ER Doctor Can Help Reduce Drinking

Doctor with stethoscope around her neck holding clipboard uid 1173327Seven Minutes of Counseling by ER Doctor Can Help Reduce Drinking

People who engage in hazardous and harmful drinking are more likely to reduce their consumption of alcohol for at least one year if they receive just seven minutes of counseling from an emergency room physician, a new study finds. Physician counseling can also reduce drinking and driving.

The study included 740 people considered hazardous and harmful drinkers, defined as men who had more than 14 drinks a week, or more than four drinks at a time, and women who had more than seven drinks a week, or more than three at a time. They were divided into three groups. One group received brief counseling aimed at limiting alcohol consumption, the second group received the counseling plus a follow-up phone call, and the third received standard care alone.

Health Day reports patients who received the counseling reduced their average number of drinks from almost 20 a week to 13 a week within six months. One year later, they drank slightly more than 14 drinks a week.

Participants who received the counseling reduced binge drinking episodes, from about seven per month to fewer than five, within six months. They engaged in slightly more than five episodes a month one year later. Among patients who received counseling, rates of driving after having more than three drinks dropped from 38 percent to 29 percent after one year.

Follow-up phone calls were found to have little benefit in reducing drinking.

“So many of the tragedies we see in the emergency department are due to problem drinking. Our study shows that brief counseling of patients can improve outcomes and have a life-saving impact,” lead researcher Gail D’Onofrio of the Yale University School of Medicine said in a news release.

The findings are published in the Annals of Emergency Medicine.

Alcohol Abuse Screenings at the Dentist

Health experts have warned that people who consume alcohol excessively are exposed to an extremely high risk of developing dental disease and mouth cancer.

Experts have also noted that in order to be able to keep things under control, treatment and constant screenings for alcohol abuse is extremely important. The published paper has been called “Alcohol misuse: screening and treatment in primary dental care”.

The study has also brought to light the fact that people generally do not visit their doctor (GP), unless they are extremely ill. On the other hand, people generally respect their regular dental visits, and therefore dentists are the professionals mostly suited to test patients for alcohol abuse issues.

If health professionals would start asking a few standard questions regarding the patient’s alcoholism problem, it would be much easier to help the patient fight against these issues.

Professor of Oral and Maxillofacial Surgery, Jonathan Shepherd clearly points out that people struggling with excessive alcohol consumption can develop cancer of the mouth, esophagus and larynx. The dental professionals may actually be the first who can discover these health complications.

There should be introduced an alcohol screening device which is extremely reliable and which can detect alcoholism, and then suggest the right path for treatment.

The paper notes that today in the UK approximately 1 in 5 men and 1 in 7 women are drinking excessively. If dental professionals would be the first to suggest the patient the importance of moderation in drinking, both the health and economic implications linked to excessive alcohol consumption could be considerably reduced.

Professor Shepherd further reveals that one of the main responsibilities of the dentist is to promote overall good health.

They are not only responsible for dental health promotion, but also for helping the patient fight off bad habits that lead to severe oral health complications, or to severe damages in any other major organ of the body.

The Government and the dentists should join their forces and provide proper screenings and treatments before it is not too late for the patient.

Overdosed by Doctor

Small But Growing Number of Doctors Face Criminal Charges Over Prescription Drugs

As the number of fatal overdoses from prescription painkillers grows, so does the number of doctors who are facing criminal charges for overprescribing painkillers and other controlled medications, Reuters reports

The issue has gained attention in light of the upcoming trial of Michael Jackson’s doctor, Conrad Murray. Prosecutors have charged him with involuntary manslaughter, which could be punishable by two to four years in prison, for his role in the drug overdose death of the music star.

There have been an estimated 37 reported criminal cases against doctors between 2001 and 2011, according to Reuters. Most recent cases involved overprescribing painkillers and other controlled substances.

Many of these cases have been brought under the Controlled Substances Act, and similar state laws. In order to prove a doctor is guilty under the law, the prosecution must prove the physician knowingly and intentionally prescribed the drug outside “the usual course of professional practice” or not for a “legitimate medical purpose.”

Jackson’s doctor is not being charged with violating  a controlled substances law because propofol, the anesthetic he is accused of giving to Jackson, is not a controlled substance. Instead, prosecutors say he breached the standard of care when he administered the drug to Jackson at home, and his gross negligence caused the singer’s death.

Diane Hoffmann, a law professor at the University of Maryland School of Law, notes doctors who treat patients with chronic pain are in a tough position, relying on their patients to tell them how much pain they are suffering from. “Doctors are not supposed to be law enforcement agents. They’re supposed to believe their patients,” she said.

From Join Together

Can AA Survive in Russia?

Can the AA 12-Step Program Thrive in Russia?

