Buprenorphine Therapy Buprenorphine, a derivative of thebaine, is an opiate that has been marketed in the United States as the Schedule V parenteral analgesic Buprenex®. In 2002, based on a re-evaluation of available evidence regarding the potential for abuse, diversion, dependence, and side effects, the DEA reclassified buprenorphine from a Schedule V to a Schedule III narcotic. In October 2002, Reckitt Benckiser received FDA approval to market a buprenorphine monotherapy product, Subutex®, and a buprenorphine/naloxone combination product, Suboxone®, for use in opioid addiction treatment. The combination product is designed to decrease the potential for abuse by injection. Subutex® and Suboxone® are currently the only medications to have received FDA approval for this indication. In January 2003, Reckitt Benckiser began shipments of Suboxone® to pharmacies in the United States. The approval of these formulations does not affect the treatment standards of previously approved medication-assisted treatments, such as methadone and LAAM (levo-alpha-acetyl-methadol). As indicated in Title 42 Code of Federal Regulations Part 8 (42 CFR Part 8), these therapies can only be dispensed, and only in the context of an Opioid Treatment Program. Also, neither the approval of Subutex® and Suboxone®, nor the provisions of DATA 2000, affect the use of other Schedule III, IV, or V medications, such as morphine, that are not approved for the treatment of addiction. Lastly, note that other forms of buprenorphine besides Subutex® and Suboxone®, e.g., Buprenex®, are not approved for treatment of opioid addiction. sona classified Applied Pharmacology Buprenorphine is an opioid partial agonist. This means that, although buprenorphine is an opioid, and thus can produce typical opioid agonist effects and side effects, such as euphoria and respiratory depression, its maximal effects are less than those of full agonists like heroin and methadone. At low doses, buprenorphine produces sufficient agonist effect to enable opioid-addicted individuals to discontinue the misuse of opioids without experiencing withdrawal symptoms. The agonist effects of buprenorphine increase linearly with increasing doses of the drug until at moderate doses they reach a plateau and no longer continue to increase with further increases in dose—the so-called “ceiling effect.” Thus, buprenorphine carries a lower risk of abuse, dependence, and side effects compared to full opioid agonists. In fact, in high doses and under certain circumstances, buprenorphine can actually block the effects of full opioid agonists and can precipitate withdrawal symptoms in an acutely opioid-intoxicated individual. Buprenorphine has poor oral bioavailability and moderate sublingual bioavailability. Thus, formulations for opioid dependence treatment are in the form of sublingual tablets. Buprenorphine is highly bound to plasma proteins. It is metabolized by the liver via the cytochrome P4503A4 enzyme system into norbuprenorphine and other metabolites. The half-life of buprenorphine is 24–60 hours. Safety Because of its ceiling effect and poor bioavailability, buprenorphine is safer in overdose than opioid full agonists. The maximal effects of buprenorphine appear to occur in the 16–32 mg dose range for sublingual tablets. Higher doses are unlikely to produce greater effects. Respiratory depression from buprenorphine (or buprenorphine/naloxone) overdose is less likely than from other opioids. There is no evidence of organ damage with chronic use of buprenorphine, although increases in liver enzymes are sometimes seen. Likewise, there is no evidence of significant disruption of cognitive or psychomotor performance with buprenorphine maintenance dosing. Information about the use of buprenorphine in pregnant, opioid-dependent women is limited; the few available case reports have not demonstrated any significant problems due to buprenorphine use during pregnancy. Suboxone® and Subutex® are classified by the FDA as Pregnancy Category C medications. Side Effects Side effects of buprenorphine are similar to those of other opioids and include nausea, vomiting, and constipation. Buprenorphine and buprenorphine/naloxone can precipitate the opioid withdrawal syndrome. Additionally, the withdrawal syndrome can be precipitated in individuals maintained on buprenorphine. Signs and symptoms of opioid withdrawal include: Dysphoric mood Nausea or vomiting Muscle aches/cramps Lacrimation Rhinorrhea Pupillary dilation Sweating Piloerection Diarrhea Yawning Mild fever Insomnia Craving Distress/irritability Abuse Potential Because of its opioid agonist effects, buprenorphine is abusable, particularly by individuals who are not physically dependent on opioids. Naloxone is added to buprenorphine to decrease the likelihood of