• Take a long drive while listening to an inspirational tape, or book on tape, or your favorite music.
• Go to a 24-hour gym and work out until you feel so totally exhausted (but in a good way) that you’ll be able to fall asleep on your return home.
• Pay a visit to a church or synagogue and sit somewhere inconspicuous and just allow the peace and serenity of the religious place to fill you up. You could pray, if that’s what you feel like doing, but you don’t need to feel obligated to do so. Places of worship are for everyone – not just the regulars.
• If you’re near a beach or the mountains, go to a spot where you can listen to the waves or stare up at the stars and meditate. Now, if you’re a woman, and it’s nighttime, exercise caution. And remember that, day or night, you shouldn’t go anyplace by yourself where you feel you may be in danger. 
• Pick up a book that you’re interested in and start reading until you feel your eyelids getting heavy. Sleep in your chair, if you don’t want to go back to the marital bed. Or sleep in another room or on the couch.

Take Some Time to Reassess

You’ve just been through a huge and dramatic change in your life. By completing treatment for drug or alcohol abuse or addiction, or for addiction to compulsive gambling, overwork, eating disorders, compulsive sexual behavior, or compulsive spending, you’ve given yourself a tremendous gift – the opportunity to start over, to begin anew, free of your addiction.

Maybe it doesn’t feel that way to you right now, but that could very well be because too much has happened all at once. You can benefit by taking some time to reassess your situation.

After all, since you made the decision to get clean and sober, this is a major lifestyle change in your life. What you do and how you do it from this day forward will be markedly different from how you lived your life before.
And it can be a lot to take in.

That’s why it’s a good idea to step back, look at the items in your life that you need to address, the goals you’ve set for yourself, and the people you surround yourself with. Think of this activity as putting things in perspective. You have a goal, and that is long-term recovery. How do you get there? What are the things that you and your therapist talked about that are critical to successful recovery? What steps do you need to take, and in what order, to jumpstart your recovery?

Don’t be alarmed if you find yourself feeling overwhelmed. Write down things that come to mind, whatever they may be. Whether it’s how to get a job or assimilate back into the one you currently have, how to repair damaged relationships, get your finances back on track, adopt a healthier lifestyle, learn how to manage stress better, or find new sober friends, just write everything down.

Talk Things Over With Family

Consider the most important people in your life – your family members. Your return home after treatment is a big deal, not only to you but also to them. Don’t you think that they may have some reservations or concerns about your ability to stay clean and sober? Maybe they are worried about saying or doing the wrong thing, afraid to set you off or stir up old arguments.

There’s really only one way to reintegrate back into the family, and that’s to begin by having an honest, caring conversation with the person you’re closest to. That person may be your spouse, parent, older child or other close family member with whom you live or interact with on a daily basis. If you don’t have family, maybe it’s your best friend, your employer, or your neighbor.

Whoever you have an extremely close relationship with and with whom you share experiences, confidences, hopes and dreams is the person (or persons) you should have this conversation with.

Express first your appreciation for their support and understanding. Tell the person that you are firmly committed to your recovery and ask for their continued help and support. The closer you are – say, with your spouse – the more you can and should feel free to say what’s on your mind. It’s also quite natural to feel reluctant to talk about what you’re afraid of, or how you don’t think you’ll be able to withstand cravings and urges, but do mention concerns that you feel are critically important.

Your family is one of the two most critical components of your support network. The other is your 12-step group.

Build Your Foundation

Once you’ve arrived back home, taken time to reassess your situation, and had an initial conversation with your spouse or loved ones about your next steps in recovery, start to build your solid foundation – and build upon the strategies you learned during treatment – by going to your 12-step meetings.

One of your first priorities is to get a sponsor. The reason many in early recovery feel that their situation is stalling is that they haven’t chosen a sponsor. They may be afraid to choose one, thinking that no one wants them, or maybe they’re just inundated with all the things in their life that they have to change. That’s where your 12-step sponsor comes in.

Go to a few meetings. Try different locations, different days of the week, even different times of the day. After a week or two, you’ll start to get in the groove, to feel comfortable with a certain group, or with certain members who attend on particular days. Listen attentively to what’s going on. If you look around you, you’ll start to see who seems to have the most solid grasp on effective recovery.

How do you know who’s in effective recovery that might be a good candidate for your sponsor? Anyone who’s in recovery for at least a year without any slips or relapses that has completed all the steps and knows and lives the 12-step principles is a good place to start.

