We're Not Alone

[Cassander]

http://www.nytimes.com/aponline/2015/06/03/health/ap-us-med-alcohol-problems-5-things.html?ref=health

[Guitarista]

Thanks Cass. And the numbers are likely to be much, much bigger due to denial and stigma. G

[Cassander]

Thanks Cass. And the numbers are likely to be much, much bigger due to denial and stigma. G

Hi G -- The reference in the article to denial and stigma is interesting. It says:

"Stigma and Denial

Dr. George Koob, director of the federal agency that did
the survey, said it is unclear why problem drinking has increased but that
many people underestimate the dangers of excessive alcohol. Many won't seek
help because of "stigma and denial," and many don't realize that medications
and behavior treatments can help. "There's a lore that there's only Alcoholics
Anonymous out there, and that's not true," he said."

This is interesting to me for a few reasons. One is the fact that Koob, who is, in fact, Director of the National Institute on Alcohol Abuse and Alcoholism, the principal agency in the United States overseeing the problem of alcoholism, finds it necessary to say that 'many don't realize that medications and behavior treatments can help.' This is stunning. The article reports that almost 33 million Americans (that's 33,000,000) have a drinking problem and the government has failed (utterly) to inform and teach the public that medical treatment is available (or, he acknowledges, that excessive alcohol use is dangerous). (The NIAAA seems to be appropriated about $450 million a year to spend on curbing alcohol misuse, which, I guess, is not enough.)

Imagine that the same situation existed today with smoking. Imagine that 'many' Americans didn't realize that smoking is dangerous and imagine that the government was largely silent on the subject. The number of smokers in the US is comparable (42 million) and the government has extensive programs to inform the public of the dangers of smoking. I guess the beer, wine and spirits lobby has prevailed where the tobacco lobby could not.

Another interesting thing, which the article does not mention, is that Koob is, in fact, an expert in the study of the neurobiology of the brain. As long ago as 2008 he was the lead author of a paper entitled 'Neurobiology of Addiction
and Stress' which discusses medical treatments for addiction and states (among other things) that: "Using the alcohol model of withdrawal-induced drinking, we found that baclofen, a γ-aminobutyric acid-B receptor antagonist, can block alcohol self-administration with an increased effectiveness in dependent animals compared with nondependent animals. Although baclofen has marked sedative effects, other agonists of this receptor may be a target for clinical development." The article also states that "Animal models that have indicated targets hypothesized to be selective for the treatment of addiction include those for extended-access intravenous self-administration, dependence-induced drinking, and binge drinking. The efficacy of drugs such as naltrexone and acamprosate (which are approved by the Food and Drug Administration for the treatment of alcoholism) provide validation for such animal models."

Here is a link to the report: http://www.scripps.edu/news/scientif...nad08koob.html

So Koob (unlike previous directors of NIAAA) in fact knows full well that alcoholism is a brain disease (and not a spiritual shortcoming or a failure of will), and that medical treatments like baclofen, naltrexone and acamprostate work. And yet the government does, essentially, so far as I can tell, nothing to inform 33 million Americans, not to mention the tens and tens of millions of family members, friends and co-workers whose lives are affected by alcohol misuse, of the availability of medical treatment.

The Times article ends, cryptically, with Koob saying ""There's a lore that there's only Alcoholics Anonymous out there, and that's not true." He (and the government) could be doing so, so much more. Its really kind of pathetic.

[Molly78]

It's the same in the UK. Naltrexone is licensed for treatment of alcoholism, but not only is it rarely used (& then only by secondary care services) it is used in a way which makes it ineffective. Sinclair showed it is effective if used in patients who are actively drinking, as it works by pharmacological extinction. And how do NICE guidelines tell doctors to use it? The patient must first be abstinent! It is virtually useless in preventing relapse. I think it must be something to do with the judgmental attitude of thee medical profession - first, show you have the willpower to give up, then we might treat you! Nalmefene, which recently got a license here, works in a similar way (though it sounds less effective from the clinical trials) but GP's generally have turned their noses up at it, claiming it "medicalises" social drinking.