The US Helsinki Commission is charged with monitoring human rights compliance in the former Soviet Union. But on August 2, the commission took a break from its routine responsibilities to examine the thorny issue of alcoholism in Russia.

Russians’ capacity for drink is legendary. During the hearing, titled US-Russian Cooperation in the Fight against Alcoholism, one of the witnesses, Heidi Brown, an analyst at Kroll Associates, tried to quantify the impact of spirits on Russian society. The numbers she proffered were alarming: half-a-million deaths each year in Russia are alcohol-related, and approximately half of all male deaths in Russia are in some way connected to excessive alcohol consumption. In addition, a whopping 2.3 billion liters of vodka are sold every year in Russia, a country with a current estimated population of 142 million.

Another witness at the hearing was Dr. Eugene Zubkov, the co-founder of a 30-bed clinic in Leningrad Oblast outside St. Petersburg that specializes in treating alcoholics. Zubkov noted that there are 2.7 million officially registered alcoholics in Russia, but added that the official count was probably low. “It means probably three times that many patients … are not registered,” he said. If Zubkov’s estimate is accurate, it means that approximately one in every 13 Russian citizens may be an alcoholic.

The hearing spent a fair amount of time examining the applicability to Russia of the 12-step program developed by Alcoholics Anonymous (AA), a mutual assistance movement designed to promote sobriety that was founded in 1935 in the United States.

Margaret Murray, the director of the International Research Program at the US National Institute on Alcohol Abuse and Alcoholism, told members of the Helsinki Commission that AA “has been an extremely important mainstay of [alcoholism] treatment in the United States.” Among the benefits, Murray said, was the “social support for abstinence that AA provides, as well as enhancing an individual’s spirituality, which we know is key to recovery for a lot of people.”

Zubkov said his clinic, called the House of Hope on a Hill, utilizes AA’s 12-step method in its 28-day treatment program. Since its opening in 1996, the House of Hope has treated about 4,500 patients, he said, adding that the facility has acted as a catalyst for the slow spread of AA chapters across Russia. “There are now 370 AA meetings … in Russia, and 40 percent of those meetings were started by – initiated by the graduates of the house,” he said.

AA encounters lots of opposition in Russia, Zubkov noted. Efforts to open an AA-based clinic in a new location often generate official opposition because the 12-step method is seen as a foreign import.

“There is a lot of mistrust of Alcoholics Anonymous there because it is seen as Western. … There are a lot of people who still have sort of a nationalism or a resentment about methods that have come from abroad,” added Brown. Some opposition also appears to be faith-based, as AA is seen by many Orthodox Christian Russians as essentially a creature of the Reformed Protestant tradition.

Preferred treatment methods in Russia lack an adequate after-care component, Zubkov said. “Russian treatment methods are largely very biologically oriented and sometimes strange.” The most popular method relies on the use of Antabuse, a drug that makes people sick when they drink alcohol. But this does not address the cultural and physical sources of the addiction. “And after this, [the] patient is basically – he is on his own,” Zubkov said. “He doesn’t get any therapeutic support. He doesn’t get any – he doesn’t go to any meetings. And when he has a personal crisis, the easiest way for him to resolve it is try to drink, and very often this could end in fatalities.”

Beyond cultural differences, the lack of a tradition of philanthropic giving in Russia is hampering the ability of AA programs to expand their reach. The House of Hope, Zubkov noted, depended on financial support provided by an American philanthropist, Lou Bantle, who died in 2010. Now, the clinic is facing an uncertain financial future. Finding Russian benefactors is an extreme challenge, Zubkov added.

Not only does the Russian government tax charitable contributions, but those corporations and philanthropists that do donate “prefer to support high-profile, socially acceptable organizations, such as the performing and visual arts.” The only exception has been the Baltika brewery, which has been “continuously supporting us for many years,” he said.

Originally published by

Treating the tiniest addicts

Treating the tiniest addicts – City & Region – The Buffalo News.

An epidemic of prescription painkiller abuse has led to another growing problem — newborns exposed to the addictive drugs their mothers use.

At the Catholic Health System in Buffalo, which operates the state’s largest methadone clinic outside of New York City, physicians used to see one to three babies a month with symptoms of withdrawal from narcotic pain pills. Now, the number approaches 10 a month, said Dr. Paul Updike, director of chemical dependency at Sisters Hospital.

The number of cases has grown enough that the hospital network is reorganizing services to standardize the care of addicted moms-to-be and their newborns.

“We can’t control the influences on a child’s environment, but withdrawal is quite treatable. We can give a child a chance for a reasonable life,” said Updike.

More at;  Treating the tiniest addicts – City & Region – The Buffalo News.

Prescription and illicit drug use | Doctor waiting lists

Prescription and illicit drug use | Doctor waiting lists.

