Sticking to a regimen of prescribed medications is the most effective way to reduce withdrawal symptoms and urges to drink alcohol in those being treated for alcohol dependence, according to a U.S. study.
The study compared two medications (naltrexone and acamprosate) used in combination with two behavioral treatments - low-intensity medical management (MM) and moderately intensive combined behavioral intervention (CBI).
The researchers analyzed data from 846 males and 380 females who took part in the National Institute of Alcohol Abuse and Alcoholism's Combine study, a large-scale, multi-site, combined medication and behavioral treatment study.
The participants were randomly assigned to one of eight different combination treatments involving naltrexone, acamprosate, a placebo, MM, and CBI. After 16 weeks of treatment, the patients' primary outcomes - including per cent days abstinent and time to first heavy drinking - were compared.
"First, high medication adherents fared better than low medication adherents across all combinations of behavioral and pharmacological treatment conditions," Allen Zweben, associate dean for academic affairs and research in Columbia University's school of social work, said in a prepared statement.
"Second, CBI - a specialty alcohol treatment - surprisingly had a beneficial impact on nonadherents receiving the placebo. This raises the issue of whether or not CBI may serve as a cushion or have a protective function for these patients," said Zweben, the corresponding author for the study.
"Conversely, CBI did not provide similar benefits for naltrexone-treated patients; their relapse rates appeared to be more a function of inadequate exposure to naltrexone and less influenced by CBI," he added.
Overall, specialized CBI did not perform better than the more primary-care MM.
"Both of these behavioral treatments performed equally as well with regard to treatment adherence and medication adherence rates," Zweben said.
The findings show that combing MM and naltrexone could benefit a large percentage of alcohol-dependent patients.
"Alcohol-dependent patients could be managed in nonspecialized or general health care settings, which, in turn, could broaden the treatment options for individuals diagnosed as alcohol-dependent," Zweben said. "We will need to adapt these findings to 'real world' medical settings and follow the results."
The study was released online by the journal Alcoholism: Clinical and Experimental Research and was to be published in the September print issue.
source: Canadian Broadcasting Corporation
Saturday, June 21, 2008
Friday, June 20, 2008
Over the past week, the HR2 team has been reading through our recently arrived (and notoriously difficult to obtain) copies of the Official Commentaries on the 1961, 1971 and 1988 UN Drug Conventions, as well as the Commentary to the 1972 Protocol amending the 1961 Convention.
These four volumes, each several hundred pages in length, are the official explanatory notes from the UN itself to member states on how to interpret each of the articles in the Conventions. In essence, the Commentaries put ‘meat on the bone’ in providing detailed guidance to states on what the drug conventions mean, don’t mean and how they are to be interpreted and implemented.
Already we are finding some interesting material.
For example, the Commentary on the 1988 Convention under Article 3 (Offences and Sanctions) expressly recognises methadone as a legitimate form of treatment. To quote the Commentary:
‘The 1971 Convention and the 1961 Convention as amended by the 1972 Protocol include a provision (identical in the two texts) to the effect that when drug abusers have committed offences under the Convention, the parties may provide, either as an alternative to conviction or punishment or in addition to conviction or punishment, that such abusers undergo measures of treatment, education, aftercare rehabilitation or social integration. Paragarph 4, subparagraphs (b), (c) and (d), of the 1988 Convention, while drawing upon that earlier provision, widen the scope of application to drug offenders in general, whether abusers or not.’ (at para 3.106) [emphasis added]
Leaving aside the antiquated language of ‘abusers’, what the 1988 Commentary reiterates is the support found in all three Conventions for drug treatment instead of, or in addition to, penal sanctions for drug offences. This is not news. What is interesting, however, is where the Commentary on the 1988 Convention goes on to define what the Conventions mean by ‘treatment’.
As stated in paragraph 3.109 of the Commentary:
‘”Treatment” will typically include individual counselling, group counselling or referral to a support group, which may involve out-patient day care, day support, in-patient care or therapeutic community support. A number of treatment facilities may prescribe pharmacological treatment such as methadone maintenance, but referrals are most frequently to drug-free programmes.’ [emphasis added]
Paragraph 3.110 of the Commentary also lists 'a maintenance programme' within the definition of legitimate - and therefore legal - 'aftercare' programmes.
But the 1988 Commentary is not the only one that cites substitution treatment as a legitimate and legal intervention.
The Commentary on the 1971 Convention also lists 'medically justified "maintenance systems"' under the definition of 'treatment' (at page 332, para 3, fn 1080) and a 'maintenance programme' within the definition of 'after-care' (at page 332, para 4). The Commentary to the 1972 Protocol to the 1961 Convention similarly lists 'medically justified "maintenance programmes"' within the definition of 'treatment' (at page 84, para 3, fn 4) as well as under 'after-care' (at page 85, para 4).
So according to the official UN Commentaries, methadone maintenance is an accepted form of treatment and after-care under all three Drug Conventions, and is explicitly recognised as being legally consistent with the definition of these terms under the Conventions.
This will certainly come as news to the Russian Government, which prohibits methadone on the claim that it is illegal under the Conventions. As stated by Russia’s Minister of Internal Affairs Boris Gryzlov in 2003, the country’s prohibition of methadone was ‘not the government’s own initiative…but rather the result of our responsibility to implement the UN drug conventions of 1961, 1971, and 1988.’
Just the opposite, methadone is expressly allowed under all three Conventions according to the official Commentaries.
It might also come as news to the International Narcotics Control Board, whose record of luke-warm support for methadone is chronicled in the excellent 'Closed to Reason' report produced by the Canadian HIV/AIDS Legal Network and the Open Society Institute.
For the benefit of the Russian Government, the INCB and the many others who could benefit from access from these hard-to-find Commentaries, IHRA is currently working with Transform Drug Policy Foundation to make them available online.
Thursday, June 19, 2008
Current diagnostic guides divide alcohol-use disorders into two categories: alcohol abuse/harmful use and alcohol dependence. Some researchers and clinicians believe this is insufficient, that there should be a third, preceding diagnosis known as "hazardous drinking," defined as drinking more than guidelines recommend. A Finnish study has found that hazardous drinking is quite common.
Results will be published in the September issue of Alcoholism: Clinical & Experimental Research and are currently available at OnlineEarly.
"This is an issue that needs to be debated," said Mauri Aalto, chief physician at the National Public Health Institute and corresponding author for the study. "Current tools - the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition, and the International Statistical Classification of Diseases - 10 - do not allow for a phenomenon like hazardous drinking, when a person drinks too much and is at risk but is not alcohol dependent."
Aalto and his colleagues examined data collected on 4,477 Finns (2,341 females, 2,136 males), 30 to 64 years of age, through the nation's Health 2000 Survey. They analyzed quantity and frequency of alcohol consumption, as well as socio-demographic characteristics.
Results showed the prevalence of hazardous drinking at 5.8 percent of the population examined.
"I think 5.8 percent is a high number, because we used rather high limits for hazardous drinking," said Aalto. Men were defined as hazardous drinkers if they reported drinking 24 Finnish standard drinks or more per week during the preceding year. The corresponding limit for women was 16 standard drinks or more per week.
"A hazardous drinker may see many other people around him or her drinking as much as him or herself," said Aalto. "This, together with not yet experiencing any alcohol-related harm, may lead the individual to wrongly think that there is no need to reduce drinking. However, hazardous drinkers do not include alcohol dependents, who usually drink a lot more. Alcohol-dependent drinkers already have significant alcohol-related harms and it is more difficult for them to change their drinking habits."
