t the way to handle it.”

Dan’s prodigal son

Dan has a son who first used alcohol and drugs at 14, attempted suicide at 18 and failed three times in rehab before finding success at a Hazelden residential rehab center in Minnesota. He stayed in residency beyond the initial rehab period, then stepped down to a halfway house, a three-quarter house and then independent living. He has been sober now eight years.

Dan, a minister, has been going to Al-Anon for eight years. Before that, his wife, a college teacher, went by herself. “I believed it was all our son’s issues. He was the drug addict and the alcohol abuser. What I found when I got to Al-Anon was that people who live around these people learn coping mechanisms.”

He had thought he could control his son’s behavior. He learned to accept that he couldn’t.

Dan and his wife go to meetings together now. Their son lives in Minnesota. Does the son attend meetings there? “I don’t know that I can answer that,” Dan said. “It’s one of those things I don’t ask about. All I know is he is clean and he manages his affairs.

“Al-Anon has helped me learn something about boundaries,” he added.

Charlene: Save thyself

Charlene’s son is an alcoholic and her husband was an alcoholic.

She and her husband were living separately when he died of his disease, Charlene said. “We were still married. I never gave up the hope he would get better. In fact, we were better friends when he was away because I didn’t get involved with everything and I wasn’t as affected. I had my own income, my own place to live and my life wasn’t as upside down anymore.”

Charlene, now in her mid-50s, stayed with her husband 10 years after she first attended an Al-Anon meeting in 1990. “His disease progressed and my situation became more tolerable because I made decisions that were right for me — with the help of Al-Anon.

“Before that I felt I was living in a cage of my own. I didn’t do anything without his approval, without his doing it with me.”

That didn’t happen often. “He was out doing his drinking and drugging while I was sitting at home worrying about where he was. I didn’t realize I alone had the key to that cage.”

When she moved out, the business she helped her husband run collapsed. She declared bankruptcy. The business was in her name.

She and her husband went to church together until his drinking and drugging got the better of him. They had Jet Skis and four-wheelers. “They’re toys,” she said. “They’re supposed to make you happy.”

Now, she has a good job and her own home. She no longer goes to church. “Al-Anon is a very spiritual program and it has brought me in touch with a higher power in a very different way, a more personal way.”

source: By Bob Schwarz
Staff writer
Sunday Gazette-Mail

PSU starts online alcohol education

Starting next year, Penn State has announced, the university will require all incoming freshmen to enroll in an online alcohol-education program before they set foot on campus.

The Web services, to be provided through the Massachusetts- based AlcoholEdu for College program, are already used by more than 200 colleges and universities nationwide.

An independent study of AlcoholEdu, done two years ago, showed that program participants reported 50 percent fewer drinking-related problems than those not enrolled.

“This program will allow us, for the first time, to educate all incoming students in the Penn State system about alcohol,” said Linda LaSalle, the coordinator of educational services at University Health Services.

Past anti-binging efforts have included gatherings in dormitories and poster campaigns.

But until now, there was “no way of actually being able to ensure that everyone is being exposed to the same information — or even that they’re exposed at all,” LaSalle said.

A $245,000 grant from the John S. and James L. Knight Foundation will help cover expenses of the four-year effort. Penn State also is kicking in some money, though the total estimated cost was not available Monday.

The Knight Foundation, which had loose ties to the former Knight Ridder newspaper company, provides targeted financial support in communities where Knight Ridder did business. The Centre Daily Times was sold by Knight Ridder to the McClatchy Co. in 2006.

A Knight Foundation director who handles grants in central Pennsylvania could not be reached immediately on Monday.

LaSalle said a local advisory committee for the foundation identified alcohol abuse as a key area of concern.

Committee members talked with leaders at Penn State about efforts that “could have a transformative effect in the community, which is part of the Knight Foundation mission,” she said.

The committee members include university Provost Rodney Erickson. In a prepared statement, he said Penn State thinks it “important to educate our incoming students about the very real dangers to which excessive drinking exposes them.”

University-supplied data suggest that alcohol-related trouble at University Park has worsened in recent years.

The number of Penn State students who make alcohol-related visits to the Mount Nittany Medical Center emergency department grew from 199 in the 1999-2000 academic year to 444 last year.

