Betsy Bates

SAN DIEGO — Patients with chronic spinal cord injury regained physical integrity and demonstrated advances in neurologic functioning with intensive restorative therapy, John W. McDonald, M.D., Ph.D., reported during a poster presentation at the annual meeting of the American Neurological Association.

Dr. McDonald and his associates at Washington University in St. Louis and the Kennedy Krieger Institute in Baltimore studied 57 adults whose injuries occurred at least 1 year prior to enrollment. Complete data were available for a total of 48 patients who participated in therapy for at least 6 months.

Patients who received traditional therapy for 6 months or longer (n = 22) were compared with those who spent a similar length of time undergoing activity-based restorative therapy that included at least 3 hours a week of functional electrical stimulation cycle ergometry (n = 26).

Patients who participated in restorative therapy increased the muscle mass of their quadriceps an average of 30%, while muscle fat decreased by 44%. Stimulated muscle strength increased by 78%, and relative spasticity was reduced by 47%. These measurements were obtained using a Biodex machine to generate free movement and velocity-dependent resistance while measuring response. No differences were seen in nonstimulated muscles, Dr. McDonald reported.

One-third of patients undergoing traditional rehabilitation lost 10 or more points on the combined motor and sensory score (CMSS) of an impairment scale established by the American Spinal Injury Association. Just one patient receiving restorative therapy lost at least 10 CMSS points.

The 69% of patients who responded to restorative therapy (18 of 26) gained an average of 38 CMSS points over the course of the study. Eleven of the 26 patients undergoing restorative therapy also decreased their dose of the antispasticity agent baclofen or discontinued it altogether. The same was true for just 3 of 22 patients receiving traditional therapy.

The positive results of this pilot study point to the need for the larger, randomized trial, which is scheduled to get underway in 2006 and will enroll 400 patients, Dr. McDonald said.

SAN DIEGO — Patients with chronic spinal cord injury regained physical integrity and demonstrated advances in neurologic functioning with intensive restorative therapy, John W. McDonald, M.D., Ph.D., reported during a poster presentation at the annual meeting of the American Neurological Association.

Dr. McDonald and his associates at Washington University in St. Louis and the Kennedy Krieger Institute in Baltimore studied 57 adults whose injuries occurred at least 1 year prior to enrollment. Complete data were available for a total of 48 patients who participated in therapy for at least 6 months.

Patients who received traditional therapy for 6 months or longer (n = 22) were compared with those who spent a similar length of time undergoing activity-based restorative therapy that included at least 3 hours a week of functional electrical stimulation cycle ergometry (n = 26).

Patients who participated in restorative therapy increased the muscle mass of their quadriceps an average of 30%, while muscle fat decreased by 44%. Stimulated muscle strength increased by 78%, and relative spasticity was reduced by 47%. These measurements were obtained using a Biodex machine to generate free movement and velocity-dependent resistance while measuring response. No differences were seen in nonstimulated muscles, Dr. McDonald reported.

One-third of patients undergoing traditional rehabilitation lost 10 or more points on the combined motor and sensory score (CMSS) of an impairment scale established by the American Spinal Injury Association. Just one patient receiving restorative therapy lost at least 10 CMSS points.

The 69% of patients who responded to restorative therapy (18 of 26) gained an average of 38 CMSS points over the course of the study. Eleven of the 26 patients undergoing restorative therapy also decreased their dose of the antispasticity agent baclofen or discontinued it altogether. The same was true for just 3 of 22 patients receiving traditional therapy.

The positive results of this pilot study point to the need for the larger, randomized trial, which is scheduled to get underway in 2006 and will enroll 400 patients, Dr. McDonald said.

SAN DIEGO — Patients with chronic spinal cord injury regained physical integrity and demonstrated advances in neurologic functioning with intensive restorative therapy, John W. McDonald, M.D., Ph.D., reported during a poster presentation at the annual meeting of the American Neurological Association.

Dr. McDonald and his associates at Washington University in St. Louis and the Kennedy Krieger Institute in Baltimore studied 57 adults whose injuries occurred at least 1 year prior to enrollment. Complete data were available for a total of 48 patients who participated in therapy for at least 6 months.

Patients who received traditional therapy for 6 months or longer (n = 22) were compared with those who spent a similar length of time undergoing activity-based restorative therapy that included at least 3 hours a week of functional electrical stimulation cycle ergometry (n = 26).

Patients who participated in restorative therapy increased the muscle mass of their quadriceps an average of 30%, while muscle fat decreased by 44%. Stimulated muscle strength increased by 78%, and relative spasticity was reduced by 47%. These measurements were obtained using a Biodex machine to generate free movement and velocity-dependent resistance while measuring response. No differences were seen in nonstimulated muscles, Dr. McDonald reported.

One-third of patients undergoing traditional rehabilitation lost 10 or more points on the combined motor and sensory score (CMSS) of an impairment scale established by the American Spinal Injury Association. Just one patient receiving restorative therapy lost at least 10 CMSS points.

The 69% of patients who responded to restorative therapy (18 of 26) gained an average of 38 CMSS points over the course of the study. Eleven of the 26 patients undergoing restorative therapy also decreased their dose of the antispasticity agent baclofen or discontinued it altogether. The same was true for just 3 of 22 patients receiving traditional therapy.

The positive results of this pilot study point to the need for the larger, randomized trial, which is scheduled to get underway in 2006 and will enroll 400 patients, Dr. McDonald said.

SAN DIEGO — Anemia is an independent risk factor for long-term mortality after myocardial infarction in both diabetic and nondiabetic patients, a large Canadian study has found.

Researchers at Queen Elizabeth II Health Sciences Centre, Dalhousie University, in Halifax, N.S., studied outcomes in 7,466 patients who were admitted with acute MI.

Of these, 1,431 had anemia but no diabetes, 1,646 had diabetes but no anemia, and 964 had diabetes and anemia.

The remaining 3,425 patients had neither diabetes nor anemia.

Patients fared worse if they had both anemia and diabetes, with greater than 25% mortality at 1 month post admission, and greater than 35% mortality within 30 months, S. Ali Imran, M.B., of the division of endocrinology at the university, reported in a poster displayed at the annual meeting of the Endocrine Society.

Diabetes was a strong independent risk factor for both 30-day and long-term (31 days to 30 months) mortality.

Anemia, defined as a hemoglobin level of less than 120 g/L in females and 140 g/L in males, did not independently predict short-term mortality, but that may have been because mild degrees of anemia were included.

However, “any degree of anemia has an adverse effect on long-term mortality post myocardial infarction,” with each lower quintile of hemoglobin at the time of an MI admission associated with an increased risk of death, noted Dr. Imran.

Long-term mortality in patients with anemia approached 30%, compared with about 13% in patients who did not have anemia or diabetes at admission. The authors pointed out that patients with anemia tended to be older and male and had worse renal function than did other MI patients.

“Since anemia is a marker of an underlying disorder, the etiology of the anemia may explain an increased risk of mortality,” they wrote.

The primary cause of death for all patients, including the group with anemia, was cardiovascular.

“Further research examining the potential of correcting anemia is needed in the hopes of reducing long-term mortality,” the researchers concluded.

SAN DIEGO — Anemia is an independent risk factor for long-term mortality after myocardial infarction in both diabetic and nondiabetic patients, a large Canadian study has found.

Researchers at Queen Elizabeth II Health Sciences Centre, Dalhousie University, in Halifax, N.S., studied outcomes in 7,466 patients who were admitted with acute MI.

Of these, 1,431 had anemia but no diabetes, 1,646 had diabetes but no anemia, and 964 had diabetes and anemia.

The remaining 3,425 patients had neither diabetes nor anemia.

Patients fared worse if they had both anemia and diabetes, with greater than 25% mortality at 1 month post admission, and greater than 35% mortality within 30 months, S. Ali Imran, M.B., of the division of endocrinology at the university, reported in a poster displayed at the annual meeting of the Endocrine Society.

Diabetes was a strong independent risk factor for both 30-day and long-term (31 days to 30 months) mortality.

Anemia, defined as a hemoglobin level of less than 120 g/L in females and 140 g/L in males, did not independently predict short-term mortality, but that may have been because mild degrees of anemia were included.

However, “any degree of anemia has an adverse effect on long-term mortality post myocardial infarction,” with each lower quintile of hemoglobin at the time of an MI admission associated with an increased risk of death, noted Dr. Imran.

Long-term mortality in patients with anemia approached 30%, compared with about 13% in patients who did not have anemia or diabetes at admission. The authors pointed out that patients with anemia tended to be older and male and had worse renal function than did other MI patients.

“Since anemia is a marker of an underlying disorder, the etiology of the anemia may explain an increased risk of mortality,” they wrote.

The primary cause of death for all patients, including the group with anemia, was cardiovascular.

“Further research examining the potential of correcting anemia is needed in the hopes of reducing long-term mortality,” the researchers concluded.

SAN DIEGO — Anemia is an independent risk factor for long-term mortality after myocardial infarction in both diabetic and nondiabetic patients, a large Canadian study has found.

Researchers at Queen Elizabeth II Health Sciences Centre, Dalhousie University, in Halifax, N.S., studied outcomes in 7,466 patients who were admitted with acute MI.

Of these, 1,431 had anemia but no diabetes, 1,646 had diabetes but no anemia, and 964 had diabetes and anemia.

The remaining 3,425 patients had neither diabetes nor anemia.

Patients fared worse if they had both anemia and diabetes, with greater than 25% mortality at 1 month post admission, and greater than 35% mortality within 30 months, S. Ali Imran, M.B., of the division of endocrinology at the university, reported in a poster displayed at the annual meeting of the Endocrine Society.

Diabetes was a strong independent risk factor for both 30-day and long-term (31 days to 30 months) mortality.

Anemia, defined as a hemoglobin level of less than 120 g/L in females and 140 g/L in males, did not independently predict short-term mortality, but that may have been because mild degrees of anemia were included.

However, “any degree of anemia has an adverse effect on long-term mortality post myocardial infarction,” with each lower quintile of hemoglobin at the time of an MI admission associated with an increased risk of death, noted Dr. Imran.

Long-term mortality in patients with anemia approached 30%, compared with about 13% in patients who did not have anemia or diabetes at admission. The authors pointed out that patients with anemia tended to be older and male and had worse renal function than did other MI patients.

“Since anemia is a marker of an underlying disorder, the etiology of the anemia may explain an increased risk of mortality,” they wrote.

The primary cause of death for all patients, including the group with anemia, was cardiovascular.

“Further research examining the potential of correcting anemia is needed in the hopes of reducing long-term mortality,” the researchers concluded.

SANTA BARBARA, CALIF. — A suffocation-based pediculicide developed by a dermatologist in his office may offer hope for regaining control over head lice, the bane of elementary school moms and the physicians they hound for a cure.

That was the word at the annual meeting of the California Society of Dermatology and Dermatologic Surgery, where Alfred T. Lane, M.D., professor of dermatology and pediatrics at Stanford (Calif.) University, expressed great hope that Nuvo lotion will someday come to the marketplace.

Dr. Lane highlighted the formula, a dry-on, suffocation-based, pediculicide (DSP) as a possible “new vista in pediatric dermatology,” in keeping with the theme of his talk.

He explained that Nuvo lotion was developed in the Palo Alto, Calif., dermatology practice of Dale L. Pearlman, M.D., to take advantage of the physiology of the common head louse, which can hold its breath long enough to outlive physical blocking agents such as mayonnaise or petrolatum.

Dr. Pearlman created a formula out of nontoxic ingredients (stearyl alcohol, propylene glycol, sodium lauryl sulfate, cetyl alcohol, and water, among others) that basically “shrink-wraps” lice when it dries on the hair, completely blocking their breathing holes, or spiracles.