You shouldn’t feel timid or afraid to ask anyone to be your sponsor. If anything, the person will be flattered. If he or she is already sponsor to a few individuals, it’s understandable if they politely decline. And you can always change sponsors if the first one, for whatever reason, doesn’t mesh with your personality. That sometimes happens, but the remedy is to choose another person as a replacement sponsor. Just be sure that you’re not avoiding doing the work of recovery. In other words, your sponsor’s role is to encourage you to do the steps, to call you on your procrastination, to listen to your problems and support your desire to live clean and sober. He or she is not your therapist, and will not dispense counseling advice.

You’ll also build your foundation by interacting with fellow 12-step group members. Just listening to the shared experiences will be an eye opener for you. While you may think that what’s happening to you – your doubts and late-night cravings, nightmares, insomnia, temptations at work, home, or out in public, difficulties with former using friends – might be unique, they’re not. Everyone in recovery has or will experience the same types of situations. Hearing how someone else was able to deal with them effectively may spur you to think of a way to adapt their strategy or technique to fit your own circumstance.

All this helps you build your foundation for recovery. You want a rock-solid base upon which to build. Your 12-step sponsor and group members – along with your family – are that base.

Get Help to Deal With Recurring Problems

When you think about it, going to treatment for 30, 60, 90 days or longer is just the first step in the path toward recovery. Who’s to say that coming out on the other side of treatment every person has a solid grasp on everything they need to know to live a life of sobriety? Maybe some individuals have such a solid understanding and glide into recovery with no problems or recurring issues. But that’s not the case with most people in recovery.

For some, the issues are minor and easily dealt with. It could have to do with scheduling time, prioritizing responsibilities, getting needed medical attention, or going back to work, to list just a few. That’s not to say that these are always easy to handle. For some people, any one of them could be a major stressor.

But other problems may involve recurring issues – such as worsening depression, intense anxiety, suicidal thoughts, overwhelming cravings and urges, inability to sleep, and nightmares every night. There’s no sense allowing these things to continue, thinking that they’ll just go away on their own. They won’t. You need to get professional help to deal with problems that are threatening to sabotage your recovery.

If you need additional psychological counseling and have continuing care or aftercare as part of your treatment program, by all means take advantage of it. If you no longer have counseling, call the treatment center and get a referral to a therapist that you can go to for help. Ask for recommendations for free, low-cost or sliding-fee counseling that may be available as part of federal, state, or local agencies. Ask your doctor for a recommendation. But definitely get professional help so that you can manage emotional or psychological problems that are interfering with your recovery.

If you need medication to help combat anxiety or depression and your doctor prescribes it, be sure to take it exactly as directed. Don’t skip it or quit taking it because you either don’t think it’s working or feel that you don’t need it anymore. Recognize as well that it takes time for medication to work, and your doctor may need to alter the dose, brand, or frequency of the medication in order to arrive at the right prescription for you.

Find Your Spiritual Side

This next recommendation for what to do when your recovery stalls applies whether you believe in a Higher Power or God or the power of the human spirit. Every person in recovery needs to tap into their spiritual nature in order to reap maximum benefit in their new clean and sober life.

If you do believe in God or a Higher Power, go to church and pray. If it’s been a long time since you’ve been to church or synagogue, don’t let that stop you. Go and sit in the back. No one will bother you or look sideways at you. A house of worship is just that. People go there to be close to the God as they know Him. Maybe you think God forgot about you. Hint: He hasn’t. Just go and have a private conversation with your Higher Power. It’s easier than you think, and it gets easier the more you do it.

But you don’t have to physically go to church to be close to God. Talk to your Higher Power wherever you are. Say a short prayer when you wake up in the morning and before you go to sleep at night. It doesn’t even have to be a recognized prayer. Use your own words. A good suggestion is to express thanks for the gift of sobriety and for His help and blessings today.

Meditation, yoga, deep breathing exercises, watching a sunset, taking in the beauty of nature on a hike – these are other ways to find your spiritual side. What you’re really doing is getting outside yourself and your daily concerns and tapping into your inner self, your inner spirit.

Believe it or not, your spirit is a very powerful entity. Enrich your spiritual side and your recovery will begin to take off.

