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Evidence continues to indicate that primary care offices could serve as effective sites for identifying alcohol use problems that might require specialty services. One of the latest studies offers the somewhat surprising finding that adults could be screened successfully in the offices of their children’s pediatricians.
Published in the November issue of Pediatrics, the study conducted at three pediatric clinics in New England found that most parents would be completely comfortable with being screened for alcohol problems by their child’s pediatrician, or through a computer or paper-and-pencil survey. Both parents who were not found to have alcohol problems through use of a questionnaire and those who were found to have alcohol problems said they would generally be comfortable with this screening, though the group found to have problems was slightly less supportive of the idea overall.
Lead study author Celeste Wilson, MD, a pediatrician with Children’s Hospital Boston and Harvard Medical School, says some procedural details will likely need to be worked out before this kind of screening becomes routine in pediatricians’ offices. But she also points out that pediatricians already ask parents about a number of family health indicators that could affect their young patients’ well-being, from smoking in the home to domestic violence.
“I see this as a very powerful relationship, that of the parent and the pediatrician,” Wilson says.
What might tend to confound pediatricians is the question of what resources they can tap into at the community level if some of their patients’ parents screen positive for an alcohol problem. This is where the role of specialty addiction treatment providers in a community could surface.
“I do think it would potentially be quite helpful if addiction treatment professionals made outreach to pediatric providers,” Wilson says. “Pediatric providers in offices would actually welcome that. One of the concerns is that pediatricians don’t really know what’s out there.”
The study, funded by the Robert Wood Johnson Foundation, cites an 11% likelihood that a screening conducted at a visit to the pediatrician will indicate a positive result. That is in line with positive screening rates derived in other primary care settings.

Labels: drug abuse, drug rehab, Drug-Addiction-Rehab, drug-testing

The Screening, Brief Intervention, and Referral to Treatment (SBIRT) program can reduce illicit drug use among patients seeking medical care in a wide variety of health care settings such as hospitals, physician offices, and community clinics, a study finds.SBIRT uses a variety of techniques to screen patients seeking medical health for signs of substance abuse. If a patient screens positive for a substance abuse problem immediate steps are taken to help the patient effectively deal with the problem before the patient’s health and well-being deteriorate.
The report in the journal Drug and Alcohol Dependence found that rates of illicit drug use dropped by 67.7 percent six months after patients using illicit drugs had received help through a SBIRT program. In addition, heavy alcohol use dropped by 38.6 percent. Illicit drug users receiving brief treatment or referral to specialty treatment also reported other quality of life improvements:
• 29.3 percent reported feeling generally healthier• 31.2 percent reported experiencing fewer emotional problems• 15.4 percent reported improved employment status• 64.3 percent reported fewer arrests• 45.8 percent who were homeless reported no longer being homeless Currently, most screening and brief intervention programs are directed primarily toward screening and assisting patients to reduce heavy alcohol use -- a use for which SBIRT has been long been shown to be highly effective.

To help expand SBIRT use and determine its efficacy for addressing illicit drug use and alcohol use, the Substance Abuse and Mental Health Administration (SAMHSA) began awarding grants to states and tribal organizations beginning in 2003. The report announced today is based on an analysis of the data provided by six of the grant recipients. SBIRT can be used in a wide variety of healthcare settings including primary care centers, hospital emergency rooms, trauma centers, and other community settings, and provides options for addressing the particular substance abuse problems of patients.
For many patients with less severe problems a health care provider may briefly intervene by discussing the problem with the patient and offering steps to address it. Brief treatments for the problem may also be offered within the healthcare setting or a community setting. In more severe cases, a healthcare provider usually refers the patient to a more specialized setting for assessment, diagnosis, and appropriate treatment.
“Over 20 million Americans with substance abuse problems don’t get the treatment they need – largely because they don’t seek it,” said SAMHSA Acting Administrator Eric Broderick, D.D.S., M.P.H. “These findings show that SBIRT can play an important role in helping people recognize they may have a substance abuse problem and that help is available.”
The article was authored by Dr. Bertha Madras, former deputy director for Demand Reduction at the Office of National Drug Control Policy (ONDCP) and currently at Harvard Medical School; Dr. Wilson Compton of the National Institute on Drug Abuse (NIDA), National Institutes of Health; and Dr. H. Westley Clark, Ms. Deepa Avula, Mr. Tom Stegbauer, and Dr. Jack Stein of SAMHSA. The report was based on data drawn from a network of health care facilities treating a wide variety of patient populations. At least 459,599 patients seeking medical treatment at these facilities were screened for alcohol and illicit drug use during the course of the study, with 104,505 (27 percent) screening positive for heavy alcohol or illicit drug use.
Programs followed up with a random sample of patients screening positive for heavy alcohol or illicit drug use to determine whether their alcohol and illicit drug use levels had changed six months after they had been screened in the SBIRT program.
“We see great promise in this approach to identifying those most in need of intervention and treatment for substance abuse problems,” said NIDA Director Nora D.Volkow, “We are committed to learning more. NIDA has awarded over $4.2 million in new grants this year alone for more SBIRT clinical trials in real-life settings.”
“Promoting services like SBIRT to all parts of the nation is a crucial part of SAMHSA’s mission to reach everyone struggling with substance abuse issues,” said Dr. Clark, director of SAMHSA’s Center for Substance Abuse Treatment.
A copy of the complete report is available at http://dx.doi.org/10.1016/j.drugalcdep.2008.08.003