diversion and abuse of the combination product. Sublingual buprenorphine has moderate bioavailability, while sublingual naloxone has poor bioavailability. Thus, when the buprenorphine/naloxone tablet is taken in sublingual form, the buprenorphine opioid agonist effect predominates, and the naloxone does not precipitate opioid withdrawal in the opioid-dependent user. Naloxone via the parenteral route, however, has good bioavailability. If the sublingual buprenorphine/naloxone tablets are crushed and injected by an opioid-dependent individual, the naloxone effect predominates and can acutely precipitate the opioid withdrawal syndrome. Under certain circumstances buprenorphine by itself can also precipitate withdrawal in opioid-dependent individuals. This is more likely to occur with higher levels of physical dependence, with short time intervals (e.g., less than 2 hours) between a dose of opioid agonist (e.g., methadone) and a dose of buprenorphine, and with higher doses of buprenorphine. Evidence of Effectiveness Studies have shown that buprenorphine is more effective than placebo and is equally as effective as moderate doses of methadone and LAAM in opioid maintenance therapy. Buprenorphine is unlikely to be as effective as more optimal-dose methadone, and therefore may not be the treatment of choice for patients with higher levels of physical dependence. Few studies have been reported on the efficacy of buprenorphine for completely withdrawing patients from opioids. In general, the results of studies of medically assisted withdrawal using opioids (e.g., methadone) have shown poor outcomes. Buprenorphine, however, is known to cause a milder withdrawal syndrome compared to methadone and for this reason may be the better choice if opioid withdrawal therapy is elected. Non-pharmacological Therapies Effective treatment of drug addiction requires comprehensive attention to all of an individual’s medical and psychosocial co-morbidities. Pharmacological therapy alone rarely achieves long-term success. Thus Suboxone® and Subutex® treatment should be combined with concurrent behavioral therapies and with the provision of needed social services. The choice of treatment setting in which to provide non-pharmacological therapies should be determined based on the intensity of intervention required for a patient. The continuum of treatment setting intensities ranges from episodic office-based therapy to intensive inpatient therapy. Ideal candidates for opioid addiction treatment with buprenorphine are individuals who have been objectively diagnosed with opioid addiction, are willing to follow safety precautions for treatment, can be expected to comply with the treatment, have no contraindications to buprenorphine therapy, and who agree to buprenorphine treatment after a review of treatment options. There are three phases of buprenorphine maintenance therapy: induction, stabilization, and maintenance. The induction phase is the medically monitored startup of buprenorphine therapy. Buprenorphine for induction therapy is administered when an opioid-dependent individual has abstained from using opioids for 12–24 hours and is in the early stages of opioid withdrawal. If the patient is not in the early stages of withdrawal, i.e., if he or she has other opioids in the bloodstream, then the buprenorphine dose could precipitate acute withdrawal. Induction is typically initiated as observed therapy in the physician’s office and may be carried out using either Suboxone® or Subutex®, dependent upon the physician’s judgment. As noted above, Buprenex®, the parenteral analgesic form of buprenorphine, is not FDA-approved for use in opioid addiction treatment. The stabilization phase has begun when the patients have discontinued or greatly reduced the use of their drug of abuse, no longer has cravings, and is experiencing few or no side effects. The buprenorphine dose may need to be adjusted during the stabilization phase. Because of the long half-life of buprenorphine it is sometimes possible to switch patients to alternate-day dosing once stabilization has been achieved. The maintenance phase is reached when the patient is doing well on a steady dose of buprenorphine (or buprenorphine/naloxone). The length of time of the maintenance phase is individualized for each patient and may be indefinite. The alternative to going into (or continuing) a maintenance phase, once stabilization has been achieved, is medically supervised withdrawal. This takes the place of what was formerly called “detoxification.” Be especially scrutinizing as you determine the drug rehab program that meets your specific needs. This site has listings of drug rehab programs and treatment centers, alcohol rehabilitation programs, teen rehabs, sober houses, drug detox and alcohol detox centers.