In the same period, the average blood-alcohol level of students who made those visits climbed from 0.221 to 0.235. The threshold for DUI in Pennsylvania is 0.08.

AlcoholEdu is a product of Outside the Classroom, a private company based in Boston.

Programming for college students is based on science but isn’t preachy, said Erika Tower, the company communications director.

“It’s not to tell the students what to think or do,” Tower said. “Rather, it’s to provide the information they need to know to make the best decisions themselves.”

She said the program is tailored differently for students who have already begun drinking. Online modules center on how alcohol affects the mind and body, plus brain science, advertising for alcohol, and alcohol’s influence on decision-making abilities.

Incoming Penn State students will be required to complete three of four modules before arriving on campus.

“We have tried so many different approaches to the alcohol problem over the past decade with, like other communities, seemingly little positive impact,” Penn State Vice President Bill Mahon wrote in an e-mail.

“This opportunity provided by the Knight Foundation funding will let us try another approach that starts with students months before their first Penn State class,” he went on. “We hope to have a positive impact, but understand we are working locally to combat a broad national trend.”

source: Central Daily Times

Twelve tips to keep your holiday season sober

Alcoholics Anonymous gives this advice to its members to help them stay sober during the holiday season.

Holiday parties without liquid spirits may still seem a dreary prospect to new members of Alcoholics Anonymous, but many have enjoyed the happiest holidays of their lives sober - an idea they would never have dreamed of, wanted, or believed possible when drinking. Here are some tips for having an all-round ball without a drop of alcohol.

• Line up extra AA activities for the holiday season. Arrange to take newcomers to meetings, answer the phones at a clubhouse or central office, speak, help with dishes or visit the alcoholic ward at a hospital.
• Be host to AA friends, especially newcomers. If you don't have a place where you can throw a formal party, take one person to a diner and spring for the coffee.
• Keep your AA telephone list with you all the time. If a drinking urge or panic comes, postpone everything else until you've called an AA member.
• Find out about the special holiday parties, meetings, or other celebrations given by groups in your area and go. If you're timid, take someone newer than you are.
• Skip any drinking occasion you are nervous about. Remember how clever you were at excuses when drinking? Now put the talent to good use. No office party is as important as saving your life.
• If you have to go to a drinking party and can't take an AA member with you, keep some candy handy.
• Don't think you have to stay late. Plan in advance an "important date"you have to keep.
• Worship in your own way.
• Don't sit around brooding. Catch up on those books, museums, walks and letters.
• Don't start getting worked up about all those holiday temptations. Remember, to take one day at a time.
• Enjoy the true beauty of holiday love and joy. Maybe you cannot give material gifts but this year, you can give love.
• Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

A history lesson

The year is 1998. A string of high-profile alcohol-related deaths has recently rocked prestigious universities across the country, such as MIT, the University of Virginia and Louisiana State University. Fearing such a nightmare scenario might occur at Princeton, the University Board of Trustees launched a Trustee Initiative on Alcohol Abuse to study the problem and propose a comprehensive plan to deal with it.

Deborah Prentice, a Princeton psychology professor, publishes a study in the Journal of Applied Social Psychology outlining the role of a phenomenon called "pluralistic ignorance" in influencing Princeton students' decisions with respect to high-risk drinking. Pluralistic ignorance occurs when students tend to misperceive how much alcohol their peers consume and adjust their behavior in order to fit this perceived norm. In general, students overestimate their peers' alcohol consumption, and therefore tend to drink more themselves in order to "act normal".

Prentice finds that students discussing pluralistic ignorance in a peer setting are less likely to binge drink. Correcting student perceptions is a crucial social science-backed strategy to curb risky behavior and age-old issues with alcohol on campus.

The Trustees' final report included a proposal to implement a "social norms marketing campaign" to help counteract pluralistic ignorance and curb binge drinking. Similar campaigns at Northern Illinois University and the University of Virginia have had consistent successes in reducing the rate of risky drinking behaviors; at NIU, the binge drinking rate halved after a decade of social norms marketing and at UVa., the rate dropped 20 percent within two years of the campaign's introduction.

Back here at Princeton, the Campus Alcohol Coalition appeared on the scene earlier this decade and replicated this strategy of postering campus with fliers created with student input regarding drinking based on those found at other institutions. Since these fliers won awards in 2004, however, they have essentially disappeared from campus.