Labels: drug abuse, drug rehab, Drug-Addiction-Rehab

USA Today has an article today about the abuse of prescription painkillers by servicemembers and returning veterans. There's also a special online follow-up about the 509th Engineering Company, based in Missouri, where at least a quarter of the soliders have admitted to abusing narcotic pain-killers. The articles note that in 2005 there were over 50,000 prescriptions written by military doctors for narcotic painkillers, and such a high rate of use carries the risk of misuse and addiction. An Army study in 2005 indicated that 4% of soldiers had abused prescription medicines in the last month, and 10% had done so at least once in the last year. The VA and military are starting to look more closely at their pain management techniques and investigating methods (such as new dispenser machines) to reduce abuse and addiction.So far, media coverage about substance use disorders among returning veterans has focused primarily on co-occurring mental health problems (for example, the comorbidity of PTSD or TBI with drug use). This article calls attention to the relationship between addiction and orthopedic injuries that cause chronic pain, which is the number one complaint of all Iraq and Afghanistan vets receiving medical care through the VA. The emphasis that veterans' mental health issues have received in the last few years has been groundbreaking and very encouraging, but the Pentagon and VA can't forget that veterans taking prescriptions for muscle, joint, or skeletal pain are at heightened risk for substance use disorders as well.

The Screening, Brief Intervention, and Referral to Treatment (SBIRT) program can reduce illicit drug use among patients seeking medical care in a wide variety of health care settings such as hospitals, physician offices, and community clinics, a study finds.SBIRT uses a variety of techniques to screen patients seeking medical health for signs of substance abuse. If a patient screens positive for a substance abuse problem immediate steps are taken to help the patient effectively deal with the problem before the patient’s health and well-being deteriorate.
The report in the journal Drug and Alcohol Dependence found that rates of illicit drug use dropped by 67.7 percent six months after patients using illicit drugs had received help through a SBIRT program. In addition, heavy alcohol use dropped by 38.6 percent. Illicit drug users receiving brief treatment or referral to specialty treatment also reported other quality of life improvements:
• 29.3 percent reported feeling generally healthier• 31.2 percent reported experiencing fewer emotional problems• 15.4 percent reported improved employment status• 64.3 percent reported fewer arrests• 45.8 percent who were homeless reported no longer being homeless Currently, most screening and brief intervention programs are directed primarily toward screening and assisting patients to reduce heavy alcohol use -- a use for which SBIRT has been long been shown to be highly effective.