Have Some Fun

How long has it been since you’ve laughed? Recovery isn’t all boring schedules and tedious days filled with deprivation. Your new life can be boring – if that’s what you make it. But who wants a boring life? No one, of course. How do you make your life more interesting – and still be true to your recovery?

Start by having fun. If you have close friends who are sober, invite them over or go to a movie with them. A comedy would be a great choice. Family members that you haven’t seen for a while are a wonderful source of stories and shared experiences.

Take up a hobby or get involved in recreational activities that you enjoy. Not only will you be out and about with other people who are good for your sobriety, but you will also be doing something creative or helping yourself become more physically active and fit.

When you’re involved and enjoying what you’re doing, it’s hard to be down in the dumps or thinking that you’re not achieving this or that in your recovery. In fact, effective long-term recovery depends on you broadening your circle of sober friends, involving yourself in healthy activities, and building upon your solid foundation.

Not only that, but laughter and having a good time with close friends and/or family makes you feel good. Laughter releases endorphins, the feel-good chemical, in the brain – and it’s totally good for you.

Live in the Present

Last but not least, strive to live in the present. Today, the way you think and act, the decisions you make, the purpose with which you go about your day – that is what is most important in your recovery. Remember that yesterday is past, never to return. Tomorrow grows out of what you do today. With that in mind, live your life to the fullest, strive to do what you say and say what you do. Be thankful for your blessings, and give back to those whom you can.

Before long, you will no longer be worrying about what’s not happening in your recovery, or what’s not coming about soon enough to suit you. Instead, you will be joyous and alive and pursuing the life in recovery that you have created for yourself.

There is no one path to follow. There is no book that lays down exactly what you should think or do or say. Learning how to walk your path, follow the 12 steps as they pertain to you, and finding your strength in recovery is truly and uniquely your journey. Begin today with confidence, hope, and determination to actively work your recovery and create the life you want and deserve.

The world’s greatest men – and women – know a secret that all of us should put front and center: We must act, not sit idle. Nothing good or worthwhile ever was achieved by inactivity. How does this apply to our life in recovery? Let’s say we’ve gone through rehab and are now in early recovery. Congratulations! This is the first phase of our newfound life of sobriety.

We know we can’t just sit back and expect life to be smooth-sailing from here on out. We’ve been told – and should have listened – that it takes hard work and a lot of practice to gain a solid foothold in recovery. We may have only paid scant attention to the coping strategies or relapse prevention training and now wish that we’d been more aware. If we continue to just exist, going day to day without putting much thought or effort into it, while we may not relapse, we are more than likely not going to make much progress, either. That’s stagnation in recovery – but it can be avoided. Here’s how.

Recovery experts recommend that we keep striving to learn new things. Always have a list of things we want to find out more about. Go to different 12-step meetings to mix it up and see a fresh group of faces in between going to our home group. When we’ve achieved a sobriety milestone – 30-, 60-, 90-day, six-months, or our first year anniversary – set our sights on the next one. Take time to reflect on what we’ve done that helped us get to this milestone. These are the strategies and behaviors that we’ve selected and used to help us weather some tough times, major or minor crises, even days when nothing much at all happened. We learned how to get through lazy days and times that were boring. We practiced how to deflect probing, intrusive questions about our sobriety or unkind remarks from others who either don’t understand or don’t want us to be successful in sobriety.

But there’s still more to learn and do. In order to keep our recovery vigorous and alive, bursting with opportunity and promise, we can’t take anything for granted. Don’t just sit back and be content with the status quo. Instead, reach higher. We can and should stretch to achieve the next level. If we can dream it, we can devise a way to get there. That will keep us from stagnation and, more importantly, will keep our recovery exciting and filled with momentum.
 

The good news is, according to this News OK report, technology developments are emerging to help individuals suffering with such an addiction. And, when such technology platforms are combined with key medications, individuals may be able to more successfully overcome their addictions.

A prescription monitoring program has been put in place in Oklahoma by the state Bureau of Narcotics and Dangerous Drugs Control. This program helps to secure access to registered pharmacies and practitioners in good standing. Prescription fraud is prevented by allowing regulatory and law enforcement agencies access to the electronic system.

A drug disposal program is also getting under way in the state and disposal boxes are expected to be in place within the next week. By 2014, hospitals throughout the nation must have electronic health records set up to ease the tracking of patient care. A tie-in with the prescription monitoring program should help to eliminate doctor shopping and other manipulative efforts by prescription drug addicts to secure their next fix.

