Humane way to tackle addiction

Ever heard of addiction psychiatry? It’s new in the medical field. Addiction psychiatrist Dr. Sanju George loves his job and the satisfaction that he derives from it is his greatest payoff. The reason that I am sitting with Dr. George is that he recently won the ‘Hospital Doctor’ Award in the United Kingdom in his field of work.

Dr. George (and “my team”, he insists) was chosen for the award for the innovation that he brought into the treatment of alcoholics and drug addicts. Traditionally treatment for substance misuse would be provided by a specialist and what Dr. George (and his team) has done is introduced the concept of ‘shared care’. Dr. George heads ‘The Bridge’. The Bridge is the specialist drug service in Solihull, part of the Birmingham and Solihull Mental Health Trust.

Innovation is what led him and his team to evolve this system of ‘shared care’ where the General Practitioner can treat an addict rather than referring him to a specialist. “Obviously there is stigma attached to addiction treatment. GPs do not want drug addicts walking in for treatment. What we are doing is encouraging them to treat addicts. We provide training, supervision and support.” Apparently unlike here where we head straight to a specialist the moment we suspect something, there everybody has to visit a GP who then decides where the sick person should be headed. The treatment would therefore be comprehensive because the patient gets holistic care. Drug addiction is accompanied by several other problems,” says Dr. George. Besides, according to him, there are fewer stigmas attached when an addict is treated at the level of GP. Of course if things get difficult at the GP’s then the specialist team steps in and takes over.

Family involved

Humaneness is what marks the system, the understanding that there are other people – the family – involved. In a gesture seldom done in foreign countries, Dr. George has handed his mobile number to his patients and their families. “It is fairly traumatic for family members when they have to bail a family member out of jail or any other problem. It is therefore good to establish a therapeutic relationship with the family too because they too need empathy and understanding,” he says. All said and done, he admits that this is no magic formula, but this is one formula that has worked or is working although there are occasional failures.

Would a system like that work in India? “I am not qualified to make a comment on that because I am not familiar with what the system is here.”

He has been at the Bridge, based in Birmingham for the last three years. Dr George did his schooling at Rajagiri School and pre-degree from Maharaja’s College before heading to St Johns, Bangalore for his MBBS and then to the United Kingdom for higher studies where he specialised in Addiction Psychiatry.

Addiction psychiatry is in its nascence. “There is a lot of scope to do things, whether it is innovative or research.”

Coming back to his payoff? “It is as I said. The satisfaction, of course I am at a privileged position of having the time as well to spend time with my patients, of being allowed to do this.” When he is not at The Bridge, Dr. George does research and he also teaches at the Birmingham Medical School.

Working in a place where 99 per cent of the population is white, has the colour of his skin been a problem? “I have never experienced discrimination because of my race, when a patient walks in my door for treatment I don’t think my race becomes the issue,” says Dr. George. How about coming back home? Dr. George stops, pauses, thinks and says, “Maybe. Sometimes I do think about doing something for my people but there are several things that have to be considered,” he signs off.
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Overindulgence Of Alcohol Encouraged By Loud Music

Commercial venues are very aware of the effects that the environment - in this case, music - can have on in-store traffic flow, sales volumes, product choices, and consumer time spent in the immediate vicinity. A study of the effects of music levels on drinking in a bar setting has found that loud music leads to more drinking in less time.

Results will be published in the October issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

"Previous research had shown that fast music can cause fast drinking, and that music versus no music can cause a person to spend more time in a bar," said Nicolas Guéguen, a professor of behavioral sciences at the Université de Bretagne-Sud in France, and corresponding author for the study. "This is the first time that an experimental approach in a real context found the effects of loud music on alcohol consumption."

