BREAKTHROUGH ADDICTION RECOVERY HOUR

JULY 29, 2007

ALCOHOL ABUSE 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 abuse 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 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 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 NIAA 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 cravings and stay focus on their 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 treatment. We are going to continue today and Jill what are the current medications used now to help combat alcoholism.

Jill: Not every 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 treatment process and we are trying to help them understand the triggers and 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 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: Welcome back, we are discussing alcohol and alcoholism and we would love to take your comments or questions, our number is 770-226-0920 and outside the area you may be listening by streaming internet, 1-888-920-2665, and this is kind of a topic that you may not want to go on the air and ask a question, but if you would like to call and give the engineer your question we will answer and discuss it over the air. Also, we have a website, it is www.breakthroughaddictionrecovery.com it is a long address but it is worth it and there is a lot of good information and all of these medications are given much more detail on our website and also you can call our treatment facility at 770-734-8091, you can talk to a human voice and we also are following up on talking about the anti-craving medications Brian, you gave a teaser before the end of the segment.

Brian: We we now have something to help our patients and not worry about it for at least a month,

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 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 abuse and so you were going to talk about how would you get a love3d one in 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 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 treatment. Stay with us we will be right back.

Commercial Break

Jill: Welcome back, we are talking about gtetting loved ones into 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 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 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 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 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 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 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 treatment and it is a phase and one key thing in 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 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 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.

BREAKTHROUGH ADDICTION RECOVERY HOUR

AUGUST 5, 2007

Brian: Good Morning and welcome to the Breakthrough Addiction Recovery Hour, my name is Brian Fujii here with my co-host Jill Mattingly, Jill what is in the news for us today?

Jill: There is never a loss for stories on addiction and substance abuse issues out there. The first story I wanted to bring up was something from last week where it was talking about liquor replacing beer as the drink of choice among teens, very interesting study, researchers were finding that four in ten teens in five states or four states, Arkansas, New Mexico, Nebraska and Wyoming where the study was done, are choosing hard liquor rather than beer. Isn’t that interesting? Everyone thinks of teen drinking is beer, but according to this study they are turning to bourbon, rum schotch and whiskey. They are starting to think possibly it is easier to conceal mixing it in you know uh, red bull or coke or something like that and also um, it helps them to get drunk a lot faster and that is what they are going for especially with binge drinking being on the rise. You know parties on campuses it brings me to the next story which is out of New Jersey, um this uh, co-ed was 18 years old from Long Beach, California and part of a fraternity and uh must have gone to a nice fraternity party and we probably have the vision of what that would look like and proceeded to drink at that party and unfortunately succumbed to alcohol poisoning and it says that when they did the blood alcohol it was .46. And that is five times the legal limit for driving and so you know obviously people need to remember that this is a poison and not something that is like a fruit drink going overboard on grape juice and this is something that can actually kill you and it did talk about the fact that he drank about a half a bottle of vodka in a short amount of time that plays back to the story that teens are using alcohol to get drunk faster and they don’t realize the danger.

Brian: When they drink they want the effect and in college they want to be accepted and that is a key area for focus today to get people into treatment. It is interesting in this story that the Dean of Students

Jill: The Dean of Students was the one that was charged and that is interesting, a turn around in terms of trying to stop hazing and uh, you know binge drinking at parties on campus is to charge the people in charge of the young people. So,

Brian: Another issue of accountability.

Jill: The story that came out last week and I don’t want any jokes Brian, but it is about females being at greater risk of alcohol related brain damage. We have been talking at our program all along in our teaching about the damage that is caused by heavy drinking and long term abuse and dependency and now the studies are coming out and backing this up with brain technology now, they said they were doing animal studies and found females more vulnerable to neuro-toxicity. If something is toxic it is going to destroy something and this neuro-toxic means it is destroying brain cells, neurons and so they are finding out that women are much more uh, at risk and usually it is in the withdrawal stage if someone is going through a withdrawal drinking lots of alcohol that is when the damage occurs and it is occurring in women at a much higher rate than men. If we can look at some things that

Brian: Things that might be hopeful at the same time though if they stop drinking and maintain sobriety we can find that over 8 to 12 months later and they maintain that sobriety then they can truly begin having brain healing.

Jill: Yes, that has shown up on PET scans and studies. When you abstain from drinking you can regain the connections that were damaged by the alcohol abuse and dependency. It kind of floods over the story of females suffering brain damage at a higher rate, well this poor woman’s picture was plastered over the internet and a news story coming out of Florida um this woman had the misfortune and uh as being arrested for the second DUI in three months so she had had one three months earlier and obviously she did not make the connection on drinking and driving as being bad and so maybe there was some brain damage going on, so the irony of the story is that she had her mug shot plastered all over with her in a t-shirt reading and you can look this up, her t-shirt read, “I am not an alcoholic, I am a drunk.. Alcoholics go to meetings.” So that is how she will be remembered you know Florida (laugh) history. Anyway, the story we end the section with is quite ironic. Um watch what you wear if you are going to be out and about drinking and driving which we do not recommend be careful what kind of t-shirt you wear cause you will get caught.

