JULY 22, 2007

ALCOHOL ADDICTION AND DEPENDENCE WITH

DR. KIM RICHARDS

Brian: Welcome Atlanta to the Breakthrough Addiction Addiction recovery Hour. I am Brian Fujii and my co-host is Jill Mattingly. We are going to continue our discussion on alcoholism and addiction treatment. I know Jill you have something to share from the AJC

Jill: Good Morning Brian, yes, I found that in the news you don’t have to look real hard to find something about alcohol and addiction and the AJC had a story this past week about alcohol addiction in the workplace and how it is reducing the work output of employees and um, and it says right here that nearly one in twelve of Americas full time workers that is more than 10 million having drug or alcohol addiction problems serious enough to require addiction treatment. That is pretty telling of our society and talks further about different types of work that usually you will find employees that struggle, the y list construction workers, food service workers and other similar jobs, but further down if you read, corporate 7.9 % of CEO’s say they are alcohol dependent.

Brian: A significant number since they are over our major corporations

Jll: Alcohol is seen as something that greases the wheel of business so how can an employer deal with a situation like this in the workplace

Brian: I know that many companies have an employee assistance program and basically what that involves is they have an individual or they contract with outside agencies to uh, provide counseling services for their employees who are struggling with alcohol or other drugs,

Jill: It seems that it is difficult out there right now and I can’t imagine having a viable work place and having a few of your employees showing up late to work or calling in sick after you know a late night (laugh)

Brian: That’s right and typically you will see this when certain patterns begin to develop and you know. Accidents in the workplace and many drug free work place environments will require especially if you are operating machinery they will require an immediate screen to make sure that drugs or alcohol were not involved.

Jill: I can’t imagine not having some type of mandatory drug testing in a job setting, that is just dangerous. Isn’t there a financial toll that is taken on uh, our economy from alcohol addiction in the workplace?

Brian: Recent studies show that loss of future earnings due to premature death accounts for almost 36 billion dollars of the economy and lost earnings due to illness related to alcoholism.

Jill: Going from that story it seems like it is a very intense problem and if you would like to discuss anything about alcohol or alcoholism you sure can call us here at 770-226-0920 or if you are out of the area 1-888-920-2665 and we would be happy to answer your questions and help you with issues relating to what we are discussing. If you do have a question and don’t want to be heard on the air or give your name you can call and give a question to our engineer and he will pass it on to us and we will get to it after the break. Um, another news item Brian, I couldn’t wait to talk about this..

Brian: Another celebrity in the news?

Jill: Lindsay Lohan has been bringing us a lot of news in the alcoholism and she went into rehab and was released, however as terms of her probation she had to have some time of new ankle bracelet that she can wear that monitors her alcohol levels in her bloodstream, so how does that happen?

Brian: Diamond studded?

Jill: Some type of bling. It weighs about 8 ounces and it looks like the pagers from the 1980’s and uh the device actually measures the alcohol content from measuring the thin layer of sweat on your skin the thin layer that no one can see so it has to fit snug on the ankle in order to do this.

Brian: Is this tremendous risk for people that want to do something like put paper under it to absorb sweat? It is my understanding that this bracelet can detect

Jill: A laser bounces off of the surface of the skin and the distance has to stay constant and if the distances change like they are taking it off or putting something on the skin, an alarm goes off and the way that this works is very interesting and she has freedom to roam but the information gets downloaded from the bracelet

Brian: Technology has advanced to help people maintain addiction treatment compliance,

Jill: Couldn’t that just be people thinking I’ll take the bracelet, I don’t need addiction treatment

Brian: The denial process is thinking the bracelet that tracks their use of alcohol and they think they have no problem? That is denial and you know we also know that denying alcohol addiction is certainly a big component in preventing people from getting into addiction treatment and goes back to some of our screening and assessment issues and looking forward to hearing what Dr. Richards says when she calls in today. Reminding our audience, things like brief interventions are great ways in which the medical community can talk to their clients, sit there with them in their offices and look at test results and help them to understand especially if liver enzymes are up and noticing that they have a fatty liver as result of a palpitated exam they can actually feel the liver enlarging and this can be some very clear and effective ways that a physician can help a person to realize that their drinking is becoming a major problem.

Jill: There is a lag time of on set of alcohol addiction and dependency and the seeking of addiction treatment and that really does go a long way in stating that there is a lot of people walking around and going into the doctor’s office and professionals can be the gatekeeper if you will

Brian: So many times we know that the office is busy but most of the time it can be as short as 15 minutes or maybe over several visits where they can provide that information to that patient. The beauty of radio is being able to share about addiction treatment programs and maybe various physicians are not aware of the options out there for addiction treatment so referrals can be made to the addiction treatment facilities and of course the facility will keep ongoing contact and make sure that the information is gotten.