Results also showed that hazardous drinking was more of a problem for males, those older than 40 years of age, those who were unemployed versus employed, and those who were cohabiting, divorced/separated or unmarried versus those who were married.
"I think it is interesting to notice that almost 80 percent of hazardous drinkers in our study were employed," said Aalto. "Yet the probability of being divorced or unemployed, which might be inferred as 'adverse social consequences' of alcohol use, increases on the continuum from moderate drinking via hazardous drinking to alcohol dependence."
Aalto said these results support viewing hazardous drinking as a genuine public-health concern. "The important point is that there is such a phenomenon like hazardous drinking and it is quite common," he added.
source: Medical News Today
Wednesday, June 18, 2008
When it comes to treatment, the experts think alcoholism needs to catch up to depression.
Three decades ago, long before the dawn of the Prozac Era, depression was a disease rarely treated in its mild form, reluctantly treated with drugs and usually treated by experts only. Today, signs of depression are actively sought, drugs are prescribed early and often, and most cases are handled by non-psychiatrists.
With alcohol abuse, however, most physicians don't go looking for trouble and don't recognize it until it's breathing in their face. Over-drinking patients often don't think of looking for help even if they know they are heading in the wrong direction. And society as a rule looks at alcohol treatment as a last-chance, 90-degree corner taken only at high speed.
All this will change if American physicians adopt the new guidelines for "Helping Patients Who Drink Too Much" promulgated by the National Institute on Alcohol Abuse and Alcoholism, part of the National Institutes of Health.
The idea is to simplify the screening for excessive alcohol use in general medical practice and to convince clinicians and patients that early intervention for drinking that hasn't yet wreaked havoc is both possible and useful.
"We're trying to increase the accessibility and attractiveness of treatment to a much broader spectrum of people," said Mark L. Willenbring, a psychiatrist who directs the Division of Treatment and Recovery Research at NIAAA.
Those especially targeted in the guidelines are heavy drinkers who are not yet physically dependent on alcohol but are at risk for becoming so.
"We know that that group responds very, very well to what we call facilitated self-change and brief motivational counseling. We could make that very widely available without much cost," Willenbring said.
A big part of the new strategy is to make primary care physicians -- people without specialized training in addiction medicine -- think about alcohol abuse the way many now think about depression, anxiety and obsessive-compulsive disorder. Which is to say, they need to think of it as something common, diagnosable and within their capacity to treat. The guidelines make this easy: The screening tool for alcohol problems consists of a single question. For men: How many days in the past year have you had five or more drinks? For women: How many days in the past year have you had four or more drinks?
"Most doctors don't know how to make the diagnosis and don't really try to do anything about it until it is so easy to diagnose that all you have to do is glance at the patient," said Charles P. O'Brien, a professor of psychiatry at the University of Pennsylvania who has been treating alcoholics for 38 years.
"It used to be said that you can't treat somebody until they are down and out. But when they are down and out, they are really hard to treat," O'Brien said.
"I think there is a belief that people with more moderate levels of dependence don't know they have a problem. I think they do. But they don't think rehab is the model of treatment for them -- and I don't, either."
The sort of therapy both advocate does not involve magic bullets or easy answers or effortless behavior change. But it does enlist pills that help a little, quite a bit of talk and lots of self-discipline.
And what does it get a person?
Perhaps not surprisingly, there's evidence that getting control of a drinking problem early can improve one's health, completely apart from the social, psychological and familial benefits it brings.
A study published two years ago looked at the experience of 628 men and women who entered alcoholism treatment (either in residential rehab or as outpatients) in their mid-30s and were followed for 16 years.
Over that period, 121 died, or 1.2 percent a year. The average age of death was 48. But the chance of dying was significantly lower in people who after the first year were abstinent or had no drinking-related problems or symptoms.
So how successful is treatment, or at least how successful has it been?
Researchers in 2000 analyzed seven studies, one going back to the late 1970s, in which more than 8,000 people were treated for alcoholism in various ways, including with drugs. After a single course of treatment, one-fourth were abstinent for at least a year and one-tenth dramatically decreased their drinking. The rest, about two-thirds of the subjects, drank less often and in quantities averaging less than half of what they consumed before treatment. Mortality in the first year was 1.5 percent.
Some of those patients had a four-week stay in "rehab," but most did not. A long treatment-center admission as the optimal strategy to stop a serious drinking problem is much more the model of the 1980s than the 2000s. The newer one emphasizes outpatient treatment -- occasionally after a brief hospital stay for acute detoxification, if necessary -- with care provided by non-specialists in many cases.
How often contemporary treatment succeeds was also explored in a complicated clinical trial of about 1,400 alcohol-dependent men and women, average age 44 and consuming 12 drinks a day, that was published in the Journal of the American Medical Association in 2006.
The researchers randomly assigned the patients to nine groups. Four of the groups got nine sessions, conducted by a doctor or nurse and lasting at least 20 minutes, that reviewed the health consequences of excessive drinking, encouraged abstinence and attendance at Alcoholics Anonymous meetings, and urged adherence to the study medicines. Four of the groups also got intensive counseling by alcohol-addiction experts -- up to 20 hour-long sessions.
Some of the patients were assigned to take a drug for three months: either naltrexone, which blocks opiate receptors in the brain that are involved in alcohol's "reward pathways," or acamprosate, which works through so-called GABA receptors to decrease the anxiety and restlessness that can come with abstinence. Some got placebo pills.
A year later, there were no big differences among any of the groups, although there were some interesting small ones. (This was true even with what the researchers considered the placebo group, the people who received specialized alcohol counseling but no time with a physician and no pills.)
People who met regularly with a doctor or nurse and then got either naltrexone or the intensive counseling did equally well; about 66 percent were abstinent. People who had those sessions and got placebos did less well; 59 percent were abstinent. Those who got intensive counseling but no pills, neither active ones nor placebos, had an intermediate outcome, with 62 percent abstinent.
Unlike some other studies, this one showed no benefit from acamprosate. But that may not be the last word.
A clinical trial not yet published showed the drug worked only when started during a period of abstinence, not while a person was still drinking. And last month researchers reported more evidence that GABA receptors play a role in alcohol addiction. Laboratory rats that got the drug gabapentin, which enhances the action of GABA, drank less -- but only if they were already chronically exposed to alcohol. Those that used alcohol only occasionally did not show such an effect, suggesting the preexisting state was crucial to the response.
Abstinence, in almost all practitioners' minds, is always the goal. But its absence doesn't signal abject failure.
"It is a fiction that the typical change process is a sudden transformation," Willenbring said. "The more common is a change process that lasts years and is characterized by lengthening periods of sobriety and shorter relapses until they are gone."
In that way, alcohol abuse is like depression. In another way, too.
"Recovery from depression requires effort. The same is true for alcohol dependence," he said.
And in both cases, he thinks they're really worth the effort.
source: The Washington Post
Tuesday, June 17, 2008
The culture of binge drinking is a plague on Britain. It causes misery in some of the country's most deprived areas and transforms even the most genteel town centres into no-go areas at weekends. With this bleak context in mind, it is understandable that ministers in Scotland are considering an increase in the legal age for purchasing alcohol from off-licences and supermarkets from 18 to 21. The role of alcohol in fuelling yobbish behaviour north of the border is exacerbated by its effect on health. Scotland has one of the fastest growing rates of liver cirrhosis in the world. Does it not make sense to make alcohol harder to get hold of, if only for teenagers?
