New Recovery

ALL ADDICTS ARE DIFFERENT — NOW THERE'S A TREATMENT THAT IS TOO

As a professional experienced with alcohol and drug addiction, you know those struggling with this debilitating disease face a long journey towards sobriety – one that requires a customized, leading-edge recovery program with a personalized approach. Unfortunately, there are few programs today that go above and beyond the standardized treatment formula to improve the odds for long-term sobriety. That's why Enterhealth, a premier alcohol and drug addiction recovery center, with its proven therapeutic approaches, neurology, technology, and leading anti-addiction medications, is earning a reputation as the better way to recover.

Here are just a few reasons why Enterhealth stands out from more traditional alcohol and drug addiction treatment programs. To learn more on how Enterhealth can help you and your clients, call 800.388.4601 or visit us at enterhealth.com.

Reason 1: Neuro therapy. In order to help clients overcome physical trauma to the brain caused by addiction, Enterhealth utilizes neurological therapy techniques. This integration of state-of-the-art diagnostics of the brain with clinical therapies involves an MRI to assess any damage caused to the brain by alcohol and/or drug use, an EEG to assess risk level of seizure, and a written neuro-psych test to check for cognitive brain function loss. The results of this evaluation support a personalized treatment plan.

Reason 2: Anti-addiction medications. Rather than rely on talk therapy alone, Enterhealth offers clients access to the latest, most effective anti-addiction medications such as Suboxone, Campral, and Vivitrol. This can help not only repair damage to the brain caused by alcohol and drug use, but also reduce cravings, providing them the opportunity to more fully participate and benefit from treatment.

Reason 3: Length of stay. In contrast to most residential treatment facilities that offer a typical length of stay of 28-30 days, Enterhealth recommends a customized length of stay based on the client's unique needs and recovery progress. This better ensures the client has the tools they need to continue sobriety post residential treatment.

Reason 4: Dual diagnosis. The Enterhealth facility is designed to diagnosis and treat both the addiction as well as other mental health disorders – which in most cases is what creates the desire for alcohol or drugs in the first place. By treating the mental disorder in tandem, typically with personalized, private therapy, the odds for relapse are greatly reduced.

Reason 5: Wellness emphasis. Enterhealth's personalized wellness program includes individual time with a trainer as well as a dietician to address physical and dietary patterns that are recommended for balance and healthy living.

Reason 6: Balance of group & private therapy. The Enterhealth facility is limited to 16 clients, offering an industry-low therapist-to-client ratio of 1:3. This intimate setting allows more focus to be placed on individualized, one-on-one therapy, while also supporting a menu of both small and large group therapies.

Reason 7: Post Residential Support. As your clients transitioned back to your care from the residential addiction treatment program, Enterhealth’s online Life Care program can assist them in continued recovery through access of Enterhealth's online recovery tools 24 hours a day from anywhere in the world.

We invite you to schedule a tour and meet our team. To learn more about what makes Enterhealth a better way to recovery and how it can help your clients, call 800.388.4601 or visit us at www.enterhealth.com

Florida Drug Rehab Center Now Offering Extended Stay Programs

Ambrosia Treatment Center, a holistic-based drug rehabilitation center located in Port St Lucie Florida, now offers extended stay addiction treatment programs specifically tailored to the needs of the patient.

When it comes to health problems, a quick and neat solution is preferred nowadays. We have pills and syrups to ease every possible symptom. Surgery procedures that can be performed the same day and leave minimal scarring. However, when it comes to drug and alcohol addiction there is no such thing as a 'quick and neat solution.' Recent scientific studies have shown that the longer the treatment, the better the recovery and the more permanent the sobriety.

Therefore, drug rehab centers nationwide have begun lengthening their programs and making recommendations to possible patients for longer treatment stays that are still cost effective. Ambrosia Treatment Center, a world-class holistic drug rehab facility located in Port St. Lucie Florida, has begun offering both 60-90 day programs and 6-12 month programs, in addition to their shorter programs, in order to provide specialized treatment for all of their clientele.



According to the National Institute on Drug Abuse, over forty to sixty percent of people 'will relapse after drug treatment.' Addiction experts are now proving that longer treatment where client's specific needs are taken into account will alleviate the massive weight of addicts relapsing and cycling between 30-day hospitalizations for years and years. Dr. David Lewis, director of Visions Rehabilitation Center in Malibu, says that 30-day treatment programs were originally established for the Air Force and were only scheduled in that manner for bureaucratic reasons--'men and women didn't need to be reassigned if they were away from duty for more than 30 days. Other treatment centers followed suit.'

However, there was at the time no direct scientific evidence that showed that 30 days was adequate time for treatment. Today, we know that there are no 'magic numbers' when it comes to drug and alcohol abuse treatment and those 30 days is not nearly enough. The Ambrosia Treatment Center, as a holistic-based drug rehab facility, follows this pattern by treating the 'whole' person in order to resolve the underlying issues that may be causing the addiction in the first place. Often times, treating the 'whole' person requires more than simply 30-days.

However, many people find that an extended stay beyond 30-days is too much for addiction treatment. People argue that they have jobs, school, families--the normal day-in-day out routine that needs attention. What they want from rehabilitation is a quick fix. Yet, as stated before, there is no quick fix for drug and alcohol addiction and abuse. Studies have shown that addiction is best analogized to a chronic disease, such as heart disease--addiction requires critical attention and perseverance in terms of treatment in order to remain healthy. The Ambrosia Treatment Center family provides strong and capable staff, each of which carry over 20 years experience treating substance abuse and addiction treatment clients from all walks of life. Their attention to detail enables them to provide each client with an individualized regiment of treatment and not necessarily 'cookie cutter' their therapy.

At the end of the day, this is what sets The Ambrosia Treatment Center different from other rehabilitation clinics--they care. They want to see your loved ones get well. They never give up on an addicted person. And, at the end of the day, they believe that you never fail unless you just quit trying.

For additional information on the AMBROSIA TREATMENT CENTER and drug abuse treatment please call 1-866-616-0069 or visit www.ambrosiatreatmentcenter.com.
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source: topix.net

Alcohol admissions triple at central London hospital

Adult alcohol-related admissions to an inner London hospital have tripled in the last four years, according to new research.

Trends in admissions were studied at the emergency departments and in medical admissions at two inner London hospitals – University College Hospital and the Whittington Hospital from 2004-8.

The total number of adult in-patient admissions at the two hospitals rose from 998 in 2004-05, to 2,690 in 2007-08. Adult attendances linked to alcohol in the emergency departments rose too - from 2,560 in 2004-05 to 3,434 in 2007-08.

