Recommitting is the Key to Long-Term Recovery from Alcoholism

By Sarah Allen Benton, M.S., L.M.H.C.


Recovery is an ongoing process and those fortunate to have long-term recovery have one thing in common- an ability to recommit themselves. It has been observed that people often get sober and as a result expect that life should go their way-a reward, in a sense, for their “good” behavior. However, that is not generally what happens. In fact, many sober high-functioning alcoholics, in particular, report that their lives often get worse before better. While this may seem unfair, it is actually a blessing in disguise- for it can ensure that the motivation to remain sober becomes internal and not based solely on external rewards. For example, a person gets sober and then receives a new job, a romantic relationship and everything external in their life takes a positive turn. Inevitably a negative situation will arise and the individual may struggle to cope and feel that there is no point to being sober because life is not going their way. In contrast, when a person is staying sober despite difficult circumstances initially, they are able to increase their distress tolerance and to realize that recovery is about slow internal growth and not dramatic external rewards. It does not matter what the conditions are in early sobriety for an individual-positive or negative, for over time difficulties will arise. It is imperative to learn how to deal with the good, bad and indifferent waves that life will inevitably bring forth.

Initially, getting sober may feel exciting, new and fresh-the world suddenly appears different and a person may feel better mentally and physically. However, this “pink cloud”, as many have labeled it, will wear off and “reality” of this lifelong venture will set in. At this time it is crucial to have a social support system in place as well as outside help for co-occurring mental health issues such as anxiety, depression, etc. (i.e., individual therapy and medication management-as needed). Getting through a difficult time while staying sober builds their “muscle” and makes the next challenge feel possible to work through. Recovery itself may start to feel mundane and tedious and it is up to the individual to take a look at all facets of their lives to see what actions they need to take in order to get back on track. This is the process of “re-committing” and it involves acknowledgement of weakness in an area(s) of recovery and then self-correcting.

There are many aspects involved in having stable recovery. Some common areas in which sober alcoholics may lose their commitment over time are:
• Attending individual therapy as recommended
• Exercising
• Obtaining proper sleep
• Maintaining balanced nutrition
• Attending regular mutual-help meeting (A.A., SMART Recovery, Women for Sobriety)
• Attending group therapy
• Staying in contact with sober peers
• Not engaging in other addictive behaviors (i.e., shopping, sex, gambling)
• Taking prescribed medication that has been assessed as necessary
• Being honest
• Pursuing spiritual practice
• Following through with daily responsibilities (i.e., work, paying bills, chores)
• Giving back to others
• Involvement in healthy relationships (friendships, family and romantic)

One pattern that can lead to relapse is, for example, not attending mutual-help meetings for a period of time and then feeling discouraged about this pattern, giving up all effort in other areas of recovery and possibly relapsing. Instead of viewing this break from an aspect of recovery as a temporary lull and then recommitting, many individuals use “black and white” thinking to judges themselves in a negative way and as a result may “give up” on sobriety. However, no one is perfect, and everyone with long-term recovery has had a time when they were lacking motivation in one area or another. The key is to observe what aspect of life is out of balance and to work on making adjustments without giving up completely. Sometimes creating small and obtainable daily goals can help a person to get back into their routine. It is important to reach out for help and to talk with others in their support network about these challenges-for no one has to be alone on this path.

Source Psychology Today

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Risk for Alcoholism Linked to Risk for Obesity

ScienceDaily


The researchers noted that the association between a family history of alcoholism and obesity risk has become more pronounced in recent years. Both men and women with such a family history were more likely to be obese in 2002 than members of that same high-risk group had been in 1992.

“In addiction research, we often look at what we call cross-heritability, which addresses the question of whether the predisposition to one condition also might contribute to other conditions,” says first author Richard A. Grucza, PhD. “For example, alcoholism and drug abuse are cross-heritable. This new study demonstrates a cross-heritability between alcoholism and obesity, but it also says — and this is very important — that some of the risks must be a function of the environment. The environment is what changed between the 1990s and the 2000s. It wasn’t people’s genes.”

Obesity in the United States has doubled in recent decades from 15 percent of the population in the late 1970s to 33 percent in 2004. Obese people — those with a body mass index (BMI) of 30 or more — have an elevated risk for high blood pressure, diabetes, heart disease, stroke and certain cancers.

Reporting in the Archives of General Psychiatry, Grucza and his team say individuals with a family history of alcoholism, particularly women, have an elevated obesity risk. In addition, that risk seems to be growing. He speculates that may result from changes in the food we eat and the availability of more foods that interact with the same brain areas as addictive drugs.