The lotion is applied at home and dried on the hair with a hair dryer. It is invisible and should be left on the hair for at least 8 hours.

After three applications at 1-week intervals, Dr. Pearlman achieved a 96% cure rate and a remission rate of 94% in 133 patients enrolled in two office-based clinical trials. He published what Dr. Lane called “excellent, excellent data” last year (Pediatrics 2004;114:e275–9).

Removal of nits with a comb was not found to statistically improve the effectiveness of the treatment.

Dr. Lane pointed out that the protocol established by Dr. Pearlman did not require exhaustive household cleaning, but rather, simple washing of clothes, spinning of bed linens in the dryer, and running combs and brushes through the dishwasher.

Currently, Dr. Pearlman is attempting to find a pharmaceutical company to sponsor the formula; in the meantime, his Web site, http://nuvoforheadlice.com

Dr. Pearlman's article disclosed his financial interest in the product as its inventor; Dr. Lane has no financial ties to the product.

SANTA BARBARA, CALIF. — A suffocation-based pediculicide developed by a dermatologist in his office may offer hope for regaining control over head lice, the bane of elementary school moms and the physicians they hound for a cure.

That was the word at the annual meeting of the California Society of Dermatology and Dermatologic Surgery, where Alfred T. Lane, M.D., professor of dermatology and pediatrics at Stanford (Calif.) University, expressed great hope that Nuvo lotion will someday come to the marketplace.

Dr. Lane highlighted the formula, a dry-on, suffocation-based, pediculicide (DSP) as a possible “new vista in pediatric dermatology,” in keeping with the theme of his talk.

He explained that Nuvo lotion was developed in the Palo Alto, Calif., dermatology practice of Dale L. Pearlman, M.D., to take advantage of the physiology of the common head louse, which can hold its breath long enough to outlive physical blocking agents such as mayonnaise or petrolatum.

Dr. Pearlman created a formula out of nontoxic ingredients (stearyl alcohol, propylene glycol, sodium lauryl sulfate, cetyl alcohol, and water, among others) that basically “shrink-wraps” lice when it dries on the hair, completely blocking their breathing holes, or spiracles.

The lotion is applied at home and dried on the hair with a hair dryer. It is invisible and should be left on the hair for at least 8 hours.

After three applications at 1-week intervals, Dr. Pearlman achieved a 96% cure rate and a remission rate of 94% in 133 patients enrolled in two office-based clinical trials. He published what Dr. Lane called “excellent, excellent data” last year (Pediatrics 2004;114:e275–9).

Removal of nits with a comb was not found to statistically improve the effectiveness of the treatment.

Dr. Lane pointed out that the protocol established by Dr. Pearlman did not require exhaustive household cleaning, but rather, simple washing of clothes, spinning of bed linens in the dryer, and running combs and brushes through the dishwasher.

Currently, Dr. Pearlman is attempting to find a pharmaceutical company to sponsor the formula; in the meantime, his Web site, http://nuvoforheadlice.com

Dr. Pearlman's article disclosed his financial interest in the product as its inventor; Dr. Lane has no financial ties to the product.

SANTA BARBARA, CALIF. — A suffocation-based pediculicide developed by a dermatologist in his office may offer hope for regaining control over head lice, the bane of elementary school moms and the physicians they hound for a cure.

That was the word at the annual meeting of the California Society of Dermatology and Dermatologic Surgery, where Alfred T. Lane, M.D., professor of dermatology and pediatrics at Stanford (Calif.) University, expressed great hope that Nuvo lotion will someday come to the marketplace.

Dr. Lane highlighted the formula, a dry-on, suffocation-based, pediculicide (DSP) as a possible “new vista in pediatric dermatology,” in keeping with the theme of his talk.

He explained that Nuvo lotion was developed in the Palo Alto, Calif., dermatology practice of Dale L. Pearlman, M.D., to take advantage of the physiology of the common head louse, which can hold its breath long enough to outlive physical blocking agents such as mayonnaise or petrolatum.

Dr. Pearlman created a formula out of nontoxic ingredients (stearyl alcohol, propylene glycol, sodium lauryl sulfate, cetyl alcohol, and water, among others) that basically “shrink-wraps” lice when it dries on the hair, completely blocking their breathing holes, or spiracles.

The lotion is applied at home and dried on the hair with a hair dryer. It is invisible and should be left on the hair for at least 8 hours.

After three applications at 1-week intervals, Dr. Pearlman achieved a 96% cure rate and a remission rate of 94% in 133 patients enrolled in two office-based clinical trials. He published what Dr. Lane called “excellent, excellent data” last year (Pediatrics 2004;114:e275–9).

Removal of nits with a comb was not found to statistically improve the effectiveness of the treatment.

Dr. Lane pointed out that the protocol established by Dr. Pearlman did not require exhaustive household cleaning, but rather, simple washing of clothes, spinning of bed linens in the dryer, and running combs and brushes through the dishwasher.

Currently, Dr. Pearlman is attempting to find a pharmaceutical company to sponsor the formula; in the meantime, his Web site, http://nuvoforheadlice.com

Dr. Pearlman's article disclosed his financial interest in the product as its inventor; Dr. Lane has no financial ties to the product.

SANTA BARBARA, CALIF. — Who's responsible for iPLEDGE, the new, highly restrictive, mandatory registry for isotretinoin prescriptions?

A Vioxx-jittery Food and Drug Administration, noncompliant pharmacists, the American Academy of Dermatology, dermatologists, and other prescribing physicians are all at fault, Alan R. Shalita, M.D., declared at the annual meeting of the California Society of Dermatology and Dermatologic Surgery.

Dr. Shalita reported that isotretinoin prescriptions declined sharply in the year after the implementation of SMART (System to Manage Accutane-Related Teratogenicity), a voluntary patient registration/pregnancy prevention program, but the pregnancy rate among women taking the drug stayed essentially the same, representing a failure of the profession to police itself and bring down the pregnancy rate, as the FDA had urged.

Doctors, pharmacists, and patients alike failed to comply with the central components of the voluntary program, he said.

When SMART was implemented in 2002, “we should have been getting monthly communications from the AAD,” said Dr. Shalita, professor and chair of dermatology at the State University of New York Downstate Medical Center in Brooklyn. But there was “no communication, no reminders, no insistence, no effort to make our specialty more adherent to the [SMART] program.”

AAD's position was to tell the FDA, “'Leave us alone and we will do our thing,' when it was perfectly obvious we weren't doing our thing,” Dr. Shalita said. Only in June, after iPLEDGE was announced, did the AAD assemble a group of thought leaders in acne to try to influence provisions in the final version of the program.

Diane M. Thiboutot, M.D., chair of the AAD's isotretinoin task force, responded to comments made at the meeting.

“The AAD has consistently opposed a mandatory registry program for managing the risks associated with fetal exposure to isotretinoin and has expressed this opposition to the FDA and the manufacturers of isotretinoin repeatedly. Once the decision was made that a registry was going to be implemented, the academy insisted on changes to the program to make it more workable and less burdensome for dermatologists and their patients,” said Dr. Thiboutot, of the dermatology faculty at Pennsylvania State University in Hershey.

“The failure, in my estimation, of the academy to stand up in the face of this is almost criminal,” said Sacramento, Calif., dermatologist John Kasch, M.D. “This represents a dramatic loss for the patients.”

Richard Odom, M.D., of the University of California, San Francisco, placed blame squarely on the FDA for what he called a “huge, huge overreaction” to a drug that has caused 160 birth defects in 23 years.

Under the FDA's new mandatory program, physicians, patients, pharmacists, wholesalers, and manufacturers will be required to “pledge to follow the rules,” Dr. Shalita explained.

Physicians who prescribe isotretinoin should have received registration materials in September, and patient registration began last month. Between now and Dec. 31, there is a transition period during which patients already on isotretinoin can continue to renew their prescriptions; mandatory compliance with iPLEDGE will be required as of Jan. 1, 2006.

Screening pregnancy tests (to determine whether a patient is qualified to enter the iPLEDGE program) can be done by the physician. The confirmatory pregnancy test and all subsequent monthly tests must be done by a CLIA-certified lab. If iPLEDGE fails to sharply reduce pregnancies, many worry that the drug will be lost.

“No program will reduce the pregnancies to zero. At the end of the day, we cannot regulate human behavior,” he said.

Dr. Shalita disclosed that he is a consultant for Ranbaxy Pharmaceuticals Inc., which manufactures an isotretinoin product.

SANTA BARBARA, CALIF. — Who's responsible for iPLEDGE, the new, highly restrictive, mandatory registry for isotretinoin prescriptions?

A Vioxx-jittery Food and Drug Administration, noncompliant pharmacists, the American Academy of Dermatology, dermatologists, and other prescribing physicians are all at fault, Alan R. Shalita, M.D., declared at the annual meeting of the California Society of Dermatology and Dermatologic Surgery.

Dr. Shalita reported that isotretinoin prescriptions declined sharply in the year after the implementation of SMART (System to Manage Accutane-Related Teratogenicity), a voluntary patient registration/pregnancy prevention program, but the pregnancy rate among women taking the drug stayed essentially the same, representing a failure of the profession to police itself and bring down the pregnancy rate, as the FDA had urged.

Doctors, pharmacists, and patients alike failed to comply with the central components of the voluntary program, he said.

When SMART was implemented in 2002, “we should have been getting monthly communications from the AAD,” said Dr. Shalita, professor and chair of dermatology at the State University of New York Downstate Medical Center in Brooklyn. But there was “no communication, no reminders, no insistence, no effort to make our specialty more adherent to the [SMART] program.”

AAD's position was to tell the FDA, “'Leave us alone and we will do our thing,' when it was perfectly obvious we weren't doing our thing,” Dr. Shalita said. Only in June, after iPLEDGE was announced, did the AAD assemble a group of thought leaders in acne to try to influence provisions in the final version of the program.

Diane M. Thiboutot, M.D., chair of the AAD's isotretinoin task force, responded to comments made at the meeting.

“The AAD has consistently opposed a mandatory registry program for managing the risks associated with fetal exposure to isotretinoin and has expressed this opposition to the FDA and the manufacturers of isotretinoin repeatedly. Once the decision was made that a registry was going to be implemented, the academy insisted on changes to the program to make it more workable and less burdensome for dermatologists and their patients,” said Dr. Thiboutot, of the dermatology faculty at Pennsylvania State University in Hershey.

“The failure, in my estimation, of the academy to stand up in the face of this is almost criminal,” said Sacramento, Calif., dermatologist John Kasch, M.D. “This represents a dramatic loss for the patients.”

Richard Odom, M.D., of the University of California, San Francisco, placed blame squarely on the FDA for what he called a “huge, huge overreaction” to a drug that has caused 160 birth defects in 23 years.

Under the FDA's new mandatory program, physicians, patients, pharmacists, wholesalers, and manufacturers will be required to “pledge to follow the rules,” Dr. Shalita explained.

Physicians who prescribe isotretinoin should have received registration materials in September, and patient registration began last month. Between now and Dec. 31, there is a transition period during which patients already on isotretinoin can continue to renew their prescriptions; mandatory compliance with iPLEDGE will be required as of Jan. 1, 2006.

Screening pregnancy tests (to determine whether a patient is qualified to enter the iPLEDGE program) can be done by the physician. The confirmatory pregnancy test and all subsequent monthly tests must be done by a CLIA-certified lab. If iPLEDGE fails to sharply reduce pregnancies, many worry that the drug will be lost.

“No program will reduce the pregnancies to zero. At the end of the day, we cannot regulate human behavior,” he said.