What happened to consistency? Granted, the posters were often ridiculed by campus satire, but rejection of these messages is likely more an indication that they were not properly designed and targeted, not that this strategy is wholly ineffective. UVa.'s methods, which are aggressive, persistent and heavily student-driven, go beyond posters and show that the social norms approach can be done; changing the campus culture is a longterm effort.

McCosh Health Center spent $350 on a line item titled "alcohol/substance abuse" (presumably prevention) in the 2005-06 school year, a total that excludes counseling for these issues. This is probably less than the amount many Princeton students spend on alcohol in an academic year. Even more troubling, this expenditure dropped 95 percent from its peak three years earlier.

While UHS has requested a much larger budget for future alcohol outreach initiatives, these cuts over the past few years call into question the administration's commitment to persisting in the approach of targeting and changing campus social norms. The Alcohol Initiative is certainly a step toward addressing these issues, but ultimately the most successful solutions involve concentrating on student psychology.

Among all the recent headlines regarding the new RCA alcohol policy was a story of how a group of administrators, faculty members and students are getting together to study high-risk drinking and create proposals to address the issue. Does this sound at all familiar? Again, there are promises to make this initiative student-driven, which is a step in the right direction, but one would hope this is not just another peak in the cycle.

The administration's "ongoing concern" regarding high-risk drinking should translate to an aggressive ongoing health and wellness promotion effort to address campus social norms, not knee-jerk responses to alcohol-related tragedies. The focus should be on crafting effective messages to correct misperceptions regarding alcohol, not on imposing an RCA police state that turns peers into law enforcement figures and sours adviser-advisee relationships.

One caveat I would like to add is that these messages need to be informative, positive, Princeton-specific and rigorously student-reviewed. The credibility of the speaker matters for ensuring student engagement, as the recent ill-attended USG-sponsored meeting with the administration regarding the RCA policy demonstrates. The lack of student participation at these forums with the administration is likely a referendum on the efficacy of attending such discussions.

Unlike posters that appeared around Bicker earlier this year regarding sexual assault, a new effort should not be moralizing and off-putting. Getting a broad, diverse swath of the student body involved instead of just a handpicked group and closely studying UVa.'s successes would be a good start.

Ultimately, working towards preventing an alcohol-related tragedy like those we have recently seen lies in changing attitudes. In 2001, President Tilghman said, "We have to get the student body to impose peer pressure, for drinking to become really uncool." The new RCA policy would do exactly the opposite, blur the line between peer and parent, and just make RCAs uncool.

Kyle Smith is an economics major from Oakton, VA. He can be reached at kyles@princeton.edu.

Mother, son warn how both struggled with his alcoholism

Toren Volkmann started drinking when he was 14 or 15. By the time he was 22, he was a self-described “full-blown alcoholic” whose life revolved around his next drink.

Yet his parents had no idea of the scope of their son’s addiction.

Toren and his mother, Chris Volkmann, shared the story of their struggle with alcoholism Tuesday at Magna Vista and Bassett high schools, and they will continue to speak in the area today. The presentations were organized by Communities Helping Improve Local Lives (CHILL), a youth task force that encourages teens not to use drugs, alcohol or tobacco.

Like most teenagers, “it wasn’t ever my intention to have any problems with alcohol,” said Toren, now 28. “I just wanted it to be fun.”

A student athlete who did well in school, Toren said he started drinking in high school and soon earned a reputation as a partier. He was brought home by the police more than once for underage drinking and kicked off of four sports teams, but Toren still didn’t think he had a problem. Although his parents grounded him, took away privileges and talked to him about drinking in moderation, they didn’t realize the seriousness of the situation either, Chris said.

The family should have done what Chris tells parents to do every time she shares her story: They should have talked about it more seriously, she said.

Instead, Toren left the family’s home in Olympia, Wash., to go to college in Southern California. There, his drinking only worsened.

“Everything was magnified and intensified” at college, Toren said. “All I was concerned about was drinking.”

Kicked out of the dorms by the end of his freshman year, Toren met with a counselor who told him to attend 10 meetings of Alcoholics Anonymous before he returned to school the next year.

Although he went to two meetings, Toren said, he didn’t really believe he needed to be there.

“I said, ‘My name is Toren and I’m an alcoholic,’” he recalled. “... But I didn’t really know if I believed that. I just wasn’t ready to listen to what they had to say.”