“Much of what we eat nowadays contains more calories than the food we ate in the 1970s and 1980s, but it also contains the sorts of calories — particularly a combination of sugar, salt and fat — that appeal to what are commonly called the reward centers in the brain,” says Grucza, an assistant professor of psychiatry. “Alcohol and drugs affect those same parts of the brain, and our thinking was that because the same brain structures are being stimulated, overconsumption of those foods might be greater in people with a predisposition to addiction.”

Grucza hypothesized that as Americans consumed more high-calorie, hyper-palatable foods, those with a genetic risk for addiction would face an elevated risk from because of the effects of those foods on the reward centers in the brain. His team analyzed data from two large alcoholism surveys from the last two decades.

The National Longitudinal Alcohol Epidemiologic Survey was conducted in 1991 and 1992. The National Epidemiologic Survey on Alcohol and Related Conditions was conducted in 2001 and 2002. Almost 80,000 people took part in the two surveys.

“We looked particularly at family history of alcoholism as a marker of risk,” Grucza explains. “And we found that in 2001 and 2002, women with that history were 49 percent more likely to be obese than those without a family history of alcoholism. We also noticed a relationship in men, but it was not as striking in men as in women.”

Grucza says a possible explanation for obesity in those with a family history of alcoholism is that some individuals may substitute one addiction for another. After seeing a close relative deal with alcohol problems, a person may shy away from drinking, but high-calorie, hyper-palatable foods also can stimulate the reward centers in their brains and give them effects similar to what they might experience from alcohol.

“Ironically, people with alcoholism tend not to be obese,” Grucza says. “They tend to be malnourished, or at least under-nourished because many replace their food intake with alcohol. One might think that the excess calories associated with alcohol consumption could, in theory, contribute to obesity, but that’s not what we saw in these individuals.”

Grucza says other variables, from smoking, to alcohol intake, to demographic factors like age and education levels don’t seem to explain the association between alcoholism risk and obesity.

“It really does appear to be a change in the environment,” he says. “I would speculate, although I can’t really prove this, that a change in the food environment brought this association about. There is a whole slew of literature out there suggesting these hyper-palatable foods appeal to people with addictive tendencies, and I would guess that’s what we’re seeing in our study.”

The results, he says, suggest there should be more cross-talk between alcohol and addiction researchers and those who study obesity. He says there may be some people for whom treating one of those disorders also might aid the other.

This work was supported by grants from the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse of the National Institutes of Health.

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Washington University School of Medicine.

Popping a Pill Can Help Some Alcoholics Curb Drinking

ScienceDaily (Dec. 16, 2010)


A little-used medication can help treat alcoholism, an updated review of studies confirms. At any given time, about 5 percent of the population suffers from an addiction to alcohol, often with devastating consequences to work, family, friends and health. Twelve-step programs have been the mainstay for helping alcoholics to quit drinking, but a significant number of people who try these programs do not find them helpful or suffer relapses.

The Cochrane review finds that the medication naltrexone — brand names are Depade and ReVia — when combined with counseling or interventions like Alcoholics Anonymous, can help cut the risk of heavy drinking in patients who are dependent on alcohol.

Naltrexone works by blocking the pleasurable feelings, or “high,” a person gets from drinking alcohol, thereby reducing motivation to drink. Naltrexone can be taken daily as a pill and is available as a long-acting injection.

The review was published by the Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

“Hundreds of drugs have been tried for relapse prevention [in alcoholism] and basically all others have failed,” said Michael Soyka, M.D., senior author of the review. “From a clinical point of view, there are few pharmacologic options for the treatment of alcohol dependence, so it is important to study those options that look promising.” Soyka and lead review author Suanne Roesner are associated with the psychiatric hospital at the University of Munich.

Alcohol dependence is different from alcohol abuse or misuse. The symptoms of alcohol dependence include craving for alcohol, an inability to control drinking, the presence of withdrawal symptoms if one tries to quit and tolerance — the need to increase alcohol amounts to feel the same effect. People who only abuse alcohol and are not dependent on it have no trouble controlling their drinking, once they decide to do so.

Soyka and colleagues examined the results of 50 previously published high-quality studies on naltrexone and alcohol dependence. Overall, the studies enrolled nearly 7,800 patients diagnosed with alcohol dependence. Of these, about 4,200 patients took naltrexone or a similar drug called nalmefene. The rest of the patients took a placebo or had some other type of treatment. Treatment with naltrexone ranged from four weeks to a year, with most patients receiving about 12 weeks of treatment. Most patients also received counseling.

Researchers found that patients who received naltrexone were 17 percent less likely to return to heavy drinking than were patients who received a placebo treatment. “That would mean that naltrexone can be expected to prevent heavy drinking in one out of eight patients who would otherwise have returned to a heavy drinking pattern,” Soyka said.

Naltrexone also increased the number of people who were able to stay abstinent by 4 percent.

