Tuesday, January 29, 2008

The Jigsaw Puzzle of Addiction

ScienceDaily (Jan. 7, 2008) — Using an integrative meta-analysis approach, researchers from the Center for Bioinformatics at Peking University in Beijing have assembled the most comprehensive gene atlas underlying drug addiction and identified five molecular pathways common to four different addictive drugs.

Drug addiction is a serious worldwide problem with strong genetic and environmental influences. So far different technologies have revealed a variety of genes and biological processes underlying addiction. However, individual technology can be biased and render only an incomplete picture. Studying individual or a small number of genes is like looking at pieces of a jigsaw puzzle - only when you gather most of the pieces from different places and arrange them together in an orderly fashion do interesting patterns emerge.

The team, led by Liping Wei, surveyed scientific literature published in the past 30 years and collected 2,343 items of evidence linking genes and chromosome regions to addiction based on single-gene strategies, microarray, proteomics, or genetic studies.

They made this gene atlas freely available in the first online molecular database for addiction, named KARG (http://karg.cbi.pku.edu.cn), with extensive annotations and a user friendly interface.

Assembling the pieces of evidence together, the authors identified 18 molecular pathways that are statistically enriched in the addiction-related genes. They then identified five pathways that are common to addiction to four different substances. These common pathways may underlie shared rewarding and response mechanisms and may be targets for effective treatments for a wide range of addictive disorders.

Journal citation: Li CY, Mao X, Wei L (2008) Genes and (common) pathways underlying drug addiction. PLoS Comput Biol 4(1): e2. doi:10.1371/journal.pcbi.0040002

Adapted from materials provided by Public Library of Science

Friday, January 25, 2008

Alcoholism and Hypoglycemia

Scientists at the leading Swedish medical university Karolinska Institutet have now disclosed the mystery how alcohol may cause exaggerated insulin secretion resulting in severe hypoglycemia (too low blood sugar). This mechanism, which is described in the latest number of Endocrinology, explains how alcohol ingestion may harm the human brain by decreasing the blood glucose concentration to inappropriately low levels.

Hypoglycemia induced by alcohol ingestion is a well known clinical problem in diabetic patients. However, the mechanisms underlying this phenomenon have largely remained elusive. Since insulin secretion can be rapidly tuned by changes in pancreatic microcirculation, scientists at the Stockholm South Hospital Diabetes Research Center, Karolinska Institutet, evaluated the influence of alcohol administration on pancreatic islet blood flow and dynamic changes in insulin secretion and blood sugar levels.

"We have now found that alcohol exerts substantial influences on pancreatic microcirculation by evoking a massive redistribution of pancreatic blood flow from the exocrine into the endocrine (insulin-producing) part via mechanisms mediated by the messenger molecule nitric oxide and the vagus nerve, augmenting late phase insulin secretion, and thereby evoking hypoglycemia" says lead investigator Åke Sjöholm.

According to Professor Sjöholm the discovery is very important. This novel mechanism may in part underlie the well known hypoglycemic properties of alcohol in diabetic patients or in alcoholics with hepatic failure.

Investigators note that their study might also be relevant to "the derailed metabolic situation in diabetic subjects." Alcohol intake might provoke sustained hypoglycemia in type 2 diabetes patients being treated with hypoglycemic sulfonylureas, such as glibenclamide, because many of these drugs have a long biological half-life. Furthermore, many alcoholics are malnourished and/or have liver cirrhosis and might therefore be unable to mount a gluconeogenetic response to hypoglycemia, Professor Sjöholm says.
Source: http://www.medicalnewstoday.com/articles/93141.php

Wednesday, January 23, 2008


"Forgiveness: It Just Ain't Fair"
by Philip Yancey
Once my wife and I were having a rather animated discussion and she turned to me and said, "You know, I think it is pretty impressive that I forgave you for some of the dastardly things you have done."

I know what you probably want me to talk about. You probably want me to tell you about those dastardly things that I've done, but I am not going to do that tonight. We are not talking about sins; we are talking about forgiveness.

As I thought about my wife's comment, I realized that she had come up in the middle of a heated exchange with a rather profound theological insight. Sometimes when you say a word like forgiveness, we think it is nice and sweet. It is like spraying perfume, but forgiveness isn't like that. It's hard; it's tough. It is one of the hardest things we ever have to do. As I thought about it, I realized that even when you forgive someone it is easy to still hurt, to still feel the sting. In a real sense, forgiveness just ain't fair.

