JULY 29, 2007

ALCOHOL ADDICTION AND DEPENDENCE

Brian: Good Morning Atlanta, welcome to the breakthrough addiction recovery hour and today we are talking about combating alcoholism, my name is Brian Fujii and my co-host is Jill Mattingly

Jill: Hey Brian, every Sunday it has rained so I think it is to keep people inside to listen to the show what do you think? (laugh) I love the first part of our program because I can talk about what is in the news and I can talk about issues with alcohol and Lindsay Lohan is keeping me busy with her antics and this week she did get in trouble again and last week we talked about the ankle bracelet and evidently it didn’t work. The secure continuous remote alcohol monitor, many look at this as a promising tool in recovery, however Lindsay didn’t do it any good this week. Looks like she decided that she was going to do what she wanted even though they were monitoring her, and the consequences are coming her way.

Brian: A starlet or anyone else, they have to go through a series of events that indicate that they are struggling with alcohol use and that is the difference with using and abusing. Psychological and Sociological consequences,

Jill: I do want to say some good words about the monitoring system, it actually is filling in some blanks that have been out there keeping people from going back to bad behaviors and especially those from incarceration. Actually it can monitor every 30 minutes to an hour and it has to be in range of a modem to download information from the last 24 hours. It is actually in the old days it was blood alcohol levels and that is a snapshot of what is going on in the blood stream. Something interesting, A 190 lb. adult man takes less than an 5 hours to go from legal DUI limit of .08 blood alcohol level to .00 blood alcohol so if you have at least every three to four hours been tested you would be unable to detect drinking events and that is where the bracelet comes into play

Brian: I could see that being a true effect especially those using alcohol in the work place or in the home and no one there to keep an eye on them, so it is easy it seems to have a person use alcohol and not be detected and that goes back to health care professionals weather they be counselors or doctors do assessments to help them identify whether they have an issue or not

Jill: On the heels of Lohan is Nicole Ritchie, uh, she was just sentenced Friday to four days in jail and at her DUI hearing, so, it is not hard to find someone stumbling because of alcohol addiction problems and I noticed another article that you brought in about NASA

Brian: Again, not just the rich and famous, even the areas of some of our professionals and today we took a look at a report from the New York Times this week that NASA was also taking a look at some problems with astronauts actually being found under the influence of alcohol and the article says in one incident the astronaut was impaired before a planned shuttle lift off and after the crew member wanted to fly their training jet home from Florida to Houston while drunk.

Jill: Oh my gosh, is that how he got caught? They were suspicious?

Brian: Again it just tells us how difficult it is as we talk on this program and family and family members that is why it is so important for families and when we start talking today of how to get people into addiction treatment and the role that the family can play identifying the problem and helping them to make some good decisions. We are looking forward to what you are saying today Jill especially where it concerns anti-craving meds.

Jill: I wanted to start out by talking about something else that has just come over the news and that is about an anti-smoking drug called Chantix. It is uh designed for smoking cessation and it is new and not like the old fashioned nicotine gum or patch you know to replace the actual smoking or dipping of tobacco and it actually goes into the brain and blocks the nicotinic receptors in the brain which is they are finding out may help with craving for alcohol.

Brian: So that means it has the same receptor sides as the ones we use for alcohol

Jill: It is proven alcohol effects receptors in the brain and the neurotransmitters in the brain so they are really excited about this and it is so fascinating how they discover these types of things and some researcher decided to get rats drunk and that is exactly how they found this out(laugh) and you know the research starts with rats. Actually they provided the rats with intermittent access to 40 proof alcohol for four months and varied the access and so the rats craved the alcohol and every time the rats had access to the alcohol they upped their intake and drank all day so maybe it is like humans, I am not sure, but by withdrawing the alcohol they wanted to drink even more and so after months of this and a total of 37 binge drinking sessions by the rats, uh, they actually decided let’s give them the Chantix and see what happens and all of the rats cut their drinking in half when they were given the alcohol all of them cut their drinking amount in half

Brian: That is significant, we know that statistically a drink is equal to 14 grams of pure alcohol about 6/10 fluid ounces or 1.2 tbs. Per drink and so if you are listening and need a comparison, well, 12 oz. Of beer is equal to one normal drink. Table wine like some do it is a standard bottle is 25 oz. And a full bottle is five standard drinks. A lot of folks don’t understand that for women it is 3 to 4 drinks per day is considered heavy and for men 4 to 5. It is something to use as a measuring stick

Jill: One thing they were excited about was that it doesn’t cause any liver problems, it is not metabolized by the liver like other meds, and there are some anti craving meds that we will talk about that are metabolized by the liver and you have to watch the liver function when they are on it. Chantix allows the release of the dopamine in the pleasure center of the brain and you don’t reinforce the smoking of cigarettes or the dipping of tobacco and

Brian: When we take a look at this for some they think when they go to addiction treatment they should only quit one thing at a time but as people are willing, to work on stopping the smoking while they are working on stopping the drinking they have found that both together really helps them and they can actually stop using both the smoking and the drinking and as a result kill two birds with one stone.