Brian: This morning we look forward to trying to find ways that individuals especially with stinking thinking is a way to get people into treatment and one of those ways is what is their willingness and many times we find out that those that are suffering from alcohol is that they are truly in denial as this young lady here, um has a real question weather or not she really needs help. So as we take a look today, one of the key things is how do we motivate people to get into treatment and last week we looked at the comments of the stages of change and I know that when we looked at motivational interviewing there are various stages and one of the first phases is absolute denial like the lady in this article. Obviously she is drunk and um, will be arrested and still probably saying I don’t have a problem and that is what we call pre-contemplative. For our audience please call at 770-226-0920 or 1-888-920-2665 and we can answer some of your questions today as we discuss this.

Jill: Her first DUI three months ago should have been a wake up call for her to realize there is a problem. If it was her first the family had an opportunity to intervene also.

Brian: As an individual begins experiencing some of the consequences of their behavior, then they might begin thinking what they said, maybe I have a problem and this is where it moves into the area of abuse. Dealing with abuse when we start having problems with social context or the law and with our employment. All of these begin to trigger us to say maybe I have a problem and that begins the person to move toward the contemplative phase where they think about it and hopefully after this lady goes through this event she is thinking that she needs help. This is a great way that family members can begin looking at ways to get their loved ones into treatment. We are at our segment’s end so if you would like to call us please do and if you have situations at home or work or you are needing to talk about difficulty with individuals in your work place call us at 770-226-0920.

Commercial Break

Jill: Welcome back to the Breakthrough Addiction Recovery Hour, this is Jill Mattingly and my co-host Brian Fujii, we are discussing alcohol and alcoholism and we will be giving our number throughout the program and you can call right now, flip open that cell and call 770-222-0920 or 1-888-920-2665. And we also know the nature of what we are talking about can be confidential and difficult to talk about and if you don’t want your name said on the air and you don’t want to be heard and so if you want to call and give a question to our engineer he will pass it on to us and we will answer for you. That is another way we can take questions and hopefully you will feel comfortable doing so. We can be reached at www.breakthroughaddictionrecovery.com that is our website and you can go get a lot of information on that website about our facility and about addiction all across the board and we have a lot of information and you can spend a lot of time on that website right Brian?

Brian: We have recently updated it and it looks wonderful

Jill: We had a big week this week

Brian: Sure did, we moved into our new facility in Norcross, Georgia, 8000 Miller Court East, Norcross, GA 30071 and we would certainly like you to come visit us or give us a call and our new number is 770-734-8091and we would love to be able to hear from you and if you have questions during the week or someone you are concerned about and want to find ways to get them into treatment we would certainly like to help. Free consultations

Jill: We have a lot more elbow room in this new location and it is really a wonderful experience being able to grow. We are adding more people and more services we are just real excited about what we can do in the Atlanta area.

Brian: Our facility can accommodate and more group rooms and new education center and especially for our programs that we will talk more about such as family education and the importance of family members understanding the addiction process and their understanding helps to better support the addicted loved ones.

Jill: The stages of change that you were talking about before the break, the last one was preparation, that is not just packing a bag is it. What is that

Brian: When you finally begin to realize that you or they have a problem they may come to someone asking for help and where can I go what can I do and the family realizes that the problem is out of hand and they have to get some help and they need to prepare for those questions when someone asks where can I go? All of the various stressors can produce interest in the family to seek help and preparation means that they are looking as to where they can go to get help. They go on line, they maybe are talking with pastors, or neighbors, trying to find ways to get help so the family now is actually doing an active search to try to find special programs that meet the family needs in such a way that is by location or treatment program. There are many types of programs there are out patient also inpatient too. I know that when we talk about detox we do an ambulatory detox.

Jill: In patient detox is a needed uh, type of hospitalization for someone who may have a lot of other physical problems or polysubstance abuse or very difficult to treat, however ambulatory detox is one of the really great tools especially that families can use but when a loved one can detox from home or in a comfortable surrounding and have medical care,

Brian: That personal attention that you can get from the family and the staff being there and providing one on one which you may not be able to get in a larger unit where you have a lot of other people surrounding you.

Jill: You are talking about having a more individual attention going through treatment

Brian: Yes, once the person gets medically stabilized and now that they are on anti-craving medication like Naltrexone or if an opiate addict they may be dealing with Suboxone and then they feel better and then thinking more clearly.

Jill: Definitely have seen that!

