Internet Mental Health

ALCOHOL USE DISORDER



Seattle is dying from a drug epidemic The Rise of Fentanyl



  • Alcohol use disorder is the continued use of alcohol despite clinically significant distress or impairment which usually includes:

    • a strong desire to take alcohol

    • difficulties in controlling its use

    • persisting in its use despite harmful consequences

    • a higher priority given to alcohol use than to other activities and obligations

    • increased tolerance

    • a physical withdrawal state

Prediction

    Episodic or continuous for years

Problems

Occupational-Economic Problems:

  • Causes significant impairment in academic or occupational functioning

  • Only a minority are so chronically disabled that they require a disability pension

  • Economic problems caused by squandering money or alcohol-related unemployment

  • Alcohol Use Disorder accounts for 9.6% of the disability caused by mental illness worldwide

Antagonistic (Antagonism):

  • Intoxicated behavior can be very uncooperative and disagreeable

Disinhibited (Disinhibition):

  • Intoxicated behavior, impaired driving

  • Impulsivity, dangerous risk taking, irresponsibility

  • Law-breaking, violence

  • Marital (or child) discord/abuse/neglect

Cognitive Impairment (Impaired Intellect):

  • Marked denial; lack of insight

  • Cognitive impairment when intoxicated

  • Chronic alcoholism can cause alcoholic hallucinosis, psychosis, amnestic disorder, delirium, or dementia

Emotional Distress (Negative Emotion):

  • Depressed mood, generalized anxiety, anger, suicidal behavior

Sociable (High Extraversion) OR Detached (Detachment):

  • Intoxicated behavior can cause, socially and sexually, either excessive disinhibition (being talkative and assertive) or inibition (being quiet and reserved)

Medical:

  • Alcoholism is the 3rd leading cause of death in the developed world.

  • Sort-term Consequences: automobile accidents, accidental injuries, accidental or deliberate overdoses, injuries and risky behavior, memory and concentration problems, coma, breathing problems, slurred speech, confusion, impaired judgment and motor skills, drowsiness, nausea and vomiting, emotional volatility, loss of coordination, visual distortions, impaired memory, changes in mood and behavior, and depression. Impaired judgment can result in inappropriate sexual behavior, sexually transmitted infections, and reduced inhibitions.

  • Long-term Consequences: impaired coordination; cardiovascular problems including heart muscle injury, irregular heartbeat, stroke, and high blood pressure; gastritis, ulcers; liver problems including steatosis (fatty liver), alcoholic hepatitis, fibrosis, and cirrhosis; pancreatitis; alcohol withdrawal seizures; peripheral neuropathy; alcohol-induced persisting amnestic disorder (Wernicke-Korsakoff syndrome); erectile dysfunction; increased risk of various cancers (including of the mouth, esophagus, larynx, pharynx, liver, colon, and rectum); weakened immune system; coma, and death due to alcohol overdose. For breast cancer, even moderate drinking may increase the risk.

  • Pregnancy-related: sudden infant death syndrome (SIDS), fetal alcohol spectrum disorders (FASD).



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Diagnose Alcohol Use Disorder

Limitations of Self-Diagnosis

Self-diagnosis of this disorder is often inaccurate. Accurate diagnosis of this disorder requires assessment by a qualified practitioner trained in psychiatric diagnosis and evidence-based treatment.

However, if no such professional is available, our free computerized diagnosis is usually accurate when completed by an informant who knows the patient well. Computerized diagnosis is less accurate when done by patients (because they often lack insight).

Example Of Our Computer Generated Diagnostic Assessment

Alcohol Use Disorder (Alcoholism) 303.90

This diagnosis is based on the following findings:
  • Abused alcohol in the past 5 years (still present)
  • Greater use of alcohol than intended (still present)
  • There is a persistent desire or unsuccessful efforts to cut down or control alcohol use (still present)
  • A great deal of time is spent in obtaining alcohol, using alcohol, or recovering from its effects (still present)
  • Craving, or a strong desire or urge to use alcohol (still present)
  • Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school or home (still present)
  • Continued alcohol use despite having persistent social problems that alcohol made worse (still present)
  • Important social, occupational, or recreational activities are given up or reduced because of alcohol use (still present)
  • Recurrent alcohol use in situations in which it is physically hazardous (still present)
  • Continued using alcohol despite knowing it caused significant problems (still present)
  • Developed tolerance to alcohol (still present)
  • Developed withdrawal symptoms to alcohol (still present)

Treatment Goals:

  • Goal: stop alcohol use because using more than intended.
    If this problem worsens: Repeated alcohol intoxication could continue to cause harmful psychological consequences (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgment, impaired social or occupational functioning).

  • Goal: stop alcohol use because it is getting out of control.

  • Goal: stop alcohol use in order to prevent wasting so much time using alcohol, or recovering from its use.

  • Goal: stop alcohol use in order to decrease craving for alcohol.

  • Goal: stop alcohol use so that she can better fulfill major role obligations at work, school or home.

  • Goal: stop alcohol use in order to improve the alcohol-related social problems.

  • Goal: stop alcohol use in order to increase time spent on important social, occupational, or recreational activities.

  • Goal: stop alcohol use in hazardous situations in order to prevent injury.

  • Goal: stop alcohol use in order to prevent further worsening of current alcohol-related physical or emotional problems.

  • Goal: stop alcohol use because tolerance to alcohol is developing.

  • Goal: stop alcohol use because alcohol withdrawal symptoms are developing.


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Diagnostic Features

Alcohol Use Disorder is a condition characterized by the harmful consequences of repeated alcohol use, a pattern of compulsive alcohol use, and (sometimes) physiological dependence on alcohol (i.e., tolerance and/or symptoms of withdrawal).

This disorder is only diagnosed when these behaviors become persistent and very disabling or distressing. There is often craving for alcohol that makes it difficult to think of anything else until drinking resumes.

Alcohol Intoxication causes significant psychological and social impairment (e.g., inappropriate sexual or aggressive behavior, mood lability, impaired judgment, impaired social or occupational functioning).

This intoxication has one or more of the following physical signs: slurred speech, incoordination, unsteady gait, nystagmus, impairment in attention or memory, stupor or coma.

Alcohol Intoxication is similar to Benzodiazepine or Barbiturate Intoxication.

Alcohol Makes Anxiety Better, Then Worse:

Many alcoholics state that they started drinking "to calm their nerves" and this led to their addiction as their anxiety got worse. This is actually a misinterpretation of what actually happened.

Alcohol initially reduces anxiety; only to increase it a few hours later. In the first hour or two after drinking, alcohol has a sedative, antianxiety effect. Thereafter, alcohol actually increases anxiety, and this prompts the individual to ingest more alcohol.

