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Survey About Smoking Cessation Drugs african history assignment help: african history assignment help

Smoking Cessation Drugs

The majority of smokers who try to quit smoking do so from six to nine times during their lives. This research paper, which focuses on smoking cessation drugs, includes a survey the researcher conducted at three medical facilities. Forty participants relate details regarding their attempts to quit smoking.

“Quitting smoking is one of the best things [one] can do for [his/her] health.

Most smokers try to quit 6-9 times in their lives”

– The U.S. Surgeon General (“Quitting can be” 2009).

Quitting Smoking

“I know I need to quit smoking.”

“I’m trying to quit.”

“I plan to quit.”

“Quitting smoking is hard.”

As most smokers “realize” the damage smoking cigarettes does to the human body, many smokers regularly verbalize the statements denoting their intentions to quit smoking. The truth, albeit, as the introductory quote for this research paper purports, even though quitting smoking constitutes one of the best things a person can do for his/her health, quitting smoking simultaneously proves to be one of the hardest challenges a smoker counters. In fact, as The U.S. Surgeon General notes, “Most smokers try to quit 6-9 times in their lives.” Smoking cessation drugs and/or methods, the focus for this research paper, therefore, the researcher asserts, qualify as subjects worthy of investigating.

The U.S. Surgeon General routinely investigates smoking cessation drugs; methods, and poses the question CHANTIX notes in their promotion for their stop smoking drug: “So why is it so hard to quit?” (“Quitting can be” 2009). CHANTIX, the primary smoking cessation drug examined during this research effort, purports that understanding the reasons why quitting smoking may be difficult at times may prove helpful. The researcher asserts that it not only helpful, but prove vital for smokers who want to quit to understand more about smoking cessation drugs such as CHANTIX .

REVIEW OF LITERATURE

Tobacco addiction contributes to approximately 438,000 deaths in the United States each year, with smoking cigarettes constituting one of the most common preventable causes of death, on report asserts. Tobacco use kills five million people a year worldwide, another source stresses (Recent safety news, para. 2). Eliminating smoking could greatly reduce the occurrence of coronary heart disease and other forms of cardiovascular disease, including cardiovascular diseases such as heart attack, stroke, high blood pressure, atherosclerosis, thrombosis, coronary artery spasm, and cardiac arrhythmia (U.S. Surgeon General 2009).

Quitting smoking, albeit, proves to be difficult to most smokers. Right after a person starts to quit smoking, along with symptoms that accompany nicotine withdrawal, he/she may experience a number of short-term effects such as weight gain, irritability and anxiety. Ways to quit smoking include “cold turkey,” step-by-step manuals, counseling or medical products may help replace or reduce nicotine addiction.

Advertisers, including drug companies, routinely market a number of stop-smoking products, scientifically “proven” to help a person quit smoking. These products, however, cannot do the “work” required to quit smoking. Using particular stop-smoking products, albeit, may help the smoker, determined to quit smoking, feel more comfortable and in control while he/she adjusts his/her life to be free from smoking.

The development of smoking cessation drugs dates back to 1971 when Pharmacia developed the first nicotine replacement product for smoking cessation, nicotine-laced chewing gum. Ensuring, contemporary nicotine replacement products can help relieve some of the withdrawal symptoms the smoker experiences when he/she attempts to quit smoking. Several nicotine replacement products currently available over-the-counter in the U.S. include two nicotine patches, nicotine gum and nicotine lozenges. In addition to over the counter products, a smoker wanting to quit smoking may obtain nicotine nasal spray, inhaler (Zyban) and the recently approved nicotine-free tablet (CHANTIX) by prescription. CHANTIX

CHANTIX asserts that its program includes a support plan with a steady, step-by-step approach designed to help the smoker quit smoking. “CHANTIX has been proven to help people quit” (“Quitting can be” 2009), CHANTIX proclaims. Some of the ways CHANTIX reported differs from other quit-smoking products reportedly include:

In studies, 44% of CHANTIX users were quit during weeks 9 to 12 of treatment (vs. 18% on sugar pill).

CHANTIX is a non-nicotine pill.

CHANTIX can reduce the urge to smoke.

It comes with GETQUIT, a support plan created just for CHANTIX users and designed to help you think and act like a quitter. (“Quitting can be” 2009)

As prescribed drugs to help smokers quit smoking include side effects, as with other types of medication, the “patient” needs to follow his/her doctor’s orders and use the prescribed smoking cessation product as prescribed; adhering to labeling directives. The drug CHANTIX (varenicline), for instance, which works on nicotine receptors in the brain and decreases the craving for smoking, reports a number of potential side effects. Some have been so serious that the European Medicines Agency (EMEA) asserts the marketer of the adult smoking cessation prescription drug CHANTIX needs to update the patient and doctor information to note that some patients using CHANTIZ have experienced suicidal ideations, with some individuals following through with suicide attempts.

To be most effective, nicotine replacement products should be used in conjunction with a behavior change program. This would help the individual attempting to quit smoking better deal with a depressed mood, which may manifest as a symptom of nicotine withdrawal. Depression, along with suicidal ideations, and suicide attempts, have been reported in patients attempting to cease smoking.

Most smokers who attempt to quit smoking do so without assistance. Less than 5% of individuals who try to quit on their own (cold-turkey), however, prove to be successful long-term. “This underscores the need to get people help with medication when quitting smoking in order to address this important public health issue. Quitting with assistance can more than double one’s chances of success” (Recent safety news, para. 2). The U.S. Public Health Service’s Clinical Practice Guideline Treating Tobacco Use and Dependence recommends a combination treatment plan of medication and intensive counseling for smokers who want to quit smoking. Combining counseling and medication reportedly proves more effective than either counseling or medication alone (Free & Clear, para. 5).

