Methadone Dosing: Use the Evidence

From: Janaburson's Blog


While Methadone and other medical replacement therapy has been badmouth by most if not
all member of organization like X Anonymous.  Methadone and Bupernorphine, for opiates
as well as Naltrexone for Alcoholics.
http://www.dpt.samhsa.gov/pdf/NTXWPFinalPDF.pdf
  Scientific evidence discoveries have shown that medication replacement therapy are substantially more effective (and safer) than Alcoholic Anonymous or Narcotics Anonymous. The animosity by members of these organizations is reprehensible given that they do not have any evidence except their own bias and poorly conceived opinions.

http://janaburson.wordpress.com/2013/07/07/methadone-dosing-use-the-evidence/

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Methadone Dosing: Use the Evidence

Posted July 7, 2013 by janaburson in Evidence-based Treatments, Methadone dosing. Tagged: methadone dosing. 7 Comments

methadone

The most successful opioid treatment programs and the most successful patients in those programs use evidence-based dosing of methadone. Many studies over the last 40 years show patients do better on adequate doses of methadone. They have better outcomes when they’re on enough methadone to block physical withdrawal signs and symptoms than when they’re on insufficient doses.
In the past, methadone clinics often had dose caps. Some clinics told their patients they didn’t need any more than 60 or 70mg of methadone per day. But over the last 40 years, we have multiple studies showing poorer outcomes at clinics with these low dose caps, as opposed to individualized dose determination. Numerous studies show higher drop-out rates in patients on doses less than 60mg, as well as more illicit opioid use and higher rates of HIV infection, as compared to patients on 100mg or more. For most patients, the blocking effect is seen in the neighborhood of 80 to 120mg of methadone per day. (In Tennessee, there are still dose caps. In that state, doctors have to get approval from a non-physician at the state’s Department of Mental Health to take a patient’s dose above 120mg.)
Patients vary widely the way they metabolize methadone. A patient with slow methadone metabolism may do best on 30mg of methadone per day, and a fast metabolize may need much more than 120mg per day. This rate of methadone metabolism is probably determined by our genetics. When patients ask me how much methadone they should be taking, my answer is, “Enough.” I’m not advocating taking doses higher than they need to be, but if the patient looks like they’re in withdrawal, and they feel like they’re in withdrawal, it’s best to take the dose up. We want to use the lowest effective dose.
There are still misguided opioid treatment programs that try to keep methadone doses low. Sometimes clinic staff can send shaming verbal or nonverbal messages, and imply patients who ask for an increase in their dose are somehow trying to get one over on the clinic. Staff shouldn’t shame patients who ask for a dose increase; staff should defer decisions about methadone dosing to their medical personnel.
Sometimes patients don’t want to increase their dose of methadone because they have mixed feelings about their treatment. If they feel guilty about being in a methadone program, they may want to keep their dose low. Sometimes family members, with the best of intentions, will demand the patient stay on a low dose, not understanding that their loved one is less likely to do well on an inadequate dose.
Frequently I see patients who are feeling bad, not sleeping, and achy all over in the mornings, and dosing at 40mg. I ask them if we can increase their dose, and they say something like, “No, I promised myself I wouldn’t go higher than 40mg.” Too often, patients don’t increase their dose for fear that coming off methadone will be harder to do at higher doses. This may be partly true. It may not be harder to come off of, but it take longer to taper off a higher dose. But the patient won’t do as well while they’re in treatment, so what’s the point?
Some patients prefer low doses because they want to have just enough methadone per day to keep them out of terrible opioid withdrawal, but not so much to block the euphoria they get from using an illicit opioid later in the day.
I tell patients that methadone is a little like chemotherapy. For chemo to work, you have to take a big enough dose to do the job. It’s the same way with methadone. It’s not a perfect analogy but patients get what I’m saying.
