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Since its launch on April 17, 2004, 12-StepRadio.com has been playing "recovery music" 24/7.

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The music played on 12StepRadio.com is a diverse cross-section of highly talented, independent artists with some songs from major-label CDs being played as well.

Beginning with a play list of less than 50 songs, the station now has 200 songs in rotation.

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Sleep problems affect alcoholism recovery

Sleep problems - real and perceived - get in the way of alcoholism recovery

Doctors and patients should discuss and address sleep issues as part of recovery

The first few months of recovery from an alcohol problem are hard enough. But they’re often made worse by serious sleep problems, caused by the loss of alcohol’s sedative effects, and the long-term sleep-disrupting impact that alcohol dependence can have on the brain.

Now, a new study gives further evidence that insomnia and other sleep woes may actually get in the way of recovery from alcohol problems. In fact, a person’s perception of how bad their sleep problems are may be just as important as the actual sleep problems themselves, the study suggests.

The study is published in the journal Alcoholism: Clinical and Experimental Research, by a team from the University of Michigan’s Department of Psychiatry. They report the results of a small but thorough evaluation of sleep, sleep perception and alcohol relapse among 18 men and women with insomnia who were in the early stages of alcohol recovery.

The authors say their results show how important it is for alcohol recovery patients, and those who are helping them through their recovery, to discuss sleep disturbances and seek help. Often, sleep isn’t discussed in alcohol recovery programs - but it should be, they stress.

In fact, members of the U-M team have now launched a new study that aims to help those who have just entered treatment for alcohol problems, and are having trouble sleeping. Instead of using sleep medications, which can carry their own risk of addiction, it’s based on a series of "talk therapy" sessions with a trained sleep therapist who can help patients change behaviors and patterns of thinking that contribute to sleep problems.

Sleep and Half Brother Death [Drunk] by John William Waterhouse

In the meantime, the newly published results add to the understanding of how alcohol and sleep intertwine.

"What we found is that those patients who had the biggest differences between their perception of how they slept and their actual sleep patterns were most likely to relapse," says lead author Deirdre Conroy, Ph.D., who led the study as a fellow in the U-M Addiction Research Center. "This suggests that long-term drinking causes something to happen in the brain that interferes with both sleep and perception of sleep. If sleep problems aren’t addressed, the risk of relapse may be high."

"We are now interested in what brain mechanisms are involved in the disrupted sleep of alcohol-dependent individuals," says Brower, who has previously led studies illustrating the prevalence of sleep disorders among people with alcohol dependence and abuse issues, and their correlation with relapse back into drinking. He is the executive director of the U-M Addiction Treatment Services, which provides alcohol and drug treatment to hundreds of patients each year.

The new study involved women who had volunteered for a randomized clinical trial of gabapentin, an experimental treatment for alcohol dependence. Each one started the trial when they had been off alcohol for about a week.

The volunteers spent two separate nights in the sleep-monitoring area of the U-M General Clinical Research Center, wearing electrodes on their head and body that measured their brain waves during sleep, as well as their breathing, muscle activity and heart rhythm. The detailed measurements, which together make up a procedure called polysomnography, allowed the researchers to determine when the volunteers were sleeping, when they were awake, and which stage of sleep they were in.

These sleep data were compared with the participants’ answers on morning evaluations of how they slept - including how long they thought it took them to fall asleep, how long they were awake in the night, and other measures. The two nights of sleep monitoring were done several weeks apart. The researchers also asked the participants to report any alcohol they drank during the six weeks following each sleep test.

In all, the patients overestimated how long it took them to fall asleep, but thought they had been awake in the middle of the night for far less time than they actually were. These perceptions about how they slept were actually more accurate in predicting their potential for relapse to alcohol use than were the actual sleep measurements.

"Our study suggests that in early recovery from alcoholism, people perceived that it took them a long time to fall asleep and that they slept through the night," says Conroy. "The reality was that it did not take them as long to fall asleep as they thought it did, and their brain was awake for a large portion of the night. On average, the participants that were less accurate about how they were sleeping were more likely to return to drinking."

Conroy explains that poor sleep quality can lead to mood disturbances. "If recovering alcoholics are irritable because they are not getting quality sleep at night, they might be more vulnerable to return to drinking," she says. "Previous studies show that non-alcoholics with insomnia actually think they are sleeping worse than they are, so they may be more likely to seek appropriate treatment.

