Alcohol Treatments and Rehabilitation Programs

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Medical intervention for drug addicts is part of achieving social normalisation. Choose a drug addiction (e.g. tobacco, alcohol, heroin, amphetamine or marijuana). Explore methods of treatment for this drug addiction within medical establishments and problems faced. What are the most effective methods and what might improve success rates of rehabilitation?

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During the ancient times alcohol consumption was basically used for medical purposes. The use of alcohol is popular in many societies, and its influences differ significantly with consumers. This trend is not only common in adult population, but also in adolescents. Although, it is often difficult to differentiate between casual drinking and alcohol abuse, continuous abuse of alcohol is often influenced by socioeconomic, mental and environmental factors, which can be life-threatening. Furthermore, alcohol can lead to potential physical disabilities and increase risks for social violence.Prolong consumption of alcohol can have harmful effects on the mental health and other important system in the body of consumers. This essay will examine different methods of alcohol treatments used in alcohol addiction such as drug treatment and non-pharmacological treatment. It will argue that the most effective treatment is Naltrexone. In addition, it will also argue that effective behavioural therapies will improve success rate of rehabilitation for alcohol dependents.

In the 19th century, alcohol was popular among the Australians, especially in New South Wales, but during 1980s, alcohol consumption was as low as two Litres per head. On the other hand, it increases to three Litres per head. Since ages ago, alcohol intake was mainly focus in Australian male beer drinking culture. Financial pressures have not been the only influences on drinking patterns but also moral and social changes. As a result to this, many women started consuming alcohol as well and there was drinking culture changes in Australia (National Drug Strategy, 2001). At some point, in 20th century high demand on alcohol lead to change in liquor store close up earlier at six p.m. However, it does not work out as the alcohol dependence addict against this rule. In 1982 alcohol use in Australia was 9.8 Litres per head but it drops to 7.5 per head in 1988 and 1993. The average age group in men that started drinking alcohol is 16 years old to compared with women. An additional, women of all ages consume a smaller amount of alcohol contrast with men or could be non-drinker. Mostly, women like better to drink wine and men regularly choose to drink beer. Binge drinking to intoxication and are common in adolescent. It is defined as having more than seven drinks in male and more than five drinks in female. As a result, binge drink is common between current age group and from community (National Drug Strategy, 2001)

There are a number of ways to treat patients with alcohol problems. These include; pharmacotherapy, psychosocial and motivation treatments. The first treatment in alcohol addiction refers to pharmacotherapy. In this therapy, there are three main drugs that are used in treating alcohol, which include; Disulfiram, Naltrexone and Methadone (Caputo, Vignoli, Grignaschi, Cibin, Addolorato, & Bernardi, 2014). The first, drug that is used in alcohol treatment is called Disulfiram. It is defined as a quaternary ammonium compound. It has been used in treating alcohol dependency for the last 60 years (Melo, Lopes, & Alves, 2014). Disulfiram has shown positive impacts in patients with alcohol dependence even through oral medication are taken (Skinner, Lahmek, Pham, & Aubin, 2014). In addition, Disulfiram was the first medication that was approval by Food Drug Administration (FDA) (Elbreder, Humerez, & Laranjeira, 2010). However, Disulfiram effectiveness depends on the capability to block the action of acetaldehyde dehydrogenises, which with alcohol ingestion sharply increases the blood absorption of Acetaldehyde according to Zindel & Kranzler, (2014). As a consequence, using Disulfiram could cause side effects such as facial flushing,headache and nausea according to Zindel & Kranzler, (2014). Furthermore, Melo, Lopes, & Alves (2014) claim that alcohol dependent may develop possible reaction after taking Disulfiram for long term such as; fatigue, delirium and also vomiting. Although this medication is frenquently used to treat alcohol patients, it can also react on the central nervous system, which inhibit dopamine as well as increasing dopamine concentration in the metabolic systems (Elbreder, Humerez, & Laranjeira, 2010). Hence, when Disulfiram is used appropraitely, it will have positive impact on patients’ health who have been depending on alohol.