Jill: Researches at the University of California along with NIALCOHOLIC ANONYMOUS they are planning on conducting clinicals in humans and the drugs effectiveness will be tried. This is already an FDA approved medication and that is exciting at this point.

Brian: The more we look at some of these medications we find out that I want to help our audience to know that these medications are there for people to use and not addictive and helps them to cut back their alcohol cravings and stay focus on their addiction treatment component.

Jill: We are going to take a break right now and we are here taking your calls at 770-226-0920 or out of the area, 1-888-920-2665, please stay with us.

Commercial Break

Welcome Back I am Brian Fujii here with my co host Jill Mattingly and we are discussing anti craving drugs to help in alcohol addiction treatment. We are going to continue today and Jill what are the current medications used now to help combat alcoholism.

Jill: Not every addiction treatment program will use the same protocol and the same medications but there are many to choose from and some coming down the pike that look very promising and some of the more main type of anti craving or behavioral change medications out there and the first one we spoke of last week with our medical director Dr. Richards was Antibuse. Developed in the 40s it was more of a behavioral modification and the adverse effects were enough to make someone not want to pick up or drink any alcohol and you have a lot of adverse reactions with Antibuse and the most famous one is I would say what it says here is copious vomiting and I apologize if you are eating breakfast but it gets quite a response when you drink alcohol and have taken alcohol and it actually interrupts the metabolism of the alcohol in your blood stream and that is what causes the nausea and vomiting. You have flushing and bad headaches some even report hyperventilation and chest pain that blurred vision sweating and so, I think the first time you experience those effects you say, ok, maybe the doctor was right. It is important that if this is used, after the patient has been abstinent for at least 12 hours they need a full run down on what exactly will happen if they do drink while taking this medication.

Brian: Do they have to be monitored closely?

Jill: Not necessarily they take it on their own and if they don’t want adverse effects then they just don’t take it,

Brian: Ok, you can’t monitor that

Jill: And, the other medication that was very promising was actually an older med that was used in the emergency rooms used to reverse the effects of opiate over doses like heroin or prescription meds and it actually was called Narcan and is used in the emergency room and it knocks the opiate off of the receptor in the brain when you administer it and keeps the person from dying of respiratory depression and very useful except the patient that you give it to is usually very angry when you interrupt the high from the opiate and then they are high one moment and then in complete withdrawal the next.

Brian: Like a psychological addiction not so much a physical craving

Jill: What they did was look at Narcan and developed a drug called Naltrexone and is also known as Revia and when you take it is taken twice a day and it actually blocks a particular opiate receptor in the brain and it has shown to interrupt the circuitry in the brain that causes the craving for alcohol and it actually is very easy to take and um, we use it in our program and see quite a bit of evidence that it does work and is not a magic pill and not the magic bullet in terms of stopping all craving and even shows that there are certain types of alcoholics that respond better to Naltrexone, you also do have a few side effects I think everything comes with a price, um, the side effects could be some nausea, some people claim of headaches but I have seen lethargy and some of these side effects go by the wayside after about two to three days. The begin to feel better

Brian  So many times when they are so miserable in withdrawal they want to know how long this will take and

Jill: Naltrexone is very easily taken only twice a day dose and people tend to stay on it sometimes more than 6 months at a time but like all of these medications when given it is very important that they have some type of counseling or therapy going along with it.

Brian: We spoke earlier, as a counselor working with patients I find that when they get through the phase of two or three days of misery and break through that and feel better they are saying I can understand things better, a result of the medication and is a compliment to the addiction treatment process and we are trying to help them understand the triggers and alcohol cravings and are actually healing and the process the brain goes through they feel very informed

Jill: Naltrexone is unfortunately you know like I said, not every medication works for every person and the metabolism issues and genetics come into play and they also have developed a newer medication called Campral and this I find a lot of people that come to our program have already been placed on it by their physician or health care provider Campral has another type of mechanism and is not very well understood but tries to normalize two neurotransmitters in your brain, gabba and glutimate and the interact cause they are opposites. Gabba is the breaks on the car, it slows things down and is a calming neurotransmitter, alcohol and xanax, and clonopin types of benzodiazapine increase gabba which is why you have a calming effect. The Glutamate is an excitatory it excites the nervous system and they conflict with each other, if one is up the other is down or inhibited and glutamate actually is the culprit in withdrawal that can cause seizures and it excites the nervous system so much that you can actually have a seizure

Brian: So when going through withdrawal that is the medical danger

Jill: Alcohol withdrawal and benzo withdrawal, xanax, clonopin are very dangerous and must be monitored by health professionals. What the Campral does is try to restore the balance between gabba and glutamate. There is a catch, Campral is difficult to take, you have to take two pills three times a day and some folks can’t remember and so it is very difficult to get them on track with the medication and that is some of the reasons why people have fallen off of taking this and being good about taking it and getting the full effect and that is difficult.