To help expand SBIRT use and determine its efficacy for addressing illicit drug use and alcohol use, the Substance Abuse and Mental Health Administration (SAMHSA) began awarding grants to states and tribal organizations beginning in 2003. The report announced today is based on an analysis of the data provided by six of the grant recipients. SBIRT can be used in a wide variety of healthcare settings including primary care centers, hospital emergency rooms, trauma centers, and other community settings, and provides options for addressing the particular substance abuse problems of patients.
For many patients with less severe problems a health care provider may briefly intervene by discussing the problem with the patient and offering steps to address it. Brief treatments for the problem may also be offered within the healthcare setting or a community setting. In more severe cases, a healthcare provider usually refers the patient to a more specialized setting for assessment, diagnosis, and appropriate treatment.
“Over 20 million Americans with substance abuse problems don’t get the treatment they need – largely because they don’t seek it,” said SAMHSA Acting Administrator Eric Broderick, D.D.S., M.P.H. “These findings show that SBIRT can play an important role in helping people recognize they may have a substance abuse problem and that help is available.”
The article was authored by Dr. Bertha Madras, former deputy director for Demand Reduction at the Office of National Drug Control Policy (ONDCP) and currently at Harvard Medical School; Dr. Wilson Compton of the National Institute on Drug Abuse (NIDA), National Institutes of Health; and Dr. H. Westley Clark, Ms. Deepa Avula, Mr. Tom Stegbauer, and Dr. Jack Stein of SAMHSA. The report was based on data drawn from a network of health care facilities treating a wide variety of patient populations. At least 459,599 patients seeking medical treatment at these facilities were screened for alcohol and illicit drug use during the course of the study, with 104,505 (27 percent) screening positive for heavy alcohol or illicit drug use.
Programs followed up with a random sample of patients screening positive for heavy alcohol or illicit drug use to determine whether their alcohol and illicit drug use levels had changed six months after they had been screened in the SBIRT program.
“We see great promise in this approach to identifying those most in need of intervention and treatment for substance abuse problems,” said NIDA Director Nora D.Volkow, “We are committed to learning more. NIDA has awarded over $4.2 million in new grants this year alone for more SBIRT clinical trials in real-life settings.”
“Promoting services like SBIRT to all parts of the nation is a crucial part of SAMHSA’s mission to reach everyone struggling with substance abuse issues,” said Dr. Clark, director of SAMHSA’s Center for Substance Abuse Treatment.
A copy of the complete report is available at http://dx.doi.org/10.1016/j.drugalcdep.2008.08.003

Alcoholics who stayed in Alcoholics Anonymous (AA) and worked through all 12 steps had lower levels of interpersonal insecurity than those who were just beginning the program, according to findings published recently in the American Journal on Addictions. Researchers Jared G. Suire and Robert K. Bothwell of the University of Louisiana at Lafayette reached this conclusion after evaluating the attitudes of alcoholics toward themselves and others after they had worked all 12 steps of an AA program relative to individuals who had not completed all of them. Specifically, the researchers implemented a quasi-experimental design in which measures of self-esteem, interpersonal trust, and related constructs were administered to a group of alcoholics who had been in a community-based AA program long enough to work all 12 steps, and another group of alcoholics who were just beginning to work the steps in a similar AA program. They predicted that significant differences would be found between these 2 groups in self-esteem and interpersonal security. Participants were alcoholics solicited outside of AA meeting rooms. Potential participants were asked if they would be willing to complete a series of personality questionnaires for a study on AA. Those who agreed to participate were later interviewed at a convenient location, such as a restaurant or coffee shop. Participants provided information on gender, race, and age, and answered questions about their AA experience, such as how long they had been in AA and how many steps they had worked. They were not exposed to questions regarding their past drinking. Measures were taken of global self-esteem, social self-esteem, social confidence, network trust, fear of negative evaluation, need for approval, preoccupation with relationships, discomfort with closeness, relationships as secondary, and optimism. Analyses were conducted on 50 "completers" who had completed all 12 steps, 7 "continuers" working on steps between Step 4 and Step 9, 24 "newcomers," and 18 "relapsers" who were starting over because they had slipped. Principal components analysis on the measures revealed two factors: "interpersonal insecurity" which reflected low interpersonal trust and high ambivalence and anxiety about close relationships; and "social potency" which reflected high social self-esteem and confidence and low fear of negative evaluation. Results indicated that there was a significant difference in interpersonal insecurity between alcoholics who had completed all 12 steps in a community-based AA program and those who had started to work the steps but had not yet completed all of them, with completers showing lower interpersonal insecurity. There were no differences in this finding on gender, age, and ethnicity. No significant differences were found in social potency between alcoholics who completed the steps and those who had not completed the steps. Study limits The design of this study does not allow for causal inference about the difference found between groups in interpersonal insecurity. It is possible that alcoholics who stayed in the program and worked through all the steps had higher levels of interpersonal security to begin with. Authors' conclusions It is possible that participation in AA brings about fundamental change in members who are able to stay in the program and work the steps. The authors note that it is likely that such change will occur in this context so gradually that it will be less obvious to the alcoholic in his or her daily reflections than to others who may see him or her at the weekly AA meeting. They posit that future research will show that as the alcoholic works the steps with the supportive backing of a community-based AA homegroup and sponsor, there will be great potential for change in the alcoholic's ability to relate to others in ways that can meaningfully enhance the quality of his or her life. Future investigations should also attempt to clarify the specific nature of changes that occur in personality as alcoholics work through the 12 steps within community-based AA programs. No funding information provided. Suire JG, Bothwell RK: The psychosocial benefits of alcoholics anonymous. Am J Addictions 2006; 15:252-255. E-mail: bothwell@louisiana.edu. Suggested readings: Moos RH, Moos BS: Long-term influence of duration and frequency of participation in Alcoholics Anonymous on individuals with alcohol use disorders. J Consult Clin Psychology 2004; 72:81-90. Study sample N=100 56 males, 44 females 76 were white, 18 were black; 6 other ethnicities
COPYRIGHT 2006 Wiley Periodicals, Inc.

