United States Changes Its Mind on Addiction - It's Not a Chronic Brain Disease After All

Psychology Today.com
Addiction in Society Blog
by Stanton Peele
November 20 2009

NIAAA says NIDA is mistaken about addiction as brain disease

Nora Volkow and the National Institute on Drug Abuse (NIDA) insist, based on peering at MRIs, that addiction is a chronic brain disease. You know - you saw it on HBO, and your kids learn this in school.

But, as I point out to Nora, she's looking in the wrong place. If you examine actual human lives, addiction is an interaction between people and their worlds that changes with time.

Now the NIDA's sister organization - the NIAAA or National Institute on Alcohol Abuse and Alcoholism - agrees with me. According to Dr. Mark Willenbring, director of treatment and recovery research at NIAAA, "We're on the cusp of some major advances in how we conceptualize alcoholism." The NIAAA's summary of the situation is titled, "Alcoholism isn't what it used to be."

This discovery, which I have described for decades , is based on the most sophisticated study yet conducted of Americans' drinking histories. Called NESARC (National Epidemiologic Survey on Alcohol and Related Conditions), the study questioned a random national sample of over 43,000 Americans about their lifetime and current drinking.

Of this group, almost 4,500 had been alcohol dependent (read alcoholic) at one point in their lives. And, although 75% had never been treated or gone to Alcoholics Anonymous - and only half of the remainder (13%) received specific alcoholism treatment - three-quarters had ceased their alcoholism. Yet most had not stopped drinking!

About 30% of Americans had experienced some kind of alcohol disorder, including abuse along with dependence, but about 70% of those quit drinking or cut back to safe consumption patterns without treatment after four years or less.

Only a tiny minority (1%) fit the stereotypical image of someone with severe, recurring alcohol addiction that Alcoholics Anonymous, addiction disease proponents like Volkow, and American mythology consider typical. My Life Process Program addresses this 1% of the addicted and is exclusively abstinence based.

Then there are the other 29% of Americans who abuse alcohol at some time. According to Willenbring, "It can be a chronic, relapsing disease. But it isn't usually that."

We know that nonabstinent remission from alcoholism is real in NESARC. In a three-year follow-up of respondents, Dawson and her colleagues found that alcohol dependence causes significant decreases in mental health and coping, but social functioning and mental health underwent "significant increases among those who achieved full and partial remission from dependence" (including alcoholics who continued drinking with either no, or reduced, problems).

The increases in social functioning and mental health "were equally great for abstinent and nonabstinent remission from dependence, butimprovements in bodily pain and general health were associated with nonabstinent remission only"(that means the alcoholics who reduced their drinking).

What's stunning in these results is not any particular finding about controlled drinkers' health outcomes. The remarkable portrait NESARC produces is about how commonplace alcohol use disorders are, how frequently they are overcome by people on their own - including even those scored alcohol dependent - and how often people improve their drinking problems while continuing to drink. THIS is an entirely different alcoholism paradigm from the one we have been oversold.

As Olivia Judson describes the impact of "On the Origin of Species": "Origin changed everything. Before the “Origin,” the diversity of life could only be catalogued and described; afterwards, it could be explained and understood. Before the “Origin,” species were generally seen as fixed entities, the special creations of a deity; afterwards, they became connected together on a great family tree that stretches back, across billions of years, to the dawn of life. Perhaps most importantly, the “Origin” changed our view of ourselves. It made us as much a part of nature as hummingbirds and bumblebees. . ."

NESARC also changes everything.

P.S. (November 27): I have just learned that, although the LA Times article quoting Dr. Willenbring appeared November 16, by that date he was no longer an NIAAA employee . Make of that what you will.

http://www.psychologytoday.com/blog/addiction-in-society/200911/united-states-changes-its-mind-addiction-its-not-chronic-brain-dis-0

The Needle Nexus

By TINA ROSENBERG
Published: November 17, 2009
NY Times

Of all the mysteries posed by AIDS, perhaps the deepest and most damaging is a human one: why have we failed so utterly to stop its transmission? Most people with H.I.V. in the world, including a vast majority of the 22 million who are infected in sub-Saharan Africa, caught it from a sexual partner. Despite billions of dollars spent to slow this form of transmission, only a few countries have had significant success — among them Thailand, Uganda and Zimbabwe — and their achievements have been unreplicable, poorly understood and short-lived. We know that abstinence, sexual fidelity and consistent condom use all prevent the spread of H.I.V. But we do not yet know how to persuade people to act accordingly.

