Tag Archives: Grand Strand

Dopamine and RDS

December 1, 2014

Dopamine Genes Affect Clinical Outcomes in Reward Deficiency Syndrome

dopamineDopamine is crucial neurotransmitter and hormone in the body. This hormone serves many purposes. It plays a role in the pleasure and reward pathway of the brain as well as in memory and motor control. And any decline in this hormone presents the body with myriads of ill-health conditions. This hormone however is greatly affected by drugs of abuse, most drugs that are taken to produce induced euphoric feelings in a person works in such a manner that they increase the production of the dopamine neurotransmitter, when this neurotransmitter is produced up to certain levels it will get depleted in the long term and hence the problem sets in. Specifically, the euphoric properties of cocaine and other drugs of leisure lead to the development of chronic abuse, and appear to involve the acute activation of central dopamine (DA) neuronal systems. They proposed that DA depletion results from overstimulation of these neurons and excessive synaptic metabolism of the neurotransmitter. When this happens may suffer ill-health conditions. These may include; poor nutrition, stress, lack of sleep and the habitual use of antidepressants, symptoms such as depression, mood swings, poor attention and food cravings will also occur. Some of the major symptoms of dopamine deficiency are depression, chronic boredom, and a loss of satisfaction, apathy, chronic fatigue and low physical energy with no desire to exercise the body. To correct these problems, it is necessary for this hormone to be supplemented so that the normal levels are restored. In addicts the use of buprenorphine to treat opioid dependent individual is common and is approved by the FDA. While to many people it has been working well with many studies supporting its use has now been reported that using buprenorphine for a long time will jeopardize the life a person as cases of severe withdrawal symptoms have been common. Researchers have found it necessary to embrace genetic testing to reveal reward circuitry gene polymorphisms especially those related to dopaminergic pathways as well as opioid receptor(s) as a way of improving treatment outcomes.

Researchers have currently proposed the use of dopamine agonists instead of antagonists like buprenorphine that is mostly used with naloxone can offer long term solution to dopamine deficiency. While it is well established that dopamine deficiency or a hypodopaminergic trait leads to aberrant substance seeking behaviors (RDS) and intact mu opiate receptors are important for maintaining “dopamine homeostasis”, scientists have suspected that opioid-dopaminergic interaction must be involved in buprenorphine response. In this regard they have provided some evidence that a putative dopamine agonist, KB220Z shows long-term potential as an opioid replacement compound especially in subjects having a genetically determined hypodopaminergic trait like RDS.

In a research study done by Kenneth Blum, Marlene Oscar-Berman, William Jacobs, Thomas McLaughlin and Mark S. Gold, it was found that dopamine genes can affect clinical outcomes in reward deficiency syndrome and therefore it is safe to use less powerful dopamine agonist dopaminergic genes in helping patients with low dopamine levels on a long-term basis.

Dopamine agonist therapy

Based on these earlier studies both Blum et al has continued to propose dopamine agonist therapy rather than dopamine antagonistic therapy currently favored by the approved FDA drugs as medical assisted treatment. Specifically, they proposed that D2 receptor stimulation can be accomplished via the use of KB220Z which is a complex therapeutic nutraceutical formulation that potentially induces DA release, causing the same induction of D2-directed mRNA and thus proliferation of D2 receptors in the human. This proliferation of D2 receptors in turn will induce the attenuation of craving behavior. In fact, this model has been proven in research showing DNA-directed compensatory overexpression which is a form of gene therapy of the DRD2 receptors, resulting in a significant reduction in alcohol as well as cocaine craving behavior in alcohol and cocaine preferring rodents.

This research done by Blum and his team suggested that utilizing less powerful dopaminergic repletion therapy to promote long term dopaminergic activation will ultimately lead to a common, safe and effective modality to treat Reward Deficiency Syndrome (RDS) behaviors including Substance Use Disorders (SUD), Attention Deficit Hyperactivity Disorder (ADHD), Obesity and other reward deficient aberrant behaviors. This concept is further supported by the more comprehensive understanding of the role of dopamine in the NAc as a “wanting” messenger in the meso-limbic DA system. This team had a hypothesis that D2 receptor stimulation signals negative feedback mechanisms in the mesolimbic system to induce mRNA expression causing proliferation of D2 receptors.

dopamineAs revealed by the researchers stress and dopamine D2 receptor levels play a significant role in alcohol seeking behaviors. Another researcher Delis and his team observed that in the presence of a stressful environment, low DRD2 levels are associated with increased ethanol intake and preference and that under this condition, increased ethanol consumption could be used as a strategy to alleviate negative mood this also supports dopamine agonist therapy not antagonistic. It is therefore safe to use dopamine agonists instead of dopamine antagonists in treating those with low dopamine levels as they are much safer.

