Neighbors,C.; Larimer,M.E.; Lostutter,T.W.; Woods,B.A.; International Journal of Drug Policy (IJDP); 17(4); 304-309; July 2006. Posted: 2006-09-10.

Excerpt:
"[A] brief overview of harm reduction and individually focused alcohol prevention strategies. Universal, selective, and indicated prevention strategies are described...

Zero-tolerance approaches continue to be the norm in... the US, despite research suggesting that harm reduction approaches can be effective. [E]xisting evidence supports that harm reduction shows considerable promise in universal prevention and have become best practices..."

See also:
Prediction of Alcohol-related Harm from Controlled Drinking Strategies & Alcohol Consumption Trajectories - Toumbourou et al.; Addiction 99(4); 498-508; 2004. Posted: 2004-10-22; Modified: 2006-09-10.

College Binge Drinking and the Prevention Paradox -Elissa Weitzman and Tobin Nelson; Harvard School of Public Health Journal of Drug Education; 34(3); 247-265; 2004. Posted: 2005-11-28. Modified: 2006-02-24.

Unhealthy Alcohol Use -Richard Saitz; New England Journal of Medicine; 352(6); 596-607; 2005-02-10.

Dennis Murphy; Dateline, NBC News; Air date: 2006-09-01. Posted: 2006-09-04. Source

Excerpt:
"'I finally had a moment of clarity that said, 'You can’t live this lie anymore.' [Kishline] posted a message to MM members that said: 'I have made the decision recently to change my recovery goal to one of abstinence rather than moderation.' The creator of MM was admitting defeat. She checked herself into a detox facility followed up by AA meetings, but she couldn’t play by those rules either."

See also:
What Audrey Kishline Told MM in January 2000 (and other stuff from way back then) - Audry Kishline; Moderation Management listServ; 2000-01-20.

The Controlled Drinking Debates: A Review of Four Decades of Acrimony - Brook Hersey, Psy.D.; Rutgers University Graduate School of Applied and Professional Clinical Psychology; 2001.

Why Controlled Drinking Never Dies - Stanton Peele; Stanton Peele Addiction website; 2000-08-08.

The Abstinence vs Harm Reduction Follies of Summer 2000 - Addiction Medicine Shoots Self in Foot, Again - compiled by Alexander DeLuca; 2001-01-07; Modified: 2006-07-09.

Related resources:
Moderation Management / Harm Reduction archives

Abstinence / Harm reduction Journalism and Advocacy archives

[END]

Katie Witkiewitza, and G. Alan Marlatt; International Journal of Drug Policy (IJDP); 17(4); 285-294; July 2006. Posted: 2006-09-01.

Excerpt:
In this article, we review recent empirical articles and scholarly reviews of harm reduction treatments for alcohol abuse and dependence.

We focus this review on peer-reviewed articles published in the last 3 years, with a particular emphasis on interventions designed to reduce alcohol-related harm, including overall levels of consumption and alcohol-related problems.

See also:
The MM Programme in 2004: What Type of Drinker Seeks Controlled Drinking? - Ana Kosok; International Journal of Drug Policy (IJDP); 17(4); 295-303; July 2006. Posted: 2006-03-26.

Are Alcoholism Treatments Effective? The Project Match Data (PDF) - Robert Cutler and David Fishbain; BMC Public Health; 2005.

Harm Reduction Psychotherapy: Extending the Reach of Traditional Substance Use Treatment - Andrew Tatarsky, Ph.D.; Journal Substance Abuse Treatment, 25(4): 249 –256, 2003.

Harm Reduction: Meeting Clients Where They Are - Kate Jackson, Social Work Today, 4(6), 2004.

The Controlled Drinking Debates: Four Decades of Acrimony - Brook Hersey, Psy.D., 2001.

The Abstinence vs. Harm Reduction Wars of Summer 2000 - Addiction Medicine Shoots Self in Foot, Again

[END]

Anton, et al., Journal of the American Medical Association; 295(17), 2003-2017; 2006-05-03.