Commercial Break

Jill: Welcome Back to Breakthrough Addiciton Addiction recovery Hour, I am Jill Mattingly my co-host Brian Fujii,l we are discussing alcohol and alcoholism the number to call is 770-226-0920, and looks like we do have a caller on the line and her name is Paula in Atlanta,

Hi, Paula,

Paula: I had blood work done recently and when the doctor called and asked me if I drank a lot because the liver enzymes were high and I don’t drink at all. Then I went to another doctor and he was pushing around on my stomach, I feel your liver, I heard you say something about fatty liver, what causes high liver enzymes besides drinking

Jill: A lot of medications broken down and excreted because of the liver actions can actually increase liver enzymes, Tylenol can be a culprit if you are taking over the amount of Tylenol on the bottle

Paula: I have been taking a lot of pain meds that have Tylenol like percoset, I just had surgery so I was taking percoset plus over the counter Tylenol.

Jill : I would recommend you talk to your doctor and just you know ease off on the Tylenol and use the Advil, alcohol is broken down by action of the liver and it can definitely stress the liver out and sometimes you know that doctor was correct to ask you about your drinking

Paula: He asked and I thought never! But I couldn’t believe it.

Jill: Anyway make sure to look at your medications such as ones for cholesterol

Paula: I take that too

Jill: Your doctor is on the right path, you let him figure this out for you

Paula: Ok, well thank you.

Brian: Good Morning Yolanda

Yolanda: Hi, how are you guys doing?

Brian: You sound chipper

Yolanda: I have a question, I have a family member who has been drinking I would suspect probably about I would say maybe about 10 to 12 years and I think that he is drinking probably about a gallon of vodka and he can go through a gallon probably in two to three days and he is always got a stash ok? Family has talked about it and we have all come up with the conclusion that he needs help and he doesn’t know that we know or we have discussed him at length, but I just am really worried about him and his health and his high blood pressure, so how as a family can we get him in addiction treatment. How can we say to him that we want him to do this. He doesn’t think there is a problem

Brian: Has he been willing to see his doctor. Sounds like if he has been drinking that much do you know if it has impacted any internal organs? Has any of those type of things that might be indicative of physical results of addiction.

Yolanda: seen his primary and they recommended a stricter diet because he has developed high blood pressure, any other problems we don’t know about

Jill: Yolanda I was going say, have you sat down with him and had a conversation with yourself and maybe another family member and how has he responded

Yolanda: of are uncomfortable brining it up to him cause he thinks everything is fine. When he comes home from work, he goes to the internet and he is drinking drinking drinking how do we say this to him and say, look you need some help

Brian: Here at Breakthrough we offer a free family consultation for family members what might be the best start is to actually sit down with your own family physician at our offices and let us talk with you and your family members and maybe the one who has suffered from the alcohol issue may or may not come in however, if you come in and we talk with you, you can get to see the strategies and we could develop something that is very specific for your need and uh another way is that if he is willing to see his physician we have a brief intervention that a doctor can sit down with him and go over his lab reports and help him to understand that he is having some physical problems and then address the issue and maybe set up a referral where he can get into addiction treatment

Yolanda: That is an idea not thought of, definitely a good option for us to take with him because we are so concerned, I know at this point he does not think it is a problem. He thinks he can drink til tomorrow and be fine. He needs more help than just stopping, some people can but I have never heard of anyone completely stopping without some kind of intervention and I will explore this

Jill: And Yolanda, this is such as difficult situation for families to be in and that it is where you know that he is teetering and you know that he might be able to change his mind and go into addiction treatment and it is very difficult to be in this position. He might have an old fashioned look at addiction treatment thinking they will lock the doors behind him with no freedom and no ability to say what he would like to happen. Encourage him and let him know that he can sit down and talk about options and he can do out patient setting which means he is responsible for coming himself and talking to the counselors and there is also medications to help with the alcohol cravings for alcohol.

Brian: That could be another thing to share Yolanda if he is willing to do that, interventions can be basically talking or having a doctor talking is an intervention or coming in and having a consultation is very non threatening and gets them to at least consider addiction treatment

Yolanda: What is this medication?

Jill: We have the medication for craving which is called Naltrexone, there is one called Campral and another form called Vivitrol, you should stay with us so that our medical director Kim Richards can share more in depth on these meds and how they are used. You could even get your loved one to tune in for the second half and he might hear something that could change your mind about wanting to seek addiction treatment and we just really support you in trying to reach out to your family member. This is a very important position you are in and get your research done so you can tell him what is available for him.

Paula, Ok, well thank you so much.