Thus the more the individual drinks alcohol to "decrease anxiety"; the more alcohol causes increased anxiety. This is why alcohol is a bad treatment for insomnia since it only sedates the person for a few hours; then alcohol increases anxiety and arousal, which wakes the person up. The longer the individual can stay "dry" off alcohol; the less problem they will have with anxiety and insomnia.

Alcohol Withdrawal only occurs after the cessation of (or reduction in) heavy and prolonged alcohol use. This withdrawal syndrome includes two or more of the following: autonomic hyperactivity (e.g., sweating or pulse rate greater than 100); increased hand tremor; insomnia; psychomotor agitation; anxiety; nausea or vomiting; and, rarely, grand mal seizures or transient visual, tactile, or auditory hallucinations or illusions.

This withdrawal syndrome can be relieved by administering alcohol or any other brain depressant. These withdrawal symptoms usually begin within 4-12 hours of abstinence, and peak on the second day of abstinence. The Alcohol Withdrawal improves markedly by the 4th or 5th day of abstinence; however, symptoms of anxiety, insomnia, and autonomic dysfunction may persist for up to 3-6 months at lower levels of intensity.

Complications

School and job performance may suffer either from hangovers or from actual intoxication on the job or at school; child care or household responsibilities may be neglected; and alcohol-related absences may occur from school or job.

The individual may use alcohol in physically hazardous circumstances (e.g., drunk driving or operating machinery while intoxicated). Legal difficulties may arise because of alcohol use (e.g., arrests for intoxicated behavior or for drunk driving).

Individuals with this disorder may continue to abuse alcohol despite the knowledge that continued drinking poses significant social or interpersonal problems for them (e.g., violent arguments with spouse while intoxicated, child abuse). Alcohol intoxication causes significant intellectual impairment (and stupid behavior).

Once a pattern of compulsive use develops, individuals with this disorder may devote substantial periods of time to obtaining and consuming alcoholic beverages. These individuals continue to use alcohol despite evidence of adverse psychological or physical consequences (e.g., depression, blackouts, liver disease, or other complications).

Individuals with this disorder are at increased risk for accidents, violence, and suicide. It is estimated that 1 in 5 intensive care unit admissions in some urban hospitals is related to alcohol and that 40% of people in U.S.A. experience an alcohol-related accident at some time in their lives, with alcohol accounting for up to 55% of fatal driving events.

More than one-half of all murderers and their victims are believed to have been intoxicated with alcohol at the time of the murder.

Severe alcohol intoxication also contributes to disinhibition and feelings of sadness and irritability, which contribute to suicide attempts and completed suicides.

Comorbidity

Individuals with Alcohol Use Disorder are at increased risk for Major Depressive Disorder, other Substance Use Disorders (e.g., drug addiction), Conduct Disorder in adolescents, Antisocial and Borderline Personality Disorders, Schizophrenia, and Bipolar Disorder.

Associated Laboratory Findings

Evidence of alcohol use can be obtained by smelling alcohol on the individual's breath, or having the individual undertake breath, blood, or urine toxicology tests.

The most direct test available to measure alcohol consumption is blood alcohol concentration, which can also be used to judge tolerance to alcohol.

An individual with a concentration of 100 mg of ethanol per deciliter of blood who does not show signs of intoxication can be presumed to have acquired tolerance to alcohol. At 200 mg/dL, most non-alcoholic individuals would demonstrate severe intoxication.

An elevation (> 30 units) of gamma-glutamyltransferase (GGT) is a sensitive laboratory test for heavy drinking. At least 70% of individuals with a high GGT level are persistent heavy drinkers (i.e., consuming 8 or more drinks daily on a regular basis).

Another sensitive test for heavy drinking is an elevation (> 20 units) in carbohydrate deficient transferrin (CDT).

Both GGT and CDT levels return toward normal within days to weeks of stopping drinking, thus are useful tests to monitor abstinence. The combination of GGT and CDT may have even higher levels of sensitivity and specificity in diagnosing heavy drinking than either test used alone.

Another useful laboratory test for heavy drinking is an elevated mean corpuscular volume (MCV). However, the MCV is a poor method of monitoring abstinence because it takes weeks to return to normal after the individual stops drinking.

Liver function tests (e.g., alanine aminotransferase [ALT] and alkaline phosphatase) can reveal liver injury that is caused by heavy drinking. High fat content in the blood also contributes to the development of fatty liver.

Prevalence

Alcohol use is highly prevalent in most Western countries. However, in most Asian cultures, the overall prevalence of alcohol-related disorders is low. In Muslim countries, the Islamic religion strictly prohibits alcohol (hence the prevalence of alcohol-related disorders is very low).

In America, the male:female ratio is 2.5:1 and the lifetime risk of Alcohol Use Disorder is approximately 15% in the general population. The 12-month prevalence of Alcohol Use Disorder in America is 4.6% among 12- to 17-year-olds and 8.5% among adults age 18 years and older.

The 12-month prevalence rate is highest among individuals 18- to 29-years-old (16.%) and lowest among individuals aged 65 years and older (1.5%). In America for adults, the prevalence rates are greater among Native Americans and Alaska Natives (12.1%) than among whites (8.9%), Hispanics (7.9%), African Americans (6.9%), and Asian American and Pacific Islanders (4.5%).

Course

Alcohol Use Disorder has a variable course that is frequently characterized by periods of remission and relapse. The first episode of alcohol intoxication is likely to occur in the mid-teens, with the age at onset of Alcohol Use Disorder peaking in the 18- to 29-years-olds. The large majority of those who develop Alcohol Use Disorder do so by their late 30s.

Outcome

Follow-up studies of the typical person with an Alcohol Use Disorder show a higher than 65% 1-year abstinence rate following treatment.

Even among less functional and homeless individuals with Alcohol Use Disorder who complete a treatment program, as many as 60% are abstinent at 3 months, and 45% at 1 year. Some individuals (perhaps 20% or more) with Alcohol Use Disorder achieve long-term sobriety even without treatment.

Comparative Lethality

Chronic users of cigarettes lose 13% of their expected lifespan, chronic users of alcohol lose 29%, chronic users of cocaine lose 44%, chronic users of methadone lose 49%, chronic users of heroin lose 52%, and chronic users of methamphetamine lose 53% of their expected lifespan.

Medical Complications

Only 5% of individuals with Alcohol Use Disorder ever experience severe complications of withdrawal (e.g., delirium, grand mal seizures).

However, repeated intake of high doses of alcohol can affect nearly every organ system, especially the gastrointestinal tract, cardiovascular system, and the central and peripheral nervous system. Gastrointestinal effects include gastritis, stomach or duodenal ulcers, and, in about 15% of those who use alcohol heavily, liver cirrhosis and pancreatitis.