Toren told his parents he was going to the meetings, but Chris didn’t ask him about it.

“I missed the opportunity to talk,” she said.

Despite his drinking problem, Toren graduated from college and entered the Peace Corps. While working in Paraguay, he sometimes went two or three weeks without drinking. But he struggled with withdrawal symptoms, such as sweating and shaking, and he always went back to binge drinking.

Eventually, Toren went to a nurse and asked for help. He was flown back to the United States, where he checked into a 30-day treatment center and spent six months in a halfway house for recovering alcoholics.

Now sober for four years, Toren lives in Portland, Ore. He and Chris travel the country sharing their experiences and talking about the book they wrote together, “From Binge to Blackout.”

As they spoke Tuesday, Chris and Toren shared facts about alcohol and its effects on teenagers.

Among them:

• More than 10 million people in the United States between the ages of 12 and 20 are heavy drinkers.

• Because people’s brains do much of their developing during adolescence, binge drinking is more dangerous for teenagers than it is for adults. Drinking as a teenager can affect the way your brain processes alcohol for the rest of your life.

• Having one family member who is an alcoholic makes a person four times more likely to develop an alcohol problem.

Toren said he knows it is difficult for teenagers to believe alcoholism can affect them. Ten years ago, he might not have listened to a speaker like himself, he said.

But he hopes not all the students are like he was.

“Even if I’m not affecting the kids that are just like me, I might affect 10 to 15 kids who are on the fence,” he said.

source: Martinsville Bulletin

Drink and drug abuse in the industry: An addict's tale

During 12 years in the hospitality industry, Chris Mordue found the perfect environment to take his drink and drug habits to the extreme. It was only an Ark Foundation seminar that eventually made him realise he had problems - and then address them.

Born in Newcastle in 1978, I was an active, happy child raised in a good family. I was outgoing, loved sports and was a successful junior athlete. Privately, though, I was nervous, felt a sense of pressure and could be over-sensitive and emotional.

I was aware of alcohol in my family and knew that my late grandfather and favourite uncle had been chronic drinkers. I grew up watching people drink in their spare time and saw it as a natural part of life. In fact I was quite amazed by the change it brought about in people and just how funny and different they seemed after a drink or two. Back then, I never saw any problems or negativity being a direct consequence of alcohol.

When I was 13 I drank to get drunk for the first time. That was my objective, and one can of Special Brew and another of Scrumpy Jack did the trick. I got drunk and was sick on my friend's mother. I lied to cover up what happened and was pleased when I got away with it. To be honest, I actually thought it was funny and liked the attention it gave me. I had no idea this would become the recurring theme of my drinking life. I'd drink to get drunk and to have a good time: most of the time I would lose control and something bad would happen, so I'd lie to try and get away with it.

During this period I started to experiment with drink, cigarettes, solvents, cannabis, LSD and amphetamines. It coincided with a difficult time in my life, including my parents' divorce and my losing some self-belief and belief in my family. Outwardly it seemed that everything was OK but I found it very difficult to make sense of my environment, struggled to relate to girls and was very self-conscious.

I looked up to people who drank and took drugs as they seemed like they had it sussed. And when I drank my personality changed. Given that I didn't like my personality, that was great.

I wanted to earn some extra money so took my first job in hospitality, working at a local restaurant. It was on the Quayside in Newcastle and, while I found it daunting, I loved it. I was nervous but thought the people were so much more interesting than my teachers and my mates at school. I was 16, a regular drinker and drug-user and quickly learnt how easy it was to get access to such substances. I spent time with older friends and became more and more disconnected from what was really important in life. Working late, picking up extra shifts, drinking and taking drugs was not conducive to school achievements and I ended up leaving before I had finished my A levels.

Over the next 12 years I bounced between front-of-house jobs in restaurants. Each time things would start off well, but then I'd push my use of drink and drugs too far - and end up leaving with no explanation, or when the restaurant had no choice but to sack me.

Working an evening shift I'd maybe sneak in a couple of vodkas from the bar at seven or eight o'clock, then do some cocaine maybe at 10ish. We'd kick out the customers just after midnight and settle in at the bar for a few hours, maybe smoking some weed to relax, before going back to someone's flat until the morning on a mix of drugs and booze.