Brian: Then they can really begin benefiting from the next phase which is the treatment phase and that can take on a wide variety of things and the most intense is the inpatient setting where you will be there 24/7 and a lot of times is a secure environment and no freedom to move in and out

Jill: Not a lock down, but there are some like that

Brian: There are others that are the intensive out patient which allows an individual to come and go to the facility but they may have it like ours, we will have at least a minimum of 9 hours a week where they can come in for psychoeducation and group therapy and individual therapy and be involved in family education. This is very intense and for us it is about 24 sessions.

Jill: That brings up an interesting situation does treatment look the same all across the board. I know there is quite a handful here in Atlanta, and that isn’t even counting the smaller treatment facilities that don’t have the big names do they all do the same type of thing? In patient, Intensive Out Patient, same materials

Brian: No, I don’t think so. We utilize a non 12 step model and some use the 12 step model. Others spend a lot more time doing individual therapy and what we find out is that as they are assessed we see and try to find what is the best level of care for that person and when we determine that then we develop a unique program that supports that need and until we do a clear assessment on the individual and understand the needs and requirements then we are able to provide the unique program for the recovery.

Jill: And there may be people in the audience thinking about m,aybe for themselves looking into treatment programs and maybe loved ones out there thinking about that person who has the alcoholism and they are kind of afraid to bring the treatment word up to them but they may be wondering what is out there and what would you recommend?

Brian: They can go to our website, or call this number 770-226-0920 and ask us right now, absolutely we will be able to share and just give us an idea where they think they are and where their loved one needs the help and once they come in we have this free consultation and that is a powerful benefit when they come in with the loved one that is suffering and talk with them and break through the resistance. They don’t want to get into treatment and as you begin to talk and begin to build that relationship it is really amazing how they begin to really look at things, maybe treatment is an option.

Jill: The free consultation is the key, definitely, we are going to take a break and we will be right back. 770-226-0920 or 1-888-920-2665.

Commercial Break

Jill: Welcome back and if this is where you are you don’t know what is waiting at home. How can I bring up the subject and what do I do, you may feel like screaming and crying or leaving the elephant in the room.

Brian: They see the individual destroying their own lives before their very lives and they feel so helpless and sometimes they think that by yelling or screaming or making them try to feel guilty is the best way but studies have shown that through motivating the individual and trying to provide empathy but also we will talk more about this in a few minutes of how a family member can block a person from treatment because they are too accommodating.

Jill: Define empathy, because sometimes you think sympathy and that is devastating for someone with this problem.

Brian: Sympathy is feeling sorry for them but empathy is saying I feel with you, and some will say you don’t know what I am going through

Jill: Putting yourself in their shoes, would you respond to someone yelling at you if you were struggling with something

Brian: That sure would not motivate me

Jill: (laugh) it is such an emotionally charged situation and that is the only thing you can think of doing sometimes.

Brian: You go back and forth because when you go into that kind of dialogue one person is getting the information and there is a lot of problem identification instead of problem resolution and that is what we talk about in our treatment because we can identify problems but what are we willing to do about it. How do you get people into treatment and one of the best ways we have found out is that we need to have a sense of empathy so if you are feeling with that person then obviously you will not be screaming at yourself you will find ways to support their willingness. Do we need confrontation? Yes. We find out that so many times when individuals get into very strong confrontation they are also dealing with their own emotional struggle.

Jill: Oh, interesting

Brian: So, it they begin to identify that they are struggling also and that is what we are talking about this area of codependency and there has to be a strong amount of acceptance, a difference between caring about the person and being very angry and out of control with their behavior, so a part of this is to help them to know that you care and support them but not the behavior. Cognitive behavior therapy is helping them change the way they think so they can change the way they behave,

Jill: I thought about how you would treat a child, you know you want to be very loving and caring and accepting however you don’t want to support a bad behavior and that’s one of the hallmarks of bringing up a well healed child.

Brian: You love the child but hate the behavior you never stop loving them but we are not talking about their addiction in some cases what you read here this morning as to what is going on on campuses they are someone child and so there is unacceptable behavior and there is anger but they are angry at the behavior and the consequences of the behavior and you find a way to separate that so that if there is empathy and acceptance it begins to build confidence in the addicted person to say, that maybe I can benefit from help.

Jill: So believing that they can change

Brian: Right, people can change. If we didn’t think they could treatment would not be an option but they can make a change and make a difference in their own lives. When they realize that they themselves become their own healing agents and take responsibility for their own feelings that becomes a powerful tool for them and it is the same thing in dealing with the family member who is trying to get the person in and I want to continue more about this area because of co-dependency, families become their own worst enemy.

Jill: It is not necessarily the person with the problem it is the person that is caring for the alcoholic that keeps treatment from working.

