Category: Counselling

Male Pain and Alcohol

Pain is a universal experience across people of all genders. How do we know when something hurts inside? It keeps coming back; first, it disrupts, then colors all aspects of everyday life. There are many shades of emotional hurt that can be emotionally crippling. Anger, grief and jealousy – are all hurtful emotional states. They are experienced and can be a part of our life for years.  How we manage these painful experiences as men can be a challenge. While recent studies suggest sexes don’t feel pain the same way, the evidence on sex differences in pain is mixed and potential biopsychosocial factors may play a role. To read the full text please visit Dr Matt Modrcin’s blog

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Updating alcohol Cochrane literature review

Cochrane

Updating Cochrane systematic reviews makes them most useful and fresh for readers. We updated our review on concurrent alcohol and drug problems again.

Cochrane podcast

Which new studies we found?

We found seven studies that examined 825 people with drug problems. Six of the studies were funded by the National Institutes for Health or by the Health Research Board; one study did not report its funding source.

One study focused on the way people think and act versus an approach based on Alcoholics Anonymous. It aimed to motivate the person to develop a desire to stop using drugs or alcohol.

Three studies looked at a counselling style for helping people to explore and resolve doubts about changing their behaviour (group, individual and intensive formats). Their controls were education, or less intensive counselling, or assessment-only.

Two Irish studies and one Swiss study looked at practices that aimed to identify an alcohol problem and motivate the person to do something about it versus usual treatment.

This study has been made into a podcast available at Cochrane.org news item at https://www.cochrane.org/news/podcast-which-talking-therapies-work-people-who-use-drugs-and-also-have-alcohol-problems

and a Network news item https://mhn.cochrane.org/news/podcast-which-talking-therapies-work-people-who-use-drugs-and-also-have-alcohol-problems Listen to the podcast below:

Updating Cochrane Review – Key results

The Swiss and Irish studies were directly compared. They took place in general practices (one trial) or methadone clinics (two trials). They included 170 participants with a mean age of 37 years. All participants had positive alcohol screening test upon entry to the trial. At the end, the scores between groups were similar (average difference in scores: -0.6, 1.7 and -2, respectively).
One study found that a brief motivational intervention led to a reduction of alcohol use (by seven or more days in the past month at 6 months).

It remains uncertain whether talking therapies affect drinking and drug-using in people who have problems with both alcohol and other drugs. We lack high quality studies.

Cited cochrane review: Klimas J, Fairgrieve C, Tobin H, Field C-A, O’Gorman CSM, Glynn LG, Keenan E, Saunders J, Bury G, Dunne C, Cullen W. Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. Cochrane Database of Systematic Reviews 2018, Issue 11

Read a summary of the previous version of this review here

Which talking therapies work for drug users with alcohol problems? A Cochrane update

Primary care looks at drinking among persons on methadone treatment

How should primary care doctors ask their methadone patients about alcohol use?

We worked with 13 primary care doctors and divided them into two groups. We trained one group on how to ask about and advise on heavy drinking. We looked at whether trained and coached doctors managed patients who drank.
photocredit: methadoneaddiction.com


Primary care can look at drinking among persons on methadone treatment and advise on risks of heavy drinking.

We found that the trained doctors asked about and advised on heavy drinking more often than the untrained doctors. Four patients in their care drank less alcohol three months later, compared to two patients of the untrained doctors. Some doctors were reluctant to use their new learning in the practice because it was too complicated.

A bigger and simpler study must prove the positive results of this modest study

Methadone helps people with opioid use disorders use less drugs, but it doesn’t stop them from drinking. About 30% of them drink in excess of the low-risk drinking limits. Drinking makes their treatment harder and their health worse. Primary care doctors who prescribe methadone see patients weekly and can help them drink less.

Reference: Henihan, AM., McCombe, G., Klimas, J., Swan, D., Leahy, D….Cullen, W. (2016)  Feasibility of Alcohol Screening among Patients receiving Opioid Agonist Treatment in Primary Care. BMC Family Practice, 17:153




What do persons on methadone in primary care think about alcohol screening?

Enhancing alcohol screening and brief intervention among people receiving opioid agonist treatment: Qualitative study in primary care

New Paper Out Now

Although very common, excessive drinking by people who also use other drugs is rarely studied by scientists. The purpose of this study was to find out patient’s and clinicians’ opinions about addressing this issue. All of them took part in a study called PINTA – Psychosocial interventions for problem alcohol use among problem drug users.

photocredit: emerald

Doctors reported obstacles to addressing heavy drinking and overlooking and underestimating this problem in this population.