There is also an increased rate of cancer of the esophagus, stomach, and other parts of the gastrointestinal tract. One of the most common associated general medical conditions is low-grade hypertension. There is an elevated risk of heart disease.

Peripheral neuropathy may be evidenced by muscular weakness, paresthesias, and decreased peripheral sensation. Most persistent central nervous system effects include cognitive deficits, severe memory impairment, and degenerative changes in the cerebellum (leading to poor balance and coordination).

One devastating central nervous system effect is the relatively rare alcohol-induced persisting amnestic disorder (Wernicke-Korsakoff syndrome) in which there is a dramatic impairment in short-term memory.

Men may develop erectile dysfunction and decreased testosterone levels.

Repeated heavy drinking in women is associated with menstrual irregularities and, during pregnancy, with spontaneous abortion and fetal alcohol syndrome (leading to mentally retarded, hyperactive children).

Alcohol Use Disorder can suppress immune mechanisms and predispose individuals to infections (e.g., pneumonia) and increase the risk for cancer.

Patients frequently have very poor insight into their addiction (i.e., denial).

Familial Pattern

Alcohol Use Disorder often has a familial pattern, and it is estimated that 40%-60% of the variance of risk is explained by genetic influences.

The risk for alcohol use disorder is 3 to 4 times higher in close relatives of people with alcohol use disorder. Most studies have found a significantly higher risk for alcohol use disorder in the monozygotic twin than in the dizygotic twin of a person with alcohol use disorder.

Adoption studies have revealed a 3- to 4-fold increase in risk for alcohol use disorder in the children of individuals with alcohol use disorder when these children were adopted away at birth and raised by adoptive parents who did not have this disorder.

Effective Therapies

Alcoholism is usually a chronic, episodic disorder associated with periods of sobriety punctuated by episodes of drinking. Therapy aims at preventing or shortening these relapses.

The "Helping Patients Who Drink Too Much: A Clinician's Guide" is an excellent treatment resource for clinicians. The "Rethinking Drinking Booklet" is an excellent educational resource for the public.

Warning: Individuals with Alcohol Use Disorder usually "forget" to take their anti-alcohol medications. Thus earlier research showed these medications weren't that effective.

Later research has shown that compliance - hence effectiveness - is significantly improved when another person daily supervises the patient's pill swallowing. The month-long injection of naltrexone dramatically increases its effectiveness.



Only 3 medications have been proven successful in relapse prevention. Each of these medications functions very differently.

Naltrexone blocks the pleasurable effect of alcohol, thus prevents the return to heavy drinking if there is an alcoholic relapse. It can be given in daily oral form, or as a month-long injection.

Acamprosate decreases the alcohol withdrawal craving, anxiety and insomnia that persists for months after termination of drinking. Thus acamprosate decreases the number of alcoholic relapses.

Disulfiram, when taken with alcohol, causes a person to turn red and vomit. Thus disulfiram can be taken to prevent drinking, or to prove that a person isn't drinking.

Antianxiety medication should only be used during medically supervised initial detoxification.

Addiction counselling and regular attendance at Alcoholics Anonymous (self-help group) meetings significantly improves treatment outcome.

Although residential rehabilitation programs are the most expensive of all treatments for Alcohol Use Disorder; there are no randomized controlled clinical trials that have yet proven the superiority of residential treatment over non-residential, outpatient treatment.







Top 20 Most Harmful Drugs In Britain In 2008

Professor David Nutt published in the Lancet the following rating of Britain's most dangerous drugs. They are listed in descending order from the most harmful.

1. Heroin

Class A drug. Originally used as a painkiller and derived from the opium poppy. There were 897 deaths recorded from heroin and morphine use in 2008 in England and Wales, according to the Office of National Statistics (ONS). There were around 13,000 seizures, amounting to 1.6m tonnes of heroin.

2. Cocaine

Class A. Stimulant produced from the South American coca leaf. Accounted for 235 deaths -- a sharp rise on the previous year's fatalities. Nearly 25,000 seizures were made, amounting to 2.9 tonnes of the drug.

3. Barbiturates

Class B. Synthetic sedatives used for anaesthetic purposes. Blamed for 13 deaths.

4. Street methadone

Class A. A synthetic opioid, commonly used as a substitute for treating heroin patients. Accounted for 378 deaths and there were more than 1,000 seizures of the drug.

5. Alcohol

Subject to increasing concern from the medical profession about its damage to health. According to the ONS, there were 8,724 alcohol deaths in the UK in 2007. Other sources claim the true figure is far higher.

6. Ketamine

Class C. A hallucinogenic dance drug for clubbers. There were 23 ketamine-related deaths in the UK between 1993 and 2006. Last year there were 1,266 seizures.

7. Benzodiazepines

Class C. A hypnotic relaxant used to treat anxiety and insomnia. Includes drugs such as diazepam, temazepam and nitrazepam. Caused 230 deaths and 1.8m doses were confiscated in more than 4,000 seizure operations.

8. Amphetamine

Class B. A psychostimulant that combats fatigue and suppresses hunger. Associated with 99 deaths, although this tally includes some ecstasy deaths. Nearly 8,000 seizures, adding up to almost three tonnes of confiscated amphetamines.

9. Tobacco

A stimulant that is highly addictive due to its nicotine content. More than 100,000 people a year die from smoking and tobacco-related diseases, including cancer, respiratory diseases and heart disease.

10. Buprenorphine

An opiate used for pain control, and sometimes as a substitute to wean addicts off heroin. Said to have caused 43 deaths in the UK between 1980 and 2002.

11. Cannabis

Class B. A psychoactive drug recently appearing in stronger forms such as "skunk". [Since this video was made; there is now conclusive proof that cannabis causes a 6.7 fold increase in the risk of developing schizophrenia.] Caused 19 deaths and there were 186,000 seizures, netting 65 tonnes of the drug and 640,000 cannabis plants.

12. Solvents

Fumes inhaled to produce a sense of intoxication. Usually abused by teenagers. Derived from commonly available products such as glue and aerosol sprays. Causes around 50 deaths a year.

13. 4-MTA

Class A. Originally designed for laboratory research. Releases serotonin in the body. Only four deaths reported in the UK between 1997 and 2004.

14. LSD

Class A. Hallucinogenic drug originally synthesised by a German chemist in 1938. Very few deaths recorded.

15. Methylphenidate

Class B drug. Brand name of Ritalin. A psychostimulant sometimes used in the treatment of attention deficit disorders.

16. Anabolic steroids

Class C. Used to develop muscles, notably in competitive sports. Also alleged to induce aggression. Have been blamed for causing deaths among bodybuilders. More than 800 seizures.

17. GHB

Class C drug. A clear liquid dance drug said to induce euphoria, also described as a date rape drug. Can trigger comas and suppress breathing. Caused 20 deaths and 47 seizures were recorded.