Excerpt
"Patients receiving medical management with naltrexone, CBI, or both fared better on drinking outcomes, whereas acamprosate showed no evidence of efficacy, with or without CBI.

'No combination produced better efficacy than naltrexone or CBI alone in the presence of medical management... Naltrexone with medical management could be delivered in [primary care settings, thus serving patients who might otherwise not receive treatment."]

See also:
A Combined Behavioral Intervention for Treating Alcohol ependence (for the COMBINE Study) - WR Miller, TB Moyers, and LT Arciniega; WR Miller (Ed): Combined Behavioral Intervention Therapist Manual (COMBINE); 2005.
Posted: 2006-04-29.

Naltrexone for the Treatment of Alcoholism - a Meta Analysis of Randomized, Controlled Trials - Manit Srisurapanont and Ngamwong Jarusuraisin, International Journal of Neuropsychopharmacology 8, 1–14, 2005.

Efficacy and Tolerability of Long-Acting Injectable Naltrexone [Vivitrol for Alcohol Dependence - A Randomized Controlled Trial] - Garbutt, Kranzler, O'Malley, Gastfriend, Pettinati, Silverman, Lowey, and Ehrich (for the Vivitrol Study Group); Journal of the American Medical Society; 293: 1617-1625; 2005-04-06.

A Group Motivational Treatment for Chemical Dependency - Jeffrey Foote, Alexander DeLuca, Steve Magura, Ann Warner, Anne Grand, Andrew Rosenblum, and Susan Stahl; Journal of Substance Abuse Treatment; 17(3): 181-192; 1999.

[END]

Chris Wright; Boston Magazine; July, 2006. Posted: 2006-07-09. Source

Excerpt:
"'I’m curious to see what the results [of real world experience with Vivitrol] will be,' says DeLuca, 'Will there be increased abstinence or will there be reduced harmful drinking? I think the latter.'

"Harvard professor of psychiatry George Vaillant is appalled by that possibility... The science behind Vivitrol, he adds, represents little more than a futile attempt to exercise control over the uncontrollable... 'What we know about the neurobiology of alcoholism has no effect on the fact that it kills 100,000 Americans a year. Our improved neurological understanding is displacement. We’re comforting ourselves.'"

Comment (DeLuca):
Author Wright does a pretty good job of explaining and tying together difficut and disparate issues including the 'disease concept' of alcoholism, the 'Abstinence vs. Harm Reduction Wars of Summer 2000', the Vivitrol randomized controlled trial, and the issues and confusion provoked by the FDA indication that Vivitrol be used to promote abstinence.

The abstinence indication is in conflict with the research in which about 90% of the patients drank during the 6 month study. The patients on Vivitrol had significantly less heavy drinking compared to patients who drank on placebo. This was the primary outcome of the study on which FDA based it's approval. Political Science can get pretty convoluted. <smile>

See also:
Vivitrol for Alcohol Dependence - A Randomized, Controlled Trial - Garbutt, Kranzler, O'Malley, Gastfriend, Pettinati, Silverman, Loewy, and Ehrich; JAMA; 293; 2005-04-06. Posted: 2006-01-08.

The Controlled Drinking Debates: Review of Four Decades of Acrimony - Brook Hersey, Psy.D., Rutgers, 2001. Posted: 2002-10-11.

The Abstinence vs. Harm Reduction Follies of Summer 2000 - Addiction Medicine Shoots Self in Foot, Again

The Naltrexone (Trexan/Revia/Vivitrol) Collection arvhives

[END]

Mohamed Ben Amar; Journal of Ethnopharmacology, 102(1-2), 1-25; 2006-04-21. Posted: 2006-06-14.