Rational Emotive Behavioral Therapy (REBT)

When thinking about getting addiction treatment, it’s important to understand what types of therapies are offered at different treatment centers, so that you can select a program that best meets your needs.
Here is an overview of Rational Emotive Behavioral Therapy (REBT), a form of cognitive-behavioral therapy (CBT) that is sometimes offered as a part of a comprehensive substance abuse treatment program.
Rational Emotive Behavioral Therapy is a counseling technique that is sometimes offered to help people increase life satisfaction, to reduce the symptoms of disorders such as anxiety or panic, or to avoid negative emotions that increase the odds of addiction relapse.
REBT was developed in the 1950s and was groundbreaking in its day as the counseling technique that pioneered cognitive-behavioral therapy. REBT is still widely practiced and respected today.
REBT as Drug or Alcohol Addiction Treatment
REBT strives to help people achieve greater happiness in life. It is used in addiction treatment to help people understand how they control their negative feelings. It teaches people new to recovery techniques to use in real-world situations that increase happiness and life satisfaction, and in doing so, reduces the odds of relapse.
A REBT counselor would advise that we are responsible for much of our happiness (or unhappiness) and that our beliefs influence our well-being far more than outside events do.
REBT – Changing Your Beliefs to Increase Your Happiness
While asking someone to change their beliefs may sound like some form of indoctrination, a REBT therapist asks patients to explore and change only certain negative and rigidly held beliefs that may contribute to unhappiness.
For example:

1. My professor gave me a “D” on my term paper.
2. He hates me because I disagree with him.
3. I give up, I’ll never pass.

Or:

1. My professor gave me a “D” on my term paper.
2. He didn’t agree with my arguments.
3. It’s too bad, I’ll have to work extra hard next time to keep my GPA up.

It’s all in the ABC’s! Actions produce Beliefs which produce Consequences. Importantly, it is not, in many cases, the action or adverse event that produces the emotional consequence; it is the belief you have about the action that does.
This is good, because you can’t very well stop anything bad from ever happening to you again, but you can change the way you think or believe, which changes how tough events make you feel.
In the first scenario, the person’s rigid belief (he hates me) led to despondent feelings and self-defeating behaviors.
In the second scenario, a more realistic belief led to a mild negative but healthier reaction and a plan to move on toward continuing happiness and success.
What Are Negative Beliefs?
A REBT therapist will argue that it is our negative beliefs that cause much of our unhappiness, and that if we practice, we can change these beliefs and start living happier more satisfactory lives – which for someone in recovery from substance abuse is a very important thing. It’s hard to stay sober over the long haul when you’re unhappy.
Unhealthy negative beliefs share certain elements, including:

• Rigidity
• Lack of acceptance for who you really are
• Demand a high level of perfection from you
• Prioritize what others think about you
• What you think about yourself depends on what others think of you

Some examples of unhealthy beliefs include:

• Those close to me must love and approve of me.
• I must succeed at what I do.
• Other people must behave correctly, or they must be punished.
• I can’t control my happiness since the things that make me unhappy are not under my control.
• If I don’t achieve my goals, things will be terrible.

In reality, we may prefer it if those close to us love and accept us, but they don’t have to, and the world won’t end if they don’t.
Other people don’t have to behave the way you think they should, and it’s not up to you to worry about punishing anyone.
You can’t control what happens to you but you can control the way you feel and respond – you can control your happiness!
Tolerance – The Path to Happiness
Accepting yourself, others and the world in general as it is, and not as it should be, is the path to greater happiness.
According to Albert Ellis, the father of REBT counseling, to live a happier life you must:

• Accept yourself unconditionally – I want to succeed at work, but I don’t have to, and if I fail to do well, I can still like myself and have fun. I want to be a better husband, but I am not perfect. I will try to do better while accepting that my few negative traits do not define me as a “bad person.”

• Accept others unconditionally – You accept every other person as a worthy person. You do not have to accept the self-defeating or antisocial actions of others, but no person’s few negative actions define that person completely.

• Accept the world unconditionally – The world is not fair and you can’t control it. You do your best to help yourself and to help others but you acknowledge that you cannot change the world and so you must not get irrationally upset about the state of the world.