The answer is no. While one can sympathise with politicians wanting to take radical action to curb binge drinking, the remedy does not lie in simplistic legislative responses. Just as new 24-hour drinking laws did not lead to the boom in alcohol-related crime that some scaremongering press predicted, so raising the legal age of buying alcohol from off-licences will not bring about a dramatic decline in the type of anti-social behaviour associated with binge drinking.
There are several practical problems with the policy under consideration by the Scottish executive.
Allowing those aged between 18 and 21 to drink alcohol but not purchase it makes no sense. The fact that they would be able to buy alcohol in pubs and clubs would further confuse the situation. It also seems absurd that an 18-year-old will be able to vote, smoke and drink, but not buy alcohol from a supermarket.
The emphasis should be on enforcing the law, not changing it. Ample powers already exist to tackle the effects of binge drinking. In many cases, binge drinkers are underage teenagers. The police already have the power to move them on from public spaces and confiscate their alcohol.
They could also take more action against off-licences selling alcohol to the underage, or against those passing on alcohol to those not old enough to buy it for themselves. The main flaw to the proposal, however, is that it fails to grasp that Britain's binge-drinking problem, shared elsewhere in northern Europe, is a cultural one.
As such, the key to fighting it lies not in fiddling with the statute book, but in fostering a longer-term change in attitudes. Such a shift can only be achieved through a concerted education campaign that makes all of us rethink our relationship with alcohol. It is no quick fix, but it remains the only realistic way of creating a more responsible attitude towards drinking in Britain.
source: The Independent U.K
Sunday, June 15, 2008
Never underestimate just how much Britain's drinking culture costs the NHS. As an ambulance man, I see it
They live together in squalor: both suffer from the diseases of the liver that we only used to see in people past their 40th birthday. Dried and bloody vomit covers the cooker. Both patients are in their early 20s.
The British Liver Trust has released figures showing that admissions due to alcohol have more than doubled in the last 12 years. Alcohol was the main or secondary cause of 207,800 NHS admissions in 2006/7. These are people who have been admitted into hospital due to the effects of drinking.
My patient, who is 24, has been incontinent. He is also covered in vomit. He is bleeding from a cut on his forehead caused when he passed out drunk.
Take another look at those figures - they are equivalent to 23 people an hour, or one person every two and a half minutes being admitted to hospital. And they do not include the much higher figure of those that received emergency treatment due to alcohol use but who didn't need to be admitted overnight into hospital.
Our Control asks if there are any ambulances available for a child who is having a seizure. I can't respond because at the moment I have in the back of my ambulance a vomiting woman who swears blind that her 10th pint of lager was spiked.
The London Ambulance Service has seen the number of calls due to alcohol increase by 12% in the last two years. In a 10-month period, they responded to 38,849 alcohol related calls. Due to the way in which this information is gathered the actual number is much higher.
A week after 24-hour drinking licences have been brought in, and at 10am I'm standing outside the local nightclub, where one drunk has been pushed down the stairs by another. His head is bleeding and as he rolls around the inside of the ambulance his blood splatters against my uniform.
The Academy of Medical Sciences warned in a report last year that the government needs to overhaul the current drug classification. By any measure, alcohol would be a Class A drug, as it is incredibly addictive and has serious effects on health.
We've battered down the door to the flat, as his ex-wife hasn't seen him in weeks. We are met with a vision of carnage; he died by vomiting out nearly all the blood in his body. Dried blood is on the bed, the walls and the ceiling. He looks 60 but was in his 40s.
British society now seems perfectly comfortable with self-inflicted alcohol poisoning. Until that changes, and it becomes culturally unacceptable to burden the NHS with emergency cases whose suffering is completely avoidable, ambulance crews will continue to struggle to deal with the ugly, expensive consequences.
source: The Guardian U.K
Saturday, June 14, 2008
The creation of drug-free prisons in England and Wales is too expensive and not a practical option with more than half the record 83,000 jail population misusing drugs, according to a consultants' report commissioned by justice and health ministers.
The study by PricewaterhouseCoopers released yesterday also says mandatory drug testing should be abandoned for individual prisoners as it is widely viewed by both inmates and staff as "open to manipulation", with clean urine samples often being used as a currency inside jails.
The review of the £75m a year drug treatment programme in prisons concludes that notable improvements in care have followed the doubling of investment in the last 10 years.
The consultants, however, add that treatment is fragmented between prisons and the community, there is little agreement on what it is trying to achieve, the evidence for some of the courses used is weak, and there is a lack of meaningful data to measure progress.
Extra funding for the treatment services in prisons was announced by ministers in March when an anodyne summary was released, but the full report was published yesterday after freedom of information requests. The prison population hit a record yesterday of 83,171 - up 140 in the past week.
The consultants say that despite the increase in funding, providing minimum standards of drug treatment in every prison in England and Wales is not feasible with current resources. Instead they suggest that some groups of prisoners such as young offenders and older prisoners for whom treatment is likely to have a bigger impact should be given priority access so that a minimum standard can be provided.
Controversially, the consultants say this would mean excluding men in their 20s who have been convicted of more serious crimes. But they add that an exception would have to be made for inmates serving indeterminate public protection sentences for whom completing a drug treatment course is a condition of their sentence, as there will be "legal consequences if they are not considered to have been fairly treated".
In drawing up a cost benefit analysis PCW estimate that the average male problem drug user - those with a heroin or crack addiction - "costs" society £827,000 over their lifetime in healthcare and criminal justice interventions.
The consultants also suggest that where there is no evidence a specific treatment programme works then it should be withdrawn, and add that there are a number whose effectiveness is uncertain.
The prisons minister, David Hanson, said the PWC report was a useful contribution which had led to the formation of a prison drug treatment review group to oversee the development of prison drug treatment and to streamline treatment provision in prisons.
source: The Guardian U.K
Friday, June 13, 2008
Thanks to blogs of David and others from Wired In, I am slowly getting familiar with the current situation in drug policy and services in UK and I read the debates around its expected transformation with a lot of concern. As I understand it (and correct me if I am wrong…), the situation has reached the point when methadone treatment is applied as a number 1 choice for heroin users who may then stay on the substitution for a long time without any (or only small) additional support.
In Czech Republic, we experience a different situation, partly because of the fact that heroin is not as popular here as in UK and partly because of the fact that not many practitioners or psychiatrists are actually willing to prescribe any kind of substitute drug. But it seems that the general direction goes towards more methadone and Subuxone prescriptions. I do not think it is bad but it needs to be followed by efficient and improving ways of recovery. Apparently, the problem starts when these approaches are seen as binary oppositions. Then, this „treatment“ x „recovery“ controversy would remind me of similar contradiction between a cage and a park.
The famous experiments with rats in a cage with access to unlimited source of heroin or cocaine are well known. A surgically implanted catheter was hooked up to a drug supply that the animal self-administered by pressing a lever. Their increasing consumption of the drug was used as an explanation for the assumption that the drug is causing the addiction which is progressive and leads to death.
Professor Bruce Alexander, a Canadian psychologist from Simon Fraser University, tried similar experiment, but with an alteration. He did not place the rats into a cage, but into an „Eden“ for rats: it was a place 200 times larger than the cage, there were cedar shavings, boxes, tin cans for hiding and nesting, poles for climbing, and plenty of food. Also, because rats live in colonies, the „Rat Park“ housed sixteen to twenty animals of both sexes. Bruce Alexander put there two bottles: in the first one, there was plain water, in the second one, there was a morphine-laced water.