Dr Andrew Smith, lead researcher, and colleagues found the figures for University College Hospital demonstrated a clear trend. This was not the case with the Whittington data.

University College Hospital is located in an area with a high concentration of pubs and nightclubs whilst the Whittington is not, which might be the reason for the increase in alcohol-related attendances at this hospital, they suggested.

Separately, they examined trends in teenage alcohol-related presentations. No increase in hospital admissions was observed, although the number of A&E attendances for under-18s rose from 98 in 2004/05 to 165 to 2007/08.

‘This increase coincides approximately with the change in the licensing laws. While under-18s might not generally be expected to be drinking in licensed premises, the law changes also affected off-licenses which may be of relevance,’ said Dr Smith.

The Licensing Act 2003 came into effect in November 2005. This change appears to have been paralleled by an increase in the presentation of alcohol-related illnesses in these two hospitals, conclude the authors.

‘A three-fold increase in the total number of adult admissions is noted at one hospital which if repeated at other centres, would have significant ramifications on NHS resources if this trend continues,’ they added.

The data were presented at the Royal College of Psychiatrists’ Faculty of General and Community Psychiatry Annual Meeting in Manchester today.

It follows last week’s calls for strong public policy measures to counter the alcohol problem in society. Dr Nick Sheron and colleagues said changes to price and availability of alcohol would work better than clinical treatments or Government initiatives to cut alcohol-related harm.

Writing in Gut, they say evidence from the WHO, the Academy of Medical Sciences and the EU, show that the best way of reducing consumption and alcohol-related harm is to tackle price.
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source: On Medica

A tough-on-crime approach to justice that actually works

Instead of jailing repeat petty criminals, we should send them to mandatory addiction treatment

In a season of tough talk on crime, I propose a challenge to our political leaders. In Canada, one group of criminals commits a disproportionate number of crimes that we could easily reduce with more coercive sentencing. However, our usual form of coercion -- imprisonment -- doesn't work for them. They need a different kind of sentence. But to make that happen -- and to significantly reduce the number of crimes they commit -- would require will and wisdom that our legislators can't seem to muster.

The legal system refers to these men -- they are almost all men -- as chronic offenders. What everyone knows, but the justice system doesn't acknowledge, is that they are also drug addicts, hooked on heroin or crack cocaine. They steal not for gain but to support their addiction, to pay for their next fix.

This has nothing to do with getting high. For an addict, the point is to avoid the effects of withdrawal, which in the case of heroin can include cramps and muscle spasms, fever, cold sweats and goose bumps (hence the phase "cold turkey"), insomnia, vomiting, diarrhea and a condition called "itchy blood," which can cause compulsive scratching so severe that it leads to open sores. For addicts, drug use is not a lifestyle choice that's easy to change.

Many have been addicted for their entire adult lives, and as a result have spent half their lives behind bars, serving dozens of sentences for minor crimes. These are the "revolving door" criminals -- arrested, tried, sentenced to a few weeks or months, then dumped back out on the street, only to be arrested, tried and convicted again a few weeks later.

Canada has hundreds of criminals like that, mainly in the larger cities. Vancouver alone recently identified 379. According to a report by the Vancouver Police Department, the vast majority were addicted to drugs or alcohol. Many also suffer from a mental disorder, generally untreated. Between 2001 and 2006, Vancouver's few hundred chronic offenders, as a group, were responsible for 26,755 police contacts -- more than 5,000 contacts per year, 14 a day. The costs are staggering. Arrests, prosecutions and incarcerations end up costing some $20,000 per criminal per month -- per month! There has to be a better way.

Punishment alone is not it, though, for a couple of reasons. For one, the idea of punishing criminals is based at least partly on the concept of specific deterrence. You steal, we lock you up. Applied most strongly to property crimes -- which is what these offenders mainly commit -- specific deterrence assumes that the criminal is a rational actor who will consider: Is it worth it? And in fact, specific deterrence often works; many offenders really do stop committing crimes after fairly short jail sentences.

But not addicts.

The problem is the presumption of a rational actor. That is exactly what we do not have with drug addicts, who do not -- usually cannot -- stop to consider the likely punishment for a crime they are about to commit. They see only the escape from the more immediate and dire punishments of drug deprivation. By comparison, the threat of being caught and thrown in jail is nothing.

As well, because chronic offenders tend to commit minor crimes and draw short sentences -- say, 30 to 90 days for theft -- their lives shift constantly between jail and the streets.

We could use longer sentences to "warehouse" chronic offenders -- the American "three strikes and you're out" approach. But long-term imprisonment would be a very high-cost way to deal with what is really a public health issue.

And there's the crux of the problem.

The criminal justice system is not designed to treat addicts. While prisons do provide some drug treatment, it is almost always short-term and underfunded.

Clearly, Canadians need more protection from chronic offenders than we are now getting.

With chronic offenders, we have an issue of both criminal law and public health. Addicted offenders must be required to undergo serious, long-term drug treatment.

Since 1996, Alberta law has required minors with an apparent alcohol or drug addiction to participate, with or without their consent, in an assessment and treatment program. Saskatchewan and Manitoba have similar legislation and even allow parents of drug-addicted children to ask a court to require treatment, whether or not the child is in trouble with the law.

Although the research is scant, mandatory treatment does appear to have about the same success rate as voluntary treatment. A 1970s American study looked at the effectiveness of methadone maintenance treatment for those who entered the program under high, moderate or no coercion and found no significant difference in outcomes for the three groups.

Given the costs of incarceration -- not counting the costs to future victims -- paying for mandatory drug treatment for them hardly seems an issue, even if it only works some of the time. As for whether mandatory treatment is somehow inhumane, how humane is it to sentence these addicts to punishments we know don't work and then dump them back on the street no better than before?

Politics aside, Canadians deserve evidence-based criminal justice policies that actually reduce crime. Our challenge is to make the tough choices that move beyond "tough on crime" rhetoric and produce real change.
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source: James C. Morton and The Ottawa Citizen

Understanding Addictions

CAMDEN (Sep 22): “Understanding Addictions” will be the subject of a free evening program open to anyone in the Midcoast area and presented by the First Congregational Church, Camden, from 7 p.m. to 9 p.m. on Thursday, September 25.

“’Understanding Addictions” is intended both for people who may be suffering from an addiction and for individuals who would like to be more helpful to a family member or a friend who is struggling with addiction,” said program leader, Mary Ellen Ostherr who works as a substance abuse therapist for Mid-Coast Mental Health and also has a private practice. She has worked in the field helping individuals and families with substance abuse and recovery for 15 years.