Excerpt:
Seventy-two controlled studies evaluating the therapeutic effects of cannabinoids were identified. For each clinical trial, the country where the project was held, the number of patients assessed, the type of study and comparisons done, the products and the dosages used, their efficacy and their adverse effects are described. Cannabinoids present an interesting therapeutic potential as antiemetics, appetite stimulants in debilitating diseases (cancer and AIDS), analgesics, and in the treatment of multiple sclerosis, spinal cord injuries, Tourette's syndrome, epilepsy and glaucoma.

See also (these articles newly added to the Medical Marijuana: 2000-2006 Collection):

Pot Smoking Not Linked to Lung Cancer - Study Shows No Increased Risk for Even the Heaviest Smokers - Salynn Boyles; WebMD Medical News; 2006-05-23. Posted: 2006-06-15.

Marijuana Smoking and Head and Neck Cancer - Hashibe, M., Ford, D.E., and Zhang, Z.; Journal of Clinical Pharmacology, 42 (11 Suppl), 103S-107S; 2002. et al.; J. Clinical Pharmacology; 2002. Posted: 2006-06-14.

Nonacute (Residual) Neuropsychological Effects of Cannabis Use - Gonzalez, R., Carey, C., and Grant, I.; Journal of Clinical Pharmacology, 42(11 Suppl), 48S-57S, 2002. Posted: 2006-06-14.

Ana Kosok; International Journal of Drug Policy; Pre-published: 2006-03-18. Posted: 2006-03-26.

Comment (DeLuca):
This is a hugely important paper, the first of three planned articles throughly describing the demographics, drinking patterns, alcohol related consequences, and the effect of the MM program on abusive drinking. MM seekers are characterized by moderate to high alcohol intake but very few life problems compared to seekers of AA or traditional treatment. Fascinating. Thank you Dr. Kosok!!

See also:
The Evolution of the Moderation Management Network - Ana Kosok and James Cannon; Partial Draft document not previously published; 2006-09-04. Posted: 2006-03-04.

Characteristics and Motives of Problem Drinkers Seeking Help from MM Groups - Klaw et al.; Cog. and Behav. Practice; 2003.

Symposium on Moderation Management - Kern, Rotgers, and DeLuca; 109th Annual Convention, American Psychological Association; 2001

The Controlled Drinking Debates: Four Decades of Acrimony - Brook Hersey, Psy.D., 2001.

The Abstinence vs. Harm Reduction Wars of Summer 2000 - Addiction Medicine Shoots Self in Foot, Again - compiled by Alexander DeLuca, 2000.

WR Miller, TB Moyers, and LT Arciniega; from: Miller (Ed): Combined Behavioral Intervention Therapist Manual (COMBINE); 2005. Posted: 2006-04-29. Source: CASAA

Comment (DeLuca):
CBI is a modular, manual-guided, semi-structured therapy integrating evidence based behavioral methods developed as the state of the art psychotherapy to be tested in the COMBINE Study. Structured around Motivational Interviewing, CBI includes assessment, feedback, and highly individualized treatment plan development that is flexible regarding treatment goal.

This Poster Presentation is a sneak preview of the CBI Therapist Manual (in press). CBI is probably the most thoughtfully designed, research based substance abuse therapy ever created. Clinicians, especially, will want to study this.

See also:
A Group Motivational Treatment for Chemical Dependency (PDF) - Foote, DeLuca, Magura, Warner, Grand, Rosenblum and Stahl; J. Substance Abuse Treatment; 17(3); 1999.

Design and Analysis of Trials of Combination Therapies [in the COMBINE Study] - Hoskings, Cisler, Couper, Gastfriend, Kivahalan, and Anton; J Stud. Alcohol, 66,Supp. No. 15: 34-42, 2005.

Comparing and Combining Naltrexone and Acamprosate - A Double-blind, Placebo-Controlled Study - Falk Kiefer, et. al.; Archives of General Psychiatry; 60(1); 2003.

Efficacy and Safety of Naltrexone and Acamprosate in the Treatment Of Alcohol Dependence: A Systematic Review - Bouza Carmen, et al.; Addiction; 99(7):811-828; 2004.