18. Ecstasy

Class A. Psychoactive dance drug. Caused 44 deaths, with around 5,000 seizures made.

19. Alykl nitrites

Known as "poppers". Inhaled for their role as a muscle relaxant and supposed sexual stimulant. Reduce blood pressure, which can cause fainting and in some cases death.

20. Khat

A psychoactive plant, the leaves of which are chewed in east Africa and Yemen. Also known as qat. Produces mild psychological dependence. Its derivatives, cathinone and cathine, are Class C drugs in the UK.

Ineffective therapies

Vitamins and dietary supplements are ineffective for preventing alcohol abuse.

Should Illicit Drugs Be Legalized?

The leading causes of death in USA in 2000 were tobacco (435 000 deaths; 18.1% of total US deaths), poor diet and physical inactivity (365 000 deaths; 15.2%), and alcohol consumption (85 000 deaths; 3.5%).

Some people argue that illicit drugs should be legalized to decrease the crime associated with these drugs. Historically, tobacco and alcohol were once illegal drugs. Tobacco smoking is now the leading cause of death in America, and alcoholism is the third leading cause of death.

Thus legalizing illicit drugs does not make them any less medically and socially harmful. In fact the opposite is true; legalizing illicit drugs increases their use and the harm they cause. The Government of Finland is passing legislation that will gradually ban all tobacco use by 2040.

Trustworthy Research (PubMed.gov)



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Experiment showing effects of alcohol drinking (to test poor reliability of breathalyzer)



Fetal Alcohol Spectrum Disorder







Scotland Has Reduced Alcoholism By Increasing The Cost Of Alcohol



Moderate drinking was supposedly good for you — until researchers added in the influence of wealth




Stories

Rating Scales

Alcoholics Anonymous

Stages of Learned Behavior

Our survival involves learning what to avoid (i.e., fear) and what to approach (i.e., crave). Both fear and craving are essential for our survival, but both can spiral out of control.

For example, an individual can develop a phobia about snakes in which the fear becomes excessive. This phobia can develop into an obsession in which the individual spends much of the time thinking about snakes, and how to avoid them.

This obsession can develop into a compulsion in which the individual spends much of the time doing superstitious, compulsive, ritual behaviors aimed at avoiding snakes.

Likewise, an individual can develop an excessive craving for alcohol which causes significant distress or disability.

This excessive craving for alcohol can develop into an obsession in which the individual spends much of the time thinking about alcohol, and how to get it.

This obsession can develop into a compulsion in which the individual spends much of the time compulsively drinking, and feeling powerless to resist this craving.

Four Stages of Fear and Craving

4 STAGES OF FEAR 4 STAGES OF CRAVING
Normal Fear:
Is in proportion to the actual danger, and doesn't cause significant distress or disability. 		Normal Craving:
Doesn't cause significant distress or disability.
Excessive Fear (Phobia):
Is out of proportion to the actual danger posed, and causes significant distress or disability. 		Excessive Craving:
Is not socially acceptable, and causes significant distress or disability (e.g., "I'm using [alcohol] too much").
Obsessional Fear:
Persistent, unwanted or obsessional thoughts about the fear develop, which cause significant distress or disability. 		Obsessional Craving:
Persistent, unwanted or obsessional thoughts about the craving develop, which cause significant distress or disability (e.g., "I spend much of my time thinking about [alcohol], and how to get it").
Compulsive Fear:
Compulsive behaviors develop (aimed at reducing the anxiety associated with the obsession), which the individual finds very hard to resist doing. 		Compulsive Craving:
Compulsive behaviors develop (aimed at satisfying the craving), which the individual finds very hard to resist doing (e.g., "I can't stop myself from using [alcohol]").

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Dependence Syndrome Due To Alcohol F10.2 - ICD10 Description, World Health Organization
Repeated alcohol use that typically includes a strong desire to take alcohol, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to alcohol use than to other activities and obligations, increased tolerance, and a physical withdrawal state.


Alcohol Use Disorder - Diagnostic Criteria, American Psychiatric Association

An individual diagnosed with Alcohol Use Disorder needs to meet all of the following criteria:

  • A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

    • Alcohol is often taken in larger amounts or over a longer period than was intended.

    • There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.

    • A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.

    • Craving, or a strong desire or urge to use alcohol.

    • Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.

    • Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.

    • Important social, occupational, or recreational activities are given up or reduced because of alcohol use.

    • Recurrent alcohol use in situations in which it is physically hazardous.

    • Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.

    • Tolerance, as defined by either of the following:

      • A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.

      • A markedly diminished effect with continued use of the same amount of alcohol.

    • Withdrawal, as manifested by either of the following:

      • The characteristic withdrawal syndrome for alcohol:

        • Cessation of (or reduction in) alcohol use that has been heavy and prolonged.

        • Two (or more) of the following, developing within several hours to a few days after the cessation of (or reduction in) alcohol use:

          • Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm).

          • Increased hand tremor.

          • Insomnia.

          • Nausea or vomiting.

          • Transient visual, tactile, or auditory hallucinations or illusions.

          • Psychomotor agitation.

          • Anxiety.

          • Generalized tonic-clonic seizures.

      • Alcohol (or closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

    • Specify if:

      • In early remission: After full criteria for Alcohol Use Disorder were previously met, none of the criteria for Alcohol Use Disorder have been met for at least 3 months but for less than 12 months (with the exception that the criterion, "Craving, or a strong desire or urge to use alcohol," may be met).

      • In sustained remission: After full criteria for Alcohol Use Disorder were previously met, none of the criteria for Alcohol Use Disorder have been met at any time during a period of 12 months or longer (with the exception that the criterion, "Craving, or a strong desire or urge to use alcohol," may be met).

    • Specify if:

      • In a controlled environment: This additional specifier is used if the individual is in an environment where access to alcohol is restricted.


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World Health Organization Alcohol Use Disorder Treatment Guidelines

Drug Therapy For Alcoholism Doesn't Cure Alcoholism, But Often It Is The Only Thing That Stops Drinking

Alcoholism is usually a chronic, episodic disorder associated with periods of sobriety punctuated by episodes of drinking. Drug therapy aims at preventing or shortening these relapses. In this regard, drug therapy for alcoholism can be very successful.

However, there is a serious limitation to drug therapy for alcoholism. Usually another person must daily supervise the taking of these medications. Warning: Missing two consecutive days of these medications often results in a drinking relapse.

Secret drinking can be accurately detected with alcohol breathalyzers.

The most recent treatment guidelines released by the American Psychiatric Association state:

  • Naltrexone and acamprosate have the best available evidence related to their benefits, and both have minimal side effects. As such, they should be considered the preferred pharmacological options for patients with moderate to severe Alcohol Use Disorder who want to reduce drinking or achieve abstinence.

