Long‐Term Recovery in Alcoholics

Soto, Clinton B. De; O'Donnell, William E.; Soto, Janet L. de

doi:10.1111/j.1530-0277.1989.tb00406.x

Cited by 96 publications

(52 citation statements)

References 22 publications

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“…This has important implications for relapse in human alcoholics as it suggests that violations of abstinence during the early withdrawal phase may increase the magnitude of subsequent lapses. Certainly, in human studies there is strong evidence that the longer a recovering alcoholic can stay abstinent, the lower the chance for relapse (De Soto et al 1989). This may primarily be due to the recovery from the protracted withdrawal syndrome and repair of social and occupational The three pre-vapor test sessions were used for group selection.…”

Section: Discussionmentioning

confidence: 99%

“…In a follow-up study, it was shown that distress-related symptoms correlated with relapse in alcoholics who were abstinent for less than two years (De Soto et al 1989). The more pro- Received March 2, 1999; revised August 25, 1999; accepted December 6, 1999.…”

mentioning

confidence: 99%

“…In a follow-up study, it was shown that distress-related symptoms correlated with relapse in alcoholics who were abstinent for less than two years (De Soto et al 1989). The more pro-tracted symptoms tended to be subacute, were often affective in nature, and appeared to precede relapses into uncontrolled alcohol drinking.…”

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confidence: 99%

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Excessive Ethanol Drinking Following a History of Dependence Animal Model of Allostasis

Roberts

Heyser

Cole

et al. 2000

Neuropsychopharmacology

324

326

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Self-administration Excessive drinking of ethanol in animals can be produced by a number of factors including altering palatability, genetics, and history of consumption. There is evidence that certain symptoms of withdrawal can persist for a number of weeks or even months following chronic ethanol exposure in humans (Kissin 1979;Begleiter and Porjesz 1979;Alling et al. 1982;Roelofs 1985;Grant et al. 1987) as well as in animals (Begleiter and Porjesz 1979). In human alcoholics, one of the factors leading to excessive drinking is the use of alcohol to relieve or avoid withdrawal symptoms (U.S. Department of Health and Human Services 1990). Fatigue and tension persisted for approximately five weeks following withdrawal in a group of 68 chronic alcoholics (Alling et al. 1982), and periods of hyperventilatory symptomology and anxiety (as determined by the Spielberger State-Trait Anxiety Inventory, a self-report inventory), which correlated with intensity of alcohol craving, were reported for up to nine months following withdrawal in a group of 37 chronic alcoholics (Roelofs 1985).In a larger cohort of 312 abstinent alcoholics, 20-25% of them showed signs of anxiety and depression, as determined from the Symptom Check-List 90 (self-report inventory with coverage of areas of symptomology and psychopathology) six months to two years following withdrawal (De Soto et al. 1985). In a follow-up study, it was shown that distress-related symptoms correlated with relapse in alcoholics who were abstinent for less than two years (De Soto et al. 1989). The more pro- Received March 2, 1999; revised August 25, 1999; accepted December 6, 1999. 582 A.J. Roberts et al. N EUROPSYCHOPHARMACOLOGY 2000 -VOL . 22 , NO . 6 tracted symptoms tended to be subacute, were often affective in nature, and appeared to precede relapses into uncontrolled alcohol drinking. For example, depression and anxiety associated with withdrawal were found to provoke drinking in 83 of 100 male alcoholics who experienced these symptoms (Hershon 1977). These patients reported that they drank alcoholic beverages when they experienced anxiety and depressed mood. In another study, both male and female alcoholics reported negative emotions as the most common trigger of relapse (Annis et al. 1998). The clinical literature suggests that alterations in affective state persist for quite some time following alcohol withdrawal and may actually be partly responsible for some relapse episodes in alcoholics.Potential rodent models of excessive ethanol drinking include the alcohol deprivation effect in nondependent animals, ethanol self-administration in dependent withdrawing animals, and ethanol self-administration in animals with a history of dependence following periods of abstinence. The alcohol deprivation effect is a transient increase in ethanol self-administration in animals following periods of abstinence from ethanol for several days to several weeks (Sinclair and Senter 1967;Spanagel et al. 1996;Heyser et al. 1997;Hölter et al. 1998). This increase in e...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Excessive Ethanol Drinking Following a History of Dependence Animal Model of Allostasis

Roberts

Heyser

Cole

et al. 2000

Neuropsychopharmacology

324

326

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“…The independent control over line crossings and social interaction behavior due to experimental manipulations (File 1980;Overstreet et al 2002) and pharmacological challenges (this study) suggest that independent neural mechanisms may be involved in the affective and physical withdrawal signs in alcoholics (De Soto et al 1989;Miller and Harris 2000). Because the drugs used in this study preferentially counteracted the affective symptom (anxiety-like behavior), and because affective symptoms are important risks to relapse in alcoholics (Curran et al 2000;Strowig 2000;Driessen et al 2001), it is possible that the agents that counteracted the social interaction deficits in the rats may reduce relapse in alcoholics.…”

