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Archive for the 'Medications and research' Category

Drinking May Raise Cancer Risk in Women

Posted by Roberta Jewell
Categories: Medications and research

New research from Georgetown University supports the existing theory about a relationship between drinking alcohol and increased risk of breast cancer. For women predisposed to a specific type of breast cancer (estrogen or progesterone receptor positive) this may mean that drinking moderate amounts of alcohol is hazardous.

In the study over 184,000 post menopausal women were followed for an average of seven years. The research team found that those who had less than one drink a day had a seven percent increased risk of breast cancer compared to non-drinkers. According to study results, women who drank one to two drinks a day had a 32 percent increased risk and those who had three or more glasses of alcohol a day had up to a 51 percent increased risk.

Researchers agree that results are preliminary and more studies are needed to prove a cause and effect link. But women with a familial history of breast cancer may want to take heed and weigh the benefit and risk of moderate drinking.

To learn more click here.

Our experience with Chantix to reduce alcohol cravings

Posted by Roberta Jewell
Categories: Medications and research

We’re following research on the prescription drug Chantix (varenicline) with great interest because it seems to be effective in curbing cravings for alcohol. Chantix was approved by the FDA for smoking cessation in May 2006 and is sold under the name Champix in Europe.

Chantix works by blocking specific activity in the brain associated with nicotine acetylcholine receptors, or nAChrs, which play an important role in both nicotine and alcohol dependence.

I’ve been getting a lot of information in about this medication over the past year or so. Doctors with whom I work have reported that their patients, when prescribed the medication for smoking, consistently lose their appetite for alcohol. And, as expected, we’ve had a bit of discussion about this drug on the My Way Out forum, where members post questions and feedback about all facets of our program, including ant-craving meds.

To see those post, visit the links below. Keep in mind, messages are unmoderated and represent the opinion the members who write them. However, anecdotal information is often a good starting point for gathering information.

Chantix messages at My Way Out forum:
Has anyone tried Chantix for alcohol?
Chantix may cause psychiatric risks
Chantix, not just for smoking cessation
Anyone on Chantix, anti smoking pill?

Anti-craving meds can be extremely beneficial in interrupting reward circuitry in the brain that drives people to drink excessively. Used in conjunction with a multi-faceted therapy to include counseling, support, nutritional improvements and other lifestyle changes, these drugs can provide a powerful jump-start to a successful recovery program. Chantix is not approved for alcohol dependence, but many people urge their physicians to prescribe medications off-label when compelling evidence is presented about their efficacy. However, it’s critical that anyone considering Chantix for a drinking problem tell their health care provider about past psychiatric issues if they exist and be monitored carefully for changes in behavior once they start taking it.

Exciting developments are underway in the field of addiction medicine, but many of the drugs now prescribed are new to the market As with any medication, you’ll want to evaluate potential side effects and keep a careful eye on how you’re feeling once you begin taking them.

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Addendum: This recent article by New York Magazine writer Derek deKoff serves as an important lesson in how Chantix affects some individuals.

Advice from the addiction doc

Posted by Roberta Jewell
Categories: Medications and research

Dr. Linda Garcia, Medical Director, My Way OutDr. Linda Garcia, MD, Medical Director of My Way Out, specializes in addiction medicine and has provided treatment to hundreds of alcohol dependent patients. As we move into New Year’s weekend she offers specific tips about how to prevent relapse in the face of holiday triggers.

Look here for her five minute audio interview and associated article.

Baclofen a promising and safe anti-craving medication

Posted by Roberta Jewell
Categories: Medications and research

We’ve been following the drug Baclofen with some interest. The research reported below is very promising, especially for anyone who’s concerned about taking an anti-craving medication like Naltrexone, which is contraindicated for those with impaired liver function. You may remember reading earlier research about an MD who self prescribed baclofen and went on to publish his findings. That article is here.