Thousands of West Australians have become addicted to dangerous prescription drugs while waiting to see a doctor, but a lag in illicit drug use statistics has left the escalating problem largely undetected, a scathing parliamentary inquiry has found.

General practitioners are concerned that about 22,000 West Australians are now addicted to opioids such as morphine and oxycodone, prescribed to them to manage chronic pain while they waited up to 12 months to see a specialist, the Education and Health Standing Committee said in an interim report tabled in parliament yesterday.

“The misuse of prescription opioids has become a significant problem within Western Australia and the number of people misusing them is now at a similar level to the number consuming heroin,” the report says.


Blur of walking people crossing city street WHY NEW YEAR’S IS THE DEADLIEST DAY OF THE YEAR FOR PEDESTRIANS 

Loyola physician warns of the perils of drunken walking — It’s the holiday season and New Year’s partiers will soon be inundated with warnings about the risks of drinking and driving.

Little is ever heard, though, about the risks of drinking and walking, which can be just as dangerous, said trauma surgeon Dr. Thomas Esposito at Loyola University Health System in Maywood, Ill.

"Alcohol impairs your physical ability to walk and to drive," Esposito said. "It impairs your judgment, reflexes and coordination. It’s nothing more than a socially acceptable, over-the-counter stimulant/depressant."

A trauma surgeon for more than 20 years, Esposito has witnessed the tragic aftermath of drunken walking in his own work and family. Several years ago, Esposito’s cousin opted to walk instead of driving home from a party where he had been drinking.

"A driver, who I don’t believe was intoxicated, did not see him and hit him, and he was killed," said Esposito, who is chief of the division of trauma, surgical critical care and burns in the Department of Surgery, Loyola University Chicago Stritch School of Medicine. "They found him on the side of the road on New Year’s Day."

In 2005, the journal Injury Prevention reported that New Year’s Day is more deadly for pedestrians than any other day of the year. From 1986 to 2002, 410 pedestrians were killed on New Year’s Day. Fifty-eight percent of those killed had high blood-alcohol concentrations.

Alcohol also plays a significant role in the deaths of pedestrians throughout the year, according to the Insurance Institute for Highway Safety. In 2008, 38 percent of fatally injured pedestrians 16 and older had blood-alcohol concentrations at or above 0.08 percent, which is the legal definition for impaired driving in Illinois. The percentage rose to 53 percent for deaths occurring during 9 p.m.-6 a.m. Fourteen percent of pedestrian deaths involved drivers with BACs at or above 0.08 percent.

From July 2009 to June 2010, 105 people were treated at Loyola after being struck by cars. Fifty-five had their blood-alcohol levels checked. Of those, 16, or 29 percent, were found to have had some level of alcohol in their system. Thirteen, or 24 percent, had blood-alcohol concentrations at or above 0.08 percent.

"If they had been driving and were stopped by police, they would have been arrested for driving under the influence," Esposito said.

He added that those statistics don’t take into account the people who suffer injuries in their homes from unintentional causes and violence after drinking.

"It’s not just walking outside. We often see people who have been drinking that have fallen down the stairs or tripped at home and injured themselves. Others have unwisely chosen to ‘get into it’ with guns, knives, bottles and fists," Esposito said.

If you drink and plan to walk on New Year’s Eve, or any other day of the year, you have to take special care, Esposito said. Don’t wear dark clothing at night that can make it difficult for drivers to see you. Walk solely on the sidewalks and cross at designated crosswalks. Also, it’s a good idea to walk in a group, which is easier for drivers to spot, and try to walk with at least one person who has not been drinking, a designated chaperone or escort.

Drivers need to take extra care when in restaurant or bar districts, since intoxicated pedestrians have slower reflexes and can be unpredictable, Esposito said. People hosting parties in which alcohol is consumed have as much of obligation to watch over their guests who are walking home as they do with those who may be driving.

"You have to be able to assess someone’s perceived ability to safely get from one place to the other," Esposito said. "If their mode of transportation is a car, you do things to prevent them from driving, such as calling them a cab or finding them an unimpaired chauffeur. If that mode of transportation is their legs, then you either drive them – assuming you’re not impaired – or make them stay at home with you."

Even if a guest stays at your home, you should be aware that they could trip and fall down the stairs, Esposito said.

"So you don’t want to send them up to the second-story bedroom," Esposito said.

Unfortunately, Esposito’s cousin took none of those precautions, the surgeon said. He was wearing dark clothing, was alone and walking in the street when he was hit.

"His death has had a devastating effect on the family, especially on his parents," Esposito said. "They required a lot of professional, psychological support and they really have never been the same, especially around the holidays."


