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Vermont became the 43rd state to join this year--not the union, of course, but the 42 states that already allowed methadone maintenance clinics. According to the September/October issue of the American Psychological Association's Psychological Science Agenda, the Vermont law stipulates that patients at the clinics must also receive behavioral therapy. In addition, a new maintenance medication, buprenorphine (BPN), must be considered ahead of methadone. BPN had not received FDA approval at the time of publication, but approval was expected soon. It is safer than methadone both medically and in terms of probability of abuse. Vermont may be the latest state to join, but its law is based on the most informed judgment! A Yale study reported in August 2000, indicated that people
addicted to both heroin and cocaine who received acupuncture were twice as
likely to be "clean" at the end of an 8-week study period as
people who received "sham" acupuncture (53.8% vs. 23.5%). Only
9.1% of patients who watched relaxation videos during treatment time were
clean. Thirty subjects, however, dropped from the study, and the authors
noted that the study should be replicated. If acupuncture were effective,
its low cost and lack of side effects would make it a very practical
treatment. An article in the issue of the Journal of the American Medical Association published on November 21, 2000, reported that people with mental illness smoke nearly half (44.3%) of the cigarettes purchased in the United States. The reason for this startling statistic is that people with mental illness are more likely than people without mental illness to be smokers. Smoking, like drinking alcohol, may be an attempt at self-medication. The researchers, led by Dr. Karen Lasser, included drug and alcohol addiction among the mental illnesses, which makes the results a little less surprising. People with psychiatric illnesses had more trouble stopping smoking than people without such problems, but were still able to quit at a rate that surprised the researchers. Alcoholism: Choose
Behavior Therapy plus Medication A recent study published in the November, 2001, issue of Alcoholism: Clinical and Experimental Research showed that the results of a treatment program were better if naltrexone was used to supplement behavioral therapy. The lead author of the paper, Dr. Peter M. Monti, encourages the use of both behavioral therapy and pharmacotherapy, not just one or the other. The study used 2 weeks of communication skills training and cue exposure, coupled with urge-specific coping skills training, as the behavior therapy component, and 90 days of follow-up treatment with naltrexone to support abstinence. Naltrexone helped only so long as patients continued to take it, prompting Dr. Monti to suggest that naltrexone be prescribed for more than 90 days. Even the combined treatment, customized for individual patients, was no magic bullet, as some patients continued to drink. However, they drank less heavily during the treatment period. Alcoholics who received the behavior therapy training were less likely to report relapse days than patients who received a control, education/relaxation, treatment. This study suggests that alcoholics are more likely to benefit from this type of combined treatment, and certainly should seek it in preference to either type of unimodal treatment. |
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