Dr. Shalita disclosed that he is a consultant for Ranbaxy Pharmaceuticals Inc., which manufactures an isotretinoin product.

SANTA BARBARA, CALIF. — Who's responsible for iPLEDGE, the new, highly restrictive, mandatory registry for isotretinoin prescriptions?

A Vioxx-jittery Food and Drug Administration, noncompliant pharmacists, the American Academy of Dermatology, dermatologists, and other prescribing physicians are all at fault, Alan R. Shalita, M.D., declared at the annual meeting of the California Society of Dermatology and Dermatologic Surgery.

Dr. Shalita reported that isotretinoin prescriptions declined sharply in the year after the implementation of SMART (System to Manage Accutane-Related Teratogenicity), a voluntary patient registration/pregnancy prevention program, but the pregnancy rate among women taking the drug stayed essentially the same, representing a failure of the profession to police itself and bring down the pregnancy rate, as the FDA had urged.

Doctors, pharmacists, and patients alike failed to comply with the central components of the voluntary program, he said.

When SMART was implemented in 2002, “we should have been getting monthly communications from the AAD,” said Dr. Shalita, professor and chair of dermatology at the State University of New York Downstate Medical Center in Brooklyn. But there was “no communication, no reminders, no insistence, no effort to make our specialty more adherent to the [SMART] program.”

AAD's position was to tell the FDA, “'Leave us alone and we will do our thing,' when it was perfectly obvious we weren't doing our thing,” Dr. Shalita said. Only in June, after iPLEDGE was announced, did the AAD assemble a group of thought leaders in acne to try to influence provisions in the final version of the program.

Diane M. Thiboutot, M.D., chair of the AAD's isotretinoin task force, responded to comments made at the meeting.

“The AAD has consistently opposed a mandatory registry program for managing the risks associated with fetal exposure to isotretinoin and has expressed this opposition to the FDA and the manufacturers of isotretinoin repeatedly. Once the decision was made that a registry was going to be implemented, the academy insisted on changes to the program to make it more workable and less burdensome for dermatologists and their patients,” said Dr. Thiboutot, of the dermatology faculty at Pennsylvania State University in Hershey.

“The failure, in my estimation, of the academy to stand up in the face of this is almost criminal,” said Sacramento, Calif., dermatologist John Kasch, M.D. “This represents a dramatic loss for the patients.”

Richard Odom, M.D., of the University of California, San Francisco, placed blame squarely on the FDA for what he called a “huge, huge overreaction” to a drug that has caused 160 birth defects in 23 years.

Under the FDA's new mandatory program, physicians, patients, pharmacists, wholesalers, and manufacturers will be required to “pledge to follow the rules,” Dr. Shalita explained.

Physicians who prescribe isotretinoin should have received registration materials in September, and patient registration began last month. Between now and Dec. 31, there is a transition period during which patients already on isotretinoin can continue to renew their prescriptions; mandatory compliance with iPLEDGE will be required as of Jan. 1, 2006.

Screening pregnancy tests (to determine whether a patient is qualified to enter the iPLEDGE program) can be done by the physician. The confirmatory pregnancy test and all subsequent monthly tests must be done by a CLIA-certified lab. If iPLEDGE fails to sharply reduce pregnancies, many worry that the drug will be lost.

“No program will reduce the pregnancies to zero. At the end of the day, we cannot regulate human behavior,” he said.

Dr. Shalita disclosed that he is a consultant for Ranbaxy Pharmaceuticals Inc., which manufactures an isotretinoin product.

SAN DIEGO – Atypical Parkinson's disease took the most profound toll on patients' ability to carry out essential daily activities among six chronic neurologic disorders evaluated in a study of disability and quality of life.

Lisa M. Shulman, M.D., codirector of the Parkinson's Disease and Movement Disorders Center at the University of Maryland in Baltimore, reported on the relative impact of six diverse movement and memory disorders on patients' daily lives.

She reported her results in poster form at the annual meeting of the American Neurological Association.

Significant variation was found in the disability and quality of life scores among patients with essential tremor (n = 58), dystonia (n = 50), Parkinson's disease (n = 425), psychogenic movement disorders (n = 34), Alzheimer's disease (n = 17), and atypical Parkinsonism (n = 45).

All of the disorders significantly undermined physical quality of life, as measured by the SF-12v2 Health Survey, but the patients with atypical Parkinson's disease had the lowest scores by far, reported Dr. Shulman and her associates from the university's department of neurology.

Just three of the disorders–Alzheimer's disease, psychogenic movement disorders, and atypical Parkinson's disease–showed reductions in mental health quality of life scores measured by the SF-12v2 survey.

Disability was assessed using the Older Americans Resources and Services scale, which includes activities of daily living (ADL) and instrumental activities of daily living (IADL) at a person's best and worst level of function.

Activities of daily living include basic functions such as eating, bathing, grooming, and continence, whereas instrumental activities of daily living include more complex tasks such as using the telephone, paying bills, preparing meals, and using transportation.

“Atypical Parkinson's disease has the greatest impact on all individual ADLs,” the investigators concluded.

Atypical Parkinson's disease and Alzheimer's disease had the greatest impact on all instrumental activities of daily living.

In general, neurodegenerative disorders (Parkinson's disease and atypical Parkinson's disease, and Alzheimer's disease) resulted in greater disability than disorders, such as essential tremor and dystonia.

The youngest patient group, those with psychogenic movement disorders (including tremor, myoclonus, and related conditions), had a mean age of 48.

Interestingly, this group reported similar or worse disability and physical quality of life scores as patients with Parkinson's disease (mean age 67), dystonia (mean age 62), and essential tremor (mean age 62).

Their scores on mental quality of life were comparable with those of patients with Alzheimer's disease (mean age, 74) or atypical Parkinson's disease (mean age 71).

SAN DIEGO – Atypical Parkinson's disease took the most profound toll on patients' ability to carry out essential daily activities among six chronic neurologic disorders evaluated in a study of disability and quality of life.

Lisa M. Shulman, M.D., codirector of the Parkinson's Disease and Movement Disorders Center at the University of Maryland in Baltimore, reported on the relative impact of six diverse movement and memory disorders on patients' daily lives.

She reported her results in poster form at the annual meeting of the American Neurological Association.

Significant variation was found in the disability and quality of life scores among patients with essential tremor (n = 58), dystonia (n = 50), Parkinson's disease (n = 425), psychogenic movement disorders (n = 34), Alzheimer's disease (n = 17), and atypical Parkinsonism (n = 45).

All of the disorders significantly undermined physical quality of life, as measured by the SF-12v2 Health Survey, but the patients with atypical Parkinson's disease had the lowest scores by far, reported Dr. Shulman and her associates from the university's department of neurology.

Just three of the disorders–Alzheimer's disease, psychogenic movement disorders, and atypical Parkinson's disease–showed reductions in mental health quality of life scores measured by the SF-12v2 survey.

Disability was assessed using the Older Americans Resources and Services scale, which includes activities of daily living (ADL) and instrumental activities of daily living (IADL) at a person's best and worst level of function.

Activities of daily living include basic functions such as eating, bathing, grooming, and continence, whereas instrumental activities of daily living include more complex tasks such as using the telephone, paying bills, preparing meals, and using transportation.

“Atypical Parkinson's disease has the greatest impact on all individual ADLs,” the investigators concluded.

Atypical Parkinson's disease and Alzheimer's disease had the greatest impact on all instrumental activities of daily living.

In general, neurodegenerative disorders (Parkinson's disease and atypical Parkinson's disease, and Alzheimer's disease) resulted in greater disability than disorders, such as essential tremor and dystonia.

The youngest patient group, those with psychogenic movement disorders (including tremor, myoclonus, and related conditions), had a mean age of 48.

Interestingly, this group reported similar or worse disability and physical quality of life scores as patients with Parkinson's disease (mean age 67), dystonia (mean age 62), and essential tremor (mean age 62).

Their scores on mental quality of life were comparable with those of patients with Alzheimer's disease (mean age, 74) or atypical Parkinson's disease (mean age 71).

SAN DIEGO – Atypical Parkinson's disease took the most profound toll on patients' ability to carry out essential daily activities among six chronic neurologic disorders evaluated in a study of disability and quality of life.

Lisa M. Shulman, M.D., codirector of the Parkinson's Disease and Movement Disorders Center at the University of Maryland in Baltimore, reported on the relative impact of six diverse movement and memory disorders on patients' daily lives.

She reported her results in poster form at the annual meeting of the American Neurological Association.

Significant variation was found in the disability and quality of life scores among patients with essential tremor (n = 58), dystonia (n = 50), Parkinson's disease (n = 425), psychogenic movement disorders (n = 34), Alzheimer's disease (n = 17), and atypical Parkinsonism (n = 45).

All of the disorders significantly undermined physical quality of life, as measured by the SF-12v2 Health Survey, but the patients with atypical Parkinson's disease had the lowest scores by far, reported Dr. Shulman and her associates from the university's department of neurology.

Just three of the disorders–Alzheimer's disease, psychogenic movement disorders, and atypical Parkinson's disease–showed reductions in mental health quality of life scores measured by the SF-12v2 survey.

Disability was assessed using the Older Americans Resources and Services scale, which includes activities of daily living (ADL) and instrumental activities of daily living (IADL) at a person's best and worst level of function.

Activities of daily living include basic functions such as eating, bathing, grooming, and continence, whereas instrumental activities of daily living include more complex tasks such as using the telephone, paying bills, preparing meals, and using transportation.

“Atypical Parkinson's disease has the greatest impact on all individual ADLs,” the investigators concluded.

Atypical Parkinson's disease and Alzheimer's disease had the greatest impact on all instrumental activities of daily living.

In general, neurodegenerative disorders (Parkinson's disease and atypical Parkinson's disease, and Alzheimer's disease) resulted in greater disability than disorders, such as essential tremor and dystonia.

The youngest patient group, those with psychogenic movement disorders (including tremor, myoclonus, and related conditions), had a mean age of 48.

Interestingly, this group reported similar or worse disability and physical quality of life scores as patients with Parkinson's disease (mean age 67), dystonia (mean age 62), and essential tremor (mean age 62).

Their scores on mental quality of life were comparable with those of patients with Alzheimer's disease (mean age, 74) or atypical Parkinson's disease (mean age 71).

LAS VEGAS — The new 1,550-nm erbium Fraxel laser, by creating minuscule dots of destruction in the surface of the skin, produces color and texture changes, and may have the ability to significantly reduce wrinkles at high fluences, Mark Rubin, M.D., said at a facial cosmetic surgery symposium.

"This, in my mind, is a therapy in flux. It's where Thermage was 2 years ago," said Dr. Rubin at the symposium, which was sponsored by the Multi-Specialty Foundation for Facial Aesthetic Surgical Excellence.

The Fraxel laser was approved by the Food and Drug Administration in March.

Using company-suggested parameters, the device can deliver perceptible improvement in the skin with significantly less traumatic healing than is required after carbon dioxide (CO₂) laser treatments.

Still, "the color and texture is really what knocks you out," said Dr. Rubin, who has no financial interest in, and receives no funding from, Fraxel manufacturer Reliant Technologies Inc.

"The big issue for me is what's happening wrinklewise. So far, my experience has been very variable," Dr. Rubin said.

It may be that very high fluences are necessary to dramatically alter wrinkles with the novel system. Dr. Rubin noted that a colleague had been experimenting with aggressive settings, and was finding "much more profound changes" than could be produced by a nonablative laser.

He suggested that it may take some time to work out the ideal ways to use the Fraxel laser for different purposes.

"Nobody really knows how to use it correctly," he said, urging colleagues to "look at it again in 6 months."