The results were very clear: unlike rats in cage, the rats in park preferred the plain water to the morphine. The modification of this experiment was that the rats had access only to the morphine water for some time.After several months, a bottle with plain water was added and the rats in the park were more likely to switch to the water! „Addiction“ did not seem progressive, chronic and untreatable any more. More importantly, it seemed that it is not the drug that induces the addiction.
People do not live in cages. But we do not even live in parks. However, in some conditions, life can look like a cage, the same as life can look like a park. Since drugs, as heroin or cocaine, may be the only possibility how to cope with life in a cage, in a park, it is one of the many options. And what needs to be said: people are not at the same distance between cage and park. But even if some are caught in a cage, many of them find their way to the park.
Obviously, we want to help people who are in a cage. As I see it, methadone makes the life in cage less stressful. Recovery is a way from the cage.
Thursday, June 12, 2008
The US House of Representatives has approved a three-year plan to tackle drug trafficking from Mexico, Central America and the Caribbean.
The bill authorises spending of $1.6bn (£800m) to support anti-drug programmes - much of it to be used in Mexico.
The US Senate still has to approve its version of the bill. Mexican opposition to provisions in it tying aid to human rights measures could be an obstacle.
Conflict between rival drugs gangs and Mexican police has escalated this year.
The violence has left well over 1,000 people dead so far this year.
The legislation passed by the House, by 311 votes to 106, stems from the so-called Merida Initiative proposed by US President George W Bush in October last year.
Under the aid plan, the US funds would be used to help train and equip security forces and strengthen justice systems in Mexico, Central America and the Caribbean.
If the Senate approves its version of the legislation, a reconciled version of the two bills will go to Mr Bush to be signed into law.
However, Mexico's President Felipe Calderon and the nation's lawmakers are deeply opposed to conditions within the Senate version which link the funding to performance on human rights, arguing that they violate their country's sovereignty.
Other provisions would allow the US to monitor the use of equipment and training by the other nations and look into allegations of abuse by security forces.
A visiting delegation of US politicians met their Mexican counterparts in the city of Monterrey at the weekend to talk about the objections raised by Mexico.
The bill approved in the House on Tuesday authorised the spending of $1.1bn for anti-drug programmes in Mexico between 2008 and 2010 and $405m for Central American and Caribbean countries.
A further $74m would go to the US Justice Department to aid its efforts to stem the flow of US guns into Mexico.
Supporters of the legislation praised Mr Calderon for his efforts to crack down on Mexico's violent drugs cartels.
However, two Texas congressman opposed the legislation, saying the US border with Mexico needed to be secured first.
source: BBC News
Wednesday, June 11, 2008
Doctors don't like the word "addiction." It has overtones of moral weakness when applied to drugs like alcohol, nicotine, cocaine or heroin.
Physicians prefer the term "dependence" because it describes withdrawal symptoms rather than depravity. Problems with withdrawal don't occur only with drugs of abuse. Many prescription medications can cause unpleasant symptoms if they are stopped suddenly.
Doctors sometimes fail to warn patients ahead of time that a medicine may be difficult to discontinue. One reader shared an experience with an antidepressant: "I have just been through detox hell from stopping Cymbalta. After a week of dizziness, nausea, diarrhea, sweats, chills, itching, disorientation, mood swings and headaches, I am angry! My doctor did not tell me about this.
"I had been on Zoloft and Cymbalta for about a year. I stopped the Zoloft with no problems and then was weaned off Cymbalta by gradually dropping the dosage until stopping completely. I expected some emotional consequences, but did not expect to be a prisoner in my own home for more than a week, unable to function in any way. If I had not had the Internet to confirm my suspicions that the symptoms were Cymbalta-related, I would have assumed I was dying of some strange flu!
"My point is not to rant and rave about the horrible time I had withdrawing from Cymbalta, but to question why? Why wasn't I warned? Why couldn't I have been told up front, before starting the drug, that the possibility of severe withdrawal existed? Why wasn't I given suggestions to ease the withdrawal symptoms?
"I know that I am not the only one who has been blindsided by this drug. Are doctors not allowed to tell?
"It must truly be up to the consumer to read every line of the insert to determine the safety of a medicine. I don't even know if the insert included possible withdrawal effects, as I am still too dizzy to read the small print!"
Other antidepressants like Lexapro, Paxil and Effexor also can cause distressing symptoms upon discontinuation. Another reader related this experience with Effexor: "I tapered off the medicine as told, but even months later I still have feelings like electrical shocks going through the brain. I finally got relief from the other symptoms, but getting off this drug has been a nightmare. If a person had to stop suddenly, he would probably go crazy with the withdrawal. Once I forgot to take my medicine with me on a short trip, and the withdrawal symptoms were excruciating."
Doctors are alert to problems of withdrawal from narcotic pain medicines or benzodiazepine anti-anxiety drugs like Xanax. They are adjusting to the idea that some antidepressants can be difficult to stop.
Even heartburn medicine like Aciphex, Nexium and Prilosec may pose problems. Some people experience rebound hyperacidity when they stop such medications. One patient reported "within a week of stopping Protonix, I had to start taking it again due to severe heartburn. I asked my pharmacist how to discontinue use, but she couldn't find out."
Before starting any drug, ask when and how you should stop it. Getting off some medications can be far more difficult than you imagine.
source: The Roanoke Times, http://www.roanoke.com
Tuesday, June 10, 2008
Sure, exercise is good for your waistline, your heart, your bones — but might it also help prevent addiction to drugs or alcohol?
There are some tantalizing clues that physical activity might spur changes in the brain to do just that. Now the government is beginning a push for hard research to prove it.
This is not about getting average people to achieve the so-called runner's high, a feat of pretty intense athletics.
Instead, the question is just how regular physical activity of varying intensity — dancing, bicycling, swimming, tae kwan do — might affect mood, academic performance, even the very reward systems in the brain that can get hijacked by substance abuse.
What first caught the attention of National Institute on Drug Abuse chief Dr. Nora Volkow: A study found tweens and teens who reported exercising daily were half as likely to smoke as their sedentary counterparts, and 40 percent less likely to experiment with marijuana.
Volkow knows — from her own 6-mile daily runs and from her scientific experiments — that the brain literally likes physical activity. Exercise seems to invigorate neurochemicals that sense and reinforce pleasure.
"In children, it's innate," she notes. "Children want to move."
But the nation's children are becoming more sedentary, as illustrated by the obesity epidemic, "screen time" replacing outdoor play and a drop in school P.E. And as youngsters approach adolescence, the run around the yard that used to be fun too often becomes a chore — the dreaded jog around the school track or the nagging to get off the couch. The sedentary teen turns into the sedentary adult.
"Why do we lose the ability to experience pleasure from physical activity?" asks Volkow.
Last week she brought more than 100 specialists in exercise and neurobiology to a two-day conference to explore physical activity's potential in fighting substance abuse, and announced $4 million in new research grants to help.
Drug treatment programs often include exercise, partly to keep people distracted from their cravings, but there's been little formal research on the effects.
The best evidence: Brown University took smokers to the gym three times a week and found adding the exercise to a smoking-cessation program doubled women's chances of successfully kicking the habit. The quitters who worked out got an extra benefit: They gained half as much weight as women who managed to quit without exercising, says lead researcher Dr. Bess Marcus.
She now is working with the YMCA on a larger, NIDA-funded study to prove the benefit.