Sigmund Freud said, "One must forgive one's enemies but not before they have been hanged." That's natural. That's fair. That's how many of us feel. It is kind of a law of nature. It is what works on the National Football League playing field. It is what works in nature. You don't have cats turning around and saying to dogs who are chasing them up a tree, "I forgive you." You don't have dolphins saying to the shark, "We forgive you for eating our playmates." It is a dog-eat-dog world out there, not a dog-forgive-dog world.

If that is the world of nature and if that is kind of instinctive to us, why is it that our faith and our Bible and God ask us to make forgiveness at the core of what we believe? I've thought about this.

Many of us pray every day, as I did this morning in church, The Lord's Prayer, "forgive us as we forgive others." It's at the core of our religion and yet it is not fair. It hurts. It is not easy to do. Why would God want us to do something that is so unlike what our instinct is, that is so unfair. I came up with three reasons that I want to share with you today.

The first reason is that forgiveness is the only way to break the cycle. You are right. It is not fair. If you want a fair religion, I would suggest that you become a Hindu because the Hindus have a very clear way of taking care of everything. It is called incarnation. If you have done many things wrong, the Hindu scholars tell us, it may take as many 6,800,000 incarnations for those things to all work themselves out. You have to realize the punishment in this life is for something you did in a former life.

I have noticed that sometimes marriage is a little bit like Hinduism in that respect. A husband says to a wife, "Why didn't you remind me that it was my mother's birthday?"

The wife says, "Wait a minute. It is your mother. Why am I supposed to remind you?"

The husband says, "Yes, but you are in charge of the calendar."

They go back and forth, back and forth, tit for tat about 6,800,00 times until finally somebody says, "Stop. This can't go on. We have got to break the cycle. I am sorry. Forgive me. I know it's not fair; I know I may be wrong. Forgive me. I'm sorry."

If we don't do that, you get a situation like we are seeing right now on a national scale in Yugoslavia. If you read the words that are coming out of Yugoslavia, one group says, "We don't like the way you treated us in World War II."

That group says, "We don't like the way you treated us in the eighteenth century."

The other group says, "We don't like the way you treated us in the fourteenth century."

It goes on and on and on and on until somebody says, "Stop. I am going to break the cycle." Forgiveness is the way to break that cycle.

I saw a tremendous example of forgiveness in operation a little over a year ago when I went to Russia, which was at that time still the Soviet Union. I was privileged to be with a group of Christians and we went and visited the headquarters of the KGB. The interpreter for that group was a Christian evangelist. He is Russian by birth but his family had to leave when he was seven years old. They were chased out of the country. His uncle was killed. He had relatives who were put in a concentration camp.

Here was an older man who had his radio programs blocked for years, jammed by KGB jamming devices, who had his visas turned down for years. He couldn't visit Russia. Now he was translating for the number two man in the KGB, who was a ramrod straight army colonel.

The KGB colonel went ahead and said, "Before there can be perestroika in our country, there has to be a stage of repentance. We have done many things wrong and we must repent for them."

The interpreter, Alex Leonovich, who is a huge bear of a man, turned to him, broke his interpretation and said, "Colonel, Jesus told us how to respond when someone repents. In the name of Christ, in the name of my family, in the name of my uncle, I forgive you for what your organization did to me."

Then we saw the amazing scene of this big bear of a man, a Russian evangelist, reaching over to a ramrod straight KGB colonel and embracing him in a huge, Russian bear hug. We could see whispers going on. We didn't know what they said until later Alex told us. The KGB colonel said, "Alex, only two times in my life have I cried. Once was when my mother died and once was tonight."

That was the power of forgiveness, a way to break the chain that can go on and on and on. It's not fair, but it breaks that chain.

There is a second reason why I believe God asks us to forgive and that is it breaks the stranglehold in you and in me, not just the stranglehold on the relationship, but the stranglehold in us.

I have seen that acted out on stage, as many people have, in the most popular musical in recent times. It is a musical based on a novel by Victor Hugo, Les Miserable. In that musical, there is a wonderful story of a convict who was a hardened, mean man and had been in jail for ten years, doing hard labor in chains.

He was finally set free, but he had a convict card. He couldn't get a job; he couldn't even stay in a hotel room. He went to a bishop's house. The bishop let him stay over night. In the middle of the night when everyone went to sleep, the convict got up, stole a silver candle stick and crept out of the bishop's house and took off through the woods.

He was caught. He was caught by the French policemen. They came in the middle of the night, woke up the bishop and said, "We've got him, this lying, conniving thief. We've got him. This time we are going to put him away for life."