    • Naltrexone is an opioid blocker which also blocks the pleasurable effect of alcohol, thus decreases the urge to drink. It can be given in daily oral form or as a month-long injection. Naltrexone can be safely used in pregnancy. Naltrexone reduces relapse rates after abstinence and also helps reduce heavy drinking in people who continue drinking during treatment.

      Naltrexone should be avoided in patients with acute hepatitis or liver failure, or in patients currently taking opioids or who may be expected to take opioids. In patients with co-occurring opioid use disorder, naltrexone be prescribed to individuals who:

      • wish to abstain from opioid use and either abstain from or reduce alcohol use and

      • are able to abstain from opioid use for a clinically appropriate time prior to naltrexone initiation.

    • Acamprosate decreases alcohol craving, anxiety and insomnia. It should be avoided in patients with significant renal impairment. For individuals with mild to moderate renal impairment, acamprosate should not be used as a first-line treatment and, if used, the dose of acamprosate be reduced compared with recommended doses in individuals with normal renal function.

  • Disulfiram, gabapentin and topiramate are also options for treatment of Alcohol Use Disorder but should typically be considered after trying naltrexone and acamprosate, unless the patient has a strong preference for one of these medications.

    • Disulfiram when taken within 12-24 hours of consumption of alcohol causes a person to get sick (elevated heart rate, flushed skin, headache, nausea, and vomiting). Thus disulfiram can be used as "aversive conditioning" in which alcoholic patients avoid alcohol in order to avoid having a sickening disulfiram-alcohol interaction.

      Disulfiram can be used to prove to alcoholic patients that they can't stop drinking. Alcoholic patients are told that they will get sick if they drink alcohol while taking disulfiram. Then, after they have been alcohol-free for 48 hours, they are started on disulfiram. Soon thereafter, alcoholic patients find that they can't stop drinking; hence get sick with the alcohol-disulfiram reaction (despite the doctor's warning). At this point, many patients realize that they are truly addicted to alcohol and can't stop drinking (without help).

      Disulfiram is suggested only to patients who wish to achieve abstinence from drinking. Disulfiram can not be used in pregnancy.

      Unfortunately, after years of use of disulfiram, some people develop a peripheral neuropathy (e.g., foot drop) which would necessitate disulfiram's termination.

    • Patients taking topiramate are at an increased risk of cognitive dysfunction, dizziness, and loss of appetite.

    • Patients taking gabapentin may experience fatigue, insomnia, and headache.

  • Antidepressant medications should not be used for treatment of Alcohol Use Disorder unless there is evidence of a co-occurring disorder for which an antidepressant is an indicated treatment.

  • Benzodiazepines should not be used unless treating acute alcohol withdrawal or unless a co-occurring disorder exists for which a benzodiazepine is an indicated treatment.

  • For pregnant or breastfeeding women with Alcohol Use Disorder, pharmacological treatments should not be used unless treating acute alcohol withdrawal with benzodiazepines or unless a co-occurring disorder exists that warrants pharmacological treatment.

  • Addiction counselling and regular attendance at Alcoholics Anonymous (or other 12-step self-help group) significantly improves treatment outcome.

  • Although residential rehabilitation programs are the most expensive of all treatments for Alcohol Use Disorder; there are no randomized controlled clinical trials that have yet proven the superiority of residential treatment over non-residential, outpatient treatment.





APA Releases New Practice Guideline on Alcohol Use Disorder Pharmacotherapy (2018)

New APA Practice Guideline on Alcohol Use Disorder Pharmacotherapy (2018)

