Abstinence isn’t for everyone – an introduction to harm reduction

When we talk about harm reduction, safe injection sites or opioid replacement therapy come to mind for many people. But the concept of harm reduction is much broader and can be applied to any substance at any level of severity. You’re  probably familiar with the concept of harm reduction when it comes to food intake, even if you don’t call it by that term. When you choose treats that have less sugar or fat, you are engaging in a harm reduction strategy. When you decide to forgo a second helping of dinner, that is harm reduction. 

Harm reduction is any strategy that reduces the negative consequences of substance use. Some examples include consuming a lower alcohol content beverage, drinking water between drinks, eating while drinking, waiting until a certain age before using substances, or using pain management techniques other than medication, such as yoga or meditation. While some people may be willing to quit substances altogether, most people are not. Harm reduction allows all people to engage with strategies that benefit their lives. The key to harm reduction is that any step in a positive direction is a beneficial step. 

“The key to harm reduction is that any step in a positive direction is beneficial.” 

But shouldn’t some people just stop using substances? Research shows that some people who struggle with substance use benefit from abstinence, particularly if they have found substance use difficult to control over time and have experienced severe consequences such as losing jobs or important relationships. 

That being said, the majority of people do well with harm reduction approaches but do not have that option when seeking treatment. Programs that provide the option of reducing or moderating substance use are rare, and many programs require that you abstain or commit  to abstinence when entering treatment. This all-or-nothing approach prevents seeking help and is not aligned with up-to-date, evidence-based understandings of addiction treatment. 

One of the main barriers to harm reduction approaches — and the reason abstinence is often touted as the gold standard — has been a dominating belief that addiction is a disease. The main premise of the disease model is that people who struggle with substance use have a progressive and irreversible illness that stays with them forever. The research evidence simply does not support this model. 

“The research evidence does not support the model of addiction as a lifelong, irreversible disease.” 

The longest follow-up study in addiction recovery is being conducted at Harvard Medical School, where they have followed the drinking patterns of a group of males since 1940. Results show that many of the participants have continued to use high levels of alcohol for decades without progressing to a more severe state. Similarly, research studies conducted by the National Institute on Alcohol Abuse and Alcoholism have found that about 75% of people who meet the criteria for an Alcohol Use Disorder no longer do so at a later time. We now know that people who struggle with substance use fall along a spectrum of problems from low to high; it is not a matter of having or not having a disease. Most people on this spectrum tend to ebb and flow in and out of struggles with substance use throughout their lifetime. 

What are the benefits of harm reduction?

Abstinence isn’t for everyone:

Many people are not ready or willing to commit to abstinence, especially those on the mild or moderate part of the spectrum who would benefit from harm reduction. Acknowledging that there are numerous pathways to resolution can have implications for drawing more people into treatment. In an analysis of 38 articles with 40 separate samples, Linda Sobell and her colleagues found that 3/4 of the individuals who had recovered from struggles with alcohol use reported that low-risk drinking was part of their recovery. Similar evidence was found for drug use, with nearly half of the combined sample reporting recovery involving some form of continued use. 

It provides early intervention:

A second benefit to harm reduction is that it helps people earlier in the process. A common belief is that recovery from addiction requires hitting “rock bottom” and receiving formal treatment. However, programs that successfully create change in the early stages of an addictive process serve to help people who may not yet have experienced negative consequences of use. 

It’s individualized:

Harm reduction is client-centric, which means techniques are tailored to the individual and meet them where they are. Imagine if you were told today that you had to give up sugar forever? Most people would struggle with this goal, but many are open to reducing their sugar intake over time. The same principles apply to substance use treatment. Allowing people to make choices about how and when they make a change offers the best chances for success. 

It’s the natural process of change:

Referring back to the sugar example, imagine if the only measure of success for good health was to never consume sugar again? What if you had reduced your sugar consumption to only on weekends, or only on holidays? Surely that would be a measure of success? Yet historically, the only measure of success in substance use treatment has been complete abstinence. This outcome does not consider the multitude of ways that someone can change in a positive direction. Most lasting changes happen in small incremental steps over time. 

What are some examples of harm reduction?

Harm reduction can come in many different forms. Here are some ideas of harm reduction you might consider: 

What does harm reduction look like in practice?