While at first glance that might not seem like a miracle cure for alcoholism, Soyka said that the effectiveness of naltrexone is on par with medications used for other psychiatric conditions.

“Naltrexone is moderately effective in reducing alcohol intake. It’s about as effective as antidepressants in depressive disorders,” he said. “From a safety point of view, there are few safety concerns. Nausea is the most frequent side effect.”

Carlton Erickson, Ph.D., director of the Addiction Science Research and Education Center at the University of Texas in Austin, says naltrexone can help a person with alcohol dependence move toward the goal of abstinence.

“Anytime you reduce the severity of drinking, the individual is more open to treatment for abstinence,” he said. “It’s almost like putting them through a series of steps if you can get them to cut down; once they start to cut down they are more likely to become abstinent with continued treatment and continued exposure to 12-step programs.” Erickson is not associated with the review or any of its authors.

Despite its possible benefits in treating alcohol dependency, naltrexone is not widely used in the United States or elsewhere, Erickson said. Some addiction specialists fear that the widespread use of naltrexone or other medications will result in patients not receiving the counseling or psychological interventions they need.

There is also a lingering attitude that the treatment of alcohol dependency must rely solely on psychological or spiritual methods.

“People in 12-step programs typically don’t believe in medications for the treatment of alcoholism,” Erickson said. “Therefore they are unlikely to accept anyone into their 12-step meetings who is on a medication like naltrexone. Secondly, they would not want to accept it for themselves, unless a physician talked them into it as part of their treatment plan.”

In addition, most large alcohol treatment centers, with the exception of Hazelden, do not advocate for the use of medications in the management of addiction, he said.

However, Erickson said that naltrexone is FDA-approved only as an adjunct to abstinence-based therapies, like Alcoholics Anonymous. “Naltrexone is not something you give to someone who says ‘I want to stop drinking, give me a pill.’ Naltrexone is only a helper to that process. The medication itself is not a magic bullet.”

The review discloses that two authors received speaker/consultancy/advisory board honoraria from pharmaceutical companies.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Health Behavior News Service, part of the Center for Advancing Health. The original article was written by Katherine Kahn

Italian Youths Who Drink With Meals Are Less Often Adult Problem-Drinkers

Underage Drinking
Underage Drinking

Italian youths whose parents allowed them to have alcohol with meals while they were growing up are less likely to develop harmful drinking patterns in the future, according to a new study led by a Boston University School of Public Health (BUSPH) researcher.

In a paper published in the journal Addiction, Research and Theory,a research team led by Lee Strunin, PhD, a professor of community health sciences at BUSPH, detailed their study of the drinking patterns and histories of 160 Italian adolescents and young adults who identified themselves as regular or heavy drinkers. The authors concluded that the introduction of a moderate amount of alcohol in a family setting could prevent young people from binge drinking and nurture healthier drinking behaviors.

“Young people allowed alcohol with meals when growing up were more likely to never drink 5 [or more drinks] or get drunk,” the authors wrote. If they did drink more heavily, it was typically at a “later age than participants who weren’t allowed alcohol in a family setting.”

The researchers interviewed two groups of young people in the Italian regions of Abruzzo and Umbria. One consisted of 80 young adults aged 25-30; the second consisted of 80 adolescents, 16 to18 years old. “We were fortunate to be able to have such a large study sample to interview to help us understand this phenomenon,” said Strunin.

Although the results focused on Italy, Strunin said they could be applied to different countries and could “assist in the design of policies to reduce alcohol problems and harmful behavior among young people.”

Other reports have also suggested that alcohol introduced in a family setting may reduce alcohol-related risk behavior among young people, according to Strunin. Part of the reason, she said, could be that when alcohol is allowed, it is in a context in which there is openness about drinking, and moderate drinking with meals is considered normal.

“Youths in these cultures learn to drink more responsibly than their U.S. counterparts because drinking is culturally normative, exposure occurs at a younger age, and alcohol is part of the fabric of family mores,” said the report.

It is important to note, the authors wrote, that the study focused on youths and young adults who drank wine during a meal with their family. “In talking about drinking in the family, we are talking about meal drinking, not sitting down with your child watching the football or baseball game with a six-pack,” Strunin said. “The wine drinking is part of the meal.

In addition to Strunin, co-authors of the study are: Kirstin Lindeman of BUSPH; Enrico Tempesta and Simona Anav of Osservatorio Permanente sui Giovani e l’Alcool, Rome, Italy; and Pierluigi Ascani and Luza Parisi of Format Research, Rome, Italy.

Funding for this study came from a grant from the National Institute of Alcohol Abuse and Alcoholism.

Story originally published at: http://www.sciencedaily.com/releases/2010/08/100819112224.htm