Brian: Give us a call at the office 678-534-1715 and we will discuss this

Commercial Break

Brian: Welcome back and call us to be on the air at 770-226-0920 or 1-888-920-2665, uh this morning we will have our medical director Dr. Kim Richards, she will discuss the medical components relating to our addiction treatment at Breakthrough and she will be helping us to understand how we use medications to help clients overcome alcohol addiction as well as some of our opiate addictions. We are very happy to have her

Kim: Good Morning, how is everybody,

Brian: Great, glad to have you

Jill: How are you this rainy Sunday,

Kim: Doing well, doing well,

Jill: Dr. Richards is Board Certified and 8 years in addiction medicine and she just really flushes out our program for us when we question what to do medically and she is a good guide. I want to start having you talk about your background in substance addiction and what attracted you to dealing with addiction

Kim: Well, I initially it was not something I had planned to get into. It was something that I had seen around not only in family members but also in practice when I first got out of residency I worked at a public health clinic in Atlanta, so I had seen hints of it then, after I decided to leave the clinic I had an opportunity to actually do physical exams at a place now that is no longer here, called Fulton County Alcohol and Alcohol detox Center, so I started out doing physicals on patients who were coming into the program and just needed a medical clearance. So, that was my first experience um medically with the alcohol and substance addiction addiction treatment.

Jill: So you saw a lot of patients coming through with alcohol problems

Kim: Absolutely, doing that it was quite obvious in retrospect probably seen a lot of the same types of patients when I was working in the public health clinic and intuitively knew something was wrong but couldn’t figure out exactly what it was so in retrospect I could see the benefit in having this experience under my belt and in addition to internal medicine, because it makes me feel as though I am addiction treatment the whole patient as opposed as treating certain components. You have other problems like substance addiction and alcohol problems.

Jill: As you do those physicals and history what were the red flags that would scream that the patient was dealing with addiction of alcohol?

Kim: Some of red flags were elevate red enzymes and the next time I consulted with them I would tell them and I don’t see that you are on any medications that cause it you know did something go on or, oh well, you know doc, I was at a big party and so you know I had too much to drink but I don’t do it on a regular basis, so usually and a lot of times what you will do is take people at their word initially and go ahead and draw them but even after you tell the patient what we will do is re-draw you in two or three weeks to make sure that there are no other medical problems. If you tell people that then a lot of times what they will do is since they know that you are going to draw them and it is alcohol related they won’t drink a few days ahead of time so that the liver enzymes go down and the addiction goes undetected.

Jill: We are at the end of the segment and I want you to talk more about the assessments, I am going to give out our number real quick for questions or comments and it is 770-226-0920 or 1-888-920-2665 the assessment that we were talking about last week the cage assessment have you used that?

Kim: Absolutely, I am also working in private practice in the city and have diagnosed several patients who really were drinking and didn’t hadn’t really told anyone and so have used the cage to bring everything to light with them, so that is a great tool.

Jill: So, just to briefly go back over the cage, a lot of folks are listening in, that is the need to cut down, are you annoyed when someone says stop drinking, have you felt guilt or do you drink for an eye opener. Pretty simple but stay with us we are coming back after this station break.

Commercial Break

Brian: We are back and if you have questions related to addiction treatment and we will be talking later on about the medication that can be used to help our clients to decrease their alcohol cravings for alcohol and other drugs. So, without further adieu, Jill do you have another question?

Jill: Hey Dr. Richards, okay, you know we were talking about the cage method, we briefly went over it before the break, but once that person is in the exam room and you know there is a problem with alcohol and you try to address that with the patient how do you choose what to do with them, in my background I will tell them where the nearest ALCOHOLICS ANONYMOUS meeting is. When they have lab results that show they need something more intensive like addiction treatment in a facility how do you decide what to tell them.

Kim: There is, well, you have to actually look at the total person in terms of that is a fact type of question, you have to look at the home environment if it would be a supportive one to do an ambulatory alcohol detox, you have to look at them medically to see if medically they could stand to do an ambulatory alcohol detox and you have to look at them psychologically to see whether or not they can actually do an ambulatory alcohol detox.

Jill: Meaning out patient alcohol detox,

Kim: Out patient without hospitalization and constant monitoring you know three or four times a day even though in out patient you can also do that but you are not in the hospital setting where you have round the clock eyes watching you.

Jill: That probably looks good to patients that, well our last caller for instance wanting to get a loved one in addiction treatment. They are not going to lock the door behind you. There are so many factors to go and see if they are appropriate for ambulatory.

Kim: Oh yes, absolutely

Brian: I know that when I do some assessments with some of those coming in who are just trying to take a look at addiction treatment options, many times studies have indicated that if a person is like you said medically stable and psychiatrically stable and at the same time needing alcohol detox from alcohol, an ambulatory program is just as effective

Kim: Absolutely, in addition what I have found is that family members that don’t know a lot about alcoholism and dependence can get a first hand look in terms of size so that is another real good tool for them to help keep the patient on track so I think it works both ways and then in addition the patient feels more comfortable

Jill: Right

Kim: In an outpatient setting as opposed to going to the hospital or the lock down unit because a lot of patients have that whole “One flew over the cuckoo’s nest,” thinking.