The bishop turned to this man cowering in chains and said, "That's no thief. That's my guest, Jean Valjean, but I gave him two candlesticks, not one. He forgot one." He reached in a drawer and gave him another silver candlestick. The police had to let him go. That experience of forgiveness for something he had done wrong, that unfair act of forgiveness seeped down inside of Jean Valjean. He kept those candlesticks for the rest of his life as mementoes of what the bishop had done.

I saw another scene of forgiveness acted out on the international stage when East Germany first started coming back together with West Germany. There was a period of time before they joined when they were not a Communist state, but they elected their parliament. Do you know what their first act as parliament was? I'll read it to you. The very first act that East Germany passed was this:

"We, the first freely elected parliamentarians of the German Democratic Republic, on behalf of the citizens of this land, admit responsibility for the humiliation, expulsion and murder of Jewish men, women and children. We feel sorrow and shame and acknowledge this burden of German history. We ask all the Jews of the world to forgive us."

That was their first act as a nation. For fifty years their leaders had been telling them, "You didn't do that. Those were your West German brothers. We weren't Nazis." We didn't do this evil, but down deep the guilt was still there. It was still a stranglehold on them. When they finally became a country freely elected, the first thing they wanted to do was to break that stranglehold, turn it back over.

There is a third reason that I think God asks us to forgive and that is because God first forgave us. It is one thing to get into a tit-for-tat war with a wife, husband, a nation. It is another thing to get into one with God because we are going to lose every time. No one of us deserves forgiveness from God.

When Jesus came to earth, He came and left a wonderful example of forgiveness. What I learned from that example was that forgiveness probably wasn't very easy for God. It was hard for Him. When Jesus was in the garden, he prayed "Lord, if there is any other way..." There was no other way but the hard way.

At the cross some of His last words were, "Father, forgive them for they don't know what they do." The Roman soldiers, the mobs yelling, people all down through the chain of history including you and me, "Forgive them for they don't know what they do." I think in some ways the cross is God's way of saying, "It is pretty impressive that I forgive you for some of the dastardly things that you have done."

I was reading the Book of Romans not long along ago and I will leave you with this verse from Romans 12:19. Paul is giving a number of commands and instructions on living and at the end he says, "Do not take revenge, my friends, but leave room for God's anger, for it is written: 'It is mine to avenge; I will repay,' says God. Do not be overcome by evil, but overcome evil with good."

In the final analysis, forgiveness is an act of faith. It is the belief that God can take care of the fairness problems. It is not fair just to pretend that something doesn't happen. It did happen. It still hurts. It still stings. Forgiveness is not fair, but forgiveness is a way of taking that burden from us and giving it to God who is fair. "I will avenge," says the Lord. You forgive. It breaks the cycle of relationships. It breaks the stranglehold on you and on me and it is what God did for us in his Son Jesus on the cross.

Tuesday, January 22, 2008

Alcoholism and Addiction Help

IF YOU NEED HELP AND SUPPORT NOW PLEASE VISIT US AT The Sober Village or Sober Musicians where we care, understand and have been there!!

Monday, January 21, 2008

Local Programs Break Cultural Barrier

The problem with many of the federally funded studies that provide valuable information to treatment and rehabilitation centers across the country is that their main study samples are usually made up of white men. The majority of people in treatment in the United States are white men, so in the beginning, this approach to research studies made sense. However, now that the basic epidemiological studies have been done, it’s about time to focus on different cultures and ethnicities that may have characteristics that affect the outcome of drug addiction treatment.

To that end, I’m highlighting a few different programs that may be local in scope but could have worldwide effectiveness. To start with the Substance Abuse and Mental Health Services Administration (SAMHSA) is sponsoring a program that focuses on substance abuse prevention in American Indian communities. The Cherokee Nation is one of five tribal groups is one of five who will take part.

The Mental Health Association of Westchester County in New York was recently awarded a $50,000 grant by the van Ameringen Foundation to support the expansion of Nuestro Futuro. This organization serves Hispanics and the grant will help wipe out the waiting list of Hispanics in need of mental health and substance abuse treatment services. It will also focus on outreach and education in this community.

San Joaquin County in California has agreed to provide the nonprofit Human Services Project with $1.1 million in an effort to learn more about the substance abuse treatment needs in a number of specific cultural groups including its Asian, American Indian, black, Hispanic, Muslim, Middle Eastern and gay populations. The goal is to help people in these groups to keep their housing and avoid hospitalization through county services.

