tag:blogger.com,1999:blog-64752504635301615962023-11-15T06:40:25.352-08:00Path of RecoveryInformation and resources on alcohol relapse preventionLisahttp://www.blogger.com/profile/11872642094442675377noreply@blogger.comBlogger9125tag:blogger.com,1999:blog-6475250463530161596.post-61620393142216708272013-07-15T12:53:00.004-07:002013-07-15T12:53:46.997-07:00The Phases and Warning Signs of Relapse<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: Arial, Helvetica, sans-serif;">RETURN OF DENIAL: During this phase the dependent person becomes unable to recognize and honestly tell others what he or she is thinking or feeling. The most common symptoms are:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1. Concern about well being.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2. Denial of the concern.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">AVOIDANCE AND DEFENSIVE BEHAVIOR: During this phase the dependent person doesn't want to think about anything that will cause painful and uncomfortable feelings to come back. As a result, he or she begins to avoid anything or anybody that will force an honest look at self. When asked direct questions about well-being, he or she begins to become defensive. The most common symptoms are:</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">1. Believing "I'll never drink again."</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2. Worrying about others instead of self.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3. Defensiveness.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">4. Compulsive behavior.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">5. Impulsive behavior.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">6. Tendencies toward loneliness.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">CRISIS BUILDING: During this phase the dependent person begins experiencing a sequence of life problems that are caused by denying personal feelings, isolating self, and neglecting the recovery program. Even though he or she wants to solve these problems and work hard at it, two new problems pop up to replace every problem that is solved. The most common symptoms are:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1. Tunnel vision.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2. Minor depression.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3. Loss of constructive planning.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">4. Plans begin to fail.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">IMMOBILIZATION: During this phase the dependent person is totally unable to initiate action. He or she goes through the motions of living, but is controlled by life rather than controlling life. The most common symptoms are:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1. Daydreaming and wishful thinking.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3. Feeling that nothing can be solved.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3. Immature wish to be happy.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">CONFUSION AND OVERREACTION: During this phase the dependent person can't think clearly. He or she becomes upset with self and those around her or him and is irritable and overreacts to small things.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1. Periods of confusion.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2. Irritation with friends.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3. Easily angered.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">DEPRESSION: during this phase the dependent person becomes so depressed that he or she has difficulty keeping to normal routines. At times there may be thoughts of suicide, drinking, or drug use as a way to end the depression. The depression is severe and persistent and cannot be easily ignored or hidden from others. The most common symptoms are:</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">1. Irregular eating habits.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2. Lack of desire to take action.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3. Irregular sleeping habits.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">4. Loss of daily structure.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">5. Periods of deep depression.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">BEHAVIORAL LOSS OF CONTROL: During this phase the dependent person becomes unable to control or regulate personal behavior and daily schedule. There is still heavy denial and no full awareness of being out of control. His or her life becomes chaotic and many problems are created in all areas of life and recovery. The most common symptoms are:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1. Irregular attendance at AA and treatment meetings.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2. Development of an "I don't care attitude."</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3. Open rejection of help.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">4. Dissatisfaction with life.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">5. Feeling of powerlessness and helplessness.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">RECOGNITION OF LOSS CONTROL: The dependent person's denial breaks and suddenly he or she recognizes how severe the problems are, how unmanageable life has become, and how little power and control he or she has to solve any of the problems. This awareness is extremely painful and frightening. By this time he or she has become so isolated that it seems that there is no one to turn to for help. The most common symptoms are:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1. Self-pity.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2. Thoughts of social drinking.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3. Conscious lying.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">4. Complete loss of self-confidence.