Dr. Rubin, who practices dermatology in Beverly Hills, Calif., purchased a Fraxel laser in hopes of finding the holy grail of skin resurfacing: a device capable of smoothing moderate to deep wrinkles without provoking a lengthy, complication-ridden healing period.

"The ablative therapies are spectacular, but no fun for you or the patient. There's risk. There's [a] nasty-looking [healing period] when you have to see patients every couple of days. There are reasons not everyone is dying to do this."

Nonablative devices seemed like a good idea—Dr. Rubin bought several of them—but they proved to be poor substitutes for the steamroller effect that ablative lasers had on deep wrinkles.

Fraxel seemed to him to be a potential bridge between the two types of skin rejuvenation therapies, creating "little islands of ablated skin in a sea of normal skin."

"Rather than burning everything off, can we burn just little tiny bits at a time to sort of fool the skin into thinking it's not been wounded so badly?" he asked.

The answer is—maybe.

The epidermis remains intact, even when the laser's energy reaches depths of 700 micrometers and beyond, a level deep enough to promote collagen remodeling. But are the pinpoints of energy enough? And are the surface areas of each microthermal zone (estimated to number 2,000 per cm

About 20% of the facial surface area is impacted during each treatment session at a low fluence, typically four to six passes, Dr. Rubin said. However, "in reality, as you go back and forth like this, you're never really where you're supposed to be. In certain places you hit the same spot two times, three times, four times, who knows? And in other places, you skip."

It may be that the microscopic zones of destruction are so small that overlap does not matter, either in terms of results or side effects, he said. However, it remains to be seen whether consistency will be achieved as the laser makes its way into general clinical practice.

A clear advantage of Fraxel lasers over CO₂ lasers is the healing process, according to Dr. Rubin. "These patients aren't weeping fluid. They're not bleeding," he explained.

When low fluences are used, edema typically lasts 1–2 days, and erythema lasts 1–3 days. Flaking and bronzing of the skin are common. Makeup can be worn because there is no open wound, but most patients need heavy makeup to cover the transient effects of the treatment.

"They certainly don't look normal enough to be fully functional a day or 2 days later. It's nonablative, but there is an impact on patient's lives as a result of this," Dr. Rubin said.

A topical anesthetic is used, and some patients require supplemental oral pain medications. A blue dye is used to enhance skin surface contours for optical scanning.

Patients, said Dr. Rubin, "look like [performers in] Blue Man Group," but the dye washes away within a day.

A grid is used to guide the laser.

Patients return for multiple treatments until 100% of the skin's surface is treated.

At low fluences with high density, the laser's zone of thermal injury extends to the superficial papillary dermis, producing excellent improvement in the appearance of actinic dyschromia and photodamage.

"There's no question color- and texturewise, these patients can really do profoundly well. Although just 20% of the epidermis is being treated [at each session], they don't look 20% better; they look 40%–50% better.

"I don't know why; it doesn't make sense. It obviously has to do with our ability to perceive changes in the skin," he said.

A greater challenge is the best and safest use of the device at high fluences with low density. In this scenario, a deep wound is created over a smaller total area of the skin—about 10% per treatment session. Associated edema and erythema may persist for some time, but the potential exists for improvement of deeper wrinkles, just as he was hoping for, Dr. Rubin said.

Fraxel Could Be Well Suited for Some

The Fraxel 1,550-nm erbium laser may fill a niche for certain patients desiring skin rejuvenation, Dr. Rubin said.

These include:

▸ Patients with dark skin prone to hyperpigmentation. Because the damage inflicted by the Fraxel laser is done with microscopic pinpoints, it does not create the persistent erythema that often leads to hyperpigmentation following ablative therapies. Used at low fluences, it may be an excellent option for these patients.

▸ Patients with melasma. Melasma is essentially a condition of "misbehaving melanocytes," according to Dr. Rubin.

"When melanocytes aren't functioning appropriately, we would love to kill them without killing the surrounding tissue and creating hypopigmentation."

The selective action of the Fraxel laser may be able to "gently" knock out enough melanocytes to control melasma without tipping the balance too far, he said.

Results in melasma patients at 1–2 months are "intriguing," he said, although 6–8 months of clearance would be necessary to prove that the therapy is a significant advance.

▸ Patients desiring significant rejuvenation of nonfacial skin. Ablative CO₂ laser treatments are risky in areas of the body with few pilosebaceous units to assist in reepithelialization. Because the Fraxel laser does not produce a widespread wound, it may be better at safely treating the skin of the neck, chest, hands, and arms.

Dr. Rubin has no financial interest in the Fraxel laser and receives no funding from its manufacturer, Reliant Technologies.

LAS VEGAS — The new 1,550-nm erbium Fraxel laser, by creating minuscule dots of destruction in the surface of the skin, produces color and texture changes, and may have the ability to significantly reduce wrinkles at high fluences, Mark Rubin, M.D., said at a facial cosmetic surgery symposium.

"This, in my mind, is a therapy in flux. It's where Thermage was 2 years ago," said Dr. Rubin at the symposium, which was sponsored by the Multi-Specialty Foundation for Facial Aesthetic Surgical Excellence.

The Fraxel laser was approved by the Food and Drug Administration in March.

Using company-suggested parameters, the device can deliver perceptible improvement in the skin with significantly less traumatic healing than is required after carbon dioxide (CO₂) laser treatments.

Still, "the color and texture is really what knocks you out," said Dr. Rubin, who has no financial interest in, and receives no funding from, Fraxel manufacturer Reliant Technologies Inc.

"The big issue for me is what's happening wrinklewise. So far, my experience has been very variable," Dr. Rubin said.

It may be that very high fluences are necessary to dramatically alter wrinkles with the novel system. Dr. Rubin noted that a colleague had been experimenting with aggressive settings, and was finding "much more profound changes" than could be produced by a nonablative laser.

He suggested that it may take some time to work out the ideal ways to use the Fraxel laser for different purposes.

"Nobody really knows how to use it correctly," he said, urging colleagues to "look at it again in 6 months."

Dr. Rubin, who practices dermatology in Beverly Hills, Calif., purchased a Fraxel laser in hopes of finding the holy grail of skin resurfacing: a device capable of smoothing moderate to deep wrinkles without provoking a lengthy, complication-ridden healing period.

"The ablative therapies are spectacular, but no fun for you or the patient. There's risk. There's [a] nasty-looking [healing period] when you have to see patients every couple of days. There are reasons not everyone is dying to do this."

Nonablative devices seemed like a good idea—Dr. Rubin bought several of them—but they proved to be poor substitutes for the steamroller effect that ablative lasers had on deep wrinkles.

Fraxel seemed to him to be a potential bridge between the two types of skin rejuvenation therapies, creating "little islands of ablated skin in a sea of normal skin."

"Rather than burning everything off, can we burn just little tiny bits at a time to sort of fool the skin into thinking it's not been wounded so badly?" he asked.

The answer is—maybe.

The epidermis remains intact, even when the laser's energy reaches depths of 700 micrometers and beyond, a level deep enough to promote collagen remodeling. But are the pinpoints of energy enough? And are the surface areas of each microthermal zone (estimated to number 2,000 per cm

About 20% of the facial surface area is impacted during each treatment session at a low fluence, typically four to six passes, Dr. Rubin said. However, "in reality, as you go back and forth like this, you're never really where you're supposed to be. In certain places you hit the same spot two times, three times, four times, who knows? And in other places, you skip."

It may be that the microscopic zones of destruction are so small that overlap does not matter, either in terms of results or side effects, he said. However, it remains to be seen whether consistency will be achieved as the laser makes its way into general clinical practice.

A clear advantage of Fraxel lasers over CO₂ lasers is the healing process, according to Dr. Rubin. "These patients aren't weeping fluid. They're not bleeding," he explained.

When low fluences are used, edema typically lasts 1–2 days, and erythema lasts 1–3 days. Flaking and bronzing of the skin are common. Makeup can be worn because there is no open wound, but most patients need heavy makeup to cover the transient effects of the treatment.

"They certainly don't look normal enough to be fully functional a day or 2 days later. It's nonablative, but there is an impact on patient's lives as a result of this," Dr. Rubin said.

A topical anesthetic is used, and some patients require supplemental oral pain medications. A blue dye is used to enhance skin surface contours for optical scanning.

Patients, said Dr. Rubin, "look like [performers in] Blue Man Group," but the dye washes away within a day.

A grid is used to guide the laser.

Patients return for multiple treatments until 100% of the skin's surface is treated.

At low fluences with high density, the laser's zone of thermal injury extends to the superficial papillary dermis, producing excellent improvement in the appearance of actinic dyschromia and photodamage.

"There's no question color- and texturewise, these patients can really do profoundly well. Although just 20% of the epidermis is being treated [at each session], they don't look 20% better; they look 40%–50% better.

"I don't know why; it doesn't make sense. It obviously has to do with our ability to perceive changes in the skin," he said.

A greater challenge is the best and safest use of the device at high fluences with low density. In this scenario, a deep wound is created over a smaller total area of the skin—about 10% per treatment session. Associated edema and erythema may persist for some time, but the potential exists for improvement of deeper wrinkles, just as he was hoping for, Dr. Rubin said.

Fraxel Could Be Well Suited for Some

The Fraxel 1,550-nm erbium laser may fill a niche for certain patients desiring skin rejuvenation, Dr. Rubin said.

These include:

▸ Patients with dark skin prone to hyperpigmentation. Because the damage inflicted by the Fraxel laser is done with microscopic pinpoints, it does not create the persistent erythema that often leads to hyperpigmentation following ablative therapies. Used at low fluences, it may be an excellent option for these patients.

▸ Patients with melasma. Melasma is essentially a condition of "misbehaving melanocytes," according to Dr. Rubin.

"When melanocytes aren't functioning appropriately, we would love to kill them without killing the surrounding tissue and creating hypopigmentation."

The selective action of the Fraxel laser may be able to "gently" knock out enough melanocytes to control melasma without tipping the balance too far, he said.

Results in melasma patients at 1–2 months are "intriguing," he said, although 6–8 months of clearance would be necessary to prove that the therapy is a significant advance.

▸ Patients desiring significant rejuvenation of nonfacial skin. Ablative CO₂ laser treatments are risky in areas of the body with few pilosebaceous units to assist in reepithelialization. Because the Fraxel laser does not produce a widespread wound, it may be better at safely treating the skin of the neck, chest, hands, and arms.

Dr. Rubin has no financial interest in the Fraxel laser and receives no funding from its manufacturer, Reliant Technologies.

LAS VEGAS — The new 1,550-nm erbium Fraxel laser, by creating minuscule dots of destruction in the surface of the skin, produces color and texture changes, and may have the ability to significantly reduce wrinkles at high fluences, Mark Rubin, M.D., said at a facial cosmetic surgery symposium.

"This, in my mind, is a therapy in flux. It's where Thermage was 2 years ago," said Dr. Rubin at the symposium, which was sponsored by the Multi-Specialty Foundation for Facial Aesthetic Surgical Excellence.

The Fraxel laser was approved by the Food and Drug Administration in March.

Using company-suggested parameters, the device can deliver perceptible improvement in the skin with significantly less traumatic healing than is required after carbon dioxide (CO₂) laser treatments.

Still, "the color and texture is really what knocks you out," said Dr. Rubin, who has no financial interest in, and receives no funding from, Fraxel manufacturer Reliant Technologies Inc.

"The big issue for me is what's happening wrinklewise. So far, my experience has been very variable," Dr. Rubin said.

It may be that very high fluences are necessary to dramatically alter wrinkles with the novel system. Dr. Rubin noted that a colleague had been experimenting with aggressive settings, and was finding "much more profound changes" than could be produced by a nonablative laser.