As Dr. Ellis would say, you aren’t perfect, others aren’t perfect and the world isn’t perfect – accept it, and then go out and have some fun!
Advantages of REBT

• REBT therapy doesn’t require the months or years of counseling that some psychodynamic methods do; a typical course of REBT treatment ranges from 5 to 30 sessions in total.

• REBT can induce lasting change and offers clients a real-world technique that can be practiced to increase life satisfaction; once learned, REBT becomes a self-help modality.

• REBT does not strive to help people change their negative environmental conditions; rather, patients learn to accept imperfections in the self, others and the world, which can lead to greater happiness and personal freedom and frequently to positive environmental changes down the road.

Bipolar and Addiction

Bipolar disorder, a disease characterized by the extreme oscillation from the highs of mania to the lows of depression, affects between 1 percent and 3 percent of people. People with bipolar face an exaggerated risk of substance abuse problems, with as many as 60 percent of bipolar patients experiencing a substance abuse disorder at some point in life.
No cure exists for bipolar disorder, but the disease can be managed through medication and psychotherapy. Left untreated, the disease can be devastating, and when bipolar is combined with alcoholism or drug addiction, this devastation is compounded.
Why Is Bipolar So Strongly Associated with Addiction?
Bipolar and addiction are so intertwined that some doctors routinely test patients with bipolar for drug or alcohol abuse or addiction. But why do bipolar patients face this elevated risk of addiction?

1. During a manic phase, people often live a more reckless lifestyle, often fueled in part by the use of alcohol or drugs. Frequent excessive use of alcohol or drugs can lead to dependency.

2. Bipolar patients may self-medicate with drugs or alcohol.

3. Bipolar medications may cause unpleasant side effects that are diminished through the use of alcohol or drugs.

The Consequences of Alcohol or Drug Abuse for Bipolar Patients
Many bipolar patients take drugs or alcohol in an attempt to regulate, stabilize or improve their moods. Drugs and alcohol can provide temporary symptom relief, but in time, the use of drugs or alcohol worsens the symptoms of bipolar disorder. This can result in ever increasing drug or alcohol use.

• Alcohol and drugs can reduce the effectiveness of bipolar medications.
• The abuse of alcohol or drugs tends to reduce bipolar treatment compliance (people aren’t as likely to remember to take their meds when on a three-day bender).
• Stimulant drugs, such as cocaine or methamphetamine, can induce mania and then deep depression.
• The withdrawal symptoms of certain drugs, such as methamphetamine or alcohol, can worsen depression.
• The abuse of drugs or alcohol can lead to a reduction in healthy social support systems. Alcoholics and drug addicts often cause strife and estrangement in the family.
• The abuse of alcohol or drugs often leads to poor eating and exercise habits and a reduction in overall physical health.
• Bipolar patients who abuse drugs or alcohol are at an elevated risk of suicide.
• Bipolar patients who abuse alcohol or drugs spend more time hospitalized than bipolar patients that abstain.

Treatment for Bipolar and Addiction
The best treatment for a dual diagnosis of mental illness and addiction integrates various concurrent therapies to treat the person as a whole, whereas in the past, doctors preferred to deal with one problem at a time.
If the patient is actively abusing drugs or alcohol, residential detoxification and treatment may be indicated for the initial phase of treatment to ensure that any withdrawal period is navigated safely and successfully. Then continuing residential dual diagnosis treatment should be considered to allow medications (for both bipolar and addiction) and psychotherapies time to start working.
Dual diagnosis treatment elements can include:

• Medication for the core mental illness
• Medication to help with alcohol or drug withdrawal symptoms or cravings
• Psychotherapy
• Support group meetings (such as the 12 Steps)
• Life skills training
• Nutritional therapy
• Recreational therapy
• Relapse prevention planning

Effective dual diagnosis treatment must address all areas of life, from social/recreational to medical/biological, to employment/living conditions.
It is vital that treatment occur at a drug rehab facility that is equipped to handle dual diagnosis patients. In many cases, bipolar symptoms are the core underlying reason for the substance abuse. Thus, to attempt treatment for addiction at any facility that is ill-equipped to treat bipolar symptoms concurrently is to invite almost certain failure.
Bipolar complicates the treatment of addiction, and so although addiction treatment does work for dual diagnosis patients, it can take longer. As always, the earlier addiction treatment occurs, the better the probability of a successful outcome.