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">OPTION REDUCTION: During this phase the dependent person feels trapped by the pain and inability to manage his or her life. There seem to be only three ways out--insanity, suicide, or drug use. This person no longer believes that anyone or anything can help him. The most common symptoms are:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">1. Unreasonable resentment.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2. Discontinues all treatment and AA.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3. Overwhelming loneliness, frustration, anger and tension.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">4. Loss of behavioral control.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">THE RELAPSE EPISODE: During this phase the dependent person begins to use alcohol or drugs again, typically struggling to control or regain abstinence. This struggle leads to shame and guilt when the attempt ultimately fails. Eventually all control is gone and serious bio-psycho-social problems develop and continue to progress. The most common symptoms are:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">1. Initial use (the lapse).</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">2. Shame and guilt.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">3. Helplessness and hopelessness.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">4. Complete loss of control.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">5. Bio-psycho-social damage.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Source: <a href="http://nmbon.sks.com/uploads/FileLinks/d2be4887fe8948e7b95df0793ca4378a/DP_phases_and_warning_signs_of_relapse.pdf">http://nmbon.sks.com/uploads/FileLinks/d2be4887fe8948e7b95df0793ca4378a/DP_phases_and_warning_signs_of_relapse.pdf</a></span></div>
Lisahttp://www.blogger.com/profile/11872642094442675377noreply@blogger.com0tag:blogger.com,1999:blog-6475250463530161596.post-39661626862036706372013-07-14T10:26:00.003-07:002013-07-15T12:43:49.238-07:00Why Alcoholics Stay Addicted<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: small;">Biological Factors</span></h3>
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<li><span style="font-family: Arial, Helvetica, sans-serif;">Biological vulnerability and genetic predisposition in interaction with certain facilitating environments create problems and eventually disease.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Pharmacological impact of excessive use of alcohol and other drugs on body chemistry, physiology , and the organ systems of the body.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Tolerance – Increased frequency of use and higher doses over time.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Withdrawal – Negative effects of cessation of addictive behaviors.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Higher risk of developing specific physical disorders (diseases) associated with the chronic and excessive use of particular substances.</span></li>
</ul>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: small;">Psychological Factors</span></h3>
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<li><span style="font-family: Arial, Helvetica, sans-serif;">Motivation – Stages of habit initiation and stages of habit change.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Expectancies – Positive outcomes of drug use and self-efficacy.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Attributions – Effects of substance use and reasons for relapse.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Sensation-Seeking – Excessive need for stimulation</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Impulsivity – Inability to effectively control or restrain behavior.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Negative Affect – Dysphoric moods such as anxiety & depression.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Poor Coping – Deficits in cognitive and behavioral skills or inhibitions in the ability to perform behaviors due to the effects of anxiety.</span></li>
</ul>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>Sociocultural Factors</b><o:p></o:p></span></div>
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<li><span style="font-family: Arial, Helvetica, sans-serif;">Family History – Dysfunctional family settings especially
parental alcohol and drug problems and parental abuse or neglect of children.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Peer Influences – Social pressure to engage in risk-taking
behaviors including substance use especially when related to gang membership.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Culture and Ethnic Background – Norms and religious beliefs
that govern the use of alcohol and drugs and ethnic variations the body’s rate
and efficiency of metabolizing drugs and alcohol.</span></li>
<li><span style="font-family: Arial, Helvetica, sans-serif;">Media/Advertising – Societal emphasis on immediate
gratification and glorification of the effects of alcohol and drug use.</span></li>
</ul>
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<span style="font-family: Arial, Helvetica, sans-serif;">Source: <a href="http://depts.washington.edu/abrc/RP_new.ppt">http://depts.washington.edu/abrc/RP_new.ppt</a></span></div>