News regarding the safety of a prescription smoking cessation therapy has contributed to some smokers avoiding medication to aid in their smoking cessation efforts (Recent safety news, para. 1). Currently, only two approved medications for smoking cessation are marketed in the U.S. (“Smoking cessation market,” para. 6). Two new drugs to help smokers quit, however, are expected to be launched in 2012 and 2013. In addition, scientists are developing vaccines to address the addiction to nicotine (“Smoking cessation market,” para. 9). One independent report asserts Nicotine Replacement Therapies (NRTs), such as gums, patches, inhalants, lozenges and pills as near useless, as it also cites dangers of using NRTs. “On the matter of NRTs, the study concludes that their use is fairly beneficial to smokers needing short-term cigarette replacement, like in an airplane, employment or while dining, but have NO IMPACT helping smokers stop, long-term (New Report, para. 4). This report contends that within five years, smokers who use NRTs will be twice as likely to relapse back to smoking cigarettes than smokers who quit cold turkey. Another study, on the other hand, claims that smokers trying to gradually kick the smoking habit can better succeed with the help of nicotine gum (Nicotine Gum effective, para. 2).

Some ex-smokers report that chewing gum or sucking on candy helped them address the oral cravings associated with smoking. Some purport herbal options to work better as they also offer therapeutic benefits. Roy Upton, executive director of the American Herbal Pharmacopoeia, based in Scotts Valley, California contends: “One potential herbal therapy for craving is lobelia because it contains lobeline, an alkaloid similar to nicotine. Herbalists have traditionally used lobelia in conjunction with a nervine to help reduce craving” (Upton quoted in Clute, para. 4). Upton recommends that people trying to quit smoking keep something to chew on with them for times the cravings attack. This could be a stick of licorice or a bag of fennel seeds, according to Upton. Licorice helps support the adrenals, Upton points out, which also relates to the stress aspect of quitting smoking.

Fewer than half of smokers who attempt to quit remain non-smokers after one year, Michael Rabinoff, DO, PhD, assistant research psychiatrist in the UCLA Department of Psychiatry. Even though quitting smoking may not be easy, in fact, even difficult despite the help of the best scientifically proven methods, smokers need to remember the old adge: “If at first you don’t succeed, try, try again” (“A new reason,” para. 1).

RESEARCHER’S STUDY

Methodology

Initially, at the start of this study, the researcher aimed to evaluate CHANTIX regarding its effectiveness, problems, side effects, and why smokers who used this smoking cessation “tool” sometimes quit it rather than quitting cigarettes. The researcher pondered whether smokers prescribing to CHANTIX discontinued using this drug because of its high cost, its potentially grave side effects, or due to both the drug’s high cost and severe side effects. Shortly after beginning to research this particular study option, albeit, the researcher confronted a dearth of current surveys relating to the use of CHANTIX . As this venue did not proffer enough data for the researcher, the researcher determined to conduct a basic survey on smoking cessation drugs in Mobile, Alabama.

For the study, the researcher conducted the surveys in two hospitals and a clinic in the Mobile area. The researcher chose one location, Providence Hospital, as it hosts a smoking cessation program. Springhill Hospital served as the researcher’s second hospital choice as the researcher learned, it houses a cardiopulmonary rehabilitations center. The researcher choose Victory Clinic as the third site for implementing the survey as it serves the community in the non-profit realm; providing needed services for people without out medical insurance.

From distributing more than 100 questionnaires at these three locations, the researcher ultimately retrieved 40 completed surveys from current smokers and ex-smokers. During the survey period, 24 persons used smoking cessation drugs or quit smoking “cold turkey.” Data the researcher amassed from the surveys indicated that sixteen participants who participated in this study did not use any smoking cessation drugs and continue to smoke.

Results

Figure 1 depicts the methods noted by patients/participants as their choice for quitting smoking.

Figure 1: Participant’s Methods for Quitting Smoking (Researcher 2009).

Figure 2: Participant Status at End of Study (Researcher 2009).

Figure 3: CHANTIX Side Effects Participants Experienced (Researcher 2009).

Figure 4: CHANTIX Claims (“Quitting can be” 2009).

Conclusion

Figure 1: Participant’s Methods for Quitting Smoking (Researcher 2009).

Figure 2: Participant Status at End of Study (Researcher 2009).

Figure 3: CHANTIX Side Effects Participants Experienced (Researcher 2009).

Figure 4: CHANTIX Claims (“Quitting can be” 2009).

WORKS CITED

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approves Chantix).” FDA Consumer. (2006). HighBeam Research. 13 Apr. 2009

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with Phone-Based Behavioral Counseling.” Business Wire. Business Wire. (2008).

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(Pfizer’s Chantix).” Trial. American Association for Justice. (2008). HighBeam

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Smoking.” PR Newswire. PR Newswire Association LLC. (2008). HighBeam

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. “Quitting can be different this time.” (2009) CHANTIX (varenicline) Pfizer Inc.

http://www.chantix.com / “Recent Safety News About Smoking Cessation Therapies Leaving Smokers Confused,

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drug Chantix to accidents, heart trouble.(Drug safety).” Adverse Event

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. “The smoking cessation therapies that are more effective than placebos.” The Hindustan Times.

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.

Troise, Damian J. “Pfizer’s Chantix banned for pilots, air traffic controllers following report on side effects.” AP Worldstream. (2008). HighBeam Research. 13 Apr. 2009

.

