by Tom Horvath, PhD There are many occupations considered to be safety-sensitive. The industries from which they are drawn include healthcare, transportation, and construction. Specific occupations include physicians, airline pilots, and heavy equipment operators. When these individuals have their substance use monitored (often because of recent substance problems), what principles should guide the creation of the monitoring plan? Let us focus on alcohol, because it may be the most common substance monitored. There are many methods to monitor alcohol use. They differ according to the timeframe they observe, their accuracy (will they miss use that occurred?), whether they assess the substance itself or a metabolite, the convenience of use (e.g., including how far one must go to get...

By Tom Horvath, PhD This article focuses on physicians with substance problems (and by extension all licensed professionals). However, the underlying idea, that those wanting to assist someone with substance problems should focus on ends not means, applies widely. In most US states there is a state-recognized Physician Health Plan (PHP) which often controls how physicians who have substance problems are dealt with. Similar plans exist for other licensed professionals. These organizations do much beneficial work. No one wants a licensed professional with substance problems. The national organization for PHPs is: https://www.fsphp.org, the Federation of State Physician Health Plans. In this article I focus on some major problems with PHPs (and the parallel organizations). The ide...

Neuronal Plasticity, Mindfulness Meditation, and Addiction Recovery by Nicholas A. Nelson, Ph.D. Part 1 of 2 It is not uncommon during active addiction or early in recovery for people to feel that their brain is working somehow differently than before, or to feel like it is going to be impossible to break out of harmful habits and thought patterns. It can feel like the mind is damaged, or operating out of our control. This lack of control, and feeling that something is broken, can lead to a sense of hopelessness. When we look at the brain there is some truth to this feeling - during engagement with problematic addictive behaviors and during early recovery, our brains are not wired in the same way as before these problems took root. Through months, years, or decades of repetiti...

by Kenneth Anderson, MA The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines binge drinking as drinking enough alcohol to reach a blood alcohol concentration (BAC) of 0.08% or higher, i.e., to become legally intoxicated. For men, this typically means drinking five or more US standard drinks in a two-hour period. For women, this is typically four or more standard drinks in a two-hour period. Extreme binge drinking, also known as high-intensity drinking, is defined as drinking enough alcohol to achieve a BAC of .16% or higher, in other words, drinking twice as much as the amount for regular binge drinking. Extreme binge drinking is associated with throwing up or passing out. In the United States, extreme binge drinking is a common occurrence at 21st birthday celebr...

Part Three from the Series: Does Alcohol Kill Brain Cells? Research on Clinical Samples by Kenneth Anderson, MA Stavro et al. (2013) conducted a review of clinical studies of cognitive impairments in people with alcohol use disorder (AUD) and their reversal with abstinence. IQ was found to be unaffected by AUD; there were no significant differences in IQ between people with AUD and control subjects. However, 11 other cognitive domains were moderately impaired in people with AUD: verbal fluency/language, speed of processing, working memory, attention, problem-solving/executive functions, inhibition/impulsivity, verbal learning, verbal memory, visual learning, visual memory, and visuospatial abilities. Cognitive impairments began to abate during the first month of abstinence from alc...

This week, Kenneth Anderson, MA, explores MRI and brain shrinkage research in part 2 of the series, "Does Alcohol Kill Braincells?" Part 1 can be found here. By Kenneth Anderson, MA A 2001 study by Kubota et al. performed MRIs on 1,432 employees and family members (1,061 men and 371 women) of a large Japanese corporation to investigate shrinkage of the frontal lobe of the brain. Subjects were each categorized by their drinking status (abstainers, light drinkers, moderate drinkers, heavy drinkers), age (30s, 40s, 50s, or 60s), and brain shrinkage (shrunken, not shrunken). Heavy drinkers were classified as those who drank 350 grams of ethanol (25 US standard drinks) or more per week. There were no significant differences between the abstainers, light drinkers, and moderate drinkers ...

Does Alcohol Kill Brain Cells? Part One: Post-Mortem Brain Research By Kenneth Anderson, MA It is a commonly held belief that alcohol kills brain cells; however, is there any truth to this belief, or is it simply a myth? While it is clear that pathological conditions such as Korsakoff's syndrome or alcohol-related dementia result in the death of brain cells, these conditions are not due to the direct effect of alcohol. Therefore, this blog post will not look at pathological conditions such as Korsakoff's syndrome or alcohol-related dementia which are due to other factors in addition to alcohol, such as nutritional deficiencies. Instead, we will limit our discussion strictly to the direct effects of alcohol on the brain. Korsakoff's syndrome or alcohol-related dementia are somewha...

The Differences Between Moderate Drinking Programs and Harm Reduction Programs Part 2: Harm Reduction Programs, and How and Why I Created HAMS By Kenneth Anderson, MA The Backstory I first attended an MM meeting in Minneapolis, Minnesota in June of 1998; this was immediately after the great storm of May 30, 1998, which had knocked out power lines and even traffic lights throughout the Twin Cities area and had hit the suburbs even worse. I was the only one to show up at this meeting, but I tried again the following week. The following week there were only two people at the Minneapolis MM meeting: me and Audrey Kishline. I actually did not realize that I was talking to the founder until the end of the meeting when she lent me a copy of the MM handbook and I saw her picture on the ...

The Differences Between Moderate Drinking Programs and Harm Reduction Programs Part 1: Moderation Drinking Programs and Moderation Management By Kenneth Anderson, MA Moderate drinking programs and harm reduction programs start from opposite assumptions and wind up in very different places. This doesn't necessarily make one type of program better than the other--different people will find different programs to be a good fit. A Brief Overview of Harm Reduction Programs Harm reduction programs start from the assumption that the more harm there is associated with behavior such as the use of a substance, the more the person who engages in that behavior can benefit from harm reduction services. Harm reduction services are low-threshold and are provided unconditionally. For example,...

By Kenneth Anderson, MA Alcohol and the Cerebellum Some drugs like opioids, benzodiazepines, and amphetamines have been called chemical scalpels because each affects only a single neurotransmitter system. Alcohol, on the other hand, is a dirty drug which affects large numbers of neurotransmitter systems, including GABA (gamma-aminobutyric acid), glutamate, and dopamine. Hence, alcohol has been referred to as a chemical hand grenade. In this post, we will be looking at alcohol's effects on the GABA system to see how it causes staggering (aka ataxic gait) and slurring of speech (dysarthrias), sedation, and memory loss. First, let's take a look at the GABA receptors. Although there is only one type of GABA, there are two types of GABA receptors: type A, which are known as GABA-A recep...