Then there is another way that H.I.V. infects: by injection with a hypodermic needle previously used by an infected person. Outside Africa, a huge part of the AIDS epidemic involves people who were infected this way. In Russia, 83 percent of infections in which the origin is known come from needle sharing. In Ukraine, the figure is 64 percent; Kazakhstan, 74 percent; Malaysia, 72 percent; Vietnam, 52 percent; China, 44 percent. Shared needles are also the primary transmission route for H.I.V. in parts of Asia. In the United States, needle-sharing directly accounts for more than 25 percent of AIDS cases.

Drug injectors don’t pass infection only among themselves. Through their sex partners, H.I.V. is spread into the general population. In many countries, the H.I.V. epidemic began among drug injectors. In Russia in 2000, for example, needle-sharing was directly responsible for more than 95 percent of all cases of H.I.V. infection. So virtually all those with H.I.V. in Russia can trace their infection to a shared needle not many generations back. Though it has been scorned as special treatment for a despised population, AIDS prevention for drug users is in fact crucial to preventing a wider epidemic.

Unlike with sexual transmission, there is a proven solution here: needle-exchange programs, which provide drug injectors with clean needles, usually in return for their used ones. Needle exchange is the cornerstone of an approach known as harm reduction: making drug use less deadly. Clean needles are both tool and lure, a way to introduce drug users to counseling, H.I.V. tests, AIDS treatment and rehabilitation, including access to opioid-substitution therapies like methadone.

Needle exchange is AIDS prevention that works. While no one wants to have to put on a condom, every drug user prefers injecting with a clean needle. In 2003, an academic review of 99 cities around the world found that cities with needle exchange saw their H.I.V. rates among injecting drug users drop 19 percent a year; cities without needle exchange had an 8 percent increase per year. Contrary to popular fears, needle exchange has not led to more drug use or higher crime rates. Studies have also found that drug addicts participating in needle exchanges are more likely to enter rehabilitation programs. Using needle exchange as part of a comprehensive attack on H.I.V. is endorsed by virtually every relevant United Nations and United States-government agency.

All over the world, however, solid evidence in support of needle exchange is trumped by its risky politics. Harm reduction is thought by politicians to muddy the message that drug use is bad; to have authorities handing out needles puts an official stamp of approval on dangerous behavior. Consider the United States. In 1988, Congress passed a ban on the use of federal money for needle exchange; President Clinton said he supported needle exchange but never lifted the ban, and it remains in effect. It not only applies to programs inside the United States but also prohibits the U.S. Agency for International Developmentfrom financing needle-exchange programs in its AIDS prevention work anywhere in the world. The administration of George W. Bush made the policy more aggressive, pressuring United Nations agencies to retract their support for needle exchange and excise statements about its efficacy from their literature. (Today, U.N. agencies again recommend that needle exchange be part of H.I.V.-prevention services for drug users.) Despite Barack Obama’s campaign pledge to overturn the ban, his first budget retained it. The House of Representatives recently passed a bill that would lift the ban — but it includes a provision that would make using federal money for needle exchange virtually impossible in cities, where it is needed most.

There are some parts of the world — Western Europe, Australia, New Zealand — that do widely use harm-reduction strategies, including needle exchange. And programs have begun even in Iran, of all places, which offers needle exchange and methadone; its program of giving prisoners methadone is now the world’s largest. China is now taking AIDS seriously, beginning to institute government-sponsored harm reduction nationwide. But the overwhelming majority of drug injectors around the world still have no such access. Because government financing is so politically unpopular, in most of the 77 countries that offer needle exchange, the programs are run by nongovernmental groups. As a result, these efforts are small, isolated and often undermined by uncooperative police and health departments. The world is casting aside the single most effective AIDS prevention strategy we know.

Russia needs needle exchange more than any other country: its H.I.V. epidemic is large, one of the fastest-growing in the world, and perhaps the most dominated by injecting drug use. Yet the needle-exchange efforts that do exist are scarce, small and under siege. I traveled there recently to see what lessons they hold. At 9 p.m. on a May night, in a tough neighborhood in Moscow’s north, I joined two young men as they climbed the stairs from the Metro. Arseniy and David were in their late 20s, wearing jeans and baseball caps. They had arrived to give out clean needles and promote harm reduction — but theirs was a guerrilla effort.