“Part of the program will be about how to understand the signs of addiction and what you can do about it as a friend or family member. The program will also cover how to recognize enabling behaviors and what to do to help stop those behaviors that can contribute to someone’s addiction,” she said. “An important part of the program will cover how we can reach out and help others.”

Denial—how to recognize it and how to deal with it as a friend or family member will also be covered, Ostherr said.

Maine currently leads the nation in per capita addiction to opiates and the state is number two in alcohol addiction. Factors that make the problem worse for the people of Maine, she said, include the long winters, the ready availability of drugs and alcohol, and the high risk nature of some jobs in Maine.

It is easy to get hurt and take prescription drugs as part of the rehabilitation, she said. Good people can find that weeks later they may develop an addiction. Another factor is the Internet. There are now websites that make it all too easy to get prescription medications. Some of these websites have doctors standing by who will write the prescription.

“Understanding Addictions” is offered through the “Live and Learn” series of free seminars and workshops presented for residents of the Midcoast area by the First Congregational Church, Camden.

“Understanding Addictions” will be held in the Mayflower Room of the church at 55 Elm Street in Camden. Participants should park in the Church parking lot behind the Church and enter through the door on the parking lot side. The Church is handicapped accessible.
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source: http://waldo.villagesoup.com/

Fear of alcohol addiction 'pandemic'

Every dollar spent on alcohol and drug treatment could save taxpayers at least $5, say experts.

They warn of a "pandemic waiting to happen" if the country's addiction problems are not addressed.

A paper released by the National Committee for Addiction Treatment (NCAT) yesterday revealed what one member called "horrifying" statistics, detailing devastation wrought by alcohol and drug addicts.

It also cited a 2005 United Kingdom study, which found that money spent on standard treatment therapies for alcohol problems saved about five times that amount in expenditure on health, social and criminal justice services.

National Addiction Centre director Doug Sellman said the difference was even more marked for drug addicts, where $8 could be saved for every dollar spent.

The statistics included:

89 per cent of serious offences are committed under the influence of alcohol and drugs.

Between 75 per cent and 90 per cent of weekend crime is alcohol-related.

Up to 50 per cent of men who physically abuse their partners have substance-abuse problems.

Alcohol plays a role in 30 per cent of fatal car crashes.

70 per cent of Emergency Department admissions are caused by alcohol abuse.

This happened in an environment where only 22,000 of New Zealanders with addictions accessed treatment services in any given year, leaving an estimated 138,000 unaided, NCAT co-chair Christine Kalin said.

Treatment costs ranged from $80 for an intervention for a low-level problem to more than $8000 for months of residential treatment.

Kalin, who released the paper at the Cutting Edge Addiction Treatment Conference in Christchurch, said staff in the sector were sick of turning away people who needed help.

"Anecdotally, I know that there are services that have waiting lists. Rather than building prisons, having health budgets overspent, having police resources stretched, let's put some of that money into services at the front end rather than the ambulance at the bottom of the cliff.

"At a very minimum, we need to have the capacity to treat the 160,000 who we know need special help, and help now," she said.

Alcohol Healthwatch director Rebecca Williams said the problem was probably worse than it appeared because people who could not access services were likely to be incorrectly recorded.

"This is a sort of pandemic waiting to happen ... I think services, if they were actually presented with all of the cases that needed help and support, they would simply not be able to cope."

Experts warned that turning people away often meant the window of opportunity to help them was missed.

Kalin said investment in the sector could take the form of community-based treatment options, aimed at specific high-risk groups such as schools and prisons.

Only one third of alcohol or drug addicts were thought to receive treatment while incarcerated, she said.

Associate Minister of Health Damien O'Connor, who addressed the conference yesterday, said the Government had increased its spending from $65 million in 2001 to $94m last year.

National health spokesman Tony Ryall said the party also recognised it was an issue, particularly for families of drug-affected young people, and would address it in its health policy.
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source: Stuff NZ, http://www.stuff.co.nz/

Restoring a People -- Program Battles Native Substance Abuse

The counselors of an intensive outpatient treatment center run here by the Navajo Nation, Pastor Cecil Lewis Jr. and Robinson Tom have started a fight against the tribe’s alcoholism and drug abuse because these problems hasten the breakdown of Indian families.

According to them, people addicted to alcohol and drugs lose self-confidence, giving up the will to live or do anything. Unable to raise their families due to addiction, they put their children under care of grandparents, uncles or aunts who are already struggling to survive on food stamps and scanty incomes.

Children who grew up watching the miseries of substance abuse often follow in their parents’ footsteps. In the end, the idea of a traditional mother and father or the concept of supportive, safe and nurturing family evaporates into thin air.

Even though tribes have made great strides in past years, the counselors argue that no less than 10 percent of Navajos could be diagnosed as alcoholics, and there isn’t a single house in the Navajo Nation that isn’t affected by alcohol or drug abuse. Use of methamphetamines among young people is also an issue. The predicament is mirrored throughout Indian reservations and communities across the country.

Pastor Lewis and Counselor Tom understand the situation very well because they have been there themselves. “I was an alcoholic,” said Pastor Lewis, a counselor for the Faith-based Initiative Project at the treatment center in this tiny town mostly populated by Navajos, about 130 miles northwest of Albuquerque. “I thought getting drunk would be a way to alleviate and resolve my problems. But they just became worse.” He said just like any other person in trouble, he tried many ways to live life and failed, until he finally found God in 1984 and turned his life around. “I run into the people everyday who remind me of my past,” said Robinson Tom, who has been sober for the last 15 years, “Not only do alcoholism and substance abuse destroy a person, but they decimate families, relationships and beliefs.”

Tom had his first drink when he was 9 years old—it was given to him by an adult relative—and he tried to kill himself in 10th grade. His suicidal urge was repeated three more times. Tom stopped drinking after he seriously injured himself by falling from a tall tree while drunk. In his sickbed, he felt that being an alcoholic wasn’t the way his creator wanted him to live.

To tackle the substance abuse problem, Crownpoint Department of Behavioral Health Services, serving the Eastern Navajo region since 1970’s, offers treatment services ranging from traditional Navajo methods to Alcoholics Anonymous classes. Since 2001, the center has administered a faith-based initiative project, to promote access to spiritual healing services for the Navajos suffering from substance abuse.

In Navajo, the center is called “Dine’ Bee lina’ Na’ Hisoolnaal” Center. According to Tom, the native phrase means “restoring the life of a person so he can live the way he was supposed to live.” Most of the center’s clients are those who ran into trouble with the law because of their addiction and were ordered to take up to six weeks of counseling programs.