Fetal Alcohol Syndrome Health Promotion history assignment help online

Fetal Alcohol Syndrome Health Promotion

Fetal alcohol syndrome has been identified as a leading cause of mental retardation affecting.2-1.5% of live births. It also produces physical defects in the child. Pregnant and other women of childbearing age who drink have to be motivated into giving up the habit or at least reducing it. The future of these children and of the nation’s health depends on what is being done today to insure it. Among the health promotion priorities of Healthy People 2000 concerns alcohol and other drugs and maternal and infant health is among its priority preventive service. This study seeks to initiate a social activity, which will promote maternal and infant health by bringing together sample pregnant alcoholics, reformed women alcoholics and health professionals in a direct encounter and exchange of information, motivation and insights.

Review of Literature

Belcher, Harolyn (2008). Fetal Alcohol Syndrome: an Undiluted Danger. Pediatric News: International Medical News Group. Retrieved on October 27, 2008 at http://findarticles.com/p/articles/mi_hb4384/is_8_42/ai_n2945915?tag=content,col1

Belcher writes that fetal alcohol syndrome or FAS is the leading but preventable and identifiable cause of mental retardation in the U.S. At 0.2 to 1.5% per 1,000 live births, mostly among minority groups. Effects on the fetus range from a full-blown syndrome to mild behavioral and cognitive delays. Not all children exposed to alcohol before birth with act or appear alike. Physical features range from sever to subtle to absent. Furthermore, some of these features may develop from other physical or behavioral disorders.

No studies have determined how much alcohol produces harmful effects on children. What is known is that women who are long-term alcoholics face a greater risk of producing a child with FAS. No specific test has been established for FAS, either. The only basis has been maternal history, which is not always possible to obtain. Assessments have been made generally on the basis of behavioral and mental health. Children afflicted with FAS have moderately deficient IQ levels, are not too responsive to social cues or rules on hygiene and generally do not learn from past experiences. The disease is detected most often at around age 3 when the child becomes hyperactive and then again at age 6 or 7. When diagnosed, management can be complicated. His or her symptoms resemble other disorders. The best approach is adjusted to the child’s personal and family circumstances. Early intervention is most desirable as children diagnosed before age 6 appear to do better than if found later. The cooperation of pediatricians and at-risk families is thus very important and elicited.

Valuable information on central nervous problems concerning alcohol in the womb has recently evolved. Public awareness on the dangers of alcohol during pregnancy has increased and improved. Pediatricians have also developed more varied modes of treating emotional and behavioral disorders with children. Overall, early diagnosis and long-term intervention provide the best chances for children with FAS to hope for some future.

Walling, Anne D. (2006). Prevention and Diagnosis of Fetal Alcohol Syndrome. American Family Physician: the American Academy of Family Physicians. Retrieved on October 27, 2008 at http://findarticles.com/p/articles/mi_m3225/is_10_73/ai_n26885596?tag=content;col1

Walling points to a lack of awareness of alcoholism in the mother and her physician’s lack of expertise in the condition as the main reasons for an under-diagnosis of FAS. Om addition, a newborn’s symptoms may be so subtle that they go undetected. A diagnosis of FAS is based on abnormalities in facial features, growth and nerve function. No specific criteria for the diagnosis have been established. Two short screening instruments, the T-ACE and TWEAK, have been used and recommended by the Agency for Healthcare Research and Quality. These take less than a minute to use and determine alcohol use more effectively than the routine physician questioning of the patient.

Recommended approaches consist of postponement of pregnancy, contraception and alcohol reduction in non-pregnant women. Intervention can be in the form of discussing the risks, evaluating the woman’s readiness to change and offering support to reduce the drinking up to 25%. Regular follow-ups are also suggested for both groups to document changes in drinking patterns and to reinforce measures to reduce alcohol intake, especially among high-risk women. Such measures have been observed to have reduced alcohol intake and improved infant conditions.

Bertrand, Jacquelyn, et al. (2005). Guidelines for Identifying and Referring Persons with Fetal Alcohol Syndrome. Morbidity and Mortality Report: U.S. Government Printing Office. Retrieved on October 27, 2008 at http://findarticles.com/p/articles/mi_m0906/is_11_54/is_11_54/ai_n5894729?tag=content,col1 scientific working group of experts on FAS issued diagnostic guidelines on when and how to refer women suspected of prenatal alcohol exposure. These include existing practices, which offer support environments long-term consequences of FAS in children afflicted with it.

Referral should be made as soon as the exposure becomes known. The suspected person should be subjected to full FAS evaluation as soon as alcohol abuse is determined. If the exposure is unknown, the person or child should still be subjected to a full FAS evaluation if the parent reports a suspicion of FAS. Evaluation should also be resorted to in the presence of facial features characteristic of FAS, or growth problems, and certain social and family history factors to prenatal exposures to alcohol. These include maternal death relating to alcohol abuse, living with an alcoholic parent, experience of abuse or neglect, previous or current involvement with children of alcoholics, a history of care-giving, foster or adoptive care. Certain circumstances warrant a diagnostic referral. These include a known prenatal alcohol exposure, valid suspicion of FAS from a parent or caregiver or the presence of the general physical features or family history and conditions earlier mentioned.

Referrals can be made throughout one’s lifespan, although the majority have been referred, diagnosed and managed during childhood.

Hankin, Janet R. (2002). Fetal Alcohol Syndrome Prevention Research. Alcohol Research & Health: U.S. Government Printing Office. Retrieved on October 27, 2008 at http://findarticles.com/p/articles/mi_mOCXH/is_1_26/ai_90681221?tag=content;col1

Hankin lists the three major prevention strategies established by the Committee to Study Fetal Alcohol Syndrome of the Institute of Medicine of the National Academy of Sciences. These are universal prevention of maternal alcohol abuse, the selective prevention of maternal alcohol abuse, and indicated prevention of FAS.