Lisahttp://www.blogger.com/profile/11872642094442675377noreply@blogger.com0tag:blogger.com,1999:blog-6475250463530161596.post-13799411885363197272013-07-14T10:25:00.000-07:002013-07-15T12:29:52.855-07:00Abstinence vs. Controlled Drinking<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="font-family: Arial, Helvetica, sans-serif;">There are two opposing ideas regarding whether abstinence or controlled drinking should be the goal of recovery. Controlled drinking means that alcoholics are given separate forms of therapeutic treatments to eventually begin drinking in moderation as long as their intake does not result in signs of dependence, intoxication, legal, or health problems (Luty, 2006). This completely goes against the philosophy of Alcoholics Anonymous, who maintain that abstinence is the only way for alcoholics to recover, and if they are able to eventually drink in moderation then they were only alcohol abusers, not alcoholics. According to Luty (2006), research suggests that:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;"> "controlled drinking may be an option for young, socially stable drinkers with short, less severe drinking histories (e.g. alcohol consumption of less than 4 units per day with normal liver function tests). An individual’s belief that controlled drinking is an achievable goal is also a good prognostic factor. Most authors agree that controlled drinking should not be recommended for people with heavy dependence or those with protracted alcohol problems."</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;">Luty (2006) mentions one study 70 individuals were divided into two groups, one with the goal of abstinence and the other with a goal of controlled drinking. Apparently there were very little differences in the success rates of either group; consumption was reduced to 51 to 13 drinks per week and 40–50% of participants had relapsed at 6 months, and at 2 years both groups had not shown a significant difference in rates of drinking and relapse.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">According to Luty (2006), it appears that regardless of the counselor's recommended goal (abstinence or controlled drinking), the client decides for themselves which path they will follow. Since different techniques are used to treat clients with each of these goals, and the initial focus of this blog will be on abstinence as the desired outcome.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif;">Luty, J. 2006. What works in alcohol use disorders? Retrieved from: <a href="http://apt.rcpsych.org/content/12/1/13.full.pdf">http://apt.rcpsych.org/content/12/1/13.full.pdf</a>.</span></div>
Lisahttp://www.blogger.com/profile/11872642094442675377noreply@blogger.com0tag:blogger.com,1999:blog-6475250463530161596.post-57216567362398091352013-07-12T11:43:00.001-07:002013-07-15T13:18:51.882-07:00Relapse Prevention Therapies<div dir="ltr" style="text-align: left;" trbidi="on">
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There are several therapies used in the treatment of alcohol addiction and relapse prevention. The list below offers a brief summary of some of the most recommended methods, and further information on many of them is available in some of the other posts and slides posted on the blog. Keep in mind that the client's age, gender, ethnicity, religious background, and other characteristics will impact the treatment that is used. Resources for some of these particular populations are linked in the Additional Resources section.</span><br />
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<b>Relapse Prevention Therapy (RPT)</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><b><br /></b>
RPT is a cognitive-behavioral approach to treating addiction and specifically relapse. RPT intervention strategies include coping skills training, thought management, and lifestyle modification. Much of the information presented on this blog incorporates RPT and cognitive-behavioral methods of treating alcohol addiction. For a thorough guideline on incorporating RPT please see this resource: <a href="http://www.bhrm.org/guidelines/RPT%20guideline.pdf">http://www.bhrm.org/guidelines/RPT%20guideline.pdf</a></span><br />
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<b>Motivational Interviewing</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><b><br /></b>
The clients themselves give reasons why they should be abstinent and draw up a list of problems caused by their alcoholism. See the blog post below for more information on this form of therapy.</span><br />
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<b>Twelve-Step Facilitation</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><b><br /></b>
Programs where clients either individually (such as in project <a href="http://www.commed.uchc.edu/match/">MATCH</a>) or in a group setting (like Alcoholics Anonymous) progress through a series of steps involving self-discovery, healing/coping skills, and support mechanisms in order to complete their recovery. This form of treatment is often used as a primary or supplementary form of therapy.</span><br />
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<b>Community reinforcement approach</b></span><br />
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A friend or family member participates in the recovery of the addict by providing positive reinforcers to reward abstinence and negative reinforcers to punish drinking. Radio, television, newspapers, telephone or driving licence are examples of reinforcers. The spouse or friend may also help reinforce other aspects of treatment such as relapse prevention group attendance, counseling sessions, and the addict's use of disulfiram prescription. You can find more information here: <a href="http://pubs.niaaa.nih.gov/publications/arh23-2/116-121.pdf">http://pubs.niaaa.nih.gov/publications/arh23-2/116-121.pdf</a></span><br />
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<b>Social behavior and network therapy</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><b><br /></b>
Alcoholics build support networks using cognitive-behavioral and community reinforcement approach principles. </span><br />
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<b>Contingency management</b></span><br />