The antisocial hours inherent in the industry meant I could sleep all day, get up, dash to work, use some amphetamines or coke to stave off the hangover then repeat the whole night again. To be frank, there was no way I could have afforded all that drink if I hadn't been taking it for free from the businesses.

I don't blame the industry for my problems because most of it was down to me, but a culture of constant drinking and recreational drugs meant that it was a dangerous place for those with little self-restraint. Colleagues were always drinking and I'm not against that, it's the nature of the industry, but employers never realised that some of us were taking it to the extreme. And in many cases owners and managers were setting the example.

I must have gone through more than 20 jobs in this period and restaurants never bothered to check up on my CV or references, so stayed ignorant of the fact I'd been sacked from my last job for gross misconduct. The problem was so endemic in some places that I even offered a manager a line of coke during one job interview and still got the position.

Eventually I achieved some success, was promoted to management, trained in wine with a Wine & Spirit Education Trust (WSET) course, despite my problem, and worked with some great companies. But the drink and the drugs always got the better of me. Every time the problem became too much for my employers I blamed someone else to justify my behaviour.

The sad truth is that, during all that time, I wasn't just coasting through the industry to get drink and drugs easily. I genuinely dreamt of owning my own restaurant and had great visions of how it would look, smell and feel. I knew where I wanted to go and what I wanted to do with my life but my actions never matched my intentions. I have since learnt that this is a common characteristic in addicts.

A growing realisation crept up on me that any new relationship I formed, be it a friend or a colleague, would eventually be damaged by my drinking. I broke trust, stole, lied and cheated, as I tried somehow to manage my drinking and drug-taking, and I surrounded myself with like-minded people. However, it was becoming clear to me that they all had some control I lacked.

I was drinking alone, hiding drinks and drinking in the morning and had growing debts as I tried to keep up with it all. I could be abusive and violent and had faced a custodial sentence for a very serious drink-driving charge but still couldn't relate to the seriousness of the situation. I knew I had a problem but was unaware of what to do about it and through a lot of the jobs no one picked up on the warning signs of my addiction.

It all came to a head in June 2004. I had lost every job I had ever had through drinking. I was working at Fifteen and was about to lose that job as well.

As a condition of my disciplinary process, Fifteen asked me to attend an Ark Foundation seminar. The speaker was former chef, alcoholic and drug addict Peter Kay, the chief executive of Sporting Chance (the charity founded by former footballer Tony Adams for the treatment of behavioural problems among professional sportspeople). As he described his life and drinking I identified with it all.

The speed with which he drank, why he drank, his feelings as a young person trying to overcome difficulties, how he moved and travelled within the industry was all a mirror of my past decade. It was a powerful story - drink and drugs nearly killed him. He had been in a life-threatening coma aged 31 and I was scared because I'd promised my long-term girlfriend I could stop at 30. Would I make it?

I knew that I would lose my job and relationship if I drank again but couldn't help myself. I loved my girlfriend, family and friends but I needed to drink alcohol. I had another blackout and it all became too much. I wasn't having fun I was hallucinating when withdrawing from the booze. I called Peter.

We met and he saw that I was in pieces, and as I had no way of funding it myself he gifted me a place at the Sporting Chance clinic. It all happened so fast. My self-esteem was so low and I was so paranoid that I thought I might be beaten up and punished when at the clinic. But it couldn't have been further from the truth, I was cared for and loved by all the therapists. Peter also liaised with Fifteen and they kindly agreed to support me and keep my job open, under conditions they agreed with the Ark.

I continued to get the right support and rebuilt my life through meetings, therapy and mentoring from Peter, and I have stayed sober since. It has been an amazing experience and my life has dramatically improved in all areas. I have been able to buy a flat, change career and set a wedding date with my girlfriend - all of which seemed impossible to me before that Ark seminar. I am very grateful to Peter, the Ark, Fifteen, Jamie Oliver and Sporting Chance for everything that they have done for me.

Once sober I continued to work at Fifteen and it was during this time that I became aware of how I had behaved while on the drink and drugs. It was a privilege when Peter saw potential in me and asked me to present seminars for the Ark. I now deliver to colleges and businesses all over the UK the same seminar that helped me so much.

It was always obvious to me that alcohol and drugs played a massive part in my life and the industry in which I worked. I had seen others experience difficulties and worked for people with heavy drink and drug habits, but at the time took it as normal. Mood swings, aggression, unreliability and other such unpredictable behaviour were all commonplace.