The initial step in the universal prevention is to increase public awareness of the effects of alcohol use during pregnancy, specifically FAS. This can include news reports, catchy magazine articles, public service announcements, billboards and warning labels.

It has been observed that the coverage of alcohol-related concerns in the five major national newspapers from 1985 to 1991 was insufficient to deal with the issue. The U.S. Congress passed the Alcoholic Beverage Warning Label Act, imposing the attachment of a label in all containers of alcoholic beverages. It warned about the risks of drinking alcohol on pregnancy. Awareness increased but, afterwards, gradually waned. In addition, the response to the increase in awareness was not too impressive.

Selective prevention addresses women of reproductive age and who drink. A study showed that brief intervention by the physician alone reduces the risk. A short session with a physician can lead the woman to state her reasons for drinking while pregnant, identify the risk situations for drinking, alternatives to it and recommendations for abstinence.

Indicated prevention is directed on populations at the highest risk for bearing children with FAS. The aim is to prevent the increased birth of children with alcohol-related defects. One brief session helped the women at risk to decide to abstain from, or limit, alcohol use.

Despite these efforts, many such women continue to drink during pregnancy. The author, thus, believes new and more effective ways are needed to reach those at-risk populations and to influence behavioral change in them.

Encyclopedia of Psychology (2001). Fetal Alcohol Syndrome. Gale Encyclopedia of Psychology: Gale Group. Retrieved on October 27, 2008 at http://findarticles.com/p/articles/mi_q2699/is_0004/ai_2699000467?tag=content;col1

Statistics show that FAS occurs in one to three babies every 1,000 births in the U.S. It has been identified as a leading and cause of mental retardation. It is also one of its few preventable causes. It remains unknown why some fetuses of alcoholic women are affected while others are now. Experts believe that combined genetic and environmental factors determine the condition. The characteristic physical and mental birth defects of both FAS and fetal alcohol effects or FAE are prenatal growth retardation, low birth weight, intellectual and attention deficiencies, behavioral problems and malformations in the skull, brain or face. FAS or FAE is a lifelong condition, which will limit the person’s productiveness and capability. At this time, only early diagnosis and appropriate intervention offer a solution to the disease.

Gaby, Alan R. (2001). Can Nutritional Therapy Prevent Fetal Alcohol Syndrome? Townsend Letter to Doctors and Patients: The Townsend Letter Group. Retrieved on October 27, 2008 at http://findarticles.com/p/articles/mi_mOISW/is_2001_Nov/ai_79757209?tag=content;col1

Because the brain develops fast in the post-natal period, findings of a study suggest that nutritional intervention can prevent some of the effects of FAS in the offspring. The author writes about the benefits of postnatal supplementation of choline from the second to the 21st days post natal. Another research suggests the use of zinc supplementation for the mother in order to reduce the teratogenic effect of alcohol consumption. If pregnant women will not stop drinking, a broad-spectrum nutritional support may be an appropriate alternative.

Christensen, Damaris (2000). Sobering Work – Fetal Alcohol Syndrome. Science News: Science Service, Inc. Retrieved on October 27, 2008 at http://findarticles.com/p/articles/mi_mOISW/us_2001_Nov/ai_79757209?tag=content;col1

The author says that no safe amount of alcohol during pregnancy has been established in lieu of avoidance. Many pregnant women who drink heavily want to know how much they drink without harming their fetuses because they do not want to give the habit up. Some researchers say that even low doses of alcohol can bring harm. Animal studies may not be applicable to human subjects as species differ in developmental patterns. The general idea is that the safe drink for pregnant women is one without alcohol.

Rheinstein, Peter H. (1992). Healthy People 2000. American Family Physician: the American Academy of Family Physicians. Retrieved on October 27, 2008 at http://findarticles.com/p/articles/mi_m3225/is_n6_v46/ai_13358040?tag=content;col1

The overall aim of this program is to significantly improve the health of all Americans by the year 2000. It intends to achieve this goal by reducing preventable deaths and disability, to enhance quality of life and increase lifespan. The Healthy People 2000 engages the participation of professionals, private organization and public agencies. It aims at promoting healthy lifestyles and preventing disease. The goals set are th enhance the quality of life. The American Academy of Family Physicians is one of the almost 300 member-organizations in its national consortium. Its priorities are health promotion, health protection, preventive services and surveillance and data systems. Alcohol and other drugs are the sixth in the list of its health promotion priorities. And maternal and infant health is the first priority under preventive services. Fetal alcohol syndrome is a preventable disease and a top preventive service in the program.

Heading of Health Promotion Project

FAS is a leading cause of mental retardation. It afflicts.2% to 1.5% of all live births and manifests both physically and behaviorally. Previous campaigns against alcohol abuse and its consequences have not gained impressive success. Target and other at-risk women need to be better motivated in a more conducive environment.

Project Objectives to invite pregnant and other childbearing-age women in a given community to a drinking party for information of value to them and for entertainment.

A to bring these women and health professionals to a friendly and supportive encounter reformed alcoholics will be invited to share their experiences of victory video can be shown on the consequences of FAS

Content Outline and Implementation

An evening party where drinks will be served to the targets, health professionals and other guests. An official of the local health department may hold it in his or her home or garden for the festive effect.

Health professionals will speak on alcohol and what it does to the body and the unborn child; FAS and its consequences; and how drinking can be curbed

Reformed alcoholics with FAS children can share their experience.

Significance of the Project

The target pregnant alcoholics will be made to see what they are taking into their body. The video will let them see what alcohol does to their unborn child. And reformed alcoholics will motivate them to give the habit up.