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"Contingency management is designed to reinforce small steps, especially at the beginning, like celebrating each attendance at a group meeting or each drug-free test result. Later, patients can move on to larger achievements like stable housing. Easy-to-earn material goods, such as movie passes and food vouchers, help to both initiate and maintain positive changes." (Rockefeller University, 2005). According to Luty (2006), contingency management (or planning) is generally considered an addition to therapy rather than a substitute, and the fact that some reinforcements may 'pay' alcoholics not to drink makes this form of treatment controversial. "</span><span style="font-family: Arial, Helvetica, sans-serif;">Furthermore, there is a tendency to relapse </span><span style="font-family: Arial, Helvetica, sans-serif;">when the reinforcing regime is ended. This may </span><span style="font-family: Arial, Helvetica, sans-serif;">explain the reluctance of many services to introduce </span><span style="font-family: Arial, Helvetica, sans-serif;">contingency managemen"t (Luty, 2006).</span><span style="font-family: Arial, Helvetica, sans-serif;"> Further information can be found here: </span><a href="http://pubs.niaaa.nih.gov/publications/arh23-2/122-127.pdf" style="font-family: Arial, Helvetica, sans-serif;">http://pubs.niaaa.nih.gov/publications/arh23-2/122-127.pdf</a><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><b><br /></b>
<b>Cue exposure</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Cue exposure involves repeated exposure to triggers in an attempt to extinguish cravings and other undesirable responses.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;"><b>Therapeutic Communities and Rehabilitation Centers</b></span><br />
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Therapeutic communities usually require several months to years of residence with extensive participation by the clients. Costs for these programs tend to be high and many are criticized as employing outdated treatment methods, but research has found that "low-cost, publicly funded clinics have better-qualified therapists and better outcomes than the high-end residential centers typically used by celebrities like Britney Spears and Lindsay Lohan" (Brody, 2013). Given the relapse rates of addicts who attend "rehab" facilities, some encourage "that most people recover (1) completely on their own, (2) by attending self-help groups, and/or (3) by seeing a counselor or therapist individually" (Brody, 2013).</span><br />
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<b>Relapse Prevention Plans</b></span><br />
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The development of a relapse prevention plan is often an intended outcome or useful by-product of many of these therapies. More information on building these plans can be found in the top right section of the blog titled: "9 Steps to Building a Relapse Prevention Plan."</span><br />
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<b>References</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><b><br /></b>
Brody, J.E. 2013. Effective addiction treatment. Retrieved from <a href="http://well.blogs.nytimes.com/2013/02/04/effective-addiction-treatment/">http://well.blogs.nytimes.com/2013/02/04/effective-addiction-treatment/</a>. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><b><br /></b>
<span style="line-height: 18px;">Luty, J. 2006. What works in alcohol use disorders? Retrieved from: </span><a href="http://apt.rcpsych.org/content/12/1/13.full.pdf" style="line-height: 18px; text-decoration: none;">http://apt.rcpsych.org/content/12/1/13.full.pdf</a><span style="line-height: 18px;">.</span></span><br />
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Rockefeller University. 2005. 'Contingency Management' Improves Addiction Recovery: Program Reinforces Each Small Step Toward Success. Retreived from: <a href="http://alcoholism.about.com/od/relapse/a/blru050402.htm">http://alcoholism.about.com/od/relapse/a/blru050402.htm</a><br />
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Lisahttp://www.blogger.com/profile/11872642094442675377noreply@blogger.com0tag:blogger.com,1999:blog-6475250463530161596.post-8235096092153901652013-07-12T11:37:00.002-07:002013-07-14T11:52:41.677-07:00Motivational Interviewing<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="font-family: Arial, Helvetica, sans-serif;">Client (lack of) motivation, and resistance may very well be one of the most frustrating aspects of working as a counselor. Since trying to inform alcoholics on the consequences of drinking and benefits of abstinence often provokes the client to offer opposing arguments and resistance, it may be useful to put the job of reasoning the pitfalls of drinking into the client's lap. This is where motivational enhancement therapy (also called motivational interviewing) has gained traction and use in treating clients with addiction.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;">One helpful acronym when implementing motivational interviewing is:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;">F Provide <b>Feedback</b> on behaviour</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">R Reinforce the patient’s <b>Responsibility</b> for changing behaviour</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">A State your <b>Advice</b> about changing behaviour</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">M Discuss a <b>Menu </b>of options to change behaviour</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">E Express <b>Empathy</b> for the patient</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">S Support the patient’s <b>Self-efficacy</b></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;">Motivational interviewing is a confrontational form of therapy, yet unique in that the conflict intended to give rise to change does not occur between the therapist and the client; it should arise within the client as they work through brainstorming sessions where they discuss topics that normally the counselor might ask questions to educate and bring the client towards desired changes in thoughts and behavior</span><span style="font-family: Arial, Helvetica, sans-serif;">.