Pastor Lewis, who is also leading about 20 to 35 congregations at Dear Spring Mission in the area, puts emphasis on spiritual healing through the words of God. During counseling, he uses the Bible as a tool, which he believes to possess the power of changing a person. “Deep inside our hearts is an inner man,” said Pastor Lewis. “There’s spirit which was always hungry for God. When you find the god, you’ll look beyond our natural instincts or ways of life and can change the miserable life.” Counselor Tom relies on treatments rooted in Navajo traditions. For example, he likes to take his clients to a sweat lodge at the center for purification ceremonies.

Dozens of alcoholics and drug abusers in shorts sit in the pitch darkness of a tent made of sticks and wool blankets. In the middle of the dirt floor, a pit has been dug and filled with rocks heated by fire.

Cedar logs are thrown on the rocks, giving off a fragrance, and then lavender, sage and sweet grass. A bucket of water is then thrown on the rocks, filling the tent with a heavy steam. There, the abusers and addicts purify their spirit corrupted with alcohol and drugs. Women clients use a separate sweat lodge.

Tom sees the sweat lodge as a way to share culture and help his fellow Navajo clients find a more spiritual path that leads them to a right way. However, the treatment alone can’t tackle the substance abuse problems. “In order to attack the substance abuse effectively, there must be a way to fight poverty, because it leads to alcoholism and drug abuse,” said Pastor Lewis. “Just think how the Navajo Nation would be improved if there was a majority of people working and earning.”
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source: New America Media, http://news.newamericamedia.org

More drug use, less treatment in E. Ky.

A higher proportion of people in Appalachia abuse prescription painkillers than in the rest of the nation, and the problem is even greater in coal-mining areas such as Eastern Kentucky, according to a federal study.

Compounding the problem, relatively few facilities in Appalachia offer short and long-term residential treatment — the kind of service needed by many people addicted to OxyContin and other painkillers.

“There's truly an access-to-health-care disparity for these coal-producing counties that we need to address,” said David Mathews, director of adult services with Kentucky River Community Care, which provides services including substance-abuse and mental-health treatment in eight Eastern Kentucky counties.

The findings are included in a new study of access to substance-abuse and mental-health treatment in Appalachia that was underwritten by the Appalachian Regional Commission— a federal-state partnership that works to create opportunities for self-sustaining economic development and a better life for Appalachian residents.

The study underlines the cyclical relationships between poverty, depression and drug abuse in parts of Appalachia, and the resulting need for more treatment facilities.

Anne Pope, federal co-chair of the agency, and Gov. Steve Beshear announced the results at a news conference Tuesday in London.

Pope said Beshear had pushed ARC to tackle the issue of substance abuse, and also cited the efforts of Louise Howell, executive director of Kentucky River Community Care.

Pope said trying to reduce substance abuse fits with ARC's mission to boost economic development because substance abuse is a barrier to improving the economy.

“Communities cannot grow if there is a major substance-abuse problem,” Pope said.

Distress, depression

Researchers found that, generally, access to substance-abuse and mental health care in Appalachia compared favorably with access in the rest of the country.

However, there were differences within the sprawling region — which includes all of West Virginia and parts of 12 other states from New York to Mississippi.

The central part of the region, including Eastern Kentucky, faces some significant challenges, the study found.

For instance, more residents of Appalachia reported problems with serious psychological distress and major depression, and the rate of such problems was higher in Central Appalachia. The study was based on analysis of information from surveys, hospitals and treatment facilities.

There is a link between the economy and mental-health problems such as depression, treatment providers said. Most of the counties considered economically distressed by the ARC are in Eastern Kentucky.

“When they're not able to provide for their families, the stress and depression are going to increase,” Kathy Tremaine, director of Cumberland River Comprehensive Care, said of people having financial problems.

The study found that, as the main reason for being admitted to treatment, abuse of drugs such as prescription painkillers was higher in Appalachia — especially in coal-mining areas — than elsewhere.

Such abuse is rising across the country, but it's going up faster in Appalachia, particularly in those mining areas, researchers found.

And despite concerns about prescription drug abuse, alcohol was the main reason for people being admitted to treatment in Appalachia, as in the nation. The study found a much higher percentage of people in Appalachia being admitted primarily for alcohol abuse – 45 percent in 2004, compared with 22 percent in the nation.

Less cocaine, meth

There was good news in the study. Among other things, it found relatively lower marijuana and cocaine use in Appalachia and lower treatment admission rates for heroin. It also found that, although there might be “hot spots” of methamphetamine abuse, use of the drug was lower overall in Appalachia than in the United States.

People in the region have recognized the problems and responded with a variety of programs such as school-based prevention activities to try to prevent drug abuse, though there is a need for more.

Researchers also found that proportionately more facilities in Appalachia offered intensive outpatient care, mental-health assessment and substance-abuse family counseling; that nearly all facilities offered some form of substance-abuse treatment; and facilities offered more free and reduced-cost treatment and accepted more forms of payment.

However, fewer facilities there offered outpatient detoxification, and there were fewer places where people could stay for short- or long-term substance-abuse treatment.

Mathews, with Kentucky River Community Care, said that it's clear there is a need for more treatment for substance-abuse and mental-health problems.

Surveys found that in the same Eastern Kentucky counties where people reported relatively high rates of painkiller abuse and drug dependence, a higher percentage of people said they had needed drug treatment in the last year but had not gotten it.

People told researchers about a variety of barriers to substance-abuse and mental-health treatment, including lack of transportation, lack of money and fear of being stigmatized.

Money is a key issue for treatment providers as well.

The state cut funding for community mental-health centers 3 percent in the current budget, and funding hadn't gone up to match costs even before, Tremaine said.

“We've gone underfunded for the last 10 years,” she said.

Tremaine said that means the centers provide services without getting reimbursed. Cumberland River doesn't turn away people needing treatment, but the question is how long that can continue, she said.

Waiting for treatment

A shortage of money for residential substance-abuse treatment services — especially to hire trained people to provide treatment — means there is a waiting list to get into such facilities in Eastern Kentucky.

The danger is that people might not come back when a spot finally opens up.

“If we don't get people in when they're motivated, we've lost them,” Mathews said.

Beshear said a state initiative to build 10 substance-abuse treatment centers in Kentucky, called Recovery Kentucky, will help address the shortage of residential care in the state. Five are already open.
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source: Lexington Herald Leader, http://www.kentucky.com

Aspen is now Colorado’s outlet for a controversial new addiction treatment

What if there was a magic pill that alcoholics and addicts could take to stop their cravings?

