Internet Mental Health


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Internet Mental Health Quality of Life Scale

  • Alcohol use disorder is the continued use of alcohol despite clinically significant distress or impairment.

  • It 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.


    Episodic or continuous for years


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

Critical, Quarrelsome (Antagonism):

  • Intoxicated behavior can be very uncooperative and disagreeable

Impulsive, Disorderly (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

Distressed, Easily Upset (Negative Emotion):

  • Depressed mood, generalized anxiety, anger, suicidal behavior

Enthusiastic, Assertive (High Extraversion) OR Reserved, Quiet (Detachment):

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


  • 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).

Explanation Of Terms And Symbols

Internet Mental Health Quality of Life Scale

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Click Here For Free Diagnosis

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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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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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.


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.

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.


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.


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%).


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.


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.

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.

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Dr. Gardere: Addiction

Dr. Willenbring: Treatment of Alcoholism

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


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

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 drinking 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 drinking").

Which Behavioral Dimensions Are Involved?

Research has shown that there are 5 major dimensions (the "Big 5 Factors") of personality disorders and other mental disorders. There are two free online personality tests that assess your personality in terms of the "Big 5 dimensions of personality.

This website uses these 5 major dimensions of human behavior to describe all mental disorders. (This website adds one more dimension, "Physical Health", but our discussion will focus on the first 5 major dimensions.)

These 5 major dimensions of human behavior seem to represent 5 major dimensions whereby our early ancestors chose their hunting companions or spouse. To maximize their chance for survival, our ancestors wanted companions who were agreeable, conscientious, intelligent, enthusiastic, and calm.

    Which Dimensions of Human Behavior are Impaired in Alcohol Use Disorder?

    Agreeableness Antagonism       Sympathetic, Kind vs. Critical, Quarrelsome
    Conscientiousness Disinhibition       Industrious, Orderly vs. Impulsive, Disorderly
    Openness To Experience Closed To Experience       Open-Minded, Creative vs. Cognitive Impairment
    Sociability (Extraversion) Detachment       Enthusiastic, Assertive vs. Reserved, Quiet
    Emotional Stability Negative Emotion       Calm, Emotionally Stable vs. Distressed, Easily Upset

The 5 Major Dimensions of Mental Illness

Our website uses the "Big 5 Factors" of personality as major dimensions of mental illness. Each of these 5 dimensions has a healthy side and an unhealthy side. The Big 5 Factors are: Agreeableness, Conscientiousness, Openness to Experience, Sociability (Extraversion), and Emotional Stability.