Click here to continue reading story at the NY Times.com

http://www.nytimes.com/2009/11/22/magazine/22FOB-idealab-t.html

An Addict Reaching Out For Help

Dear Colleagues:

I am copying below a correspondence I have had with an opiate addicted woman, "an addict since the age of 14", asking me for help. She asks if I can help her get into a heroin maintenance program overseas, a treatment that she sees as offering her "a small glimmer of hope" after years of failing to get free of her addiction or finding other treatments unhelpful. I offered to do an intensive, extensive evaluation and planning consultation if she is interested in that but also said I would find out what I can about these programs.

I am sending this letter to my professional community for two reasons.

Firstly I would greatly appreciate any information that may facilitate her getting in touch with one of the existing heroin maintenance programs.

Secondly, and even more importantly, I would like to use this woman's heart breaking story of chronic addiction and failed treatments to open a discussion about the need to seriously examine the negative way we tend to view addicted people and the limitations of our existing treatment system here in the United States. Unfortunately, this woman's story is more likely the norm than the exception. Untreated or poorly treated substance abuse and addiction characterizes the experience of the majority of people who struggle with substance use problems. Addiction treatment in this country is in crisis. Our evidence-based practices are not being implemented. Addiction treatment is not viewed as desirable by most addicted people or else why would the majority of patients in treatment be mandated and not voluntary patients? Most addiction treatment is conducted by poorly trained, poorly paid counselors. Our understanding of addiction as a chronic disorder, our appreciation of the motivational stages of change and the fact that most addicted people struggle with serious co-occurring psychiatric and psychosocial issues all suggest the need for non-abstinence requiring treatments to attract the entire spectrum of substance misusers and enable them to stay in treatment despite their substance use status.

Yet, our ideological, anti-scientific commitment to abstinence-only treatment is reflected in a treatment system that is irrelevant to most substance misusing people. This system, in effect, turns patients off from seeking treatment and sends the message that the patient is at fault. I still hear these practices being done at "the best" treatment programs! As a result, patients don't seek treatment because it is inadequate, substance use escalates as substance users' despair grows and overdose occurs at alarming rates. Rather than examining what we are doing wrong as a field and at the federal level to correct this tragic situation, we do business as usual and hold the drug user responsible for our failure to offer and make available appropriate treatments.

Why not support a broad continuum of care that engages substance users wherever they are ready to begin the process of positive change? Why continue to licence and fund treatment programs that don't offer state of the art treatment, don't properly train and supervise their staff, have embarrassing low rates of retention and positive outcomes and seem to thrive on the failure to help people? Why does the federal government still not actively support and promote syringe exchange? Why not lead the world in innovation in addiction treatment and explore heroin maintenance, safe injection facilities, harm reduction psychotherapy and substance use treatments that engage patients at all stages of change and around all positive change goals? If the government acknowledges that substance misuse is one of the leading public health problems in our country, why do we spend so much more on incarcerating drug users than helping them?

I would welcome dialogue on these questions. I also think it is time for us as a field to engage this crisis.

Andrew Tatarsky, PhD
Addiction Division, The New York State Psychological Association
Harm Reduction Psychotherapy and Training Associates
303 Fifth Avenue, Suite 1403
New ork, NY 10016
www.andrewtatarsky.com

***************************************************************************************************************

Subject: an addict reaching out for help

hello,

my name is R and i am a heroin/dilaudid addict from the united states and i have been researching the herion maintence programs in canada, switzerland and the uk. i have been an addict since the age of 14 and have been to over 20 treatment programs in the states and over christmas of 2008 went to mexico to do the ibogaine program at a clinic in cancun. i have been on suboxone and have been to pain management clinics and although i have learned a great deal about addiction i have had no long term success as a result of these treatments. My family life is in a shambles and i am filled with guilt and shame that are the consequences of my addiction. i come from a good family and even managed to attend university, although i wasn't able to graduate because the drugs became to important and my life has been a neverending cycle of chaos in which heroin is the central cause, the sheer amount of time spent finding, getting and using the drug is exausting. i am 32 years old now, a have hep C, and i am desperate for change. It seems i have looked everywhere for the cure, not realising the that has to come from within myself. I have come to the conclusion that abstince, at this time, is just too big a step for me to handle, let alone all the many times i have tried this method and failed. that is why a small glimmer of hope began to burn in my heart when i read of the maintence programs that are beginning to be offered. I can imagine finally living a life of success... finishing school, a job, perhaps a mending with my family, a future to speak of that i can finally be the woman of dignity who lives on in my soul despite my addiction. I am eager for any information or availability on the maintence programs that you could offer me. I have the time and the willingness to be a model patient, i have health insurance and i know that being from the united states might be a problem but i am willing to do whatever it takes, travel as far as needed to finally have the chance to live the life of my dreams, with help, of course. thank you so much for taking the time to read this letter and any response would be so gratefully received.