Let’s turn to the other side of dosing. I’ve seen some clinics with many patients on what I would consider very high methadone dosing. It’s hard to criticize, because I do think there are some patients who need doses higher than 250mg, particularly if they’re on certain medications, or are pregnant. But that’s rare, and at some clinics, many patients seem to be on these big doses. Since these patients have their dose increased slowly, they build a tolerance to the methadone, so such patients aren’t sedated. There’s no long-term damage to the body with very high dose methadone, but higher doses can cause some problems.
It may be hard for a patient on a very high dose to transfer to another clinic. Some methadone clinic medical directors are hesitant to accept a patient in transfer if they’re on 200-plus milligrams of methadone, unless there’s evidence that this dose is required. For example, I was looking over the records of a patient on 290mg, in preparation for transfer. This man was on no other medications and otherwise healthy. When I saw the peak and trough data, I was puzzled, because they were both high, and this was done at 200mg of methadone. So why was the patient taken to 290 milligrams? I know peak and trough levels aren’t the only factor to be considered when determining the right methadone dose, but there was scant information about why the doctor decided to raise the dose, or even if the patient had even seen the doctor recently. I wasn’t particularly concerned the patient would be sedated, because the dose had been raised slowly, over months. But I was concerned that the patient was on more methadone than he needed, especially since many of the patients at this clinic were on doses of more than 200mg per day.
Some studies have shown higher doses of methadone affect the way electrical impulses are transmitted through the heart. In some studies, higher methadone doses are more likely to produce prolongation of the QT interval than lower doses. (2) This QT prolongation does put patients at risk for a potentially fatal heart rhythm problem. The medical literature at present suggests that periodic EKG screening of patients on doses above 100mg is probably a good idea, but there’s still disagreement on this issue.
There is another factor to be considered. This may offend some readers, but we need to acknowledge the nature of addiction. It’s a disease who tells its sufferers, “More is better!” I think it’s important to acknowledge this point, and discuss it openly, but not in a shaming way. This psychological part of addiction doesn’t always go away within the first few weeks.
My approach to a patient on a relatively high dose, who desires an increase in methadone, is to meet with the patient, preferable prior to dosing. Sometimes I like to meet the patient two hours post-dose if I’m worried about sedation. I ask about withdrawal symptoms and check for pupil size and reaction, and other signs. I check the last drug screen. If the patient doesn’t describe withdrawal symptoms, and I don’t see objective signs of withdrawal, I’ll ask the patient how they expect to feel on an ideal dose of methadone, and if it’s possible their addiction is driving the desire to increase. I’m surprised that most patients aren’t offended, but welcome the opportunity to talk openly. Some patients say they honestly can’t tell if they are in withdrawal, or if their addiction tells them they are in withdrawal. My job is to help decide which it is.
Some patients feel “high” for the first few days after a dose increase, but tolerance builds quickly to this feeling. Some patients mistakenly believe they should always get that high after dosing. If the addiction is driving the patient’s way of thinking, the dose may never be “enough.” When I explain this to patients, most understand.
1. http://international.drugabuse.gov/sites/default/files/pdf/methadoneresearchwebguide.pdf
2. Krantz, Lewkowlez, Hays, et.al., “Torsade de Pointes Associated with Very-High Dose Methadone, Annals of Internal Medicine, Sept. 17, 2002, Vol 137(6) pp 501-505.

FREEEEEEE Suboxone Treatment in South Florida

If you live in South Florida or can get there for the number of times that are required by the researchers. There is a Suboxone Treatment starting now in June 2013. You receive the treatment by participating in the studies (and you get paid $500 instead of you paying for the treatment).The study is sponsor by a different pharmaceutical company, not Reckitt Benckiser Pharmaceuticals.

