By Lloyd Vacovsky

The millennium has signaled the dawn of a new era in the treatment of alcohol and substance dependence in the United States. New treatment protocols, which include pharmacotherapy, are attracting increased attention from the Alcohol and Substance Dependence Treatment Community. At the forefront of this movement is The Pennsylvania Model of Recovery, which is so named in that its protocols are based on the research and work of the University of Pennsylvania School of Medicine, Treatment Research Center in Philadelphia. This is a medical model, which offers a full range of empirically tested treatment options to individuals dependent upon alcohol and other drugs. The Pennsylvania Model differs dramatically from the Minnesota Model or 12 Step format in that it wholeheartedly embraces Pharmacotherapy as a cornerstone of treatment, along with individual and group psychosocial support.

The Pennsylvania Model can be compared to a three-legged stool. The three legs are the biological, psychological and social components of recovery. All three components are essential. Take away one of the legs, and the stool becomes ineffective. The Pennsylvania Model seeks to address each of these components of addiction, for individuals seeking recovery.

The biological component includes not only the physical addiction to the alcohol or drug, as manifested for example by the presence of "the Shakes", but also the intense cravings that persist long after the physical discomfort have dissipated. Most people can deal with the physical discomfort. It is the emotional issues caused by imbalances in the brain chemistry that precipitate most relapses. Relapses are common, indeed expected. This despite the dire consequences that many individuals face by their continued drinking. Social and non-drinkers do not understand what drives an alcohol dependent individual to drink alcohol, without regard to consequences. A simple explanation is that it can be said that an alcohol dependent person does not drink to feel "good" but rather drinks in order to not feel "bad". The use of safe, effective, approved medications addresses the biological component of the recovery process.

Cognitive Behavioral Therapy is utilized for the psychological issues which must also be addressed. Recovery is at best an extremely difficult path. Being burdened by such issues as clinical depression makes it all but impossible to achieve abstinence. The use of alcohol is clearly the most common form of self-medication utilized by individuals suffering from psychological trauma. Simply stopping the alcohol consumption for example, in most situations, will not eliminate depression or any other psychological symptom. Using depression as an example, many individuals simply do not understand that they are suffering from depression. Depression for them, over the years, becomes the "norm". They have forgotten the difference between feeling good and feeling bad. For most alcohol dependent individuals, feeling "bad" is the "norm" and alcohol is their only known form of relief.

Equally important are the social issues faced by individuals in recovery. Learning how to adjust to sobriety is often more difficult than making the decision to stop. Dealing sober with family, friends and employers can be so intimidating to individuals in recovery that many relapse. Alcohol dependent individuals over the years become extremely skillful in manipulating situations and lying in order to insure a supply of alcohol. The "news" that one has made a commitment to stop drinking is most often met with justifiable skepticism. The individual has probably given the news about stopping the drinking so often that listeners react much as those who heard the warning from "the boy crying wolf". Support from concerned family and friends is essential to recovery, yet the bridge has been burned so badly, that such support is no longer offered.

Alcohol dependent individuals often experience intense isolation and loneliness, even when surrounded by family and friends. Often they do not realize or are in denial as to the impact that their drinking has on the people around them. As with most addicted individuals, alcoholics tend to rely on their own ability to control their addiction. The end result is usually another failed attempt to achieve sobriety. Most individuals seeking help do so only after disastrous events have compelled them to do so. For recovery to become possible, numerous issues as discussed must be addressed. In the end, it is critical for the individual to realize that the help of others is a vital component of recovery.


On December 30, 1994, the United States Food & Drug Administration approved for use in the treatment of alcohol dependence, the opioid antagonist Naltrexone HCI. The approval of naltrexone marked a turning point in the history of treatment for alcohol dependence. Naltrexone is at the forefront of emerging pharmacotherapy protocols utilized by the Pennsylvania Model. Since the approval of naltrexone in 1994, additional medications have been added to the arsenal in the battle against alcohol dependence. These medications include Ondansetron, Campral and Topamax.

Within a few minutes of ingestion, Naltrexone will dramatically reduce or suppress the intense craving to consume alcohol. The medication is extremely safe, has very minor or no side effects, is not addicting either physically or emotionally, can be discontinued at anytime without adverse effects and is generally administered for six months or less.

It is clear neither that Naltrexone, nor any of the other effective medications, in themselves are a cure for alcohol dependence. They are not magic nor are they the silver bullet that will destroy this disease known as alcoholism. They are however, extremely valuable tools, that when properly utilized, will enable motivated individuals to embark upon a successful path to recovery.

The primary difficulty with medications such as Naltrexone is that they only addresse specific issues of a very complicated disease. Naltrexone will effectively suppress the cravings, however it does not address any of the remaining issues for example clinical depression and or social problems which in themselves can cause relapse. It does however create a window of opportunity in which an alcohol dependent individual can address the countless issues of maintaining sobriety, without the overwhelming desire to drink alcohol. Even with the use of naltrexone, the path to recovery is at best difficult.

Alcohol can be compared to a sandbox. Consuming alcohol enables individuals to stick their head in the sand and avoid issues and problems. The problems, the pain, do not go away. They simply lurk in the background, waiting for the individual to attempt to get their head out of the sand. Relapse occurs when the individual is not able to deal with the intense cravings, coupled with their inability to face the almost countless lurking demons that exist in everyday living. Medications effectively take away the sandbox, forcing the individual to address the numerous issues that occur during the recovery process.