  • Alcohol Use Disorder Treatment Guidelines
  • Determining the relative importance of the mechanisms of behavior change within Alcoholics Anonymous: a multiple mediator analysis. (2012) Among out-patients the effect of AA attendance on alcohol outcomes was explained primarily by adaptive social network changes and increases in social abstinence self-efficacy. Among more impaired aftercare patients, in addition to mediation through adaptive network changes and increases in social self-efficacy, AA lead to better outcomes through ncreasing spirituality/religiosity and by reducing negative emotion. The degree to which mediators explained the relationship between AA and outcomes ranged from 43% to 67%.
  • Does sponsorship improve outcomes above Alcoholics Anonymous attendance? A latent class growth curve analysis. (2012) Any pattern of Alcoholics Anonymous attendance, even if it declines or is never high for a particular 12-month period, is better than little or no attendance in terms of abstinence. Greater initial attendance carries added value. There is a benefit for maintaining a sponsor over time above that found for attendance.
  • Do women differ from men on Alcoholics Anonymous participation and abstinence? A multi-wave analysis of treatment seekers. (2012) Women and men attended AA at similar rates and similarly practiced specific AA behaviors, and they were alike on most factors associated with AA participation and abstention across time including abstinence goal, drink volume, negative consequences, prior treatment, and encouragement to reduce drinking. Relative to men, women with higher drug severity were less likely to participate in AA. Although higher AA participation was a predictor of abstinence for both genders, men were less likely to be abstinent across time. Men were also more likely to reduce their AA participation across time.
  • Predictors of membership in Alcoholics Anonymous in a sample of Successfully remitted alcoholics. (2011) This study identifies factors associated with Alcoholics Anonymous (AA) membership in a sample of 81 persons who have achieved at least one year of total abstinence from alcohol and other drugs. Forty-four were AA members, 37 were not. Having more positive views of God and more negative consequences of drinking were significantly associated with AA membership. This information can be used by clinicians to identify clients for whom AA might be a good fit, and can help others overcome obstacles to AA or explore alternative forms of abstinence support.
  • Driving while intoxicated among individuals initially untreated for Alcohol Use Disorders: one- and sixteen-year follow-ups. (2011) More extended participation in outpatient treatment and Alcoholics Anonymous (AA) during Year 1 was associated with a lower likelihood of DWI at the 1-year follow-up. More extended participation in AA through Year 3 was associated with a lower likelihood of DWI at the 16-year follow-up. Improvement on personal functioning and life context indices was associated with reduced risk of subsequent occurrences of DWI.
  • How safe are adolescents at Alcoholics Anonymous and Narcotics Anonymous meetings? A prospective investigation with outpatient youth. (2011) Overall, youth reported feeling very safe at meetings, and ratings did not differ by age or gender. Reasons for discontinuation or nonattendance were unrelated to safety or negative incidents.
  • Meta-analysis of pharmacological therapy with acamprosate, naltrexone, and disulfiram--a systematic review. (2011) The meta-analysis is based on 16 randomized controlled trials of acamprosate, 18 of naltrexone and 7 of disulfiram. Acamprosate and naltrexone were 52% (RR = 1.52; 95% confidence interval (CI): 1.35-1,72) and 27% (RR = 1.27; 95% CI: 1,06-1,52) better than placebo when it came to supporting continuous abstinence. Acamprosate increased the total number of abstinence days by 14% (MD = 14.02; 95% CI: 9.57-18.47). Disulfiram appeared to be effective only when the intake was supervised. Based on the amount of scientific evidence, acamprosate and naltrexone therapy should be increased in clinical practice in the treatment of alcoholism.
  • Mindfulness based interventions for addictive disorders: a review. (2011) Results of six clinical trials evaluating four different programs were found. Five studies were controlled and four were randomized. Drop-out rates were relatively high (from 28 to 55%). In five cases out of six, the program significantly reduced substance use. In four comparative trials out of five, interventions based on mindfulness proved more effective than control conditions.
  • A literature review of cost-benefit analyses for the treatment of Alcohol Use Disorder. (2011) In the psychotherapy studies, major benefits are typically seen within the first six months of treatment. The benefit-cost ratio ranged from 1.89 to 39.0. Treatment with acamprosate was found to accrue a net benefit of 21,301 BEF (528 euros) per patient over a 24-month period in Belgium and lifetime benefit for each patient in Spain was estimated to be Pta. 3,914,680 (23,528 euros). To date, only a few studies exist that have examined the cost-benefit of psychotherapy or pharmacotherapy treatment of AD. Most of the available treatment options for AD appear to produce marked economic benefits.
  • Brief interventions for heavy alcohol users admitted to general hospital wards. (2011) Objective: To determine whether brief interventions reduce alcohol consumption and improve outcomes for heavy alcohol users admitted to general hospital inpatient units. Our results demonstrate that patients receiving brief interventions have a greater reduction in alcohol consumption compared to those in control groups at six month, MD -69.43 (95% CI -128.14 to -10.72) and nine months follow up, MD -182.88 (95% CI -360.00 to -5.76) but this is not maintained at one year. In addition there were significantly fewer deaths in the groups receiving brief interventions than in control groups at 6 months, RR 0.42 (95% CI 0.19 to 0.94) and one year follow up, RR 0.60 (95% CI 0.40 to 0.91). Furthermore screening, asking participants about their drinking patterns, may also have a positive impact on alcohol consumption levels and changes in drinking behavior.
  • How cognitive assessment through clinical neurophysiology may help optimize chronic alcoholism treatment. (2011) Although psychosocial treatments (e.g. individual or group therapy) have historically been the mainstay of alcoholism treatment, a successful approach for alcohol dependence consists in associating pharmacologic medications with therapy, as 40-70% of patients following only psychosocial therapy typically resume alcohol use within a year of post-detoxification treatment. Nowadays, two main pharmacological options, naltrexone and acomprosate, both approved by the US Food and Drug Administration, are available and seemingly improve on the results yielded by standard techniques employed in the management of alcoholism. However, insufficient data exist to confirm the superiority of one drug over the other.
  • The efficacy of disulfiram for the treatment of Alcohol Use Disorder. (2011) Supervised treatment with disulfiram has some effect on short-term abstinence and days until relapse as well as number of drinking days when compared with placebo, none, or other treatments for patients with alcohol dependency or abuse. Long-term effect on abstinence has not been evaluated yet. However, there is a need for more homogeneous and high-quality studies in the future regarding the efficacy of disulfiram.
  • A systematic review and meta-analysis of health care utilization outcomes in alcohol screening and brief intervention trials. (2011) Systematic review results suggest that alcohol screening and brief intervention has little to no effect on inpatient or outpatient health care utilization, but it may have a small, negative effect on ED utilization.
  • Medical treatment of alcohol dependence: a systematic review. (2011) The evidence base for oral naltrexone (6% more days abstinent than placebo in the largest study) and topiramate (prescribed off-label) (e.g., 26.2% more days abstinent than placebo in a recent study) is positive but modest. Acamprosate shows modest efficacy with recently abstinent patients, with European studies showing better results than U.S. ones. The evidence-base for disulfiram is equivocal. Depot naltrexone shows efficacy (25% greater reduction in rate of heavy drinking vs. placebo, in one of the largest studies) in a limited number of studies. Some studies suggest that patients do better with extensive psychosocial treatments added to medications while others show that brief support can be equally effective.
  • Does Teen Drug Rehab Cure Addiction or Create It? (2010)
  • Following problem drinkers over eleven years: understanding changes in alcohol consumption. (2010) Results suggest that problem and dependent drinkers continue to drink at an elevated level over the course of years. Gatekeepers, family members, and policymakers should encourage and facilitate contact with social service agencies and with AA for problem drinkers. Suggestions from others to do something about one's drinking and seeking specialty care occur more often in those with more severe problems and do not appear to be linked to less drinking over time.
  • Negative emotion, relapse, and Alcoholics Anonymous (AA): does AA work by reducing anger? (2010) Findings revealed substantially elevated levels of anger in those attending AA compared with the general population (98th percentile) that decreased over 15-month follow-up but remained high (89th percentile). AA attendance was associated with better drinking outcomes, and higher levels of anger were associated with heavier drinking. However, AA attendance was unrelated to changes in anger.
  • Mechanisms of behavior change in alcoholics anonymous: does Alcoholics Anonymous lead to better alcohol use outcomes by reducing depression symptoms? (2010) AA attendance was associated both concurrently and predictively with improved alcohol outcomes. Although AA attendance was associated additionally with subsequent improvements in depression, it did not predict such improvements over and above concurrent alcohol use. AA appears to lead both to improvements in alcohol use and psychological and emotional wellbeing which, in turn, may reinforce further abstinence and recovery-related change.
  • Opioid antagonists for alcohol dependence. (2010) Naltrexone reduced the risk of heavy drinking to 83% of the risk in the placebo group RR 0.83 (95% CI 0.76 to 0.90) and decreased drinking days by about 4%, MD -3.89 (95% CI -5.75 to -2.04). Naltrexone appears to be an effective and safe strategy in alcoholism treatment; even though the sizes of treatment effects might appear moderate in their magnitudes.
  • A comprehensive review: methodological rigor of studies on residential treatment centers for substance-abusing adolescents. (2009) Out of the four most rigorous studies reviewed, two found significant differences in substance use reduction between the treatment and comparison groups. Of the remaining studies, despite having strong selectivity bias, only one found significant differences between treatment and comparison groups, and it was for females only at the one-year follow-up.
  • Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol. (2009) Systematic reviews and meta-analyses show that policies regulating the environment in which alcohol is marketed (particularly its price and availability) are effective in reducing alcohol-related harm. Enforced legislative measures to reduce drink-driving and individually directed interventions to already at-risk drinkers are also effective. However, school-based education does not reduce alcohol-related harm, although public information and education-type programmes have a role in providing information and in increasing attention and acceptance of alcohol on political and public agendas. Making alcohol more expensive and less available, and banning alcohol advertising, are highly cost-effective strategies to reduce harm.
  • Acupuncture for alcohol dependence: a systematic review. (2009) The poor methodological quality and the limited number of the trials do not allow any conclusion about the efficacy of acupuncture for treatment of alcohol dependence.
  • Epidemiology of alcoholics anonymous participation. (2008) Fully one-half of those completing AA's most recent membership survey reported that they had been abstinent for more than 5 years. Disengagement from AA does not appear to necessarily translate to loss of abstinence among those with initial high levels of AA exposure, but long-term abstinence is more likely among those with continued engagement.
  • The Surgeon General's Call to Action To Prevent and Reduce Underage Drinking (2007)

Treatment Evaluation

Crime




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Alcohol Abuse Treatment and Self-Help


Self-Help Groups for Alcohol Addiction

Monitoring Your Progress

NOTE: When each of the following presentations finish; you must exit by manually closing its window in order to return to this webpage.