Baclofen Aids Abstinence in Alcoholics With Cirrhosis
Study finds drug’s anti-craving action, safety could play role in liver treatment

Posted 12/7/07 FRIDAY, Dec. 7 (HealthDay News) — The drug baclofen promotes alcohol abstinence in alcoholics with cirrhosis of the liver, says an Italian study in this week’s issue of The Lancet.The study included 84 alcohol-dependent patients with liver cirrhosis who received either oral baclofen (42 patients) or a placebo (42 patients). Total alcohol abstinence and duration of this abstinence were assessed during outpatient visits. Relapse was defined as alcohol intake of more than four standard drinks per day (a standard drink defined as equal to 12 grams of absolute alcohol) or overall consumption of 14 or more standard drinks per week over a period of at least four weeks. Among those taking baclofen, 71 percent (30 of 42 patients) achieved and maintained alcohol abstinence, compared to 29 percent (12 of 42) of those who took the placebo. The study also found that patients taking baclofen abstained from alcohol for more than twice as long as those taking the placebo — 62.8 days vs. 30.8 days. More…  

We’ve come a long way in two years

Posted by Roberta Jewell
Categories: Medications and research

It’s been interesting, this past week, watching the plethora of news stories roll in about Topamax and its potential for treating alcohol dependence. Patients of the My Way Out program have known about this for over two years. I based my book and the therapy I developed around Dr. Bankole Johnson’s 2003 clinical trial as published in The Lancet. It’s always puzzled me that outside of our program and the esoteric work of addiction specialists, his original breakthrough study didn’t gain more notoriety among physicians and their alcoholic patients. We’ve found it to be an extremely effective medication for many alcohol dependent individuals, particularly when it’s used in the context of a multi-faceted program with nutritional supplementation, exercise, behavior modification and support.

So…fast forward four years and here we are. Topamax, does indeed curb the desire to drink. In the meantime, other medications including Campral, Revia, Acomplia, Baclofen and Chantix have also been introduced and found helpful.

Research takes time. I get that. I understand it’s important we adopt rigorous standards when testing new meds. We need to ensure objective results and safeguard those who will eventually trust their health to those remarkable little pills that dance on the receptors of our mid-brains.

But like many people, I wanted results faster than science was willing to offer. It’s one of the reasons I grabbed the research at hand and ran with it. I mixed it up with some rather non-traditional strategies–at least at the time–and incorporated elements from the far East, including kudzu, an herb known by practitioners of Traditional Chinese Medicine. They’d used it for hundreds of years to blunt alcohol craving, so I did too. It has since been proven effective in human studies in the west and is only one of several important nutritional supplements to help detoxify and heal the body while addressing addiction.

I looked also at what holistic medicine had to offer and added hypnotherapy to the program. It’s a powerful tool in overriding old habits while overpowering drinking triggers. Exercise and nutrition were equally important as elements of this newfangled system.

Then came the technology. The online forum. The place to meet for those lab rats brave enough to try all this out. It’s also where much of the magic happens. Even a traditional alcohol recovery counselor will tell you that success in sobriety is very much dependent on a support system. Thousands of people from around the world have found that very thing at My Way Out’s message board and I’m very proud of what happens there each and every day. The support, camaraderie and information sharing are unparalleled.

Our members are often individuals who will not attend face-to-face 12-step meetings. For them, we offer a safe, anonymous and supportive alternative. That is not to say our site is mutually exclusive of local meetings or sponsors. Those are often lifelines for individuals in recovery and in fact, our members sometimes encourage others to seek help at a community AA or Women For Sobriety meetings. We are all about choice.

So what’s next? I certainly have no shortage of ideas. The same is true of Dr. Linda Garcia, MD, the Medical Director of My Way Out, who is called upon to speak about the program, and does so throughout the United States. We have found that health care providers are eager to learn about effective new strategies in addiction treatment, particularly those that are inexpensive and easily managed. This is certainly the case for MWO, which can be administered by any prescribing clinician.

I’ve learned much since writing My Way Out, and to be honest, I do not aspire to write another book (having never aspired to write the first!) because the process simply takes too long. But I do have much to say.

My goal is to continue to refine the MWO program to help ensure individual success for everyone who seeks help by it. I want to provide specific resources in terms of research, motivation, products, and guidance that will not only give people hope that they can overcome their alcohol dependence, but will guarantee their success. We don’t use that word–guarentee–in this “industry”. It’s not allowed. But I don’t care. Because I think we have to continue breaking rules if we want to win this battle. We have to see ourselves healthy and know it will happen before we take that very first step. In my heart, I am convinced that is just as important as any pill that any company will ever develop.