I believe as long as an addict is breathing it is never too late, you never give up. There is still time to save their life.

I believe this because I am a product of an intervention. I have the gift of being able to help people break the cycle, and that gift was given to me when an intervention was performed on me in 1989. I was addicted to crystal meth, alcohol and anything I could get my hands on. I believed I could do it on my own, but I was wrong. My employers sat me down with a professional interventionist and, in a loving way, told me I needed some help. Because of the intervention, I agreed to go into a treatment facility and have been clean since July 14, 1989.

I’m now an addiction interventionist and have been working in the field for most of my sobriety. I ended up in this line of work because of my own personal experience with addiction and because of my passion for helping others. I became educated in the field and continue to learn and develop ways to stay one step ahead of this addiction. Being able to help people break through the walls of addiction and denial is a gift that I will cherish until the day I die.

With addiction there’s a wall of denial that needs to be broken through before the healing can begin. Like many other medical conditions addiction can run in the family. Ten percent of the people in the world are born with a gene that makes them vulnerable to addiction. I had an incredible upbringing and I’m an addict while my sister is not. It’s the luck of the draw, so to speak.
Sometimes people blame the parents or the family. I work with hundreds of families all over the world, and while some of them are difficult, some of them are the most loving parents, and yet their kid suffers with addiction. Sometimes parents are addicts, but the children are not.

It’s important that people who blame get more education. Certainly family behaviors and trauma can do damage and can magnify the addiction but it’s not the root cause of addiction.

Addicts can be the most selfish people in the world – when using – and people who love addicts often experience a lot of anger. That can be a healthy anger if they’re angry about the addiction. They have to separate the addiction and their loved one. Addicts aren’t bad people, they’re sick people. Instead of being angry with the addict, stand up in front of the addiction and say, “I love you, but I’m not going to love you to death.” Many families and loved ones can be helped though Al-Anon or counseling before during or after the addicts find recovery.

Standing up to addiction isn’t easy. Between addiction and the human spirit, addiction is stronger, but if you become unified as a family, then you can become stronger than the addiction. The individual cannot fight the addiction by themselves once it has gone to a certain level, and that’s why there are treatment centers all over the world. In America, there are 23 million Americans suffering from addiction, and only one per cent of them get treatment on their own. The denial is just so strong that it requires a combined effort. Environment plays a huge part in people’s addiction. You have to create an environment that stops the addiction. To stop the addiction, the person has to hit a bottom and realize they don’t want to live that way. That is where we come in to intervene, help raise the bottom of the addiction so it does not have to be jail or death.

We facilitate the healing process by getting as many family members, friends, co-workers or anybody who loves the addict, together in a room to confront the addict. Most of the addict’s prayers are, “Please don’t let me wake up tomorrow. I don’t want to live this way.”
For some reason, when you have all these people in a room talking about how much they love the addict, it gives the addict a bit of hope to want to stay alive.

There’s no cookie cutter formula for an intervention.
Doing an intervention on a prescription medication addict is completely different than on someone who is getting their drugs off the street. What addicts have in common is that they all need to hit some form of bottom in order to break through. Every addict hits a bottom where using is not as fun as it use to be and is more devastating then wanting to seek help. Professional interventionists help to create the type of rock bottom appropriate for a particular addict.