Here’s an example of how someone has benefited from a harm reduction approach: 

Jackie likes to relax after work with a few drinks, and sometimes more when she’s feeling stressed out. On the weekends, she often gets together with her girlfriends for nights on the town and boozy brunches. But in the last few years, she feels like these habits have caught  up with her. Her hangovers are getting worse, she’s given up some of her nighttime hobbies, her spending on alcohol has been increasing, and she’s been getting anxiety around all of it. In the last few months, Jackie has been working with a coach to implement harm reduction practices. She now considers the low-risk drinking guidelines by sticking to two drinks a night, except for on special occasions. She’s decided to make Mondays to Wednesdays alcohol free days. On the weekends, she’s determined to forgo any day drinking, and when she does meet up with friends in the evenings, she leaves her car at home, so she’s not tempted to drive home after a few drinks.

Jackie never saw abstinence as a realistic option or something she needed. But making these changes in her life has given her a sense of accomplishment and improved her health and mood. As a way to continue to motivate herself, she’s been socking away the money she saves on alcohol and putting it towards monthly massages and pedicures, as well as saving for a vacation she’s wanted to take for a long time. 

How can I change my substance use? 

If you or a loved one has been thinking about changing your substance use, think about one small change you can make today that would move you in a positive direction. This change could include reducing the amount of substance you use or reducing the harmful consequences of use. 

ALAViDA provides a range of support options for anyone wanting to change their relationship with substances, whether that’s through harm reduction or abstinence. Support is accessed through the TRAiL platform, and includes iCBT modules, daily notifications and tracking tools, coach-assisted support, live classes, and facilitated care groups. Access the ALAViDA TRAiL.

 

 

 

Substance Use and COVID-19: Risks

Vaccine Hesitancy and COVID-19 Risk Amongst Individuals with Substance Use Disorders

The ASAM (American Society for Addiction Medicine) recently revealed an under-examined trend in vaccine hesitancy—the population of individuals struggling with Substance Use Disorder (SUD’s). This group of individuals has a higher risk of contracting COVID-19 and experiencing worse symptoms, but they’re less likely to pursue vaccination. Feelings of shame, or past discrimination in healthcare settings are substantial barriers, which stop this group of people from engaging in a voluntary health visit. Studies show that even when vaccinated, those with SUD’s are more vulnerable to the virus. 

Even before SARS-CoV-2 threatened the global community, the World Health Organization reported that vaccine hesitancy was one of the biggest threats to global health. Media attention has highlighted the impact of COVID in death and hospitalization rates in areas that are under vaccinated. In many such regions, distrust in the government, or misinformation adopted through social media is the cause for vaccine hesitancy, but there is very little emphasis on the evidence base and experience of substance users.

To read more about the effect of COVID-19 on SUD’s from a variety of leading scientific magazines, click here.

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CBT and Brain Function

How Does CBT Change Brain Function?

What is CBT?

Cognitive behavioural therapy (CBT) is a therapeutic intervention that gives individuals the tools to examine their thoughts, feelings, and behaviours. Dr. Beck and Dr. Ellis, the psychiatrists who developed CBT, looked at the way thoughts are formed and how they shape beliefs and behaviour. Specifically, he categorized different types of thoughts such as the distortion of automatic thoughts, core schemas, beliefs, and underlying assumptions. The first role of the cognitive model was to investigate how negative beliefs maintain symptoms in depressed patients. Since then, CBT has had broad applications in mental health and substance use challenges. The premise of CBT is that many struggles are sustained by biases in thinking.  

Many of the thoughts that we have occur automatically and so part of the goal of CBT is to change unconscious processes to mindful practices. The patient tests the way they see reality against available facts. Part of the process of therapy is learning that negative thoughts have consequences. Individuals learn how to describe their experience with accuracy and to rely on facts as opposed to leaning into generalizations. For instance, a therapist might encourage their client to restructure their automatic thoughts. If the client thinks, “I am a failure,” the therapist will help them reframe their thought to: “I did not achieve my goals on this specific task at this time.”

Here are some ways you can reframe your thoughts: 

When you’re experiencing challenging thoughts, it can help to focus on your breathing. There are many apps and tools which can assist you with breathing and different forms of meditation. A simple grounding exercise is to breathe in for the count of four, hold at the top for four, breath out for four, and hold at the bottom for four. You can repeat this simple technique as many times as you need to feel calm and grounded. 