Another drug which is used for alcohol treatment is Methadone, which is a synthetic opioid that is used as anti-addiction medication. Methadone is often used for residents with an opioid dependency such as; heroin, oxycodone, hydrocodone, morphine, oxymorphone, fentanyl and many more (Caputo, Vignoli, Grignaschi, Cibin, Addolorato, & Bernardi, 2014). Methadone helps to stabilise withdrawal symptoms during detoxification and helps recovering addicts manage their cravings. In addition, methadone is used in alcohol addiction treatment and can either be a short term or a longer term program. It is used to assist the detoxification process, and can help manage symptoms of recovery and support residents in maintaining sobriety. Dyer & White (1997) claim that during the intake of methadone there are general side effects such as; insomnia, sweating, painful joints and bones. In addition, it is also claimed that majority of alcohol addicts complain of constipation, dry mouth as well as depression, perhaps due to hormonal changes (Dyer & White, 1997). According to Petrakis, et al., (2006) patients will also have symptom such as, delirium and anxiety. As a result during the admistration of this medication, patients need to be monitered closely from those symptoms. Thus, methadone is use in alcohol treatment from stopping patient from having craving of alcohol and also helps patient to overcome from alcohol.

Another, drug that is used to treat patients with alcohol addictions are also treated with Naltrexone. This is a drug that is given to patients who are dependent on alcohol and is safe for psychiatric disorder patients. In addition, Naltrexone can be administered through two methods, which include patients taking through long-acting injection and the other through oral tablets (Elbreder, Humerez, & Laranjeira, 2010; Anton, et al., 2011; Galvez, Fernandez, & Manzanaro, 2013). The primary function of Naltrexone primary is to decrease chances of withdrawal symptoms and the cravings of alcohol (Littleton & Zieglgansberger, 2010). Furthermore, naltrexone is more effective for a patient with high craving (Elbreder, Humerez, & Laranjeira, 2010). According to Mark, Kranzler and Song (2003) Naltrexone it reduces the addict’s desire for alcohol consumption. Also, Caputo, Vignoli, Grignaschi, Cibin, Addolorato, & Bernardi ( 2014) state that side effects can be faced by alcohol dependent while on this medication such as, head-aches, nause and anxiety. Another side effect of this drug include; sleep difficulty, irritability and anxiety (Anton, et al., 2011). However, the advantages of using this medication is that, for the duration on this medication treatment, the patient is allowed to consume small amount of alcohol (Anton, et al., 2011). Despite, its side effects, Naltrexone can still have positve impact on alcohol dependents. Thus, Naltrexone is generally given to patients to stop the craving for alcohol, because it can be taken through oral or injection method.