Most sincerely, R

***************************************************************************************************************

Dear R,

I hope you are well. I would like to post the letter you sent asking for help on my website and send it out to various people to help raise some important questions that your situation highlights about the limitations of addiction treatment in this country. I would like your permission to re-print your letter as I have it below (without any identifying information) because I think your letter is very powerful and moving as you describe your personal struggle with addiction. I would absolutely respect your wishes if you are not comfortable with this or if you want to change the letter in any way....but I think your letter is really powerful as it is.

I think we need real change in the way people who struggle with substance use problems are seen and treated, or mis-treated, in this country and I think sharing your letter may support that cause.

I look forward to your response.

Best, Dr. Andrew Tatarsky

***************************************************************************************************************

hey doc,

you absolutley have my permission to send any and all of our correspondence to whom you wish. Any voice in the dark that may help another addict make it one more day is the voice that speaks from my heart. Any help i might inadvertently provide would thrill me, people just dont care about the plight of addicts in this country and my wish is that one day that will change. The woman i told you about. trish walsh who is involved in the trials of the HAT program in canada asked me if i would be willing to speak publicly about these issues and of course i would be willing to speak to those who would listen. what really burns me is that the problem of addiction is a fixable one and with the right kind of tx options many could be helped, but most people just want to pretend addicts don't exist or should just be locked up, much like the homeless, people just want to look the other way rather than stop to help.
just an update, i have entered the methadone program here in ft lauderdale and i'm 2 days without injecting a substance, im a little sick but i'm going to give this program a chance. the dope will always be there, heroin isnt going anywhere so why not try yet once again to get myself together. and the folks at the clinic really seem dedicated to the cause. it felt really nice to be complimented by you about the letter, ironically i have always been able to express my feelings through my writing but not so good at dealing with them in real life, hence one of the core issues surrounding my addiction. i enclose a piece of writing that best expresses my struggles with addiction, the utter helplessness i feel and deal with alot. This poem is called

Run and hide, run and hide
stay fast the demons i hold deep inside
chaotic screams cut through my mind
an eternal void sounds horrid cries
and tread carefully upon my tracks
its a maze that's confused the devils wrath
you think you're safe, but you just can't see
there are no windows here
A mothers son has undone her soul
with no repast lays to waste its toll
upon a heart, forever broken
shattered pieces all but lost
save one solitary token
its a hope that's dim, so far away
chained up, guarded well, unspoken today
yet somewhere deep, where demons reside
burns a flame unseen to mortal eye
i feel its heat but never for long
its a gunners dream, a sorrow filled song
and you think you're safe
but you'll still be blind
there are no windows here

this poem is the way i feel when the chaos of my using threatens to consume my very existence, trapped and no way out of the cycle i create when i put i needle in my arm. You feel like the biggest loser on earth but you just do it over and over and over again. That is why i am so desperate for any kind of help and so grateful that there are people out there like you that are willing to help and understand that addicts are human beings who are sick and need treatment for their illness just the same as someone who has cancer needs and deserves to be treated as well. Thankyou again doc, for you interest and ongoing support. You've no idea how much it means
most sincerely,

Alissa

Moderate Drinking May Not Preserve Thinking Skills

By Joene Hendry
November 16, 2009
ABC News Health

NEW YORK (Reuters Health) - Think that a drink or two a day help keep your mind sharp into older age? Researchers from the United Kingdom may have poked a hole into that idea.

Dr. Claudia Cooper, at University College London, and colleagues note in a study that moderate drinkers - generally that's two drinks a day for men and one for women - tend to have less forgetfulness and better mental skills as they age.

However, moderate drinkers also tend to have social, economic, and educational advantages that help them amass greater thinking skills over time.

A report by Cooper's team in the Journal of Neurology, Neurosurgery and Psychiatry, suggests that it's these advantages - and not moderate drinking itself - that are responsible for the benefits.

Cooper's team evaluated social, economic, and physical factors, plus thinking skills, in 1735 men and women 60 to 74 years old. Most - about 87 percent - of the participants reported drinking moderately or abstaining. The rest had histories that suggested problem drinking, and were excluded from the study.