Individuals that have "a Life" but cannot get past the cravings in their efforts to abstain from alcohol find Naltrexone "a wonder drug". Generally, within an hour, the monkey that has been on their back for years, jumps off, and does not return if the medication is taken for the recommended period of time. It is rare however for an individual that is alcohol dependent not to have numerous and severe issues which effect recovery. Individuals with more intense issues are far more likely to slip or relapse.

Again, it must remember that the Naltrexone only addresses the cravings. Years of drinking are not washed away by the taking of a pill. Perhaps the most difficult part of recovery is learning how to be happy. Just as the bottom line of a business is profit, the bottom line of recovery is happiness and contentment. The individual must further recognize that happiness and contentment are not always available to us 24 hours a day, 7 days a week. That we have good days and bad days, and that the sandbox is not the answer for the bad days.

Minnesota Model protocols expect failure, over and over, until the individual has bottomed out. Then, out of desperation, the individual is expected to rebuild a life that the bottle took years to destroy. A Pennsylvania Model program does not expect the individual to fail. This does not mean that failures do not occur. The lure of the sandbox and all the lurking demons often overwhelm the individual. However, by properly addressing the Biological, Psychological and Social issues, the sandbox can be filled with concrete, never again to be used in desperation.

Brain imaging shows that the brains of teens that use marijuana are working harder than the brains of their peers who abstain from the drug.

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At the 2008 annual meeting of the American Academy of Pediatrics in Boston, Mass., Krista Lisdahl Medina, a University of Cincinnati assistant professor of psychology, presented collaborative research with Susan Tapert, associate professor of psychiatry at the University of California, San Diego.

Medina’s Oct. 12 presentation, titled, “Neuroimaging Marijuana Use and its Effects on Cognitive Function,” suggests that chronic, heavy marijuana use during adolescence – a critical period of ongoing brain development – is associated with poorer performance on thinking tasks, including slower psychomotor speed and poorer complex attention, verbal memory and planning ability. Medina says that’s evident even after a month of stopping marijuana use. She says that while recent findings suggest partial recovery of verbal memory functioning within the first three weeks of adolescent abstinence from marijuana, complex attention skills continue to be affected.

“Not only are their thinking abilities worse, their brain activation to cognitive tasks is abnormal. The tasks are fairly easy, such as remembering the location of objects, and they may be able to complete the tasks, but what we see is that adolescent marijuana users are using more of their parietal and frontal cortices to complete the tasks. Their brain is working harder than it should,” Medina says.

She adds that recent findings suggest females may be at increased risk for the neurocognitive consequences of marijuana use during adolescence, as studies found that teenage girls had marginally larger prefrontal cortex (PFC) volumes compared to girls who did not smoke marijuana. The larger PFC volumes were associated with poorer executive functions of the brain in these teens, such as planning, decision-making or staying focused on a task.

Medina says adolescence is a critical time of brain development and that the findings are yet another warning for adolescents who experiment with drug use. She says more study is needed to see if the thinking abilities of adolescent marijuana users improve following longer periods of abstinence from the drug. “Longitudinal studies following youth over time are needed to rule out the influence of pre-existing differences before teens begin using marijuana, and to examine whether abstinence from marijuana results in recovery of cognitive and brain functioning,” says Medina.

A National Survey on Drug Use and Health will be released today, stating that about 20 Milion people used illicit drugs during the past month.

Drug use increased among those 50-59 years old as more baby boomers joined that age group. Previously, their drug use rose from 4.3 percent in 2006 to 5 percent in 2007.

According to John Walters, director of the White House Office of National Drug Control Policy, “Baby boomers have much higher rates of self-destructive behaviors than any other age group from which we have statistics.”

About 20% of young adults acknowledged illicit drug use within the previous month last year, a rate that has held steady. However cocaine use declined by 25% and meth by 33%. Cocaine and methamphetamine use declined last year mainly due to dwindling supplies which lead to higher costs and less potency.

Across the board, the overall use of illicit drugs showed little change.

‘I called the clinic and discovered he had checked out. I knew I had to go to him. I chartered a private plane and flew from LA to Palm Springs.’ Pamela learned that David had been taken to a local hospital, but didn’t know which one. ‘I got into a taxi and went to every hospital until I found him.’

She discovered later that he’d drunk the entire contents of the minibar and had been found by a maid, semi-conscious and half-naked on the floor. The police had been called. This sordid episode, like so many before, was covered up by Pamela and a team of minders. Hasselhoff was, after all, America’s most bankable TV star at the time.

‘Had news leaked out, it would have destroyed the image he created for himself and the image I created for my friends and family,’ says Pamela. ‘We were both living a lie but the biggest tragedy was that David loved the bottle more than me.’

To his fans – and he has thousands of them in Britain – David Hasselhoff is simply ‘The Hoff’, a  perma-tanned hunk of Hollywood beefcake.

He shot to fame in the Eighties as crime-fighter Michael Knight in the cult series Knight Rider, starring alongside a talking super-powered car called Kitt. But he is most famous, of course, for his starring role in Baywatch – the all-action series that followed the adventures of the muscled-up boys and gorgeous girls who made up a team of LA beach lifeguards.

With ratings boosted by swimsuit-clad co-stars such as Pamela Anderson, the series became, according to Guinness World Records, the most watched in TV history with 1.1billion viewers in 140 countries.

Even when the starring acting roles dried up ten years ago, Hasselhoff managed to reinvent himself thanks to his self-deprecating charm and an ability, rare among Hollywood stars, to appear not to take himself too seriously.