The Healthy Social Behavior Scale lists social behaviors that research has found to be associated with healthy social relationships. You can keep score (totaling its 4-point scale answers) on a separate piece of paper to monitor your progress.



The Mental Health Scale lists behaviors and symptoms that research has found to be associated with mental health (or disorder). You can keep score (totaling its 4-point scale answers) on a separate piece of paper to monitor your progress.



The Life Satisfaction Scale lists the survey questions often used to measure overall satisfaction with life. You can keep score (totaling its 4-point scale answers) on a separate piece of paper to monitor your progress.



Life Satisfaction Scale (5-Minute Video)

The "Big 6" Dimensions of Mental Health

Research has shown that there are 5 major dimensions (the "Big 5 Factors" or Five-Factor Model) of personality disorders and other mental disorders.

This website uses these 5 major dimensions of human behavior (i.e., Agreeableness, Conscientiousness, Openness/Intellect, Extraversion/Sociability, and Emotional Stability) to describe all mental disorders. This website adds one more dimension, "Physical Health", to create the "Big 6" dimensions of mental health.

The behaviors of the "Five Factor Model of Personality" represent five adaptive functions that are vital to human survival. For example, when one individual approaches another, the individual must: (1) decide whether the other individual is friend or foe [ "Agreeableness" ], (2) decide if this represents safety or danger [ "Emotional Stability" ], (3) decide whether to approach or avoid the other individual [ "Extraversion/Sociability" ], (4) decide whether to proceed in a cautious or impulsive manner [ "Conscientiousness" ], and (5) learn from this experience [ "Openness/Intellect" ].



Desiderata (5-Minute Video)



The following "Morning Meditation" allows you to plan your day using these "Big 6" dimensions of mental health.



The following "Evening Meditation" allows you to review your progress on these "Big 6" dimensions of mental health.




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    "In physical science a first essential step in the direction of learning any subject is to find principles of numerical reckoning and practicable methods for measuring some quality connected with it. I often say that when you can measure what you are speaking about and express it in numbers you know something about it; but when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meagre and unsatisfactory kind: it may be the beginning of knowledge, but you have scarcely, in your thoughts, advanced to the stage of science, whatever the matter may be."

    Lord Kelvin (1824 – 1907)

  • The best summary on bad research is given by Laura Arnold in this TEDx lecture. If you read nothing else about research, you owe it to yourself to watch this short video - it is excellent!

  • Economist in grim battle against deceptive scholarship

  • List of Predatory Journals and Publishers

  • The power of asking "what if?"

  • The active placebo effect: 2300 years ago, the Greek Stoic philosophers taught that it is not the objective event, but our subjective judgment about the event, that determines our behavior. The active placebo effect bears witness to this ancient wisdom.

  • Criteria For High Quality Research Studies

    • It is troubling that a recent study found that two-thirds of important psychological research studies couldn't be replicated. High quality research must meet the following criteria:

    • Randomized Controlled Trial:
      Ask: Was the trial randomized? Was the randomization procedure described and was it appropriate? The best research design is to have research subjects randomly assigned to an experimental or control group. It is essential that confounding factors be controlled for by having a control group or comparator condition (no intervention, placebo, care as usual etc.).

    • Representative Sample:
      Ask: Do the research subjects represent a normal cross-section of the population being studied? Many psychological research studies using university students are flawed because their subjects are not representative of the normal population since they are all W.E.I.R.D. (White, Educated, Intelligent, Rich, and living in a Democracy).

    • Single Blind Trial:
      Ask: Was the treatment allocation concealed? It is essential that the research subjects are kept "blind" as to whether they are in the experimental or control group (in order to control for any placebo effects).

    • Double Blind Trial (Better Than Single Blind Trial):
      Ask: Were blind outcome assessments conducted? In a double blind study, neither the research subjects nor the outcome assessors know if the research subject is in the experimental or control group. This controls for both the placebo effect and assessor bias.

    • Baseline Comparability:
      Ask: Were groups similar at baseline on prognostic indicators? The experimental and control groups must be shown to be comparable at the beginning of the study.

    • Confounding Factors:
      Ask: Were there factors, that weren't controlled for, that could have seriously distorted the study's results? For example, research studies on the effectiveness of mindfulness cognitive therapy in preventing depressive relapse forgot to control for whether the research subjects were also simultaneously receiving antidepressant medication or other psychological treatments for depression.

    • Intervention Integrity:
      Ask: Was the research study protocal strictly followed? The research subjects must be shown to be compliant (e.g., taking their pills, attending therapy) and the therapists must be shown to be reliably delivering the intervention (e.g., staying on the research protocol).

    • Statistical analysis:
      Ask: Was a statistical power calculation described? The study should discuss its statistical power analysis; that is whether the study size is large enough to statistically detect a difference between the experimental and control group (should it occur) and usually this requires at least 50 research subjects in the study.

      Ask: Are the results both statistically significant and clinically significant? Many medical research findings are statistically significant (with a p-value <0.05), but they are not clinically significant because the difference between the experimental and control groups is too small to be clinically relevant.

      For example, the effect of a new drug may be found to be 2% better than placebo. Statistically (if the sample size was large enough) this 2% difference could be statistically significant (with a p-value <0.05). However, clinicians would say that this 2% difference is not clinically significant (i.e., that it was too small to really make any difference).

      Statistically, the best way to test for clinical significance is to test for effect size (i.e., the size of the difference between two groups rather than confounding this with statistical probability).

      When the outcome of interest is a dichotomous variable, the commonly used measures of effect size include the odds ratio (OR), the relative risk (RR), and the risk difference (RD).

      When the outcome is a continuous variable, then the effect size is commonly represented as either the mean difference (MD) or the standardised mean difference (SMD) .