If you’re not finding treatment services in your community that speak specifically to your needs, you can take matters into your own hands. Those who are addicted to opiate painkillers may find that the treatment services nearest to them are not conducive to rehabilitation for them. Especially in small towns or rural areas, ethnic and cultural minorities may not feel especially welcome in drug rehab programs. The feeling of alienation due to drug addiction is bad enough without feeling like you’re even more singled out due to your religion, skin color or family’s cultural background. You can get a Suboxone prescription and treat your drug addiction in the privacy of your own home. Your family and friends don’t even have to know that you have a problem since you take your Suboxone pills just as you’ve taken other prescription painkillers before. It’s hard to hide your addiction to drugs when you enroll in an inpatient treatment or day treatment rehab center. Handle your addiction privately with a truly private Suboxone treatment.
Source: http://www.meditoxofpalmbeach.com/blog/detox/addiction/page/2/

Wednesday, January 16, 2008

Fun Facts

Did you know that the human body produces its own supply of alcohol naturally on a continous basis, 24 hours a day, seven days a week? 25 Did you know that the world's oldest known recipe is for beer? 2 For interesting alcohol-related facts and trivia, select a topic below.
Alcohol and Drinking Facts in States across the US

Enjoy these interesting facts about alcohol and drinking in different states.
Alchohol Trivia

The word "toast," meaning a wish of good health, started in ancient Rome, where a piece of toasted bread was dropped into wine. 3.10
Would You Believe...

Vikings used the skulls of their enemies as drinking vessels. 1
It's The Law!

Anyone under the age of 21 who takes out household trash containing even a single empty alcohol beverage container can be charged with illegal possession of alcohol in Missouri. 8
Cavemen to Columbus

The early Church declared that alcohol was an inherently good gift of God to be used and enjoyed. While individuals might choose not to drink, to despise alcohol was heresy. 12
Puritans to Prohibition

While there wasn't any cranberry sauce, mashed potatoes, sweet potatoes, or pumpkin pie to eat at the first Thanksgiving, there was beer, brandy, gin, and wine to drink. 1.1
Prohibition: The Noble Experiment

During Prohibition, temperance activists hired a scholar to rewrite the Bible by removing all references to alcohol beverage. 8.a
Beverages: Ales to Zombies

Bourbon takes its name from Bourbon County in Kentucky, where it was first produced in 1789 by a Baptist minister. 7
Health and Safety

The alcohol in drinks of either low alcohol content (below 15%) or high alcohol content (over 30%) tend to be absorbed into the body more slowly. 9

Monday, January 14, 2008

Cocaine Vacine?

Have not yet formulated an opinion on this but worthy of watching for updates I suppose.- Chy

A husband and wife team based at Baylor College of Medicine (BCM) in Houston, Texas, have developed a cocaine vaccine that is currently undergoing clinical trials. The vaccine, which is based on an inactivated form of the drug, teaches the immune system to fight real cocaine and stop it getting to the brain and delivering the expected "high".

Developing a vaccine to free millions of addicts from dependency on substances such as cocaine, methamphetamine and nicotine, has been a long term goal of Tom and Therese Kosten for more than 30 years. They were ice skating partners as teenagers, and both went to Yale, he to complete his medical training and she to do a PhD in psychology and neuroscience. They joined BCM's Menninger Department of Psychiatry & Behavioral Sciences 18 months ago after relocating from Connecticut.

Tom Kosten, who is now psychiatry professor at the college told the Houston Chronicle the vaccine should help people who want to stop using cocaine:

"At some point, most users will give in to temptation and relapse, but those for whom the vaccine is effective won't get high and will lose interest," he explained.

Tom Kosten recently asked the US Food and Drug Administration (FDA) to give the go ahead to a phase III clinical trial of the vaccine. All being well, the multi-centre study will begin in the spring, although full FDA approval may take several years after that. The trial involves 300 participants in six locations around the US, including Houston.

Speaking in an interview shortly after they joined BCM, Tom Kosten said he and his wife were both:

"Interested in developing medications to treat addictions."

"One attraction for me is the immense social implications of the area," he added.

The Substance Abuse and Mental Health Services Administration estimated that in 2005 some 22.5 million Americans were classed as substance dependent.

The habit has a large price tag, costing the nation over 480 billion dollars a year, according to the National Institute on Drug Abuse. This is almost three times as much as cancer, with considerable social implications.

When under the influence of drugs, and often for up to a week after stopping, some abusers become sociopathic, and homicidal. As Kosten explained to online college magazine BCM Solutions last summer, drugs hijack the normal brain pathways that are needed for normal social functioning:

"Through brain imaging studies, we have learned that many abusers can be insensitive to feelings and emotions in others. The abuser's brain just doesn't register that another person is in pain or that the abuser may be causing that emotional, and in extreme cases, that physical pain."