He suggested that it may take some time to work out the ideal ways to use the Fraxel laser for different purposes.

"Nobody really knows how to use it correctly," he said, urging colleagues to "look at it again in 6 months."

Dr. Rubin, who practices dermatology in Beverly Hills, Calif., purchased a Fraxel laser in hopes of finding the holy grail of skin resurfacing: a device capable of smoothing moderate to deep wrinkles without provoking a lengthy, complication-ridden healing period.

"The ablative therapies are spectacular, but no fun for you or the patient. There's risk. There's [a] nasty-looking [healing period] when you have to see patients every couple of days. There are reasons not everyone is dying to do this."

Nonablative devices seemed like a good idea—Dr. Rubin bought several of them—but they proved to be poor substitutes for the steamroller effect that ablative lasers had on deep wrinkles.

Fraxel seemed to him to be a potential bridge between the two types of skin rejuvenation therapies, creating "little islands of ablated skin in a sea of normal skin."

"Rather than burning everything off, can we burn just little tiny bits at a time to sort of fool the skin into thinking it's not been wounded so badly?" he asked.

The answer is—maybe.

The epidermis remains intact, even when the laser's energy reaches depths of 700 micrometers and beyond, a level deep enough to promote collagen remodeling. But are the pinpoints of energy enough? And are the surface areas of each microthermal zone (estimated to number 2,000 per cm

About 20% of the facial surface area is impacted during each treatment session at a low fluence, typically four to six passes, Dr. Rubin said. However, "in reality, as you go back and forth like this, you're never really where you're supposed to be. In certain places you hit the same spot two times, three times, four times, who knows? And in other places, you skip."

It may be that the microscopic zones of destruction are so small that overlap does not matter, either in terms of results or side effects, he said. However, it remains to be seen whether consistency will be achieved as the laser makes its way into general clinical practice.

A clear advantage of Fraxel lasers over CO₂ lasers is the healing process, according to Dr. Rubin. "These patients aren't weeping fluid. They're not bleeding," he explained.

When low fluences are used, edema typically lasts 1–2 days, and erythema lasts 1–3 days. Flaking and bronzing of the skin are common. Makeup can be worn because there is no open wound, but most patients need heavy makeup to cover the transient effects of the treatment.

"They certainly don't look normal enough to be fully functional a day or 2 days later. It's nonablative, but there is an impact on patient's lives as a result of this," Dr. Rubin said.

A topical anesthetic is used, and some patients require supplemental oral pain medications. A blue dye is used to enhance skin surface contours for optical scanning.

Patients, said Dr. Rubin, "look like [performers in] Blue Man Group," but the dye washes away within a day.

A grid is used to guide the laser.

Patients return for multiple treatments until 100% of the skin's surface is treated.

At low fluences with high density, the laser's zone of thermal injury extends to the superficial papillary dermis, producing excellent improvement in the appearance of actinic dyschromia and photodamage.

"There's no question color- and texturewise, these patients can really do profoundly well. Although just 20% of the epidermis is being treated [at each session], they don't look 20% better; they look 40%–50% better.

"I don't know why; it doesn't make sense. It obviously has to do with our ability to perceive changes in the skin," he said.

A greater challenge is the best and safest use of the device at high fluences with low density. In this scenario, a deep wound is created over a smaller total area of the skin—about 10% per treatment session. Associated edema and erythema may persist for some time, but the potential exists for improvement of deeper wrinkles, just as he was hoping for, Dr. Rubin said.

Fraxel Could Be Well Suited for Some

The Fraxel 1,550-nm erbium laser may fill a niche for certain patients desiring skin rejuvenation, Dr. Rubin said.

These include:

▸ Patients with dark skin prone to hyperpigmentation. Because the damage inflicted by the Fraxel laser is done with microscopic pinpoints, it does not create the persistent erythema that often leads to hyperpigmentation following ablative therapies. Used at low fluences, it may be an excellent option for these patients.

▸ Patients with melasma. Melasma is essentially a condition of "misbehaving melanocytes," according to Dr. Rubin.

"When melanocytes aren't functioning appropriately, we would love to kill them without killing the surrounding tissue and creating hypopigmentation."

The selective action of the Fraxel laser may be able to "gently" knock out enough melanocytes to control melasma without tipping the balance too far, he said.

Results in melasma patients at 1–2 months are "intriguing," he said, although 6–8 months of clearance would be necessary to prove that the therapy is a significant advance.

▸ Patients desiring significant rejuvenation of nonfacial skin. Ablative CO₂ laser treatments are risky in areas of the body with few pilosebaceous units to assist in reepithelialization. Because the Fraxel laser does not produce a widespread wound, it may be better at safely treating the skin of the neck, chest, hands, and arms.

Dr. Rubin has no financial interest in the Fraxel laser and receives no funding from its manufacturer, Reliant Technologies.

SANTA BARBARA, CALIF. — Smoking appears to heighten neuropsychological deficits found in heavy social drinkers, researchers reported at the annual meeting of the Research Society on Alcoholism.

Specifically, deficits in executive functioning and balance seen in people who both smoked and drank heavily were significantly worse than those seen in heavy-drinking nonsmokers, said Timothy C. Durazzo, Ph.D., a neuropsychologist and neuroscience researcher at the San Francisco Veterans Administration Medical Center.

“We believe smoking may compound alcohol-induced neurobiologic and neurocognitive dysfunction among individuals with alcohol use disorders,” said Dr. Durazzo following the meeting.

The neuropsychological results build on Dr. Durazzo's earlier identification—by MRI and magnetic resonance spectroscopy—of specific brain metabolite deficits in the frontal lobes and subcortical structures of smokers who had recently undergone alcohol detoxification (Alcohol. Clin. Exp. Res. 2004;1849–60).

The study concluded that smoking exacerbates alcohol-related frontal lobe neuronal injury and cell membrane damage, but also has an independent adverse effect on subcortical structures.

In the current study, Dr. Durazzo and associates administered neuropsychological tests to 33 socially functioning heavy drinkers, 13 of whom were also daily smokers, as well as to 22 nonsmoking light drinkers.

Heavy drinking was defined as consuming more than 80 drinks per month, but study subjects actually consumed considerably more. Nonsmoking heavy drinkers averaged 141 lifetime drinks per month, while heavy drinkers who smoked drank an estimated 227 drinks per month.

Subjects were mostly in their early 40s and had a relatively high level of education (14–15 years, on average). Most were males. No subject suffered a medical condition that could impair neurocognition.

Significant differences between smoking and nonsmoking heavy drink-ers were seen on the Wisconsin Card Sorting Test, reflecting executive function, and on the Fregly-Graybiel Ataxia Battery, reflecting balance.

Nonsmoking heavy drinkers performed better than smoking heavy drinkers on every Wisconsin Card Sorting Test measure except nonperseverative errors.

Perseverative response scores, for example, averaged 14.7 for nonsmoking heavy drinkers and 24.5 for heavy drinkers who smoked. As a point of comparison, the matched controls who neither smoked nor drank heavily had an average perseverative response score of 12.1.

Ataxia and balance-related scores showed significant differences as well.

Total raw scores on the Fregly-Graybiel Ataxia Battery and the Sharpened Romberg Test were 151.8 for nonsmoking heavy drinkers and 107.7 for smoking heavy drinkers. The nonsmoking light drinkers who served as controls scored significantly higher at 208.5.

By contrast, no significant differences were found in visuospatial memory and working memory among heavy drinkers who smoked, nonsmoking heavy drinkers, and controls.

Previous research has concluded that heavy drinking is associated with depleted cortical gray matter volume and diminished levels of N-acetylaspartate (a marker of neuronal viability) in the lower frontal white matter and gray matter, said Dr. Durazzo.

Cigarette smoke contains many toxic compounds that may have an added negative effect on brain structure and function, particularly the cortical gray matter and the frontal lobes—“critical components of functional circuits mediating executive and motor functions,” he explained in a poster presented at the meeting.

“Thus, chronic cigarette smoking may account for a portion of the dysfunction in executive functioning and balance that had been previously attributed solely to long-term heavy alcohol consumption,” he said.

SANTA BARBARA, CALIF. — Smoking appears to heighten neuropsychological deficits found in heavy social drinkers, researchers reported at the annual meeting of the Research Society on Alcoholism.

Specifically, deficits in executive functioning and balance seen in people who both smoked and drank heavily were significantly worse than those seen in heavy-drinking nonsmokers, said Timothy C. Durazzo, Ph.D., a neuropsychologist and neuroscience researcher at the San Francisco Veterans Administration Medical Center.

“We believe smoking may compound alcohol-induced neurobiologic and neurocognitive dysfunction among individuals with alcohol use disorders,” said Dr. Durazzo following the meeting.

The neuropsychological results build on Dr. Durazzo's earlier identification—by MRI and magnetic resonance spectroscopy—of specific brain metabolite deficits in the frontal lobes and subcortical structures of smokers who had recently undergone alcohol detoxification (Alcohol. Clin. Exp. Res. 2004;1849–60).

The study concluded that smoking exacerbates alcohol-related frontal lobe neuronal injury and cell membrane damage, but also has an independent adverse effect on subcortical structures.

In the current study, Dr. Durazzo and associates administered neuropsychological tests to 33 socially functioning heavy drinkers, 13 of whom were also daily smokers, as well as to 22 nonsmoking light drinkers.

Heavy drinking was defined as consuming more than 80 drinks per month, but study subjects actually consumed considerably more. Nonsmoking heavy drinkers averaged 141 lifetime drinks per month, while heavy drinkers who smoked drank an estimated 227 drinks per month.

Subjects were mostly in their early 40s and had a relatively high level of education (14–15 years, on average). Most were males. No subject suffered a medical condition that could impair neurocognition.

Significant differences between smoking and nonsmoking heavy drink-ers were seen on the Wisconsin Card Sorting Test, reflecting executive function, and on the Fregly-Graybiel Ataxia Battery, reflecting balance.

Nonsmoking heavy drinkers performed better than smoking heavy drinkers on every Wisconsin Card Sorting Test measure except nonperseverative errors.

Perseverative response scores, for example, averaged 14.7 for nonsmoking heavy drinkers and 24.5 for heavy drinkers who smoked. As a point of comparison, the matched controls who neither smoked nor drank heavily had an average perseverative response score of 12.1.

Ataxia and balance-related scores showed significant differences as well.

Total raw scores on the Fregly-Graybiel Ataxia Battery and the Sharpened Romberg Test were 151.8 for nonsmoking heavy drinkers and 107.7 for smoking heavy drinkers. The nonsmoking light drinkers who served as controls scored significantly higher at 208.5.

By contrast, no significant differences were found in visuospatial memory and working memory among heavy drinkers who smoked, nonsmoking heavy drinkers, and controls.

Previous research has concluded that heavy drinking is associated with depleted cortical gray matter volume and diminished levels of N-acetylaspartate (a marker of neuronal viability) in the lower frontal white matter and gray matter, said Dr. Durazzo.

Cigarette smoke contains many toxic compounds that may have an added negative effect on brain structure and function, particularly the cortical gray matter and the frontal lobes—“critical components of functional circuits mediating executive and motor functions,” he explained in a poster presented at the meeting.

“Thus, chronic cigarette smoking may account for a portion of the dysfunction in executive functioning and balance that had been previously attributed solely to long-term heavy alcohol consumption,” he said.

SANTA BARBARA, CALIF. — Smoking appears to heighten neuropsychological deficits found in heavy social drinkers, researchers reported at the annual meeting of the Research Society on Alcoholism.

Specifically, deficits in executive functioning and balance seen in people who both smoked and drank heavily were significantly worse than those seen in heavy-drinking nonsmokers, said Timothy C. Durazzo, Ph.D., a neuropsychologist and neuroscience researcher at the San Francisco Veterans Administration Medical Center.