Agreeableness (Sympathetic, Kind)
Description: Agreeableness is synonymous with cooperation and social harmony; whereas Antagonism is synonymous with competition and aggression. The Agreeableness dimension measures the "friend vs. foe" behaviors that are central to the concept of JUSTICE (good vs. bad behavior).
Descriptors: Sympathetic, kind, appreciative, affectionate, soft-hearted, warm, generous, trusting, helpful, forgiving, pleasant, good-natured, friendly, cooperative, gentle, unselfish, praising, sensitive
Ask yourself: "How will I show JUSTICE? Who should I help? How will I neither harm nor allow harm?"
MRI Research*: Agreeableness was associated with increased volume in regions that process information about the intentions and mental states of other individuals.
"I am helpful and unselfish with others."
"I have a forgiving nature."
"I am generally trusting."
"I am considerate and kind to almost everyone."
"I like to cooperate with others."
"I don't find fault with others."
"I don't start quarrels with others."
"I am not cold and aloof."
"I am not rude to others."
"I feel other's emotions."
"I inquire about others' well-being."
"I sympathize with others' feelings."
"I take an interest in other people's lives."
"I like to do things for others."
"I respect authority."
"I hate to seem pushy."
"I avoid imposing my will on others."
"I rarely put people under pressure."
Antagonism (Critical, Quarrelsome)
* Callousness:
"It's no big deal if I hurt other people's feelings."
"Being rude and unfriendly is just a part of who I am."
"I often get into physical fights."
"I enjoy making people in control look stupid."
"I am not interested in other people's problems."
"I can't be bothered with other's needs."
"I am indifferent to the feelings of others."
"I don't have a soft side."
"I take no time for others."
* Deceitfulness:
"I don't hesitate to cheat if it gets me ahead."
"Lying comes easily to me."
"I use people to get what I want."
"People don't realize that I'm flattering them to get something."
* Manipulativeness:
"I use people to get what I want."
"It is easy for me to take advantage of others."
"I'm good at conning people."
"I am out for my own personal gain."
* Grandiosity:
"I'm better than almost everyone else."
"I often have to deal with people who are less important than me."
"To be honest, I'm just more important than other people."
"I deserve special treatment."
* Suspiciousness:
"It seems like I'm always getting a “raw deal” from others."
"I suspect that even my so-called 'friends' betray me a lot."
"Others would take advantage of me if they could."
"Plenty of people are out to get me."
"I'm always on my guard for someone trying to trick or harm me."
* Hostility:
"I am easily angered."
"I get irritated easily by all sorts of things."
"I am usually pretty hostile."
"I always make sure I get back at people who wrong me."
"I resent being told what to do, even by people in charge."
"I insult people."
"I seek conflict."
"I love a good fight."
("Agreeableness vs. Antagonism" modified from "PID-5" by Kreuger RF, Derringer J, Markon KE, Watson D, Skodol AE and Between facets and domains: 10 aspects of the Big Five)
*MRI Research: Testing predictions from personality neuroscience. Brain structure and the big five.

Conscientiousness (Industrious, Orderly)
Description: Conscientiousness is synonymous with being industrious and orderly; whereas Disinhibition is synonymous with being impulsive and disorderly. The Conscientiousness dimension measures the "self-controlled vs. disinhibited" behaviors that are central to the concept of SELF-CONTROL.
Descriptors: Self-disciplined, achievement-oriented, industrious, competent, reliable, responsible, orderly, deliberate, decisive
Ask yourself: "How will I show SELF-CONTROL and MODERATION? What duties must I perform? What are today's goals?"
MRI Research*: Conscientiousness was associated with increased volume in the lateral prefrontal cortex, a region involved in planning and the voluntary control of behavior.
"I do a thorough job. I want everything to be 'just right'. I want every detail taken care of."
"I am careful."
"I am a reliable hard-worker."
"I am organized. I follow a schedule and always know what I am doing."
"I like order. I keep things tidy."
"I see that rules are observed."
"I do things efficiently. I get things done quickly."
"I carry out my plans and finish what I start."
"I am not easily distracted."
Rigid Perfectionism (Excessive Conscientiousness)
"Even though it drives other people crazy, I insist on absolute perfection in everything I do."
"I simply won't put up with things being out of their proper places."
"People complain about my need to have everything all arranged."
"People tell me that I focus too much on minor details."
"I have a strict way of doing things."
"I postpone decisions."
Disinhibition (Impulsive, Disorderly)
* Irresponsibility:
"I've skipped town to avoid responsibilities."
"I just skip appointments or meetings if I'm not in the mood."
"I'm often pretty careless with my own and others' things."
"Others see me as irresponsible."
"I make promises that I don't really intend to keep."
"I often forget to pay my bills."
* Impulsivity:
"I usually do things on impulse without thinking about what might happen as a result."
"Even though I know better, I can't stop making rash decisions."
"I feel like I act totally on impulse."
"I'm not good at planning ahead."
* Distractibility:
"I can't focus on things for very long."
"I am easily distracted."
"I have trouble pursuing specific goals even for short periods of time."
"I can't achieve goals because other things capture my attention."
"I often make mistakes because I don't pay close attention."
"I waste my time ."
"I find it difficult to get down to work."
"I mess things up."
"I don't put my mind on the task at hand."
* Risk Taking:
"I like to take risks."
"I have no limits when it comes to doing dangerous things."
"People would describe me as reckless."
"I don't think about getting hurt when I'm doing things that might be dangerous."
* Hyperactivity:
"I move excessively (e.g., can't sit still; restless; always on the go)."
"I'm starting lots more projects than usual or doing more risky things than usual."
* Over-Talkativeness:
"I talk excessively (e.g., I butt into conversations; I complete people's sentences)."
"Often I talk constantly and cannot be interrupted."
* Elation:
"I feel much more happy, cheerful, or self-confident than usual."
"I'm sleeping a lot less than usual, but I still have a lot of energy."
("Conscientiousness vs. Disinhibition" modified from "PID-5" by Kreuger RF, Derringer J, Markon KE, Watson D, Skodol AE and Between facets and domains: 10 aspects of the Big Five)
*MRI Research: Testing predictions from personality neuroscience. Brain structure and the big five.

