Vaccine Hesitancy and COVID-19 Risk Amongst Individuals with Substance Use Disorders

The ASAM (American Society for Addiction Medicine) recently revealed an under examined trend in vaccine hesitancy—the population of individuals struggling with Substance Use Disorder (SUD’s). This group of individuals has a higher risk of contracting COVID-19 and experiencing worse symptoms, but they’re less likely to pursue vaccination. Feelings of shame, or past discrimination in healthcare settings are substantial barriers, which stop this group of people from engaging in a voluntary health visit. Studies show that even when vaccinated, those with SUD’s are more vulnerable to the virus. 

Even before SARS-CoV-2 threatened the global community, the World Health Organization reported that vaccine hesitancy was one of the biggest threats to global health. Media attention has highlighted the impact of COVID in death and hospitalization rates in areas that are under vaccinated. In many such regions, distrust in the government, or misinformation adopted through social media is the cause for vaccine hesitancy, but there is very little emphasis on the evidence base and experience of substance users.

To read more about the effect of COVID-19 on SUD’s from a variety of leading scientific magazines, click here.

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How Does CBT Change Brain Function?

What is CBT?

Cognitive behavioural therapy (CBT) is a therapeutic intervention that gives individuals the tools to examine their thoughts, feelings, and behaviours. Dr. Beck and Dr. Ellis, the psychiatrists who developed CBT, looked at the way thoughts are formed and how they shape beliefs and behaviour. Specifically, he categorized different types of thoughts such as the distortion of automatic thoughts, core schemas, beliefs, and underlying assumptions. The first role of the cognitive model was to investigate how negative beliefs maintain symptoms in depressed patients. Since then, CBT has had broad applications in mental health and substance use challenges. The premise of CBT is that many struggles are sustained by biases in thinking.  

Many of the thoughts that we have occur automatically and so part of the goal of CBT is to change unconscious processes to mindful practices. The patient tests the way they see reality against available facts. Part of the process of therapy is learning that negative thoughts have consequences. Individuals learn how to describe their experience with accuracy and to rely on facts as opposed to leaning into generalizations. For instance, a therapist might encourage their client to restructure their automatic thoughts. If the client thinks, “I am a failure,” the therapist will help them reframe their thought to: “I did not achieve my goals on this specific task at this time.”

Here are some ways you can reframe your thoughts: 

When you’re experiencing challenging thoughts, it can help to focus on your breathing. There are many apps and tools which can assist you with breathing and different forms of meditation. A simple grounding exercise is to breathe in for the count of four, hold at the top for four, breath out for four, and hold at the bottom for four. You can repeat this simple technique as many times as you need to feel calm and grounded. 

An underlying goal of CBT is to move from fixed to flexible thinking. The therapist helps the individual develop the muscle to find evidence for and against an assumption and to manage uncertainty. This helps the individual with the realization that things can be looked at from different perspectives and behaviour can be modified. CBT interrupts the feedback loop that maintains problems over time. As well, it is collaborative and action oriented. The goal of therapy is not simply to feel better but to develop tools to cope with future problems. 

Scientists are encouraged by the results of neuroimaging which shows that therapeutic treatment has neurobiological effects. This helps us understand the relationship between symptoms, emotional regulation, and behaviour better. 

So How Does CBT Change the Structure of the Brain?

Let’s look at the results of a neuroimaging study examining the effects of CBT on social anxiety which can lead to drinking. 18 individuals were assessed and randomized for treatment with an antidepressant called citalopram, CBT, or a waiting list. CBT focused on cognitive restructuring, bibliotherapy, and exposure. There was no difference between the CBT and citalopram groups. Participants were assessed in a public speaking task, which activates social anxiety. Bilateral regional blood flow was assessed in the amygdala, hippocampus, and the anterior temporal cortex and there were significant reductions in regional blood flow to these areas after treatment with CBT, which meant that the patients had decreased symptoms and showed overall improvement.

CBT changes the structure and pathways of the brain. For instance, the limbic response, which is associated with emotions and triggers, was linked to long-term clinical outcomes. Other studies including phobia, OCD, and panic show promising results related to areas of the brain which become activated by disease, and this strengthens the evidence for treatment in substance use disorder. Behavioural therapies are associated with reductions in substance use and increased cognitive control, management of impulsivity, motivation, and attention.

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Virtual Care

“In-person appointments are more effective.”