Our study shows that an alcoholic in early recovery has a lot of wakefulness in the night but they are not necessarily picking up on this. It is important for the clinician working with the alcohol-dependent patient to have a differential of poor sleep quality in the back of their mind as a potential challenge for the patient throughout alcohol recovery."

Kara Gavin | Source: EurekAlert! Further information: www.umich.edu

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Abstinence - treatment, philosophy, methods

Abstinence - treatment, philosophy, methods

In a second part article Dr Gordon Morse tackles detoxification as a route to abstinence, putting a relevant focus on the individual, philosophical or even spiritual meaning for the patient.

His view, that it is the individual’s confidence and approach, the significance given to their endeavour, rather than method per se, which is central in successful preparation, aftercare and outcome. Ed. (Part 2 continued from Network issue16)

In the last article I gave some of the background against which drug users will ask us to help them achieve abstinence: the time to rid ones self, once and for all from dependency on drugs, doctors, pharmacists and services, and the (very real) daily fear of having any of these withdrawn.

Perhaps the first thing that the doctor will consider, and the patient will worry about, is the chemical process of detox. I will talk a little about detox later, but I am not going to spend much time discussing it - after overseeing many thousands of detoxes I am firmly of the opinion that the method of detox has very little bearing on the success or failure of achieving durable abstinence.

“ . . . it is very often the narrowest (and most puritanical) sense of abstinence, namely from ALL mind affecting substances, which affords the easiest route.”

Preparation for abstinence begins with the debate about what abstinence actually is.

• Is it to be (at its simplest) abstinence from heroin, but continue on methadone?
• Or abstinence from all drugs but allow occasional alcohol?
• And maybe allow cannabis as well?
• Or maybe leave off all illegal drugs and alcohol, but cigarettes and caffeine are OK?

All of these paths can be adopted and are achieved with varying degrees of success, but perhaps paradoxically, it is very often the narrowest (and most puritanical) sense of abstinence, namely from ALL mind affecting substances, which affords the easiest route.

Why is this? Well, at the very least, it is the simplest. It avoids all those judgement calls about what drug is all right and what isn’t, when it is all right, how much is all right and so forth - it is completely black and white.

“This is as much a spiritual journey as anything else - and that is not to confuse it with a religious state as some of the abstinence-knockers would like to do.”

And it avoids leaving another addictive avenue to be exploited when one is closed, as frequently can happen with alcohol when opiates are stopped.

And setting the hurdle high sets the prize for achieving it high as well: this is a life saving process where the reward of life is used in its fullest sense - in both quantity and quality. It is an admission that although drug use may have been nice, and maybe others can get away with it, for me, I just can’t do it any more.

And by being so black and white, so it identifies a person: how often our patients are identified as “drug addicts” - as if that defines and explains everything about them. Rather like shedding the pupa’s case, so the recovering addict can metamorphose and re-identify himself as abstinent.

This is as much a spiritual journey as anything else - and that is not to confuse it with a religious state as some of the abstinence-knockers would like to do. It can be religious if that works for you - certainly many world faiths embrace abstinence from Methodists to Muslims - but it can be as simple as respect for ones own health and sanity, and the health and sanity of those around us.

Preparation also (vitally) includes education about relapse on loss of opiate tolerance, education on the detox process itself, educating the “significant others” in the person’s life to support them through the detox process and the weeks and months that follow, and so forth.

So what of aftercare? Stanton Peele says that all you need do is give them a home and give them a job. William Miller (after Gorsky’s work) says that relapse can be avoided in 80% of cases if you deal with their isolation and demoralisation.

Then there are psychological therapies such as Marlatt’s CBT Relapse prevention model, group therapies that addresses interpersonal skills, and drugs such as naltrexone and antidepressants.

And of course there are support groups, rehabilitation centres and the 12 Step Fellowships of Narcotics Anonymous, Cocaine Anonymous. Alcoholics Anonymous and others.

All of these models are invaluable for some and useless to others. Indeed we know that many people achieve durable abstinence with no help from anyone - they just get fed up and get on with it. As GP’s we have a good understanding of our patients as people - we have often known them for a long time and can help them make some of these choices about which path to take and what support might fit in with their individual philosophies.

I have left detox to the end of this piece, because it is lowest in terms of importance.