9 Alcoholism Risk Factors – Are You at Risk?

There is no stereotypical alcoholic. Alcoholics come in all shapes and sizes, and although many people think of “street people” when they think of alcoholics, homeless alcoholics account for only a small percentage of the total.
Although anyone can succumb to alcoholism, some people are at greater risk than others. Fortunately, anyone concerned about their predisposition to alcoholism can eliminate their risk entirely, simply by abstaining from alcohol.
It is important to note that some people with no or few risk factors for alcoholism will develop the disease and some people with many risk factors will drink heavily for years and never have a problem. There is nothing straightforward about alcoholism.
Here is a list of nine factors that increase a person’s risk of developing alcoholism.
1. Drinking Heavily
Those who abstain from alcohol aren’t at risk of becoming alcoholics, so in functional terms, any alcohol consumption increases the risks. In reality, people who drink moderately have a much lower risk than heavy drinkers. The National Institute of Health recommends not exceeding one drink a day for women and 2 drinks per day for men.
2. Having a Low Response to Alcohol
A study published in the September 2009 issue of Alcoholism, Clinical and Experimental Research showed that people who needed more alcohol to feel buzzed prior to the development of an alcohol tolerance tended to drink more alcohol in a sitting, and drinking more alcohol in a sitting increased the risk of becoming alcohol dependent.
3. Starting to Drink at a Young Age
The earlier you start drinking, the greater your chances of becoming an alcoholic. Teens who start drinking before the age of 15 are about 50 percent more likely to become alcoholics as adults than teens who wait until 18 or older to start drinking (Alcoholism Clinical and Experimental Research, December 2008).
4. Having a Mental Illness
Having a mental illness, such as bipolar disorder, depression, PTSD or an anxiety disorder, greatly increases the risks of developing alcoholism or other addictions. People with a mental health disorder may self-medicate with drugs or alcohol or may drink out of a loss of inhibition.

5. Suffering Abuse or Trauma as a Child
Numerous studies have reported a higher than average incidence rate of childhood trauma in patients undergoing treatment for alcohol or dug addiction, especially among women. Trauma can be physical, emotional or sexual.
6. Having Easy Access to Alcohol
People immersed in societies that do not allow or condone drinking, or in societies that prohibit the sale of alcohol, face very minimal risk of becoming alcoholics. If you can’t buy it, it’s hard to drink it.
7. Having a Family History of Alcoholism
A man that has one alcoholic parent is roughly three times as likely as a man without an alcoholic parent to succumb to the disorder. Women seem less affected by this familial link, though women with at least one alcoholic parent are still at a higher than normal risk of the disease.
8. Being a Man
Men are about twice as likely to experience alcoholism over a lifetime.
9. Certain Personality Types (Personality Characteristics)
The American Psychiatric Association has identified certain personality characteristics that seem to increase a person’s risk of alcoholism. These personality traits include:

• Having a low tolerance for frustration
• Having aggressive tendencies or difficulty with impulse control
• Needing an inordinate amount of praise
• Feeling unsure or not worthy
• Demanding perfection

6 Ways to Help a Loved One Beat Addiction

It can be heart-wrenching to witness a loved one’s descent into addiction or alcoholism. Feeling powerless to create lasting change is often the hardest part as we watch a friend, parent, child or sibling risk early death to keep on getting drunk or high. It’s unbelievable, but it’s reality.
Fortunately, although you may feel powerless, you have more influence than you realize. Here are six ways that you can help get a loved one to stop abusing drugs or alcohol.
1. Get Educated
Until you get educated about the problem, you can’t hope to provide workable solutions.
The situation may seem black and white to you – “just stop using what’s killing you” – but with addiction, what seems to make the most sense isn’t necessarily what’s true or needed. Addiction creates physiological changes in the brain that make it very difficult to just “say no.”
Addiction erodes impulse control. Without treatment and relapse avoidance techniques, constant cravings are difficult to overcome.
Read all you can about the disease of addiction. It will help you to understand what your loved one is going through, why treatment is needed and what types of treatment are most likely to work – and it may increase your feelings of compassion. You are going to need the help and support of others in the family as well, so it’s important that you offer informed opinions about what can and should be done to create real and lasting change.
Go to the library and read online. You should also plan to meet with an addiction specialist to get opinions and recommendations for treatment.
2. Intervene
Myths