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;">"A guideline suggested by practitioners is </span><span style="font-family: Arial, Helvetica, sans-serif;">that one should aim to increase the proportion and accuracy of reflective listening statements and decrease the proportion of questions. The more thoughtful and understanding </span><span style="font-family: Arial, Helvetica, sans-serif;">is the practitioner, the more likely the patient is to become contemplative and, in doing so, </span><span style="font-family: Arial, Helvetica, sans-serif;">to make new connections... </span><span style="font-family: Arial, Helvetica, sans-serif;">In the example below, a client is engaged in talking about ambivalence. The counsellor’s </span><span style="font-family: Arial, Helvetica, sans-serif;">task is not to jump ahead to any other topic but merely to allow the client to explore this </span><span style="font-family: Arial, Helvetica, sans-serif;">conflict. Simple reflective listening statements are used to do this.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;">Counsellor: So what have you noticed about the effect of alcohol on your mood?</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;">Client: It’s like my saviour, because you see it is sometimes the only time I really feel at </span><span style="font-family: Arial, Helvetica, sans-serif;">peace with myself, like really relaxed.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;">Counsellor: It comes over you and you feel so different.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Client: Yes, and this goes on for a long time. There can be all hell breaking loose around </span><span style="font-family: Arial, Helvetica, sans-serif;">me and I won’t let it touch me.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;">Counsellor: It protects you from all sorts of troubles.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;">Client: For a while and then it’s like my punishment is not far away, like the time will </span><span style="font-family: Arial, Helvetica, sans-serif;">come when I feel upset, little things, and I get upset and even angry.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;">Counsellor: You get this lovely lift and you also get these darker moments.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;">Client: Exactly, but they don’t just last for a moment. You should see what I am like the </span><span style="font-family: Arial, Helvetica, sans-serif;">next day, I feel really down, like my life is a roller coaster of highs and lows, and the </span><span style="font-family: Arial, Helvetica, sans-serif;">drink is my master. I don’t like that."</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;">Having learned the downside of relying on questions as a counselor, motivational interviewing seems like a valuable resource for getting clients to discover the discrepancies in their personal goals and the destruction alcohol is wreaking on those goals. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;">For more information and examples see: <a href="http://elib.fk.uwks.ac.id/asset/archieve/e-book/GEJALA%20-%20DIAGNOSIS%20-%20TERAPI%20-%20SIMPTOMS%20AND%20DIAGNOSIS/John.Wiley.And.Sons.The.Essential.Handbook.Of.Treatment.And.Prevention.Of.Alcohol.Problems.eBook-LiB.pdf#page=118">The Essential Handbook of Treatment and Prevention of Alcohol Problems: Ch. 7 Motivational Interviewing</a></span></div>
Lisahttp://www.blogger.com/profile/11872642094442675377noreply@blogger.com0tag:blogger.com,1999:blog-6475250463530161596.post-32765576236718881152013-07-09T11:36:00.003-07:002013-07-14T12:50:38.318-07:00Self-Talk<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: small;"><span style="font-weight: normal;">One of the tools that may help alcoholics cope with cravings is something called </span>Self-Talk<span style="font-weight: normal;">. Some automatic thoughts clients have only lead them down a slippery slope of giving up:</span></span></div>
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<span style="font-weight: normal;"><span style="font-size: small;"><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><i><span style="font-family: Arial, Helvetica, sans-serif;">"Ugh I want a drink. I won't be able to stand this. The urge is going to keep getting stronger and stronger until I blow up or drink."</span></i></span></span><br />
<span style="font-weight: normal;"><span style="font-size: small;"><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;">Other types of self-statements can make the urge easier to handle:</span></span></span><br />
<span style="font-weight: normal;"><span style="font-size: small;"><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><i><span style="font-family: Arial, Helvetica, sans-serif;">"Even though my mind is made up to stay sober, my body will take a while to learn this too. This urge is uncomfortable, but in 15 minutes or so, I'll be feeling like myself again."</span></i></span></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: small; font-weight: normal;">There are two basic steps in using self-talk constructively:</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: small; font-weight: normal;">1. Have the client pinpoint what they tell him- or herself about a craving that makes it harder to cope with the urge. One way to tell if the client is on the right track is when he or she hits upon a self-statement that increases their discomfort. That discomfort-raising self-statement is a leading suspect for challenge, since it pushes their buttons.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: small; font-weight: normal;">2. Use self-talk constructively to challenge that statement. An effective challenge will make the client feel better (less tense, anxious, panicky) even though it may not make the feelings disappear entirely. The most effective challenges are ones that are tailored to the client's specific upsetting self-statements.</span></div>