Steve Ayers, an Aspen doctor, and Annie Brown, an Aspen nurse with a clinical specialty, don't claim to have a magic pill.

But they do claim to have something almost as useful: a drug cocktail that can relieve cravings, reduce sleeplessness, restore normal brain function, and help patients feel better so that they can fully engage in recovery.

Since November, the two have been providing a controversial treatment called Prometa to alcoholics, cocaine addicts and a few methamphetamines addicts in the Aspen area.

Brown and Ayers, who also is chief of staff at Aspen Valley Hospital, an emergency room physician, and the Pitkin County coroner, are convinced the program does what it claims, and they are backed by several studies. But nationwide, some critics have argued that the treatment, needs more study and/or approval from the Food and Drug Administration (FDA).

A combination of three drugs (flumazenil, hydroxyzine, and gabapentin), nutritional therapy, and psycho-social counseling, the Prometa treatment program was developed by a Spanish doctor in the 1990s. Since Terren Peizer bought the protocols and began marketing it, approximately 3,000 patients have been treated in the United States, according to Brown.

Treatment begins with a three-day infusion of flumazenil, given intravenously for three- to five-minute intervals while the patient's cardiac state is monitored.
The flumazenil infusion is followed by dosages of hyroxyzine, gabapenin and nutritional supplements over a 39-day period.

The drugs help change the anatomy and chemistry of the brain to return addicts to a pre-addiction state in which they do not have a physiological dependence on the drug, said Ayers. In short, it allegedly reduces cravings.

“You can remodel [brain tissue] quickly with the right influence. That's how you learn a new skill, like throwing a Frisbee. Your brain tissue is actually forming new cells,” explained Ayers.

The partners, who are the only people licensed to administer the protocol in Colorado or Wyoming, say the program has been even more successful than they'd hoped. While not all their clients have achieved sobriety without relapse, all patients claim their cravings have been reduced, they say.

“I've been working 25 years with addiction — this is the most robust intervention, the best tool I've had,” Brown said.

Their clients, in e-mails forwarded by Brown, are equally glowing.

“What Prometa did for me I cannot put into words,” wrote one recovering alcoholic.
Another patient, who earned a college scholarship after kicking his cocaine addiction, cautioned that Prometa is not a magic pill, but is “the wind in the sails of those that are ready.”

A third testified to its effect on his psyche: “Before Prometa I had cravings all the time. All I could think about was drinking. After Prometa the cravings have decreased … if I am at lunch and I see someone drinking, I think about ordering a drink and then I don't.

Critics

Not everyone in the medical community has given wholehearted support for the treatment. Prometa has had several public-relations challenges, perhaps chief among them the fact that Terren Peizer, who owns and markets the treatment program through his company Hythiam, is former junk bond salesman.

Given the cost of the treatment, Peizer — who visited Aspen last summer as an Aspen Institute panelist for a bioethical dilemmas seminar — stands to become a very wealthy man. Aspen treatments, for example, cost $12,000 to $18,000, a portion of which is returned to Peizer as a “licensing fee.”

Also, Peizer has not sought approval from the FDA for the treatment protocol. Technically, he does not have to, as the drugs have individually received FDA approval for other uses.

Opponents have also argued the protocol hasn’t been thoroughly and independently studied. An October 2007, Hythiam-funded study, led by Dr. Harold C. Urschel and published in the Mayo Clinic Proceedings medical journal, was criticized for not having a control group or placebo. The television show 60 Minutes later reported that Dr. Urschel's clinic sold the Prometa treatment during the trial, suggesting that doing so was a conflict-of-interest.

Several other “double-blind” studies have since been held with control groups and placebos, and have found that Prometa reduces cravings. But none have yet been peer-reviewed in a medical journal, note critics.

But Ayers and Brown say that not all the criticisms are valid.

Ayers countered that many medical protocols have never been studied. For example, he said, every alcoholic who is admitted to an emergency room in America gets a shot of thiamine, the dosage of which has never been studied.

“There's a million things in medicine that are considered standard of care and scientifically founded that are not double-blind studied,” he said.

Having said that, he did acknowledge that Prometa should be “if people are going to pay that much for it.”

On the topic of FDA approval, he argued that the FDA doesn't approve protocols, only drugs. Many drugs are now prescribed for a use other than their approved use, he said.

Brown countered concerns about cost by noting that Hythiam has said its first priority this year is to convince managed care programs to pay for Prometa. Acknowledging that some never will (many insurance companies don't cover drug and alcohol treatment), she also pointed out the high cost of addiction, a number that can easily top the cost of Prometa, given time.

Brown also noted that $1,500 of the fee goes toward therapy in the person’s hometown.

Future

Prometa is revolutionary, say Brown and Ayers, because it claims to reduce cravings. But for years, treatment centers have used drugs to help manage addiction.
Perhaps the most famous is Antabuse, which makes the alcoholic very ill if he or she drinks. Vivitrol, a short-term immunization that blocks alcohol's ability to work on the brain, has also been used with some success.

But Ayers argues that Prometa, and the drug protocols that will likely follow it in the next few years, are the future of addition medicine. Within two years, he predicted, all addictions will likely be treated medically — and the medical community will laugh about the fact that it ever considered addiction to be simply a behavioral problem.
“The addiction medical community is all over this concept of treating [addiction] medically and finding different ways to treat it,” he said.

He even predicted that doctors might be able to provide immunizations to protect children with a family history of addiction, some day. Immunized people would be able to snort cocaine, but it would have no effect on their brain.

“All these things are going to create ethical dilemmas in medicine,” he said. “How do you immunize someone? How do you take away their ability to experience cocaine?”
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kredding@aspentimes.com
The Aspen Times

Unanswered cries for help

Instances are growing in which certain prescription drugs do a lot more than kill the pain — they kill the user.

In articles published this month, Las Vegas Sun reporters Marshall Allen and Alex Richards reported that this tragic trend is national and particularly acute in Nevada.

Their research revealed that 258 people in Clark County died last year — as opposed to 57 in 1997 — from conditions related to overdoses of prescription drugs.

They also documented that Nevadans consume about twice the national average of several prescription painkillers — a statistic that is probably more than coincidental to the rising numbers of fatal overdoses.

To add perspective, Allen and Richards did some comparisons of last year’s in-state deaths. There were more from prescription drug overdoses than from auto accidents. And from firearms. And from overdoses of cocaine, heroin and methamphetamine combined.

On Monday Allen reported that the number of Nevadans who are addicted to prescription drugs has reached crisis proportions. The result is that the state’s inpatient and outpatient substance abuse treatment programs, already overwhelmed by tens of thousands of people addicted to alcohol and street drugs, are increasingly not meeting the need.