Many drugs like cocaine are made of small particles that are too small for the immune system to react to and then destroy with antibodies. What was needed thought Tom and Therese, was something bigger that the immune system could react to and at the same time "learn" to fight cocaine.

The solution, which seems obvious now, but has taken nearly ten years to perfect, is very clever. Take an inactive cholera toxin protein and attach inactivated cocaine to its surface. This "tricks" the immune system into making antibodies against cocaine. The immune system "sees" the inactivated cholera toxin and also the cocaine pattern and makes antibodies against both substances.

Then, when the vaccinated patient ingests cocaine, the antibodies made in response to the inactivated version attack the real thing by binding to it and stopping it reaching the brain. The expected "high" doesn't occur, the reinforcement pattern is broken, and the patient eventually loses interest. Or that's the theory that needs to be tested.

Should the vaccine get through clinical trials (assuming the FDA give the go ahead), it will be a significant breakthrough in the treatment of cocaine addiction, which currently comprises psychiatric help and a 12 step programme.

Some experts have urged people excited by the idea not to expect too much. Not only may it be some time before a vaccine hits the market, it may not work for every one.

As with all new treatments there are a number of ethical and other questions to resolve. Who should get the treatment? What type of support will people need? And what if hardened addicts just take a lot more of the substance as a way to overcome the ability of the immune system to respond? What effect might that have on their sociopathic tendencies, quite apart from the medical implications?

According to law professor and chairman of the District of Columbia Medical Society's physician health committee, Peter Cohen, interviewed by the Houston Chronicle, these issues are not unsurmountable:

"Overall, the benefits to society of such vaccines would outweigh the risks."

Click here to read full story in Houston Chronicle.

Sources: Houston Chronicle, BCM Solutions.

Written by
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Saturday, January 12, 2008

Mental Ward

It is now accepted that alcohol related brain damage is the largest cause of mental retardation in the United States.

When I was "hospitalized" some years ago, before coming to terms with my illness, I was admitted to an old psychiatric institution. It was a huge place, covering over 100 acres and used to be a self-sufficient town in it's own right. Back then, it was where you ended up if you were found in breach of what was known as the Inebriates Act. It also applied to other substances. In fact, everyone in the area whom society found distasteful because they were intellectually/physically disabled or mentally ill ended up there. But it was the safest place for them, and for society.

When I was allowed to have my "clothes" back, I was also given the privilege of being able to explore the hospital grounds. I used to walk as far away from the building as I could, into the paddocks, to be on my own and escape the screaming and antics of the tortured souls of the ward.

One day I came across a clump of trees, and in amongst these trees were mounds. They were old graves, probably from the late 1800s and early 1900s.

Men, women and children - forgotten, no names were on the wooden crucifixes. Some of those people went to their deaths no longer remembering who they were either.

Today, the "hospital" is closed, it is no longer somewhat a refuge to those who cannot look after themselves. While it wasn't a pleasant place and many frightening things occurred while I was there, it was still home for me and many others.

My 9 months as a patient taught me many things. They were hard lessons to learn at the age of 21, but looking back, I consider myself very lucky to have been in that place, unpleasant as it was. Before I did my "tours of duty", I really had no idea what the terms ARBD, Wernicke-Korsakoff Syndrome and DIP really meant.

There I met a 17 year old who had just "done" his first line of speed. He was stuck in a psychotic state, which will probably be forever. I met many people suffering from paranoid schizophrenia, which is a terrifying illness - for everyone. Many of these people were marijuana users. Don't let anyone ever tell you that marijuana is a soft drug. If you have mental illness running in your family, such as endogenous depression or schizophrenia , marijuana will often trigger it - and will exacerbate the illness. And perhaps what may have been an intermittent problem in your life will become your constant companion.

There were other patients who had burnt their brains out with drugs like LSD, bad cocaine (cut with all sorts of toxic materials - dealers often mix powder drugs with cheap materials to increase profit margins). You name the poison, it's final effects lived (if you can call it that) in that hospital.

There were people with HIV and all the forms of Hepatitis, mainly IV drug users. Many patients had mild ARBD (alcohol related brain damage/birth defects) to accompany their various mental illnesses. Common symptoms of ARBD include difficulty in planning new tasks, difficulty in learning new things, aggression, paranoia, deterioration in work performance, confusion, or poor coordination.