“Seeing my therapist or doctor online won’t give me the same support.”

“I might as well hold off on appointments until I can see my therapist face-to-face again.”

Many individuals have been skeptical about having virtual appointments as they are under the impression that they are not receiving the same care or that emotions might not be portrayed accurately. 

The aim of virtual care is to maximize the efficacy and quality of patient care. Virtual care is not a new concept but across the globe, people have unequal access. Canada is behind many other nations when it comes to this effective and accessible form of care. It’s a concept which has been put to practice around the world and the U.S. is cutting edge when it comes to virtual healthcare. The Kaiser Permanente system cares for 12 million health plan members and reports from 2017 highlight that about one half of all connections between patients and the healthcare team were virtual. 

Of the 85.5 million virtual contacts: 

But in Canada, the growth of telehealth and virtual care is slower moving. While COVID-19 has accelerated the emphasis on virtual care as a part of Canadian healthcare, the integration of virtual practices lag. 

Despite the delay to integrate virtual care, Canada was a pioneer in this clinical practice. Dr. Maxwell House of Memorial University of Newfoundland used telehealth to reach patients in remote sites throughout the province in the 1970’s. Canadians have placed increased emphasis on developing education and infrastructure to support virtual care, as The World Health Organization (WHO) has stated that there will be a global shortage of 18 million health workers by 2030. One strategy to circumvent this deficit is digital health. A survey of 27 countries found that although 10% of individuals polled had used virtual care, 44% had an interest in trying it. Virtual care has the potential to change the burden of chronic illnesses, according to WHO, 80% of which can be eliminated with early prevention. 

The biggest benefit of virtual care is that it removes barriers to access including common road blocks such as accessibility, affordability, geographical distance, travel burden, and out of pocket expenses. For people who live in rural areas or wish to consult with specialists at a distance, it offers unique opportunities for more specialized care. When it comes to substance use and mental health, virtual care enables the patient to seek support without the stigma of leaving work and taking big chunks of time out of their schedule which leave them feeling vulnerable to judgment from management. Virtual healthcare may be more challenging for the elderly or those with less experience when it comes to technology and this is an important consideration. 

Only 1 in 10 companies have adopted virtual care technologies into their benefits plans. In contrast, 71% of employees state that they would access virtual care if it was available. Virtual care can change the workplace. It increases productivity and wellbeing and prevents costly downstream events through a prevention and early intervention model that bypasses the delay to treatment. 

So how can you get ready for your virtual care appointment:

Virtual care gives you the opportunity to stay on top of your health and connect with specialists from anywhere. Prevention can make the difference in your substance use and connecting with ALAViDA is a great place to start.

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How is Alcohol Absorbed in the Body?

The feeling of having a drink is familiar: warm belly, light head, calm nerves, and relaxed muscles. Your past sensations while drinking give you a sense of how long the drink has been in your bloodstream and how long it will remain. You can likely discern how long you should wait before driving and what time you’re likely to fall asleep. You know roughly how many drinks it takes before it’s harder to walk in a straight line or to put together a coherent sentence. But what about the science of how alcohol is metabolized in the body? 

Alcohol is classified as a depressant; it is referred to in this way because it depresses the nervous system. This mechanism of action leads to slurred speech, wobbly movements, altered perceptions, and changes in the ability to think, judge and react. Alcohol directly affects the front part of the brain – the cerebral cortex – inhibiting our ability to use judgment, as well as the hippocampus where memories are formed. That is why you might forget parts of the evening when you engage in heavy drinking. Additionally, alcohol affects the amygdala which is responsible for social behaviour, the cerebellum which is in charge of balance and coordination, and the hypothalamus which keeps appetite, temperature, pain and emotions in balance. 

Alcohol has a short stay in the body. Once it enters your bloodstream, your body metabolizes alcohol at a rate of 20mg per deciliter (mg/dL). To put that into perspective, if your blood alcohol level was 40mg/dL, it would take two hours to metabolize the alcohol consumed. The rate at which alcohol is felt or metabolized depends upon individual factors. This comes down to blood alcohol concentration or (BAC), which is a measure of the amount of alcohol in your blood in relation to the amount of water in your blood. Some of the factors that impact your BAC and how you respond to drinking alcohol are:

What happens when alcohol enters the body?