Baclofen has done the trick for me, but I have only just realised through reading that Naltrexone can be equally effective for some people.......if it is used correctly.

It starts to seem like a conspiracy to stop people asking for treatment. Alcoholism STILL isn't widely seen as a brain disease, here or in the US. It needs people like Koob to shout louder.

[Cassander]

It's the same in the UK. ... I think it must be something to do with the judgmental attitude of the medical profession...

Hi Molly -- Thanks for your post. The attitude of most doctors to medical treatment of alcoholism is truly puzzling. Doctors go to school forever...and then they train forever...before they are allowed to see patients and practice on their own. You would have thought they would be objective, open-minded seekers of the truth...all for the purpose of c u r i n g d i s e a s e. Instead (and especially in respect of alcoholism), they are all-too-often dogmatic, close-minded nay-sayers who do no good at all. I really don't understand why.

[Spiritfree]

Hi Cass -tonight, I was preparing to respond to the news articles relative to what you have posted on my med thread.
Thank you for making this post -it extremely helpful to all concerned.

Cass, before I post some additional information relative to the topic, I would like to tell you about a call that I received today from a friend of mine who used to participate on MWO. Baclofen, as it turned out, never was a solution for him and he felt -once again, that something must be wrong with him if Baclofen was not performing the miracle for him as it has done for others. As such, he stopped posting on the site but he I and have continued to communicate.

The call that I received from my friend was one out of desperation, total loss of hope, and it actually scared me and I am still very concerned at this moment -for his life. Strangely enough, I was/am so concerned that almost called you or began to write you as to what you would recommend me to do, but then decided that I would not pass that burden on along to you. As I write this, I am waiting on a call from some folks that might be able to help him -immediately.

Now, regarding the article(s). AUD (Alcoholism) is the MOST under diagnosed, most under-treated, most deadly, most costly, disease/disorder that our country and world has experienced -since their inception. Never, ever in the history of mankind has there been such a killing off of humans by a disease that has not been brought into the main focus of treatment and media. Those afflicted and their families have to start speaking out! The HUGE revenues to the governments and alcohol companies are an extreme obstacle to saving these lives -believe or not -I have done the research.

It is my opinion that we are VERY fortunate to have Dr. George Koob as the director of the NIH-Alcoholism/Abuse division. Dr. Koob acknowledges and knows that this is a brain disorder, and as such, has to be treated as such. He also seems to be willing to share the reality of the REAL destruction that alcohol/drugs is posing on our country.

The new facts: According to JAMA, "one third of U.S adult population may be addicted to alcohol". This represents a huge problem. This is an epidemic like none that we have ever known. This has to stop or we will all eventually die off as a result of this "hidden and denied" disease.

Articles:
NIH study finds alcohol use disorder on the increase | National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Epidemiology of DSM-5 Alcohol Use Disorder | Psychiatry | JAMA Psychiatry | The JAMA Network
Page not found – STGIST

Cass, many still scoff and laugh, but we have to begin taking more seriously the hallucinogen medications more seriously in order to stop this deadly disease (Ibogaine, etc.).

Again, thank you for your post.

--sf--

[Cassander]

Hi Spirit -- In a more perfect world, in a situation where you fear for the life of a friend, shouldn't the medical profession be deeply involved? I understand...this is your point. You are so right. Cass

[Spiritfree]

Cass -One other thought/opinion. Dr. Koob can not just go running into the NIH as the director and totally disrupt the current system. He is doing a job bringing the idea of medication to the forefront to treat the disease, but if he pushed too hard, he would find his walking papers on his desk.