      The MD is the difference in the means of the treatment group and the control group, while the SMD is the MD divided by the standard deviation (SD), derived from either or both of the groups. Depending on how this SD is calculated, the SMD has several versions such, as Cohen's d, Glass's Δ, and Hedges' g.

        Clinical Significance: With Standard Mean Difference, the general rule of thumb is that a score of 0 to 0.25 indicates small to no effect, 0.25-0.50 a mild benefit, 0.5-1 a moderate to large benefit, and above 1.0 a huge benefit. It is a convention that a SMD of 0.5 or larger is a standard threshold for clinically meaningful benefit.

      The statistical summary should report what percentage of the total variance of the dependent variable (e.g., outcome) can be explained by the independent variable (e.g., intervention).

      In clinical studies, the study should report the number needed to treat for an additional beneficial outcome (NNTB), and the number needed to treat for an additional harmful outcome (NNTH).

        Number Needed To Benefit (NNTB): This is defined as the number of patients that need to be treated for one of them to benefit compared with a control in a clinical trial. (It is defined as the inverse of the absolute risk reduction.) Note: Statistically, the NNTB depends on which control group is used for comparison - e.g., active treatment vs. placebo treatment, or active treatment vs. no treatment.

        Number Needed To Harm (NNTH): This is defined as the number of patients that need to be treated for one of them to be harmed compared with a control in a clinical trial. (It is defined as the inverse of the absolute increase in risk of harm.)

        Tomlinson found “an NNTB of 5 or less was probably associated with a meaningful health benefit,” while “an NNTB of 15 or more was quite certain to be associated with at most a small net health benefit.”

      Ask: Does the researcher accept full responsibility for the study's statistical analysis? The researcher should not just hand over the study's raw data to a corporation (that may have $1,000 million invested in the study) to do the statistical analysis.

    • Completeness of follow-up data:
      Ask: Was the number of withdrawals or dropouts in each group mentioned, and were reasons given for these withdrawals or dropouts? Less than 20% of the research subjects should drop out of the study. The intervention effect should persist over an adequate length of time.

    • Handling of missing data:
      Ask: Was the statistical analysis conducted on the intention-to-treat sample? There must be use of intention-to-treat analysis (as opposed to a completers-only analysis). In this way, all of the research subjects that started the study are included in the final statistical analysis. A completers-only analysis would disregard those research subjects that dropped out.

    • Replication of Findings:
      Ask: Can other researchers replicate this study's results? The research study's methodology should be clearly described so that the study can be easily replicated. The researcher's raw data should be available to other researchers to review (in order to detect errors or fraud).

    • Fraud:
      Ask: Is there a suspicion of fraud? In a research study, examine the independent and dependent variables that are always measured as a positive whole number (e.g., a variable measured on a 5-point Likert-type scale ranging from "1 = definitely false to 5 = definitely true" etc.). For each of these variables, look at their sample size ( n ), mean ( M ) and standard deviation ( SD ) before they undergo statistical analysis. There is a high suspicion of fraud in a study's statistics:

      • If the M is mathematically impossible (online calculator): This is one of the easiest ways to mathematically detect fraud. The mean ( M ) is defined as "the sum ( Sum ) of the values of each observation divided by the total number ( n ) of observations". So: M = Sum / n . Thus: ( Sum ) = ( M ) multiplied by ( n ). We know that, if a variable is always measured as a positive whole number, the sum of these observations always has to be a whole number. For these variables to test for fraud: calculate ( M ) multiplied by ( n ). This calculates the Sum which MUST be a positive whole number. If the calculated Sum isn't a positive whole number; the reported mean ( M ) is mathematically impossible - thus the researcher either cooked the data or made a mistake. A recent study of 260 research papers published in highly reputable psychological journals found that 1 in 2 of these research papers reported at least one impossible value , and 1 in 5 of these research papers reported multiple impossible values. When the authors of the 21 worst offending research papers were asked for their raw data (so that its reliability could be checked) - 57% angrily refused. Yet such release of raw data to other researchers is required by most scientific journals. (Here is an example of a research paper filled with mathematically impossible means.)

      • If the SD is mathematically impossible (online calculator): When researchers fraudulently "cook" their data, they may accidently give their data a mean and standard deviation that is mathematically impossible.

      • If the SD/M is very small (i.e., the variable's standard deviation is very small compared to the mean suggesting data smoothing).

      • If the SD's are almost identical (i.e., the variables have different means but almost identical standard deviations).

      • If the 4th digit of the values of the variables aren't uniformly distributed - since each should occur 10% of the time (Benford's Law).

      • If the researcher is legally prevented from publishing negative findings about a drug or therapy because that would violate the "nondisclosure of trade secrets" clause in the research contract (i.e., it is a "trade secret" that the drug or therapy is ineffective - hence this can not be "disclosed"). Approximately half of all registered clinical trials fail to publish their results.

      • If the researcher refuses to release his raw data to fellow researchers (so that they can check its validity). In order to be published in most scientific journals, a researcher must promise to share his raw data with fellow researchers. Thus a researcher's refusal to do so is almost a sure indicator of fraud.

      • If the research study's data contradicts the study's own conclusions - surprisingly, this often occurs.

  • Calling Bullshit In The Age of Big Data - "Bullshit is language, statistical figures, data graphics, and other forms of presentation intended to persuade by impressing and overwhelming a reader or listener, with a blatant disregard for truth and logical coherence." Reading the syllabus of this university course should be required reading for every student of mental health. This syllabus is absolutely fantastic!

  • Statistical Methods in Psychology Journals: Guidelines and Explanations - American Psychologist 1999

  • Not All Scientific Studies Are Created Equal - video

  • The efficacy of psychological, educational, and behavioral treatment

  • Estimating the reproducibility of psychological science

  • Psychologists grapple with validity of research

  • Industry sponsorship and research outcome (Review) - Cochrane Library

  • 'We've been deceived': Many clinical trial results are never published - (text and video)

  • Junk science misleading doctors and researchers

  • Junk science under spotlight after controversial firm buys Canadian journals

  • Medicine with a side of mysticism: Top hospitals promote unproven therapies - Are some doctors becoming modern witchdoctors?

  • When Evidence Says No, But Doctors Say Yes


  • Cochrane Reviews (the best evidence-based, standardized reviews available)


Research Topics

Alcohol Use Disorder - Core Clinical Journals

Alcohol User Disorder - All Journals

Alcohol Use Disorder - Review Articles - Core Clinical Journals

Alcohol Use Disorder - Review Articles - All Journals Alcohol Use Disorder - Treatment - Core Clinical Journals

Alcohol Use Disorder - Treatment - All Journals

Warning: There Is No Safe Dose Of Alcohol - The Lancet



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Internet Mental Health © 1995-2019 Phillip W. Long, M.D.