Finally, We at AWAREmed Health and Wellness Resource Center are committed to availing help to addicts by availing some of the most integrative approaches to healing an addict. We advocate for natural healing to all kinds of addiction. Call on Dr. Dalal Akoury (MD) at Myrtle Beach, South Carolina for help.

Dopamine Genes Affect Clinical Outcomes in Reward Deficiency Syndrome

 

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Drug Abuse in London on the rise

November 30, 2014

Substance Abuse Trend in London Current Treatment Available

LondonDrug abuse is common in London with the major drugs that are commonly abused being cocaine, ketamine, heroine, alcohol, cannabis and designer drugs. The drugs that were commonly abused in the past decades were cannabis and cocaine but in 2012 there was rise in the use of other drugs probably because of the pressure that authorities put on the users of cocaine and cannabis as they are illegal in London just the same way they are in most countries of the world. Ketamine was purportedly being produced in India from where it was smuggled into the United Kingdom and most of the users of this drug were the Londoners. Other drugs were also reported to be in use and most designer drugs that were in use were not even known. This onslaught of readily available drugs had become a major worry to employers. In 2007, the City of London Corporation published a report titled Tackling alcohol and drugs in the workplace. Its research found that 22 per cent of London businesses reported absenteeism as a direct result of drug abuse. This is an illustration that if not looked into keenly and appropriate solution given then the economy of London will be adversely affected by drug abuse as the workforce are slowly but surely losing their lives to drug abuse.

In 2012 LondonlovesBusiness.com published The City’s toxic new drug trends, an expose of drug abuse in the City. The feature highlights the prevalent use of drugs such as GHB among City boys. In 2007 the City of London report cited ecstasy, cannabis, alcohol, cocaine and heroin as substances to watch out for, but neglected new drugs that were increasingly being used like GHB and even ketamine.

There were a whole host of other substances that were not listed in the 2007 report. These included 2CI, 2CB, 2CE, GBL, GBH, mephedrone, ketamine, methamphetamine, speed, crack and opium, all of which were increasingly being used in London. With these designer drugs creating hybrid-like mix and match highs (2CI, 2CB and 2CE are said to replicate acid-type trips but without the same intensity, or for the same period of time), those with demanding jobs can achieve shorter highs with shorter comedowns.

Cocaine capital of Europe

The use of drugs of abuse has been at an all-time rise in London with designer drugs contributing a good percentage of the drugs that are consumed in London. Unfortunately, as I stated above most reports about drug use in this city has emphasized the use of major drugs of abuse like cocaine and cannabis while ignoring the use of other equally dangerous drugs like ketamine and other designer drugs. There are today very many drugs of abuse in London but still according to the recent report on drug just in the United Kingdom, it has been found that cocaine is still the most abused drug in the London, in fact London is now referred to us the ‘cocaine capital of Europe’. Yeah you heard it right-London is the cocaine capital of Europe and has the highest use of the drug than any other city on the continent, new research published today is proof to this statement.

This report was from The European Drug Report 2014 that reached this conclusion having analyzed the sewage systems of 42 cities for traces of the drug and found the English capital had the highest cocaine use of any city tested, with consumption of the drug appearing to peak on a Tuesday. The samples, which were taken and tested during a week in 2013 to provide a forensic snapshot of drug use, found London was one of the cities with the highest use of ecstasy. Contained in the report was the information that the sewages water in London contained 711 mg of benzoylecgonine, the main chemical in cocaine, per 1,000 people, compared to 393 mg in Amsterdam and 233 mg in Milan.

LondonGenerally, cocaine and ecstasy were the more popular drugs in western and some southern cities, while crystal meth remained the most popular in Eastern Europe. However, overall use of the drug is continuing to decline in countries such as Denmark and the United Kingdom after a peak in 2008. Eleven out of the 12 countries also reported falls in cocaine use in surveys undertaken between 2011 and 2013.