Alcohol first travels to the digestive system. Unlike food, 20% of alcohol from a drink goes to the blood vessels, meaning that it is carried to your brain. The remaining 80% goes to your small intestine and into your bloodstream. The last step is that alcohol is taken out of the body through the liver and any deficit in your liver may slow this process down. 

Another key factor in determining how long it will take to metabolize alcohol is to know how much alcohol is in your drink. Generally, it takes one hour for one serving of alcohol to be metabolized, which is the equivalent of 5 oz of wine, 12 oz of beer, or 1.5 oz of liquor. 


How can you reduce the effects of alcohol?

It’s important to take into account all of the factors that affect your body’s absorption of alcohol. Safety and moderation are the best approach.

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The Connection Between Alcohol and Cancer

Nearly 1 in 2 Canadians is expected to develop cancer in their lifetime and the effects can be devastating. If you’ve watched a family member battle cancer, maybe you’ve wondered about whether you share their genetic predisposition. This fear can lead you to examine whether external factors like diet, exercise, and environment might play a role in your chance of developing cancer. But how often do you think about alcohol consumption in relation to cancer? Science shows that alcohol can be a contributing factor in the development of certain kinds of cancer, including cancers of the mouth, throat (pharynx), voice box (larynx), esophagus, liver, colon and rectum, and breast. If you haven’t thought about the connection between alcohol and cancer before, you’re not alone; 7 out of 10 North Americans are unaware of this link because alcohol is so intertwined in our social lives that we don’t think twice about it. 

Alcohol is a part of our culture. It’s ingrained in the way we connect and it helps us to feel comfortable and confident in social interactions. Many people don’t realize the long-term effects of alcohol and often the short term gain is not worth the health risks. Instead, we might take a reactive approach to our problems, including our health, but with a proactive approach, you can prevent alcohol-related cancers. To drive this home, another perspective you can consider is your dental health. While it can be a pain to brush and floss regularly, or to visit the dentist several times a year, it pays off in comparison to having to get a cavity filled. Checking in with your substance use can be similar to flossing your teeth, you may want to floss twice a day, or you may want to do so several times a week but your preventative and mindful approach will pay off in the long run. 

So what are the stats on alcohol and cancer?

The more you drink, the greater the likelihood that you will develop cancer and the more serious the cancer will be. Those who drink two to three drinks or more per day are most at risk. Even if you don’t drink much, say, a few drinks a week, your risks are higher than for non-drinkers. Alcohol increases your risk to develop cancer in seven parts of your body and the most common type of cancer that alcohol causes is called squamous cell carcinoma, it lives in the lining of your esophagus. Colon and rectum cancer is also common and people who engage in heavy drinking have a 44% higher probability of getting colon or rectal cancer than those who choose not to drink. The risk of getting breast cancer is also increased in proportion with the amount of alcohol consumed weekly. 

So why is alcohol harmful? 

  1. DNA mutation: Alcohol has inflammatory properties and particularly, it has this effect on your organs and tissues. In defense, your body responds by trying to repair itself and this can lead to mistakes in your DNA which cause cancerous cells to grow. 
  2. Hormones: In women, alcohol can increase estrogen levels, which is a risk factor that can lead to the growth of cancer cells. 
  3. Toxic Chemicals: When your body processes the ethanol in alcohol, it makes a compound. Researchers believe that this compound causes cancer. 
  4. Nutrients: Alcohol compromises your immune system and it makes it more challenging for your body to absorb key vitamins which pose a cancer risk. These vitamins include B vitamins and folate, among others. 
  5. Weight Gain: Alcohol has sugars and carbohydrates that can lead you to put on weight and being overweight is a risk for developing cancer. 

As evidence and research continues to develop when it comes to alcohol and its role as a risk factor for cancer, one thing is for sure: the less alcohol you drink, the less risk you have of alcohol-related cancer. Studies have confirmed that the most serious risks come from drinking four or more drinks per day. It’s important to remember that many of us drink more than a 1.5 ounce shot of liquor, 5 ounces of wine or 12 ounces of beer. So, it’s possible that you’re drinking outside of the limits that you set for yourself. Change doesn’t need to happen all at once but becoming mindful of the impact that alcohol can have on your body is an integral step to taking charge of your health. When it comes to cancer and alcohol, knowledge is power. 

It’s so easy to lose sight of what counts as one drink. Canada’s low risk guideline simplify the process of defining your limits. 