Apart from pharmacological treatments, there are two non-pharmacological treatments that can assist patients depending on alcohol. These non-pharmacological treatments include; behavioural therapy and community-based rehabilitation programs. The first treatment refers to behavioural therapies. For example, a counselling and motivational interviewing with alcohol addicts can play an important role to assist patients. The advantage of using this therapy is that, it is implemented outside from health institutions, such as primary care, community centre and school (Kalapatapu, Ho, Cai, Vinogradow, Batki, & Mohr, 2014; Feinn, R, & Kranzler, 2007). In addition, behavioural therapies are principally successful in giving self confidence, changes for change, and provide the ability for some people to quit drinking on their own (Feinn, R, & Kranzler, 2007). On the other hand, financial and organizational resources are generally restricted in alcohol treatment. This means that the treatment is focused on improving and changing drinking behaviors of alcohol addicts. Also patients, who are staying in countryside, might have difficulties to get medical treatment due to time-consuming, especially to travel from distances to access the rehabilitation services. Such limitations could deny the patient from being treated. Indeed, there was alternative method to treat alcohol addiction patient via telephone, which might not need to be confronting each other, between the medical staff and client. The result from that treatment, using telephone as a technique to communicate with alcohol patient has shown positive response. In contrast, using telephone to talk to alcohol addiction cannot identify where there the patient is going through any sign and symptom such as depression during alcohol withdrawal (Kalapatapu, Ho, Cai, Vinogradow, Batki, & Mohr, 2014). In general, it is a good method to treat patient from alcohol withdrawal without worrying even though the patient is in rural area. The second non-pharmacological treatment involves community-based programs. This treatment focuses on helping alcohol patients from overcoming alcohol habits are through community rehabilitation. It is a treatment utilized to serve patients which have both mental and physical disabilities. For example, a study was done with 65 participants from State-funded vocational rehabilitation agencies to get three or four days for patients to participate in that study (Sprong, E, D, Pappas, & Melissa, 2012). The aim of community rehabilitation was to determine that this course could be effective to contribute and identify the barrier in community rehabilitation. However, from this study, 27 patients disagreed to take part in the survey. There were 23 males and 15 females who participated in this study. During the study, patients are asked to answer few question and what are likely symptoms often they encounter while on alcohol, such as vomiting, hand shaking or sleepless night (Sprong, E, D, Pappas, & Melissa, 2012). Unfortunately, this study was unsuccessful because of patients low education background, but by providing some motivational programs and counseling sessions could help achieve the aims of this community-based program (Sprong, E, D, Pappas, & Melissa, 2012). Thus, it is one of the treatments in alcohol patient that could help to live normal life.

In conclusion, alcohol is an addictive substance and can lead to many social and mental health problems when abused. However, there are various medical treatments and effective social rehabilitation programs for alcohol addiction that can play an important role to assist in recovery processes of addicts who are struggling to cope with this problem. Effective alcohol treatments and rehabilitation programs will not only reduce the rate of alcohol dependence successfully, but will also prevent other alcohol-related issues in the society.

References

Anton, R. F., Myrick, H., Wright, T. M., Latham, P. K., Baros, A. M., Waid, L. R., & Randall, P. K. (2011). Gabapentin Combined with Naltrexone for the treatment of alcohol dependence. Am J Psychiatry, 709-717.

C. B. (2000). Medical Consequences of Alcohol Abuse. alcohol research and health, 27.

Caputo, F., Vignoli, T., Grignaschi, A., Cibin, M., Addolorato, G., & Bernardi, M. (2014). Pharmacological management of alcohol dependence : From mono-therapy to pharmacogenetics and beyong. European Neuropsychoparmaology, 24, 181-191. doi:http://dx.doi.org/10.1016/j.euroneuro.2013.10.004

Desai, M. M., Rosenheck, R. A., & Craig, T. J. (2005). Screening for Alcohol Use Disorders Among Medical Outpatients: The Influence of Individual and Facility Characteristics. The American Journal of Psychiatry, 1521.

Dyer, K. R., & White, J. M. (1997). Patterns of symptom complaints in methadone maintenance patient. National Drug Strategy Postgraduate Research Scholarship, 1445.

Elbreder, M. F., Humerez, D. C., & Laranjeira, R. (2010). The use of disulfiram for alcohol-dependent and duration of outpatient treatment. Eur Arch Psychiatry Clin Neurosci, 191-195.

Feinn, C. E., R, A. A., & Kranzler. (2007). Exploring Treatment Options for Alcohol Use Disorders. National Institutes of Health, 214-221.

Galvez, P. B., Fernandez, L. G., & Manzanaro, V. M. (2013). Addressing Unhealthy Alcohol Use In Primary Care. New York: Richard Saitz.

Hulse, G. K. (2012). Improving clinical outcomes for naltrexone as a management of problem alcohol use. British Journal if Clinical Pharmacology, 632-641.

Kalapatapu, R. K., Ho, J., Cai, X., Vinogradow, S., Batki, S. L., & Mohr, D. c. (2014). Cognitive-Behavioral Therapy in Depressed Primary Care Patient with Co-Occuring Problematic Alcohol Use : Effect of Telephone-Administered vs. Face-to-Face Treatment -A Secondry Analysis. Journal of Psychoactive rugs, 37-41.