“We believe smoking may compound alcohol-induced neurobiologic and neurocognitive dysfunction among individuals with alcohol use disorders,” said Dr. Durazzo following the meeting.

The neuropsychological results build on Dr. Durazzo's earlier identification—by MRI and magnetic resonance spectroscopy—of specific brain metabolite deficits in the frontal lobes and subcortical structures of smokers who had recently undergone alcohol detoxification (Alcohol. Clin. Exp. Res. 2004;1849–60).

The study concluded that smoking exacerbates alcohol-related frontal lobe neuronal injury and cell membrane damage, but also has an independent adverse effect on subcortical structures.

In the current study, Dr. Durazzo and associates administered neuropsychological tests to 33 socially functioning heavy drinkers, 13 of whom were also daily smokers, as well as to 22 nonsmoking light drinkers.

Heavy drinking was defined as consuming more than 80 drinks per month, but study subjects actually consumed considerably more. Nonsmoking heavy drinkers averaged 141 lifetime drinks per month, while heavy drinkers who smoked drank an estimated 227 drinks per month.

Subjects were mostly in their early 40s and had a relatively high level of education (14–15 years, on average). Most were males. No subject suffered a medical condition that could impair neurocognition.

Significant differences between smoking and nonsmoking heavy drink-ers were seen on the Wisconsin Card Sorting Test, reflecting executive function, and on the Fregly-Graybiel Ataxia Battery, reflecting balance.

Nonsmoking heavy drinkers performed better than smoking heavy drinkers on every Wisconsin Card Sorting Test measure except nonperseverative errors.

Perseverative response scores, for example, averaged 14.7 for nonsmoking heavy drinkers and 24.5 for heavy drinkers who smoked. As a point of comparison, the matched controls who neither smoked nor drank heavily had an average perseverative response score of 12.1.

Ataxia and balance-related scores showed significant differences as well.

Total raw scores on the Fregly-Graybiel Ataxia Battery and the Sharpened Romberg Test were 151.8 for nonsmoking heavy drinkers and 107.7 for smoking heavy drinkers. The nonsmoking light drinkers who served as controls scored significantly higher at 208.5.

By contrast, no significant differences were found in visuospatial memory and working memory among heavy drinkers who smoked, nonsmoking heavy drinkers, and controls.

Previous research has concluded that heavy drinking is associated with depleted cortical gray matter volume and diminished levels of N-acetylaspartate (a marker of neuronal viability) in the lower frontal white matter and gray matter, said Dr. Durazzo.

Cigarette smoke contains many toxic compounds that may have an added negative effect on brain structure and function, particularly the cortical gray matter and the frontal lobes—“critical components of functional circuits mediating executive and motor functions,” he explained in a poster presented at the meeting.

“Thus, chronic cigarette smoking may account for a portion of the dysfunction in executive functioning and balance that had been previously attributed solely to long-term heavy alcohol consumption,” he said.

SANTA BARBARA, CALIF. — People who receive any form of treatment to help them with alcohol dependency are twice as likely to recover as are those who receive no treatment.

However, recovery prompted by treatment is often a slow process, and may take longer than recovery initiated and carried out by an individual on his or her own, Deborah A. Dawson, Ph.D., reported at the annual meeting of the Research Society on Alcoholism.

Dr. Dawson and her colleagues at the National Institute of Alcohol Abuse and Alcoholism identified several predictors of success and failure in alcohol dependency recovery by studying a subset of individuals included in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

The cohort included 4,422 subjects from the nationally representative NESARC sample who met DSM-IV diagnostic criteria for alcohol dependency.

About 64% of the sample was still dependent on alcohol, while 36% had recovered to some degree, either achieving total abstinence or continuing to drink without possessing symptoms of alcoholism.

Hazard ratio curves showed remission and recovery short of abstinence peaked about 1–4 years after the onset of dependence before declining by about half in the next 5 years and then reaching a steady mean. Abstinent recovery showed no peak, but was achieved by individuals over time.

Proportional hazard models with time-dependent covariates showed several characteristics predictive of recovery.

“Treatment was by far the strongest positive predictor of abstinent recovery. A prior history of relapse was the strongest negative predictor of all types of recovery,” said Dr. Dawson.

Recovery was less likely in people whose onset of dependence was rapid and/or early, starting before 18 years of age.

That might not be surprising, but some of Dr. Dawson's findings were counterintuitive. For example, she found individuals with anxiety disorders and those with a positive family history of alcohol dependence were more likely to recover from alcohol dependency. Individuals with personality disorders were less likely to achieve an abstinent recovery.

Smoking and recent smoking initiation were positively associated with abstinent recovery, perhaps because cigarettes serve as a substitute for alcohol in some individuals, Dr. Dawson said.

And individuals who were still dependent on alcohol 3 or more years after quitting smoking had diminished rates of recovery. But stopping smoking more recently was positively associated with stopping drinking as well.

Current drug use, as expected, lowered the chances of any form of recovery, but quitting drugs more than 3 years ago was positively associated with recovery.

Having attended college lowered the likelihood of achieving recovery or abstinent recovery, with hazard ratios of 0.77 and 0.69, respectively. Other life events affected the chances of recovery as well.

Getting married for the first time—or, ironically, being newly divorced—strongly enhanced chances of any degree of recovery and of nonabstinent recovery, with nonabstinent recovery hazard ratios of 1.39 and 1.94, respectively.

But having been married or divorced for more than 3 years failed to have the same effect. In fact, Dr. Dawson found being married for more than 3 years had a negative association (hazard ratio 0.77).

A recent graduation neither positively nor negatively associated with recovery. But completing schooling more than 3 years ago was negatively associated with achieving any recovery, and starting a full-time job more than 3 years ago was negatively associated with an abstinent recovery.

Transitions in life are not necessarily causal in terms of enhancing recovery chances, Dr. Dawson said. “Rather, failure to recover shortly after making these transitions is a strong indicator that recovery is not likely to occur in the future.”

SANTA BARBARA, CALIF. — People who receive any form of treatment to help them with alcohol dependency are twice as likely to recover as are those who receive no treatment.

However, recovery prompted by treatment is often a slow process, and may take longer than recovery initiated and carried out by an individual on his or her own, Deborah A. Dawson, Ph.D., reported at the annual meeting of the Research Society on Alcoholism.

Dr. Dawson and her colleagues at the National Institute of Alcohol Abuse and Alcoholism identified several predictors of success and failure in alcohol dependency recovery by studying a subset of individuals included in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

The cohort included 4,422 subjects from the nationally representative NESARC sample who met DSM-IV diagnostic criteria for alcohol dependency.

About 64% of the sample was still dependent on alcohol, while 36% had recovered to some degree, either achieving total abstinence or continuing to drink without possessing symptoms of alcoholism.

Hazard ratio curves showed remission and recovery short of abstinence peaked about 1–4 years after the onset of dependence before declining by about half in the next 5 years and then reaching a steady mean. Abstinent recovery showed no peak, but was achieved by individuals over time.

Proportional hazard models with time-dependent covariates showed several characteristics predictive of recovery.

“Treatment was by far the strongest positive predictor of abstinent recovery. A prior history of relapse was the strongest negative predictor of all types of recovery,” said Dr. Dawson.

Recovery was less likely in people whose onset of dependence was rapid and/or early, starting before 18 years of age.

That might not be surprising, but some of Dr. Dawson's findings were counterintuitive. For example, she found individuals with anxiety disorders and those with a positive family history of alcohol dependence were more likely to recover from alcohol dependency. Individuals with personality disorders were less likely to achieve an abstinent recovery.

Smoking and recent smoking initiation were positively associated with abstinent recovery, perhaps because cigarettes serve as a substitute for alcohol in some individuals, Dr. Dawson said.

And individuals who were still dependent on alcohol 3 or more years after quitting smoking had diminished rates of recovery. But stopping smoking more recently was positively associated with stopping drinking as well.

Current drug use, as expected, lowered the chances of any form of recovery, but quitting drugs more than 3 years ago was positively associated with recovery.

Having attended college lowered the likelihood of achieving recovery or abstinent recovery, with hazard ratios of 0.77 and 0.69, respectively. Other life events affected the chances of recovery as well.

Getting married for the first time—or, ironically, being newly divorced—strongly enhanced chances of any degree of recovery and of nonabstinent recovery, with nonabstinent recovery hazard ratios of 1.39 and 1.94, respectively.

But having been married or divorced for more than 3 years failed to have the same effect. In fact, Dr. Dawson found being married for more than 3 years had a negative association (hazard ratio 0.77).

A recent graduation neither positively nor negatively associated with recovery. But completing schooling more than 3 years ago was negatively associated with achieving any recovery, and starting a full-time job more than 3 years ago was negatively associated with an abstinent recovery.

Transitions in life are not necessarily causal in terms of enhancing recovery chances, Dr. Dawson said. “Rather, failure to recover shortly after making these transitions is a strong indicator that recovery is not likely to occur in the future.”

SANTA BARBARA, CALIF. — People who receive any form of treatment to help them with alcohol dependency are twice as likely to recover as are those who receive no treatment.

However, recovery prompted by treatment is often a slow process, and may take longer than recovery initiated and carried out by an individual on his or her own, Deborah A. Dawson, Ph.D., reported at the annual meeting of the Research Society on Alcoholism.

Dr. Dawson and her colleagues at the National Institute of Alcohol Abuse and Alcoholism identified several predictors of success and failure in alcohol dependency recovery by studying a subset of individuals included in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

The cohort included 4,422 subjects from the nationally representative NESARC sample who met DSM-IV diagnostic criteria for alcohol dependency.

About 64% of the sample was still dependent on alcohol, while 36% had recovered to some degree, either achieving total abstinence or continuing to drink without possessing symptoms of alcoholism.

Hazard ratio curves showed remission and recovery short of abstinence peaked about 1–4 years after the onset of dependence before declining by about half in the next 5 years and then reaching a steady mean. Abstinent recovery showed no peak, but was achieved by individuals over time.

Proportional hazard models with time-dependent covariates showed several characteristics predictive of recovery.

“Treatment was by far the strongest positive predictor of abstinent recovery. A prior history of relapse was the strongest negative predictor of all types of recovery,” said Dr. Dawson.

Recovery was less likely in people whose onset of dependence was rapid and/or early, starting before 18 years of age.

That might not be surprising, but some of Dr. Dawson's findings were counterintuitive. For example, she found individuals with anxiety disorders and those with a positive family history of alcohol dependence were more likely to recover from alcohol dependency. Individuals with personality disorders were less likely to achieve an abstinent recovery.

Smoking and recent smoking initiation were positively associated with abstinent recovery, perhaps because cigarettes serve as a substitute for alcohol in some individuals, Dr. Dawson said.

And individuals who were still dependent on alcohol 3 or more years after quitting smoking had diminished rates of recovery. But stopping smoking more recently was positively associated with stopping drinking as well.

Current drug use, as expected, lowered the chances of any form of recovery, but quitting drugs more than 3 years ago was positively associated with recovery.

Having attended college lowered the likelihood of achieving recovery or abstinent recovery, with hazard ratios of 0.77 and 0.69, respectively. Other life events affected the chances of recovery as well.

Getting married for the first time—or, ironically, being newly divorced—strongly enhanced chances of any degree of recovery and of nonabstinent recovery, with nonabstinent recovery hazard ratios of 1.39 and 1.94, respectively.

But having been married or divorced for more than 3 years failed to have the same effect. In fact, Dr. Dawson found being married for more than 3 years had a negative association (hazard ratio 0.77).