A drink means: 

Taking care of your limits reduces your long-term health risks. For women that means:

For men, the limits are:

It is useful to:

Sometimes zero is the limit: 

Safe drinking tips: 

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The Effect of Alcohol on Diabetes / Les effets de l’alcool sur le diabète

13% of North American adults have diabetes and that’s not including those who are pre-diabetic or at risk. It takes concerted effort, planning, and grit to manage your sugars. While many of us go through stages of wanting to reduce our sugars, there’s added pressure, temptation, and stress when there isn’t a choice around consuming sugars. Still, you might make the decision to cut out cake and chocolate – obvious candidates – but forget that while drinking, you also consume sugars. Drinks often slip under the radar when it comes to maintaining balanced glucose levels and for those who struggle to keep theirs under control, drinking can be a way to relax. This oversight can be costly to health. Not only are there substantial calories in alcohol, but there is a lot of sugar. 

Alcohol is made from natural sugars and starch and the number of calories depends on the fermentation process specific to the kind of alcohol you are consuming. The calories in alcohol are empty calories, meaning they don’t have any nutritional value. It’s easy to write off drinks and focus your successes on the way you abstain from unhealthy food choices but drink calories add up. For instance, one gram of alcohol contains seven calories and one gram of fat contains nine calories. Keep in mind that when you’re drinking hard liquor, it’s common to add in other sodas and drinks with added sugars. 

Let’s break down the calories and sugar content in common alcoholic beverages. 

You might drink a cider each evening to wind down while talking to a friend on the phone and you probably don’t even think about it. 

You might not even put that much in a picture of lemonade. So, if your sugars are off kilter and you feel foggy and low energy the morning after drinking, you know the culprit. If you choose to drink, your best bet for an option with the lowest sugar content is a glass of red wine or a beer.

Alcohol starts to affect your body the moment you take your first sip. While it may feel as if the occasional drink isn’t a concern, the cumulative effects of drinking wine, beer, or spirits over a prolonged period can negatively affect your health. It’s not just about putting that extra sugar in your body but instead about the way that alcohol affects your body’s ability to process sugar. Drinking alcohol affects your pancreas and liver, and your pancreas is responsible for keeping balanced sugar levels in the body. Drinking too much can take its toll on the pancreas, which can cause an imbalance in your blood sugars and lead to increased diabetes-related complications.  

Aside from the direct impact on blood-glucose levels, consuming less sugar can make you feel better. It can be hard to find a compelling enough reason to reduce sugar but at ALAViDA, we get an inside look at how members feel at the start of their program and when they leave the program. At that point most have reduced their drinking and sugars and it shows. Many members feel increased energy and desire to exercise, as well as experiencing weight loss. When you know the sugar content of alcohol, it empowers you to make choices about how you consume your sugars and you might find that you prefer the occasional piece of cake to a bottle of wine. 

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Les effets de l’alcool sur le diabète

13 % des adultes nord-américains sont diabétiques, sans compter les personnes pré-diabétiques ou à risque. Il faut des efforts réfléchis, bien planifier et avoir du courage pour bien gérer sa glycémie. Beaucoup d’entre nous souhaitent réduire leur consommation de sucre, mais la pression, la tentation et le stress augmentent lorsque nous n’avons pas d’autre choix que de consommer du sucre. Tu peux décider d’éliminer les gâteaux et le chocolat – c’est ce qui semble le plus évident – mais n’oublies pas qu’en buvant, tu consommes aussi du sucre. On ne pense pas forcément aux boissons alcoolisées lorsque l’on essaye de maintenir un taux de glucose équilibré et, pour ceux qui ont du mal à contrôler le leur, boire peut être un moyen de se détendre. Cette négligence peut être coûteuse pour la santé. Non seulement l’alcool contient beaucoup de calories, mais il contient aussi beaucoup de sucre.

L’alcool est fabriqué à partir de sucres naturels et d’amidon et le nombre de calories dépend du processus de fermentation propre au type d’alcool que tu consommes. Les calories contenues dans l’alcool sont des calories vides, ce qui signifie qu’elles n’ont aucune valeur nutritionnelle. Il arrive souvent que l’on n’accorde pas d’importance aux boissons alcoolisées et que l’on se concentre uniquement sur le fait de s’abstenir de consommer des aliments malsains, mais les calories des boissons s’additionnent. Par exemple, un gramme d’alcool contient sept calories et un gramme de graisse en contient neuf. De plus, lorsque l’on boit de l’alcool fort, il est courant d’ajouter d’autres sodas et boissons contenant des sucres ajoutés.