Open To Experience (Open-Minded, Creative)
Description: Open to Experience is synonymous with being open-minded and creative; whereas Closed to Experience is synonymous with being closed-minded and uncreative. The Openness to Experience dimension measures the "open-minded vs. closed-minded" behaviors that are central to the concept of WISDOM.
Descriptors: Wide interests, imaginative, intelligent, original, insightful, curious, sophisticated, artistic, clever, inventive, sharp-witted, wise
Ask yourself: "How will I show WISDOM and GAIN KNOWLEDGE? How will I make time for quiet contemplation?"
MRI Research*: Openness To Experience did not have any significant correlation with the volume of any brain structures. (This could suggest that "Openness To Experience", as defined here, is more a function of culture rather than of brain neurobiology.)
"I am original, and come up with new ideas."
"I am curious about many different things."
"I am quick to understand things."
"I can handle a lot of information."
"I like to solve complex problems."
"I have a rich vocabulary."
"I think quickly and formulate ideas clearly."
"I enjoy the beauty of nature."
"I believe in the importance of art."
"I love to reflect on things."
"I get deeply immersed in music."
"I see beauty in things that others might not notice."
"I need a creative outlet."
Closed To Experience (Closed-Minded, Uncreative)
"I prefer work that is routine."
"I have difficulty understanding abstract ideas."
"I avoid philosophical discussions."
"I avoid difficult reading material."
"I learn things slowly."
"I have few artistic interests."
"I seldom notice the emotional aspects of paintings and pictures."
"I do not like poetry."
"I seldom get lost in thought."
"I seldom daydream."
Cognitive Impairment
* Memory Impairment:
"I have difficulty learning new things, or remembering things that happened a few days ago."
"I often forget a conversation I had the day before."
"I often forget to take my medications, or to keep my appointments."
* Impaired Reasoning or Problem-Solving:
"My judgment, planning, or problem-solving isn't good."
"I lack creativity or curiosity."
* Eccentricity:
"I often have thoughts that make sense to me but that other people say are strange."
"Others seem to think I'm quite odd or unusual."
"My thoughts are strange and unpredictable."
"My thoughts often don’t make sense to others."
"Other people seem to think my behavior is weird."
"I have several habits that others find eccentric or strange."
"My thoughts often go off in odd or unusual directions."
* Unusual Beliefs and Experiences:
"I often have unusual experiences, such as sensing the presence of someone who isn't actually there."
"I've had some really weird experiences that are very difficult to explain."
"I have seen things that weren’t really there."
"I have some unusual abilities, like sometimes knowing exactly what someone is thinking."
"I sometimes have heard things that others couldn’t hear."
"Sometimes I can influence other people just by sending my thoughts to them."
"I often see unusual connections between things that most people miss."
* Perceptual Dysregulation:
"Things around me often feel unreal, or more real than usual."
"Sometimes I get this weird feeling that parts of my body feel like they're dead or not really me."
"It's weird, but sometimes ordinary objects seem to be a different shape than usual."
"Sometimes I feel 'controlled' by thoughts that belong to someone else."
"Sometimes I think someone else is removing thoughts from my head."
"I have periods in which I feel disconnected from the world or from myself."
"I can have trouble telling the difference between dreams and waking life."
"I often 'zone out' and then suddenly come to and realize that a lot of time has passed."
"Sometimes when I look at a familiar object, it's somehow like I'm seeing it for the first time."
"People often talk about me doing things I don't remember at all."
"I often can't control what I think about."
"I often see vivid dream-like images when I’m falling asleep or waking up."
("OPENNESS TO EXPERIENCE vs. BEING CLOSED TO EXPERIENCE" modified from "PID-5" by Kreuger RF, Derringer J, Markon KE, Watson D, Skodol AE and Between facets and domains: 10 aspects of the Big Five)
*MRI Research: Testing predictions from personality neuroscience. Brain structure and the big five.