Marcus cautions that people trying to kick an addiction have a powerful incentive to exercise. Could that possibly translate into prevention? Among the clues:
_Rats were less likely to ingest amphetamines if their cages had running wheels, suggesting exercise stimulated a reward pathway in the brain to leave them less vulnerable to the drug's rush.
_In people, exercise acts as a mild antidepressant and relieves stress. Depression, anxiety and stress increase risk of alcoholism, smoking or drug abuse.
_Volkow is intrigued that attention deficit disorder and obesity both involve problems with the brain chemical dopamine, one system that drugs hijack to create addiction.
_Baby monkeys who don't play enough in childhood have problems controlling aggression when they're older. The most aggressive tend to have defects involving the feel-good brain chemical serotonin — and binge-drink when researchers offer them alcohol.
_Back to rats, physical activity increases production of growth factors and stem cells in key brain regions important for learning and mood; increases formation of blood vessels; and strengthens communication networks between brain cells.
Together, that's far too little research to know if exercise really matters for substance abuse, scientists at the National Institutes of Health meeting cautioned.
But, a few studies of school-age children suggest physical activity predicts better performance on math, verbal and other tests — and better school performance in turn is linked to lower risk for substance abuse.
And getting sedentary seniors moving improves brain function — research aimed at preventing dementia, not drug abuse, although the improvement is in an area that in younger people is linked to risky decision-making.
A caveat: If your own youth includes memories of parties with beer-guzzling athletes, well, the research concurs. A major study that tracks adolescent risk behaviors found that by 12th grade, exercise offers no protection against binge-drinking.
"Now the kids who exercise the most actually drink the most," says Dr. Lloyd Johnston of the University of Michigan. It may have to do with the celebratory nature of team sports, or getting revved for college — or, other researchers suggested, even that competition is to blame.
source: The Associated Press
Monday, June 9, 2008
Jazz singer who lost parents to addictions raises funds for treatment agency
When Ottawa jazz singer Kim Kaskiw performs Wednesday night at a benefit concert, she'll not only be playing for her own enjoyment -- she'll also be playing in memory of her parents.
Kaskiw lost both her parents to addictions. Her father, Michael, an alcoholic, died from cirrhosis of the liver in 1992. Her mother, an alcoholic but also a heavy smoker, died from lung cancer in 2004.
"I was devastated when they died," said Kaskiw, a jazz vocalist and tuba player who moved to Ottawa from Toronto 20 years ago after graduating from Humber College. She performs in shows around town and also teaches voice at Carleton University.
"You feel so helpless, you want to help, and you can see them killing themselves but they don't see it. My mother was in Alcoholics Anonymous for 30 years before she died, but she couldn't give up the nicotine addiction and she was severely addicted to it."
The concert at Library and Archives Canada is in support of Serenity Renewal for Families, an Ottawa agency that provides counselling and treatment for men and women suffering from substance abuse. It also provides counselling and support for the families of those struggling with substance abuse.
Kaskiw said even though she tried to help her parents, it was difficult growing up as they constantly struggled with their addictions.
"My father was still drinking at the time and once he showed up at my college during a performance of mine very drunk. I was so embarrassed," she recalled.
"There was a lot of shame on both sides. There is shame of the alcoholics who do these things and they have remnants of memories of doing these things, and some don't remember at all.
"And the child of an alcoholic, of course, remembers everything and is continually traumatized by it," she said.
"So, it is a family disease in this way, and you need to get the help that you need so that you can enjoy your life."
She said she got the idea for the benefit concert after reading stories about the growing drug problems among addicts in Ottawa.
"I saw these disturbing photos of people finding needles on the ground and people being upset about crack pipes being provided to addicts when really I think, there should be treatment centres for addicts, not crack pipes," she said.
For the benefit concert she's lined up some of Ottawa's top jazz musicians. They include J.P. Allain on piano, Norm Glaude on bass, Don Johnson on drums, Sandy Gordon on saxophone and Fred Pachi on trumpet and fluegelhorn. The night will feature original compositions and songs from Kaskiw's CD Shades of Love, which was released in 2006.
Tickets are $20 and available at The Ottawa Folklore Center, Compact Music, Leading Note Music and Serenity Renewal for Families.
source: © The Ottawa Citizen 2008
Sunday, June 8, 2008
DePaul Addiction Services will close all inpatient beds at its Main Quest Treatment Center in mid-August, and Monroe County officials are searching for a new organization to run the area's primary detox facility for patients going through severe withdrawal.
Because of declining occupancy rates and ongoing financial troubles, the organization will move all patients into local hospitals or to another DePaul addiction treatment center in Bath, Steuben County, said Marcia Dlutek, a DePaul spokeswoman.
Kelly Reed, Monroe County's commissioner of human services, said county officials are working with DePaul to find organizations to take over the addiction services.
DePaul will continue operating its outpatient program, but the county sent a request to local organizations last week asking for applicants to take over both the inpatient and outpatient addiction services offered by Main Quest. The county also plans to send requests for organizations to take over DePaul's Problem Gamblers program and the Rochester Area National Council on Alcoholism and Drug Dependency, also run by DePaul, said Kathleen Plum, director of the county's office of mental health.
According to Dlutek, the need for Main Quest's inpatient detox program has declined as addiction treatment increasingly shifts toward outpatient services. Occupancy rates at Main Quest have dropped in the last several years, and the inpatient unit was recently downsized from 35 beds to 20 beds.
"There seems to be capacity in the community at other programs," said Dlutek.
Plum said outpatient treatment has become the trend for recovering opiate addicts and some alcoholics in the early stages of withdrawal. But Main Quest's closure still leaves a "potential gap" when it comes to treating some of the most severe addicts who need supervision during withdrawal.
The John L. Norris Addiction Treatment Center in Rochester and Unity Health Systems offer inpatient chemical dependency rehabilitation programs, and local hospitals take in some addicts going through withdrawal, but Main Quest runs the area's only major inpatient detox facility.
"The need is certainly there," said Doug Stewart, vice president of Unity Behavioral Health. "If there were no inpatient detox facilities in that area, that would be a significant gap."
Stewart said Unity, which runs an outpatient detox program, has space in its outpatient and rehabilitation programs but is not licensed to run an inpatient detox facility.
"It's a difficult service to develop and run," said Plum.
Main Quest's closure comes four years after DePaul took over the treatment facility, at 774 W. Main St., from the now-defunct Health Association. Both DePaul and the Health Association faced constant financial troubles running a program for which Medicaid reimbursements often don't match costs. The program was never "fiscally viable," Dlutek said.
"We're hoping other providers in the community will take this as an opportunity to step up," said Reed. "I'm sure there's going to be some interest in the community."
source: Rochester Democrat and Chronicle
Saturday, June 7, 2008
New detox center is a big step in helping chronic inebriates
An advanced alcohol treatment center has been the aim of several visionary Fairbanksans for about a decade. To see work actually under way on the center must bring them great satisfaction.
What would likely bring those people even greater professional and personal pleasure, however, is to see the Fairbanks community view the new center as part of a larger effort to reduce the problem of chronic inebriation in this town.
The new detoxification center being built on the south side of town — named the Golden Heart Gateway to Recovery Center — won’t add many treatment beds to the small number already available. But the beds it is adding could produce success stories that have been too rare in Fairbanks. That’s because the center will feature a multi-pronged treatment program that, with perseverance and a lot of work, hopes to turn chronic public inebriates into former chronic public inebriates. Nurses from Fairbanks Native Association’s Ralph Perdue Center and case managers from Fairbanks Community Behavioral Health and Tanana Chiefs Conference Mental Health Services will work together at the center to provide comprehensive treatment.