Littleton, J., & Zieglgansberger, W. (2010). Pharmacological Mechanisms of Naltrexone and Acamprosate in the Prevention of Relapse in Alcohol Dependence. The American Journal on Addictions, 53-61.

Mark, T. L., Kranzler, H. R., & Song, X. (2003). Understanding US addiction physicians’ low rate of Naltrexone Prescription. Drug & Alcohol Dependence, 71, 219-228. doi:http://dx.doi.org/10.1016/S0376-8716(03)00134-0

Melo, R. C., Lopes, R., & Alves, J. C. (2014). A Case of Psychosi in Disulfiram Treatment For Alcoholism. Hindawi Publishing Corporation, 1-4.

Petrakis, I. L., Poling, J., Levinson, C., Nich, C., Carroll, K., Ralevski, E., & Rounsaville, B. (2006). Naltrexone and Disulfiram in patient with alcohol Dependence and Comorbid Post-Traumatic Stress Disorder. Veterans Affairs MERIT grant (to ILP) and the VISN I Mental Illness Research Education and Clinical Center (MIRECC) (BR), 777-783.

Skinner, M. D., Lahmek, P., Pham, H., & Aubin, H. J. (2014). Disulfiram Efficacy in the Treatment of Alcohol Dependence : A Meta-Analysis. OPEN ACCESS Freely available online, 16.

Sprong, E, M., D, T., Pappas, & Melissa. (2012). Utilization of Community Rehabilitation Programs : Screening for Alcohol and Drugs. Journal of Rehabilitation , 13.

strategy, N. D. (2001). Alcohol in Australia : Issues and Strategies. Canberra: The National Alcohol Strategy.

Zindel, L., & Kranzler, H. R. (2014). Pharmacotherapy of Alcohol Use Disorders:Seventy-Five Years of Progress. Journal of Studies on alcohol and drugs/supplement, 79-88.

Medical intervention for drug addicts is part of achieving social normalisation. Choose a drug addiction (e.g. tobacco, alcohol, heroin, amphetamine or marijuana). Explore methods of treatment for this drug addiction within medical establishments and problems faced. What are the most effective methods and what might improve success rates of rehabilitation?

During the ancient times alcohol consumption was basically used for medical purposes. The use of alcohol is popular in many societies, and its influences differ significantly with consumers. This trend is not only common in adult population, but also in adolescents. Although, it is often difficult to differentiate between casual drinking and alcohol abuse, continuous abuse of alcohol is often influenced by socioeconomic, mental and environmental factors, which can be life-threatening. Furthermore, alcohol can lead to potential physical disabilities and increase risks for social violence.Prolong consumption of alcohol can have harmful effects on the mental health and other important system in the body of consumers. This essay will examine different methods of alcohol treatments used in alcohol addiction such as drug treatment and non-pharmacological treatment. It will argue that the most effective treatment is Naltrexone. In addition, it will also argue that effective behavioural therapies will improve success rate of rehabilitation for alcohol dependents.

In the 19th century, alcohol was popular among the Australians, especially in New South Wales, but during 1980s, alcohol consumption was as low as two Litres per head. On the other hand, it increases to three Litres per head. Since ages ago, alcohol intake was mainly focus in Australian male beer drinking culture. Financial pressures have not been the only influences on drinking patterns but also moral and social changes. As a result to this, many women started consuming alcohol as well and there was drinking culture changes in Australia (National Drug Strategy, 2001). At some point, in 20th century high demand on alcohol lead to change in liquor store close up earlier at six p.m. However, it does not work out as the alcohol dependence addict against this rule. In 1982 alcohol use in Australia was 9.8 Litres per head but it drops to 7.5 per head in 1988 and 1993. The average age group in men that started drinking alcohol is 16 years old to compared with women. An additional, women of all ages consume a smaller amount of alcohol contrast with men or could be non-drinker. Mostly, women like better to drink wine and men regularly choose to drink beer. Binge drinking to intoxication and are common in adolescent. It is defined as having more than seven drinks in male and more than five drinks in female. As a result, binge drink is common between current age group and from community (National Drug Strategy, 2001)