Researchers discretely visited two bars for three Saturday evenings in a medium-size city located in the west of France. The study subjects, 40 males 18 to 25 years of age, were unaware that they were being observed; only those who ordered a glass of draft beer (25 cl. or 8 oz.) were included. With permission from the bar owners, observers would randomly manipulate the sound levels (either 72 dB, considered normal, or 88 dB, considered high) of the music in the bar (Top 40 songs) before choosing a participant. After the observed participant left the bar, sound levels were again randomly selected and a new participant was chosen.

Results showed that high sound levels led to increased drinking, within a decreased amount of time.

Guéguen and his colleagues offered two hypotheses for why this may have occurred. "One, in agreement with previous research on music, food and drink, high sound levels may have caused higher arousal, which led the subjects to drink faster and to order more drinks,"" said Guéguen. "Two, loud music may have had a negative effect on social interaction in the bar, so that patrons drank more because they talked less."

In France, observed Guéguen, more than 70,000 persons per year die because of chronic alcohol consumption, and alcohol is associated with the majority of fatal car accidents. "We have shown that environmental music played in a bar is associated with an increase in drinking," he said. "We need to encourage bar owners to play music at more of a moderate level ... and make consumers aware that loud music can influence their alcohol consumption."
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source: Medical News Today

France to crack down on under-age binge drinking

France will ban the sale of alcohol to minors and drinking in public near schools as part of a broad crackdown on binge drinking among youths, the health minister said in an interview published on Sunday.

Roselyne Bachelot said that a recent study showed an over all decline in alcohol consumption among youths but the frequency of drunkenness was increasing.

"Almost half of youths said they had had five glasses of alcohol on a single night on at least one occasion in the previous 30 days, which is the definition of binge drinking," she said in an interview with Journal du Dimanche newspaper.

She said she was working on a new bill that would also ban promotions known as "open bar" which allow customers to drink as much as they want to for a fixed price.

"We are also going to ban open bars ... which are a classic at student parties and which encourage binge drinking," Bachelot said.

She said the number of under-25s hospitalised because of excessive drunkenness had doubled between 2004 and 2007.

"Drinking alcohol in public places close to schools will also be forbidden," she said.

She told the newspaper that at present there was a grey area surrounding sales of alcoholic drinks to teenagers aged 16 to 18, with different rules depending on the kind of alcohol and whether the sales point was a bar, a club or a supermarket.

She said her bill would unambiguously ban any sale of alcohol to under-18s anywhere in France.

Another measure will be to ban sales of alcohol in filling stations. Bachelot said that at present, such a ban exists only from 10 p.m. to 6 a.m. and the new rule should help curb drunk driving.

Bachelot said the measures, which she expected will come into force in 2009, would be accompanied by an advertising campaign featuring youths in a heavenly environment that turns hellish after they have been drinking.

In May, a government body in charge of fighting drug and alcohol addiction said it was considering banning "happy hours" during which bars offer cheaper drinks early in the evening to attract customers. Bachelot's interview made no mention of this.
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source: International Herald Tribune

Weighing in on the alcohol issue

The toughest question about alcohol today isn't whether to shake or stir that martini. It's whether it's going to hurt or help your health. If you've been following the news about alcohol, it's enough to give you whiplash: One study says it's good; the next says it's bad. It depends on the study's perspective. For instance, alcohol is bad for your liver and increases your risk of diseases like breast cancer. But it's good for your arteries. So there's always a tradeoff.

Still, if you're female, you might wonder if it's ever safe, thanks to recent studies that found that two daily drinks raise your risk for the most common types of breast cancer by a scary 32 percent. Three drinks a day raise these odds by 50 percent.

But then there's the healthy side of alcohol: Moderate drinking can cut your risk of cardiovascular disease by 25 percent to 40 percent. That's because the ethanol in a 1990 Bordeaux, a Bud or any other alcoholic drink increases good cholesterol and discourages blood clots. It also may have an anti-inflammatory effect on plaque. True, red wine has special antioxidants (quercetin, catechins and resveratrol) that combat the inflammation and free radicals that make a mess of blood vessel walls. But mouse studies suggest it would take about 180 bottles of red wine a day to do your vessels any good. So it's probably the alcohol that benefits your arteries. And healthier arteries mean fewer heart attacks, strokes, wrinkles, senior moments - plus better sexual function for men. What about the new study linking a glass of wine a day (wine only; not beer or liquor) to lower risks of non-alcoholic fatty liver disease, the No. 1 liver ailment in the U.S.? It's much too early to toast to that. More studies need to be done to see if the link holds up.