If you don’t believe me, just go to the forum and read the posts of those who have followed the program, or modified it to their needs, and take note of those who are now posting about their success. Notice their user names. Observe their “mood” icons. Read those messages. Feel that energy. You’ll see a pattern, I promise.

That’s not something I wrote about in my book. But it’s equally important. Those individual teach all of us something. And they reminds us of just how far we’ve really come.

It’s time to change the label

Posted by Roberta Jewell
Categories: Medications and research

labelLabeling someone is usually not politically correct, but occasionally it can help debunk an old stereotype. Take alcoholics for example. Until now, conventional treatment for alcohol dependence has been centered around 12-step programs, in-patient care, or a drug that makes you throw up. These strategies have been considered the most effective in helping the typical alcoholic — that middle aged, late stage drinker — in overcoming his or her battle with the bottle. Problem is: most alcoholics don’t fit that mold.

New research from the National Institute on Alcohol Abuse and Alcoholism has identified five alcoholic subtypes. It turns out chronic, late stage alcoholics represent less than ten percent of the overall alcoholic population. In a nutshell, here’s what researchers found:

“The young adult subtype accounts for about 32 percent of U.S. alcoholics. They’re young adults who rarely seek help for alcohol dependence. About 24 years old, they became alcoholics by age 20, on average. They drink less frequently than other alcoholics, but they tend to binge drink when they drink. This is the largest subtype.

The young antisocial subtype comprises 21 percent of U.S. alcoholics. They are 26 years old, on average. More than half have antisocial personality disorder. They tended to start drinking at 15 and became alcoholics by 18 — earlier than other subtypes. They are more likely to smoke tobacco and pot. The young antisocial subtype and the young adult subtype don’t overlap, Moss tells WebMD.

The functional subtype accounts for about 19 percent of U.S. alcoholics. They’re generally middle-aged, working adults who tend to have stable relationships, more education, and higher incomes than other alcoholics. They tend to drink every other day, often consuming five or more drinks on drinking days.

The intermediate familial subtype makes up nearly 19 percent of U.S. alcoholics. Nearly half have close relatives who are alcoholics. Alcoholics in this subtype typically began drinking by 17 and became alcoholics in their early 30s.

The chronic severe subtype is the rarest subtype, accounting for about 9 percent of U.S. alcoholics. This subtype mainly includes men, has the highest divorce rate, and frequently includes users of illicit drugs.”

Study author Howard Moss, M.D., agrees that in all cases, “alcohol dependence must be viewed as a severe disease with a significant adverse impact on health and well-being.”

We’re glad to see these distinctions identified so appropriate care can be provided. Many young adult, middle age, and highly functional alcoholics visit our website and join our program. As a general rule, they have refused conventional treatment because they don’t feel they fit the stereotype of a traditional alcoholic. Many categorically reject existing options which force them to quit drinking completely or attend meetings that offend their sensibilities. So the downward spiral continues.

Interestingly, once those same individuals begin a course of customized therapy, many ultimately decide they want to eliminate alcohol from their lives forever. They gain control, insight, and support on their path to health. Some even follow up with fellowship based meetings in addition to the free online support we provide. But they’ve begun a program of healing with a therapy tailored to their needs. No more cookie cutter assumptions about what defines an alcoholic or how best to treat them.

Vivitrol continues to perform

Posted by Roberta Jewell
Categories: Medications and research

Vivitrol

John started drinking as a teenager, stealing booze from his parents’ liquor cabinet. Once he became an adult, his problem only worsened, ultimately wreaking havoc on his personal and professional lives.  

“I was staying out late, coming home drunk,” said John, 62, a married Bergen County, N.J., businessman who requested that his last name not be used.

Today, John says, he hasn’t touched a drink in almost six months. And he points to his backside while making that declaration of sobriety.

Once a month, John receives a shot in his buttocks that seems to turn off his craving. Vivitrol is the first-ever injectable medication for alcohol dependence.

Approved by the federal Food and Drug Administration in April 2006, Vivitrol is an injectable version of an oral medication — naltrexone — which has been used for more than a decade.

Doctors think Vivitrol works by blocking neurotransmitters in the brain associated with alcohol dependence.