Project Innovation

The event is social in nature. It will allow the target guests to drink, have fun and feel accepted. But the health professionals, the video and the reformed alcoholics will also have the chance to open the targets’ mind to the realities of alcohol abuse. The approach is non-combatant but enhancing of self-esteem in the targets.

Project Evaluation Methods

The success of the event can be observed. Because of its social nature, the targets will speak up openly about their goals and inclinations. Those who agree at least in principle to try giving up may be directly helped by the health professionals. Those who refuse or hesitate will at least divulge the cause/s for their hesitation and be helped from there.

Bibliography

Belcher, H. (2008). Fetal alcohol syndrome: an undiluted danger, 3 pages. Pediatric News: International Medical News Group. Retrieved on October 27, 2008 at http://findarticles.com/p/articles/mi_hb4384/is_8_42/ai_n2945915?tag=content,col1

Bertrand, J. et al. (2001). Guidelines for identifying and referring persons with fetal alcohol syndrome. 24 pages. Morbidity and Mortality Report: U.S. Government Printing Office. Retrieved on October 27, 2008 at http://findarticles.com/p/articles/mi_m0906/is_11_54/is_11_54/ai_n5894729?tag=content,col1

Christensen D. (2000). Sobering work – fetal alcohol syndrome. 5 pages. Science News: Science Service, Inc. Retrieved on October 27, 2008 at http://findarticles.com/p/articles/mi_mOISW/us_2001_Nov/ai_79757209?tag=content;col1

Encyclopedia of Psychology (2001). Fetal alcohol syndrome. 2 pages. Gale Encyclopedia of Psychology: Gale Group. Retrieved on October 27, 2008 at http://findarticles.com/p/articles/mi_q2699/is_0004/ai_2699000467?tag=content;col1

Gaby, Alan R. (2001). Can nutritional therapy prevent fetal alcohol syndrome? 2 pages. Townsend Letter to Doctors and Patients: The Townsend Letter Group. Retrieved on October 27, 2008 at http://findarticles.com/p/articles/mi_mOISW/is_2001_Nov/ai_79757209?tag=content;col1

Hankin J.R. (2002). Fetal alcohol syndrome prevention research. 14 pages. Alcohol Research and Health: U.S. Government Printing Office. Retrieved on October 27, 2008 at http://findarticles.com/p/articles/mi_mOCXH/is_1_26/ai_90681221?tag=content;col1

Rheinstein P.H. (1992). Healthy people 2000. 5 pages. American Family Physician: the American Academy of Family Physicians. Retrieved on October 27, 2008 at http://findarticles.com/p/articles/mi_m3225/is_n6_v46/ai_13358040?tag=content;col1

Walling, a.D. (2005). Prevention and diagnosis of fetal alcohol syndrome. 2 pages. American Family Physician: the American Academy of Family Physicians. Retrieved on October 27, 2008 at http://findarticles.com/p/articles/mi_m3225/is_10_73/ai_n26885596?tag=content;col1

Efficacy of Naltrexone in the Treatment of Alcoholism ap history essay help: ap history essay help

Naltrexone

The Efficacy of Naltrexone in the Treatment of Alcoholism

The economic, social and physical toll exacted by alcoholism is enormous by any measure, and identifying effective ways to treat this condition has been the focus of an increasing amount of research in recent years. While there has been a consensus among healthcare providers, clinicians and researchers alike that alcoholism is in fact a disease, there are some environmental and behavioral issues that have been shown to play a significant role as well. One approach that may offer some potential for treating many of the symptoms typically associated with alcoholism, as well as some of the concomitant behaviors, is the use of naltrexone. It is the hypothesis of this study that Naltrexone will reduce the cravings associated with alcoholism, as well as related relapse rates, and episodes of heavy drinking compared to a placebo with alcoholics based on a preponderance of evidence in the peer-reviewed and scholarly literature. The critical review of the literature used for this purpose is followed by a summary of the research in the conclusion, together with recommendations for policymakers and healthcare providers alike.

Review and Discussion

Background and Overview.

The impact of alcohol abuse and alcoholism is well documented and need be mentioned only to establish the extent of the problem considered herein. In this regard, Bhagar and Schmetzer (2006) report that, “Alcohol dependence is a problem that affects about 10% of the general population. It not only impacts the affected individual with disorders such as cirrhosis of the liver, pancreatitis, dementia, and others, but also affects the whole family from issues related to abuse, drunken driving, divorce, or loss of employment” (p. 29). Likewise in her essay, “Rationale for Combining Acamprosate and Naltrexone for Treating Alcohol Dependence,” Mason (2005) emphasizes that the alcoholism is a prevalent, chronic disorder that carries with it profound worldwide public health consequences. Therefore, the identification of safe and effective medications has assumed new importance in recent years in an effort to augment the modest efficacy of current behavioral treatments designed to reduce the high risk of drinking relapse after an initial period of abstinence.

Treatments for this purpose have traditionally focused primarily on support groups with behavioral interventions such as Alcoholics Anonymous (AA) (Bhagar & Schmetzer, 2006). Antidipsotropics, or drugs that decrease drinking like disulfiram (which is an acetaldehyde dehydrogenase inhibitor) and naltrexone (which is an opioid antagonist), have been shown to be effective in certain settings; however, poor compliance continues to restrict their general efficacy (Bhagar & Schmetzer, 2006). According to Mason, “Primary goals for alcoholism pharmacotherapy typically include maintaining abstinence, increasing the duration of an abstinent interval prior to a lapse and reducing the intensity of drinking if a relapse occurs. Such drug effects may also serve to increase retention in behavioral treatment, thereby facilitating behavioral changes supportive of an alcohol-free lifestyle” (p. 148). A wide range of treatment modalities are available for substance abuse, with most authorities recommending a combination of approaches to help improve chances for success in recovering from alcohol dependence and alcoholism, which studies have shown remain meager despite the best efforts of all concerned, including the patients themselves. In this regard, Bean and Nimitz (2004) emphasize that, “Withdrawal and detoxification regimes [sic] have a high failure rate unless linked to long-term rehabilitation” (p. 24).