An underlying goal of CBT is to move from fixed to flexible thinking. The therapist helps the individual develop the muscle to find evidence for and against an assumption and to manage uncertainty. This helps the individual with the realization that things can be looked at from different perspectives and behaviour can be modified. CBT interrupts the feedback loop that maintains problems over time. As well, it is collaborative and action oriented. The goal of therapy is not simply to feel better but to develop tools to cope with future problems. 

Scientists are encouraged by the results of neuroimaging which shows that therapeutic treatment has neurobiological effects. This helps us understand the relationship between symptoms, emotional regulation, and behaviour better. 

So How Does CBT Change the Structure of the Brain?

Let’s look at the results of a neuroimaging study examining the effects of CBT on social anxiety which can lead to drinking. 18 individuals were assessed and randomized for treatment with an antidepressant called citalopram, CBT, or a waiting list. CBT focused on cognitive restructuring, bibliotherapy, and exposure. There was no difference between the CBT and citalopram groups. Participants were assessed in a public speaking task, which activates social anxiety. Bilateral regional blood flow was assessed in the amygdala, hippocampus, and the anterior temporal cortex and there were significant reductions in regional blood flow to these areas after treatment with CBT, which meant that the patients had decreased symptoms and showed overall improvement.

CBT changes the structure and pathways of the brain. For instance, the limbic response, which is associated with emotions and triggers, was linked to long-term clinical outcomes. Other studies including phobia, OCD, and panic show promising results related to areas of the brain which become activated by disease, and this strengthens the evidence for treatment in substance use disorder. Behavioural therapies are associated with reductions in substance use and increased cognitive control, management of impulsivity, motivation, and attention.

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Care that fits into your life

You’ve heard it before, maybe you’ve thought it yourself:

In-person appointments are more effective.

Seeing my therapist online won’t offer the same support.

I might as well hold off on appointments until I can see my therapist face-to-face again.

Many individuals are skeptical about virtual appointments. It’s common to feel that something will be missing from a phone or video interaction, or that without an in-person connection, the clinician won’t see their experience. At ALAViDA, we have been offering virtual care to clients struggling with substance use challenges for five years. We’ve found that this form of treatment empowers clients to stay engaged with their lives while developing meaningful therapeutic relationships to support sustainable change. 

Virtual care isn’t a downgraded option; it’s a clinical model defined to increase the quality and accessibility of care. It is designed to produce positive outcomes and to give individuals the option to stay engaged in their work and home life without disruption while receiving the support they need. Virtual care has become popularized but it’s not a new concept. The U.S. is a leader in this model with cutting-edge services modelled by the Kaiser Permanente systems. 12 million health plan members had access to the healthcare services offered by Kaiser Permanente by 2020—80% of which was virtual. Despite these advances, access to virtual treatment is not uniformly distributed across the globe. 

Of the 85.5 million virtual contacts: 

But in Canada, the growth of telehealth and virtual care is slower moving. While COVID-19 has accelerated the emphasis on virtual care as a part of Canadian healthcare, integration lags. 

Canada is no stranger, however, to adaptive methods of care delivery. In the 70s, Dr. Maxwell House introduced telehealth to extend the reach of care to isolated communities across the province of Newfoundland. The World Health Organization (WHO) has identified that in under a decade, the world will face a global shortage of 18 million health workers. This burning problem can be circumvented through digital health. A global survey that included 27 countries showed that 10% of individuals had tried virtual care but nearly half of the population was interested in trying it. Virtual care has the potential to change the burden of chronic illnesses, according to WHO, 80% of which can be eliminated with early prevention.

Virtual care removes barriers to access including common roadblocks such as accessibility, affordability, geographical distance, travel burden, and out-of-pocket expenses. For people who live in rural areas or wish to consult with specialists at a distance, it offers unique opportunities for more specialized care. It is also useful in emergencies and as a mediator for emergency room visits. When it comes to substance use and mental health, virtual care enables the patient to seek support without the stigma of leaving work and taking big chunks of time out of their schedule which leaves them feeling vulnerable to judgment from management. It’s important to consider the anxieties and challenges that the older population may experience with this format and to consider approaches to reduce barriers to access. 

The evidence is robust that virtual care has an important place in healthcare delivery and can make a powerful difference. Still, only 1 in 10 companies have adopted virtual care technologies into their benefits plans. These choices do not represent the 71% of employees who state that they would access virtual care if it was available. It has the potential to change the workplace and put a dent in the downstream effects of absenteeism, presenteeism, and disability. It saves thousands, per employee, in absenteeism alone. Virtual care gives patients the opportunity to fit care into their schedule in a more flexible range of hours, to avoid long wait times, prevent interruption to work, less stress, convenience, and more regular touchpoints. Prevention and early intervention are the gold standards and with easy access and minimal compromise, employees can bypass delay to treatment and avoid more serious health consequences. 