Some patients who have tried to drink while taking the injections no longer report a “buzz.”

It’s not right for everyone

“One of my patients said it was like drinking lemonade,” said Sharad Wagle, chief of psychiatry at Holy Name Hospital in Teaneck, N.J.

Raye Litten, associate director of the Division of Treatment and Recovery Research at the National Institutes of Health, said that though Vivitrol won’t work for everyone, “it gives clinicians a greater menu of medications to choose from.”

Some addiction specialists are giving it even higher marks.

Because the shot is given in the privacy of a doctor’s office and the effects in the body last the entire month at an accepted therapeutic range, the social stigma associated with being an alcoholic is virtually removed, they say.

“It legitimizes the disease, and you don’t have to feel demoralized,” said Hugo Franco, a staff psychiatrist at the Carrier Clinic, an addiction treatment facility in Belle Mead, N.J.

Even when people do reach out for help, they can still be resistant to treatment, said Jeffrey Berman, president of the New Jersey Society of Addiction Medicine. “Patients might fill the prescription, but then it winds up sitting in the medicine cabinet.”

Of 24 patients he has treated with Vivitrol, 12 have remained off alcohol.

Six others relapsed and are no longer in treatment.

Six others “binged” but immediately got back into treatment, he said.

“It’s not a silver bullet,” Berman said.

Tempting environments

Since John started getting his shots, he reports, he has been in plenty of situations where he might have been tempted to drink. He even admits he has a “burning desire” to try it just to see what happens, but he doesn’t yet feel he’s strong enough. 

“I have been in bars and at parties where I talk it (Vivitrol) up while I’m drinking club soda and lime,” he said.

One day, John hopes to stop the injections.

“I’m almost over the hump,” he said.

John’s doctor, family physician and addiction specialist Aleksandr Martirosov, who practices in Fair Lawn, N.J., says most of his patients are giving him positive feedback: “They say it’s working.”

Making gains over hair loss

Posted by Roberta Jewell
Categories: Medications and research

hair loss

As anti-craving medications become more widely accepted in treating alcohol dependence, dealing with potential side effects plays an increasingly important role. It’s one of the reasons we urge everyone to work closely with a qualified health care provider. 

One of the most popular drugs many drinkers have sought over the past couple of years to help curb craving is Topamax and it appears to do a pretty good job. But like any powerful medication, it has a down side: a lengthy list of potential side effects. It includes a lowered bicarbonate level in the blood which can lead to hyperventilation, irregular heartbeat and kidney stones; a rare form of glaucoma; cognitive slowing; sleepiness; weight loss; tingling in the extremities; flu-like symptoms; and other possible problems. The list may sound terrifying, but anyone who understands the the horror of addiction realizes it may pale in comparison to the self loathing of a mother whose young daughter admits to pouring her vodka down the drain in a futile attempt to save her.

Patients and members on our message board often complain about the cognitive slowing associated with Topamax and I consider it to be the most common and problematic of all side effects. But another one reported more ‘on the board’ than in the literature is this: hair loss or thinning.

In fact, I experienced some hair thinning myself and found it a little disturbing (although to be honest, I was somewhat stressed at the time, so wasn’t sure if it was caused by the meds.) Brenda, whose journals were included in my book, also reported changes to her hair, but only to texture. Neither one of us found ourselves devastated by significant hair loss like some women. And ours eventually passed.

But last week, I was interested to read that the FDA had approved a product to promote hair growth and I’m wondering if it may help those in our program who suffer with this problem. The device is purported to work by combining a laser with a comb and emit low-level pulses to stimulate hair growth. In a 26-week clinical trial, some 93% of the participants using this Hairmax Lasercomb saw an increase in hair density, with an average increase of 19 hairs per centimeter.

Recommend usage is 10-15 minutes three times a week and it is currently only approved to “promote hair growth in males with androgenetic alopecia”, although a number of testimonials on the company’s website include those of women who say they have enjoyed success with the product.

One would certainly hope so. Customers pay $545 for this wondercomb!

But for those who are devastated by hair loss, it may be worth every penny. I was interested to read feedback, both good and bad, on the company’s message board and they seem to be fairly liberal about allowing customers to post their experiences about the device. (I note that it is a moderated forum, which means administrators must approve each post. I know this because one of our members told me she recently registered there and was awaiting approval for her question regarding hair loss due to Topamax.)