It’s taken a lot of time, planning and money to get the center to this point. Those involved held a brief celebratory ceremony earlier this week to mark the pouring of the building’s foundation and to thank some important and prominent donors — Tanana Chiefs Conference, Doyon Limited and the Greater Fairbanks Community Hospital Foundation. Funding for this public-private partnership has also come from the federal government’s Denali Commission, the state Department of Health and Social Services, the Alaska Legislature, the Rasmuson Foundation and the Alaska Mental Health Trust.
Chronic public inebriation is a community problem in need of a community solution. The private donors to the alcohol center’s construction in particular deserve thanks for not only recognizing the need to solve this problem but also for agreeing to participate in a solution in such a prominent way.
The new treatment center will help those who have tumbled far into the abyss of alcoholism, but that’s only one part of the overall attack on chronic public drunkenness. The other part is curbing the availability of the cheap alcohol that finds its way into the ever-weakening body and mind of a public inebriate. City leaders have again begun the discussion about limiting the supply of cheap and fortified alcohol in a select part of the city.
Fairbanks is a good distance away from minimizing the problem of chronic public drunkenness, a problem that has cost the city, state and Fairbanks Memorial Hospital millions of dollars. Construction of an enhanced detoxification center is a major step toward the goal of eliminating chronic public inebriation and deserves continued financial and community support.
source: Fairbanks Daily News-Miner
Friday, June 6, 2008
Classical musicians are not paragons of virtue - but are recent tales of drink and drug abuse in the pit realistic, asks oboeist Blair Tindall
Professional classical musicians are a glamorous, vulnerable and largely voiceless population. They sweep on stage in black tie and gowns, then quietly go home; often, we know almost nothing about their lives outside their performance. But this week a lesser known aspect of those seemingly decorous lives has come to light, after a horn player for Simon Rattle's Berlin Philharmonic admitted to drinking before performances to calm his nerves. "You go for tranquilisers or beer," Klaus Wallendorf told a documentary film-maker. "With me it was beer. Then you drink two beers and it goes smoothly so you think you should do it all the time." The revelation has prompted further admissions, and German tenor Roland Wagenführer expressed concerns about drug abuse in the opera world. So does classical music have a drink-and-drugs problem?
Let's start with full disclosure. I am a professional musician - an oboeist - and have performed with four major orchestras in the US, including the New York Philharmonic. Like many people my age (I'm 48), I've tried marijuana and Valium in the past. Today, I drink alcohol on a social basis, as well as beta blockers, which are prescribed by my doctor, and which I take for performance anxiety once or twice a year.
That's not so shocking, is it? Despite my musical accomplishments, I am a normal person who addresses various challenges like anyone else. Yet some would label me a troubled substance abuser, and say that classical musicians are trying to one-up Amy Winehouse.
First, let's dissect the effect of various drugs, and consider why classical musicians would want to take them. Alcohol, tranquilisers, marijuana, and beta blockers have dramatically different applications and effects, many of which are undesirable for musicians. Musicians are not exempt from alcoholism, and it affects performance in a negative way. Classical musicians rely on minute technique and quick response time; alcohol only dampens these skills, and although initially it might ameliorate stage fright, once on stage, drunkenness only amplifies terror. The violinist Nigel Kennedy may have a reputation as a hellraiser, but even he says he would only smoke or drink after a concert - never before. "Performing under the influence of alcohol or dope would be cheating the audience," he told Focus magazine in Germany last month. I have seen, on rare occasions, musicians drinking pre-concert, and it never works out well.
Cocaine is a drug only the most successful musicians use - because it's expensive. (Newsflash: working-class musicians don't earn big.) In small amounts, cocaine does seem to enhance confidence, which, depending on how much preparation you've put in, could be a good thing - or highly embarrassing when it comes to reading the reviews the next morning. I do know musicians who use it while performing, but they are a tiny minority.
Tranquilisers like Valium have similar consequences to alcohol: they compromise technique and response time. Still, some people are prescribed these drugs for medical reasons, so it's difficult to separate the "abusers" from the legitimate patients.
Few people use marijuana these days. In general, musicians want and need to be mentally acute. Pot doesn't fit the bill. Furthermore, one of the drug's main symptoms is paranoia, which doesn't go well with stage fright.
Finally we come to beta blockers, a class of heart medications that treat blood pressure, angina and migranes. Since a 1965 Lancet article explored their use for stage fright, they've also been widely prescribed for musicians, public speakers, and even surgeons who must steady their hands.
Beta blockers are not recreational drugs. They do not affect cognitive abilities, but instead block adrenaline-like chemicals in the human system. For a violinist, this means performance can feel like practice, with no bouncing bow or slippery fingers.
An article in the Times yesterday reported that there is a "black market" for beta blockers among classical musicians. But these are legal drugs - taken for medical reasons by as many as 10% of the world's (and therefore any orchestra's) population; they are routinely prescribed for stage fright.
As a teenager, I suffered debilitating stage fright. When I went to college, I asked the conducting staff to assign me to pit orchestras, instead of onstage groups. And so I asked my doctor for a prescription for beta blockers.
On the subway in New York in 1986, I took my first dose of Inderal, a beta blocker, some 45 minutes before an audition. It seemed miraculous. Although I still felt nervous, my hands didn't shake as usual, I wasn't gasping for air and my mind remained clear. I played exactly as I had meticulously prepared to do. I won the job, and went on to play a Carnegie Hall debut recital, record a Grammy-nominated CD, and hold a solo position with four major Broadway productions.
Beta blockers are not a class of drug that's subject to abuse. No one would want to overdose: I once took too much (which I later learned was only a quarter of my elderly mother's daily prescription) and the boring performance that ensued made me commit to smaller doses from then on.
It always seems surprising to audiences that classical musicians are like any other cross section of society - subject to the same joys, sorrows, and misbehaviour. Yes, some musicians are alcoholics. Some are stoners, who stumble through life on pot, middling about on the worst possible gigs, ones that barely support them. Some lose everything in the wake of cocaine and crack abuse.
I knew a beautiful blonde cellist in New York in the 1980s, who was married, owned a gorgeous apartment overlooking Central Park, and landed a chair in Phantom of the Opera, which is playing two decades later. Yet she surrendered to cocaine, and then crack. She died three years ago after battling Aids for a decade, leaving behind a young son. She was a stellar musician, but also an ordinary human being with demons like anyone else.
Three years ago, I published a book about drugs and classical music, Mozart in the Jungle. On my book tour, a journalist asked me to clarify why "musicians are more noble than other people". Where did he get such an idea? Although most of us don't end up in dire circumstances, we, like anyone else, are just people. We're tempted. We say yes or no to drugs. But, because of our discipline, we most often say no: drugs and impairment are not worth risking a lifetime of practice.
Wednesday, June 4, 2008
Most addicted people need help to find a way to live clean, sober lives. Treatment Centers, therapists and specialists are often the last stop in the vicious cycle that is substance addiction.
Maryland 6/03/2008 07:29 PM GMT (TransWorldNews)
TreatmentCenters.com is a national directory for treatment centers, therapists and specialists. We offer a free, simple and comprehensive index that provides assistance and guidance for those seeking help regarding alcohol addiction, drug addiction, eating disorders, cancer and many other conditions that affect the mind, body and soul. We also offer a wide variety of addiction and illness treatment centers, as well as individual counselors that can address your specific needs. We include peer support and detoxification programs. In addition, we can provide you with many resources for outpatient and residential programs.