The international report also warned against the increasing use of so-called ‘legal highs’, which are sold over the internet and often try to mimic the effects of drugs such as cocaine or LSD. The agency identified more than 80 new chemical drugs last year, making a total of almost 250 detected over the past four years.

Available treatment options for drug addicts in London

Here in London like any other part of the world addicts can mostly get help by visiting rehab centers. There are very many rehabs in the London and you may have to do a little research on which rehab can suit the case. In rehabs there are different ways through which an addict will be helped. One of the ways of fighting addiction is through drug and alcohol detoxification.

Finally, We at AWAREmed Health and Wellness Resource Center are committed to availing help to addicts by availing some of the most integrative approaches to healing an addict. We advocate for natural healing to all kinds of addiction. Call on Dr. Dalal Akoury (MD) at Myrtle Beach, South Carolina for help.

Substance Abuse Trend in London Current Treatment Available

 

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Intoxication and Withdrawal

November 25, 2014

Clinical Signs and Symptoms of Intoxication and Withdrawal

Intoxication and withdrawalThe use of drugs and substance of abuse will eventually produce some effects on the user. Most importantly the user will suffer intoxication that is common to users of drugs for a long time. Withdrawal symptoms will be reached when a person’s neurotransmitters have been affected by the use of the drugs so much that certain signals cannot be sent without the use of the drug. This is called dependence; it is a situation where a person ceases to exist without the drug. The drug becomes the driver of life and whenever he has not used the drug he will be sick and his body will cease to work normally. In this instant if a person tries to stop using the drugs then the withdrawal symptoms will set in making it hard for them to quit using the drugs. In this article we are looking at some of the signs and symptoms that are associated with intoxication and withdrawal.

Clinical signs and symptoms of intoxication and withdrawal

According to World Health Organization (WHO) intoxication is a condition that follows the administration of a psychoactive substance and results in disturbances in the level of consciousness, cognition, perception, judgment, affect, or behavior, or other psychophysiological functions and responses. Withdrawal is a known term as it has been defined in previous articles. Here are some signs and symptoms of intoxication and withdrawal. Different drugs will cause different signs and symptoms of intoxication and withdrawal;

Signs and symptoms of alcohol intoxication

The intoxication in alcohol will vary depending on the amount taken. When taken in low risk levels the person may feel reduced levels of anxiety and sedation but as the blood alcohol content increases so do the severity of the symptoms. These are some signs and symptoms associated with alcohol intoxication.

  • Confusion
  • Coordination difficulties
  • Expansive mood
  • Impaired memory
  • Poor judgment
  • Sense of well-being
  • Short attention span
  • Slurred speech
  • Talkativeness
  • Unstable gait

Signs and symptoms of alcohol withdrawal

  • Hallucinations – the user will have hallucinations of sights, sounds, or physical sensations on the skin. He will also experience abnormal changes about the temperatures.
  • Hand tremor
  • Insomnia- the sleep may be hard to come by or too short to let the brain rest and get refreshed.
  • Nausea, vomiting
  • Autonomic hyperactivity. This may include sweating and pulse rate greater than 100.
  • Delirium tremens showed as anxiety, increased heart rate, sweating, trembling and confusion. Delirium tremens is the most severe withdrawal symptom associated with alcohol.
  • Difficulty performing tasks involving coordination
  • Grand mal seizures– convulsions resulting in loss of consciousness and muscle contractions.

Signs and symptoms of cocaine intoxication

Cocaine is a drug of recreation that is normally taken for its euphoric effects. It gives a person an induced sense of well-being and may give a person an increased sense of sexuality. However as it is addictive anybody using it may become tolerant, taking in more and more which may result in severe intoxication. The following are signs and symptoms of cocaine intoxication.

  • hyperactivity and muscle damage
  • hyperthermia -seriously elevated body temperature
  • kidney damage
  • seizures
  • stroke
  • irregular heart beats
  • Anxiety and agitation
  • Chest pain or pressure
  • Enlarged pupils
  • Feeling of being “high” (euphoria),
  • Increased heart rate and blood pressure
  • sweating
  • tremors
  • confusion
  • sudden death

Signs and symptoms of cocaine withdrawal

Cocaine withdrawal symptoms are not so severe and they last for a shorter time possibly a week but still it depends on the immunity of a person. Just like any other drug when you stop using cocaine you are bound to experience some of the symptoms of withdrawal. These are some withdrawal symptoms that you will go through if you stop using cocaine.