F. Massa, G. Marsicano, H. Hermann, A. Cannich, K. Monory, B.F. Cravatt, G. Ferri, A. Sibaev, M. Storr and B. Lutz; Journal of Clinical Investigation; 113(8): 1202-1209; 2004. Posted: 2006-03-27.
Excerpt:
"Our results indicate that the endogenous cannabinoid system represents a promising therapeutic target for the treatment of intestinal disease conditions characterized by excessive inflammatory
responses."
Comment (DeLuca):
The U.S. insists there is no medical use for cannabis. What do you think?
See also:
Cannabinoids Show Long-Term Benefits for MS Patients, Study Says - NORML eZine, 8(42), 2005.
Endocannabinoid Control of Food Intake and Energy Balance - Marzo and Matias; Nature Neuroscience; 2005.
Decreased Depression in Marijuana Users - Densona and Earleywine; Addictive Behaviors; 2005.
WAR ON PAIN SUFFERERS #6 - Medical Marijuana: 2000-2006

Donald F Klein; Neuropsychopharmacology; 31(4):689-699; 2006; Posted: 2006-03-21.
Excerpt:
"The data necessary for objective evaluations of post-marketing harm cannot be gathered by the current process. Proper prospective surveillance by linked computerized medical records is a crucial issue that deserves major public and political attention and prompt action."
See also:
FDA Approves Transdermal Selegiline (Emsam) for Treatment of Depression - PRNewswire; 2006-02-28.
Unhealthy Alcohol Use - Richard Saitz, M.D., MPH; New England Journal of Medicine; 352(6); 596-607; 2005-02-10. Posted:2005-02-14.
Detox / Patient Engagement archives
Abstinence / Harm Reduction Academic Literature

W.R. Miller, J.S. Locastro, R. Longabaugh, S. O'Malley, and A. Zweben; J Stud. Alcohol, Supp. 15:17-23, 2005. Posted: 2006-02-27.
Comment (DeLuca):
The COMBINE trial is designed to study the efficacy (alone and combined) of naltrexone and acamprosate with 'medical management' and a psychotherapy treatment known as the Combined Behavioral Intervention (CBI). This important, large, multisite Study is in progress. I will post more interim articles soon.
See also:
A One-Year Pragmatic Trial of Naltrexone vs. Disulfiram in the Treatment of Alcohol Dependence - deSouza and deSouza; Alcohol and Alcoholism; 2004.
Vivitrol for Alcohol Dependence - A Randomized Controlled Trial - James Garbutt et al; Journal of the American Medical Association; 293; 2005-04-06.
Harm Reduction: Meeting Clients Where They Are - Kate Jackson, Social Work Today, 4(6), 2004.
Study Questions Effectiveness of Alcoholism Therapy - Reuters Health; 2005-07-22.
Related resources:
Pharmacotherapy of Substance Use Disorders Collection, and, The Naltrexone Collection

Ana Kosok and James Cannon; Partial Draft document; Addiction, Pain and Public Health website; Issue date: 2006-09-04; Posted: 2006-03-04.
Excerpt:
"The Network (MM) now has 10 years of real experience. Subjective review suggests the practices of MM [remain] relatively true to the original design. [Experience and practice have brought about] several improvements in program policy that have been incorporated into the culture and literature of [modern] MM."
See also:
The Moderation Management website: http://www.moderation.org/
Symposium on Moderation Management - Drs. Mark Kern, Fred Rotgers, and Alexander DeLuca; Three slide/lectures presented at the American Psychological Association 109th Annual Conference, San Francisco; 2001.
A Research-Based Analysis of the Moderation Management Controversy - Keith Humphreys, Ph.D.; Psychiatric Services; 54:621-622, 2003.
Characteristics and Motives of Problem Drinkers Seeking Help from MM Groups - Elena Klaw, Shira Luft, and Keith Humphreys; Cognitive and Behavioral Practice; 10:384-389; 2003.
The Abstinence vs. Harm Reduction Wars of Summer 2000 (Addiction Medicine Shoots Self in Foot, Again) - compiled by Alexander DeLuca; Addiction, Pain, and Public Health website; 2001-01-27.
The Controlled Drinking Debates: Four Decades of Acrimony - Brook Hersey, Psy.D., 2001.