They tested how well the participants could read words pronounced differently from how they are spelled, which indicates how much of their early-learned reading skills each retained into older age.

It's also a skill that isn't lost until mental function declines a great deal, Cooper told Reuters Health by email, which makes it a good indicator of previously obtained thinking skills.

When Cooper's team only took social and economic factors into account, they saw an association between moderate alcohol consumption and greater thinking abilities, similar to findings reported in earlier studies.

But when they allowed for current thinking skills, and the fact that participants with greater physical health were also more likely to drink more, the association between moderate drinking and current thinking skills disappeared.

The authors note that the American Heart Association recently warned against putting too much stock in the link between moderate drinking and better thinking skills, and that more than three drinks per day are linked to a variety of medical conditions such as heart disease and stroke.

SOURCE: Journal of Neurology, Neurosurgery and Psychiatry, November 2009.

http://abcnews.go.com/Health/wireStory?id=9099630

"You can cut back on alcohol" - Abstinence Not the Only Path to Recovery

Research has shown that there are different degrees of drinking disorders, and many people can change habits on their own.

By Shari Roan
Los Angeles Times Health
November 16, 2009

Seventy years ago, Bill Wilson -- the co-founder of Alcoholics Anonymous -- declared his powerlessness over alcohol in a book by the same name. The failed businessman contended that, as an alcoholic, he had to "hit bottom" before changing his life and that sobriety could only be achieved through complete abstention.

For generations, Americans took these tenets to be true for everyone. Top addiction experts are no longer sure.

They now say that many drinkers can evaluate their habits and -- using new knowledge about genetic and behavioral risks of addiction -- change those habits if necessary. Even some people who have what are now termed alcohol-use disorders, they add, can cut back on consumption before it disrupts education, ruins careers and damages health.

In short, say some of the nation's leading scientists studying substance abuse, humans travel a long road before they become powerless over alcohol -- and most never reach that point.

"We're on the cusp of some major advances in how we conceptualize alcoholism," says Dr. Mark Willenbring, director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism. The institute is the nation's leading authority on alcoholism and the major provider of funds for alcohol research. "The focus now is on the large group of people who are not yet dependent. But they are at risk for developing dependence."

Many of these people need not give up alcohol altogether. The concept of so-called controlled drinking -- that people with alcohol-use disorders could simply curb, or control, their drinking -- has existed for many years. Evidence now exists that such an approach is possible for some people, although abstinence is still considered necessary for those with the most severe disease.

The overall reassessment has been fueled by the groundbreaking National Epidemiologic Survey on Alcohol and Related Conditions, the largest and most comprehensive look at alcohol use in America. The project surveyed 43,000 people 18 and older in 2001 and 2002, and again in 2004 and 2005, with the results released in increments beginning in 2006.

This survey alone has been enough to convince even national addiction experts that they've been too narrow in their approach to alcohol disorders. But the findings are being further bolstered by research in genetics and psychology.

Perhaps the most remarkable finding of the epidemiologic study was how many Americans experienced an alcohol-use disorder (either abuse or the more severe dependence) at some point -- and how many recovered on their own. About 30% of Americans had experienced a disorder, the research showed, but about 70% of those quit drinking or cut back to safe consumption patterns without treatment after four years or less.

Only 1% of those surveyed fit the stereotypical image of someone with severe, recurring alcohol addiction who has hit the skids.

The data suggest that there are two forms of alcohol disorders: one that fits the traditional view of alcoholism, in which the need for a drink takes over a person's life, and a time-limited form in which people drink heavily for a period but then cut down and recover.

"It can be a chronic, relapsing disease. But it isn't usually that," Willenbring says.

Differentiating

Alcohol abuse is defined as use that repeatedly contributes, within a 12-month period, to the risk of bodily harm, relationship troubles, problems in meeting obligations and run-ins with the law. Alcohol dependence includes the same symptoms, plus the inability to limit or stop drinking; the need for more alcohol to get the same effect; the presence of withdrawal symptoms; and a consumption level that takes increasing amounts of time.

"For a long time there was an emphasis on alcoholism as if it were one thing," says Carol Prescott, a psychology professor at USC who has studied alcohol-use disorders. "I think that has been abandoned. People with alcohol-related problems don't all look the same at all. Some people only have problems for a short time. Others develop disorders that are ultimately fatal to them."

The other key finding from the survey is that, at least once in the previous year, 28% of adults had exceeded the daily or weekly limits at which drinking is considered low-risk.