Thousands of Nevadans who are succumbing to addiction and want help are being told to wait, when waiting can be perilous to their health.

Inpatient treatment programs are considered best for addicts, but in Clark County there is a total of 375 beds for this service.

Addicts who have money or who have good health insurance have little problem getting treated in Nevada, but the numbers of addicts without these attributes are legion.

Rising fatalities are not the only cost. Addiction often leads to domestic violence and other crimes that take a human toll and overcrowd our courts, jails and prisons. It fills emergency rooms and beds at our public hospitals. It leads to traffic accidents, unemployment and homelessness. These consequences add up to a much greater public cost than an expanded treatment system.

The lack of adequate assistance for addicted Nevadans who lack the means to help themselves is a grave problem that should be addressed by the 2009 Legislature.
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source: Las Vegas Sun

Titan Pharmaceuticals Announces Positive Results from Phase III Clinical Trial of Probuphine for the Treatment of Opioid Addiction

Titan Pharmaceuticals, Inc. (AMEX:TTP) today announced positive, statistically significant results from its randomized, double-blind, placebo controlled, multi-center Phase III clinical trial of Probuphine®. Probuphine is Titan’s novel, subcutaneous implant formulation designed using its ProNeura technology to deliver six months of buprenorphine. Buprenorphine is currently marketed as a sublingual formulation for the treatment of opioid addiction.

Probuphine showed a clinically and statistically significant difference over placebo in illicit opioid use over 16 weeks as measured by urine testing performed three times per week (p=0.0361) – this was the primary endpoint acceptable to the U.S. Food and Drug Administration (FDA). Additionally, Probuphine achieved statistical significance in the Phase III trial’s key secondary endpoint, the difference in illicit opioid use from weeks 17-24 (p=0.0004). Moreover, Probuphine treatment showed a statistically significant difference in illicit opioid use versus placebo over the full six-month (weeks 1-24) period (p=0.0117).

“We are extremely pleased by these positive results and the potential of Probuphine to be an important advance in the treatment of opioid addiction,” said Marc Rubin, M.D., President and CEO of Titan. “Even as buprenorphine, with estimated sales of half a billion dollars in worldwide sales, is fast becoming the gold standard for opioid addiction treatment, there are growing concerns about compliance with and abuse of the currently available treatment options and a critical need for safe, effective treatment options. These data show that our proprietary subcutaneous implant can safely deliver Probuphine over six months. We look forward to completing this development program and forging strategic alliances to commercialize Probuphine worldwide.”

Additional secondary efficacy analyses, including the mean percentage of urines negative for illicit opioids over treatment weeks 1-16, 17-24, and the complete six-month period also statistically favored Probuphine over placebo. Another important indicator of treatment effectiveness, patient retention, was approximately 66 percent for Probuphine compared to 31 percent for placebo. Probuphine was also well tolerated throughout the six-month trial.

“These data are very promising and I believe that the success of Probuphine should have a very significant impact on our ability to effectively treat opioid addiction,” said Walter Ling, M.D., Professor of Psychiatry and Director of the Integrated Substance Abuse Programs at the David Geffen School of Medicine at UCLA, and a principal investigator in this trial. “As a clinician, I am concerned by the growing problem of opioid addiction, especially prescription opioid abuse, and the challenge of effectively treating our patients with a safe, abuse-resistant and diversion-resistant treatment. These data could translate into a dramatic change in our treatment possibilities.”

Worldwide, it is estimated that there are 6 million opioid addicts. Approximately one-half of this potential patient population is addicted to illicit opioids, such as heroin, and the other half to prescription drugs, such as oxycontin, methadone, and codeine. Until recently, the only approved medication assisted therapies for opioid addiction had been available at only a limited number of authorized facilities in the U.S. As of 2000, U.S. physicians can be certified to prescribe less restricted opioid addiction medications in an office setting, which has greatly expanded patient access to opioid addiction pharmaceutical therapies. Despite these advances, this remains a highly underserved market with only about 750,000 people globally receiving medicinal treatment for opioid addiction.
More details here...
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source: Business Wire

Success of drug program is celebrated

Inmates hear encouraging words about beating addiction

At 19, Jacoby Smith was sentenced to 55 years because of his cocaine addiction.

He robbed people making late-night bank deposits so he could feed his habit.

"I had a weapon sometimes," Smith, 41, said. "My intentions were never anything more than to [get] money to support my habit."

He finished his prison term in 2006 and now supports four generations of family, from grandmother to grandkids, by working at the Wilmington docks while on probation.

And he thanks the Key Program, a substance abuse program at Young Correctional Institution that celebrated its 20th anniversary Monday.

"I'm proud. I'm proud now of who I am," said Smith, who's been clean for seven years.

Without drug treatment, recidivism rates can top 70 percent, according to the Delaware Department of Correction. While state officials couldn't immediately provide numbers for the Key Program, a similar program in New Jersey boasts of cutting male recidivism by a third and female recidivism by half, said William Palatucci, senior vice president of Community Education Centers, which sponsors the Key Program.

Smith knew he would be at Monday's celebration. He needed to show the success that's possible for those in the program.

"It was heartfelt, just to be in the atmosphere [of Key] and rekindle a lot of experiences that happened here," he said.

The program relies on group and individual therapy to break self-destructive cycles. Participants gradually take on more responsibilities during the program's roughly 18-month regimen. Toward the end of his term, Smith counseled younger inmates.

The prisoners in Key are separated from the general population. They referred to each other as family during the celebration, and a group of them put on a play about life for family members on the outside.

For Smith, it was the one-on-one therapy with a counselor that changed him. He said the one-hour sessions were never enough time to talk. He wrote a lot of essays about self-destructive tendencies and would talk them over regularly.

One realization he had was that using his ability to rile people up and get their attention could be put to better use than getting friends together to cause trouble.

With his long purple T-shirt standing out in the ocean of white prison garb, Smith spoke to the crowd of about 200 inmates currently in the program. He told them of his life of crime and drugs. He gave them encouraging words and drew a standing ovation.

"I was overwhelmed," Smith said. "To receive that response when I'm not being an active participant, that was rewarding."

One of the program's strengths is that it teaches the inmates responsibility, said Smith and Dohn Price, an inmate currently in the program. Their problems are their own and they can't blame circumstances or other people for crimes they commit.

"It's good to come to prison and do more than just jail time and work on yourself," said Price, who is serving a 16-month term.

It's also a tough program, he said. Inmates work seven days a week on their problems, regardless of bad days. That system also keeps out the unmotivated, Price said.