Then there were the men of Ward 13 - Mainly Wernicke-Korsakoff Syndrome (WKS) patients. Many of these people are the ones you see huddled in alleyways, drinking strange and poisonous liquids out of brown paper bags. This is a disease that many long-term alcoholics seem to contract. It is also commonly known as "wet brain". As the brain shrinks the ventricles become enlarged. It basically eats away at the frontal lobe. It is caused through a B1 (Thiamine) deficiency. Alcohol destroys B1. Approximately .5 - 2.9% of the population have WKS in some form.

Based on clinical research studies, between 22% to 29% of individuals with dementia are found to be heavy drinkers or alcoholics

Amongst its many symptoms are:

- double vision
- uncontrollable or twitching of the eyes. Sometimes one eye may be permanently askew
- eyelid drooping
- loss of muscle coordination
- unsteady, uncoordinated walking
- weakness
- hand tremor
- muscle contractions
- muscle atrophy
- facial paralysis
- sensation changes
- decreased sensation in the feet or hands, numbness
- abnormal sensations, tingling
- thin, malnourished appearance
- loss of hair
- dry skin
- swallowing difficulty
- speech impairment - slurring, choked
- hoarseness or changing voice
- mood changes, emotional changes, and behavior changes, including aggression
- loss of memory, can be profound
- confabulation - pathological lying to fill in gaps of time
- decreased intellect/cognitive skills
- decreased problem solving, confusion when presented with minor challenges
- loss of ability to think abstractly
- orthostatic dizziness
- constipation
- inability to tolerate cold environment
- incontinence

WKS is incurable.

Some of the people I met in Ward 13 were once doctors, lawyers and scientists. Some of them were under the age of 40. Addiction does not discriminate. The lucky ones die, the rest get diseases like "wet brain". When I spoke to a nurse about the condition, she told me that in some of the patients their memories were so bad that they could not remember one minute to the next.

She told me that she could call them in for breakfast, they would eat and return to the courtyard. Five minutes later, she could call them again and they would return and start breakfast all over again. They would have forgotten that they had eaten.

Some of them had forgotten how to use a toilet and had to wear diapers. From a scientist to quivering, dribbling, incontinent carcass with a heartbeat. It was tragic.

One man that I walked past outside the ward proudly declared to me that he was "going home today, family is coming". He had been waiting there every day for 8 months. The saddest thing was, he truly believed it. Confabulation. He had forgotten that his family had disowned him.

When I came to terms with my condition and went to a detox clinic instead of a psychiatric ward, I met a farmer who thought it was 1969. It was 1994. He had lost the farm in 1969 after a massive binge. He did not know what his name was. His condition was so bad when he came into detox that they had to administer Valium intravenously. For two days he took seizures every 15 minutes or so. Watching these seizures occur is truly frightening.

Some people who have Korsikoffs, ARBD, and DIP get caught in a space in time that is absolute agony. Remember that movie "Ground Hog Day"? It was set in a quaint little town. Now imagine the setting being the worst day you have ever experienced in your life. That is what these people experience, every day for the rest of their lives. Do they deserve it? Some may say yes, but while most of us consciously chose to drink/use, none of us chose to be alcoholics/addicts.

But, here's the catch.... once we have the education we need to be responsible our our own illness. There were some days that I hated the people who helped me, because the education they gave me also gave me the burden of knowledge. I could no longer claim ignorance.

Many of us "fall off the wagon" in our struggle for recovery, it is a life-long battle and the stakes are high...it is sometimes very tiring. But "falling off" shouldn't prevent us from trying again.

I saw my future as an addict/alcoholic and learned..

There is something worse than death.

There is insanity.

There is Ward 13.

Michael Bloch

Friday, January 11, 2008

Acute Stress Disorder

Acute stress disorder develops within one month after an individual experiences or sees an event involving a threat or actual death, serious injury, or physical violation to the individual or others, and responded to this event with strong feelings of fear, helplessness or horror. The diagnosis was established to identify those individuals who would eventually develop post-traumatic stress disorder. As far back as World War I this condition was referred to as "shell shock," in which there are similarities between reactions of soldiers who suffered concussions caused by exploding bombs or shells and those who suffered blows to their central nervous systems. Civilians may also suffer from it. More recently, ASD was brought to light as it became clear that for a short period, people might exhibit PTSD-like symptoms immediately after a trauma.

Trauma has both a medical and a psychiatric definition. Medically, trauma refers to a serious or critical bodily injury, wound or shock. This definition is often associated with trauma medicine practiced in emergency rooms and represents a popular view of the term. Psychiatrically, trauma has assumed a different meaning and refers to an experience that is emotionally painful, distressful or shocking, which often results in lasting mental and physical effects.