Brian: Compliance with any medication and three times a day is

Jill: We have found at Breakthrough that we can combine Naltrexone and Campral together in the early stages after a person has gone into recovery and found uh, that that has worked extremely well with keeping away from the alcohol and keeping the alcohol cravings at a very bare minimum if not completely.

Brian: I am looking forward to this last one, and it can really be able to help the clients to stay in compliance with their medication. We will be back in a few minutes, call us at 770-226-0920.

Commercial Break

Jill: About one year ago it came out, it is Vivitrol, now it is the injection form of Naltrexone which is one of our main anti-craving medications and is given in the south end of your body (laugh), one injection

Brian: Southeast or west

Jill: It doesn’t matter and works over the course of 28 to 30 days and so there is no need for compliance of taking a pill and this has really freed up a lot of people and kept them away from the craving that really starts to make them stumble after about 30 days to about three months.

Brian: I get questions about the medications and is this

Jill: the medications listed from chantix antibuse campral vivitrol are not addictive you just don’t want to throw grease on a burning fire, you want to make sure that the person is being drawn away from the behavior and by interrupting the circuitry in the brain and working with neurotransmitters and receptor cites you get much better results without causing more problems,

Brian: Also it is a chance for the brain to heal and we understand that alcoholism is a brain disease and it will reduce their craving and they can stop the alcohol and give the brain a chance to heal and we know through studies that the brain can heal in such a way between eight months to a year or so where the brain can restore some of it’s natural neurotransmitter balances. In this area about how to treat and how do we get people into addiction treatment

Jill: Very important part of the brain healing is the cognitive healing and these medications are not designed to be lifetime, they are designed to give a firm foundation when they are trying to get away from the behavior of drinking or any other type of drug addiction and so you were going to talk about how would you get a love3d one in addiction treatment

Brian: We talked about the last couple of weeks how physicians can help, how about the family members. So many times families are caught up in this and they just don’t know where to turn and are very confused and they are angry and a sense of frustration and they have tried for so long to get the person in and get them to look at their problems and they have faced issues of denial and this kind of helps us to understand that family roles can play a very vital component as far as people getting into addiction treatment. Some of the questions we need to look at are the family might be able to say let’s look at the whole problem, how does it impact communication and our social commitments and this is what happens so many times families children and spouses can be getting ready for a big event

And the addict drinks too heavily and the family has to make excuses and that is so hard and it puts a real burden and strain on the family and it begins moving them into a sense of actually making excuses for that loved one and of course that produces a lot of anxiety and frustration.

Jill: It is such an emotionally charged situation when you have the family members um, having the struggle

Brian: We will be back in the next few minutes to talk about helping families to get that loved one into addiction treatment. Stay with us we will be right back.

Commercial Break

Jill: Welcome back, we are talking about gtetting loved ones into addiction treatment and what happens in the midst of a family struggle with an alcoholic, um you know sometimes besides hagving screaming matches or slamming doors or people peeling out of the driveway it must be easier to walk on eggshells and you know ignore the elephant in the middle of the room

Brian: Individuals don’t want to be engaged and as a result of their involvement they have been turned off or yelled at and we have a call this morning.

Sarah: Good morning. Um, my sister is 49 years old, um, she has been an alcoholic for at least 20 years and um, I am just I am really confused as to the relapse situation um, she got clean went to addiction treatment and uh no sooner was she out she began to hit some hard times in her life and it was worse than ever.

Brian: That is usually the case when they go into addiction treatment and one thing we try to do is help the individual to cope. There is no promise that life will go smooth and one thing a recovering alcoholic learns is how to cope with life stressors without the use of alcohol.

Sarah: When we; try to tell her to get help she gets very angry and says it is not a problem and she knows what to do and we know that she doesn’t and she starts hiding it and becoming um, you know beligerant with her language and we are just trying to figure out the best way to help her seek addiction treatment

Brian: When she is angry and yelling do you listen or do you just state clearly, “That kind of behavior won’t be tolerated.”

Sarah: Normally we are afraid

Brian: What fear

Sarah: That she will do something worse and uh, she has had a tendency to do cocaine along with her alcohol

Brian: That is a very common thing because so many times they say the cocaine will sober them or help them feel smoother, sometimes they get a better rush, to help them feel calm. Again, the family member I think the key thing that we talk about with intervention is that the family and it is difficult they have to keep their cool and not get engaged with the same kinds of tense behavior that is exhibited by the alcoholic.