Brian: Let’s focus on this issue and ask some questions and see if someone will look at their own life. Give us a call at 770-226-0920 and we will be right back.

Commercial Break

Jill: Welcome back my name is Jill Mattingly and my co-host Brian Fujii, please if you have any questions or comments about alcohol or alcoholism please call at 770-226-0920 or 1-888-920-2665 and you can call outside of the area. We also have a website that you can get lots of information on addiction, www.breakthroughaddictionrecovery.com and that is easy to remember. Brian, we are opening a can of worms, we are going away from just the alcoholic now and we are really talking about the web of denial and web of illness and talking about the family and the people closest to the alcoholic and not necessarily family but good friends

Brian: We talked earlier that the alcoholic impacts a minimum of 4 to 6 people in their life, that can be husband or wife or children or boss or relatives, anyone of those it is amazing at how this web begins to build.

Jill: That obviously calls for some type of intervention with the families also and I know a program you do that is Family Education and tell us about that in those sessions.

Brian: The Family Education is the cornerstone for treatment because in a family usually there is no one person that takes center stage but yet in the individual that is addicted everyone is focused on that person’s behavior should I bringh a friend home? Well I don’t know if I should can I will Dad be sober, now the constellation begins to change and everyone in the family begins to try to ask questions and make adjustments dependent on how that key person’s behavior is at that time,

Jill: Sober or under the influence. Sometimes when they aren’t the family wishes they were. Because the you know activities are a little less stressful I guess, and then there is

Brian: There is a lot of dysfunction it is also the passivity and that can be just as difficult as aggressivness and you want responses and they don’t do anything. The non interaction is also just as much a disparity with the family and so in Family Education we try to help the individual family members to understand first of all how an individual moves from just using the alcohol to abusing the alcohol and finally becoming dependent on the alcohol. It is really amazing when the family begins to understand and also how the brain that pleasure pathway is being impacted by the use of the alcohol. That they come to understand that that is the reason why they can’t stop drinking.

Jill: Is this the reason why this is not the person I married.

Brian: Right because as we do our study, someone moves from stage to stage in addiction process all of the normal things school work family friends, the more they drink the more the other external situations these relationships are going down the drain. If you could get into the brain of the alcoholic you would find that less and less important items such as family and friends, work and so forth was being replaced through this focus on alcohol.

Jill: That is a difficult situation for the children that are involved in these families and the spouses. When you do the education are the children involved or private sessions with the whole family.

Brian: They will bring grown children where they can understand and we have had some teens and some adult brothers and sisters, that is the first thing, they really never understood why they could not stop drinking now I know. Also, there is hope and there are some very specific phases of recovery and that is very helpful for the family and gives them hope and anticipation and they know how their behaviors are changing

Jill: It also doesn’t give them ammunition to attack the family member with the problem cause they want to point the finger and say you are the problem.

Brian: It is interesting I have not seen that as much as people saying wow I can be a part of the recovery process and that is very encouraging to the one who is recovering.

Jill: How do you deal with family members that start to cover up for the one with the problem and say well he wasn’t that bad, etc.,.

Brian: That is a good point because that is co-dependency and the definition is a co dependent person has let another person’s behavior effect them and is obsessed with controlling that person’s behavior.

Jill: Their whole focus is on the other person and controlling their behavior and they find they can’t do it and then the frustration and anger, we see situations like this in our programs and having the family member want to be involved in treatment but actually being detrimental to the progress and

Brian: That is where healing needs to come because addiction is a family illness. That is so hard for many to hear because they aren’t the addict but as we take a look at the web that interfacing of family members they do begin realizing that they have to break free of that.

Jill: That is why we are Breakthrough, let’s go ahead and go through some questionnaires and identify if someone is having a problem with co-dependency.

Commercial Break

Brian: Welcome back and to our audience we would like you to reflect upon some of these that we are talking about today. Let’s take a look at one of the questions. Do you put others wants and needs before your own?

Jill: Every mother in Atlanta is saying yes,

Brian: To the extreme however where they don’t feel that they have ownership for their own wants and desires and one of the key things about codependency is that an individual that has an issue of codependency is very reactionary person and they rarely make active choices and they are usually in reaction to another’s behavior and they basically are revolving all of their thoughts and behaviors and their activities around that one individual so take for example in some ways most care givers have an issue with codependency whether they are a doctor or a nurse of social worker. We hear the statement that they are working the treatment more than they are. If you are putting so much energy into someone else’s treatment and they just listen then they aren’t working and somehow that is very easy for doctors nurses, etc., to get very hooked into that so that even we can be very not immune right.

Jill: Right

Brian: Do you ignore your own values to maintain a relationship that goes right to the heart of what we were saying we don’t want that person to get mad at us and we don’t want to feel embarrassed because that behavior and as a result we struggle and the person is saying how can I be my own [person and that is one of the real issues that we teach.