Tips for your virtual care appointment:

Virtual care gives you the opportunity to stay on top of your health and connect with specialists from anywhere. Prevention can make the difference in your substance use and connecting with ALAViDA is a great place to start.

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Metabolizing Alcohol

How is Alcohol Absorbed in the Body?

The feeling of having a drink is familiar: warm belly, light head, calm nerves, and relaxed muscles. Your past sensations while drinking give you a sense of how long the drink has been in your bloodstream and how long it will remain. You can likely discern how long you should wait before driving and what time you’re likely to fall asleep. You know roughly how many drinks it takes before it’s harder to walk in a straight line or to put together a coherent sentence. But what about the science of how alcohol is metabolized in the body? 

Alcohol is classified as a depressant; it is referred to in this way because it depresses the nervous system. This mechanism of action leads to slurred speech, wobbly movements, altered perceptions, and changes in the ability to think, judge and react. Alcohol directly affects the front part of the brain – the cerebral cortex – inhibiting our ability to use judgment, as well as the hippocampus where memories are formed. That is why you might forget parts of the evening when you engage in heavy drinking. Additionally, alcohol affects the amygdala which is responsible for social behaviour, the cerebellum which is in charge of balance and coordination, and the hypothalamus which keeps appetite, temperature, pain and emotions in balance. 

Alcohol has a short stay in the body. Once it enters your bloodstream, your body metabolizes alcohol at a rate of 20mg per deciliter (mg/dL). To put that into perspective, if your blood alcohol level was 40mg/dL, it would take two hours to metabolize the alcohol consumed. The rate at which alcohol is felt or metabolized depends upon individual factors. This comes down to blood alcohol concentration or (BAC), which is a measure of the amount of alcohol in your blood in relation to the amount of water in your blood. Some of the factors that impact your BAC and how you respond to drinking alcohol are:

What happens when alcohol enters the body?

Alcohol first travels to the digestive system. Unlike food, 20% of alcohol from a drink goes to the blood vessels, meaning that it is carried to your brain. The remaining 80% goes to your small intestine and into your bloodstream. The last step is that alcohol is taken out of the body through the liver and any deficit in your liver may slow this process down. 

Another key factor in determining how long it will take to metabolize alcohol is to know how much alcohol is in your drink. Generally, it takes one hour for one serving of alcohol to be metabolized, which is the equivalent of 5 oz of wine, 12 oz of beer, or 1.5 oz of liquor. 

 

How can you reduce the effects of alcohol?

It’s important to take into account all of the factors that affect your body’s absorption of alcohol. Safety and moderation are the best approach.

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Alcohol-Related Cancer Risk

The Connection Between Alcohol and Cancer

Nearly 1 in 2 Canadians is expected to develop cancer in their lifetime and the effects can be devastating. If you’ve watched a family member battle cancer, maybe you’ve wondered about whether you share their genetic predisposition. This fear can lead you to examine whether external factors like diet, exercise, and environment might play a role in your chance of developing cancer. But how often do you think about alcohol consumption in relation to cancer? Science shows that alcohol can be a contributing factor in the development of certain kinds of cancer, including cancers of the mouth, throat (pharynx), voice box (larynx), esophagus, liver, colon and rectum, and breast. If you haven’t thought about the connection between alcohol and cancer before, you’re not alone; 7 out of 10 North Americans are unaware of this link because alcohol is so intertwined in our social lives that we don’t think twice about it. 

Alcohol is a part of our culture. It’s ingrained in the way we connect and it helps us to feel comfortable and confident in social interactions. Many people don’t realize the long-term effects of alcohol and often the short-term gain is not worth the health risks. Instead, we might take a reactive approach to our problems, including our health, but with a proactive approach, you can prevent alcohol-related cancers. To drive this home, another perspective you can consider is your dental health. While it can be a pain to brush and floss regularly, or to visit the dentist several times a year, it pays off in comparison to having to get a cavity filled. Checking in with your substance use can be similar to flossing your teeth, you may want to floss twice a day, or you may want to do so several times a week but your preventative and mindful approach will pay off in the long run. 

So what are the stats on alcohol and cancer?