Detox from opiates is all about confidence - it is seldom dangerous. There are all manner of detox methods out there: probably the most popular is a slow weaning off methadone over whatever period the patient dictates. Intuitively that seems the easiest, but I am inclined to doubt it. These very slow reductions span periods that frequently stretch motivation beyond its limit, and I have never seen anyone stop smoking by cutting down, cigarette by cigarette, over weeks or months. And the end of these weanings, as every golden milligram is chipped away, seem to be coloured by severe withdrawals the intensity of which follows no physiological logic whatever.

It is true that many achieve their abstinence this way, but I suspect that is because tradition has made this the overwhelmingly most popular detox method.

No, I am inclined toward the “grasp the nettle” detox over a couple of weeks or so when the patient is at their motivational zenith, and accompanied by as much intensive support as possible.

There are various chemical regimen that can aid this process which are to be found in the literature, and for the sake of space, I will leave there for now.

Because abstinence is about everything other than detox: In Abstinence there is something redemptive in it that allows the individual to leave the chaos, pain and shame behind, and start their life again. And that is all about philosophy, not pharmacology.

With thanks to Brahms, whose “German Requiem” was playing as I wrote this. (A Requiem reflects on a past life whilst welcoming the next - and Brahms was an atheist)

Dr Gordon Morse GP Medical Consultant to Clouds House, Trust Specialist and Lead GP Clinician for West Wiltshire Specialist Drug and Alcohol Service, RCGP Regional Lead. From - NETWORK 17 APRIL 2007

Part one

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Quality of Primary Care May Lower Addiction Severity

Higher Quality of Primary Care May Lower Addiction Severity

The quality of primary care affects health outcomes in patients with certain chronic disorders.

In this study, researchers examined whether patient-reported quality of primary care influenced addiction outcomes in 183 patients who sought primary care after detoxification from alcohol, heroin, and/or cocaine.

Using patient interviews, researchers measured primary care quality at baseline and substance use and addiction severity 6 to 18 months later. Analyses were adjusted for potential confounders (e.g., education, homelessness).

Of the 9 attributes* of quality primary care that were assessed, all but preventive counseling were significantly associated with lower alcohol addiction severity at follow-up. Three attributes (physician knowledge of the “whole person,” organizational access, and visit-based continuity) were associated with lower alcohol addiction severity and lower drug addiction severity.

Whole-person knowledge and patient trust of the provider were significantly associated with a lower likelihood of any drug use or alcohol intoxication (>3 drinks on any occasion) at follow-up (odds ratios, 0.7 for whole-person knowledge and 0.8 for trust).

Comments:

In this study, higher quality of primary care was associated with decreased addiction severity (particularly related to alcohol) over time in patients who had completed detoxification. Two characteristics of the patient-physician relationship-trust and whole-person knowledge-were associated with less substance use. These findings support efforts to link patients with substance use disorders to primary care and to cultivate key attributes of patient-physician relationships.

David A. Fiellin, MD

*The 9 attributes, measured by the Primary Care Assessment Survey, included

• communication,
• interpersonal treatment,
• thoroughness of the physical exam,
• provider knowledge of the “whole person,”
• preventive counseling,
• patient trust of the provider,
• organizational access,
• financial access, and
• visit-based continuity.

References: Kim TW, Samet JH, Cheng DM, et al. Primary care quality and addiction severity: a prospective cohort study. Health Serv Res. 2007;42(2):755-772.

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Pain Increases Risk of Relapse

Persistent pain is prevalent among people with substance use disorders.

It is not known, however, whether such pain increases the risk of relapse following periods of abstinence.

Researchers assessed data on pain and substance use in 397 adults who, as part of a larger trial, had been interviewed periodically in the 2 years after their discharge from an urban, residential alcohol and drug detoxification unit.

• Sixteen percent of people reported persistent pain in the 2 years after detoxification.

People reporting persistent pain were significantly more likely than those with mild or no pain to have used the following in the past month at the 2 year follow-up:

• heroin/opioids not prescribed for pain (5 times as likely than those without pain);
• heavy amounts of alcohol (More than twice as likely as those without pain).

Comments: Persistent pain is common among alcohol and drug users who have undergone residential detoxification and increases the likelihood of relapse. This study suggests that people need to be aware and clinicians must be careful to screen for pain symptoms in patients with substance dependence.

When persistent pain is present, thoughtful management is required to minimize risks associated with undertreatment while not fostering opioid analgesic or alcohol abuse.

References: Larson MJ, Paasche-Orlow M, Cheng DM, et al. Persistent pain is associated with substance use after detoxification: a prospective cohort analysis. Addiction. 2007.

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