According to industry research, painkiller prescriptions throughout the nation are rising, and not all because of legitimate purposes. One in five Americans have reported chronic pain that lasts for several months or longer and Hydrocodone retail sales have risen by 178 percent, demanding regulatory change to help save addicts from themselves.
 

Dr. O’Brien believes that it is not workable to talk about "substance abuse" and "substance dependencies." Since 1986 he has been fighting to change these categories into one simply called "addiction" or "substance abuse disorder." Today he can point to some 50 studies from peer-reviewed journals to back up his opinion that the older terms are not helpful in identifying people with drug problems. He argues that the new DSM-5 should have one classification for disorders related to substance abuse and do away with "Substance Abuse" and "Substance Dependency" altogether.

Dr. O’Brien points out that a person can be chemically dependent on a drug but not be addicted. Addiction, according to Dr. O’Brien, must include the components of drug-seeking behavior, drug cravings, and wanting to overcome inner compulsions that are too big for willpower alone.

A baby, for example, can be born chemically dependent on heroin. He will have to go through a withdrawal process that includes the same symptoms that his drug-using mother endures if she too stops using heroin. The baby is not a drug addict. Another example would be people in chronic pain. They can become chemically dependent on opioid painkillers and develop withdrawal symptoms if they stop taking their drugs, but they are not drug addicts. Chemical dependency is about what drugs do to the body, and addiction also includes what they do to the mind.

"The term dependence is misleading, because people confuse it with addiction, when in fact the tolerance and withdrawal patients experience are very normal responses to prescribed medications that affect the central nervous system," said Dr. O’Brien said. "On the other hand, addiction is compulsive drug- seeking behavior which is quite different. We hope that this new classification will help end this widespread misunderstanding."

If some of the proposed changes go through, a person could be addicted not only to drugs but also to certain behaviors. The new DSM would include disorders related to use of the Internet, gambling, sex, and binge eating, for example. People suffering from these compulsive behaviors often need residential treatment and counseling to overcome forms of withdrawal and to learn how to cope with stress.

"There is substantive research that supports the position that pathological gambling and substance-use disorders are very similar in the way they affect the brain and neurological reward system," said O’Brien. "Both are related to poor impulse control and the brain’s system of reward and aggression."

The new manual changes the number of criteria needed to be diagnosed with an addiction. There would be 11 criteria used for diagnosing substance abuse disorder, including the controversial "cravings." The new version would also have "severity specifiers," which means that the more criteria you have, the more "severe" your disorder would be rated. The ratings would be mild, moderate, and severe.

Dr. O’Brien’s way of thinking is being challenged by people who believe that talking in terms of "addiction" will mean that more people get a pejorative label by society. It is one thing to go back to work after treatment for a "chemical dependency," and quite another to return after "drug addiction rehabilitation."

The University of Pennsylvania professor admits that the word "addiction" is extremely controversial. Nevertheless, he has wanted the word included since the 1987 edition of the DSM. If it is not included, he intends to demand at least one concession.

"I will insist on a definition of dependency as a normal response by everyone to repeated use of a drug," he said. And that is not the same as addiction.
REFERENCES
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (DSM-4), 1994.
American Psychiatric Association, Proposed Draft Revisions to DSM Disorders and Criteria for Diagnostic and Statistical Manual of Mental Disorders (DSM-5), posted on their website.
American Psychiatric Association DSM-5 Proposed Revisions Include New Category of Addiction and Related Disorders, New Category of Behavioral Addictions Also Proposed, official news release, February10, 2010, posted on line.

Carey, Benedict. Revising the book on disorders of the mind. New York Times, Feb. 10, 2010.

O’Brien, Charles. DSM-V Diagnostic criteria to move away from "abuse" and "dependency." Alcoholism and Drug Abuse Weekly, May 25, 2009, Vol.21, Issue 21.
 

From 1998 to 2008, the overall rate of substance abuse admissions in the United States remained stable at about 770 admissions per 100,000 people. Admissions for alcohol abuse dropped by 15 percent nationally, but remained stable in Arkansas, Iowa, Kansas, Minnesota, North Dakota, South Dakota, and Nebraska.

Admission rates for marijuana use increased by 30 percent across the nation, and were highest in the afore-mentioned states and New York, New Jersey, and Pennsylvania.