For men, low-risk drinking is defined as no more than four drinks on any given day or no more than 14 drinks per week. For women, the limit is three drinks per day or seven drinks per week. (A standard drink is 12 ounces of beer, eight to nine ounces of malt liquor, five ounces of wine or 1.5 ounces of 80-proof spirits.) The majority of Americans who drink beyond these limits have mild to moderate disorders, meaning they occasionally have trouble controlling their intake, Willenbring says.

That's where the overall risk assessment comes in. Willenbring compares it to treating high blood pressure or cholesterol before the condition develops into heart disease.

"People with mild to moderate alcohol disorders can be treated with medications or behavioral therapy with a primary care doctor," he says. "But many people can do this on their own without having a professional. The idea is teaching people how to reevaluate their drinking."

In the national survey, about half of the people who'd had an alcohol-use disorder recovered, enabling them to drink at low-risk levels without symptoms of dependence. "Some people are uncomfortable with that," Prescott says. "It's a safer prescription to tell someone to quit. But the studies suggest that a large proportion of people are able to cut down and aren't out-of-control."

To continue reading the article click here

http://www.latimes.com/features/health/la-he-alcohol16-2009nov16,0,474959.story?page=2

Ketamine drug use 'harms memory'

Frequent use of ketamine - a drug popular with clubbers - is being linked with memory problems, researchers say.

Tuesday
17 November 2009
BBC Health News

The University College London team carried out a range of memory and psychological tests on 120 people.

They found frequent users performed poorly on skills such as recalling names, conversations and patterns.

Previous studies said the drug might cause kidney and bladder damage. The London team and charity Drugscope said users should be aware of the risks.

Ketamine - or Special K as it has been dubbed - acts as a stimulant and induces hallucinations.

It has been increasing in popularity, particularly as an alternative to ecstasy among clubbers, as the price has fallen over recent years.

A gram now costs about £20 - half the price of cocaine.

In response, the drug was made illegal three years ago - it is currently graded class C - although it still remains legal for use as an anaesthetic and a horse tranquiliser.

The study split the participants into five groups - those using the drug each day, recreational users who took the drug once or twice a month, former users, those who used other drugs and people who did not take any drugs.

All of the people took part in a series of memory tests as well as completing questionnaires and were then followed up a year later, the Addiction journal reported.

Researchers found the frequent users group performed significantly worse on the memory tests - in some they made twice as many errors.

The study also showed performance worsened over the course of the year.

There was no significant difference between the other groups.

However, all groups of ketamine users showed evidence of unusual beliefs or mild delusions, such as conspiracy theories, the psychological questionnaires showed.

Addiction

The study also raised concerns about the addictiveness of the drug - hair sampling from the recreational group showed drug use had doubled over the year.

Lead researcher Dr Celia Morgan said: "Ketamine use is increasing faster than any other drug in the UK, particularly among young people, and has now become a mainstream club drug.

"However, many young people who use this drug may be largely unaware of its damaging properties and its potential for addiction.

"We need to ensure that users are informed of the potentially negative consequences of heavy ketamine use."

Martin Barnes, chief executive of Drugscope, said the charity had already raised concerns about the drug and the study provided "further evidence" of the risk of using it.

"It is important that people are aware of the harms associated with the drug and that treatment services are equipped to provide necessary support."

http://news.bbc.co.uk/2/hi/health/8362575.stm

An Alternative to the Intervention: Seminar for Parents and Spouses

CENTER FOR MOTIVATION & CHANGE
An Alternative to the Intervention: Seminar for Parents and Spouses

Does your loved one have a drinking or substance use problem?
You haven't heard the whole story.

You may have been told to "detach with love," or to stage an intervention. Before you go down either of these painful paths, come to an introductory seminar on CRAFT, a New York Times-reported treatment that harnesses the powerful influence of family to safely help a loved one change.
Hear about a non-confrontational option that works.

WESTCHESTER
Wednesday, December 2nd, 2009
6:00-7:30 pm
245 Main Street, White Plains

New York City
Monday December 7th 2009
6:00-7:30 pm
276 Fifth Avenue (30th St) Suite 605

Space is limited Advance registration required Attendance fee: $15 To reserve a spot, please e-mail events@motivationandchange.com or call (212) 683-3339 x38.

Want to quit? Don't go to light smokes

Tue Nov 3, 2009 6:45pm EST
Rueters.com

WASHINGTON (Reuters) - Smokers who switch to a low-tar, light or mild brand of cigarette will not find it easier to quit and in fact may find it harder, researchers reported on Tuesday.