  • Depression
  • Anxiety
  • Chills
  • Body aches
  • Tremors and shakiness
  • Pain
  • Inability to feel pleasure
  • Exhaustion
  • Challenges in concentration
  • Intense craving for cocaine

Signs and symptoms of opioid intoxication

Opioids are pain drugs. They are clinically used to help pain patients manage the pain. Opioids are commonly used by cancer patients and other chronic pain patients. However in some situation a patient may be overwhelmed by pain so much that he takes more than the prescribed dosage. When this happens intoxication will take place. The degree of intoxication will depend on the amount of the drug you have taken. Your level of intoxication depends on how much of the drug you take. Opioid drugs that are commonly used are: methadone, morphine, oxycodone, codeine and heroin. Some of the signs and symptoms of opioid intoxication include;

  • small (constricted) pupils
  • slowed breathing
  • absent breathing
  • extreme fatigue
  • changes in heart rate

intoxication and withdrawalSigns and symptoms of opioid withdrawal

As said earlier opiates are used in clinics to help patients with chronic pain. These patients may use these drugs for a long time that their bodies’ will get desensitized to opioids. The body will need more of the drugs to feel the pain relief, this is called tolerance. In the long term use you will become dependent so much that if you try to creep out of opioid use then you will suffer the withdrawal symptoms. These signs and symptoms may include;

  • nausea and vomiting
  • dilated pupils and possibly blurry vision
  • rapid heartbeat
  • high blood pressure
  • inability to sleep
  • yawning very often
  • diarrhea
  • abdominal cramping
  • goose bumps on the skin
  • muscle aches
  • restlessness
  • anxiety
  • lacrimation (eyes tearing up)
  • runny nose
  • excessive sweating

Access treatment and management

There various ways through which intoxication and withdrawal symptoms can be managed and treated. Visit us at AWAREmed Health and Wellness Resource Center, located in Myrtle Beach, South Carolina and get attended to by Dr. Dalal Akoury (MD) who has vast experiences in integrative medicine having worked with different addicts chained to different drugs.

Clinical Signs and Symptoms of Intoxication and Withdrawal

 

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SBIRT and Its Benefits

November 24, 2014

Screening and Brief Intervention and Referral for Treatment

SBIRTWhat is SBIRT?

SBIRT is an abbreviation that stands screening, brief Intervention and Referral for Treatment. It is an evidence-based approach to identifying patients who use alcohol and other drugs at risky levels with the goal of reducing and preventing related health consequences, disease, accidents and injuries. Risky substance use is a health issue and often goes undetected. Screening, brief intervention and referral for treatment helps detect these health issues

It is a comprehensive, integrated, public health approach that provides opportunities for early intervention before more severe consequences occur of drug use occurs. There are tools that that have been approved to be effective in identifying people with or are at risk of a Substance Use Disorder that must be used in this procedure. Based on implementation of this model nationally, of 459,599 patients screened, 22.7 percent screened positive for a spectrum of use (risky/problematic, abuse/addiction). Of those who screened positive 15.9 percent were recommended for a brief intervention with a smaller percentage recommended for brief treatment (3.2 percent) or referral to specialty treatment (3.7 percent).

Why is Screening, brief intervention and referral for treatment Important?

SBIRT has been found to be effective in dealing with addiction. Apart from screening, SBIRT is an effective tool for identifying risk behaviors and providing appropriate intervention. Healthcare providers can use evidence-based brief interventions focusing on health and other consequences, preventing future problems by simply screening for high risk behavior.

The main objective of SBIRT is to identify and effectively intervene with those who are at moderate or high risk for psychosocial or health care problems related to their substance use so as to formulate strategies to help them evade the dire consequences associated with drug use.

Research Demonstrates Effectiveness

All studies that have been done on this subject have shown that SBIRT is an effective approach to dealing with issues associated with drug addiction. It has been found to be very cost effective yet has very positive outcomes. Several research findings show that SBIRT is an effective way to reduce drinking and substance abuse problems.