There are a number of ways to treat patients with alcohol problems. These include; pharmacotherapy, psychosocial and motivation treatments. The first treatment in alcohol addiction refers to pharmacotherapy. In this therapy, there are three main drugs that are used in treating alcohol, which include; Disulfiram, Naltrexone and Methadone (Caputo, Vignoli, Grignaschi, Cibin, Addolorato, & Bernardi, 2014). The first, drug that is used in alcohol treatment is called Disulfiram. It is defined as a quaternary ammonium compound. It has been used in treating alcohol dependency for the last 60 years (Melo, Lopes, & Alves, 2014). Disulfiram has shown positive impacts in patients with alcohol dependence even through oral medication are taken (Skinner, Lahmek, Pham, & Aubin, 2014). In addition, Disulfiram was the first medication that was approval by Food Drug Administration (FDA) (Elbreder, Humerez, & Laranjeira, 2010). However, Disulfiram effectiveness depends on the capability to block the action of acetaldehyde dehydrogenises, which with alcohol ingestion sharply increases the blood absorption of Acetaldehyde according to Zindel & Kranzler, (2014). As a consequence, using Disulfiram could cause side effects such as facial flushing,headache and nausea according to Zindel & Kranzler, (2014). Furthermore, Melo, Lopes, & Alves (2014) claim that alcohol dependent may develop possible reaction after taking Disulfiram for long term such as; fatigue, delirium and also vomiting. Although this medication is frenquently used to treat alcohol patients, it can also react on the central nervous system, which inhibit dopamine as well as increasing dopamine concentration in the metabolic systems (Elbreder, Humerez, & Laranjeira, 2010). Hence, when Disulfiram is used appropraitely, it will have positive impact on patients’ health who have been depending on alohol.

Another drug which is used for alcohol treatment is Methadone, which is a synthetic opioid that is used as anti-addiction medication. Methadone is often used for residents with an opioid dependency such as; heroin, oxycodone, hydrocodone, morphine, oxymorphone, fentanyl and many more (Caputo, Vignoli, Grignaschi, Cibin, Addolorato, & Bernardi, 2014). Methadone helps to stabilise withdrawal symptoms during detoxification and helps recovering addicts manage their cravings. In addition, methadone is used in alcohol addiction treatment and can either be a short term or a longer term program. It is used to assist the detoxification process, and can help manage symptoms of recovery and support residents in maintaining sobriety. Dyer & White (1997) claim that during the intake of methadone there are general side effects such as; insomnia, sweating, painful joints and bones. In addition, it is also claimed that majority of alcohol addicts complain of constipation, dry mouth as well as depression, perhaps due to hormonal changes (Dyer & White, 1997). According to Petrakis, et al., (2006) patients will also have symptom such as, delirium and anxiety. As a result during the admistration of this medication, patients need to be monitered closely from those symptoms. Thus, methadone is use in alcohol treatment from stopping patient from having craving of alcohol and also helps patient to overcome from alcohol.