Making the choice to seek treatment for an illness or addiction can be challenging. Our goal at TreatmentCenters.com is to make that job easier for you. We provide a bridge between people seeking treatment and the centers, physicians and counselors who provide that treatment. Keeping in mind that any disorder can affect the entire family, we provide resources and information for friends and family members as well. If you are a person seeking treatment, you will find a vast number of resources on our site.
If you are a professional offering services, we provide a first class showcase for what you have to offer. Our site consists of an easy to use search center that will match your needs to the services provided by professionals in your area. We also offer discussion forums where you can dialogue with others about various relevant topics. We provide cutting edge news on a variety of treatment related topics and offer a blog section in which you can journal about your personal experience.
Many individuals will not seek treatment for various reasons. It has been our experience that 'active' addicts and alcoholics, as well as people afflicted with different addictions or physical conditions can sometimes lose the ability to reason. A therapist or specialist for a specific illness or addiction issue, or a full-fledged residential treatment center can and will help. You, and/or your loved one, can find it at TreatmentCenters.com.
We appreciate input to further refine and maintain the efficiency of this website.
Please contact us with your thoughts. Thank You.
"Turn over a new leaf with TreatmentCenters.com"
Our motto "Hope, Help, Heal, and Happiness" shows the path.
You provide the hope. We provide the help
TreatmentCenters.com is a national directory for treatment centers, therapists and specialists. We offer a free, simple and comprehensive index that provides assistance and guidance for those seeking help regarding alcohol addiction, drug addiction, eating disorders, cancer and many other conditions that affect the mind, body and soul.
For further information, please contact us at 713.992.2828.
source: TransWorld News
Tuesday, June 3, 2008
We celebrate many milestones at this time of year -- graduations, proms and the end of the school year. These are joyous occasions indeed. These events also heighten awareness of the dangers that come with using drugs and alcohol in excess.
Here are a few facts about alcohol abuse: Alcohol is frequently a factor in the three leading causes of death (motor vehicle crashes, homicides and suicides) for 15-to 24-year-olds. Harmful and hazardous drinking is involved in about one-third of suicides, one-half of homicides and one-third of child abuse cases. Fetal Alcohol Spectrum Disorders is the leading preventable cause of birth defects in the United States, affecting as many as 40,000 babies per year. More than 9 million children live with a parent dependent on alcohol and/or illicit drugs.
Alcohol is a drug that can affect judgment, coordination and long-term health. Research suggests that early use of alcohol by teenagers may contribute significantly to dependence on alcohol and other drugs later in life, with 40 percent of children who begin using alcohol before the age of 13 becoming alcoholics at some point in their lives. We have many images of those who abuse alcohol, but it can be anyone -- college students who binge at local bars, pregnant women who drink and put their babies at risk for fetal alcohol syndrome, professionals who drink after a long day of work or senior citizens who drink out of loneliness.
The National Council on Alcoholism and Drug Dependence and its local affiliate, the Alcohol and Addictions Resource Center continually work to reach the American public with information about the disease of alcoholism -- that it is a treatable disease, not a moral weakness, and that alcoholics are capable of recovery. The AARC seeks to increase the public's awareness and understanding about the nature of alcoholism and drug addiction and work to eliminate misconceptions about these diseases. It also encourages proper diagnosis, treatment and continuum of care for individuals and families who are affected by the disease of alcoholism or drug addiction.
The AARC is a local not-for-profit agency that has been serving our community for more than 40 years. The mission of the AARC is to prevent alcohol and other drug abuse through prevention, education, intervention, assessment and referral services for individuals, families and the community as well as provide leadership for collaborations and partnerships.
Like other diseases, addiction can be overcome with proper treatment, prevention and more research. By increasing access to care, the costly toll on society and the burden it places on families can be reduced.
The Comprehensive Assessment Treatment Outcomes Registry Data in Ohio have documented dramatic results in decreasing occupational problems, including the following reductions after treatment:
* Absenteeism decreased by 89 percent
* Tardiness decreased by 92 percent
* Problems with supervisors decreased by 56 percent
* Mistakes in work decreased by 70 percent
* Incomplete work decreased by 81 percent
Additionally, a California Study found significant decreased health-care costs from before to after treatment in:
* Hospitalizations for physical health problems (-36 percent)
* Drug overdose hospitalizations (-58 percent)
* Mental health hospitalizations (-44 percent)
* The number of emergency room visits (-36 percent)
* The total number of hospital days (-25 percent)
As a nation, we are becoming more aware of the fact that alcoholism and drug dependence is a disease that affects us in many ways. When adequately provided, treatment enables many people to recover and rebuild productive lives.
Last month, AARC held its fundraising dinner. Keynote speaker Christopher Kennedy Lawford, son of Peter Lawford and Patricia Kennedy Lawford, shared this message of hope and recovery. Prior to his involvement in politics, business and acting, Lawford experienced his own alcoholism and drug addiction. He spoke openly and poignantly on the challenges of overcoming such an illness. We thank all those who made the event an evening to remember.
AARC also posthumously presented its Bronze Key Award to the family of Rex Rakow that evening. Rex died in March 2007. At the time of his death, he was the director of security at the University of Notre Dame and AARC board member. Rex was an integral part of the AARC and its impact within the community. The Bronze Key is a national recognition award granted by the NCADD to an individual or organization that has made an outstanding contribution to an NCADD affiliate. It is the highest local award presented by an NCADD affiliate.
We have been a local presence for many years. We know we have much more work to do in assisting those touched by addiction. However, we also know that the evidence demonstrates that treatment for alcohol and other drug abuse works. If you or someone you know is struggling with alcohol or other drug abuse issues, we encourage you to call for help. An online assessment tool is available at www.aarcinfo.org.
source: South Bend tribune
Monday, June 2, 2008
Imagine if there were a magic pill - an efficacious medicine that would produce instant immunity from the insanity that begins the vicious cycle of obsession and craving - that we know today as alcoholism? How cool would that be?
There is no such thing - yet immunity is not only possible but within the experience of millions of people who have discovered the common solution to their common problem.
"Immunity" is such a beautiful word when it's attributed to drinking alcohol. Did you know that many of us alcoholics become immune to it? That’s right. It can’t get us anymore. We are placed in a position of neutrality, safe and protected.
We get to this place through a spiritual awakening -- when the desire to drink is entirely removed. We stay there by continuing our spiritual growth.
Growth and immunity comes from working with others - by helping them achieve a spiritual awakening though the practice and teaching of the Twelve Steps. Not from prayer. Not from meditation. Not from reading spiritual books and agreeing with them. Not from AA meetings. These are great and wonderful things we do when we become practitioners of AAs Twelve Steps - they are essential preparatory activities but there is nothing that contributes more to spiritual growth that when we are actually engaging in the things for which we were created - to be of maximum service to God and our fellows.
I know many of us would like to think that we can pray and meditate and wish and will and read and meet and "share" our way toward spiritual perfection -- especially when we don’t actually do the things that do promise spiritual growth. Meditation for example - I would no sooner give up my all important meditation time with my Creator than I would cut off my right hand - please don’t get me wrong. But the learning time I spend in meditation with God has to be put to good use - not coveted and extolled for my own self-veneration.