A previous SAMHSA report found that admission rates for opiate abuse other than heroin (including painkillers such as OxyContin) increased by 345 percent over the ten-year period. The latest report found that admission rates for opiate abuse (besides heroin) increased nationally and were highest in Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island, Vermont, Alabama, Kentucky, Mississippi, and Tennessee.

For methamphetamine abuse, the treatment rate increased by 53 percent since 1998, although it’s lower than it was in 2005. Admissions for cocaine abuse decreased by 23 percent across the United States.

Pamela S. Hyde, SAMSHA administrator, said that the study highlights the shifting trends in the reasons for treatment admissions, providing insight into the regional nature of substance abuse.

Source: HealthDay News, Drug Abuse Treatment Rates on the Rise: U.S. Report, December 29, 2010

John F. Kelly, lead author of the study and associate professor in psychiatry at Harvard Medical School, as well as associate director of the Center for Addiction Medicine at Massachusetts General Hospital, said that although spirituality is an important aspect of AA, it isn’t the only way to help recovering addicts.

He said that he has heard that AA is too spiritual and not spiritual enough, and that although spirituality is only one way to help recovering addicts, the study’s findings support the idea that AA works partly by enhancing people’s spirituality.

For the study, more than 1,500 adults were assessed at 3, 6, 9, 12 and 15 months into their recovery process. The study examined the participants’ attendance to AA meetings, their religious or spiritual practices, and their alcohol-use outcomes to determine whether spirituality is associated with behavioral changes.

The researchers found that there was a significant association between an increase in AA meeting attendance with increased spirituality and a decrease in the frequency and intensity of alcohol consumption over time. Interestingly, the same amount of recovery was seen in both agnostics and atheists, which suggests that while spirituality is important in behavioral change, it is not the only method used in AA.

Keith Humphreys, a career research scientist with the Veterans Health Administration and a professor of psychiatry at Stanford University, said that many people will find it surprising that alcohol-dependent individuals with little or no interest in spirituality attended AA meetings and seemed to have more success than those who already had a strong sense of spirituality. He added that this suggests that AA reaches a wider audience than people may think.

The researchers noted that although spirituality can be an important aspect of recovery, it is still unknown how these beliefs work in regard to recovery methods. Kelly said that they have found that participating in AA leads to recovery because the program helps members improve their social network, as well as their coping skills, motivation to remain abstinent, and psychological well-being.

Kelly added that it will be important to conduct more research and replicate the study’s findings to better understand how spiritual practices and beliefs can influence behavioral changes in the recovery process.

Source: Science Daily, Attending Alcoholics Anonymous Meetings May Increase Spirituality and Help Decrease Frequency and Intensity of Alcohol Use, December 14, 2010

Chemically Dependent Anonymous groups explain that the concept is uncomplicated and straightforward: they desire to help guide people toward recovery from the entire spectrum of substances that can change moods or alter behaviors.

CDA is based on the big-picture perspective that at the root of members’ “disease” is an addictive-compulsive nature. In agreement with theories that call addiction a genetic or brain chemical imbalance, members believe that using any substance that can alter their mood could trigger a relapse.

The concept behind CDA is not new; people have been battling addictions for generations. Many of the members’ philosophies are based upon the longstanding beliefs of Alcoholics Anonymous, founded decades ago to help people overcome an addiction to drinking.

Also called substance abuse or drug addiction, chemical dependence can actually involve an addiction to both drugs or alcohol, or only one substance. Once a person becomes chemically dependent, they cannot resist cravings to abuse a substance, even when it means their jobs and relationships will suffer harm. Like other diseases, chemical dependence can bring serious health consequences or become deadly.

Members of Chemically Dependent Anonymous recognize the progressive nature of addiction and the reality that maintaining recovery can be a lifelong endeavor. Similar to other 12-Step based groups, there is a strong belief that group sharing of members’ experiences creates a fellowship that heightens people’s chances for recovery. Also resembling other 12-Step based programs, members of CDA say that addicts have lost their ability to control their substance abuse and no amount of willpower alone will bring positive change.
 

Over time, the thought patterns of people addicted to mood-altering substances may become illogical and distorted, often deeply rooted in denial. The user can also quickly become unnaturally preoccupied with a substance, or go from one substance to another – a condition they can freely and confidentially discuss in Chemical Dependence Anonymous group meetings.