Jill: Nurse Ratchett

Kim: (laugh)

Jill: With the medical protocol you have written we can handle anything that comes down the pike with symptoms of withdrawal or risk

Kim: If there is a history of untreated seizures or psychiatric problems or something else then or liver failure or cirrhosis then they are best treated in patient. But as long as it is medically ok and psychologically they are ok, any symptoms we have lots of medications that we can use to help patients through any of these withdrawal symptoms. The good thing is that we don’t have just one, if the first one does not work, we have some alternatives.

Jill: You know these are not medications that the patient stays on,

Kim: No, this is temporary simply to get you through the few days of acute withdrawal is what we call is which is when you will have the bulk of your symptoms and your body is actually getting rid of the alcohol.

Brian: We know that so many times Dr. Richards that when people get ready to come in they are just trying to avoid the discomfort of withdrawal and some of the medications we will discuss later will be of interest to our audience.

Kim: Absolutely,

Brian: I know it is scary for them because they are dependent on their drug of choice and they need to avoid discomfort

Kim: Think about this, one of the reasons they are in substance addiction is because they want to feel better so, having them get off is going to be a strain to begin with and then having them get off and not be painful it is counterintuitive to the reason why they have been using them to begin with.

Brian: That is so true, and we take a look at how people do use like we just said that is why they are called mood altering drugs because they avoid the feelings they are going through at the time.

Jill: Well it looks like we are coming down to the end of the segment so let’s use the next segment to talk briefly about the medications we use after alcohol detoxification. So let’s see here we can take a break and you can still call in and ask questions at 770-226-0920, outside the area, 1-888-920-2665, stay with us and we will be right back.

Commercial Break

Jill: Welcome back, we have a special guest today, Dr. Kim Richards, she is our Medical Director and has spent 8 years specializing in addiction medicine and is talking about the medications used in alcohol detoxification, we left talking about the medications of alcohol detox and you know using medications for the symptoms of withdrawal but one thing since we are close to the end of the hour, I want to get the audience the information on anti-craving medications, about changing behavior, the behavior of going for the alcohol.

Kim: First is Antibuse, it has been around since the 1940s or so, but one of the problems with Antibuse is that it once you start a patient on it if they take any alcohol whatsoever it makes them violently ill, so and the feel bad from anywhere from 24 to 48 hours so a lot of times what happens is patients who may want to take something or even you know depending on how sensitive you are to it, you know even if you have cough medicine, older cough medicine in the 40s and 50s was made with alcohol and they couldn’t take that either and they would end up throwing up because of the Antibuse.

Jill: That is behavior modification at it’s best

Kim: Exactly

Jill: In the 90s FDA approved Naltrexone, is that a warmed over version of

Kim: A medication we used to use in the ER named Narcan. So, used Narcan a lot simply for people who came in with drug overdoses and one thing that we knew was that if we gave them the Narcan it worked in receptors or places in your brain to actually stop the effects of drugs in giving you the high at those times a lot of times patients come in with overdoses or potential overdoses and we wanted to bring them back

Jill: Usually heroin or an opiate

Kim: Right, such that they would um bring them back and they would not die from a overdose.

Jill: So they found out that Naltrexone when they made it it was able to basically block the alcohol cravings

Kim: It works in the same areas in the brain as the opiates which is part of the pleasure center, so like I was saying before when you are taking these medications you do it because it makes you feel good

Brian: One of the things from the clinical especially when they have that opiate blocker it gives them the ability to think more clearly and I know that even in clinical practice it gives them the ability to concentrate and stay focused on counseling or day addiction treatment and I know that this is a real plus and when it comes to out patient component they can really stay focused.

Jill: Naltrexone, right? They didn’t stop there. There are two more medications that have come into vogue and I want to mention those.

Kim: Vivitrol and Campral

Jill: Vivitrol is injected

Kim: The injectable version of Naltrexone, Who likes to take pills on a daily basis? If you are already taking medication adding another is not what you want to do, so taking an injection once a month is a wonderful thing and so it is like just get it and forget it phenomenon.

Brian: It helps with compliance

Kim: Right but you have to remember to return for your injection once a month.

Jill: Dr. Richards we want to spend more time talking about the medications and we are running out of time so we are definitely going to start on this next week and we would love for you to join us if you can

Kim: I will definitely try

Jill: We are grateful to have you on the air today and we also are going to be talking a bit about alcoholism addiction treatment next week right Brian?

Brian: Yes, options for addiction treatment to help overcome alcohol or alcohol issues, that completes our show for today and we hope that this has been helpful to you, please visit our website, www.breakthroughaddictionaddiction recovery.com or call us at our office in Tucker for your free consultation at 678-534-1715 and we will be happy to sit down with you and help you find answers.