So should you sample that pinot noir or not? Someday, a genetic test may help you decide that. For now, here are the five best ways to get alcohol's health benefits without the risks:

1. Set your limits and stick to them. That means one-half to one drink per day for typical women and one to two for men. Men can safely drink a little more because they have an enzyme that metabolizes alcohol in their stomach lining - when most men have two drinks, only one is absorbed.

2. If you're a woman, weigh and balance. Some docs believe that women who are premenopausal, have a family history of breast cancer or are cancer survivors or are thinking about becoming pregnant simply shouldn't drink. (Definitely don't drink if you're already expecting.) On the other hand, heart disease - not breast cancer - is the No. 1 killer of women. Balance, ah, that's the key. If you're at average risk for breast cancer but high risk for ticker trouble, a drink a day might be a helpful addition to the other heart-healthy steps we know you're taking.

3. If you don't drink already, don't start. Especially if you have a family history of drug or alcohol abuse. Alcohol's risks range from addiction to overindulging enough to cause high blood pressure, strokes, heart failure, liver problems and car accidents. There are plenty of other ways to get its protective benefits against heart disease, wrinkles, memory gaps and erectile dysfunction.

The three biggies: Stay active, maintain a healthy weight and eat smart - avoid saturated and trans fats; simple sugars and syrups; and any grain that isn't 100 percent whole.

4. Think small. French fries and clothing sizes aren't the only things that have been supersized. Drinks have gotten huge, too, thanks in part to extra-large barware. Stick to official amounts: 1 glass of wine is 5 ounces (that's little); one beer is 12 ounces; 1 cocktail is 1.5 ounces of 80-proof spirits, such as vodka.

5. One a day doesn't mean seven on Saturday. Forget "saving up" your daily drinks for a weekend binge. The benefits vanish and alcohol turns toxic, aging your immune system and stressing your heart. Not to mention scrambling your ability to avoid waking up with someone you don't recognize or on a bus to Vegas.
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source: Athens Banner-Herald

Savings in alcohol, drug addiction treatment an Illusion

Nearly $18 million in state funds earmarked for alcohol and drug treatment was diverted to other uses in 2006, according to a watchdog agency report released last week.

If that sounds like a cost savings, think again.

In the same year, 1,185 men and women were sent back to prison because of probation violations. Fifty-seven percent are drug users, according to the Virginia Department of Corrections. The department expects these "technical violators" to increase to 3,000 inmates over the next five years.

This trend is one factor contributing to growth in the state's prison population, which will require Virginia to build one new prison a year for six years. Each new 1,000-bed prison will cost about $100 million to build and $25 million annually to operate.

Suddenly, an extra $18 million to help drug addicts kick the habit sounds like a good deal.

Analysts with the Joint Legislative Audit and Review Commission said the state is doing a poor job in evaluating which treatment and prevention programs are most effective, but it did find evidence that recidivism is lower among inmates who complete drug programs.

But drug treatment is not just for criminals behind bars. JLARC said few services are available for school dropouts and children of substance abusers. Adults indicated in a survey that they have trouble finding transportation and someone to watch their children so they can obtain drug treatment. Providers are unwilling to treat low-income people because the government-funded Medicaid program reimburses only a fraction of the true costs.