Another, drug that is used to treat patients with alcohol addictions are also treated with Naltrexone. This is a drug that is given to patients who are dependent on alcohol and is safe for psychiatric disorder patients. In addition, Naltrexone can be administered through two methods, which include patients taking through long-acting injection and the other through oral tablets (Elbreder, Humerez, & Laranjeira, 2010; Anton, et al., 2011; Galvez, Fernandez, & Manzanaro, 2013). The primary function of Naltrexone primary is to decrease chances of withdrawal symptoms and the cravings of alcohol (Littleton & Zieglgansberger, 2010). Furthermore, naltrexone is more effective for a patient with high craving (Elbreder, Humerez, & Laranjeira, 2010). According to Mark, Kranzler and Song (2003) Naltrexone it reduces the addict’s desire for alcohol consumption. Also, Caputo, Vignoli, Grignaschi, Cibin, Addolorato, & Bernardi ( 2014) state that side effects can be faced by alcohol dependent while on this medication such as, head-aches, nause and anxiety. Another side effect of this drug include; sleep difficulty, irritability and anxiety (Anton, et al., 2011). However, the advantages of using this medication is that, for the duration on this medication treatment, the patient is allowed to consume small amount of alcohol (Anton, et al., 2011). Despite, its side effects, Naltrexone can still have positve impact on alcohol dependents. Thus, Naltrexone is generally given to patients to stop the craving for alcohol, because it can be taken through oral or injection method.

Apart from pharmacological treatments, there are two non-pharmacological treatments that can assist patients depending on alcohol. These non-pharmacological treatments include; behavioural therapy and community-based rehabilitation programs. The first treatment refers to behavioural therapies. For example, a counselling and motivational interviewing with alcohol addicts can play an important role to assist patients. The advantage of using this therapy is that, it is implemented outside from health institutions, such as primary care, community centre and school (Kalapatapu, Ho, Cai, Vinogradow, Batki, & Mohr, 2014; Feinn, R, & Kranzler, 2007). In addition, behavioural therapies are principally successful in giving self confidence, changes for change, and provide the ability for some people to quit drinking on their own (Feinn, R, & Kranzler, 2007). On the other hand, financial and organizational resources are generally restricted in alcohol treatment. This means that the treatment is focused on improving and changing drinking behaviors of alcohol addicts. Also patients, who are staying in countryside, might have difficulties to get medical treatment due to time-consuming, especially to travel from distances to access the rehabilitation services. Such limitations could deny the patient from being treated. Indeed, there was alternative method to treat alcohol addiction patient via telephone, which might not need to be confronting each other, between the medical staff and client. The result from that treatment, using telephone as a technique to communicate with alcohol patient has shown positive response. In contrast, using telephone to talk to alcohol addiction cannot identify where there the patient is going through any sign and symptom such as depression during alcohol withdrawal (Kalapatapu, Ho, Cai, Vinogradow, Batki, & Mohr, 2014). In general, it is a good method to treat patient from alcohol withdrawal without worrying even though the patient is in rural area. The second non-pharmacological treatment involves community-based programs. This treatment focuses on helping alcohol patients from overcoming alcohol habits are through community rehabilitation. It is a treatment utilized to serve patients which have both mental and physical disabilities. For example, a study was done with 65 participants from State-funded vocational rehabilitation agencies to get three or four days for patients to participate in that study (Sprong, E, D, Pappas, & Melissa, 2012). The aim of community rehabilitation was to determine that this course could be effective to contribute and identify the barrier in community rehabilitation. However, from this study, 27 patients disagreed to take part in the survey. There were 23 males and 15 females who participated in this study. During the study, patients are asked to answer few question and what are likely symptoms often they encounter while on alcohol, such as vomiting, hand shaking or sleepless night (Sprong, E, D, Pappas, & Melissa, 2012). Unfortunately, this study was unsuccessful because of patients low education background, but by providing some motivational programs and counseling sessions could help achieve the aims of this community-based program (Sprong, E, D, Pappas, & Melissa, 2012). Thus, it is one of the treatments in alcohol patient that could help to live normal life.

In conclusion, alcohol is an addictive substance and can lead to many social and mental health problems when abused. However, there are various medical treatments and effective social rehabilitation programs for alcohol addiction that can play an important role to assist in recovery processes of addicts who are struggling to cope with this problem. Effective alcohol treatments and rehabilitation programs will not only reduce the rate of alcohol dependence successfully, but will also prevent other alcohol-related issues in the society.

References

Anton, R. F., Myrick, H., Wright, T. M., Latham, P. K., Baros, A. M., Waid, L. R., & Randall, P. K. (2011). Gabapentin Combined with Naltrexone for the treatment of alcohol dependence. Am J Psychiatry, 709-717.