A recent MSNBC story about the HairMax Lasercomb with video is here and a reference to an earlier piece they produced is listed on About.com.

Time will tell as to whether or not the Hairmax is effective and if people are willing to pay such a hefty price to restore their hair.

If so, it may be helpful to some who are ready to be done battling yet another indignity of the addiction.

Defining our terms

Posted by Roberta Jewell
Categories: Medications and research

Tara Conner, Miss USAI’m not sure why I continue to find the interviews with the new Miss USA, Tara Conner, a little distasteful, but I think I’m closing in.

You may recall after some hard partying she nearly lost her crown; then agreed to a month-long rehab stint after a talk with the Donald, who co-owns the pageant. I completely believe her when she says she’s come clean. I am moved by her honest account of dealing with her demons. And I know she means it when she says she’s in a much better place.

I suppose what’s bothersome is this new, conspicuous characterization of the 21-year old Kentucky beauty. It sounds so steeped in traditional recovery dogma and it feels to me like the queen has been made a bit of a pawn.

“I didn’t think I had any kind of issue going into rehab,” she was quoted as saying recently, “but I’ve realized I do have an issue. I suffer from the disease of alcoholism and addiction.”  

So of course the headlines scream “I am an alcoholic!”

In fact, I had a tough time with this one when I wrote my book. Was I an alcoholic? A problem drinker? Alcohol dependent? Excessive drinker? Which was it?

As I said, in the end it really didn’t matter that much – I just wanted to fix it. But for a number of reasons, I simply couldn’t bring myself to stand in front of a room full of strangers and pin that tag on my shirt. For one thing, I wasn’t sure if it was medically and therapeutically valid. And emotionally, the thought of branding myself scared the hell out of me. Or perhaps I simply wasn’t as brave as others who have done so. I admire their courage.

But a new study, as reported in Science Daily, may support the position that many drinkers have been misclassified – and I assume, directed to improper treatment. The research reveals that binge drinking is the most prevalent form of excessive drinking and many alcohol related problems may be a result of drinking among people who are not, in fact, alcoholics. They point to a study in the February 2007 issue of Alcoholism: Clinical and Experimental Research in which 16.5% of 4,751 New Mexico adults were considered excessive drinkers, but only 1.8 percent of them met the criteria for alcohol dependence.

According to the National Institute on Alcohol Abuse an Alcoholism, alcoholism is defined by an individual’s continued drinking despite repeated alcohol-related problems. Specifically, it is measured by symptoms which include craving, impaired control, physical dependence and tolerance. More formal diagnostic criteria have been developed, as well.

In response to the recent study, Tim Naimai, a physician with the alcohol team at the Centers for Disease Control & Prevention, says we must recognize and address excessive drinking, in addition to alcoholism, if we are to prevent most alcohol related problems, including alcoholism.

“Focusing exclusively on alcoholism will identify only a small percentage of those at risk of causing or incurring alcohol-related harms, precludes the possibility of prevention, and is very costly, at least on a per-person basis,” says Naimai.

And then there’s treatment. How helpful, say, is a 12-step program to an individual whose binge drinking is tied to episodes of spousal abuse? Anger management classes, perhaps. But AA? Maybe, maybe not. Or a person who binge drinks to blunt depressive symptoms – perhaps they would be better served with a program of pharmacology, counseling and improved diet than forced to an in-patient facility away from their home and support network.

In the end, if Miss America is satisfied with her treatment and is empowered to lead a healthier, more productive life while setting a good example for others, it’s all worked out for the best. I mean that. I am in no position to judge whether or not she was a binge drinker or a true alcoholic.

And me, three years later, I freely admit that I am, in fact an alcoholic, not a binge drinker. I do (did) meet the criteria. Among other things, I drank to excess every night, had developed a tolerance for alcohol, and was powerless to control the craving.

I had a lot to lose before I got help – not a crown, certainly – but equally important to me: my family, my health, my career, my self respect. Thankfully, I wasn’t forced into rehab as many people are. I found something that worked well for me and my drinking is now in check.