Jill: Sarah, finding a way when she is calm and listening uh, you know I know that this is a very difficult situation that you are in and you know you must feel like we were saying minutes ago like you were walking on eggshells

Sarah: Actually she is in the other room, she has had bouts with illness and things and uh, she um, had been clean and did well and then went out Friday night and had wine and her husband won’t speak to her and she is frustrated and I am afraid because she is frustrated she will give up

Jill: This is a good time when you are frustrated with consequences, sometimes they will listen to you ask them to make a phone call and talking with someone who is a professional,

Sarah: I think she would do that, I think that um, this was a good thing for me to do even though she is in the next room, she has no clue that I am talking about her

Jill: This is a very difficult journey for your family but when you have a consequence in a person’s life it is a good in road

Sarah: She does feel bad about Friday

Brian: That is typical too, and that is the guilt that they feel and the shame,

Sarah: Right, we don’t want her to feel hopeless

Brian: That is the idea, in fact the guilt which is basically feeling bad about what they did is that is a great teaching moment and in feeling bad you can look at how to change it. That can be a focus, don’t go back go forward

Sarah: Can we go on your website for information

Jill: Yes, sounds like you need to get back to her so she won’t be suspicious, so go ahead and we will continue talking about this and you continue to tune in and thank you very much for your call

Brian: And Sarah take care of yourself

Sarah: Thank you so much

Jill: That is pretty much the story that runs through most alcoholic families

Brian: Again, what we heard Sarah say is how do I assess the real problem, a person comes out of addiction treatment and there is no magic bullet and as we have people go into recovery we understand that the first zero to fifteen days, of course we didn’t know how long she was in addiction treatment and that is the withdrawal phase and from fifteen to forty five days it is the honeymoon phase and everything is fantastic and then the pink cloud. Hopefully as Sarah listens on is that they realize there are various phases so we will find out that she can call us and we can help what day or week she is on for addiction treatment and we can help her identify where she is at. So the next one before our break is recognizing the extent or severity of the problem. So, if she is taking it could be lapsing and relapsing so she took that one drink and she just feels bad about it and goes back and gets back into recovery and says I need additional help and that would be a great experience

Jill: I like that, relapse is not failure it is part of healing, we are coming to the break, our number is 7707-226-0920 or 1-888-920-2665.

Commercial Break

Brian: Welcome back, we were talking before the break about the withdrawal phase and

Jill: We call it post acute withdrawal medically, we look for certain types of behavior problems.

Brian: When they are in that time they are feeling emotionally charged, irritable, lethargy and they don’t feel that perhaps, or paranoia you know everyone is after me and usually between that fifteenth to the forty fifth is the honeymoon phase. Everything seems fantastic, so when Sarah called I wasn’t sure how long her loved one was in addiction treatment and it is a phase and one key thing in addiction treatment is to help them to understand that the recovery process does take time. Like you said there is no magic bullet and as you take a look at some of the ways family can help them is that they need to first take a look at the family dynamics and one of the things we hear is what does it mean to be co-dependent. That means when family members attempt to assume guilt because they feel they are the ones causing you to drink or they feel they keep blaming themselves or making excuses on behalf of that loved one and therefore it becomes a family type of illness where they are getting just as much of the emotional drain as the person who is doing the drinking and one thing we see is that if the family member is constantly cleaning up after them or taking care of them and no allowing them to deal with it themselves then

Jill: That reminds me of the wife calling in for the husband when they have had too much to drink the night before and saying he is sick, that is very common

Brian: They do it because they care and love them, but their protection is not helping, if they continue to do that the alcoholic or addict does not explerience the consequences of that and that is hard for family member to do.

Jill: What about the opposite what about loved ones that are very confrontational with the drinking family member that are angry with

Brian; There are different ways to do intervention but there is confrontational at a high level, and they confront heavily and certainly that has worked many times also there is the motivational approach, even though they did have a brief intervention with a physician if a person is truly motivated and they get them into addiction treatment they realize they are having a problem and sometimes if they have gone too far, a family intervention done by an interventionist would be important and the

Jill: The caller would do an intervention with her sister by approaching her in this hour of experiencing consequences for her drinking that would be a brief intervention,

Brian: Right and at the same time not rescuing her, if she is late for work and she refuses to call for her or there may be a lot of anxiety

Jill: Or problems in a relationship and not blaming someone else

Brian: I think it is important for us to know that we are facing a challenges in the family

We are at the break time again,

Jill: We need another week to talk about this getting a loved one in addiction treatment and we have learned so much today from medicine to intervention techniques,

Brian: We will get specifics next week. We are closing our show today and we hope that you will visit us at www.breakthroughaddictionrecovery.com or call our office 866-497-6237. Hope you will join us next week.