Addiction Treatment Blog

Over the past two decades there appears to have been a shift within health care from an expectation that patients with medical problems should entrust themselves passively to the care of physicians to an expectation that they should co-operate in their own care and indeed have some responsibility for the outcome of medical procedures they undergo. The changes are reflected in the terms we used; the word patient, which means someone who endures, is being replaced by terms such as client or consumer, which suggest a more active and discriminating participant in the medical process.

Nowhere is this shift more clear than when it comes to the question of what is known as informed consent. Informed consent was not an issue in medical practice 20 years ago. Today it forms a central issue in a number of ethical codes from the Nuremberg Code to the Helsinki Code as well as Codes originating from the Food and Drugs Administration (FDA) in the United States and the US Department of Health. Read more…

Separation Liability

Liability for drug induced injuries did not become an issue of general concern until quite recently. However, a number of drug-induced problems from thalidomide in the 1960s to Opren and diethylstilbestrol in the 1970s have caused widespread public disquiet and led to increasing awareness of issues to do with liability. In psychiatry, concern in the UK focuses on the question of benzodiazepine prescribing, while in the US the paramount issue concerns the occurrence of tardive dyskinesia in individuals taking neuroleptics. The question has become an emotive one with some commentators who survey the problem referring to the appalling frequency of drug-induced injury, while others comment on its astonishing tray (1). Whatever the absolute frequencies, contrary probably to public belief, the evidence suggests that the larger the pharmaceutical company, the better its practice regarding drug safety is likely to be (2).

Drug-induced problems may stem from toxic effects of a drug, or toxic effects caused by an impure additive, or from allergic reactions to the drug or its additive. Problems may also stem from over prescribing. For instance, in the case of someone who dies from a resistant bacterial infection, a relative could claim that the subject’s death arose in part from the excessive prescription of antibiotics that in its own right brings about the production of resistant infections. In the case of neuroleptics, problems may be brought about by the overuse of these drugs but this overuse, far from being solely promoted by drug companies stems in part from the current politics of mental health – deaths have stemmed from rapid tranquillisation often by harassed staff in psychiatric units. Read more…

Dementia Treatment

It is not clear yet that damage to the cholinergic pathway is the central deficit in Alzheimer’s dementia. Indeed, it has recently become clear that a number of other neurotransmitters are affected in both Alzheimer’s and other cortical dementias. It is also clear that, because of the interactions between various neurotransmitter systems, it is almost impossible to manipulate one neurotransmitter systems, it is almost impossible to manipulate one neurotransmitter without affecting the others.

Finally, from the vantage point of the 1990s, it seems that many cortical dementias may involve cell protective mechanisms that have been thrown out of gear. Normally, there are a range of mechanisms within cells for neutralizing toxins of various sorts. These often involve the binding of a protein to the toxin, which labels it so that the cell’s own degredative processes destroy the offending agent. In the dementias, however, such mechanisms seem to have been stimulated to the point where the large amounts of cell-protective proteins are produced, to the point where large amounts of cell-protective proteins are produced, to the point that they themselves poison the cell. Whether the stimulus is genetic, viral, toxic (as in aluminium) or some combination of these and other factors is uncertain. The treatment options are to find compounds that will switch off the process or else compounds that will compensate for it. Read more…

Dementia

Part of the problem in finding drugs which may be effective for dementia is that our ideas about what constitutes dementia have been undergoing radical change in recent years. It had been traditional to distinguish between Alzheimer’s dementia, or senile dementia of the Alzheimer’s type (SDAT) and multi-infarct dementia (MID), which is theoretically caused by small strokes which insidiously pick off brain tissue to the point where an individual’s cognitive function is compromised. Read more…

There are a number of steps that can be taken in the management of insomnia before resort is made in hypnotics. These include:

The elimination of all caffeine containing drinks

Such as tea, coffee, colas etc.

Ensuring quiet surrounds.

This is a particular problem for a shift worker, especially when he wants to burn the candle at both ends, or resents having to be on shift work. There are further shift work related difficulties – see point below on body awareness.

Relaxation exercises, in particular progressive muscular relaxation.

These are useful in their own right, but not particularly sleep inducing in the short term. They also require considerable patience and regular practice to master, as how they work depends on building up associations between relaxation and sleep. With regular practice, subjects find they drift off half way through their exercises. Cassette tapes or relaxation programmes promising sleep, however, rarely mention the fact that considerable hard work and patience is required. The failure of these methods to deliver, in the short term, seems to lead most subjects to feel frustrated or a failure and to abandon what is a useful skill. Read more…

Insomnia itself can be difficult to manage and live with it.

An initial complaint of insomnia may refer to a number of different things, such as;

• An inability to get to sleep.
• An inability to stay asleep.
• Waking too early.
• Unsatisfying sleep.
• Tiredness during the day, which individuals assume is caused by inadequate sleep the previous night.