Eric D. Collins, Herbert D. Kleber, Robert A. Whittington, Nicole E. Heitler, JAMA, 294:903-913, 2005. Posted: 2006-02-22.
"[Withdrawal] severities were comparable... [no differences] in rates of completion [or] retention [or urine tox]... The anesthesia procedure was associated with 3 potentially life-threatening adverse events. Conclusion: These data do not support the use of general anesthesia for heroin detoxification and rapid opioid antagonist induction."
See also:
What is Ultra-Rapid Opiate detox (UROD) and how is it different from Rapid Opiate detox (ROD)? - Alexander DeLuca, Addiction-related FAQ #18, 2001.
Heroin Detoxification - Michael M. Miller, Letter to the Editor, JAMA, 295:885-886, 2006.
Two Doctors May Lose Licenses Over Fast-Detox Method Medicine - Associated Press; 2000-12-31.

Richard Saitz, NEJM, 352(6), 2005-02-10. Posted:2005-02-14; Modified: 2006-02-20.
"The balance of <increased risk of> harm and <reduced risk of ischemic disease> determines <what are moderate, or less-than-risky,> amounts... Either naltrexone or acamprosate is first-line therapy; naltrexone is the better choice if the patient has not abstained... Disulfiram is an alternative that works best when supervised."
See also:
Are Alcoholism Treatments Effective? The Project Match Data (PDF) - Cutler & Fishbain; BMC Public Health; 2005-07-13.
College Student Binge Drinking and the 'Prevention Paradox': Implications for Prevention and Harm Reduction - Weitzman and Nelson; Journal of Drug Education; 2004.
British Livers and British Alcohol Policy - Robin Room; The Lancet; 2006-01-07.

Garbutt, Kranzler, O’Malley, Gastfriend, Pettinati, Silverman, Loewy, Ehrich, Journal of the American Medical Society; 293: 1617-1625; 2005-04-06.
"Compared with placebo, 380 mg of (Vivitrol) resulted in a 25% decrease in heavy drinking days... (Vivitrol) resulted in reductions in heavy drinking among treatment-seeking alcohol-dependent patients during 6 months of therapy."
See also:
Comparing and Combining Naltrexone and Acamprosate in Relapse Prevention by Kiefer et. al., Arch Gen Psychiatry, 60(1), 2003.
Pharmacotherapy of Substance Use Disorders Collection including sections on acamprosate and disulfiram.
The Naltrexone FAQ aka: "Dopey Docs and Naltrexone"

Stanton Peele, Annals of the New York Academy of Sciences, 602:205-220, 1990.
"Our conception of addiction... has arisen independent of lab or epidemiological data about drug use. [It] has never reflected actual patterns of heroin [or cocaine] use. [Nor does] an equally popular, complimentary model of alcoholism..."
See also:
The Discovery of Addiction by Harry Levine; Journal of Studies on Alcoholism, 493-506, 1979.
The Cultural Framing of Addiction by Robin Room, Janus Head, 6(2): 221-234, 2003.

by Brook Hersey, Psy.D., 2001 - From the Introduction:
"The debate about whether abstinence is necessary for people with drinking problems has been going on for four decades. The paper represents this writer’s effort to better understand the controversy’s heat and longevity, by tracing it from J.P. Davies’ 1962 paper through to (Smithers Center firing DeLuca in 2000). This historical review concludes with a discussion of some important issues that confront a contemporary observer of the controlled drinking debate."
See also:
Harm Reduction Approaches to Alcohol Use by Marlatt and Witkiewitz, Addictive Behaviors, Vol 27, 2002.
The Abstinence vs. Harm Reduction Follies of Summer 2000 (OR) Addiction Medicine Shoots Itself in the Foot, Again.

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