The researcher Segal Institute conduct approximately 300 multi-centered, so there maybe one research center near you that maybe doing the study. The pharmaceutical sponsor for this study is using a different variation of the initial formula. This formula ought to make the Buprenorphine Naloxone more effective and to last longer in the nervous system. To make an appointment in South Florida please call Segal Institute at 1 877 734 2588. When they answer the telephone and you tell them that you want to participate in the new Buprenorphine study, please also tell them that Franco referred you to the study and provided with this initial information. At the end of the number of weeks the studies, (I believe it is 40 but I will double check this number) having participated in the study will approve you for a longer participation. I believe that the sponsor is willing to provide participants with one year of Buprenorphine treatment.

Soon they are also preparing to do a study on medications for cocaine dependence. Perhaps this is the first medication for this ailment.

There are a number of other paid studies now available most of them in Mental Health and Substance Use treatment. When the list becomes available, the list will be made available here. And always tell the researcher that Franco referred you to the study. Let Franco know that you contacted the Segal Institute for Medical Trials. http://www.segaltrials.com there are also studies for Bipolar Disorder; Constipations due to use of Opiate Medication (such as methadone); If you are accepted into one of their studies, I will give you a tip if you informed them of my referring you to them. Please email contact Franco so that arrangements can be made. Franco33139ca@hotmail.com


(to be continuo)

New post on Janaburson's Blog / Case Report of Death from Ibogaine Ingestion

http://janaburson.wordpress.com/author/janaburson/

Case Report of Death from Ibogaine Ingestion

Posted by janaburson in Uncategorized. Tagged: ibogaine, ibogaine death, opioid addiction and ibogaine. 5 Comments

IBOGAINE

In the latest issue of the American Journal on Addictions (Volume 22 (3) May/June 2013, p. 302) was a one-page case report of a death due to ibogaine, ingested for the purpose of curing heroin addiction.
Ibogaine is a hallucinogenic psychoactive substance found in some species of plants that grow in Africa. It’s been used in religious ceremonies, chewed to give a mild stimulant effect. With increased doses, this substance has hallucinogenic effects. Ibogaine is a sloppy drug, affecting at least three types of brain receptors. Ibogaine’s metabolite, noribogaine, has serotonin reuptake inhibition properties, like found in many antidepressants. It also has a weak opioid effect on the mu opioid receptors and a stronger effect at the kappa opioid receptors, causing less dopamine to be released. It also has effects on at least two other receptor types.
Limited studies show that since the drug does block the release of dopamine, it may have some benefit in the treatment of addiction to these drugs. Both animal studies and case reports suggest ibogaine may reduce withdrawal symptoms of opioid addiction and craving for cocaine. But so far there have been no good scientific trials of the drug. This drug has been outlawed in the U.S. and in most European countries due to concerns about the drug’s side effects and case reports of death. Ibogaine’s supporters claim this drug can cure addiction to alcohol, cocaine, opioids, and nicotine.
In this case report, the decedent was a 25-year old male with heroin addiction and a history of supraventricular tachycardia, meaning he had an underlying heart problem that caused episodes of rapid heart rate. This man took ibogaine 2.5 grams over 3 hours, and then had hallucinations, difficulty with balance, fever, and muscle spasms. He improved over the first day, but by the next day he developed problems breathing and had a respiratory arrest. Despite cardiopulmonary resuscitation, he remained in a deep coma and died after two days of multi-organ failure.
This death was of course a tragedy, but I’m not sure this case and other similar cases mean ibogaine won’t ever have a place in the treatment of opioid addiction. It surely gives us information that patients with underlying heart disorders are at increased risk of death from ibogaine.
I still think there’s a need for further (careful) research on ibogaine. This can’t be done at present in the U.S. or Europe, but perhaps other counties can do necessary trials.
Yes, this is a medication that can kill, but then, addiction kills, too. And many medications routinely used in the medical treatment of various illnesses can be deadly at the wrong doses or in the wrong patients. For all medical treatments, the risks have to be weighed against the benefits. Right now, we don’t have a full idea of the benefits or the risks of ibogaine.
Like many treatments for addiction, there are also people who make unsubstantiated claims in favor of ibogaine, and sell it via the internet or in countries where it isn’t outlawed, as a miracle cure for opioid addiction. The evidence for this claim is lacking, to put it mildly. This case report reminds us that ibogaine can be deadly. Until/unless we have more knowledge about the risks/benefits of ibogaine, evidence-based treatment of opioid addiction with methadone and buprenorphine are much better options and should be recommended.
For further information of the state of ibogaine research, here’s a great reference:
http://www.ibogaine-research.org/Ibogaine-Research-Project/Areas/Media/JAMA.htm