Jill: Not just values that is a nebulous word, but your taste, the things you even like to hang on the wall, changing your places like the church you go to, the friends you hang with all to keep this relationship together for fear of rejection, that is how I see someone that is really spiraling into deep codependency. What is your favorite flavor of ice cream? If they don’t know that is difficult.

Brian: Another is do you feel overly responsible or assume responsibility for someone else’s feelings or behaviors. Now in the addictive family the individual is determining how the family structure is to be developed who comes to the house, what functions they go to or don’t go to, how are they going to handle the emotional outbursts that may occur and then are they going to remain victims or are they going to choose to not allow that behavior to impact

Jill: When they become center stage because they are the alcoholic the codependent is giving excuses for them being center stage.

Brian: That is right and that is another way that individuals prevent them getting help. They are just as much in denial of the problem as well as the individual who is addicted. You find out that co-dependency is reactionary but like I said rarely to that take proactive steps. These behaviors are destructive and keep people from finding peace and happiness. So many times they find their only sense of peace and happiness is making someone else happy

Jill: I know that, because that is a clear cut way to put it and the other thing is

Brian: They are miserable as a result

Jill: Criticism and shame are some of the characteristics of not necessarily who you are but they do come out when you are in the throws of codependent behavior.

Brian: That diminishes the identity and the sense of self esteem it is a real challenge and that is the reason why family education is so vital to helping for true recovery and holistic recovery for the family as well as the individual that is addicted.

Jill: That questionnaire and it has hit home with me and so I know our audience knows it too. You can continue to call the station or go to our website, www.breakthroughaddictionrecovery.com and get a free consultation it’s always worth it to get the information and to talk to someone.

Brian: That is our show for today, hope it has been helpful.

BREAKTHROUGH ADDICTION RECOVERY HOUR

JULY 22, 2007

ALCOHOL ABUSE AND DEPENDENCE WITH

DR. KIM RICHARDS

Brian: Welcome Atlanta to the Breakthrough Addiction Recovery Hour. I am Brian Fujii and my co-host is Jill Mattingly. We are going to continue our discussion on alcoholism and 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 abuse and the AJC had a story this past week about alcohol abuse 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 abuse problems serious enough to require 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 abuse 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 treatment compliance,

Jill: Couldn’t that just be people thinking I’ll take the bracelet, I don’t need 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 abuse is certainly a big component in preventing people from getting into 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 abuse and dependency and the seeking of 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 treatment programs and maybe various physicians are not aware of the options out there for treatment so referrals can be made to the treatment facilities and of course the facility will keep ongoing contact and make sure that the information is gotten.

Jill: Working between the medical and clinical is really important and at our program we are constantly discussing back and forth patients and their progress, medically and clinically, I want to give out our number and see if anyone out there wants to call with questions or comments. 770-226-0920 if you are listening outside Atlanta, 1-888-920-2665 uh, we also have a website that may fill in some of the questions or fill in the information that you might have questions about, that is www.breakthroughaddictionrecovery.com it is worth it the information is valuable. We are coming to the first break Brian

Brian: Yes we are, success depends on the willingness of the individual who is drinking to seek treatment, we will be talking about this when we return.

Commercial Break

Jill: Welcome Back to Breakthrough Addiciton 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 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 abuse.

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 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 treatment and it is very difficult to be in this position. He might have an old fashioned look at 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 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 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 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 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 abuse 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 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 abuse 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 treatment the whole patient as opposed as treating certain components. You have other problems like substance abuse 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 abuse 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 abuse 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 treatment and we will be talking later on about the medication that can be used to help our clients to decrease their 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 AA meeting is. When they have lab results that show they need something more intensive like 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 detox, you have to look at them medically to see if medically they could stand to do an ambulatory detox and you have to look at them psychologically to see whether or not they can actually do an ambulatory detox.

Jill: Meaning out patient 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 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 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 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 abuse 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 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 detoxification, we left talking about the medications of 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 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 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 treatment next week right Brian?

Brian: Yes, options for 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.breakthroughaddictionrecovery.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.

BREAKTHROUGH ADDICTION RECOVERY HOUR

July 15, 2007

Alcohol Abuse and Alcohol Dependence

Brian: Good Morning Atlanta, welcome to the Breakthrough Addiction Recovery Hour, last week we were talking about the disease of alcoholism taking our country by storm, and today, my name is Brian Fujii, good morning to my co-host Jill Mattingly, good morning Jill!

Jill: Today your name is Brian Fujii, that is good to know (laugh) Another rainy Sunday in Atlanta, a good day to turn your radio on and tune in to AM920.

Brian: We have been talking about alcoholism and getting help for our loved ones. Most families recognize the alcohol problem with their loved one and we can help them take a look and see if they really have a problem. Screening issues, we will look at those.