C. B. (2000). Medical Consequences of Alcohol Abuse. alcohol research and health, 27.

Caputo, F., Vignoli, T., Grignaschi, A., Cibin, M., Addolorato, G., & Bernardi, M. (2014). Pharmacological management of alcohol dependence : From mono-therapy to pharmacogenetics and beyong. European Neuropsychoparmaology, 24, 181-191. doi:http://dx.doi.org/10.1016/j.euroneuro.2013.10.004

Desai, M. M., Rosenheck, R. A., & Craig, T. J. (2005). Screening for Alcohol Use Disorders Among Medical Outpatients: The Influence of Individual and Facility Characteristics. The American Journal of Psychiatry, 1521.

Dyer, K. R., & White, J. M. (1997). Patterns of symptom complaints in methadone maintenance patient. National Drug Strategy Postgraduate Research Scholarship, 1445.

Elbreder, M. F., Humerez, D. C., & Laranjeira, R. (2010). The use of disulfiram for alcohol-dependent and duration of outpatient treatment. Eur Arch Psychiatry Clin Neurosci, 191-195.

Feinn, C. E., R, A. A., & Kranzler. (2007). Exploring Treatment Options for Alcohol Use Disorders. National Institutes of Health, 214-221.

Galvez, P. B., Fernandez, L. G., & Manzanaro, V. M. (2013). Addressing Unhealthy Alcohol Use In Primary Care. New York: Richard Saitz.

Hulse, G. K. (2012). Improving clinical outcomes for naltrexone as a management of problem alcohol use. British Journal if Clinical Pharmacology, 632-641.

Kalapatapu, R. K., Ho, J., Cai, X., Vinogradow, S., Batki, S. L., & Mohr, D. c. (2014). Cognitive-Behavioral Therapy in Depressed Primary Care Patient with Co-Occuring Problematic Alcohol Use : Effect of Telephone-Administered vs. Face-to-Face Treatment -A Secondry Analysis. Journal of Psychoactive rugs, 37-41.

Littleton, J., & Zieglgansberger, W. (2010). Pharmacological Mechanisms of Naltrexone and Acamprosate in the Prevention of Relapse in Alcohol Dependence. The American Journal on Addictions, 53-61.

Mark, T. L., Kranzler, H. R., & Song, X. (2003). Understanding US addiction physicians’ low rate of Naltrexone Prescription. Drug & Alcohol Dependence, 71, 219-228. doi:http://dx.doi.org/10.1016/S0376-8716(03)00134-0

Melo, R. C., Lopes, R., & Alves, J. C. (2014). A Case of Psychosi in Disulfiram Treatment For Alcoholism. Hindawi Publishing Corporation, 1-4.

Petrakis, I. L., Poling, J., Levinson, C., Nich, C., Carroll, K., Ralevski, E., & Rounsaville, B. (2006). Naltrexone and Disulfiram in patient with alcohol Dependence and Comorbid Post-Traumatic Stress Disorder. Veterans Affairs MERIT grant (to ILP) and the VISN I Mental Illness Research Education and Clinical Center (MIRECC) (BR), 777-783.

Skinner, M. D., Lahmek, P., Pham, H., & Aubin, H. J. (2014). Disulfiram Efficacy in the Treatment of Alcohol Dependence : A Meta-Analysis. OPEN ACCESS Freely available online, 16.

Sprong, E, M., D, T., Pappas, & Melissa. (2012). Utilization of Community Rehabilitation Programs : Screening for Alcohol and Drugs. Journal of Rehabilitation , 13.

strategy, N. D. (2001). Alcohol in Australia : Issues and Strategies. Canberra: The National Alcohol Strategy.

Zindel, L., & Kranzler, H. R. (2014). Pharmacotherapy of Alcohol Use Disorders:Seventy-Five Years of Progress. Journal of Studies on alcohol and drugs/supplement, 79-88.

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