Organization of American States OES Report on history of Drug Policy

This article comes from Stop the War.org

 

OAS Releases Historic Report on Drug Policy Alternatives [FEATURE]

 

by Phillip Smith, May 17, 2013, 06:51pm, (Issue #785)

Posted in:

 

The Organization of American States (OAS) Friday released a ground-breaking report on hemispheric drug control that includes not only an assessment of the current state of affairs, but also looks at a number of alternate scenarios for future directions in drug policy, including explicit analysis of possible regulation and legalization regimes.

Colombian President Santos (l) receives the report from OAS head Insulza in Bogota Friday (oas.org)

The report comes even as the US military is expanding its drug war in Latin America.The military is deploying assets to Central and South America, and US military assistance in Latin America has quadrupled in the last decade -- even as the region faces no external and diminishing internal threats.
The report, The Drug Problem in the Americas, was commissioned at last year's Cartagena Summit of the Americas, where a number of Latin American leaders led by Colombian President Juan Manuel Santos criticized existing drug policies and called for a discussion of alternatives. On Friday, OAS head Jose Miguel Insulza hand-delivered the report to Santos in Bogota.
Prepared by researcher and analysts at the Inter-American Drug Abuse Control Commission (CICAD) under the supervision of the OAS, the report is divided into two discrete sections, an analytical report and a scenarios report. It is the scenarios report that addresses possible directions in drug policy, including the formal consideration of legalization and regulation regimes.
The scenarios report envisions four possible (and not necessarily mutually exclusive) policy directions and how each scenario "understands" the drug problem, what the attempted response would be under that scenario, and the opportunities and challenges involved in acting on those scenarios.
Two scenarios, "Together" and "Resilience," represent largely traditional responses to drug use and the drug trade, with calls for the strengthening of weak states and their judicial institutions or addressing underlying social problems and strengthening communities to fight violence and addiction, respectively.
It is the other two scenarios, "Pathways" and "Disruption," that represent innovations in thinking at the policy-making level. In the "Disruption" scenario, the violence and instability created by the drug trade under prohibition is so severe that authorities "cut a deal" with traffickers in a bid to achieve social peace. This might, more or less fairly, be called "the Mexican scenario," given that previous Mexican PRI governments are almost universally assumed to have made such bargains with trafficking organizations, and given widespread speculation these days that the current PRI government may be considering something similar.

drug seizure, Mexico (sedena.gob.mx)

In the "Pathways" scenario, CICAD "understands" the problem as "the current regime for controlling drugs through criminal sanctions (especially arrests and incarceration of users and low-level dealers) is causing too much harm." The response is "trying out and learning from alternative legal and regulatory regimes, starting with cannabis."
The opportunities presented under the "Pathways" scenario include "development of better drug policies through experimentation, reallocation of resources from controlling drugs and drug users to preventing and treating problematic use, and shrinkage of some criminal markets and profits through regulation," while potential problems include "managing the risks of experimentation, especially with transitioning from criminal to regulated markets (including possible increases in problematic use), dealing with contraband, and new inter-governmental tensions that result from differences in regimes between jurisdictions."
The report is being welcomed as marking a true advance in the drug policy dialog at the hemispheric and international levels.
"The review explores what can be done in a post-drug war world," said Kasia Malinowska-Sempruch, director of the Open Society Global Drug Policy Program. "This report envisions a number of possibilities that will broaden the current debate on drug policy reform."
"As part of the scenarios team, we worked to make it clear that another reality is indeed possible, that our countries can move orderly toward regulated drugs markets, and that there are possibilities to achieve better results," said Lisa Sanchez, coordinator of drug policies at the Transform Drug Policy Foundation and Mexico Unido Contra la Delinquencia, who worked on the report. "It is clear that the state should no longer ignore its responsibility to guarantee the health and security of all its citizens, and to do this, it needs to regain control over the drug markets which are currently illegal."
"While leaders have talked about moving from 'criminalization' to 'public health' in drug policy, punitive, abstinence-only approaches have still predominated, even in the health sphere," said Daniel Wolfe, director of the Open Society International Harm Reduction Program. "These scenarios offer a chance for leaders to replace indiscriminate detention and rights abuses with approaches that distinguish between users and traffickers and offer the community-based health services that work best for those in need."