A recent graduation neither positively nor negatively associated with recovery. But completing schooling more than 3 years ago was negatively associated with achieving any recovery, and starting a full-time job more than 3 years ago was negatively associated with an abstinent recovery.

Transitions in life are not necessarily causal in terms of enhancing recovery chances, Dr. Dawson said. “Rather, failure to recover shortly after making these transitions is a strong indicator that recovery is not likely to occur in the future.”

SANTA BARBARA, CALIF. — Enhancing positive thinking may be the best way to help severely mentally ill alcohol abusers reduce their dependence on alcohol, a State University of New York at Buffalo study suggests.

Clara M. Bradizza, Ph.D., and her associates at the Research Institute on Addictions at the State University of New York at Buffalo studied the relationship between coping behaviors and substance abuse recovery in 171 patients with bipolar disorder or schizophrenia-spectrum disorder. Participants came from a university-affiliated, mental health center, dual-diagnosis treatment program.

At the completion of 6 months of substance abuse treatment, they were asked which of four coping strategies they used most to avoid alcohol relapse:

▸ Positive thinking (e.g., “Thinking how much better off I am without drinking”)

▸ Negative thinking (e.g., “Thinking of the mess I've got myself in because of drinking”)

▸ Avoidance/distraction (e.g., “Keeping away from people who drink”)

▸ Seeking social support (e.g., “Going to an AA meeting”)

Positive thinking was negatively related to the total number of drinks over the previous 60 days, the percentage of days patients consumed alcohol, and the average number of drinks during the 60-day period, and was positively related to the percentage of days abstinent from alcohol, Dr. Bradizza and her associates reported at the annual meeting of the Research Society on Alcoholism.

In other words, participants who drew on positive thinking most often during their recovery were doing a better job of reducing their alcohol consumption.

Negative thinking was associated with higher rates of drinking on two outcome measures: total number of drinks during the 60-day period and average number of drinks over the 60-day period.

Social support was marginally correlated with a reduction in drug use and abstinence from drugs, although the researchers said the connections need “further exploration.”

“Overall, these results indicate that alcohol-specific coping strategies may be a productive avenue of research aimed at improving treatments for seriously mentally ill individuals diagnosed with an alcohol or drug-use disorder,” the authors concluded in a poster presented at the meeting.

SANTA BARBARA, CALIF. — Enhancing positive thinking may be the best way to help severely mentally ill alcohol abusers reduce their dependence on alcohol, a State University of New York at Buffalo study suggests.

Clara M. Bradizza, Ph.D., and her associates at the Research Institute on Addictions at the State University of New York at Buffalo studied the relationship between coping behaviors and substance abuse recovery in 171 patients with bipolar disorder or schizophrenia-spectrum disorder. Participants came from a university-affiliated, mental health center, dual-diagnosis treatment program.

At the completion of 6 months of substance abuse treatment, they were asked which of four coping strategies they used most to avoid alcohol relapse:

▸ Positive thinking (e.g., “Thinking how much better off I am without drinking”)

▸ Negative thinking (e.g., “Thinking of the mess I've got myself in because of drinking”)

▸ Avoidance/distraction (e.g., “Keeping away from people who drink”)

▸ Seeking social support (e.g., “Going to an AA meeting”)

Positive thinking was negatively related to the total number of drinks over the previous 60 days, the percentage of days patients consumed alcohol, and the average number of drinks during the 60-day period, and was positively related to the percentage of days abstinent from alcohol, Dr. Bradizza and her associates reported at the annual meeting of the Research Society on Alcoholism.

In other words, participants who drew on positive thinking most often during their recovery were doing a better job of reducing their alcohol consumption.

Negative thinking was associated with higher rates of drinking on two outcome measures: total number of drinks during the 60-day period and average number of drinks over the 60-day period.

Social support was marginally correlated with a reduction in drug use and abstinence from drugs, although the researchers said the connections need “further exploration.”

“Overall, these results indicate that alcohol-specific coping strategies may be a productive avenue of research aimed at improving treatments for seriously mentally ill individuals diagnosed with an alcohol or drug-use disorder,” the authors concluded in a poster presented at the meeting.

SANTA BARBARA, CALIF. — Enhancing positive thinking may be the best way to help severely mentally ill alcohol abusers reduce their dependence on alcohol, a State University of New York at Buffalo study suggests.

Clara M. Bradizza, Ph.D., and her associates at the Research Institute on Addictions at the State University of New York at Buffalo studied the relationship between coping behaviors and substance abuse recovery in 171 patients with bipolar disorder or schizophrenia-spectrum disorder. Participants came from a university-affiliated, mental health center, dual-diagnosis treatment program.

At the completion of 6 months of substance abuse treatment, they were asked which of four coping strategies they used most to avoid alcohol relapse:

▸ Positive thinking (e.g., “Thinking how much better off I am without drinking”)

▸ Negative thinking (e.g., “Thinking of the mess I've got myself in because of drinking”)

▸ Avoidance/distraction (e.g., “Keeping away from people who drink”)

▸ Seeking social support (e.g., “Going to an AA meeting”)

Positive thinking was negatively related to the total number of drinks over the previous 60 days, the percentage of days patients consumed alcohol, and the average number of drinks during the 60-day period, and was positively related to the percentage of days abstinent from alcohol, Dr. Bradizza and her associates reported at the annual meeting of the Research Society on Alcoholism.

In other words, participants who drew on positive thinking most often during their recovery were doing a better job of reducing their alcohol consumption.

Negative thinking was associated with higher rates of drinking on two outcome measures: total number of drinks during the 60-day period and average number of drinks over the 60-day period.

Social support was marginally correlated with a reduction in drug use and abstinence from drugs, although the researchers said the connections need “further exploration.”

“Overall, these results indicate that alcohol-specific coping strategies may be a productive avenue of research aimed at improving treatments for seriously mentally ill individuals diagnosed with an alcohol or drug-use disorder,” the authors concluded in a poster presented at the meeting.

SANTA BARBARA, CALIF. — A comprehensive 10-year study of Alcoholics Anonymous participants has unveiled several surprising, sometimes counterintuitive findings about the program's influence over a membership that numbers more than 1.2 million in the United States and 2 million worldwide.

Perhaps most notably, J. Scott Tonigan, Ph.D., and his associates at the University of New Mexico, Albuquerque, found that many one-time AA participants rarely or never attend meetings and may not place much stock in a higher power's role in their recovery, yet continue to read AA literature and believe that the organization helps them stay sober.

One of the underlying premises of AA is that, to be successful, members must commit to lifelong abstinence and meeting attendance, as well as dedication to a “spiritual awakening” that includes turning over to “a power greater than themselves” the control alcohol holds over their lives.

Eight of the 12 steps forming AA's core framework mention a higher power, “God, as we understand Him,” and/or prayer. “It's a little bit of heresy to say one can benefit from a 12-step program without believing in a higher power, but there are people who do just that,” Dr. Tonigan said in an interview after his presentation of 10 posters detailing his study at the annual meeting of the Research Society on Alcoholism.

Study's 10-Year Follow-Up

Dr. Tonigan and his associates at the university's Center on Alcoholism, Substance Abuse, and Addictions followed up on participants in the Matching Alcoholism Treatments to Client Heterogeneity (Project MATCH) study, which, in the mid-1990s, recruited 226 heavy drinkers and randomly assigned them to one of three manual-guided, therapist-client therapies: cognitive-behavioral therapy (CBT), motivational enhancement training (MET), or 12-step facilitation aimed at “engaging clients into the lifelong program of AA.”

In the ensuing 10 years, some participants died and others were lost to follow-up, but investigators achieved a remarkable 85% follow-up rate among 175 eligible subjects. They conducted lengthy interviews and obtained detailed drinking and lifestyle information from 50 participants who had undergone CBT, 48 who received MET, and 52 assigned to 12-step facilitation.

“This study offered a rare, long-term view of treatment outcome,” Dr. Tonigan and coinvestigator William R. Miller, Ph.D., also of the University of New Mexico, noted in a poster. Dr. Tonigan and Dr. Miller found that people in all three groups were doing quite well 10 years after the intervention, both in terms of the number of days they remained abstinent and in their total number of drinks per drinking day, compared with baseline drinking patterns. There was no relationship, however, between which therapy they had received and their current abstinence or drinking intensity.

“In fact, while at the end of year 1 and year 3, 12-step facilitation clients reported significantly higher rates of complete abstinence relative to CBT and MET, this advantage was lost such that the 12-step facilitation clients reported the lowest rates of abstinence (24%) at 10-year follow-up,” they reported. Total abstinence rates in the CBT group and MET group were 31% and 35%, respectively.

AA Viewed as Valuable Resource

A closer look at 51 of the clients originally assigned to the 12-step group found that just 5 achieved sustained and regular 10-year attendance at AA meetings. Sixteen more attended erratically over the years, but at the time of follow-up fewer than half were attending AA meetings.

Dr. Tonigan stressed that meeting attendance is “but one dimension of the AA experience.”

Members of the original 12-step group still drew on AA for support, with 22 of 51 reporting that they still read AA core literature and 25 saying that they considered themselves members of AA.

Moreover, AA appeared to be “an important resource” for study participants assigned to the non-12-step arms of the study, he said.

Overall, 66% of all 151 Project MATCH clients who participated in the follow-up said they attended AA during or after the original study.

Recent AA attendance was reported by 39%. This percentage increased to 49% when non-AA meeting behaviors and beliefs were included to define commitment to AA doctrine, for example, reading core AA literature. “It is clear, therefore, that problem drinkers view AA as a valuable resource regardless of formal treatment orientation,” Dr. Tonigan wrote.

A separate analysis found that regular attendees of AA meetings were more likely than were erratic or former attendees to express commitment to core elements of the program, including making amends, believing in and deferring to a higher power, and participating in fellowship and step activities of AA. Some of these activities predicted abstinence or total alcohol consumed among consistent AA attendees, but belief in a higher power and deferring to that power did not.

Among erratic or former attendees of AA, no relationship could be seen between commitment to the core elements of the program and abstinence or a reduction in drinking, despite the fact that one in four said AA was “pretty helpful” or “very helpful” in helping them to combat their drinking problems.

In his interview, Dr. Tonigan said it is important to find out which elements of AA are successful and which are not, so that those elements can be integrated into therapy for people who choose not to remain in the formal AA program.

“We have a lot of work to do to understand why people move into, through, and out of AA, and why,” he said. “Is it the program that helps people stop drinking, or is it the fellowship? That's the $64 million question.”

One piece of advice he gave to clinicians was to suggest that patients sample several AA groups and not make a decision to quit based on a few meetings with one group. Some are highly structured and focused on formal AA principles; others offer relaxed fellowship and support. With more than 50,000 groups in the United States, people with a desire to stop drinking are highly likely to find a group with which they feel comfortable and can get the help they need, Dr. Tonigan said.

Program Focuses On 'Higher Power'

Eight of the 12 steps forming Alcoholics Anonymous' core framework mention a higher power, “God, as we understand Him,” and/or prayer. The 12 steps describe the experience of the organization's early members:

1. We admitted we were powerless over alcohol—that our lives had become unmanageable.

2. Came to believe that a Power greater than ourselves could restore us to sanity.

3. Made a decision to turn our will and our lives over to the care of God as we understood Him.

4. Made a searching and fearless moral inventory of ourselves.

5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

6. Were entirely ready to have God remove all these defects of character.

7. Humbly asked Him to remove our shortcomings.

8. Made a list of all persons we had harmed, and became willing to make amends to them all.

9. Made direct amends to such people wherever possible, except when to do so would injure them or others.

10. Continued to take personal inventory and when we were wrong promptly admitted it.

11. Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.