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<span style="font-weight: normal;"><span style="font-size: small;"><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;">Examples of challenges the client can pose to themselves:</span></span></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: small; font-weight: normal;">What is the evidence? What is the evidence that if you don't have a drink in the next 10 minutes, you will die? Has anyone (who has been detoxed) ever died from not drinking? What's the evidence that people who are recovering from an alcohol problem don't experience the feelings that you have? What is the evidence that there is something the matter with you, that you will never improve? Of course you can survive it. Who said that sobriety would be easy? What's so terrible about experiencing an urge? If you hang in there, you will feel fine. These urges are not like being hungry or thirsty - they are more like a craving for food or an urge to talk to a particular person- they pass, in time.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: small; font-weight: normal;">Some of the substitute thoughts or self-statements will only be necessary or helpful initially, as ways of distracting the client from persistent urges; the client will have an easier time if they replace the uncomfortable thoughts with other activities. After a while, sobriety will feel less unnatural; many of the urges will diminish and drop out, and the client won't need constant replacements. </span><br />
<span style="font-weight: normal;"><span style="font-size: small;"><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;">Adapted from: <a href="http://pubs.niaaa.nih.gov/publications/matchseries3/project%20match%20vol_3.pdf">http://pubs.niaaa.nih.gov/publications/matchseries3/project%20match%20vol_3.pdf</a></span></span></span></div>
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Lisahttp://www.blogger.com/profile/11872642094442675377noreply@blogger.com0tag:blogger.com,1999:blog-6475250463530161596.post-30274295005033023732013-07-09T11:10:00.002-07:002013-07-14T12:52:04.165-07:00Urge Surfing<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="font-family: Arial, Helvetica, sans-serif;">Many people try to cope with their urges by gritting </span><span style="font-family: Arial, Helvetica, sans-serif;">their </span><span style="font-family: Arial, Helvetica, sans-serif;">teeth and toughing it out. Some urges, especially when </span><span style="font-family: Arial, Helvetica, sans-serif;">the client </span><span style="font-family: Arial, Helvetica, sans-serif;">first returns to their old drinking environment, are just too </span><span style="font-family: Arial, Helvetica, sans-serif;">strong </span><span style="font-family: Arial, Helvetica, sans-serif;">to ignore. When this happens, it can be useful for the client to stay </span><span style="font-family: Arial, Helvetica, sans-serif;">with </span><span style="font-family: Arial, Helvetica, sans-serif;">their urge to drink until it passes. This technique is called </span><span style="font-family: Arial, Helvetica, sans-serif;"><b>urge surfing</b>. </span><span style="font-family: Arial, Helvetica, sans-serif;">Urges </span><span style="font-family: Arial, Helvetica, sans-serif;">are a lot like ocean waves. They are small when they </span><span style="font-family: Arial, Helvetica, sans-serif;">start</span><span style="font-family: Arial, Helvetica, sans-serif;">, grow in size, and then break up and dissipate. The client can </span><span style="font-family: Arial, Helvetica, sans-serif;">imagine him- or herself</span><span style="font-family: Arial, Helvetica, sans-serif;"> as a surfer who will ride the wave, staying on </span><span style="font-family: Arial, Helvetica, sans-serif;">top </span><span style="font-family: Arial, Helvetica, sans-serif;">of it until it crests, breaks, and turns into less powerful, </span><span style="font-family: Arial, Helvetica, sans-serif;">foamy surf.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;">There are three basic steps in urge surfing that you can encourage the client to participate in:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;">1. Take an inventory of how you experience the craving. Do </span><span style="font-family: Arial, Helvetica, sans-serif;">this by sitting in a comfortable chair with your feet flat on </span><span style="font-family: Arial, Helvetica, sans-serif;">the floor and your hands in a comfortable position. Take a </span><span style="font-family: Arial, Helvetica, sans-serif;">few deep breaths and focus your attention inward. Allow </span><span style="font-family: Arial, Helvetica, sans-serif;">your attention to wander through your body. Notice where </span><span style="font-family: Arial, Helvetica, sans-serif;">in your body you experience the craving and what the </span><span style="font-family: Arial, Helvetica, sans-serif;">sensations are like. Notice each area where you experience </span><span style="font-family: Arial, Helvetica, sans-serif;">the urge, and tell yourself what you are experiencing. For </span><span style="font-family: Arial, Helvetica, sans-serif;">example, "Let me see... My craving is in my mouth and </span><span style="font-family: Arial, Helvetica, sans-serif;">nose and in my stomach."</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;">2. <span class="Apple-tab-span" style="white-space: pre;"> </span> Focus on one area where you are experiencing the urge. </span><span style="font-family: Arial, Helvetica, sans-serif;">Notice the exact sensations in that area. For example, do </span><span style="font-family: Arial, Helvetica, sans-serif;">you feel hot, cold, tingly, or numb? Are your muscles tense </span><span style="font-family: Arial, Helvetica, sans-serif;">or relaxed? How large an area is involved? Notice the </span><span style="font-family: Arial, Helvetica, sans-serif;">sensations and describe them to yourself. Notice the </span><span style="font-family: Arial, Helvetica, sans-serif;">changes that occur in the sensation. "Well, my mouth feels </span><span style="font-family: Arial, Helvetica, sans-serif;">dry and parched. There is tension in my lips and tongue. I </span><span style="font-family: Arial, Helvetica, sans-serif;">keep swallowing. As I exhale, I can imagine the smell and </span><span style="font-family: Arial, Helvetica, sans-serif;">tingle of booze."