Psychiatric trauma, or emotional harm, is essentially a normal response to an extreme event. It involves the creation of emotional memories about the distressful event that are stored deep within the brain. In general, it is believed that the more direct the exposure to the traumatic event, the higher the risk for emotional harm. Thus in a school shooting, for example, the student who is injured probably will be most severely affected emotionally; and the student who sees a classmate shot or killed is likely to be more emotionally affected than the student who was in another part of the school when the violence occurred. But even secondhand exposure to violence can be traumatic. For this reason, all children and adolescents exposed to violence or a disaster, even if only through graphic media reports, should be watched for signs of emotional distress.


For a diagnosis of acute stress disorder, symptoms must persist for a minimum of two days to up to four weeks within a month of the trauma.

A person may be described as having acute stress disorder if other mental disorders or medical conditions do not provide a better explanation for the person's symptoms. If symptoms persist after a month, the diagnosis becomes post-traumatic stress disorder.

Symptoms include:

* Lack of emotional responsiveness, a sense of numbing or detachment
* A reduced sense of surroundings
* A sense of not being real
* Depersonalization or a sense of being dissociated from self
* An inability to remember parts of the trauma, "dissociative amnesia"
* Increased state of anxiety and arousal such as a difficulty staying awake or falling asleep
* Trouble experiencing pleasure
* Repeatedly re-experiencing the event through recurring images and/or thoughts, dreams, illusions, flashbacks
* Purposeful avoidance of exposure to thoughts, emotions, conversations, places or people that remind them of the trauma
* Feelings of stress interfering with functioning; social and occupational skills are impaired affecting the patient's ability to function, pursue required tasks and seek treatment


When a fearful or threatening event is perceived, humans react innately to survive: They either are ready for battle or run away (hence the term "fight-or-flight response"). The nature of the acute stress response is all too familiar. Its hallmarks are an almost instantaneous surge in heart rate, blood pressure, sweating, breathing and metabolism, and a tensing of muscles. Enhanced cardiac output and accelerated metabolism are essential to mobilizing for fast action. This explanation is thought to be in part a cause for anxiety disorders. Yet over the past decade, the limitations of the acute stress response as a model for understanding anxiety have become more apparent. The first and most obvious limitation is that the acute stress response relates to arousal rather than anxiety. Anxiety differs from arousal in several ways: First, with anxiety, the concern about the stressor is out of proportion to the realistic threat. Second, anxiety is often associated with elaborate mental and behavioral activities designed to avoid the unpleasant symptoms of a full-blown anxiety or panic attack. Third, anxiety is usually longer lived than arousal. Fourth, anxiety can occur without exposure to an external stressor. Cognitive factors, especially the way people interpret or think about stressful events, play a critical role in the etiology of anxiety. A decisive factor is the individual's perception, which can intensify or dampen the response. One of the most salient negative cognitions in anxiety is the sense of uncontrollability. It is typified by a state of helplessness due to a perceived inability to predict, control or obtain desired results. These are among the factors considered as causes of anxiety disorders such as acute stress disorder.


Cognitive behavioral therapy is the treatment that has met with the most success in combating ASD. It has two main components: First, it aims to change cognitions, patterns of thought surrounding the traumatic incident. Second, it tries to alter behaviors in anxiety-provoking situations.

Cognitive behavioral therapy not only ameliorates the symptoms of ASD, but also it seems to prevent people from developing post-traumatic stress disorder. The chance that a person diagnosed with acute stress disorder will develop PSTD is about 80 percent; the chance that they will develop PTSD after cognitive-behavioral therapy is only about 20 percent.

Psychological debriefing and anxiety management groups are two other types of therapy that have been examined for the treatment of ASD. Psychological debriefing involves an intense therapeutic invention immediately after the trauma, so that traumatized individuals can "talk it all out." In anxiety management groups, people share coping strategies and learn to combat stress together. However, both types of therapy have proven to be largely ineffectual for the treatment of ASD.


* American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition

Tuesday, January 8, 2008

Addiction and Genetics

Following on from my article "Addiction - the disease concept", I would also like to state the case for addiction being a genetic predisposition, not just a problem caused by social environment. This is another concept that creates a fair amount of controversy.

Without getting into the scientific technobabble regarding this subject, let's consider a several groups of people... the Australian Aboriginal, the Native American and the New Zealand Maori -prior to the European invasion.

These three groups share many things in common. They all lived in harmony with their environment, they had strong social networks, they were proud people, they are all very creative and artistic.