12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

Source: Alcoholics Anonymous

SANTA BARBARA, CALIF. — A comprehensive 10-year study of Alcoholics Anonymous participants has unveiled several surprising, sometimes counterintuitive findings about the program's influence over a membership that numbers more than 1.2 million in the United States and 2 million worldwide.

Perhaps most notably, J. Scott Tonigan, Ph.D., and his associates at the University of New Mexico, Albuquerque, found that many one-time AA participants rarely or never attend meetings and may not place much stock in a higher power's role in their recovery, yet continue to read AA literature and believe that the organization helps them stay sober.

One of the underlying premises of AA is that, to be successful, members must commit to lifelong abstinence and meeting attendance, as well as dedication to a “spiritual awakening” that includes turning over to “a power greater than themselves” the control alcohol holds over their lives.

Eight of the 12 steps forming AA's core framework mention a higher power, “God, as we understand Him,” and/or prayer. “It's a little bit of heresy to say one can benefit from a 12-step program without believing in a higher power, but there are people who do just that,” Dr. Tonigan said in an interview after his presentation of 10 posters detailing his study at the annual meeting of the Research Society on Alcoholism.

Study's 10-Year Follow-Up

Dr. Tonigan and his associates at the university's Center on Alcoholism, Substance Abuse, and Addictions followed up on participants in the Matching Alcoholism Treatments to Client Heterogeneity (Project MATCH) study, which, in the mid-1990s, recruited 226 heavy drinkers and randomly assigned them to one of three manual-guided, therapist-client therapies: cognitive-behavioral therapy (CBT), motivational enhancement training (MET), or 12-step facilitation aimed at “engaging clients into the lifelong program of AA.”

In the ensuing 10 years, some participants died and others were lost to follow-up, but investigators achieved a remarkable 85% follow-up rate among 175 eligible subjects. They conducted lengthy interviews and obtained detailed drinking and lifestyle information from 50 participants who had undergone CBT, 48 who received MET, and 52 assigned to 12-step facilitation.

“This study offered a rare, long-term view of treatment outcome,” Dr. Tonigan and coinvestigator William R. Miller, Ph.D., also of the University of New Mexico, noted in a poster. Dr. Tonigan and Dr. Miller found that people in all three groups were doing quite well 10 years after the intervention, both in terms of the number of days they remained abstinent and in their total number of drinks per drinking day, compared with baseline drinking patterns. There was no relationship, however, between which therapy they had received and their current abstinence or drinking intensity.

“In fact, while at the end of year 1 and year 3, 12-step facilitation clients reported significantly higher rates of complete abstinence relative to CBT and MET, this advantage was lost such that the 12-step facilitation clients reported the lowest rates of abstinence (24%) at 10-year follow-up,” they reported. Total abstinence rates in the CBT group and MET group were 31% and 35%, respectively.

AA Viewed as Valuable Resource

A closer look at 51 of the clients originally assigned to the 12-step group found that just 5 achieved sustained and regular 10-year attendance at AA meetings. Sixteen more attended erratically over the years, but at the time of follow-up fewer than half were attending AA meetings.

Dr. Tonigan stressed that meeting attendance is “but one dimension of the AA experience.”

Members of the original 12-step group still drew on AA for support, with 22 of 51 reporting that they still read AA core literature and 25 saying that they considered themselves members of AA.

Moreover, AA appeared to be “an important resource” for study participants assigned to the non-12-step arms of the study, he said.

Overall, 66% of all 151 Project MATCH clients who participated in the follow-up said they attended AA during or after the original study.

Recent AA attendance was reported by 39%. This percentage increased to 49% when non-AA meeting behaviors and beliefs were included to define commitment to AA doctrine, for example, reading core AA literature. “It is clear, therefore, that problem drinkers view AA as a valuable resource regardless of formal treatment orientation,” Dr. Tonigan wrote.

A separate analysis found that regular attendees of AA meetings were more likely than were erratic or former attendees to express commitment to core elements of the program, including making amends, believing in and deferring to a higher power, and participating in fellowship and step activities of AA. Some of these activities predicted abstinence or total alcohol consumed among consistent AA attendees, but belief in a higher power and deferring to that power did not.

Among erratic or former attendees of AA, no relationship could be seen between commitment to the core elements of the program and abstinence or a reduction in drinking, despite the fact that one in four said AA was “pretty helpful” or “very helpful” in helping them to combat their drinking problems.

In his interview, Dr. Tonigan said it is important to find out which elements of AA are successful and which are not, so that those elements can be integrated into therapy for people who choose not to remain in the formal AA program.

“We have a lot of work to do to understand why people move into, through, and out of AA, and why,” he said. “Is it the program that helps people stop drinking, or is it the fellowship? That's the $64 million question.”

One piece of advice he gave to clinicians was to suggest that patients sample several AA groups and not make a decision to quit based on a few meetings with one group. Some are highly structured and focused on formal AA principles; others offer relaxed fellowship and support. With more than 50,000 groups in the United States, people with a desire to stop drinking are highly likely to find a group with which they feel comfortable and can get the help they need, Dr. Tonigan said.

Program Focuses On 'Higher Power'

Eight of the 12 steps forming Alcoholics Anonymous' core framework mention a higher power, “God, as we understand Him,” and/or prayer. The 12 steps describe the experience of the organization's early members:

1. We admitted we were powerless over alcohol—that our lives had become unmanageable.

2. Came to believe that a Power greater than ourselves could restore us to sanity.

3. Made a decision to turn our will and our lives over to the care of God as we understood Him.

4. Made a searching and fearless moral inventory of ourselves.

5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

6. Were entirely ready to have God remove all these defects of character.

7. Humbly asked Him to remove our shortcomings.

8. Made a list of all persons we had harmed, and became willing to make amends to them all.

9. Made direct amends to such people wherever possible, except when to do so would injure them or others.

10. Continued to take personal inventory and when we were wrong promptly admitted it.

11. Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.

12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

Source: Alcoholics Anonymous

SANTA BARBARA, CALIF. — A comprehensive 10-year study of Alcoholics Anonymous participants has unveiled several surprising, sometimes counterintuitive findings about the program's influence over a membership that numbers more than 1.2 million in the United States and 2 million worldwide.

Perhaps most notably, J. Scott Tonigan, Ph.D., and his associates at the University of New Mexico, Albuquerque, found that many one-time AA participants rarely or never attend meetings and may not place much stock in a higher power's role in their recovery, yet continue to read AA literature and believe that the organization helps them stay sober.

One of the underlying premises of AA is that, to be successful, members must commit to lifelong abstinence and meeting attendance, as well as dedication to a “spiritual awakening” that includes turning over to “a power greater than themselves” the control alcohol holds over their lives.

Eight of the 12 steps forming AA's core framework mention a higher power, “God, as we understand Him,” and/or prayer. “It's a little bit of heresy to say one can benefit from a 12-step program without believing in a higher power, but there are people who do just that,” Dr. Tonigan said in an interview after his presentation of 10 posters detailing his study at the annual meeting of the Research Society on Alcoholism.

Study's 10-Year Follow-Up

Dr. Tonigan and his associates at the university's Center on Alcoholism, Substance Abuse, and Addictions followed up on participants in the Matching Alcoholism Treatments to Client Heterogeneity (Project MATCH) study, which, in the mid-1990s, recruited 226 heavy drinkers and randomly assigned them to one of three manual-guided, therapist-client therapies: cognitive-behavioral therapy (CBT), motivational enhancement training (MET), or 12-step facilitation aimed at “engaging clients into the lifelong program of AA.”

In the ensuing 10 years, some participants died and others were lost to follow-up, but investigators achieved a remarkable 85% follow-up rate among 175 eligible subjects. They conducted lengthy interviews and obtained detailed drinking and lifestyle information from 50 participants who had undergone CBT, 48 who received MET, and 52 assigned to 12-step facilitation.

“This study offered a rare, long-term view of treatment outcome,” Dr. Tonigan and coinvestigator William R. Miller, Ph.D., also of the University of New Mexico, noted in a poster. Dr. Tonigan and Dr. Miller found that people in all three groups were doing quite well 10 years after the intervention, both in terms of the number of days they remained abstinent and in their total number of drinks per drinking day, compared with baseline drinking patterns. There was no relationship, however, between which therapy they had received and their current abstinence or drinking intensity.

“In fact, while at the end of year 1 and year 3, 12-step facilitation clients reported significantly higher rates of complete abstinence relative to CBT and MET, this advantage was lost such that the 12-step facilitation clients reported the lowest rates of abstinence (24%) at 10-year follow-up,” they reported. Total abstinence rates in the CBT group and MET group were 31% and 35%, respectively.

AA Viewed as Valuable Resource

A closer look at 51 of the clients originally assigned to the 12-step group found that just 5 achieved sustained and regular 10-year attendance at AA meetings. Sixteen more attended erratically over the years, but at the time of follow-up fewer than half were attending AA meetings.

Dr. Tonigan stressed that meeting attendance is “but one dimension of the AA experience.”

Members of the original 12-step group still drew on AA for support, with 22 of 51 reporting that they still read AA core literature and 25 saying that they considered themselves members of AA.

Moreover, AA appeared to be “an important resource” for study participants assigned to the non-12-step arms of the study, he said.

Overall, 66% of all 151 Project MATCH clients who participated in the follow-up said they attended AA during or after the original study.

Recent AA attendance was reported by 39%. This percentage increased to 49% when non-AA meeting behaviors and beliefs were included to define commitment to AA doctrine, for example, reading core AA literature. “It is clear, therefore, that problem drinkers view AA as a valuable resource regardless of formal treatment orientation,” Dr. Tonigan wrote.

A separate analysis found that regular attendees of AA meetings were more likely than were erratic or former attendees to express commitment to core elements of the program, including making amends, believing in and deferring to a higher power, and participating in fellowship and step activities of AA. Some of these activities predicted abstinence or total alcohol consumed among consistent AA attendees, but belief in a higher power and deferring to that power did not.

Among erratic or former attendees of AA, no relationship could be seen between commitment to the core elements of the program and abstinence or a reduction in drinking, despite the fact that one in four said AA was “pretty helpful” or “very helpful” in helping them to combat their drinking problems.

In his interview, Dr. Tonigan said it is important to find out which elements of AA are successful and which are not, so that those elements can be integrated into therapy for people who choose not to remain in the formal AA program.

“We have a lot of work to do to understand why people move into, through, and out of AA, and why,” he said. “Is it the program that helps people stop drinking, or is it the fellowship? That's the $64 million question.”

One piece of advice he gave to clinicians was to suggest that patients sample several AA groups and not make a decision to quit based on a few meetings with one group. Some are highly structured and focused on formal AA principles; others offer relaxed fellowship and support. With more than 50,000 groups in the United States, people with a desire to stop drinking are highly likely to find a group with which they feel comfortable and can get the help they need, Dr. Tonigan said.

Program Focuses On 'Higher Power'

Eight of the 12 steps forming Alcoholics Anonymous' core framework mention a higher power, “God, as we understand Him,” and/or prayer. The 12 steps describe the experience of the organization's early members:

1. We admitted we were powerless over alcohol—that our lives had become unmanageable.

2. Came to believe that a Power greater than ourselves could restore us to sanity.

3. Made a decision to turn our will and our lives over to the care of God as we understood Him.

4. Made a searching and fearless moral inventory of ourselves.

5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

6. Were entirely ready to have God remove all these defects of character.

7. Humbly asked Him to remove our shortcomings.

8. Made a list of all persons we had harmed, and became willing to make amends to them all.

9. Made direct amends to such people wherever possible, except when to do so would injure them or others.

10. Continued to take personal inventory and when we were wrong promptly admitted it.

11. Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.

12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

Source: Alcoholics Anonymous