The more you drink, the greater the likelihood that you will develop cancer and the more serious the cancer diagnosis will be. Those who drink two to three drinks or more per day are most at risk. Even if you don’t drink much, say, a few drinks a week, your risks are higher than for non-drinkers. Alcohol increases your risk to develop cancer in seven parts of your body and the most common type of cancer that alcohol causes are called squamous cell carcinoma, which lives in the lining of your esophagus. Colon and rectum cancer is also common and people who engage in heavy drinking have a 44% higher probability of getting colon or rectal cancer than those who choose not to drink. The risk of getting breast cancer is also increased in proportion with the amount of alcohol consumed weekly. 

So why is alcohol harmful? 

  1. DNA mutation: Alcohol has inflammatory properties and particularly, it has this effect on your organs and tissues. In defence, your body responds by trying to repair itself and this can lead to mistakes in your DNA which cause cancerous cells to grow. 
  2. Hormones: In women, alcohol can increase estrogen levels, which is a risk factor that can lead to the growth of cancer cells. 
  3. Toxic Chemicals: When your body processes the ethanol in alcohol, it makes a compound. Researchers believe that this compound causes cancer. 
  4. Nutrients: Alcohol compromises your immune system and it makes it more challenging for your body to absorb key vitamins which pose a cancer risk. These vitamins include B vitamins and folate, among others. 
  5. Weight Gain: Alcohol has sugars and carbohydrates that can lead you to put on weight and being overweight is a risk for developing cancer. 

As evidence and research continues to develop when it comes to alcohol and its role as a risk factor for cancer, one thing is for sure: the less alcohol you drink, the less risk you have of alcohol-related cancer. Studies have confirmed that the most serious risks come from drinking four or more drinks per day. It’s important to remember that many of us drink more than a 1.5 ounce shot of liquor, 5 ounces of wine or 12 ounces of beer. So, it’s possible that you’re drinking outside of the limits that you set for yourself. Change doesn’t need to happen all at once but becoming mindful of the impact that alcohol can have on your body is an integral step to taking charge of your health. When it comes to cancer and alcohol, knowledge is power. 

It’s so easy to lose sight of what counts as one drink. Canada’s low-risk guidelines simplify the process of defining your limits. 

A drink means: 

Taking care of your limits reduces your long-term health risks. For women that means:

For men, the limits are:

It is useful to:

Sometimes zero is the limit: 

Safe drinking tips: 

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Alcohol & Diabetes Risk

The Effect of Alcohol on Diabetes

13% of North American adults have diabetes, and that’s not including those who are pre-diabetic or at risk. It takes concerted effort, planning, and grit to manage your sugars. While many of us go through stages of wanting to reduce our sugars, there’s added pressure, temptation, and stress when there are no choice around-consuming sugars. Still, you might decide to cut out cake and chocolate – apparent candidates – but forget that you also consume sugars while drinking. Drinks often slip under the radar when it comes to maintaining balanced glucose levels, and for those who struggle to keep theirs under control, drinking can be a way to relax. This oversight can be costly to health. Not only are there substantial calories in alcohol, but there is a lot of sugar. 

Alcohol is made from natural sugars and starch, and the number of calories depends on the fermentation process specific to the kind of alcohol you are consuming. The calories in alcohol are empty calories, meaning they don’t have any nutritional value. It’s easy to write off drinks and focus your successes on how you abstain from unhealthy food choices but drink calories add up. For instance, one gram of alcohol contains seven calories, and one gram of fat contains nine calories. Remember that when you’re drinking hard liquor, it’s common to add in other sodas and drinks with added sugars. 

Let’s break down the calories and sugar content in common alcoholic beverages. 

You might drink a cider each evening to wind down while talking to a friend on the phone, and you probably don’t even think about it. 

You might not even put that much in the picture of lemonade. So, if your sugars are off-kilter and you feel foggy and low energy the morning after drinking, you know the culprit. If you choose to drink, your best bet for an option with the lowest sugar content is a glass of red wine or a beer.

Alcohol starts to affect your body the moment you take your first sip. While it may feel as if the occasional drink isn’t a concern, the cumulative effects of drinking wine, beer, or spirits over a prolonged period can negatively affect your health. It’s not just about putting that extra sugar in your body but instead about the way that alcohol affects your body’s ability to process sugar. Drinking alcohol affects your pancreas and liver, and your pancreas is responsible for keeping balanced sugar levels in the body. Drinking too much can take its toll on the pancreas, which can cause an imbalance in your blood sugars and lead to increased diabetes-related complications.  