Examinons de plus près les calories et la teneur en sucre de certaines des boissons alcoolisées les plus courantes.

Il est possible que tous les soirs tu boives un cidre pour te détendre tout en parlant avec un ami au téléphone et il est probable que tu n’y penses même pas.

Tu ne mets peut-être même pas une quantité aussi importante dans une limonade. Si ton taux de sucre n’est pas équilibré et que tu te sens dans le brouillard et sans énergie le lendemain matin lorsque tu as bu, tu connais donc le coupable. Si tu décides de boire, les boissons avec une teneur en sucre plus faible seraient un verre de vin rouge ou une bière.

L’alcool commence à affecter ton corps dès la première gorgée. Bien que l’on puisse avoir l’impression que la consommation occasionnelle d’alcool n’est pas un problème, les effets cumulatifs de la consommation de vin, de bière ou de spiritueux sur une période prolongée peuvent avoir des répercussions négatives sur ta santé. Le problème n’est pas seulement l’apport de sucre supplémentaire dans ton corps, mais c’est surtout la façon dont l’alcool affecte la capacité de ton corps à traiter le sucre. La consommation d’alcool affecte le pancréas et le foie, et le pancréas est responsable de l’équilibre des niveaux de sucre dans l’organisme. Une consommation excessive d’alcool peut avoir des conséquences néfastes sur le pancréas, ce qui peut provoquer un déséquilibre de la glycémie et entraîner une augmentation des complications liées au diabète.

Outre l’impact direct sur la glycémie, consommer moins de sucre peut te faire te sentir mieux. Il est parfois compliqué de trouver une raison suffisamment convaincante pour réduire la consommation de sucre. À ALAViDA, nous demandons à nos membres comment ils se sentent au début et à la fin de leur programme. Lorsqu’ils terminent, la plupart d’entre eux ont réduit leur consommation d’alcool et de sucre, et cela se voit. Beaucoup d’entre eux se sentent plus énergiques, ont envie de faire de l’exercice et ont perdu du poids. Le fait d’être au courant de la teneur en sucre de l’alcool te permet de mieux contrôler ta consommation de sucre, et tu te rendras peut-être compte que tu préfères une part de gâteau occasionnelle à une bouteille de vin. 

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Genome BC Invests in ALAViDA


Vancouver, Canada — Heavy drinking is associated with the risk of developing health problems such as mental and behavioural disorders, including alcohol dependence, major noncommunicable diseases such as liver cirrhosis, some cancers and cardiovascular diseases. It is also associated with injuries resulting from violence and road collisions.

Many believe 12-step intervention programs, such as Alcoholics Anonymous are the only way to overcome addiction. While this traditional treatment approach may be effective for some, it may not work for everyone. Decades of mounting scientific evidence show therapeutic and pharmaceutical interventions can be also effective.

To broaden support and accessibility for treating addictions, Genome BC has invested in BC based ALAViDA Health Ltd.— a Vancouver based digital health company that offers a new approach to treatment and an alternative to 12-step programs.

Read more here. Also featured on Markets Insider and Newswire.

Genome British Columbia  leads genomics innovation on Canada’s West Coast and facilitates the integration of genomics into society. A recognized catalyst for government and industry, Genome BC invests in research, entrepreneurship and commercialization in life sciences to address challenges in key sectors such as health, forestry, fisheries and aquaculture, agrifood, energy, mining and environment. Genome BC partners with many national and international public and private funding organizations to drive BC’s bioeconomy.

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Pills Can Help People Control Risky Drinking, So Why Aren’t Doctors Prescribing Them?

There are medications that help people curb their drinking. Why aren’t they used as part of alcohol treatment programs, and why don’t we hear more about them?

Check out this article from the National Post to find out how this medication has helped a woman (and many more) go from heavy to social drinking.