Every single addict who finally puts an end to their addiction - hits what the general public known as “rock bottom”. But what exactly is “rock bottom”? And how many different ways are there to get to that painful, yet powerfully healing place? Here is what I have come up with: The five “rock bottoms”, the definition of “rock bottom”, (Health, Emotional, Legal, Personal Finances and Spiritual) and why each of them works.
Health bottom: is usually very effective at stopping the addiction, since it usually means the addict is confronted with failing health and left with no choice but to either quit or die.
Emotional bottom: can be a variety of things, but is usually when the addict has pushed so many people from their life that the emotional strain becomes too great for them to bear.
Legal bottom: is when the law intervenes. It’s when their addiction has caused them to break the law and they have some form of legal action being taken against them. This leaves the addict with no choice but end the addiction due to facing criminal charges.
Personal finances bottom: is when the addict has used up all their resources—money, possessions and everything they own—leaving them with nothing but their own addiction.
Spiritual bottom: is something very personal between the addict and their God. It can be incredibly powerful, but also very difficult to predict.
Each of these bottoms is equal to each other—and just as influential as the other—for stopping an addiction in its’ tracks, so that the loved ones can once again reclaim their life back. Best of all, the five “rock bottoms” are easy to remember, since they spell out the word “HELPS”—something that each rock bottom does either individually and/or collectively to cure the disease of addiction. This is something I spend year on developing and it works.
In an intervention, we will also explain to the participants that having an addict in their life unfortunately means that they are also well on their
way to hitting their own rock bottom. Afterwards, I’ll offer assurance that the tools they are about to learn will prevent them from ending up here again.
We do our best to facilitate a rock bottom for the addict. For a lot of people the physical bottom isn’t enough to make them stop – they’ll be brought back from the brink of death and go right back into their addiction.
There’s an emotional bottom, which is what we deal with in a professional intervention. We see people quit drinking because they ended up driving drunk with their kids in the car and they don’t remember how they got home. For some, that’s enough of an incentive. We try to pull at an addict’s heart strings in order to beat the addiction.
If that’s not enough, then there’s the financial bottom. That’s what ultimately worked for me – I got fired from my job and had no way to support myself. A lot of families give the addict money, and we get them to agree to stop doing that. We may go to the employer and ask them to support the intervention by cutting off the money. There are times when we have no control over this bottom either though, like the executive or business owner that has plenty of funds to live on if they stop working.
The legal bottom, a lot of people go to treatment because the courts say, “You either go to jail or you go into treatment.”
Every human being has a living nightmare meaning a bottom, and so we have to figure out how to make that nightmare a reality in a respectful and loving manner. We only do this if they choose not to go to treatment after the letters are read and they did not hit that emotional bottom. The more bottoms that can be achieved the better the chances are of success.
Often family members will turn away because they simply feel they’ve done all they could, but I believe the only time you close that door is when the addict stops breathing. Do whatever you can to pull your loved one back. Closing the door while your loved one is still alive is a lose-lose situation – the addict goes further into addiction, and the family members’ hearts still ache. Love doesn’t stop.
Interventions work. It worked on me and I have seen it work on countless families. But an intervention is only the beginning of the road to recovery for the addict and the family. There is a lot of work ahead for everyone.
The payoff for me is seeing families heal and find the love and happiness they thought was gone forever.
If you have someone you love that needs help, please contact a professional.

Ken Seeley, BRI II, CNDAI II, RASi is the founder of Intervention911.com and an interventionist on the A&E show Intervention.

Addiction is more than a dependency upon alcohol, drugs, or painkillers. It is a disease that causes people to become self-destructive and hurtful toward others. If addiction goes untreated, the person will be unable to control unhealthy and self-defeating behaviors despite the physical and mental risks. Those who suffer from addiction - whether to alcohol, drugs, or other obsessive behaviors like gambling - stand to damage their health, relationships with family and friends, careers and finances if nothing to done to help.
Physicians who operate and consult with drug and addiction rehabilitation clinics recognize that patients often need different treatment programs in order to get overcome their destructive behaviors. To this end, physicians and counselors work with clinic residents toward a common goal: full, long-term remission from this disease.
Can addicts be completely cured? No. Addiction is a chronic illness that never wholly goes away. Addiction can be controlled to a point that allows the addict to live a normal life. Rehab clinics may offer state of the art treatment programs and specialized rehab counseling to effectively achieve long-term remission for addicts. When done properly, abstinence treatment can ensure a happy future, free of dependency and full of love and hope.
To achieve remission, abstinence-based treatment is introduced immediately to clinic residents. This begins with a safe withdrawal from all controlled substances. Our Rehabilitation programs may include counseling and education on avoiding relapse, so that recovering alcoholics and drug addicts may enjoy a life in recovery for many years. The goal of abstinence treatment is to ensure that ill behaviors fade, that the body no longer craves the substances that can damage health and happiness.
If you suspect a loved one is abusing alcohol or drugs, or engaging in other destructive behaviors, it is important to contact a professional to determine the next steps. The sooner an addict is introduced to abstinence, the better the changes for strong recovery.
Stephanie Loebs is the executive director of Williamsburg Place, one of the top drug rehab clinics in the nation. Williamsburg Place aids those who suffer from drug and/or alcohol addiction, and specializes in caring for health care professionals. For over twenty years Williamsburg Place and its joint rehabilitation center, the William J. Farley Center, have helped thousands of people from all walks of life take back their lives and overcome substance abuse.