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FDA Okays Vivitrol for Opiate Addiction

Vivitrol FDA Okays Vivitrol for Opiate Addiction

In a 12-1 vote, the US Food and Drug Administration (FDA) approved the use of Vivitrol to treat addiction to opiates like heroin and prescription painkillers, ABC News reported Oct. 13.

Vivitrol, a form of naltrexone manufactured by Alkermes, is already used to treat about 10,000 patients a year for alcoholism. Though available in pill form, it is usually administered as a monthly shot, and can be prescribed by physicians.

Naltrexone works by blocking opioid receptors in the brain, ensuring that patients will not feel any effects if they attempt to use while being treated. Over time, their cravings diminish. By contrast, methadone is used as a replacement drug for opiates — users can still be addicted to it — and buprenorphine blocks some receptors, but not all. 

The FDA said it based its approval of Vivitrol on studies showing that 36 percent of those treated remained in treatment for six months, compared to 23 percent of those on a placebo. Possible side effects include depression, suicide, liver damage and a reaction at the injection site serious enough to require surgery. 

Vivitrol was approved for use to treat alcoholism in 2006, but according to an Oct. 12 CNN blog post, insurance companies generally do not pay for it. Shots cost about $1,000 each, and treatment can take over a year. According to doctors interviewed by CNN, Vivitrol is not meant to be used alone, but as part of a larger treatment plan.  

"Addiction is a serious problem in this country, and can have devastating effects on individuals who are drug-dependent, and on their family members and society," said Dr. Janet Woodcock, who directs the FDA’s Center for Drug Evaluation and Research. "This drug approval represents a significant advancement in addiction treatment."

From Join Together

See also

Doctors Not Reporting Addicted Doctors

Doctor wearing mask and goggles uid 1173626 Doctors Not Reporting Impaired Colleagues, Survey Finds

A study from the Harvard Medical School found that 17 percent of doctors knew of drunk, addicted or otherwise incompetent colleagues, but one-third said they did nothing to report fellow physicians‘ dangerous behavior, the Associated Press reported July 13.

The findings come from a 2009 survey of 1,891 doctors practicing in the U.S.

While the American Medical Association and many state laws require doctors to report their colleagues if they behave in a way that could endanger their patients, the study suggests many physicians don’t know where to turn, or believe they could suffer reprisals if they do take action.

Matthew Wynia, director of the AMA Institute for Ethics, doesn’t believe that matters. “I don’t think there’s any excuse for less than 100 percent of physicians holding true to these ideals,” he said.

Most states have retraining, intervention, and treatment programs for doctors, said the study’s author, Catherine DesRoches, but the survey indicates doctors don’t have faith in the system in place.

The research was published in the July 14, 2010 issue of the Journal of the American Medical Association.

From Join Together

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Mind-altering medications can cause birth defects

pregnant woman holding stomach Between 1998 and 2007, mind-altering medications were associated with 429 adverse drug reactions in Danish children under the age of 17. Researchers from the University of Copenhagen’s Faculty of Pharmaceutical Studies have published an article in the open access journal BMC Research Notes concluding that more than half of the 429 cases were serious and several involved birth defects, such as birth deformities and severe withdrawal syndromes.

Professors Lise Aagaard and Ebbe Holme Hansen from the University of Copenhagen studied all 4,500 paediatric adverse drug reaction reports submitted during the study period to find those which were linked to mind-altering medications. The two researchers found that 42% of adverse reactions were reported for psycho-stimulants, such as Ritalin, which treats attention deficit disorder (ADD), followed by 31% for antidepressants, such as Prozac, and 24% for antipsychotics, such as Haldol.

"A range of serious side effects such as

  • birth deformities,
  • low birth weight,
  • premature birth, and
  • development of neonatal withdrawal syndrome

were reported in children under two years of age, most likely because of the mother’s intake of mind-altering medication during pregnancy," says Associate Professor Lisa Aagaard.

Use of antidepressants is increasing

The researchers believe that these tendencies should serve as a warning to pregnant women, doctors and health care personnel.

"Mind-altering medication should not be prescribed in ordinary circumstances, because this type of medication has a long half-life. If people take their medicine as prescribed it will be a constantly high dosage, and it could take weeks for one single tablet to exit the body’s system. Three out of four pregnancies are planned, and therefore society must take responsibility for informing women about the serious risks of transferring side effects to their unborn child," says Aagaard.

There is a clear indication that use of antidepressants is increasing in Denmark, as well as in many other countries, and the tendency is the same when it comes to pregnant women.

"We are constantly reminded about the dangers of alcohol use and smoking during pregnancy, but there is no information offered to women with regards to use of mind-altering medication. There is simply not enough knowledge available in this area," concludes Aagaard, suggesting that greater control should be required when prescribing mind-altering medications to pregnant women.

From EurekAlert