Section: Discussionmentioning

confidence: 99%

A 5-HT1A agonist and a 5-HT2c antagonist reduce social interaction deficit induced by multiple ethanol withdrawals in rats

et al. 2003

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Rationale-Repeated withdrawals from chronic forced ethanol exposure sensitize animals to withdrawal-induced deficits in social interaction behavior. The deficits in social interaction behavior following withdrawal from continuous ethanol exposure can be reduced following acute treatments with 5-HT 2C antagonists or 5-HT 1A agonists.Objectives-The present study investigated whether prior treatment with these serotonergic agents during early withdrawals in rats subjected to repeated withdrawals from ethanol exposure would ameliorate the social interaction deficits observed following the final withdrawal.Methods-Sprague-Dawley rats were exposed to three cycles of 5 days forced ethanol (7%, w/v), with 2 days of control diet after the first and second cycles. Drugs were administered IP 4 h after removal of ethanol on the first and second cycles but not the third in one group and 4.5 h after removal of ethanol on the third cycle in another. The social interaction test was performed 5 h after removal of ethanol on the third cycle. Drugs tested included SB-242084, a 5-HT 2C antagonist; buspirone, a 5-HT 1A partial agonist; WAY-100635, a 5-HT 1A antagonist; ketanserin, a 5-HT 2A antagonist; ritanserin, a mixed 5-HT 2A/2C antagonist; and Ro-601075, a 5-HT 2C agonist.Results-Both SB-242084 and buspirone reduced ethanol withdrawal-induced deficits in social interaction when given either acutely 30 min before the test or at 4 h after withdrawal from the first and second cycles. WAY-100635 and ketanserin were completely ineffective regardless of mode of treatment. In contrast, the 5-HT 2C agonist, Ro-601075, accentuated the withdrawal-induced deficit in social interaction behavior in rats exposed to either 4.5 or 7% ethanol diet. Conclusions-These results support the utility of 5-HT 1A agonists and 5-HT 2C antagonists in reducing anxiety-like behavior induced by ethanol withdrawal and reducing the adaptive changes associated with repeated withdrawals.

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“…He found that both groups were more likely to get sober through AA than with any professional treatment available at that time (28). Similarly, reduced symptoms, better work, and family history were found in examining long-term outcome of a sample of AA members (29). Of interest, both professional treatment and AA participation were each associated with an improved clinical outcome, but a better outcome was observed when patients experienced both treatment and AA participation (30).…”

Section: Two Culturesmentioning

confidence: 99%

Combining medically assisted treatment and Twelve-Step programming: a perspective and review

Galanter

2017

The American Journal of Drug and Alcohol Abuse

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Background: People with severe substance use disorders require long-term rehabilitative care after the initial treatment. There is, however, a deficit in the availability of such care. This may be due both to inadequate medical coverage and insufficient use of community-based Twelve-Step programs in many treatment facilities. In order to address this deficit, rehabilitative care for severe substance use disorders could be promoted through collaboration between practitioners of medically assisted treatment, employing medications, and Twelve-Step-oriented practitioners. Objective: To describe the limitations and benefits in applying biomedical approaches and Twelve-Step resources in the rehabilitation of persons with severe substance use disorders; and to assess how the two approaches can be employed together to improve clinical outcome. Method: Empirical literature focusing on clinical and manpower issues is reviewed with regard (a) to limitations in available treatment options in ambulatory and residential addiction treatment facilities for persons with severe substance use disorders, (b) problems of long-term rehabilitation particular to opioid-dependent persons, associated with the limitations of pharmacologic approaches, (c) the relative effectiveness of biomedical and Twelve-Step approaches in the clinical context, and (d) the potential for enhanced use of these approaches, singly and in combination, to address perceived deficits. Results: The biomedical and Twelve-Step-oriented approaches are based on differing theoretical and empirically grounded models. Research-based opportunities are reviewed for improving addiction rehabilitation resources with enhanced collaboration between practitioners of these two potentially complementary practice models. This can involve medications for both acute and chronic treatment for substances for which such medications are available, and Twelve-Step-based support for abstinence and long-term rehabilitation. Clinical and Scientific Significance: Criteria for developing evidence-based approaches for combined treatment should be developed, and research for evidence-based treatment on this basis can be undertaken in order to develop improved clinical outcome.

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Long‐Term Recovery in Alcoholics

Cited by 96 publications

References 22 publications

Excessive Ethanol Drinking Following a History of Dependence Animal Model of Allostasis

Excessive Ethanol Drinking Following a History of Dependence Animal Model of Allostasis

A 5-HT1A agonist and a 5-HT2c antagonist reduce social interaction deficit induced by multiple ethanol withdrawals in rats

Combining medically assisted treatment and Twelve-Step programming: a perspective and review

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