methamphetamine user under arrest, US (wikimedia.org)

"This is the beginning of an international conversation on a new approach to drugs," said David Holiday, senior regional advocacy officer for the Open Society Latin America Program. "We can hope this will move policies from those currently based in repression to strategies rooted in public health and human rights."
That international conversation on drug policy will get going next week, when the OAS report will be presented and discussed at the bi-annual CICAD meeting in Washington, DC. Two weeks after that, the report and discussions over drug policy in the Americas will be the main agenda item -- "Toward a comprehensive anti-drug policy in the Americas" -- at the annual session of the OAS General Assembly, which is attended by foreign ministers in the region. Advocates are hoping that these regional discussions will also be taken up at the 2016 United Nations General Assembly Special Session on Drugs.
"Never before has a multilateral organization engaged in such an inclusive and intellectually legitimate analysis of drug policy options," said Ethan Nadelmann, executive director of the Drug Policy Alliance. "Indeed, it would have been inconceivable just two years ago that the OAS -- or any multilateral organization -- would publish a document that considers legalization, decriminalization and other alternatives to prohibitionist policies on an equal footing with status quo policies. Political pressures by the US and other governments would have made that impossible."
But much has changed in just the past few years, Nadelmann noted. In 2009, former presidents Fernando Henrique Cardoso (Brazil), César Gaviria (Colombia) and Ernesto Zedillo (Mexico) joined with other members of the Latin American Commission on Drugs and Democracy in saying the time had come to "break the taboo" on exploring alternatives to the failed war on drugs.
In 2011, those presidents joined with former UN Secretary General Kofi Annan, former U.S. Secretary of State George Shultz, former Federal Reserve Board chairman Paul Volcker, former Swiss President Ruth Dreifuss and other members of the Global Commission on Drug Policy in calling for fundamental reforms to national and global drug policies. Former presidents Jimmy Carter, Ricardo Lagos (Chile), Vicente Fox (Mexico) and Aleksander Kwasniewski (Poland) were among those who seconded their recommendations.
Late that year, sitting presidents began to join the calls of their predecessors. These included President Santos in Colombia, Otto Perez Molina in Guatemala, José Mujica in Uruguay and then-President Felipe Calderonof Mexico. Simultaneously, the victorious marijuana legalization ballot initiatives in Washington State and Colorado transformed a previously hypothetical debate into real political reform. Other states will almost certainly follow their lead in coming years.
"The OAS scenarios report thus represents the important next step in elevating and legitimizing a discussion that until a few years ago was effectively banned from official government circles," Nadelmann said. "It is sure to have legs in a way that few reports by multilateral institutions ever do."