First and foremost, patients that stop drinking heavily all at once are at increased risk of seizures and the other symptoms that go hand in hand with alcohol withdrawal syndrome, and this is where naltrexone could provide a patient with the ability to withstand the nightmarish aspects of this condition in order to progress further in the treatment regimen. In this regard, Heather and Stockwell (2004) report that pharmacological agents such as naltrexone are, of course, the main method of treatment for the alcohol withdrawal syndrome, but its use has been questioned by healthcare providers and family members alike: “Treating an addiction with another drug sometimes alarms sufferers, their families and therapists. Is it not substituting one addiction with another?” (Heather & Stockwell, 2004, p. 53). These authors emphasize, though, that therapies using naltrexone to reduce relapse during outpatient treatment have not been shown to be abused for their psychotropic effects, and do not prolong a dependent state because of cross-tolerance with alcohol, as occurs with benzodiazepines. Moreover, and given the high rate of relapse among recovering alcoholics, naltrexone does not produce the same type of adverse physical reactions characterized by disulfiram or intensify the effects of alcohol should a person decide to drink while taking it (Heather & Stockwell, 2004).

Efficacy of Naltrexone.

A number of early studies suggested that the opioid-antagonist naltrexone was nontoxic and appeared to represent a good tool in the clinician’s repertoire to help reduce craving for alcohol and post-treatment alcohol consumption for their patients; these findings led to more widespread application of naltrexone pharmacotherapy with alcoholics (Howard & Vaugh, 2004). There have been an increasing number of scientific studies conducted in recent years concerning the efficacy of naltrexone. A good overview of these studies is provided in the recent study, “Behavioral Therapy to Augment Oral Naltrexone for Opioid Dependence: A Ceiling on Effectiveness?,” wherein Carpenter, Kleber, Nunes, Rothenburg and Sullivan (2006) report that, “The opioid antagonist naltrexone is a theoretically promising treatment for opioid dependence that has never lived up to its potential. A recent meta-analysis and accompanying editorial support the conclusion that oral naltrexone is effective” (p. 503). In their randomized trial among opioid-dependent patients, the researchers found that, “Patients retained on naltrexone three months or more achieved high rates of abstinence” (Carpenter et al., 2006, p. 503).

Some of the barriers to adherence with the naltrexone regimen identified by these researchers included the following:

Difficulty with induction, which requires patients to be detoxified and off opioids for at least 7 days to avoid precipitated withdrawal; and,

The ease with which patients can discontinue oral naltrexone and relapse to opioid use, after which naltrexone cannot be resumed without repeat detoxification; however, behavioral interventions, such as contingency management or couples therapy, have shown promise in improving adherence to oral naltrexone (Carpenter et al., 2006). According to these authors, “Oral naltrexone depends on daily compliance, and just a few missed doses is all that is needed to permit relapse to occur, at which point naltrexone is not easily resumed. This may be a fundamental limiting factor” (Carpenter et al., 2006, p. 503).

The most commonly reported endpoint of the naltrexone trials conducted to date has been relapse to heavy drinking which is typically defined as more than 5 drinks per day in men, and more than 4 drinks per day in women, and it is on this measure that Mason (2005) suggests that the efficacy has been most consistently demonstrated as shown by the recapitulation of studies concerning the use and effects of naltrexone to date in Table 1 below.

Table 1.

Recapitulation of selected findings from naltrexone studies to date.

Author/Date

Key findings

Comments

Bhagar & Schmetzer (2006)*

Naltrexone is extensively metabolized and its main active metabolite is 6-beta naltrexol. Because of a lack of first pass metabolism with the long-acting intramuscular formulation, significantly less 6-beta naltrexol is generated than with the oral formulation of naltrexone.

No comparative data between the 2 formulations is available. It is excreted by the kidneys, and mild renal insufficiency has no impact on its pharmacokinetics. Its clearance in moderate and severe renal insufficiency has not been evaluated.

Ait-Daoud & Johnson (1999)*

Naltrexone has been shown to decrease alcohol consumption; however, its practical effective-ness may be compromised by poor patient compliance and other factors.

Human laboratory studies exploring the effects of naltrexone on alcohol-induced mood and craving have produced mixed results; one factor that may contribute to the discrepancy among research results is a person’s genetic susceptibility to alcoholism. Nevertheless, alcohol consumption by laboratory animals is reduced by naltrexone.

Krystal et al. (2001)

The demonstration of a decrease in relapse has not been observed in all studies, including the largest to date (N = 627)

There are a number of factors that could explain this; i.e., because the effect of naltrexone may be to reduce consumption when drinking, potential treatment effects in the clinical trials may be diluted by patients who remain abstinent throughout.

Morris et al. (2001)

If the analysis is restricted to patients that resume drinking during the trials, then the size of the treatment effect may be increased.

Chick et al. (2000)*

No significant difference was found between control group using placebo and naltrexone to time to first heavy drinking or time to first drink outcomes. Alcohol consumption for naltrexone group was lower in last 4 weeks of 12-week trial but was not significant; however, naltrexone group reported significantly less craving for alcohol.

Oslin et al. (1997)

14.3% of subjects in the naltrexone group relapsed versus 34.8% in the placebo group. No significant differences in treatment compliance or reported craving were found.

This study revealed an effect where none existed before.

O’Malley, Jaffe, Rode & Rounsaville (1996)*

The naltrexone group reported significantly lower levels of craving compared with the placebo group.