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How can Medication Help you Curb Cravings for Alcohol? [Testimonial]

Endorphin-blocking medications have been around since 1990s when the Food and Drug Administration approved its commercialization (Carmen, Angeles, Ana, & María, 2004). Although this type of medication has proved to be really effective in helping people curb their drinking, not many people are familiar with it. One core reason is due to the fact that general practitioners don’t feel confident in prescribing it or had much training with it (Mark, Kranzler, & Song, 2003). In addition, most programs and treatments for heavy drinking are based on abstinence, which doesn’t leave space for this type of medication as they work best when taken before drinking alcohol (Heinälä et al., 2001; Rubio et al., 2002). But this has been changing and we see a shift in the way addiction is treated, with the rise of harm-reduction-based treatments and programs (Marlatt & Witkiewitz, 2002).

When abstinence isn’t an option – for various reasons such as work, social environment, personal preferences and lifestyle – harm-reduction is an effective way to tackle heavy drinking (Witkiewitz & Marlatt, 2006). By gradually reducing the alcohol consumption, rather than going ‘cold-turkey’, withdrawal symptoms are less likely to occur. It also gives the brain time to adjust to a new behaviour: drinking 1 to 2 glasses of wine on one occasion instead of a bottle of spirits. Going into the details, endorphin-blocking medications block the dopamine receptors, so the euphoric sensation that comes from drinking alcohol is neutralised. To learn more about how this particular type of medication works, and its impact on the lives of those struggling with heavy drinking, check out the interview CBC Ontario gave on the topic – it’s eye-opening.

We recommend taking the time to hear the whole thing, but if you don’t get a chance, we’ve curated below some of the testimonials from professional and participating guests that have had experience with prescribing or taking endorphin-blocking medications to treat heavy drinking.

“[This type of medications] really help people reduce the amount they drink and sometimes stop altogether, as well as all the harms that are associated with alcohol. This is an area of great opportunity for the medical system to help support folks who are struggling with these Alcohol Use Disorders, from the mild to moderate and severe spectrums. “ Dr. Chetan Mehta, Toronto

“The evidence shows that for people who are on this medication on a daily basis, about 1 in 9 people at the end of 12 months will have completely stopped drinking. And for the people who are still drinking, there is a sizeable reduction.”  Dr. Chetan Mehta, Toronto

“Naltrexone has really changed [my partner’s] life. He used to drink enormous quantities of alcohol, a bottle at a time, of vodka or other spirits. (…) It came to the point where he almost died one time from alcohol poisoning. And having Naltrexone has given him that edge. It’s incredible. At Christmas, there was no alcohol. Nobody was worried about alcohol. He wasn’t worried about alcohol. It was a really good Christmas.” Grace, Ontario

“Taking the pill on its own will do quite a bit of work but sometimes that’s not enough. [The medication] can definitely be an important part of therapy. It can really help people engage in other parts of the non-medical therapy, once they have a little bit of their edge curbed from alcohol use.” Dr. Chetan Mehta, Toronto

“Since 2016 I’ve been on Naltrexone for Alcohol Use Disorder. It’s been just a miracle for me. I was a chronic abuser of alcohol for about 10 years. I have watched Claudia Christian’s TED Talk and read the book “The cure for alcoholism”. I have taken that to my family doctor, and she refused to prescribe [the medication] (…)I had to go to a methadone clinic to get my hands on it. At this time at work, I was missing a lot, I was destroying my relationship with my life partner, and it got pretty ugly.” Alison, Stratford

“I didn’t ever think that [abstinence] would be a realistic expectation for me. Substance Use Disorders are in both sides of my familial tree and I’m still quite young so the idea of abstaining from something so socially available, accepted and even celebrated, normalized for almost 70 years, was unimaginable. The idea of being able to, if I wanted was very intriguing.” Alison, Stratford

Sometimes, hearing it from other people might be the little nudge we needed to take action. Other times, the information just sits there until we’re ready to make a change. Whatever the case might be, the evidence is there, and we hope that this interview will invite others to join us in reducing barriers to getting treatment. Heavy drinking is one of the leading risk factors for death and disability, and science-based solutions can help those who are at risk, wherever they find themselves on the spectrum. To listen to the whole interview, click here.