Bogota

Colombia

The Stigma of Drug Overdose from North Carolina Harm Reduction Coalition

I am in agreement with this article and the need of the Substance Use Treatment  community need to speak loud about Drug Over Dose and many other issues such as racism of Drug Laws misinformation and treatment.   Blogger from The Worse Treatment I ever had; Solrac           North Carolina Harm Reduction Coalition (NCHRC) Home | About Us | Harm Reduction | Law Enforcement | Advocacy | Contact

The Stigma of Drug Overdose: A Mother’s Story Article by Tessie Castillo Denise Cullen has lived through one of the worst tragedies a mother can experience – losing a child. But if there is anything worse than losing a child, it is losing a child to a drug overdose, because grief is accompanied by stigma and blame. Denise lost her only son, Jeff, when he was 27 years old to a fatal combination of morphine and Xanax. She remembers him as “warm, open, loving, bright and stubborn. He had a huge laugh and a fabulous smile,” she says. He was also impulsive and suffered from ADD. “We were very, very close,” Denise recalls. “Even during those horrible years [of drug use], he and I never became distant from each other. It was torturous at times but the one thing that was always, always apparent was that he loved his family and his family loved him. No matter what.” Jeff began using drugs in the 9th grade, possibly to self-medicate his ADD. Over the next 12 years he experimented with a variety of drugs, including his final drug of choice, opiates. During those years, “Jeff tried so, so hard to stop,” says Denise. “He felt ‘broken’ and guilty for the hurt he inflicted on his parents. He once wrote about his ‘fairytale life’ that he had screwed up so badly, and his self-esteem was gone toward the end. But he always took total responsibility for what he did.” For Denise, the pressure and fear of watching her only child battle addiction was “like a roller coaster with good periods and crashes. You learn to be hyper-vigilant, living always with fear. You have hope as well – as long as they are alive you have hope, but the sound of the phone ringing at night, or not hearing from them in a normal way is very difficult. It’s always in the back of your mind that your child could die in some way as a result of their addiction. You may think you can imagine it, that you are in a way prepared…but you are not.” The fateful day arrived on August 5, 2008. Jeff was at the beach with a friend waiting for a bed to open up in a long-term rehab facility. Denise remembers that he was happy and hopeful about the treatment center. “I called him in the afternoon to ask when he would be home,” says Denise. “He said he’d call, but hadn’t done so by 6:30 or 8:30pm. Finally at 10pm I called and left a very angry message. I was upset that he was acting like ‘the old days’ and making [his parents] worry. He never got those last messages. He was lying on the grass in a nice neighborhood…dying.” According to eyewitnesses – and shockingly, there were many – Jeff was lying on the grass starting around 4:30pm. He lay very near a curb where cars parked on an active street, yet no one stopped to ask what a clean, good-looking kid was doing motionless on the grass. At 11pm a woman finally called police, saying that Jeff hadn’t moved an inch in two hours. The time of death was around 10pm. He could have been saved. “At around 3:00am a very kind man, a Sheriff from the Orange County Coroner’s Office, rang our doorbell,” says Denise. “He had Jeff’s wallet, keys, phone, and beach gear…I am not a dramatic person but I fell to the floor and screamed until I couldn’t scream anymore and simply made sounds like a wounded animal.” Losing her only son was the worst kind of pain Denise could imagine, and she began visiting grief groups for parents. To her shock and chagrin, parents whose children had died of non drug-related means were judgmental about Jeff’s overdose. “I could actually feel people move their chairs away from me [when they heard Jeff had died of an overdose],” says Denise. “They had an attitude like ‘your child chose what killed him. Mine didn’t.” But judgment and accusation didn’t stop Denise. She left the traditional grief groups to found her own chapter of GRASP (Grief Recovery After a Substance Passing), for parents who also bear the unique stigma attached to drug overdose. GRASP was originally founded by Pat and Russ Wittberger of San Diego, but after they stepped down, Denise and her husband volunteered to take over. Today GRASP has 43 chapters in 24 states and offers healing and advice to parents in mourning. “My advice to parents is to learn as much as they possibly can about addictive illness and drug use from responsible sources early on,” says Denise. “Talk honestly about the risk factors of becoming addicted by ‘experimenting,’ talk about family history of alcohol or substance abuse.” Denise and her husband Gary also founded Broken No More, a nonprofit that works to change how substance abuse is viewed by the public and to fight failed drug policies. Run by people dealing with substance abuse issues in their families, the organization advocates for sterile syringe availability, 911 Good Samaritan laws that encourage witnesses to an overdose to call for help, and greater access to naloxone, an antidote to opiate overdose. Most importantly, Denise believes that to resolve the overdose crisis, people whose lives have been touched by this issue need to speak up. “We must get loud about overdose,” she says. “During the AIDS crisis, nothing was done until the gay community spoke up, then help came by the bucketfuls. Now, not only has the disease become more manageable, but the stigma has been reduced as well. With overdose, we must address both these elements. We must research addiction and find better treatments and a cure. It can be done. We just have to care enough to do it.” Death is not a time for blame. It is a time for reflection. And then, it is a time to speak. ----------------- This article was written by Tessie Castillo, NCHRC Program Coordinator