CDA acknowledges that many people have addictive tendencies by nature, and may have experimented with a long list of substances. Particularly as new “addictions” continue to emerge and be named, CDA members encourage people to address their addictive thought and behavior patterns themselves, rather than specific disorders.

Chemically Dependent Anonymous literature also offers the premise that if a person is honest with themselves and their patterns of compulsive behaviors, they may benefit from the fellowship of others who also struggle with addictive behaviors toward substances. The group encourages people who suffer from both drug and alcohol addictions simultaneously to seek their support and help.
 

A notable element of CDA is that total abstinence from any substance that can change or affect a person’s mood is called for in some chapters, in order to help prevent people from jumping from one addiction to the next.

Though it may be a challenging road, CDA is part of a path some recovering addicts are choosing to follow as they become more aware of lifelong addiction patterns and learn to utilize the support that is offered from others with the same experiences.

The same is true for smokers as they are not only dealing with an addiction, but also a habit. In a recent Science Daily release, a study conducted by researchers in the Oregon Health & Science University Smoking Cessation Center revealed that changes may need to be made in the way clinicians apply treatment for those who smoke.

The findings from this study suggest that current treatment theories suggesting that smoking after the planned quit day predicts a failure in treatment may need to be expanded. Such theories may need to consider a more dynamic quitting process to be effective.

In this research, the team identified two types of successful quitters: those who quit smoking immediately and stay away from the substance through the end of the treatment; and those who face delay in achieving abstinence, but eventually achieve success by the time treatment is complete.

According to David Conzales, PhD and the study’s lead author, health care providers in real-world clinic settings must determine whether or not to continue on a specific treatment path based on their clinical judgment, as well as the published reports in the scientific literature.

Both treatment specialists and patients can become discouraged when treatment is not immediately working or is perceived to not be working when the patient is unable to quit on the recommended target quit day or cannot maintain total abstinence within weeks of completed treatment. The process is then considered a failure.
 

Still, there is merit in considering whether clinical trials may prove efficacious in the prevention, treatment, or recovery from substance abuse or addiction. For many people, however, the whole arena of clinical research and trials remains a mystery. What are clinical trials? What actually happens during one? How do you apply, or do you have to be referred? How do you even find clinical trials in your area?

These are all good questions and will be dealt with shortly. The reason it’s important to understand more about clinical trials and how they may benefit individuals with substance abuse or dependence is that it’s only with full knowledge can anyone make an informed decision on whether or not participating in a clinical trial is right for them.

What are Clinical Trials?

In the basic sense, it’s fairly easy to figure out what clinical trials are just by examining the words. Clinical is an adjective that refers to medical treatment, practice, observation or diagnosis. Trial is a noun whose third accepted definition says that it is a test or experiment to determine the quality, safety, usefulness, performance, and public acceptance of the thing or process being tested. So, in this case, a clinical trial is a test of a medical treatment, practice, observation or diagnosis as to its quality, safety, usefulness, performance and public acceptance.

Fair enough – but this isn’t sufficient to give a full picture of clinical trials.

The National Library of Medicine (http://www.nlm.nih.gov/services/ctclintrial.html), of the National Institutes of Health (NIH), publishes this definition of a clinical trial:

“A clinical trial (also clinical research) is a research study in human volunteers to answer specific health questions. Carefully conducted clinical trials are the fastest and safest ways to find treatments that work in people and ways to improve health. Interventional trials determine whether experimental treatments or new ways of using known therapies are safe and effective under controlled environments. Observational trials address health issues in large groups of people of populations in natural settings.”

What Actually Happens During a Clinical Trial?

What happens during a clinical trial depends on the kind of trial being conducted. In brief, there are the following types of clinical trials:

• Treatment Trials – These test experimental treatments, new combinations of drugs, or new approaches to surgery or radiation therapy.

• Prevention Trials – As the name implies, prevention trials look for better ways to prevent disease in people who have never had it or to keep it from returning. These trial approaches may include medicines, vaccines, minerals, vitamins, and/or lifestyle changes.

• Diagnostic Trials – These trials are conducted to find better procedures or tests for diagnosing a particular condition or disease.

• Screening Trials – In a screening trial, the purpose is to test the best way to detect certain health conditions or diseases.

• Quality of Life Trials – Also known as Supportive Care trials, these explore ways to improve the quality and comfort of life for those with a chronic illness.