Modern science has given us many types of 'immunities' these days. There is adaptive, innate, artificial, natural and a host of other types. I am sure Bill and the boys had in mind what any layman would - some simple and in common usgae. So let's look at an old 1938 definition since that was their time. Let's be on their page.
Immunity - Freedom from obligation. Exemption from natural, ordinary liabilities, evil or misfortunes. 2, special privileged 3. Condition of not being susceptible to a given disease, with naturally or by inoculating against it.
WOW - First word: FREEDOM.
Today with our accelerated knowledge and advances in science and medicine it is only natural that the first and most prominent definition of the word immunity would have to do with pathological disease.
Not so seventy years ago at the time of the founding of the Fellowship, Alcoholics Anonymous. Back then immunity meant a kind of ‘freedom’ and we all know - or should know - what the AA definition of sobriety is: “Freedom from alcohol.”
Should we be free anger? Yes. Enjoy freedom from self-will? Of course. But being SOBER primarily is being free from the tyranny of King Alcohol -- immunity from his iron fisted and cruel rule which demands that we drink. Please do not mistake this as immunity to alcohol - we are NEVER immune to its effect. We ARE immune from the obsession to drink it - despite its horrific effect.
The effect of which I speak is one that only alcoholic experience. Heavy, hard drinking alcohol abusers who are not real alcoholics do not experience the alcoholic experience.
If you take exception with my experience as an alcoholic who has become immune to drinking alcohol - please notice something important. I did not say that I had become immune to alcohol. I did say that I had become immune to drinking. There is a big distinction and I have no lurking notion in my head to the contrary.
If I ingest any alcohol whatever in to my system I WILL experience the abnormal physical reaction of ‘craving’. That part of the illness I don’t believe has been repaired in me. I don't know of anyone for whom this is so. Once a pickle -- always a pickle, you know. What I know has been repaired is the mental obsession part of the malady - the insanity - the lunacy if you will, of taking that first drink - not being able to bring into my consciousness with sufficient force the memory of the suffering and humiliation of even a week or a month ago - being without defense against the first drink.
What I have experienced as a practitioner of the Twelve Steps is that whereas once I was powerless over alcohol - I now have so much freakin' power over it that I cannot even contain it. This is an entirely different experince than many folks are having in recovery. My experience is much more akin to the ones we read about in "Alcoholics Anonymous' - but it is my experience never-the-less.
My only choice is to give some of that power away - to pass it on - by helping others get what I have by doing showing them what I do to stay recovered from alcoholism. The only way to do that, as prescribed by the co-authors of "Alcoholics Anonymous" is to search out still puking drunks and get them to God as fast as they can get there. It is a race and when the next first-drink wins out, people suffer. Many die.
Peace & Love,
Sunday, June 1, 2008
Defiant Londoners Party on the Subway Before a Ban on Alcohol Begins
Pete Duffell stood on the subway platform late Saturday, swigging a cold beer and ready to party.
Duffell, 24, a professional scuba diver from Kent, and two buddies -- one with his hair dyed green for the occasion -- hauled three plastic bags filled with beer and wine onto a Circle Line subway train.
At midnight Saturday, drinking on London's Tube would suddenly be banned for the first time in the storied history of the world's oldest underground train system. Duffell and thousands of others, many wearing tuxedos, Mexican sombreros and Darth Vader masks, decided to hold one last public guzzle-a-thon to mark the moment.
So in super-octane parties organized largely on the social networking Web site Facebook, thousands of raucous revelers transformed the Tube into a huge, sweaty party all Saturday evening. They sang, hooted, ripped off their shirts in the swampy heat and consumed massive amounts of alcohol -- some through funnels -- as if there were no tomorrow, which, in the case of drinking on the Tube, there wasn't.
"I am not in favor of anarchy, I am not trying to cause harm; we are just here to have a laugh," said Duffell, who said he started his "Tube crawl" at 2 p.m. and planned to go until the last legal second.
"If you tell a British person not to do something, if you say no, we will do it even more," said Duffell, offering a drink to six passing police officers, who ignored him -- at least for a few more hours.
When Mayor Boris Johnson took office this month, one of his first acts was to ban, as of June 1, the age-old London tradition of boozing on subways and buses.
In sharp contrast to the United States, it is perfectly common to see people drinking alcohol on London public transportation. In fact, it is legal to drink in almost any public place in the city.
"People have been consuming alcohol in public places in this city longer than the United States has been around," said Tim O'Toole, an American who is managing director of the London Underground. "This is much more of a drinking culture, so a change like this would seem more dramatic."
With a stroke of his mayoral pen, Johnson created a debate that cuts to the heart of a society that cherishes drinking the way Americans revere shopping.
"This has hit a nerve. People are asking about civil liberties," said Stephen Emslie, 27, who announced a Tube drinking party on Facebook, prompting more than 4,000 people to sign up.
"A part of British culture is about drinking," he said. "I had no intention of throwing a big party. It seems people are using this as a way to express the way they feel."
Supporters of the open-container ban said it is a centuries-overdue, common-sense move that will reduce assaults and other crime. But critics said Johnson's first official decree was a decidedly un-British spasm of politically correct overkill.
"They are taking away our freedom and liberties," said Duffell's green-haired friend, Marek Tomecki, as he slurped a Baileys Irish Cream and milk.
"When I get drunk I don't beat people up on the Tube," said Tomecki, 30, a New Zealander who lives in London. "Aren't there bigger issues to worry about? I came to liberal England to enjoy. I didn't come here for the weather."
The Tube is one of London's most renowned attractions, transporting more than 3.2 million commuters and tourists every day. More than 6 million ride the buses.
But at night the character of the Tube and London buses often turns much more rough and menacing, as people spilling out of pubs continue their drinking on the way home.
Johnson said the ban fulfills a campaign pledge to make London's public transport safer and crack down on the drunkenness that leads to assaults and other crime. Duffell, for example, said he had been mugged "a couple of times" on London buses by people who had been drinking.
The union that represents most Tube and bus workers has criticized Johnson for passing the ban without consulting its members, who will now have to ask people to throw away their drinks.
"Violence against our members is already a major problem, particularly from people who have been drinking," said union chief Bob Crow. "Perhaps the mayor will come out with his underpants on over his trousers like Superman one Saturday to show us how it should be done."
O'Toole said he believed that people would adjust their habits to the ban as easily as they adapted to a ban on smoking. "These things become self-policing," he said.
Saturday night, the mood on the Tube was a mixture of Halloween, an Irish wake and a sticky, sloppy fraternity party. Tube trains were packed with sweaty partiers, including some who hung by their feet from the handrails on the ceiling.
Many dressed as Johnson, wearing white-blond wigs to mimic the mayor's memorable head of unruly platinum blond hair.
"For the British public, alcohol is an important release, it's part of how we work," said Roy Halcro, 20, a pub manager wearing a Johnson-esque wig and pink tie.
"It's an infringement on our civil liberties not to be able to drink a legal substance on the Tube," he said, as several hundred people on his train car started pounding on the ceiling and chanting obscenities about Johnson.
Organizers of the Tube parties repeatedly reminded people to maintain a fun atmosphere, and not to resort to the sort of recreational brawling so common to pub closing times around Britain.
Susanna Marshall, 45, brought her 5-year-old son with her to bear witness to the last day of legal boozing on the Tube.
"I wanted to show him it is okay," she said, sipping pink zinfandel from a wine glass. "We were once okay. He will say he was here. People have been drinking since the Stone Age. This won't change much."