Question: Which pharmacotherapies are associated with improved outcomes for people with alcohol use disorder?
Findings: In this systematic review and meta-analysis that included 118 clinical trials and 20 976 participants, 50 mg/d of oral naltrexone and acamprosate were each associated with significantly improved alcohol consumption-related outcomes compared with placebo.
Meaning: These findings support oral naltrexone at 50 mg/d and acamprosate as first-line therapies for alcohol use disorder.
Abstract
Objective: To compare efficacy and comparative efficacy of therapies for alcohol use disorder.
Study Selection: For efficacy outcomes, randomized clinical trials of at least 12 weeks’ duration were included. For adverse effects, randomized clinical trials and prospective cohort studies that compared drug therapies and reported health outcomes or harms were included.
Main Outcomes and Measures: The primary outcome was alcohol consumption. Secondary outcomes were motor vehicle crashes, injuries, quality of life, function, mortality, and harms.
Conclusions and Relevance: In conjunction with psychosocial interventions, these findings support the use of oral naltrexone at 50 mg/d and acamprosate as first-line pharmacotherapies for alcohol use disorder.
(This is the same trajectory our National Drug Strategy has been re-tasked to comply with. Harm Reduction, an important pillar in our 3 Pillar strategy, has not only become the only priority, but has been used to rename the Harm Minimisation Platform to the point where Demand and Supply Reduction, are not only downplayed, but more and more ignored.
Sadly, pro-drug activists, who seek not to end addiction – thus decrease the cause of it, drug use – they instead seek only ways to normalise substance use and silence the overwhelmingly responsible non-drug using public through coercive speech codes that don’t even permit the identification of a problem. Ah, but that is a key to normalisation of behaviour, no matter how aberrant. You must compel people to accept it, and all the attending harms that accompany it. And this is the ‘new normal’?
This callous soft-bigotry and worse, humanity diminishing endorsement, enabling, and empowering of self and public harm, is a reckless public health destroying strategy that generations will pay for, and not just fiscally.
Who is driving this narrative? Who is controlling the policy interpretation levers?
Methadone accounts for almost 50 per cent of all Scotland’s drug related deaths; a figure which has almost tripled since 2015. This is more than double the rate of the United States. Methadone is prescribed by doctors wanting to wean addicts off heroin and this comprises a key part of the Scottish government’s harm reduction strategy.
In recent years, tensions have emerged between the governments of the UK and Scotland over how to view and deal with drugs. Unlike health, drug law is not a devolved issue. And whereas the UK government seemingly favours a criminal justice approach to dealing with drugs, the Scottish administration has opted for a public health centred approach. However, this apparent difference is not as clear cut as first presented. Both governments approach the problem largely through the purview of ‘harm reduction’. Yet in the case of Scotland, advocates steadfastly argue against the idea of abstinence and prohibition as appropriate approaches to drug treatment, with disastrous results.
Indeed, as recent academic research has identified, the rapid increase in opioid related deaths in Scotland is both ‘remarkable’ and ‘worrisome’. When comparing opioid related death rates across the UK as a whole, research suggests that there are ‘… no clear regional differences…’ and the role of demographics and deprivation as key drivers of the Scottish opioid crisis is limited (2). The key distinction between Scotland and the rest of the UK is policy.
The Scottish government has become enthralled to the idea of harm reduction as an end in itself, rather than as part of a more comprehensive strategy that places the problem of addiction at its centre. Policy has largely jettisoned any assumption that with opportunity and support, an addict might overcome their addiction. Indeed, in April 2021, Scottish First Minister Nicola Sturgeon suggested that public discussion on the ‘rehabilitation’ of addicts was largely a distraction and that too much time had been wasted debating the issue.
The SNP view is that the discrimination experienced by drug addicts, rather than their actual addiction, is responsible for the annual increase in drug deaths.
In reality, the Drug Deaths Taskforce campaign has little to do with helping drug addicts. It is a deliberate attempt to forcibly reengineer the common norms and values that shape wider Scottish society. Far from promoting tolerance and respect, the campaign sets out to stigmatise the belief held by many ordinary people that individuals are responsible for what they do, and if their actions are harmful to themselves or others, they have a responsibility to desist from such behaviour
As such, the Scottish government has set itself the task of re-educating local communities, and the Scottish population more broadly, in how their stigmatised options are discriminatory and perpetuate social inequality and, ultimately, drug deaths.
However, the view that underpins this outlook is highly cynical and dangerous. The focus upon harm reduction, at the expense of recovery and rehabilitation, and the targeting of so-called stigmatising views against addicts, endorses an idea that addiction is socially acceptable and, in fact, should be respected by wider society. It provides a technocratic managerial solution – albeit dressed up in the language of therapy – to what is in fact a fundamentally moral question about the individual’s responsibility to wider society and their ability to contribute purposefully to that society – in this case the addict’s willingness to exercise personal responsibility for their condition.
Conclusion: The Scottish government’s weaponization of addiction serves as the basis through which an increasingly technocratic and unaccountable political class delegitimises the moral and restitutive capacity of shared social norms. Legislative attempts to normalise addiction, through the undermining of liberal values such as individual responsibility and agency, seem to be readily accepted by politicians, policy makers and academic experts alike. Might this not be the real cause of Scotland’s drug crisis?
Recovery-Ready Workplaces adopt policies and practices that:
expand employment opportunities for people in or seeking recovery;
facilitate help-seeking among employees with substance use disorder (SUD);
ensure access to needed services, including treatment, recovery support, and mutual aid;
inform employees in recovery that they may have the right to reasonable accommodations and other protections that can help them keep their jobs;
reduce the risk of substance misuse1and SUD, including through education and steps to prevent injury in the workplace
educate all levels of the organization on SUD and recovery, working to reduce stigma and misunderstanding, including by facilitating open discussion on the topic; and,
ensure that prospective and current employees understand that the employer is recovery-ready and are familiar with relevant policies and resources.
Talking Therapies: Still a Key to Better Emotional, Psychological and Social Health Therapy may have its roots in treating severe mental disorders, but it has since gone mainstream. You don't have to have a mental illness to benefit from therapy -- and seeking therapy does not mean you are mentally ill. Nor is it a sign of weakness. In contrast, it's a sign of resourcefulness. When life feels like it's spinning out of control, therapy is one tool to help you control the spin. Therapy provides tools for solving problems and enhancing quality of life, says psychologist Parinda Khatri, PhD. These tools may include relationship skills, anger management, or techniques for controlling thoughts and actions. "You don't have to go into past issues," Khatri tells WebMD. "You can be very focused on the present and specific problems you are targeting." Source: Therapy: Myths, Facts, and More (webmd.com)
“Sustained abstinence from alcohol after treatment for alcohol use disorder is associated with substantial recovery of neural and non-neural tissue that contributes to the thickness of the human cortex.”
A recent scientific study has unveiled promising news for individuals recovering from alcohol abuse. Researchers discovered that the brains of those who abstained from alcohol for approximately 7.3 months exhibited significant improvements in brain structure, suggesting a remarkable potential for recovery. This new finding, published in the journal Alcohol, provides hope for people with alcohol use disorders and underscores the importance of sustained abstinence. (Source: https://www.sciencedirect.com/science/article/abs/pii/S074183292300263X)