</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;">3. Repeat the focusing with each part of your body that expe</span><span style="font-family: Arial, Helvetica, sans-serif;">riences the craving. Pay attention to and describe to yourself the changes that occur in the sensations. Notice how </span><span style="font-family: Arial, Helvetica, sans-serif;">the urge comes and goes. Many people, when they urge surf, </span><span style="font-family: Arial, Helvetica, sans-serif;">notice that after a few minutes the craving has vanished. </span><span style="font-family: Arial, Helvetica, sans-serif;">The purpose of this exercise, however, is not to make the </span><span style="font-family: Arial, Helvetica, sans-serif;">craving go away but to experience the craving in a new way. </span><span style="font-family: Arial, Helvetica, sans-serif;">If you practice urge surfing, you will become familiar with </span><span style="font-family: Arial, Helvetica, sans-serif;">your cravings and learn how to ride them out until they go </span><span style="font-family: Arial, Helvetica, sans-serif;">away naturally. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;">Adapted from: </span><a href="http://pubs.niaaa.nih.gov/publications/matchseries3/project%20match%20vol_3.pdf">http://pubs.niaaa.nih.gov/publications/matchseries3/project%20match%20vol_3.pdf</a></div>
Lisahttp://www.blogger.com/profile/11872642094442675377noreply@blogger.com0tag:blogger.com,1999:blog-6475250463530161596.post-71543733172583350132013-07-08T13:02:00.005-07:002013-07-15T12:18:19.719-07:0012 Step Programs<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="line-height: 18px;">12 Step programs like Alcoholics Anonymous (AA) have proven effective in helping many remain sober for years, but they are not for everyone. When considering such programs you may wish to discuss the following with your client: </span></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: small;">Pros</span></h3>
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<li style="font-style: inherit; list-style-type: disc; margin: 0px 0px 0px 18px; padding: 0px; text-decoration: inherit;"><span style="font-family: Arial, Helvetica, sans-serif;">Free and unlimited</span></li>
<li style="font-style: inherit; list-style-type: disc; margin: 0px 0px 0px 18px; padding: 0px; text-decoration: inherit;"><span style="font-family: Arial, Helvetica, sans-serif;">No wait time</span></li>
<li style="font-style: inherit; list-style-type: disc; margin: 0px 0px 0px 18px; padding: 0px; text-decoration: inherit;"><span style="font-family: Arial, Helvetica, sans-serif;">Everyone is accepted</span></li>
<li style="font-style: inherit; list-style-type: disc; margin: 0px 0px 0px 18px; padding: 0px; text-decoration: inherit;"><span style="font-family: Arial, Helvetica, sans-serif;">The other group participants understand the problem through personal experience</span></li>
<li style="font-style: inherit; list-style-type: disc; margin: 0px 0px 0px 18px; padding: 0px; text-decoration: inherit;"><span style="font-family: Arial, Helvetica, sans-serif;">Structure to the "recovery" process (12 steps) you can do without a counselor</span></li>
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: small;">Cons</span></h3>
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<li style="font-style: inherit; line-height: 18px; list-style-type: disc; margin: 0px 0px 0px 18px; padding: 0px; text-decoration: inherit;"><span style="font-family: Arial, Helvetica, sans-serif;">May cause more difficulties for people with problems such as depression and social anxiety</span></li>
<li style="font-style: inherit; line-height: 18px; list-style-type: disc; margin: 0px 0px 0px 18px; padding: 0px; text-decoration: inherit;"><span style="font-family: Arial, Helvetica, sans-serif;">Other people's stories can be a trigger to relapse</span></li>
<li style="font-style: inherit; line-height: 18px; list-style-type: disc; margin: 0px 0px 0px 18px; padding: 0px; text-decoration: inherit;"><span style="font-family: Arial, Helvetica, sans-serif;">Unregulated participants' advice may be inaccurate</span></li>
<li style="font-style: inherit; line-height: 18px; list-style-type: disc; margin: 0px 0px 0px 18px; padding: 0px; text-decoration: inherit;"><span style="font-family: Arial, Helvetica, sans-serif;">Some group members may be intolerant of medication use</span></li>
<li style="font-style: inherit; line-height: 18px; list-style-type: disc; margin: 0px 0px 0px 18px; padding: 0px; text-decoration: inherit;"><span style="font-family: Arial, Helvetica, sans-serif;">Commitment to the process is difficult if you disagree with idealogies behind the 12 steps (powerlessness, relinquishing control to higher power, etc.)</span></li>
<li style="font-style: inherit; line-height: 18px; list-style-type: disc; margin: 0px 0px 0px 18px; padding: 0px; text-decoration: inherit;"><span style="font-style: inherit; text-decoration: inherit;"><span style="font-family: Arial, Helvetica, sans-serif;">Many group participants have severe emotional problems themselves, outside relationships should probably be avoided</span></span></li>
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<span style="font-family: Arial, Helvetica, sans-serif; font-style: inherit; line-height: 18px; text-decoration: inherit;">Attendance of 12 step groups should be balanced with other activities to avoid becoming overly dependent on the group.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-style: inherit; line-height: 18px; text-decoration: inherit;">Source: </span><a href="http://addictions.about.com/od/overcomingaddiction/gr/12step.htm">http://addictions.about.com/od/overcomingaddiction/gr/12step.htm</a></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-style: inherit; line-height: 18px; text-decoration: inherit;">There are many interesting articles that discuss various controversial aspects of AA and offer alternatives:</span><br />