Aside from the direct impact on blood glucose levels, consuming less sugar can make you feel better. It can be hard to find a compelling enough reason to reduce sugar, but at ALAViDA, we get an inside look at how members feel at the start of their program and when they leave the program. At that point, most have reduced their drinking and sugars, and it shows. Many members feel increased energy and desire to exercise, as well as experiencing weight loss. When you know the sugar content of alcohol, it empowers you to make choices about how you consume your sugars, and you might find that you prefer the occasional piece of cake to a bottle of wine. 

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Genome BC Invests in ALAViDA

 

Vancouver, Canada — Heavy drinking is associated with the risk of developing health problems such as mental and behavioural disorders, including alcohol dependence, major noncommunicable diseases such as liver cirrhosis, some cancers and cardiovascular diseases. It is also associated with injuries resulting from violence and road collisions.

Many believe 12-step intervention programs, such as Alcoholics Anonymous are the only way to overcome addiction. While this traditional treatment approach may be effective for some, it may not work for everyone. Decades of mounting scientific evidence show therapeutic and pharmaceutical interventions can be also effective.

To broaden support and accessibility for treating addictions, Genome BC has invested in BC based ALAViDA Health Ltd.— a Vancouver based digital health company that offers a new approach to treatment and an alternative to 12-step programs.

Read more here. Also featured on Markets Insider and Newswire.

Genome British Columbia  leads genomics innovation on Canada’s West Coast and facilitates the integration of genomics into society. A recognized catalyst for government and industry, Genome BC invests in research, entrepreneurship and commercialization in life sciences to address challenges in key sectors such as health, forestry, fisheries and aquaculture, agrifood, energy, mining and environment. Genome BC partners with many national and international public and private funding organizations to drive BC’s bioeconomy. genomebc.ca

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About ALAViDA

ALAViDA, part of the LifeSpeak Inc. (TSX: LSPK) family of companies, is a leading virtual care provider focused on the science of substance use management. It offers a one-stop-shop approach for any level of substance use disorder – alcohol and drugs – mild, moderate and severe. ALAViDA connects patients with behavioural coaches, therapists and physicians who work as a team to deliver personalized care right to their smartphones. ALAViDA is an employee benefit with varying plans and personalized therapeutic programs, which has proven to minimize time out of the workplace. Traditional rehab often costs $30,000 or more a month. ALAViDA’s program is a mere fraction of that. More than 79 per cent of those signed on reported increased control and 86 per cent reduced substance use. To learn more visit ALAViDA.co For information on corporate programs or to establish a referral relationship contact [email protected]

Chris Gomes

ALAViDA Health

+1 888-315-4617

email us here

 

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Is Medication Right For Me?

There are medications that help people curb their drinking. Why aren’t they used as part of alcohol treatment programs, and why don’t we hear more about them?

Check out this article from the National Post to find out how this medication has helped a woman (and many more) go from heavy to social drinking.

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How can Medication Help you Curb Cravings for Alcohol? [Testimonial]

Endorphin-blocking medications have been around since 1990s when the Food and Drug Administration approved its commercialization (Carmen, Angeles, Ana, & María, 2004). Although this type of medication has proved to be really effective in helping people curb their drinking, not many people are familiar with it. One core reason is due to the fact that general practitioners don’t feel confident in prescribing it or had much training with it (Mark, Kranzler, & Song, 2003). In addition, most programs and treatments for heavy drinking are based on abstinence, which doesn’t leave space for this type of medication as they work best when taken before drinking alcohol (Heinälä et al., 2001; Rubio et al., 2002). But this has been changing and we see a shift in the way addiction is treated, with the rise of harm-reduction-based treatments and programs (Marlatt & Witkiewitz, 2002).

When abstinence isn’t an option – for various reasons such as work, social environment, personal preferences and lifestyle – harm-reduction is an effective way to tackle heavy drinking (Witkiewitz & Marlatt, 2006). By gradually reducing the alcohol consumption, rather than going ‘cold-turkey’, withdrawal symptoms are less likely to occur. It also gives the brain time to adjust to a new behaviour: drinking 1 to 2 glasses of wine on one occasion instead of a bottle of spirits. Going into the details, endorphin-blocking medications block the dopamine receptors, so the euphoric sensation that comes from drinking alcohol is neutralised. To learn more about how this particular type of medication works, and its impact on the lives of those struggling with heavy drinking, check out the interview CBC Ontario gave on the topic – it’s eye-opening.