The clinical trial consists of a team of doctors and nurses as well as social workers and other health care professionals. These team members check the participant’s health at the beginning of the trial, give specific instructions for participation in the trial, carefully monitor the participant during the course of the trial, and remain in touch after the trial’s completion.

There are some clinical trials that involve more tests, doctor visits, procedures than an individual would normally have for a condition or illness. For all trial types, however, the participant works with a research team. Participation in a clinical trial is most successful when the protocol (study plan) is followed carefully and there is frequent contact with the research staff.

Clinical Trial Phases

There are four phases of clinical trials. In effect, these are stages of clinical trials where researchers seek answers to different questions.

• Phase I – In Phase I clinical trials, researchers test an experimental treatment or drug in a small group of people (20 to 80) for the first time in order to evaluate safety, determine a safe dosage range, and identify side effects.

• Phase II – In Phase II clinical trials, the experimental treatment or drug is given to a larger group of people (100 to 300) to see if it is effective and to further evaluate its safety.

• Phase III – In Phase III clinical trials, the experimental treatment or drug is given to an even larger group of people (1,000 to 3,000) to: confirm its effectiveness, monitor side effects, compare it to commonly used treatments, and collect information to allow the experimental treatment or drug to be used safely.

• Phase IV – In Phase IV clinical trials, post-marketing studies delineate additional information on the experimental treatment or drug, including potential benefits, risks, and optimal use.

How to Find a Clinical Trial in your Area

The best way to find clinical trials being conducted in the area of substance abuse or dependence is by using a comprehensive website such as ClinicalTrials.gov (http://www.clinicaltrials.gov/). ClinicalTrials.gov is a registry of federally and privately supported clinical trials that are conducted in the United States and around the world. Using the resources of ClinicalTrials.gov, interested parties can obtain information about a particular trial’s purpose, who may participate, locations, and phone numbers for more information.

The website currently contains nearly 94,500 trials sponsored by the NIH, other federal agencies, and private industry. Studies listed in its database are conducted in all 50 states and in 173 countries.

Use the website’s search tool to look for clinical trials by condition and area. For example, enter “Substance Abuse AND Los Angeles” to find clinical trials being conducted on this condition and in this geographic area. One recent search using these criteria resulted in listings for 90 studies. Included are clinical trials that are recruiting, not yet recruiting, active but not recruiting, and completed.

Such a search may show several clinical trials for methamphetamine dependence, for example. Research trials involving tests of various medications for the treatment of methamphetamine dependence – such as Varenicline, Bupropion, Atomoxetine, and Methylphenidate, and one trial using behavior therapy are either recruiting or not yet recruiting participants. Separate trials for the drugs Modafinil, Prometa and Perindopril in connection with methamphetamine dependence have been completed.

There is also a trial for exercise to improve the outcomes of treatment for methamphetamine users.

The fact that there are numerous trials active, recruiting, not yet recruiting, or completed for methamphetamine dependence is encouraging. Since the crystal meth scourge is sweeping America with 70 percent of the meth from Mexican drug labs being distributed within our borders, and the ravages of meth addiction are so potentially deadly, effective means of treating meth dependence are desperately needed.

But meth is just one example of clinical trials. There are clinical trials for marijuana dependency among adolescents, trials for alcoholism, opioid dependence, cocaine and alcohol dependence, schizophrenia and comorbid cannabis use disorder, mental illness and substance abuse, gender-responsive treatment for women offenders with substance dependence, alcohol and drug intervention for middle school youth, and many more.

Drill down further by clicking on the study to find out who’s conducting and sponsoring the study, the purpose, type, and design of the study, as well as further study details (primary and secondary outcome measures), enrollment number, study start date and estimated study completion date, eligibility criteria, contacts, locations, and links for more information.
For further help on how to search for clinical trials, see the ClinicalTrials.gov help topics page (http://clinicaltrials.gov/ct2/help/help) for basic search, advanced search, refine search and search expressions.

How to Get Involved in a Clinical Trial

In order to be considered for a clinical trial, or to ask questions about a particular trial, interested parties should get in touch with the contact person listed for the study on ClinicalTrials.gov. It is important to note that you cannot sign up for any clinical trial on the ClinicalTrials.gov site, since this is strictly a clinical trial database.