Sociability (Enthusiastic, Assertive)
Description: Sociability is synonymous with being outgoing, enthusiastic and assertive; whereas Detachment is synonymous with being reserved and quiet. The Sociability (Extraversion) dimension measures the "approach vs. avoidance" behaviors that are central to the concept of SOCIABILITY and LEADERSHIP.
Descriptors: Enthusiastic, assertive, active, energetic, outgoing, outspoken, dominant, forceful, show-off, sociable, spunky, adventurous, noisy, bossy
Ask yourself: "How will I be SOCIALLY OUTGOING, enthusiastic and assertive? How will I make time to talk to those I love?"
MRI Research*: Sociability (extraversion) was associated with increased volume of medial orbitofrontal cortex, a region involved in processing reward information.
"I'm talkative"
"I'm not reserved."
"I'm full of energy."
"I generate a lot of enthusiasm."
"I'm not quiet."
"I have an assertive personality."
"I'm not shy or inhibited."
"I am outgoing and sociable."
"I make friends easily."
"I warm up quickly to others."
"I show my feelings when I'm happy."
"I have a lot of fun."
"I laugh a lot."
"I take charge."
"I have a strong personality."
"I know how to captivate people."
"I see myself as a good leader."
"I can talk others into doing things."
"I am the first to act."
Attention Seeking (Excessive Sociability)
"I like to draw attention to myself."
"I crave attention."
"I do things to make sure people notice me."
"I do things so that people just have to admire me."
"My behavior is often bold and grabs peoples' attention."
Detachment (Reserved, Quiet)
* Social Withdrawal:
"I don’t like to get too close to people."
"I don't deal with people unless I have to."
"I'm not interested in making friends."
"I don’t like spending time with others."
"I say as little as possible when dealing with people."
"I keep to myself."
"I am hard to get to know."
"I reveal little about myself."
"I do not have an assertive personality."
"I lack the talent for influencing people."
"I wait for others to lead the way."
"I hold back my opinions."
* Intimacy Avoidance:
"I steer clear of romantic relationships."
"I prefer to keep romance out of my life."
"I prefer being alone to having a close romantic partner."
"I'm just not very interested in having sexual relationships."
"II break off relationships if they start to get close."
* Anhedonia (Lack of Pleasure):
"I often feel like nothing I do really matters."
"I almost never enjoy life."
"Nothing seems to make me feel good."
"Nothing seems to interest me very much."
"I almost never feel happy about my day-to-day activities."
"I rarely get enthusiastic about anything."
"I don't get as much pleasure out of things as others seem to."
* Restricted Affectivity:
"I don't show emotions strongly."
"I don't get emotional."
"I never show emotions to others."
"I don't have very long-lasting emotional reactions to things."
"People tell me it's difficult to know what I'm feeling."
"I am not a very enthusiastic person."
("Sociability vs. Detachment" modified from "PID-5" by Kreuger RF, Derringer J, Markon KE, Watson D, Skodol AE and Between facets and domains: 10 aspects of the Big Five)
*MRI Research: Testing predictions from personality neuroscience. Brain structure and the big five.