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References: [1] Heinälä, P., Alho, H., Kiianmaa, K., Lönnqvist, J., Kuoppasalmi, K., & Sinclair, J. D. (2001). Targeted use of naltrexone without prior detoxification in the treatment of alcohol dependence: a factorial double-blind, placebo-controlled trial. Journal of clinical psychopharmacology, 21(3), 287-292. | [2] Mark, T. L., Kranzler, H. R., & Song, X. (2003). Understanding US addiction physicians’ low rate of naltrexone prescription. Drug and Alcohol Dependence, 71(3), 219-228. | [3] Marlatt, G. A., & Witkiewitz, K. (2002). Harm reduction approaches to alcohol use: Health promotion, prevention, and treatment. Addictive behaviors, 27(6), 867-886. | [4] Rubio, G., Manzanares, J., Lopez-Muñoz, F., Alamo, C., Ponce, G., Jimenez-Arriero, M. A., & Palomo, T. (2002). Naltrexone improves outcome of a controlled drinking program. Journal of substance abuse treatment, 23(4), 361-366.

Alex Lee is a doctoral candidate in social work (DSW C), a licensed clinical social worker (LCSW) and Clinic Director at Alavida Health. He has over ten years of experience in designing, facilitating, and evaluating evidence-based interventions for individuals and families. Alex is trained in addressing mental health issues, trauma, and substance use and has overseen large-scale mental health services for Navy Medicine and the Red Cross. He also served as the interim Clinical Director for the Department of Mental Health and Statewide Clinical Director for Developmental Centers in California and Nevada.

From Heavy Drinking to Sobriety with Alavida: My Journey Using Naltrexone. [Testimonial]

When I enrolled in Alavida, one of my biggest questions was naturally how the medication would work. I’d done a little research before enrolling, just to see what I could find online. I’d read about the Sinclair Method, which is the practice of taking naltrexone shortly before drinking, rather than taking it daily. The internet seemed to agree that was the most effective medical approach. There seemed to be broad agreement that naltrexone had been well-tested and presented little danger of serious side effects. And it was FDA-approved. So I decided to be my own guinea pig. I wanted it to be true, but the burden of proof was squarely on Alavida. I’m a skeptic by nature.

The onboarding process began with a phone call. The medical directions were pretty simple:

  1. Take a pill at least an hour before drinking.  
  2. Don’t drink liquor because naltrexone is less effective against it.
  3. If you are still drinking after six hours, take another dose.

They were careful to emphasize that naltrexone is not a magic pill that makes desire disappear, and that only 30-40% of people have success with medication only. However, with counseling and coaching, it could be as high as 70%. I soon had my first virtual session with my Alavida physician. We also reviewed the instructions for taking naltrexone and how it was supposed to work to gradually diminish the brain’s reward response from alcohol. After all that preview, I was eager to get started.

I put in my order at the local pharmacy and picked up my prescription soon thereafter. I knew I was unlikely to feel a big shift immediately. And that was true. Initially, I could not detect any difference in how I felt or reacted to alcohol. But of course, I stuck with it, keeping a “wait and see” attitude. After a couple weeks, I had my first video conference with my counselor. He confirmed I was taking my naltrexone and asked if I’d experienced any side effects. I had not. I also wasn’t sure if it was working or not. My drinking had declined a bit, but that may have been influenced by my counseling or simply the desire to drink less that got me into the program in the first place.

A few weeks into the program, my wife and I were having a date night. I’d nursed a few glasses of wine over the period of many hours. Out of habit, I poured myself a fourth glass around the beginning of a movie, and for pretty much the whole movie, I let it just sit there. I’d glance at it every once in a while, to observe it was still there, untouched. At a certain point, it occurred to me that might be the medication working. At the end of the evening, instead of finishing my drink, I poured it back into the bottle. That was oddly satisfying. 

Throughout the program, my results were a bit cyclical. Like before the program, I’d go through a phase of strict adherence to a regimen, a phase of backsliding and then a phase of correction. But those indulgences became briefer and less indulgent. In a conversation I had with my Alavida counselor, he noted that naltrexone may affect your brain’s physiological craving, but it doesn’t change your psychology. That seemed about right to me. It doesn’t make you never want alcohol again, but it does seem to make it easier to say no.

One more thing about taking naltrexone. I’m now out of the program. My Alavida physician was able to continue renewing my prescription, so supply hasn’t been a problem. I’m actually in abstinence mode right now, so my supply is in steady state, but if/when I decide to try moderation again, it’ll be a comfort to have my naltrexone there to help keep me on track.

[Editor’s note: the links above have been added for clarity.]

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Aaron is a former Alavida client that has volunteered to share his experience with the medication he was prescribed during his treatment. His identity has been protected for privacy reasons.