March 12, 2005
Having recently talked to many substance abuse councilors, I have decided to put an area on my website for them. I have done this because it is my belief that I have something to contribute in regards to the problem of alcoholism. What I teach about alcoholism may apply to other addictions to some extent. I have attached four modules lasting one hour each that are PowerPoint presentations. These are also available through the Continuing Education Universe of Medical Services at www.ceuhs.com. These modules expand on my concept of alcoholism as a metabolic disorder with a psychosocial contribution. The metabolism in alcoholics is disrupted by nutritional imbalances as well as neurotransmitter deficiencies that involve a variety of compounds. No simple antidepressant will significantly change the success rate of alcohol treatment and psychotherapeutic measures have only a limited success. In my opinion the poor outcomes occur because the alcoholic has, in the immediate post detoxification state, a residual organic brain syndrome with special deficit in abstract conceptualization. In other words, talk therapy doesn't usually work with a toxic, malnourished brain. Improve that early on, aggressively and specifically, and you have a better change to get through to him.
Another concept that appears outmoded is to blame the patient and basically talk him out of abusive behavior. Though other addictions may not follow the same trend, alcoholism (as opposed to alcohol abuse) has a strong genetic trend. Genetics is at least 50% of the problem according to the National Institute of Chemical Dependency. It may be best to look at alcoholism in the same way as diabetes with "horns". Diabetics do best when they follow nutritional rules. So do alcoholics.
In my slides, I have stressed outcomes of both the conventional model as it is practiced today as well as the metabolic model. There are now enough pilot studies using this new model to reinforce my belief that the success rate of treating alcoholics can be at least doubled. Interestingly this model does not replace the conventional model. The metabolic model must be added like a module on top of the existing disease-psychosocial model.
It is my hope that this dual protocol will translate not into more successes in treatment, but cause a positive economic impact with Federal, State and County governments as well as industries. The current total cost of alcoholism in this country is $276 billion per year. This is more than heart disease, diabetes and cancer combined. Yet much less money is being diverted to fund research in substance abuse that these three disorders.
Alcohol contributes to many other diseases including atherosclerosis, cancer and diabetes. Alcohol abuse during pregnancy provides us with fetal alcohol syndrome in our children, the most common preventable cause of metal retardation. If State legislatures can see improved outcomes, perhaps they will divert some of their money now going to more prison facilities and invest in a realistic and optimistic outlook for the 18 Million alcoholics.
The problem is, who will carry through the change? Will our friends, the dieticians. Will they be common participant and partner to the councilor in the outpatient treatment programs? Will a subset of existing substance abuse councilors add the knowledge to enforce the change? The latter may be better from an organizational point of view. Either way neither group is currently equipped to offer advice without proper training. It is hoped that these PowerPoint modules serve as an introduction to my concepts. I was privileged to know some of the pioneers of these concepts. Men like Linus Pauling PhD and Roger Williams PhD. Those interested in following up should contact me in writing. My business address on this website. I will act as a catalyst and help.
Sincerely,
Stevan Cordas DO MPH