Emotional Stability (Calm, Emotionally Stable)
Description: Emotional Stability is synonymous with being calm and emotionally stable; whereas Negative Emotion is synonymous with being distressed and easily upset. The Emotional Stability dimension measures the "safety vs. danger" behaviors that are central to the concept of COURAGE.
Descriptors: Stable, calm, relaxed, contented
Ask yourself: "How will I show COURAGE to face my fears? How will I CALMLY and POSITIVELY respond to adversity?"
"I am relaxed, and I handle stress well."
"I am emotionally stable, and not easily upset."
"I remain calm in tense situations."
"I rarely get irritated."
"I keep my emotions under control."
"I rarely lose my composure."
"I am not easily annoyed."
"I seldom feel blue."
"I feel comfortable with myself."
"I rarely feel depressed."
"I am not embarrassed easily."
Negative Emotion (Distressed, Easily Upset)
Description: Degree to which people experience persistent negative emotions (anxiety, anger, or depression) and are easily upset. (This could be thought of as high threat sensitivity or low stress tolerance.)
Descriptors: Emotional instability, anxiety, irritability, depression, rumination-compulsiveness, self-consciousness, vulnerability
MRI Research*: Negative Emotion was associated with increased volume of brain regions associated with threat, punishment, and negative emotions.
* Emotional Instability:
"I get emotional easily, often for very little reason."
"I get emotional over every little thing."
"My emotions are unpredictable."
"I never know where my emotions will go from moment to moment."
"I am a highly emotional person."
"I have much stronger emotional reactions than almost everyone else."
"My emotions sometimes change for no good reason."
"I get angry easily."
"I get upset easily."
"I change my mood a lot."
"I am a person whose moods go up and down easily."
"I get easily agitated."
"I can be stirred up easily."
* Anxiousness:
"I worry about almost everything."
"I'm always fearful or on edge about bad things that might happen."
"I always expect the worst to happen."
"I am a very anxious person."
"I get very nervous when I think about the future."
"I often worry that something bad will happen due to mistakes I made in the past."
"I am filled with doubts about things."
"I feel threatened easily."
"I am afraid of many things."
* Separation Insecurity:
"I fear being alone in life more than anything else."
"I can't stand being left alone, even for a few hours."
"I’d rather be in a bad relationship than be alone."
"I'll do just about anything to keep someone from abandoning me."
"I dread being without someone to love me."
* Submissiveness:
"I usually do what others think I should do."
"I do what other people tell me to do."
"I change what I do depending on what others want."
* Perseveration:
"I get stuck on one way of doing things, even when it's clear it won't work."
"I get stuck on things a lot."
"It is hard for me to shift from one activity to another."
"I get fixated on certain things and can’t stop."
"I feel compelled to go on with things even when it makes little sense to do so."
"I keep approaching things the same way, even when it isn’t working."
* Depression:
"I have no worth as a person."
"Everything seems pointless to me."
"I often feel like a failure."
"The world would be better off if I were dead."
"The future looks really hopeless to me."
"I often feel just miserable."
"I'm very dissatisfied with myself."
"I often feel like nothing I do really matters."
"I know I'll commit suicide sooner or later."
"I talk about suicide a lot."
"I feel guilty much of the time."
"I'm so ashamed by how I've let people down in lots of little ways."
"I am easily discouraged."
"I become overwhelmed by events."
("Emotional Stability vs. Negative Emotion" modified from "PID-5" by Kreuger RF, Derringer J, Markon KE, Watson D, Skodol AE and Between facets and domains: 10 aspects of the Big Five)
*MRI Research: Testing predictions from personality neuroscience. Brain structure and the big five.

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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.