Jill: There was a terrible event this week here, a young man driving the wrong way on the highway, and the part that caught my attention was the interview of the witnesses. This young man, as he was described, this man got on the wrong way at Interstate 20 and people were honking at him and he was watching a dvd in his car while driving going the wrong way and then a head on collision, took someone’s life and once again, the destruction

Brian: Again, people really understand the impact that alcohol. You know I was noticing that we had about 100,000 alcohol related deaths this year, whether it is physical or accidents, this is a major problem in our country and people don’t realize that there is help out there.

Jill: We talked last week about the differences between use, abuse and dependency, moving into each stage there is not a red flag to tell you where you are moving. And we went over the details about that but today as we talk about you know people getting into treatment I was reading on the National Institute of Health news website where they were talking about the difference between the age of onset of abuse and dependency and the age where they seek treatment and it was amazing. The average age of onset of dependency which we should go over one more time, is 22 years old and the average age of seeking treatment for dependency is 29, that is eight years.

Brian: That is a good point, we see this in treatment when you see dependence and what we see is denial and until there are major life issues that come up but inspite of some of the consequences people won’t stop.

Jill: I know that it does effect a lot of lives in a negative way and this is a call in show, so please call us with questions or comments, if you are listening outside of Atlanta, 1-888-920-2665, if you have had alcoholism touch your life in some way we want to hear from you, you could not only get help for yourself but for someone else. , if you have had alcoholism touch your life in some way we want to hear from you, you could not only get help for yourself but for someone else. You know Brian when you were talking about abuse and dependence and those characteristics, were you saying that the problems with legal issues or work, was that just dependence.

Brian: No in fact that is when you see the abuse. Let’s review uh, the three different levels. People use alcohol and use it responsibility and have no problem and yet we know that people can move into the area of abuse and some of the qualifications are using in hazardous situations, driving under the influence, getting in trouble at work, and we also find getting into interpersonal or social issues where people are saying hey, you don’t act the same, what is wrong. We see this among family members too. These are indications that people are experiencing difficulty with their alcohol drinking.

Jill: Well going back to the lag time between agbuse and dependency and then the time that it takes before a person seeks treatment, now I think in the article it said that seeking treatment could be broadly defined, either from physician or by just attending a 12 step program crisis center, maybe even employee assistance program.

Brian: Employee assistance programs can be very helpful as they identify issues by drinking, supervisors can be a tremendous asset. Looking at work performance we try to help people, understand there is help. They can help through various counseling sessions but if that continues to be a problem they can make referrals to other sources.

Jill: We are giving out the number again, 770-226-0920 and 1-888-920-2665. Call us with comments or questions. I am going to state also that that lag time study did talk about abuse being a longer lag time between the age of onset and the age of getting treatment as being 10 years. So, Brian, you know, I am a health professional and I know that that person saw a doctor or some type of health professional in that 10 years

Brian: I am sure they have, but so many times the difference between abuse and dependence, once they reach that level it becomes worse and they realize the negative impact that their drinking is having and they may seek out treatment a bit sooner because the pressure is on.

Jill: coming into a doctor’s office is usually the last thing they want to talk about is their alcohol use and some of the problems it causes.

Brian: In fact studies show that only 1/3 of healthcare practitioners actually ask questions about alcohol and alcoholism. What a great place to get that information and yet some don’t

Jill: I am on the other side of that because I know that when we are told by managed care how many patients we can see in one hour we have maybe five or ten minutes so the high blood pressure and diabetes is more important to handle than whether or not they are drinking two or four glasses of wine a night.

Brian: I believe it is really something to look at, all of us in the healthcare profession and I agree time is a major issue, and that is great about Breakthrough we can use the screening tool and expedite the process. The “cage” have you used it?

Jill: Of course, it is a great screening tool, tell the audience where that information has come from that you are holding there. That is very important for people to know that there are free materials out there.

Brian: The National Institute on Alcohol Abuse and Alcoholism. It is done through the US Department of Health and Human Services, www.NIAAA.NIH.gov and there is a tremendous amount of information that can be received in all areas to get information out to lay people as well as professionals.

Jill: There is quite a bit of information in that brochure. You mentioned “cage” the acronym something in your pocket for a health professional, we are out of time for this segment and we will be back after the break to take your calls. 770-226-0920.

Commercial Break

Brian: We are back and my name is Brian Fujii and my co-host is Jill Mattingly, at Breakthrough Addiction Recovery, a drug treatment program in Tucker, Georgia. And we were back on the topic of talking about the screening tool called the “cage” to give you information for quick screening for health care practitioners as well as counselors,

Jill: Even if you are not in medicine, to know that there is a tool out there. If you are in the doctor’s office with your husband and they see an enlarged liver and don’t ask questions, you need a screening tool for the liver to see if alcohol is effecting their physical health. It is so good for lay people to arm themselves with knowledge.