Update on: White House Announces Brain Mapping Initiative

This article comes from Dr. Mark Willenbrigh Substance Matter: Science and addictions.

Whew! Long drought! I was caught a bit off guard by the response to Jane Brody's column about Inside Rehab, which generated a lot of inquiries and new patients for Alltyr! All good things, plus opening the new office in downtown St. Paul and many other activities have left me a bit overwhelmed. Today's blog is written by Ian McLoone, a graduate student at the University of Minnesota Master of Professional Studies in Integrated Behavioral Health. Ian has been working with me learning about clinical work, as well as helping with Alltyr Clinic and other activities. He's going to be a regular contributor to Substance Matters.

MW

White House Announces Brain Mapping Initiative

President Obama announced on Tuesday plans to invest more than $100 million to develop and fund technology to map the human brain. The project, titled “Brain Research through Advancing Innovative Neurotechnologies”, or BRAIN Initiative, aims to improve our understanding of the human brain and, according to the White House, “uncover new ways to treat, prevent, and cure brain disorders like Alzheimer’s, schizophrenia, autism, epilepsy, and traumatic brain injury.”

Being hailed as the next Human Genome Project, the ambitious initiative will direct $50 million to the Defense Advanced Research Projects Agency (DARPA), $40 million to the National Institutes of Health (NIH), and another $20 million to the National Science Foundation (NSF). In addition, several private sector foundations and institutes have pledged significant contributions, each with specific goals in mind.

Cori Bargmann of Rockefeller University and William Newsome of Stanford University will lead the NIH working group. They will be tasked with creating specific plans, goals, a time frame, and cost estimates for the project moving forward. Of course this begs the question: what goals or plans would blog readers like to see addressed in this process? Is this initiative too ambitious, or not ambitious enough, given its size and scope? Leave your comments after the jump.

Welcome to Drinkers Check-up

This belongs to Dr. Reid Hester programs and I copy and pasted here as I think it is a good assessment tool for persons with alcohol problem to check.

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Get started to Find out what this program is all about take a confidential screening and get objective feedback about whether the program might be useful for you. After getting feedback from the screening you can decide whether or not to register. Once you've registered, you can get A comprehensive evaluation detailed feedback help with making a decision about whether or not to change your drinking. This program will not, however, pressure you to change in any way. The Check-up is free to use. At the end though we will ask for your support. It's entirely voluntary. Users of the program are its sole source of support. If you decide to cut back your drinking, our Moderate Drinking app can help you be successful. Its effectiveness is supported by scientific research. And Moderation Management is a mutual-help group that supports people in cutting back on their drinking. If you decide to stop drinking, consider SMART Recovery® to help you be successful. We are also studying the effectiveness of a new web app for them, Overcoming Addictions and that app will become available this summer. Privacy & Confidentiality Copyright/Patent Info About us/Contact us Limitations Ad Policy Site last updated May 21, 2013. © 2013 All rights reserved. Drinker's Check-up ™