I had never seen a real way out and knew that there were others who were experiencing, or would experience, similar problems. I felt for a while that there was a shame associated with coming forward and admitting your problem, but it's not the case. It felt natural to want to support those people and the Ark offered me that opportunity.

When I was offered a job at Sporting Chance I left Fifteen. It's amazing to think that I had been treated there but now worked in that field. I am now being trained in psychotherapy and counselling, supporting the clinical staff as well as directing the education and training arm of the charity.

When working with Ark or Sporting Chance it's amazing to see the relief and satisfaction chefs, managers, other hospitality workers and even Premiership footballers get from talking about their problems.

The industry, in my experience, is perfect for a functioning alcoholic. I bent the truth on my CV and was never checked I was constantly exposed to alcohol and drank at work without getting caught out I finished late and slept all day and really had to do a lot wrong to get sacked. I was not alone and always found those who, like me, wanted to drink and we all covered for each other.

In the seminars, I say to colleges, employers and managers that, like the Ark, I am not against people drinking and that this is not a cure-all for the problem. I hope that participants can relate better to their use of alcohol and make better choices once they have been educated in the subject. And I always stress the positive aspects of the industry and the place of alcohol in it.

The truth is that, as a naïve 13-year-old getting drunk for the first time I never thought that bright young kid would have turned into someone who, 13 years later, would be an addict who had contemplated, and once attempted, suicide. I'd been in an industry for 10 years surrounded by people drinking and taking drugs as a way of life, and was able to bury myself in amongst them and push my habits to the extreme.

I am not blaming the industry for what happened to me, but I am inviting it to recognise that this problem exists. People often don't realise that all addicts start as occasional users. Full-blown addiction may affect only a minority, but it is no joke. It not only affects the sufferer and his employer but their families and communities and it's the responsibility of the industry to acknowledge this. Ark is not a quick fix, but it was life-changing for me.

How to spot if you have a problem

Below is a list of 20 questions, as used by the Ark Foundation, relating to alcohol and drugs usage. Read through the questions and answer them as honestly as you can before checking your responses against the guide at the end.

1. Do you find one drink is not enough, and halfway through it are thinking about the next?

2. Do you find the first drink "disappears" very quickly, maybe in a single gulp?

3. Is drinking or drug-taking making your home life unhappy?

4. Is it more comfortable drinking alone than with others?

5. Is drinking or drug-taking affecting your reputation?

6. If your dependency has escalated, has your ambition decreased?

7. Have you ever felt remorse and sadness after drinking?

8. Have you often drunk last thing at night to aid sleep, or in the middle of the night for the same purpose?

9. Have you ever "lost" periods of time the next day attempting to piece together what took place?

10. Have you ever been in hospital, a police cell or prison because of your dependency?

11. If a function you were attending was "alcohol free", would you "slip a few in" before attending?

12. Would it seem "odd" to you to leave a half-full glass of your own drink?

13. Have you ever decided to "give up" for any period of time, say a week or a month, to prove to yourself you could do it?

14. Do you drink because you are shy around people?

15. Has anyone expressed concern about your drinking or drug taking?

16. Do you ever find you end up drinking considerably more than you had intended to at the start of the evening?

17. Has a relationship ever broken down because of alcohol or drugs?

18. Do you ever "sneak" a drink at the bar when ordering a round?

19. Do you feel ill at ease with people who do not drink, or drink very little?

20. Have you ever lost time from work through drink or drug taking?

According to the Ark Foundation, if you answered YES to any of these questions it should serve as a warning. If you answered YES to three there is valid reason for having a close look at your dependency. And if you answered YES to more than three, Ark's experience tells it you are displaying symptoms and characteristics which need addressing.

What is Ark?

The Ark Foundation is a service offered by industry charity Hospitality Action.

It was founded in 2001 by Michael Quinn, whose own career as a chef was blighted by alcoholism. Quinn set up the Foundation to educate students and hospitality professionals about the dangers and consequences of alcohol and drug dependency.

Ark uses experienced industry professionals who, having themselves fallen victim to alcoholism and/or drug dependency and sought help for their problems, now give seminars on the effects of excessive alcohol consumption and drug misuse.

Source: Caterer Search