But the larger question is whether a particular clinical trial – or any clinical trial – is right for you or for your loved one with substance abuse or dependence. Your first conversation should be with your doctor or health care provider. He or she knows your medical history, is conversant with developments in the field – especially if this is a substance abuse treatment provider, and can give you valuable insight into the merits or potential downside of such a trial in your case.
Even if your doctor or health care provider recommends a particular clinical trial, there are still inclusion and exclusion criteria and eligibility requirements that need to be satisfied. These are based on age, gender, type and stage of a disease, previous treatment history, and other medical conditions. Note that some studies are looking for individuals with particular addictions or conditions, while others are looking for healthy participants.

Either look up the clinical trial to begin with to try to determine if you meet the requirements and then talk with your doctor about the advisability of pursuing it further, or talk with your doctor first and then search the particular trial online to find out more about the study’s eligibility requirements.

In the event that you are eligible for a particular trial, you still need to meet with the trial coordinator. Be sure to write down all the questions you have so you can ask them during the meeting. It’s also recommended that you bring a friend or relative along and tape record the meeting so that you can play the recording back later. Many times, it’s easy to forget information you’ve heard, including important facts, dates, and requirements.

Questions to Ask

You need to be as informed as possible in order to make your decision to participate in a clinical trial. While you may have other questions, here are some to definitely get answers to. Even though some of the answers may appear on the website listing, you need to hear the specifics from the study’s coordinator.

• What is the purpose of the study?
• Who will be in the study?
• Why do you (researchers) believe the experimental treatment being tested in the study will be effective? Has it been tested before? What were the results?
• What kind of tests and/or experimental treatments will be involved?
• Tell me about the possible risks, side effects, and benefits in the study compared with my current treatment.
• Tell me how this clinical trial may affect my daily life.
• How long will the trial last?
• Will hospitalization be required?
• Who pays for the experimental treatment?
• Will I receive reimbursement for any other expenses?
• What kind of long-term or follow-up care is part of this study, if any?
• How will I know if the experimental treatment is working? Will I be provided with the results of the trial?
• Who will be in charge of my care during the trial?

Informed Consent

An informed consent document will be provided by the research team to the eligible participant. In the informed consent document, the research team includes details about the study, such as its purpose, length, required procedures, and key contacts. In addition, the trials potential risks and benefits are spelled out. The potential participant can then make the decision to sign the document or not, to participate in the trial or not. The informed consent document, however, is not a legal contract. The participant may withdraw from the trial at any time.

One of your key questions that you want answered concerns the results of the clinical trial. In most informed consent documents, researchers pledge to share with you the results of the trial. In other words, they will share with you what they learned from the trial. This includes a summary of the responses of all study participants. In addition, the researcher will discuss with you results that relate to your diagnosis or that may be beneficial to you as you decide on the best treatment for your disorder or addiction.

Make Your Decision Weighing All Factors

The decision to participate in a clinical trial goes beyond meeting eligibility requirements, recommendations from doctors, family, or friends. It’s a very personal decision for most people. Although it is true that there are some individuals for whom others need to make the decision (in the instance that a person is severely impaired due to mental illness, perhaps in conjunction with substance abuse), most make the decision after weighing all the possible risks and benefits and whether they feel in their gut that this is the right choice for them.

Should you or shouldn’t you? Your best course of action is to gather as much information as you can, ask all the pertinent questions (at any time they occur to you, whether prior to or during the trial), confer with your doctor, family, and close friends, and then allow the information to sink in. Don’t rush to jump into the trial. Give it careful thought. If you are desperate for something to help you avoid recurring relapse for opioid dependence, or can’t get off meth by any other means, or alcoholism and drug use has resulted in your inability to adhere to your recovery program, perhaps participating in a clinical trial may be of benefit.

Remember, however, that there are no guarantees in clinical trials, just as there is no sure-fire outcome to any addiction treatment. If, however, you’ve weighed all the risks against the potential benefits and still feel that you want to go through with it, and are accepted, by all means go for it.

How do you think any new medication or treatment for substance abuse or dependence ever gets approved in the first place? Without clinical trials, there wouldn’t be any hope of finding more effective ways of prevention, treatment, and recovery for substance abuse and dependence.

There’s one more thing to think about in making your decision to participate in a clinical trial. This is one more example of you taking action to manage your disease, to learn how to overcome it and live a full and productive life that’s free of drugs and/or alcohol. Isn’t that worth a lot? Even if you’re long into recovery and still having recurring symptoms or difficulties, there may be a clinical trial that you can become part of that will further the research into addiction recovery. In the end, however, it has to be right for you.