Many individuals are only convinced that they are alcoholics when they drink, turn bright red, and vomit while on disulfiram - despite knowing this would happen. Only then do they realize that they can't stop drinking. Thus disulfiram should be taken daily to prevent (or diagnose) alcoholic relapses.

Unfortunately, years of use of disulfiram in some people may cause a peripheral neuropathy (e.g., foot drop) which would necessitate its termination.

Only three medications - disulfiram, naltrexone, and acamprosate - are approved for the treatment of alcoholism by the U.S. Food and Drug Administration:

  • Disulfiram:
    When taken with alcohol, causes a person to turn bright red and vomit. Thus disulfiram can be taken to prevent drinking, or to prove that a person isn't drinking. Alcohol can not be taken 48 hours before or after the ingestion of disulfiram. Disulfiram can not be used in pregnancy.

  • Naltrexone:
    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.

  • Acamprosate:
    When taken daily, decreases craving, anxiety and insomnia. Acamprosate can not be used in pregnancy.

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.

  • Alcohol Use Disorder Treatment Guidelines
  • The Surgeon General's Call to Action To Prevent and Reduce Underage Drinking
  • Does Teen Drug Rehab Cure Addiction or Create It?
  • "The Science and Treatment of Alcoholism" - omits mention of proven treatments for alcoholism (2015) This article (at omits to mention the three medications - disulfiram, naltrexone, and acamprosate - that are approved for the treatment of alcoholism by the U.S. Food and Drug Administration. That is quite an omission.
  • 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 increasing 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.
  • 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.

Treatment Evaluation


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Alcohol Abuse Treatment and Self-Help

Self-Help Groups for Alcohol Addiction

Improving Positive Behavior

Philosophers for the past 2,500 years have taught that it is very beneficial to start the day with goal-setting, and end the day with a brief review.

This habit of planning the day in the morning, then assessing these plans in the evening has been shown to increase health and happiness. There is an additional benefit from doing a weekly review of your life satisfaction.

Note: When each of the following videos finishes; you must exit YouTube (by manually closing the window) in order to return to this webpage.

International Space Station (For Meditation)

Planning My Day (5 Minute Meditation Video)

Reviewing My Day (5 Minute Meditation Video)

Life Satisfaction Scale (Video)

Healthy Social Behaviors Scale (Video)

Mental Health Scale (Video)

The Philosophy Of Stoicism (5 minute video)

Stoicism 101 (52 minute video)

The Roman emperor and Stoic philosopher Marcus Aurelius ruled from 161 to 180 A.D.

An Example Of Mindfulness Meditation (10 minute video)

In the 5th century BCE, Buddha spent 6 years of his life mastering mindfulness meditation. He then decided to look beyond meditation. Buddha concluded that simply emptying the mind of thought is calming, but otherwise it accomplishes little - since "You return to the same world". Instead, Buddha taught that we should change our world by seeking enlightenment through practicing compassion, and living a calm, peaceful, happy life.

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  • 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!

  • Criteria For High Quality Research Studies

  • It is imperative that medical researchers conduct high quality research studies, otherwise the US Food and Drug Administration (FDA) refuses to licence their new drug or therapy. In 2009, the cost of successfully licensing one new drug or therapy under the FDA scheme was estimated to be US$1,000 million. Thus psychiatric research which leads to FDA approval of a new drug or therapy has to be of the highest quality; however the majority of psychological research studies on new therapies fail to reach these high standards for research. This could explain why two-thirds of psychological research studies can'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? The results should be both statistically significant (with a p-value <0.05) and clinically significant using some measure of Effect Size such as Standardized Mean Difference (e.g., Cohen's d >= 0.33). The summary statistics 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 for a (normally distributed) strictly positive variable (because the "cooked" M and SD would mathematically require the strictly positive variable's range of data to include negative numbers). For a normally distributed sample of size of 25-70, this occurs when the SD is greater than one-half of the M; for a sample size of 70+, this occurs when the SD is greater than one-third of the M [using these formulas].

      • 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

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