Drug treatment programs shouldn't be just about saving money. They should be motivated by the desire to save men, women and children from the misery of addiction. However, the financial benefits are clear. Eighteen million dollars won't solve all of the problems, but that money does nothing if it is left unused. A penny saved will cost Virginia far more in dollars and lives.
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source: The Virginian Pilot

Local authorities shirk responsibility in treatment of alcoholics

Public health officials say that people seeking treatment for alcohol abuse are clearly in worse shape than a few years ago. There are queues for long-term treatment, even though there is no actual shortage of available treatment facilities.
One problem is that municipalities are cutting costs by refusing to sign vouchers for alcohol treatment, even though doctors see an urgent need for the treatment.
Finnish drinking habits are also changing. Near teetotalers are becoming “moderate drinkers”, while former moderate drinkers are becoming heavy consumers.
“As the number of heavy consumers grows, the damage caused by alcohol accumulates on that group”, says Kalervo Kiianmaa, research professor at the National Public Health Institute. This is seen in increased pressure on public health clinics and treatment centres.
“The quantity is decisive”, Kiianmaa says. “Some have wanted to believe that by encouraging the consumption of mild drinks rather than spirits, it might be possible to reduce the harm that is caused, but in spite of this development, the damage has just increased.”

The growth in problems has also been noted by the National Research and Development Centre for Welfare and Health (STAKES), which makes an annual survey of visits to health centres in which intoxicants were involved in one way or another.
Last October's survey showed more than 12,000 such visits. In about 90% of the cases, alcohol was the drug that was used.
In the previous such assay, in 2003, the number was 10,946.
Pressure is also on home services. With older people, the use of alcohol, which might have been problem-free previously, can prove to cause problems later. The body becomes more frail, and medicines can bring surprises.

The need for longer-term treatment has increased, and there are queues for treatment.
“The shortage of money in municipalities is also a problem”, says Pekka Puska, Director-General of the National Public Health Institute. “Occasionally, existing vacancies for treatment are not utilised.”
“When a problem has emerged over years, even decades, it requires long and repeated courses of treatment”, says STAKES development chief Airi Partanen. “Unfortunately, local authorities call them into question.”
Pekka Heinälä, head physician at the A-Clinic Foundation, says that he has seen situations recently in which doctors say that the need for treatment is clear, but the municipality rejects the idea.
“Sometimes it can happen that the customer does not want any dealings with the local authorities, because the lady next door works at the municipal office.”

The threshold for seeking treatment has risen, and it can also be seen. “Those seeking help today are in much worse shape than a few years ago”, Partanen notes.
Private treatment facilities are available for those with enough money. “Their share will undoubtedly grow”, Heinälä predicts.
Now local authorities deal with more than half of the treatments of alcohol addicts. The A-Clinic Foundation handles about 40%, and private care takes care of 10%.

Failure to intervene in time can lead to cirrhosis of the liver. For researchers, cirrhosis mortality is a key indicator of the prevalence of alcohol problems in a society.
“Nobody gets cirrhosis without being an alcoholic”, says Kalervo Kiianmaa.
In 1970 there were 200 deaths of the liver disease in Finland. Now the annual death rate is about 1,000.
Not all alcoholics succumb to cirrhosis - only about one third. Nevertheless, the figures suggest that the number of alcoholics has increased at least fivefold.
In 2006, 3,049 people in Finland died of alcohol-related causes. About 2,000 deaths were attributed to diseases and accidents caused by drinking.

“Alcoholism radiates to a very wide area”, Kiianmaa says. “It also often causes a chain reaction of social problems. Drinking causes problems at work; a person is fired, which leads to economic problems, which cause marginalisation.”
“Alcoholics are also a burden on the health care system. Intoxicated people are prone to accidents, and drinking causes diseases. About 11,000 people are on disability pension because of ailments caused by alcohol”, Kiianmaa says.
He sees only one way to reduce the harm caused by alcohol: consumption needs to be reduced.

Kiianmaa proposes immediate and tough measures against youth drinking. “Now it is too easy to acquire drinks that are favoured by the young. Beer and cider are available anywhere and at any time, and young people consume them a great deal.”
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source: www.helsinginsanomat.fi