We recommend taking the time to hear the whole thing, but if you don’t get a chance, we’ve curated below some of the testimonials from professional and participating guests that have had experience with prescribing or taking endorphin-blocking medications to treat heavy drinking.

“[This type of medications] really help people reduce the amount they drink and sometimes stop altogether, as well as all the harms that are associated with alcohol. This is an area of great opportunity for the medical system to help support folks who are struggling with these Alcohol Use Disorders, from the mild to moderate and severe spectrums. “ Dr. Chetan Mehta, Toronto

“The evidence shows that for people who are on this medication on a daily basis, about 1 in 9 people at the end of 12 months will have completely stopped drinking. And for the people who are still drinking, there is a sizeable reduction.”  Dr. Chetan Mehta, Toronto

“Naltrexone has really changed [my partner’s] life. He used to drink enormous quantities of alcohol, a bottle at a time, of vodka or other spirits. (…) It came to the point where he almost died one time from alcohol poisoning. And having Naltrexone has given him that edge. It’s incredible. At Christmas, there was no alcohol. Nobody was worried about alcohol. He wasn’t worried about alcohol. It was a really good Christmas.” Grace, Ontario

“Taking the pill on its own will do quite a bit of work but sometimes that’s not enough. [The medication] can definitely be an important part of therapy. It can really help people engage in other parts of the non-medical therapy, once they have a little bit of their edge curbed from alcohol use.” Dr. Chetan Mehta, Toronto

“Since 2016 I’ve been on Naltrexone for Alcohol Use Disorder. It’s been just a miracle for me. I was a chronic abuser of alcohol for about 10 years. I have watched Claudia Christian’s TED Talk and read the book “The cure for alcoholism”. I have taken that to my family doctor, and she refused to prescribe [the medication] (…)I had to go to a methadone clinic to get my hands on it. At this time at work, I was missing a lot, I was destroying my relationship with my life partner, and it got pretty ugly.” Alison, Stratford

“I didn’t ever think that [abstinence] would be a realistic expectation for me. Substance Use Disorders are in both sides of my familial tree and I’m still quite young so the idea of abstaining from something so socially available, accepted and even celebrated, normalized for almost 70 years, was unimaginable. The idea of being able to, if I wanted was very intriguing.” Alison, Stratford

Sometimes, hearing it from other people might be the little nudge we needed to take action. Other times, the information just sits there until we’re ready to make a change. Whatever the case might be, the evidence is there, and we hope that this interview will invite others to join us in reducing barriers to getting treatment. Heavy drinking is one of the leading risk factors for death and disability, and science-based solutions can help those who are at risk, wherever they find themselves on the spectrum. To listen to the whole interview, click here.

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References: [1] Heinälä, P., Alho, H., Kiianmaa, K., Lönnqvist, J., Kuoppasalmi, K., & Sinclair, J. D. (2001). Targeted use of naltrexone without prior detoxification in the treatment of alcohol dependence: a factorial double-blind, placebo-controlled trial. Journal of clinical psychopharmacology, 21(3), 287-292. | [2] Mark, T. L., Kranzler, H. R., & Song, X. (2003). Understanding US addiction physicians’ low rate of naltrexone prescription. Drug and Alcohol Dependence, 71(3), 219-228. | [3] Marlatt, G. A., & Witkiewitz, K. (2002). Harm reduction approaches to alcohol use: Health promotion, prevention, and treatment. Addictive behaviors, 27(6), 867-886. | [4] Rubio, G., Manzanares, J., Lopez-Muñoz, F., Alamo, C., Ponce, G., Jimenez-Arriero, M. A., & Palomo, T. (2002). Naltrexone improves outcome of a controlled drinking program. Journal of substance abuse treatment, 23(4), 361-366.

Alex Lee is a doctoral candidate in social work (DSW C), a licensed clinical social worker (LCSW) and Clinic Director at Alavida Health. He has over ten years of experience in designing, facilitating, and evaluating evidence-based interventions for individuals and families. Alex is trained in addressing mental health issues, trauma, and substance use and has overseen large-scale mental health services for Navy Medicine and the Red Cross. He also served as the interim Clinical Director for the Department of Mental Health and Statewide Clinical Director for Developmental Centers in California and Nevada.