Croop et al. (1997).

The overall safety profile of naltrexone is good; however, care must be taken in prescribing the drug to certain patient populations; e.g., naltrexone shows a dose-dependent hepatotoxicity (package insert) and is therefore contraindicated in patients with significant hepatic impairment, which is frequently encountered in alcohol-dependent populations.

The clinical trials of naltrexone have typically been conducted in patients without significant impairment in hepatic function. Another consequence of the hepatic impact of naltrexone is the possibility of drug-drug interactions.

Kim et al. (2001) potentially clinically significant interaction has been reported between naltrexone and nonsteroidal anti-inflammatory drugs; these researchers found elevated liver function tests in study participants receiving both medications, although the doses of naltrexone used in this study were higher than the typical 50 mg daily dose.

Naltrexone is not appropriate for use with patients taking prescribed or illicit opioid drugs. Antagonism of the effects of these drugs at opiate receptors will generally precipitate an opiate withdrawal syndrome. As a result, naltrexone would be contraindicated for methadone-maintained patients with alcohol dependence or those patients with needs for narcotic analgesics, and a small proportion of patients will not be able to tolerate naltrexone, primarily because of nausea.

Pettinati et al. (2000)* combined medication management and motivational enhancement regimen was used to provide individualized clinical care while monitoring pharmaco-therapy or individualized counseling. The study found that for compliant subjects, much lower relapse rates were experienced in the naltrexone group compared to the control group; however, for noncompliant subjects there was no advantage to naltrexone over placebo.

This 3-month intervention used 50-100 mg of naltrexone daily or an identical placebo. Compliance with the intervention developed by these researchers was significantly higher than with individualized counseling (83% versus 55% for trial completion and 77% versus 60% for medication compliance.

Kranzler et al. (2000)*

This study found no significant difference on outcome measures between control group using placebo and those using naltrexone.

In general, among all groups, treatment compliance predicted slightly less drinking, but there were no significant differences didentified between the two groups.

Monti et al. (2001)*

Naltrexone showed results superior to placebo, while subjects took medication; however, the effects did not persist. Overall, cue exposure training with coping and communication skills training showed better long-term outcomes.

Anton & Randall (2005)*

It has generally been shown, possibly because of blockade of the reinforcement or rewarding effects of alcohol, that naltrexone will most likely inhibit a heavy drinking episode after initial “slip drinking.”

Several trials showed that naltrexone also increased the percentage of days abstinent.

Howard & Vaughn (2004)*

More studies that experimentally manipulate the psychosocial treatments delivered in conjunction with opioid antagonists are still required. To date, most studies have compared groups receiving naltrexone to a given placebo, all of whom received standard agency-based psychosocial interventions.

Future research should include longer follow-up periods, ensure that they evaluate treatment effects in patients who are compliant with treatment, and examine the effects of treatment on the extent of drinking in patients who relapse.

Source: Cited in Mason (2005) unless otherwise indicated with (*).

Conclusion

Naltrexone is a long-acting oral opiate antagonist that many researchers and clinicians believe has useful effects in treating alcohol abuse and the symptoms that are associated with withdrawal from alcohol (Bean & Nemitz, 2004). The research showed that naltrexone appears to be well-tolerated and effective in many patients by helping them to stop resumption of episodes of binge drinking. To date, there have been more than a dozen studies concerning the various aspects of using naltrexone as an adjunct to alcohol treatment; however, the research also showed that additional studies will be needed in the future to determine more specific doses, the optimal duration of treatment, and whether subtypes of alcoholics would benefit from using naltrexone (Heather & Stockwell, 2004). Finally, strategies to support medication compliance may need to be emphasized to optimize the therapeutic outcomes associated with naltrexone regimens (Mason, 2005).

References

Ait-Daoud, N., & Johnson, B.A. (1999). Medications to treat alcoholism. Alcohol Research & Health, 23(2), 99.

Anton, R.F., & Randall, C.L. (2005). Measurement and choice of drinking outcome variables in the COMBINE study. Journal of Studies on Alcohol, 66(4), 104.

Bhagar, H.A., & Schmetzer, a.D. (2006). New antidipsotropics. Annals of the American Psychotherapy Association, 9(4), 29.

Bean, P., & Nemitz, T. (2004). Drug treatment: What works? New York: Routledge.

Carpenter, K.M., Kleber, H.D., Nunes, E.V., Rothenberg, J.L., & Sullivan, M.A. (2006). Behavioral therapy to augment oral naltrexone for opioid dependence: A ceiling on effectiveness? American Journal of Drug and Alcohol Abuse, 32(4), 503.

Chick, J., Anton, R., Checinski, K., Croop, R., Drummond, D.C., Farmer, R., Labiola, D., Marshall, J., Moncrief, J., Morgan, M.Y., Peters, T., & Ritson, B. (2000). A multicentre, randomized, double-blind, placebo-controlled trial of naltrexone in the treatment of alcohol dependence or abuse. Alcohol and Alcoholism, 35, 587-93.

Croop, R.S., Faulkner, E.B., & Labriola, D.F. (1997). The safety profile of naltrexone in the treatment of alcoholism: Results from a multicenter usage study. The Naltrexone Usage Study Group. Archives of General Psychiatry, 54, 1130-35.

Heather, N., & Stockwell, T. (2004). The essential handbook of treatment and prevention of alcohol problems. Hoboken, NJ: Wiley.

Kim, S.W., Grant, J.E., Adson, D.E., & Remmel, R.P. (2001). A preliminary report on possible naltrexone and nonsteroidal analgesic interactions. Journal of Clinical Psychopharmacology, 21, 632-34.