1. An addict needs to hit rock bottom before they’ll ever get help.
2. An addict has to decide when to get treatment.

Those two pervasive myths about addiction stop too many well-meaning and concerned family members from intervening to help their loved one get needed addiction treatment.
Addicts and alcoholics never need to hit rock bottom. Waiting for things to get worse only makes treatment harder and less likely to succeed, and many people never find their own rock bottom, until it’s too late.
Many alcoholics and addicts enter into substance abuse treatment programs initially on the urging of concerned friends or family members, at the request of employers or as mandated by the courts. Statistics show that people who do not enter into treatment as self-motivated participants are just as likely to succeed as anyone else. It does not matter how you feel walking in the door to that treatment center, it only matters how you feel walking out.
Talk to the person you love about drug rehab treatment. Sometimes you can convince them to get the help they need – sometimes they’re just waiting for someone to ask.
Often, though, it’s not that easy. Addiction hijacks the mind and treatment threatens the very existence of this addicted mind. Some of the strategies commonly employed to deflect treatment include:

• Denying the problem or the extent of the problem
• Lying about what they plan to do
• Agreeing to get help, but not following through
• Reacting with anger, deflecting the conversation away from their problem and back onto you

In many cases, an intervention is required to convince someone who is reluctant to get help into the addiction treatment they need.
A family intervention brings together everyone close to the addict or alcoholic for a loving conversation, during which the addict hears what harms their drinking or using does to them and to others.
When everyone comes together to tell personal stories of pain and to demand treatment, it is tough for the addict to continue to deny the existence of the problem and the need for treatment.
Interventions work well, but they should never be taken lightly. They are serious, difficult and emotional events that require forethought, planning and preparation. Be sure to get educated about the process before attempting your own, and consider enlisting the services of a professional interventionist to facilitate the event.
3. Participate in Treatment
Addiction affects the family, and family affects the addiction. If at all possible, family members should participate in the addiction treatment process. Family counseling and family education sessions can help reveal family dynamics that may contribute to the substance abuse and may help mend some of the wounds inevitably caused by addiction.
Getting educated as a family also prepares the group to offer the kinds of relapse prevention support that can really make a difference in those first tough months of sobriety.
4. Offer Support During and After Treatment
Addiction treatment should never end after a stay at a drug or alcohol rehab, but even with continuing aftercare, those first months of real-world temptation are a high risk period for relapse. Family support and involvement during this time can make a difference. Be there for your loved one, stay in close contact and be a good source of sober support. Boredom threatens sobriety, so arrange fun outings that avoid drinking or drug use – go for a walk in the forest!
Encourage your family member to stay active in continuing addiction treatment programs. People that participate in addiction treatment for one year or longer have a much better long-term success rate; overconfidence during the initial months is a big red flag!
If you use or drink, don’t do it anywhere near them.
5. Be Realistic
Understand that your addicted family member might slip or even relapse. Addiction is a chronic disease and relapse is an unfortunate part of it. Addiction treatment is best thought of as a medical treatment that induces symptom remission; in many cases, multiple bouts of treatment are required over a lifetime.
Working hard to get someone into treatment only to watch them relapse can be incredibly frustrating. Addiction is a frustrating disease. But it does not nullify the importance of the treatment or diminish the need for subsequent treatment. It’s just an unfortunate part of life for anyone who struggles with addiction.
6. Get Support for Yourself
You can’t help someone you love if you burn out. And ultimately, you can’t live anyone else’s life for them. It is vital that you look after yourself. Helping someone you love battle addiction isn’t a sprint, it’s a marathon, and you offer the most help if you are there for the long haul.
Many people find that support groups like Alanon or Alateen help them deal with the often painful realities of loving an addict or alcoholic. Others prefer individual counseling or other forms of support.