They found that smokers who traded to light cigarettes were 50 percent less likely to kick the habit.

"It may be that smokers think that a lighter brand is better for their health and is therefore an acceptable alternative to giving up completely," Dr. Hilary Tindle of the University of Pittsburgh School of Medicine, who led the study, said in a statement.

Her study of 31,000 smokers found that 12,000, or 38 percent, had switched to a lighter brand.

A quarter said they switched because of flavor but nearly 20 percent said they had switched for a combination of better flavor, wanting to smoke a less harmful cigarette, and as part of an effort to give up smoking completely, Tindle's team reported in the journal Tobacco Control.

Those who switched brands were 58 percent more likely to have tried to quit smoking between 2002 and 2003 than those who stuck with their brand. But they were 60 percent less likely to actually succeed in quitting, Tindle's team found.

"Forty-three percent of smokers reported a desire to quit smoking as a reason for switching to lighter cigarettes. While these individuals were the most likely to make an attempt, ironically, they were the least likely to quit smoking," Tindle said.

Other research has shown that so-called low-tar cigarettes have just as much tar, nicotine and other compounds as regular cigarettes, making their .

The U.S. Food and Drug Administration was given the power to regulate cigarettes in June and was immediately sued by companies such as Reynolds American Inc and Lorillard Inc. Altria Group Inc's Philip Morris unit, the nation's largest tobacco company, supports FDA oversight.

(Reporting by Maggie Fox; Editing by Cynthia Osterman)

http://www.reuters.com/article/newsOne/idUSTRE5A263920091103

Drinking By Either Partner Cuts Odds of IVF Success

Posted by Maia Szalavitz Tuesday, October 27, 2009 at 9:52 am
Time.com

Couples having difficulty conceiving may want to skip one item that is ordinarily considered helpful to the process—alcohol—at least if they are using in-vitro fertilization (IVF). A new study of 2,574 couples undergoing 5,363 IVF cycles between 1994 and 2003 found that couples in which both partners drank four or more alcoholic beverages per week decreased their chances of having a live birth by 26%.

If only the woman reported drinking that amount or greater, the odds of a successful pregnancy fell by 16%; if the man was the one imbibing at that level, the odds fell 14%. The researchers adjusted the data to account for other factors like age and obesity which can significantly affect fertility.

The type of alcohol also seemed to matter: for women, white wine caused the most problems, cutting the live birth rate by 24%. For men, the culprit was beer, which reduced the chances of pregnancy success by 30%. Very few couples reported consuming hard liquor at these levels—so it's hard to know what effect that had.

Given that the worst outcomes were for the type of alcohol most likely to be consumed by each gender, it's possible that the couples who were drinking most heavily under-reported their use, making the effects of lower levels of drinking look worse than they are. However, the study's lead author, Brooke Rossi, MD, a clinical fellow in reproductive endocrinology at Brigham and Women's Hospital in Boston notes that these effects were seen at a level below that considered as moderate drinking by national guidelines.

“It comes down to this,” says Rossi, “There are many factors in an IVF cycle that contribute to success or failure. Most of these, patients have no control over, like age. But one thing you can control is alcohol intake. You can decrease or stop alcohol consumption, knowing that you are going to have to do it anyway if you do get pregnant and it may increase the chances of success in IVF cycle.”

The research was presented at a meeting of the American Society of Reproductive Medicine, held last week in Atlanta.

http://wellness.blogs.time.com/2009/10/27/drinking-by-either-partner-cuts-odds-of-ivf-success/

HOLOTROPIC BREATHWORK ALL-DAY WORKSHOP - Nov 21

Tim O'Connell, PhD, and Oliver Williams will offer Holotropic Breathwork on Saturday, November 21st, 2009

Time: 9.00am - 8.00pm. First time HB participants please arrive by 8.30am.

Location: Trinity House, 1292 Long Hill Road, Stirling, NJ 07980

Holotropic Breathwork has demonstrated the ability to assist individuals in recovery from alcohol and chemical dependencies. Tim Brewerton, MD, following his presentation “Long-Term Abstinence Following Holotropic Breathwork as Adjunctive Treatment of Substance Abuse” to the International Society for Addiction Medicine (ISAM) 10th Annual Meeting in Cape Town, South Africa in November 2008, is currently preparing case reports documenting “…the successful use of Holotropic Breathwork in four cases in which complete abstinence was obtained for extended periods” into a case study for submission to a peer-reviewed journal.