A range of underlying physical conditions can contribute to sleep disturbances, such as coughs, itches, pain, restlessness, frequency or urination and breathlessness. These may lead to any of the above complaints, and they need diagnosis and proper treatment.

There is a particular condition that deserves special notice. This is obstructive sleep apnoea, a condition commonest in middle aged men who are somewhat overweight, but who in particular have large necks. In a serious form, it may affect up to 3% of men. It involves the airway collapsing on attempted inhalation, which typically happens when sleeping at night lying on the back. Collapse of the airway leads to the individual stopping breathing until the respiratory drive becomes so intense that the airway is forced open – usually with a loud snort. The effort is so intense that individuals usually have their sleep disturbed, leading to poor quality sleep and hence tiredness next day. The snort is so dramatic and loud that bed partners are often woken. The diagnosis is therefore commonly made by interviewing the sleeping partner who complains about snoring, and will usually have noticed that their partner often appears to stop breathing for anything from 10-60 seconds. The significance of this condition for our purposes is that, because there is poor sleep and fatigue next day, the individual may come seeking something to improve his sleep, but treatment with hypnotics may be fatal. The condition can be treated very successfully with a method called CPAP (continuous positive airways pressure), which involves wearing a specially constructed device while asleep. Read more…

Sleep Disorders

There are a number of sleep disorders, of which by far the commonest relate in some way to the complaint of insomnia, which will be the principal focus of this and the following blogs. Regarding insomnia, strange though it may sound, strictly speaking this is a complaint rather than a condition. The management of insomnia is not the management of people who have sleeplessness. Rather it is the management of people who complain about insomnia differs little from that of those who do not complain. In both groups, there are individuals who appear, on objective tests such as sleep EEGs, to have excellent sleep. Surveys suggest that about 1 in 5 individuals in the general population feel their sleep is not as satisfying as it should be. Read more…

In addition to the types of anxiety mentioned earlier, there are a number of different situations in which anxiety arises according to which it is categorised and treatment given. There are many different occasions of anxiety and in this article, you will find a detailed explanation to each of them in different subjects; such as Stage Fright Anxiety, Panic Disorder, Obsessive Compulsive Disorder, Generalised Anxiety Disorder (GAD), etc. Read more…

Lithium Pellets

There are some suggestions from as early as the 2nd century AD that spring waters that were alkaline (which would be expected with a high concentration of lithium salts) were known to be of some use in the treatment of overactive states such as mania (1).

Lithium itself was isolated first by August Arfwedson in 1817. It was named lithium as it was found in stone – lithos being the Greek for stone. During the 1850s alkaline compounds, like lithium, were known to be of some use in preventing gout by interfering with the precipitation of uric acid in the blood and joints. At the time mania and melancholia were often seen as being part of the same family of diseases as gout and this led to the use of lithium for these conditions also. As early as 1880, the use of lithium in this manner led Carl Lange to suggest that it might have a role in preventing episodes of periodic depression.

Surprisingly, however, despite these discoveries and what would now appear to be correct hunches, lithium slipped out of use for mood disorders and had to be rediscovered in 1949. In part this was because of its side effects. In the middle of the 19th century, several investigators took lithium and noted that it caused increased urine flow, tremor of the hands and difficulties with memory or concentration, which led to wariness regarding its use. Later in the 1930s, it was used as part of a salt restriction diet in the United States and in many cases it caused such clear cut toxicity that its use was banned by the Foods and Drugs Administration (FDA). Read more…

Twelve Step Programme

The ‘Twelve Step Programme‘ was created and developed in 1935 by the two founders of Alcoholics Anonymous, New York stockbroker Bill Wilson and Ohio surgeon Bob Smith. Since then, the Twelve Step Programme has been the basis of AA’s recovery plan, and has been used and adapted by numerous other self-help groups ranging from Narcotics Anonymous to Gamblers Anonymous.

The Twelve Step Programme carries a strong spiritual message and attracts both loyalty and criticism – perhaps partly because of its strong Christian language, and the encouragement to surrender to a higher ‘Power’ on the journey to recovery. Following the Twelve Steps involves working towards various milestones in the presence of the support group. These include amongst others, admission of the problem, seeking help, a spiritual awakening and supporting others who want to recover.

For some people suffering from addiction problems, the required practice of the Twelve Steps may not be enough to solve the root cause of the problem, and they may need to find a good therapist to work with. The Twelve Step process requires commitment and determination and can stretch what a person is capable of. In the words of one member, the best thing about it is that, ‘It’s like a spiritual and mental carwash – while the worst thing is that at times, it can feel a little bit like going back to school.’ Read more…