It is often stated that it was the arrival of the European that decimated these peoples. It wasn't so much the arrival that caused the mass destruction, but what accompanied it. Guns, prejudice, disease......and alcohol. While the open slaughter of these peoples does not occur today as it did previously, and tolerance to introduced communicable disease has risen, alcohol is still the major factor in the steady loss of these cultures.

And it isn't just the direct effects of alcohol on the body. I remember speaking with an Aboriginal elder about the challenges faced by their youth in my area. I was told they don't listen to the elders any more because so many of them have alcohol problems. The ancient tradition of respect for the elders within this culture is crumbling.

Why is it that these groups tend to have greater problems with alcohol? It isn't anything to do with intelligence, nor ability to socialise or express .... they are masters of these things. The simple fact is that these groups, like myself, have little tolerance for specific substances; and it is an inherited trait, just the same as the colour of our skin and eyes.

In Europeans, I have noticed a pattern. If one or both parents had drug problems, it was much more likely that the children would as well. Okay, so we could state that environment is the main factor. But so many times I spoke with addicts whose parents did not abuse substances. But digging back a bit further, one or more of their grandparents did. Or perhaps, in the case of adopted persons, no-one in the entire foster family was a drug abuser -but they later discovered that their natural parent was.

I have found it surprisingly common for addiction to skip generations, especially in Europeans. But it seems that if two generations are "addict free", then the condition seems to disappear. I am sure there are exceptions to that rule, but this has been my experience.

When I was growing up my father warned me to be careful with alcohol. I didn't listen as I didn't understand the genetic factors. I also didn't care at the time.

So please, if you are a parent with a substance addiction (present or past), or your parents were people with drug problems - educate your children. Impress upon them that alcohol and drug usage for them is like playing Russian Roulette, and describe to them that while they may have Grandad's eyes, they may be also carrying a dangerous hidden legacy......

.....the genetic predisposition to a disease called addiction

Michael Bloch

Friday, January 4, 2008

Internet Addiction

The Internet has joined the ranks of gambling and alcohol as an addiction that people use to escape from real life, a new study says.

The study is being introduced today at the American Psychological Association's conference in Chicago by Kimberly Young of the University of Pittsburgh at Bradford. Based on 360 Internet surveys of active online users, the study found that people dependent on online communication, including chat rooms, Web surfing, and email, suffered withdrawal and other symptoms similar to drug or alcohol addiction.

Young has been studying Internet addiction through the Center for Online addiction for several years and last year introduced a paper to the American Psychological Association bringing to light the idea of online addiction. This year's study focuses not only on the addiction, but the people who are in constant need of cyber-stimulation.

One of the most intriguing findings in Young's study is that while the average Internet user is still a well-educated male, middle-aged women are the most likely to be addicted. Many of these women were housewives who, like other Internet addicts, had a lot of time to kill.

But those time-killers aren't bored Silicon Valley techies who surf the Web at work. Instead, the other major groups in the Internet-addicted category include the disabled, the retired, and students. High-tech white collar workers accounted for only 8 percent of Internet addicts, while the other groups totaled 42 percent of the addicts surveyed.

These addicts were originally intimidated by the technology, Young wrote, but eventually became comfortable and started using online services ten times more than they had before.

Users realizing they had a problem would try to invoke self-imposed time-limits, which usually failed. Then, Young wrote, "Dependents canceled their Internet service, threw out their modems, or completely dismantled their computers to stop themselves from using the Internet."

In what she compares to a cigarette craving, even those extreme measures didn't work. "Dependents explained that these cravings felt so intense that they resumed their Internet service, bought a new modem, or set up their computer again to obtain their 'Internet fix,'" Young wrote.

Most of these addicts spend about 40 hours a week on the Web, with their primary areas of interest in chat rooms and online games. Email and newsgroups were also popular, but the actual surfing of the Web--particularly for anything educational--was one of the lowest areas.

Young's original study, introduced last year, created some controversy among the psychological community, said Doug Fizel, deputy director of public affairs for the American Psychological Association. What academics and practitioners are having difficult with is applying the word "Internet" to the field of addiction.

"Usually that term is applied to some substance like alcohol, tobacco, or drugs, versus a behavior," he said.

This has forced Young to describe it as "pathological" Internet use, though she still uses the word "addiction" frequently in her report.

Fizel also said that although online addiction has not been thoroughly studied, there is a growing interest among academics and we should expect to see more information produced on the topic.

"With the growth of the Internet being exponential, this will be something looked at as time goes on to see what effects it's having on behavior," Fizel said.

Young could not be reached for comment today.