Please watch the following video (if you not already). Also, please try to ignore the fact that the interviewer is wearing "knock-off" shirt-lol.
YouTube

[Spiritfree]

Hi Spirit -- In a more perfect world, in a situation where you fear for the life of a friend, shouldn't the medical profession be deeply involved? I understand...this is your point. You are so right. Cass

I can not thank you enough.
--sf--

[Cassander]

... Dr. Koob can not just go running into the NIH as the director and totally disrupt the current system. ...

Of course, you make a point, Spirit, but the wheels turn so slowly...its been years since Dr Ameisen published his book, four years, I believe since I first came to this site and learned of the impact of medication for alcoholism, and a couple of years since the French health authorities (what do they know?) approved baclofen for alcoholism. It seems like we have been waiting forever for the definitive double blind study 'proving' that baclofen works to be published. And, there are dozens (if not scores or hundreds) on this board who can attest that medication can often play an important point in reducing and eliminating craving.

A few years ago Otter (god bless Otter) was going off on the urgency of the problem here and it was I who told him to have patience. But it really is now about time...

[Spiritfree]

Of course, you make a point, Spirit, but the wheels turn so slowly...its been years since Dr Ameisen published his book, four years, I believe since I first came to this site and learned of the impact of medication for alcoholism, and a couple of years since the French health authorities (what do they know?) approved baclofen for alcoholism. It seems like we have been waiting forever for the definitive double blind study 'proving' that baclofen works to be published. And, there are dozens (if not scores or hundreds) on this board who can attest that medication can often play an important point in reducing and eliminating craving.

A few years ago Otter (god bless Otter) was going off on the urgency of the problem here and it was I who told him to have patience. But it really is now about time...

Cass -You are absolutely 100% correct in your comment "the wheels turn so slowly". I stay frustrated with this entire situation almost on a daily basis. We currently have 88,000 human LIVES DIE each year as a result of AUD (alcoholism). We have REAL solutions available NOW that are not sanctioned or, even worse, considered illegal to use, by our government -for the elimination or reduction of drug use. (Baclofen, Gabapentin, Ibogaine, etc., etc.)

I truly just don't understand it though I think a lot of the obstacles that are placed in front of these medications relate to money. This has to change and it has to do so sooner rather than later. How can we get the cures into the market place?

[Molly78]

Hi Molly -- Thanks for your post. The attitude of most doctors to medical treatment of alcoholism is truly puzzling. Doctors go to school forever...and then they train forever...before they are allowed to see patients and practice on their own. You would have thought they would be objective, open-minded seekers of the truth...all for the purpose of c u r i n g d i s e a s e. Instead (and especially in respect of alcoholism), they are all-too-often dogmatic, close-minded nay-sayers who do no good at all. I really don't understand why.

The problem is related to the fact that doctors (especially GPs) rely on "guidelines", because it would just be too labour intensive to research the literature for every condition they encounter. And guidelines come from government organisations such as NICE. Who supposedly review the evidence on behalf of doctors in order to guide their practice. But it takes NICE years to come up with their guidelines. So they are always "behind the times". And if there isn't a guideline GPs particularly will not prescribe anything which does not have a license. Which takes years of research to acquire, & then has to be included in a guideline........I'm sure you start to get the picture!

Medical professionals are conservative people to begin with, & in the current climate of litigation they are all watching their backs. It's called practicing defensive medicine, & I'm afraid it has come to the UK like so many things from the US. So, you as a patient have the right to sue your doctor for malpractice, but given that right, you can't blame him for being cautious in his prescribing.

What I object to is the attitude of most doctors to alcoholism - ie it's a failure of willpower. There is NO EXCUSE for this attitude as it has been recognised as a disease for many years in the DSM 5 & ICD 10.

[Spiritfree]

Hi Cass -perhaps the main stream media will continue to try and get the word out:

"The enormous scope of our national drinking problem"

http://theweek.com/articles/558639/enormous-scope-national-drinking-problem

[Spiritfree]

Alcohol Disorders: Nearly 1 in 3 Adults Are Problem Drinkers

http://www.livescience.com/51066-alcohol-use-disorders-prevalence-us.html

[_serenity_]

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