"The process is made to weed out those that aren't ready," he said.
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source: Delaware Online, http://www.delawareonline.com

Detox centre set for next year

Mattress detox will take the place of police cells or emergency rooms once a new Addictions Treatment Centre opens next year in downtown Regina.

The project is the result of the Regina & Area Drug Strategy Report, which identified the need for a stronger treatment continuum, said Dave Hedlund, executive director of mental health and addictions services for the Regina Qu'Appelle Health Region.

"One part of which was the capacity to deal with people who are drunk or high at the time in a way that was more therapeutic as opposed to only using police cells or emergency rooms," Hedlund said. "That kind of service -- a place to sleep, to get cleaned up and to have a conversation hopefully in the morning about how you could start to think about turning your life around -- they usually refer to that as brief detox or mattress detox."

The new centre will replace the Detox Centre at 2839 Victoria Ave., and integrate services offered by Regina Recovery Homes and the region to help people recover from alcohol and drug addictions. Many individuals who will use the brief detox beds may need observation but not hospitalization, said Foster Monson, executive director of the Detox Centre.

Aside from the one- to three-day program that will have space for up to 20 clients on a 24/7 basis, a comprehensive 10- to 14-day program called Social Detoxification Services will have 25 single rooms.

"Once they're in the brief detox, it gives the staff and especially the client an opportunity to evaluate their situation to the extent that they would move to the social detox, which is a longer period of detoxification," said Monson. He added that one individual went through detox 44 times before he became sober.

The centre's services will include an addictions assessment, physician visits and optional AA meetings. Hedlund said the direct pathway from one level of treatment to the next in the same building will help ensure an addict's success.

Work will begin this fall to renovate the building at 1640 Victoria Ave., where Future Print is currently located. The treatment centre is slated to open at the end of 2009 and will employ 23 full-time addictions workers. The purchase of the building and renovation cost is pegged at $5.8 million and funded by the provincial and federal governments and the RQHR.

The Ministry of Health has provided $5.1 million in capital funding and $1.25 million towards the centre's $1.8-million operating costs, said Joceline Schriemer, legislative secretary for addictions.

"It's a step in the right direction," Schriemer said. "We're maintaining a relationship with Recovery Homes and that's very important ... Enhancing the drug and alcohol services in this province is a top priority for our government."

The health region distributed information sheets to area residents in June and visited 30 nearby agencies to explain the project. Since planning is in the early stages, the region will hold public consultation meetings in September to provide residents with an opportunity to get more information about the centre.

Leila Francis, executive director of the Core Community Association, doesn't dispute the need for addiction services but wonders why the region didn't arrange public consultations before the building was purchased. She questions whether the centre will generate extra traffic, create parking issues and raise security issues.

"The community here doesn't have a lot of resources within its boundaries yet we house the major feeding programs in the city, so is it going to generate any additional clientele?" Francis asked. "We want to ensure that there is minimal fallout to the community with this centre because all the (addictions) services will be concentrated there."

Glen Perchie, executive director of the region's EMS and emergency services, said the brief detox beds will reduce the pressure on emergency departments.

"A lot of times, people with addictions problems and those coming in intoxicated have a chronic underlying problem and we're not so good at that," he said. "This is an opportunity to bypass the emergency department in many cases and take them directly to a place that's actually focused on their care and get them the appropriate help. It's the fast track to the right place."
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source: © The Leader-Post (Regina) 2008, http://www.canada.com/reginaleaderpost

Children often innocent victims of adult addiction, drug abuse

For one 12-year-old girl, addiction is a drawing of a green monster with red eyes that has a steel band around her mom, dad and older sister. It carries a bag of alcohol, nicotine and inhalants.

For another child, addiction is a sketch of his mom and dad in a beer can, with the words “please stop” etched above in crayon.

And for a handful of kids, it’s an image of a broken heart, sometimes drawn with parent’s names on each side, or the names of a brother or sister, aunt or uncle.

Whatever the image, the picture is the same for kids who were asked to describe the disease: drug and alcohol addiction hurts families, especially children.

“It’s now a huge issue. Almost one out of three, one out of four kids are living in a family with alcohol or drug abuse,” said Jerry Moe, vice president and national director of children’s programs at The Betty Ford Center in California. “They’re the No. 1 at-risk group.”

Moe, speaking Monday at Indiana University of Pennsylvania to kick-off the 20th year of the Mid-Atlantic Addiction Research Training Institute Summer School, said that, though the issue is prevalent now, this is the time to stop the multi-generational disease and push back the first age a child may use a substance. Children in families with addiction are at a higher risk of getting the disease than those without any family history, he said.

“If one takes a coin that says at-risk and turns it over, it says at-promise. Some kids have the most incredible strength and promise. They just need safe people to guide them,” he said.

Ten years ago, the average age for a child to have his or her first drink was 15 years old, he said, but today the average age is 12 years old.

“Younger kids start regardless of any other risk and are more likely than ever to get harmfully involved,” he said.

Part of the reason for such prevalent effects on children has been a change in the family form over the last 35 to 40 years, said Robert Ackerman, director of MARTI.

“I don’t think children today are different than when I was a child. If you let a child do what they want, they’ll do what they want,” he said. “What has changed dramatically is adult behavior. Children in many cases are trying to survive changes in adult behavior in our culture.”

Child abuse, neglect, abandonment and divorce are some of the many interrelated problems that affect families suffering from addiction.

“We hear the African saying ‘It takes a village to raise a child.’ Well it takes that same village to stop the parents,” he said.

Pictures drawn by kids in the programs at the Betty Ford Center illustrate the feelings of guilt, shame, hopelessness, anger and sadness that children in families with addiction experience.

One girl drew a picture of her dad passed out on a couch the entire time she was with him for the weekend while she sat alone on a chair crying. Another drew an image of his mom with a bottle on a bed while he was on the phone with his grandpa, asking for help.

Conflict, Moe said, is what hurts families the most, but children are also hurt by what doesn’t happen in the family place, especially when they know something is wrong.

“They may not be able to name it specifically. They may not be able to name addiction. But they know something is wrong because they love their parents more than anything else,” he said. “… Kids know a lot. We don’t give them enough credit for how much they know and some feel they’re going crazy because no one validates.”

But the situation is not hopeless as treatment and research organizations are shifting their focus to advocate and work for all children, not just those from addicted families, Ackerman said.

Another step is for people to become conscious of the effects on children. It is important, he said, for adults to admit that kids are affected by their behavior, whether they realize it or not.