Brian: These are very bask and easy questions, it becomes less invasive and seen by observation, for example the letter C, it says have you ever felt that you need to cut down on your drinking? I am sure many who struggle have said, tomorrow I am going to quit and somehow the tomorrow never comes and they feel the frustration as to why they can not quit. We spoke earlier that people don’t understand that alcoholism is a disease of the brain and not something that means weak willpower.

Jill: I think people believe that when they come in, ok I like the A. Have people been annoyed or annoyed you by criticizing your drinking. Very interesting (laugh) you tell someone to cut down and they respond by being annoyed with you, hmmm that is a sign something is going on.

Brian: I think the defensive mechanisms do come about when someone is confronted or asked, that is something too that we don’t want to be so confrontational so that they become alienated. But we do understand that as they use it will become problematic and they will have problems with communications or problems with other areas and that is annoying

Jill: What is the G

Brian: Have you ever felt guilty about drinking.

Jill: The big G

Brian: That is one of the key factors in addiction and we feel the sense of guilt and shame and then again guilt is feeling bad about what we have done as far as our behavior and people see that and usually what I find with people I work with is that when they are drinking and feel no control, they feel their lives are unmanageable and feel a lot of guilt about that. And they feel embarrassed and that is also what motivates them to get through the denial and get the help, ok, that brings us to

Jill: Brings us to E, have you ever had to drink early in the morning to get rid of the hangover and we call this the E for the eyeopener. This tells me as a health care practitioner that this falls on the side of dependency and if you are waking up with tremors and feeling anxiety maybe even sweats, uh you just feel like you can’t be yourself and then you take a few swigs of vodka or you know looking for a reason to go out and have a bloody mary in the morning there probably could be something going on with dependency and it is having to drink to feel normal.

Brian: That is the key right there Jill, a lot of times people use drugs to feel an extra Zing or an extra High, but typically for alcoholics the drink is to just feel normal or ok. Of course one of the key factors too is that people who drink in order to avoid the pain of withdrawal is a big one too, so if they have been drinking the night before and they are really into having that cellular addiction they are drinking to avoid the uncomfortable feeling of not having the alcohol.

Jill: That is interesting for someone to be in this place and walking into a doctor’s office and asked these questions, I am sure the shame just goes into overdrive when they have to start talking about his and yet when the professional starts to get the conversation going there is a sense of relief from the patience that finally you know I have a private safe place to talk about this and a lot of times that could be the place where someone starts to get the help.

Brian: Confidentiality and feeling safe, if we have anyone out there that may want to know something about an issue that they are struggling with and don’t want anyone to know please feel free to call us at our number 770-226-0920 and just let the engineer know that you don’t want to talk on the air. You just want to ask the question and he will write it down and we can answer on the air. We want to encourage you if you are struggling and not wanting to get on the air but want the information please call us again the number is 770-226-0920 we would be delighted to answer.

Jill: We also have a website full of information about all types of addictions and it is at www.breakthroughaddictionrecovery.com that is a lot of typing but it is worth it to get the information.

Brian: I would like to move toward after the physician has been able to identify the issues and say that this person may have some problems with abuse or with dependency, then what is the next move and I think one of the most effective methods that we have seen and studied nationally is the thing called the “Brief Intervention” this is a phenomenal approach where they begin taking the factual data and perhaps if you are sitting or they are sitting in your office and you are sharing their bloodwork results and the reports that indicate liver problems, or maybe they are actually having problems with addiction because of the fact of the lab reports

Jill: Objective data carries a whole lot of weight. If I get lab work back and it shows clear signs of alcohol taking it’s toll, the actual laying on of hands to feel possibly an enlarged liver to look in the throat and see things happening or erosions uh, there are many different things that if a practitioner really does all of the things that are needed in a screening or health history and physical there can be powerful information

Brian: You can feel the enlarging of the liver

Jill: Yes, and the patient can’t deny this and of course they can deny it is because of the drinking and you can encourage them to start seeking treatment. Years ago doing internal medicine, I would say that they only thing I could tell them is to go to AA meetings and there is a world of treatment options out there and I think that being well versed on that is very important by the practitioner.

Brian: We are coming up to our next break. The number is 770-226-0920 or out of the Atlanta area, 1-888-920-2665. We will be right back after this break. Stay with us.