SBIRT incorporates screening for all types of substance use with brief, tailored feedback and advice. It can also be done in different settings. Screening does not have to be performed by a physician. Research shows that Simple feedback on risky behavior can be one of the most important influences on patient behavior and change.

Through research it has been found that:

Brief interventions are cost effective and yield positive results. Brief interventions are most effective among persons with less severe problems. In a report of a study done for U.S. Preventive Services Task Force in 2004 it is quoted that; “Brief interventions are feasible and highly effective components of an overall public health approach to reducing alcohol misuse.”

Based on many researches that have been done on the subject there is substantial evidence for the effectiveness of brief interventions for harmful drinking. There is a growing body of literature showing the effectiveness of SBIRT for risky drug use.

Since 2003, SAMHSA has supported SBIRT programs, with more than 1.5 million persons screened. Out of these people, 40 percent showed a reduction in harmful use of alcohol by those drinking at risky levels and a 55 percent reduction in negative social consequences. The data also showed positive benefits for reduced illicit substance use. The evidence of this is in a review of SBIRT GPRA data (2003−2011).

Brief Intervention

Brief Intervention refers to a brief motivational and awareness-raising intervention given to risky or problematic substance users. There are steps involved in brief intervention.

Steps involved in Brief Intervention

  1. Build rapport– here begin with a general conversation to avoid tension and create a good relationship with the patient. Ask the patient to allow you to speak about alcohol and drugs, whichever he may be subject to. When the conversation is going on discuss the advantages and disadvantages of using alcohol, let him tell you these points.
  2. Provide feedback- ask the patient to allow you to give your feedback on the issue, discuss your screening findings with him and link any substance use behaviors to any known consequences.
  3. Build readiness to change- Create the urge to change in the patient, talk to the patient and let him know that you really have to know how much he is interested in making a change. You know how bad he wants the change by using a scale of 1-10. Ask him this question: On a scale from 1 to 10, 1 being not ready at all and 10 being completely ready, how ready are you to make any changes in your substance use?
  4. Negotiate a Plan for Change

SBIRTAfter knowing where his interest lies on the scale you will give him the opportunity to choose which way to take between the available options. Whether to choose a plan for reducing alcohol use to low risk levels or to go continue with receiving specialty treatment services.

What are the benefits of SBIRT?

This approach to treatment of alcohol and addiction to other drugs has been found to be very beneficial. Some of its benefits include: It prevents disease, accidents and injuries related to substance use, resulting in better patient outcomes. It also reduces the cost of healthcare needless to mention SBIRT is reimbursable, billing codes are available in New York State.

Finally, Here at AWAREmed Health and Wellness Resource Center we are committed to availing help to addicts by availing some of the most integrative approaches to healing an addict. We advocate for natural healing to all kinds of addiction. Call on Dr. Dalal Akoury (MD) at Myrtle Beach, South Carolina for help.

Screening and Brief Intervention and Referral for Treatment

 

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Withdrawal Syndrome

November 24, 2014

Withdrawal Syndrome, Withdrawal Seizures and the CIWA Scale

Withdrawal syndromeWithdrawal syndrome refers to is a set of symptoms that occurs when a person discontinues using a drug or when he reduces the dosage of the drug. Not all drugs will result in withdrawal symptoms but some prescription drugs and other drugs of recreation will result in withdrawal syndrome when one discontinues using them. For example a person who has been using alcohol for a long time will suffer withdrawal syndrome when he reduces the amounts he takes or when he stops taking alcohol completely. Normally the withdrawal syndrome will result in the patient taking more of the drug and for a longer time. In case of alcohol the withdrawal syndrome may make the addict to continue using alcohol as an escapade or other to mitigate the effects of the severe withdrawal symptoms.

People using different drugs will suffer withdrawal syndrome when they stop using the drugs or when they reduce the dosage, however there will be different symptoms. For example a person who has stopped using opiates will exhibit such symptoms as; Shaky hands, Sweating, Mild anxiety, Nausea and/or vomiting, headache and Insomnia. On the other hand a person who has stopped using opiates will exhibit the following withdrawal syndrome symptoms; muscle ache, restlessness, anxiety, lacrimation (eyes tearing up), runny nose, excessive sweating, inability to sleep and yawning very often. Withdrawal syndrome will most likely affect someone who has used the substance of abuse for so long that he has got dependent on the drug. It does not only happen to those who ate suing the recreational drugs alone but can also happen with prescription drugs. For example many people who are prescribed opioids to help manage their pain end up exhibiting withdrawal syndrome symptoms and in most cases have to be helped to quit using the drugs that were once given with medical intentions.