Will Years of Heavy Drinking Cause Brain Damage?

The beer belly and a life of morning hangovers may or may not be an acceptable price for a party lifestyle – but are those nightly drinking binges worth irreversible brain damage?
Alcohol, when consumed regularly and in excess, has no health benefits and harms many of the body’s organs and systems, including the brain. Chronic heavy drinking can lead to a host of neurological problems and even severe cognitive declines.
Alcohol is toxic to the brain and a life of overindulgence can have some tragic consequences. Here is a brief overview of some of the more common forms of alcohol-related brain damage.
Alcohol-Related Brain Damage
Wernicke-Korsakoff Syndrome
Chronic thiamine (vitamin B1) deficiencies can lead to Wernicke-Korsakoff syndrome, a syndrome characterized by memory problems, a loss in cognitive functioning and in severe cases, death. Wernicke-Korsakoff Syndrome is also known colloquially as “wet brain.”
The National Institute on Alcohol Abuse and Alcoholism estimates that as many as 80 percent of alcoholics are deficient in thiamine, though only a small percentage of these people will develop Wernicke-Korsakoff. Alcoholics become deficient in thiamine through:

• Insufficient nutritional intake (liquid lunches don’t have vitamin B1)
• Alcohol causing limited absorption of thiamine into the body
• Alcohol reducing the body’s ability to use the limited thiamine it does absorb

Insufficient thiamine levels lead to problems in brain cell metabolism, particularly in the cerebellum and in the frontal lobes. Wernicke-Korsakoff Syndrome very closely resembles Alzheimer’s disease, as people with the disorder may remember events from childhood clearly, but forget what they did or said only minutes before. Wernicke-Korsakoff impairs the brain’s ability to form new memories.
Other symptoms of the disorder include:

• A dragging or staggering stride
• Mental confusion
• Living in a fantasy world that is perceived to be true
• Paralyzed eye movements

If caught in the early stages, Wernicke-Korsakoff Syndrome can be treated through significant vitamin injections. In later stages, the condition is incurable and fatal.
Brain Shrinkage
Our brains shrink as we age but chronic heavy drinking accelerates the rate of brain shrinkage substantially. And the more you drink, the greater the shrinkage. This effect seems more pronounced in women than men. Brain volume declines are indicative of cognitive declines.
Liver Disease Related Brain Damage (Hepatic Encephalopathy)
Heavy chronic drinking is strongly associated with liver disease, including alcoholic cirrhosis. Alcoholic cirrhosis greatly compromises the liver’s ability to function, allowing certain toxins to build up in the body. Two of these toxins, manganese and ammonia, can enter the brain, causing brain cell death and a condition known as hepatic encephalopathy.
Symptoms of hepatic encephalopathy include:

• Changes in personality
• Mood or anxiety disorders
• Sleep problems
• A reduced attention span
• Shaking hands
• A loss of coordination

Hepatic encephalopathy can be fatal, and liver transplant can result in a significant improvement of brain function.
Alcoholic Neuropathy
Long-term heavy drinking can harm nerve tissue in the body and lead to a condition known as alcoholic neuropathy. The most common symptoms of the condition are burning or tingling sensations in the feet that can last for years.
Other symptoms include:

• Nerve pain
• Pins and needles
• Muscle weakness
• A loss of sensation (numbness)
• Erectile dysfunction and incontinence
• Nausea

Patients diagnosed with alcoholic neuropathy must stop drinking to prevent further nerve damage. Abstinence from alcohol usually reduces the severity of symptoms and prevents further damage, but existing nerve damage is, sadly, permanent.
Alcohol-Related Dementia
Alcohol can kill brain cells directly, or nutritional problems associated with alcoholism can do the damage. Chronic heavy drinking is associated with an increased risk for an alcohol-related form of dementia.
Heavy drinkers are less likely to consume adequate levels of essential vitamins and minerals and additionally, alcohol’s effects on the gastrointestinal system can limit the body’s ability to absorb these essential vitamins and minerals.
Alcohol-related dementias are not the same as Alzheimer’s disease, though they share some similarities. Alcohol-related dementia impacts cognitive capacities more globally, affecting far more than just memory. In addition to memory problems, symptoms of alcohol-related dementia include:

• Changes in personality
• Altered judgment
• A reduction in social skills
• A reduction in logical planning skills
• A loss of coordination

If caught in the early stages, abstinence can lead to substantial symptom improvement.
Heavy Drinking Comes at a Price
Some people drink heavily for years without apparent harm; others aren’t so lucky. Lengthy alcohol abuse is associated with an increased risk of early death and for some, saddening cognitive declines.
Heavy drinkers who can reduce or eliminate their drinking greatly reduce their risks for cognitive problems later in life. Heavy drinkers who cannot reduce their drinking may want to consider seeking alcohol treatment.

Vivitrol for Alcoholism: How Does It Work?

What Is Vivitrol?
Vivitrol is a medication that helps alcoholics maintain abstinence during the early period of recovery. It is injected into your body once every 4 weeks and stays active in the body for this period of time. 
Vivitrol contains the active ingredient naltrexone, which works by blocking natural opiate receptors in the brain. When you drink alcohol, endogenous opiates are released, and it feels good. When you drink alcohol after taking Vivitrol, the endogenous opiates that get released are blocked from having any effect, and so you don’t feel the pleasure that alcohol normally gives you.
Taking the pleasure out of drinking helps alcoholics stay motivated to quit and avoid relapse.
Does It Work?
The naltrexone in Vivitrol takes a lot of the fun out of drinking. Studies have shown that alcoholics taking Vivitrol drink fewer alcoholic beverages and less often than alcoholics not given the medication.
Studies also show that taking Vivitrol in addition to getting alcohol counseling (psychosocial therapy) works about three times better than getting counseling alone, when you compare abstinence rates at six months as a measure of success.
Vivitrol helps, but it won’t solve your problems on its own. Vivitrol can help make the early months of sobriety easier, especially when it is combined with other types of alcoholism treatment.
The Advantages of Once a Month Injections
Getting a shot once a month is a lot easier than deciding every day to continue taking a medication that takes the pleasure out of drinking. Even motivated alcoholics in recovery face temptation, and it’s a lot easier to decide to take your medicine once a month than every day.
Is Vivitrol Addictive?
Vivitrol (naltrexone) is in no way addictive. There is no withdrawal associated with sudden discontinuation of the medication.
Will It Make Me Feel Sick if I Drink?
Drinking alcohol within a month of taking Vivitrol won’t be as enjoyable, but it won’t make you feel sick.
An older medication used to treat alcoholism, Antabuse (disulfiram), worked by making alcoholics who drank while taking the medication violently ill. Antabuse is no longer commonly prescribed as anyone who wanted to start drinking could simply stop taking the Antabuse and drink without consequence, so it didn’t work all that well.
What Are the Side Effects?
Most people tolerate the medication well. Some people report feeling some nausea after the initial injection of Vivitrol, but this passes within a couple of days and isn’t normally experienced after subsequent injections.
Injection site reactions are also sometimes experienced. These can include redness, tenderness, itchiness and pain around the site of the injection.
Some other occasionally experienced side effects include:

• Tiredness
• Headache
• Joint pain
• Muscle cramps
• Dizziness
• Vomiting

Naltrexone, in high doses, can be harmful to the liver, and people with liver damage may not be able to take Vivitrol safely. Your doctor will likely tell you to watch out for any signs of liver problems after an injection of Vivitrol.
Will Vivitrol Counteract Pain Medications?
Naltrexone works by blocking the opiate receptors in the brain. Opiate pain medications, such as Vicodin, Oxycodone or Percocet, work by stimulating these same opiate receptors. Since naltrexone blocks these receptors, taking an opiate medication while on Vivitrol won’t result in any significant analgesia – naltrexone keeps opiate medications from working.
It is important to let your doctor know about your use of Vivitrol, especially in any trauma situation, to ensure that you receive adequate (non-opiate) pain relief when needed.
What If I’m Addicted to Opiates, Too?
Vivitrol should not be used by anyone currently dependant on opiate medications or illicit drugs such as heroin. Since naltrexone blocks the opiate receptors, an opiate-dependent person who uses Vivitrol will enter into immediate full opiate withdrawal.