Cost: $150 ($135 with $50 deposit one week prior). Please send deposit to:
Oliver Williams at 114 Horatio Street #809, New York, NY 10014-1574.

Bring: blanket and pillow for your own use; food and beverage supplied. There is a full kitchen so please feel free to bring anything you wish to eat or drink.

Contact: Oliver Williams; (917) 331-8971

http://www.rebecoming.org

Supervision and Training Activities Fall 2009

Monthly Supervision Group on Integrative Harm Reduction Psychotherapy (IHRP) for Professionals Starting November 16, 2009

This group provides training and case supervision in my approach to Integrative Harm Reduction Psychotherapy for people with drug and alcohol concerns. Substance use problems are understood as being intertwined with the unique complexity of the person in context. IHRP is based on an integration of relational psychoanalytic and cognitive-behavioral theory and technique. IHRP blends a skills building focus on cognitive and behavioral change with an exploration of the multiple meanings and functions of substance use and other risk behaviors in the context of a therapeutic relationship that anchors the process and is also an agent of change.

The harm reduction principles that inform this approach are: meeting the patient as a unique individual, the primacy of the therapeutic alliance, abandoning the abstinence requirement and any other preconceived agenda for the patient, special attention to social, personal and induced countertransference, building self-management skills, working collaboratively to assess and identify problems, clarify goals and strategies that best suit the patient's needs and recognizing small incremental positive change as success. In this spirit the form, structure and timing of the therapy emerge out of the therapeutic process rather than being predetermined.

The group will combine topical presentations and case presentation with selected readings as appropriate to the members.

Fee: $60.00 The group will meet on a monthly basis on Mondays, 12-1:30 PM. It may meet more frequently if there is interest.

• November 21, 2009
  
  Treating Drug and Alcohol Users in Your Practice: Rationale, Theory and Technique of Integrative Harm Reduction Psychotherapy
  
  A one-day introductory training at:
  
  The Training Institute for Mental Health
  115 W. 27th Street
  New York, NY To Register: 212-627-8181
  
  
• December 11, 2009
  
  Effective Psychotherapy with Drug and Alcohol Users in Your Practice: Rationale, Theory and Technique of Integrative Harm Reduction Psychotherapy
  
  A one-day training at:
  
  The Albert Ellis Institute
  45 East 65th Street
  New York, NY
  
  To register call: 212-535-0822 and tell them Andrew Tatarsky told you about the training…
  
  
  
• Integrative Harm Reduction Psychotherapy Workshops and Training
  
  Over the last several years I have been offering workshops and training in the U.S. and internationally for groups that wish to get a deeper immersion in harm reduction philosophy, epidemiological and outcome research support, theoretical basis and applications to psychotherapy and counseling. This approach integrates a skills building focus to cognitive and behavioral change with an exploration of the multiple meanings and functions of substance use and other risk behaviors in the context of a therapeutic relationship the anchors the process and is also an agent of change. There is an emphasis on group participation and learning both theory and technique. Trainings are delivered in the collaborative spirit of harm reduction. These trainings can be delivered from half day to five full day formats depending on the needs of the group. Trainings can be tailored to the specific needs of the agency and client population.
  
  Modules include:
  
  
  • History and Evolution of Harm Reduction Philosophy and History
    
    
  • Clinical Challenges and Limitations of Traditional Treatment
    
    
  • Clinical and Epidemiological Rationales for Harm Reduction Psychotherapy
    
    
  • Theoretical Basis of Harm Reduction Psychotherapy
    • Biopsychosocial Process Model of Addiction
    • Multiple Meanings of Drug Use
    • Motivational Stages of Change
      
      
  • Clinical Philosophy of Harm Reduction Psychotherapy: The New Paradigm
    
    
  • Overview of Integrative Harm Reduction Psychotherapy
    
    
  • Building Alliances with Drug Using Patients for Physicians
    
    
  • Therapeutic Tasks
    • Managing the Therapeutic Alliance
    • Therapeutic Relationship as Agent of Change
    • Facilitating Self-management Skills for Change: awareness and affect tolerance
      
    • Assessment as Treatment
    • Embracing Ambivalence
    • Harm Reduction Goal Setting
    • Active Strategies for Facilitating Positive Change

All activities will be led by Andrew Tatarsky, PhD. and colleagues at 303 Fifth Avenue, Suite 1403, NE corner at 31st Street. For more information call 212-633-8157. More information can be found at: www.andrewtatarsky.com