Withdrawal seizures

Withdrawal seizures may occur as a withdrawal syndrome symptom. It refers to the convulsions that occur when a person has stopped using a drug he has been using for a long time. It is common to users of opiates and alcohol addicts. As for alcoholics it occurs in up to one-third of alcoholics when they abruptly reduce their alcohol intake, the effects of which peak within 24 hours after the most recent alcohol ingestion. These seizures are in most cases brief or partial. It however should not be taken lightly since if not taken care of in good time an alcoholic who suffers seizures may develop delirium tremens. Most alcohol withdrawal seizures normally resolve spontaneously or respond well to benzodiazepines but the risk of delirium tremens should not be overlooked. In most addicts it is said that withdrawal seizures is responsible for their physical injuries such as burns and wounds.

Withdrawal delirium

Withdrawal delirium is common among alcoholics. In fact it is the most severe form of withdrawal syndromes associated with alcoholism. It causes sudden and severe problems in your brain and nervous system. It is approximated that five percent of hospital patients being treated for alcohol withdrawal also experience Alcohol withdrawal delirium. Alcohol Withdrawal delirium is also known as delirium tremens or Delirium tremens. It is a medical emergency.

Alcohol withdrawal delirium is mostly caused by sudden stop in alcohol consumption after a long time of heavy drinking. However other causes may include; reduce their alcohol use too quickly, don’t eat enough when reducing alcohol use, have a head injury and infections. A person suffering from alcohol will show the following symptoms among others;

  • hallucinations
  • nightmares
  • fever
  • fatigue
  • nausea
  • restlessness
  • chest pain
  • excitement
  • fear
  • sudden mood changes
  • delirium
  • sensitivity to light
  • sensitivity to sound
  • sensitivity to touch
  • anxiety
  • agitation
  • irritability
  • confusion
  • delusions

Treating alcohol withdrawal delirium

Firstly, you should know that withdrawal delirium can cause death and so treatments should only take place in hospital. It is also crucial that the patient should access treatment as soon as possible. When a delirium tremens patient has been taken to hospital the doctors may employ the following means to treat him;   anticonvulsants to prevent or stop seizures, sedatives to calm agitation and treat anxiety, antipsychotic medications to prevent hallucinations, medication to reduce fever, treatment for other alcohol related conditions and rehabilitation to help you stop drinking and avoid future cases of the disease striking again.

Clinical Institute Withdrawal Assessment for Alcohol

Withdrawal SyndromeOften abbreviated as CIWA, Clinical Institute Withdrawal Assessment for Alcohol is an item that is used in assessment and management of alcohol withdrawal. The main purpose of the CIWA scale is to provide an efficient and objective means of assessing alcohol withdrawal. The scale is used to test for severity of the common withdrawal syndrome symptoms independently after which the aggregates will be used as an insight into the severity of alcohol withdrawal. The ranges on the scale show what should be done at each level to manage the withdrawal symptoms for example administering benzodiazepines. The maximum score on the CIWA scale is 67; while any score less than 15 is termed a mild alcohol withdrawal, moderate with scores of 16 to 20, and severe with any score greater than 20. The ten items evaluated on the scale are common symptoms and signs of alcohol withdrawal, and are as follows:

  • Nausea and vomiting
  • Tremor
  • Paroxysmal sweats
  • Anxiety
  • Agitation
  • Tactile disturbances
  • Auditory disturbances
  • Visual disturbances
  • Headache
  • Orientation and clouded sensorium

Finally, Here at AWAREmed Health and Wellness Resource Center we are committed to availing help to addicts by availing some of the most integrative approaches to healing an addict. We advocate for natural healing to all kinds of addiction. Call on Dr. Dalal Akoury (MD) at Myrtle Beach, South Carolina for help.

Withdrawal Syndrome, Withdrawal Seizures and the CIWA Scale

 

 

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