I absolutely encourage others to attend fellowship based meetings or consider rehab if they’re willing and comitted to doing so. Both have been immensely helpful to millions of people.

Whatever the path, it’s important we expand our thinking about alcoholism and how we define it. How we define ourselves.

And I think it’s great to see new research is helping us do just that.

committed

Catching up on Campral

Posted by Roberta Jewell
Categories: Medications and research

campralI haven’t written much about Campral, an anti-craving medication approved by the FDA in July, 2004 for treatment of alcohol dependence. It’s been prescribed in Europe, Canada, Australia and other countries and is growing in popularity in the US. We get a lot of questions about Campral at our discussion board as members prepare to approach their docs. They want to know: does it work? What are the side effects? How does it compare to other meds? Does it take long to kick in?

Here are a few observations I’ve made from MWO patients and members who have shared their experience:

  • At this time, it’s generally easier to get a prescription for Campral than other anti-craving meds. Topamax requires off-label prescribing and some physicians are simply uncomfortable doing that. Vivitrol (injectable naltrexone) hit the market only recently and many doctors don’t know about it. Oral naltrexone (ReVia) doesn’t seem to be prescribed very much for some reason.
  • Campral is well suited for those who plan to pursue complete abstinence from alcohol and haven’t had anything to drink for at least a few days.
  • If you begin drinking while on it, Campral loses its efficacy pretty quickly.
  • Patients sometimes complain of diarrhea, gas, and stomach discomfort when taking Campral. This side effect is said to be dose specific.
  • Campral kicks in fairly soon for most people.
  • Many patients find Campral quite effective. One clinical trial suggested people who took Campral were two or three times more likely to achieve abstinence a full year later than those who took a placebo.
  • Others say they were not able to be compliant while on Campral and found other medications (usually Topamax) more effective. Some research supports these findings, however, there are differing views within research circles about the study design in some of the clinical trials.
  • Side effects are often considered less harsh for Campral than Topamax.
  • People who do drink while on Campral report getting drunk faster and feeling more hung over the next day.
  • Campral can be used in combination with naltrexone.
  • Like other anti-craving medications, Campral is most effective if used in conjunction with counseling and/or support. Patients who adopt multiple strategies tend to have greater long-term success.

So just how does Campral work?

According to manufacturer Forest Labs’ website, “Campral is thought to restore the normal brain balance, which has been disturbed in someone who is alcohol dependent.”

Hmmm. I don’t know if that’s terribly helpful, but I would certainly agree that our brains are disturbed once we’ve become alcohol dependent.

To be more specific, Campral targets and helps restore balance in two important neurotransmitters: glutamate and GABA. Glutamate is an excitatory transmitter and GABA is inhibitory. They have a see-saw type of relationship. GABA and glutamate receptors are also involved in the reward centers of the forebrain and are responsible for creating a system of positive reinforcement. But when a person chronically overdrinks, as we do, it depletes GABA functioning and results in a hyperexcitable glutamate system.

Drinkers feel great while they’re drinking. But the short-term buzz eventually ends up throwing the entire system off. And when alcohol is removed from the equation, the brain is left with way too much glutamate activity. This causes discomfort, anxiety and eventually an endless craving for alcohol.

Enter Campral, which helps restore the GABA-glutamate equilibrium by acting specifically on receptor sites tied to the alcohol reward signaling center. Or, as Forest Lab explains, again at third grade level, it “makes it easier for people not to drink.” Got it.

Campral is prescribed in two 333 mg. time-release tablets, taken three times a day with food or on an empty stomach. It should be used with caution if you have kidney problems and will not be prescribed if you have severe kidney disease. The medication cost about $150 a month. The package insert is here if you like reading the teeny weeny print.

By the way, if you have questions for those currently taking Campral, be sure to visit our online community. I’m not plugging our message board, but I think you’ll find some really good info because many of our members have tried a couple of different meds, including Campral, and they’re very generous about sharing their experience. You can simply enter the term “Campral” in the search field and you’ll find dozens of posts with lots of rich info, as well.

Do keep in mind that anti-craving medications target different brain receptors and how they work depends on a number of variables. So you won’t really know until you get started how effective they will be for you.

But there’s no time like the present to begin. Who knows, Campral may be just be what your doctor should order.