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<a href="http://mentalhealth.about.com/cs/chemicaldependency/a/womenetoh.htm"><span style="font-family: Arial, Helvetica, sans-serif;">For Women, The 12 Steps Don't Always Work</span></a><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2746426/pdf/nihms143522.pdf">Alcoholics Anonymous Effectiveness: Faith Meets Science</a></span><br />
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Lisahttp://www.blogger.com/profile/11872642094442675377noreply@blogger.com0tag:blogger.com,1999:blog-6475250463530161596.post-75340753552747203132013-07-01T12:37:00.000-07:002013-07-15T12:23:37.956-07:00Medications<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: Arial, Helvetica, sans-serif; line-height: 1.15; white-space: pre-wrap;">The use of medication to treat alcohol abuse is a subject of controversy, but some have proven relatively effective in managing cravings and reducing relapse.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline; white-space: pre-wrap;">APPROVED</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline; white-space: pre-wrap;"><b>Antabuse</b></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline; white-space: pre-wrap;">Used to aid with initial abstinence; will make the user sick if they drink. One of the biggest drawbacks to this medication is non-compliance with actually taking the drug.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline; white-space: pre-wrap;"><b>Naltrexone</b></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline; white-space: pre-wrap;">Treats addiction during first 3 months; shown to decrease relapse by 50%-70% when combined with comprehensive treatment program. Drawbacks include: hard on liver, blocks effects of opioid pain medications (which may actually be desired if intended to reduce opiate addiction relapse).</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline; white-space: pre-wrap;"><b>Acamprosate</b></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline; white-space: pre-wrap;">Has shown modest success in lowering cravings.</span></div>
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<b style="line-height: 1.7em; word-spacing: 0.2em;"><span style="font-family: Arial, Helvetica, sans-serif;">Chlordiazepozide</span></b></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Treats withdrawal symptoms.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="vertical-align: baseline; white-space: pre-wrap;">OFF-LABEL</span></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="vertical-align: baseline; white-space: pre-wrap;"><br /></span></span></div>
<div style="line-height: normal; word-spacing: 0px;">
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="vertical-align: baseline; white-space: pre-wrap;"><b>Clonidine</b></span></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="vertical-align: baseline; white-space: pre-wrap;"><br /></span></span></div>
<div style="line-height: normal; word-spacing: 0px;">
<span id="docs-internal-guid-5779f01b-bfe0-8f8d-a65b-ebfdde992e7c"><span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline; white-space: pre-wrap;"><b>Topiramate (and other anti-seizure medications)</b></span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline; white-space: pre-wrap;"><b><br /></b></span>
<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline; white-space: pre-wrap;">Blocks dopamine, preventing alcohol from stimulating reward/reinforcement pathway.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
<div style="line-height: normal; word-spacing: 0px;">
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="white-space: pre-wrap;"><b>Baclofen</b></span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="white-space: pre-wrap;"><b><br /></b></span></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="white-space: pre-wrap;">A GABA receptor agonist.</span></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="white-space: pre-wrap;"><br /></span></span></div>
<div style="line-height: normal; word-spacing: 0px;">
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="white-space: pre-wrap;"><b>Nalmefene</b></span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="white-space: pre-wrap;"><b><br /></b></span></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="white-space: pre-wrap;">An opioid antagonist.</span></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="white-space: pre-wrap;"><br /></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif; line-height: normal; word-spacing: 0px;"><span style="white-space: pre-wrap;"><b>More information can be found here:</b>
</span></span><span style="font-family: Arial, Helvetica, sans-serif;"><span style="white-space: pre-wrap;"><a href="http://www.casacolumbia.org/upload/2012/20120626addictionmed.pdf">http://www.casacolumbia.org/upload/2012/20120626addictionmed.pdf</a></span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="white-space: pre-wrap;"><br /></span></span>
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="vertical-align: baseline; white-space: pre-wrap;"><b>Source: </b></span><span id="docs-internal-guid-0-4d158d-e3a0-7e88-0eb4-c073e8df26d4"><span style="vertical-align: baseline; white-space: pre-wrap;">Inaba, D. S., & Cohen, W. E. (2011). Uppers, downers, all arounders: Physical and mental effects of psychoactive drugs (7</span><span style="vertical-align: super; white-space: pre-wrap;">th</span><span style="vertical-align: baseline; white-space: pre-wrap;"> ed.). Medford, OR: CNS Productions, Inc.</span></span></span></div>
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