🚀 go-pugleaf

Jean:
        Thanks for your comments, questions, and obvious interest.
I want to reply quickly, before the discussion moves into
new areas. I'll try to hit the majority of your questions
but I'm sure I'll miss some.

1. Naltrexone (NTX, trade name ReVia) is an opioid blocker
medication that has been used for years in treating opiate
overdoses. As you know, a blocker (or "antagonist")
occupies receptor sites without firing them. I think 2
nanograms/ml of block achieves effective blockade.
Naltrexone seems to reduce the craving for alcohol in
dependent clients. It also seems to increase the sedation
of drinking ETOH while decreasing disinhibition.
Disinhibition is addicting while sedation is not. SO, the
reinforcing properties of alcohol are altered by the drug.
The theory is that ETOH gets your brain to release
endogenous opioids (which are also blocked by NTX). The
effects are subtle so your client may not perceive them. We
are completely up front about what we think we know about
the drug and we share that even placebos have real effects.
To really know if it's the compound aside from attributions
to it would involve, IMHO, an immoral level of deception of
our human subjects. Some seem to notice feeling different
(I've worked with over 200 people on this in research).
They need to watch it, however, if they get injured,
though, as opioid pain killers won't work if you're taking
this. I really believe that taking medication is a
psychosicial, interactional treatment as well as medical
treatment. I will probably never know the effects of pills
without therapy b/c I really feel it's immoral to withhold
psychotherapy (short, long, informational, whatever) from
people in need. Re unknown effects of the drugs: I often
wonder if these people could achieve a "runner's high." It
may be a small price to pay to control an addiction. We are
doing studies that monitor many aspects of the client's
day. Maybe we'll find something, but the medication seems
pretty benign so far. It is FDA approved.
2. Re setting goals with alcohol dependent clients: This is
not simple advise giving. You need to really stick with
your client and learn about his/her hx and capabilities.
After 13 years as a psychotherapist, I can tell you that
telling an addict that it's OK to use destroys your
credibility with the client. Consciously or not, they know
they are hurting themselves. When you join with that, you
are potentially joining the client in a slow suicide.
They'll know. I did not say that moderate drinkers with
addiction histories are killed by drinking. Substance
dependent clients are. There's a lot of clinical complexity
here that won't fit into an e-mail. I agree that individual
assessment is the key. Severe addicts are usually not seen
past the identification stage by generalists. Most of their
treatment is done by addiction specialists.
3. The P3 wave EEG marker (reduced habituation of the P3
wave over repeated visual presentation of a stimulus) seems
to be related to males with a history of being aggressive
when drunk. We all know families in which all the males are
mean drunks or tea-totallers. Why is this true? I dunno.

Thanks for talking about this. It's easy to think addicts
are uninteresting or robotic. They're not! I hope some of
the people on the list get into working with addicts.

Chris Penta
penta@mail.snet.net