Commercial Break

Jill: We are back my name is Jill Mattingly with Brian Fujii, we are discussing alcohol and alcoholism, we are covering a lot of information call us, 770-226-0920 and outside of the area, 1-888-920-2665 even down in Macon. We also because of the nature of what we are discussing and the confidentiality that many people like to stay with, you can call the station and our engineer will take down the questions and we will answer for you on the air. Don’t be shy, call in if you can. We have been talking about healthcare professionals and the importance that they have in being kind of a gatekeeper in getting people into treatment and also pointing out the problem with use, abuse or dependency. There is a lag time between the onset of abuse and dependency and the actual time where this person may seek treatment. So, the average onset is usually around 22 and they don’t seek treatment for at least l8 to 10 years after that. What is going on Brian?

Brian: Well, this thing about 22 is that it is young, college, looking at various activities on campus which usually involve alcohol and a rite of passage and you know one of the key things we talked about last week is some of the genetic related issues and also familiar issues, if a family history a grandmother, aunts or uncles with alcoholism then you have a greater propensity to fall into that same trap or realm and also too when you start taking a look at family environments like dinner time or evening hours where alcohol is used with great prevalence. You need to find ways to either avoid those or to just change the behavior that takes place. So for example if you are drinking wine at every dinner and some do it responsibly then you realize that you can’t and now you have to address the issue.

Jill: The college years, a lot of people graduate college around 21 or 22 and yah there was probably a lot of partying in college but if you continue the behaviors to such a level that may be something going on that you are still partying like you have class in the morning and not a 9 to 5 job.

Brian: Those behaviors carry on into the workplace. Usually things are not changing until there becomes the actual negative implications. So, you know going back to the way to get people into treatment or going back to your work in the medical area, uh, we find out that not only time but this brief intervention and using the cage can take fifteen minutes or one or two visits so it really benefits a healthcare practitioner to do the screening and there is physical problems that occur as a result of alcohol. Jill tell us how it effects the liver, the brain or cancer.

Jill: All of the above, one thing that happens if there is severe dependency usually the result is death. Death occurs a lot earlier than it should have if there is continued abuse so it is important for health care providers who want to prolong life that they do the screening and one of the things we look for or course is liver disease, and liver disease takes on a few different types of looks. The first look could be that you have something on your labs that makes it seem like maybe the liver is not doing so well,

Brian: Why is the liver so important?

Jill: We can’t live without a liver and for the detoxification of our body, um without it you either pass away or you get a new one, so um, but liver disease actually up to a point is reversible and uh, if it is caught at the right time and defending agents are taken away the person can actually do much better and return to normal liver function which is very important to tell people.

Brian: Actually from abstinence you can heal the liver?

Jill: Absolutely, and once you pass a certain place though, you will go into a disease that most have heard of called cirrhosis of the liver which is when the liver is barely functioning and ready to shut down and have one to two years left before needing a transplant or making their final plans. Of course cancers are very much involved with uh, end stages of alcohol abuse and dependency and those cancers can be all over the body.

Brian: I think before you have said that the liver is not working well can produce something like a problem of bile backing up into the

Jill: We might not want to get too technical and gross, ok, so let’s take a break and let the audience get over that comment. Call us at 770-226-0920. We are waiting for your call.

Commercial Break

Brian: Welcome back this morning we are talking about alcohol and alcoholism and getting treatment. We were discussing how alcohol impacts the body and for instance cancer.

Jill: I didn’t want to interrupt brunch this morning with some of the toll the physical toll that alcohol takes when you are dependent. Cancer is a very real threat when someone is dependent on alcohol not only the liver but you can have problems with the esophagus and throat cancers along with immunity problems and one of the topics people forget about is pregnancy issues, a pregnant woman drinking and we have a lot of people getting pregnant later in life in their 30’s and 40’s and dependency has already set in, fetal alcohol syndrome is devastating to the family and the child. Also, brain damage, people don’t realize that neuron damage is very real with alcohol dependency, there can be dementia and sometimes it is tied to the liver failure not just out and out brain damage. So, we can have an alcoholic dementia and some out there may be dealing with that in their family. Since I am bringing up the physical if you would like to call and ask questions about this or comment or privately ask the engineer to write it down for us, you can call at 770-226-0920, or outside Atlanta, 1-888-920-2665.

In terms of drinking heart disease can be there. A stroke sudden death from alcohol use, and think about the caloric intake and increasing blood pressure and no nutrition. At our program I spend a lot of time with my patients talking to them about changes in their nutrition and they are coming to us where alcohol has been their main food group and it does take some teaching of what needs to be added back into their diet.

Brian: That point brings us back to this piece of how to get people to recognize the need for treatment and one of the other ways besides the brief intervention is if they are willing to be linked up with a therapist and then the physician following up and making sure the treatment is effective and the second would be motivational interviewing developed by William Miller a therapist and some of his colleagues. This approach is um, new and it is fundamentally empathetic and um,. Spiritual approach to human suffering and it is a non-confrontational approach. We help to educate and give skills and training for our clients to help them understand that treatment works.

Jill: An example of motivational interview is encouragement