For Moe, anyone that can get involved in the life of a child can help. Forming relationships and letting a child know someone safe is there for them can help tremendously, he said.

“What are their strengths? Build them. Skills? Give them some new ones. Supports? Be one,” he said. “Help kids find the beauty and goodness inside.”

In his arsenal of games and techniques at the Betty Ford Center, his most potent weapon is love.

“It’s our most basic human need that from the time we’re conceived to when we take our last breath. We need to love and be loved,” he said.
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source: http://www.indianagazette.com

Mixed progress for bupe

As city includes hard-core addicts, more drop out

Baltimore has doubled the number of people using the medication buprenorphine to shake off heroin addiction but has struggled to keep them in treatment.

As the Baltimore Buprenorphine Initiative has accepted more hard-core drug addicts dealing with complications such as mental illness, more drop out. At the start of the initiative in October 2006, officials had picked mostly highly motivated participants.

The retention rate dropped to 52 percent for the year that ended June 30 compared with 65 percent in fiscal year 2007. That is prompting city health officials to question which patients do best on buprenorphine, sold as Suboxone and widely known as "bupe."

"Who is the right candidate for bupe?" asked Dr. Joshua M. Sharfstein, Baltimore's health commissioner. "It's just really hard to tell." He said officials will examine that issue closely.

The initiative, which cost about $2 million last year, is "continuing to gain momentum," he said. "More clinics are participating. More patients are being treated. More doctors are interested in seeing patients."

The novel program introduces addicts to Suboxone in city-backed clinics that stabilize patients before transferring them into the care of private doctors who have become qualified to prescribe the drug.

The city has streamlined its process of securing health insurance for the mostly low-income participants and added clinics and doctors to expand access.

But the 771 patients who entered the program over the past year are taking longer than the first year's 388 patients to make the transfer because they still abuse drugs other than heroin, such as cocaine.

Some studies have shown that methadone is better for longtime heroin addicts while Suboxone is best for people who are newly addicted or who are hooked on pain pills like OxyContin. Sharfstein hopes that pairing public and private resources will render buprenorphine an effective new weapon to battle heroin addiction.

In 2006, more than 10,000 city residents were admitted to facilities for heroin addiction treatment. Each year more 200 die from overdoses of heroin and other narcotics.

Valarie Clark abused heroin for nearly 20 years. After enrolling in the city initiative nearly two years ago, she has experienced her longest stretch without using heroin.

But her struggles demonstrate the challenge of getting even the best patients - Clark was held up as model before the City Council last summer - to stick with treatment.

Last month, after a dispute in her recovery house, Clark moved out and stopped taking Suboxone, without consulting her doctor or therapist at Total Health Care, the city's largest participating clinic.

She fell into a depression that left her with a choice: heroin or bupe.

"I would have used," said Clark, 52.

But she chose the bupe, starting again with the pills left over from her earlier prescription. "The depression went away and I'm continuing my therapy," she said. "I'm back in the [recovery] house."

A recent report showed that fewer addicts stuck with Suboxone treatment after 90 days than in the first year. The city's goal was to retain 67 percent at least that long. In the period from October 2006 to June 2007, the initiative succeeded in keeping 65 percent that long. But that dropped to just over half in the 12 months ending June 30.

"The retention rate has fallen," Sharfstein said.

One major reason is that the initiative has broadened its reach to take in people who are new to treatment, who suffer from other psychological problems or addictions and who engage in high-risk activities like prostitution.

It also took longer for patients to get off all drugs so they could be transferred out of city-backed clinics into the care of private doctors. Many patients stop using heroin but continue to abuse cocaine, leaving them ineligible to transfer. The city had wanted to transfer patients to the medical system after 90 days. In the first year, it took an average of 155 days. For the year that ended June 30, it took 163 days.

In addition, the initiative's pace of training doctors has lagged. Sharfstein had wanted 100 doctors to receive the federal waiver required to prescribe the pills. So far, 82 have received the clearance after completing an eight-hour training course.

The initiative also made a special effort to recruit more psychiatrists to deal with patients suffering both addiction and other mental illnesses.

"I would characterize this as good progress," Sharfstein said in an e-mail. "While we have not had 100 new waivered doctors yet, I am confident we will get there."

Suboxone's expense remains an issue. Methadone for heroin addiction costs about $8,000 per person over two years, the city reported last year. Suboxone treatment costs nearly twice that and has gotten more expensive.

Wendy Merrick, who directs addiction care at Total Health Care in West Baltimore, said the price per bottle of 30 pills has increased from $107.15 to $111.70.

To help cut costs, the Baltimore Substance Abuse Systems Inc., which manages most of the budgets for nearly all of the participating addiction treatment centers in Baltimore, has started buying in bulk, said Marla Oros, a consultant with BSAS.

The city's first report on its initiative in July 2007 made little mention of efforts to prevent misuse and illegal sales of buprenorphine. In December, The Sun published a three-part series that showed that abuse of Suboxone was on the rise across the nation as its availability increased. The drug was rolled out in 2003 after the federal government allowed doctors to prescribe it from their offices, unlike methadone, which is dispensed from highly regulated clinics.

The latest report devotes an entire section to efforts that the city has taken to minimize misuse of the drug: counting pills, testing urine and monitoring patients when they first start taking the pills. But the report states that "there is no evidence of a significant public health threat from buprenorphine diversion in Baltimore at this time."

A survey of 30 Baltimore physicians conducted by a consultant with the drug's manufacturer, Reckitt Benckiser Pharmaceuticals Inc., found that 67 percent were "aware of buying and selling of Suboxone, a percentage higher than the national average," the report states.

Clark, who was profiled in the series and has returned to treatment at Total Health Care, said she has seen the street demand for Suboxone increase.

"I was just at Lexington Market getting lunch and, wow, it's amazing," said Clark, who first tried Suboxone on the street. "It's almost like people are asking for Suboxone more than other things. The bupes. They ask for bupes."
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doug.donovan@baltsun.com

Copyright © 2008, The Baltimore Sun

Prescribed Meds Still Best Treatment for Alcoholism

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.
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source: Canadian Broadcasting Corporation

Agency Wants to Help Doctors Identify Heavy Drinkers and Get Them Treatment Promptly

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.

Willenbring concurs.

"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.
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source: The Washington Post

Creation of drug-free jails too expensive, say consultants

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.
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source: The Guardian U.K

Who lives in a park? Who lives in a cage?

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.
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source: http://pavelwiredin.blogspot.com

DePaul Addiction Services facility in Rochester closing in mid-August

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."

JUWANG@DemocratandChronicle.com
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source: Rochester Democrat and Chronicle