Patients revealed that their drinking was rarely spoken about and feared that their methadone would be withheld.

Read the full article in the latest issue of the Drugs and Alcohol Today: http://www.emeraldinsight.com/loi/dat

See also my previous posts about the PINTA study:

New paper out now: Psychosocial Interventions for Alcohol use among problem drug users

2014

Beg, steel or borrow: getting physicians to recruit patients in clinical trials

Addiction Medicine Education for Healthcare Improvement Initiatives: New Paper out Now

2013

Honor pot: testing doctors’ drug counselling skills in a new pilot study in Ireland

Fidelity questions

Why Empirically Supported Psychosocial Treatments Are Important for Drug Users? New research project

XXV Annual Meeting & Canadian Scientific Conference 2015 CSAM – SMCA (#WhatTheFentanyl #abhealth)

What is the future of addiction medicine? What is the future addiction specialist going to look like? Nobody knows what the future is going to look like, but the delegates of the 25th CSAM annual conference imagined answers to these questions in Banff, Alberta at the Banff Centre on Tunnel Mountain. As a first comer to the conference, I had a lot to learn and a lot to write down. Read more below.

photocredit: csam-smca.org

Seven high-profile experts explored trends at home and abroad and the scientific topics impacting the future of addiction treatment delivery in their keynote plenaries.

1.         Prescription Abuse (Dr. Roger Weiss)
Dr Weiss updated he delegates on the progress of the Prescription Opioid Addiction Treatment Study (POATS). The outcomes of the first phase of the trial were disastrously low, in contrast with the buprenorphine that was 7 times more effective after 4 weeks. Who did well? If you’d ever been in a treatment, or used not-as-prescribed prescription opioids, or the OxyContin was your most frequently used opioid – that was a bad sign. Older people did better. Interestingly, depression was also a good sign. What initiates the addiction is not necessarily what maintains the addiction.
2.         Marihuana and Anxiety (Dr. Matthew Hill)
Dr Hill introduced the insights from the basic science field. Why people use cannabis? 84% say it helps them relax; to help reduce feelings of stress, tension and anxiety. The endocanabinoids tends to keep the amygdala quiet when it should be quiet. They act as natural regulators of the amygdala. Anxiety may be related to impairment in the endocannabinoid signalling. Dr Hill’s 2014 talk on the same topic has been recorded and posted online.
3.         State of the Science for Technology-Based Approaches to Substance Use: Directions for the future (Dr. Sarah E. Lord)
Internet Electronic Therapy was the focus of the first afternoon plenary. Dr Lord described some of the tools that are out there, gave examples of them and validation data. Brief intervention and CBT-4-CBT were among them. The space of phone applications industry is far ahead of the science.
4.         Integrative Addiction Medicine (Dr. G. Bunt)
The weather conditions worsened in Banff so much that Dr Bunt slipped and fell down on the way to the lecture hall (see Figure 1).
5.         Brain Plasticity and Addiction (Dr. Bryan Kolb)
Dr Kolb kicked off the Saturday conference programme. Brain changes constantly. Anything you learn is going to occur because the brain changes. Play and stress too modify pre-frontal cortex. Interaction of brain and psychoactive drugs keeps fascinating scientists.
6.         Clinical considerations for behavioural addictionsin the settings of DSM-5 and ICD-11 (Dr. Marc Potenza). During the first part of this millennium the perspectives on addiction changed, especially the behavioural addictions. How are they different or similar to substance use disorders? Many are strongly associated with behavioural addictions, e.g., heavy alcohol use and gambling. In addition to the high rates of co-occurrence, there are similar clinical courses, similar clinical characteristics, similar biologies and similar treatments for behavioural addictions.
7.         The Alberta Addiction & Mental Health Review: Current challenges & lessons learned (Dr. David Swann).

Investment into addiction treatment is only a fraction of the Alberta’s budget – 0.1%. The current government of Alberta isn’t doing evidence-based policy but policing evidence. Racism is alive and well in Alberta. Lack of understanding led to the fiasco of the primary care reform in Alberta. It has an ambiguous direction on harm reduction. Dr Swann concluded his talk with 30 questions for the audience.

Figure 1. Banff centre snow