Kranzler, H.R., Modesto-Lowe, V., & Von Kirk, J. (2000). Naltrexone vs. nefazodone for treatment of alcohol dependence: A placebo-controlled trial. Neuropsychopharmacology, 22, 493-503

Krystal, J.H., Cramer, J.A., Krol, W.F., Kirk, G.F., & Rosenheck, R.A. (2001). Veterans Affairs naltrexone cooperative study 425 group: Naltrexone in the treatment of alcohol dependence. New England Journal of Medicine, 345, 1734-39.

Mason, B.J. (2005). Rationale for combining acamprosate and naltrexone for treating alcohol dependence. Journal of Studies on Alcohol, 66(4), 148.

Monti, P.M., Rohsenow, D.J., Swift, R.M., Gulliver, S.B., Colby, S.M., Mueller, T.I., Brown, R.A., Gorolon, a., Abrams, D.B., Niaura, R.S., & Asher, M.K. (2001). Naltrexone and cue exposure with coping and communication skills training for alcoholics: Treatment process and 1-year outcomes. Alcoholism: Clinical and Experimental Research, 25, 1634-47.

Morris, P.L., Hopwood, M., Whelan, G. et al. (2001). Naltrexone for alcohol dependence: A randomized controlled trial. Addiction, 96, 1565-73.

O’Malley, S.S., Jaffe, a.J., Rode, S., & Rounsaville, B. (1996). Experience of a ‘slip’ among alcoholics treated with naltrexone or placebo. American Journal of Psychiatry, 153, 281- 83.

Oslin, D., Liberto, J.G., O’Brien, J. et al. (1997). Naltrexone as an adjunctive treatment for older patients with alcohol dependence. American Journal of Geriatric Psychiatry, 5, 324-32.

Pettinati, H.M., Volpicelli, J.R., Pierce, J.D., & O’Brien, C.D. (2000). Improving naltrexone response: An intervention for medical practitioners to enhance medication compliance in alcohol dependent patients. Journal of Addictive Diseases, 19, 71-83.

Funding for International Students 12 pages history assignment help book

Financial Aid and Funding for International Students

The objective of this work is to research the financial aid and funding similarities and differences for international students at private vs. public colleges and universities in the United States. This work will answer the question of whether there are federal funding restrictions and look at what some institutions have done in order to overcome these restrictions.

The work of Altbach entitled: “The Coming Crisis in International Education in the United States” relates that in order to keep pace with the global world “American universities will need to be international institutions.” (nd) Information concerning financial aid, specifically for international students states, at least on one website, that education in the United States is “very expensive” since each year the cost for tuition, room and board will be approximately $15,000 to $40,000 a year in an undergraduate institution varying in relation to the specific school one attends. For students from other countries, or international students who travel to the U.S. To study, there are practically no venues of financial aid however students from Canada and Mexico are exceptions to the rule. Generally, grants, scholarships and loans from public and private entities are only for citizens of the United States and international students are restricted from these sources in funding. (eduPASS: The SmartStudents Guide to Studying in the U.S.A., 2007)

Upon having made a review of the literature in this area revealed is the fact that there are, while very few, some banks in the United States that will make students loans to the international student however, the loan requires a co-signer that is a United States citizen or permanent resident who has a good credit history. The type of visa may present a restriction in receiving a student loan. However, some international student do qualify for the Federal Stafford and PLUS loans.

The Astute Student Loan is one that has been established as a private program allowing students attending schools in the United States to receive loans of a maximum of $40,000 per year with a 20-year loan schedule. The minimum one may borrow is $1,500 per year. International students must have a U.S. citizen cosigner with good credit. Interest rates and fees depend upon the cosigner credit history. Another program is the ‘Canadian Higher Education Loan Program (CanHELP) which is a program designed to assist Canadian students in pursuing college education in the United States. The International Education Finance Corporation (IEFC) in collaboration with Bank of America, Fleet Boston, Citizens Bank, and the Education Resources Institute (TERI) loan students as much as the full cost of the education, which includes the student’s tuition, room and board, and fees. The maximum amount the graduate student is loaned per year is $15,000 unless the students has a cosigner and then the entire educational cost may be loaned. The minimum loan amount per year is $1,000. Students are allowed 20 years to repay the loan. A $50.00 per month payment minimum is set and provisions for deferment are also included in the loan agreement.

The work entitled: “Is the U.S. Right for You?” published in the Princeton Review states that “of the 1.4 million students pursuing postsecondary education outside their home countries, more than one-third chose to study in the United States.” (the Princeton Review, 2007) U.S. schools makes the offering of:

1) Academic excellence;

2) Variety of educational opportunity;

3) Cutting-edge technology;

4) Opportunities for research, teaching experience and practical training;

5) Flexibility;

6) Support services for International students;

7) Campus life; and (8) global educational.” (Princeton Review, 2007)

In the work of Miller and Huff, entitled: “International Students and Medical Education: Options and Obstacles” it is related that colleges in the United States are increasingly seeking “to attack a geographically diverse student population” and this is true of the smaller liberal arts colleges throughout the United States. Miller and Huff state that: “Indeed, many undergraduate admissions offices now use a ‘need-blind’ financial aid policy, which means that foreign students from all economic levels can now consider an undergraduate education in the United States.” (Princeton Review, 2007) it is extremely difficult for individuals who are not permanent residents or citizens in the United States to be granted admission to medical school in the U.S. And for those who do apply there are two primary barriers, which are:

1) the lack of funding for foreign students; and 2) the small number of American medical schools who will consider applications from foreign students.” (Miller and Huff, 2004)

For the foreign students who enters the medical school in the United States a requirement exists for these students to “escrow the equivalent of one to four years’ tuition and fees (U.S. $40,000 to U.S. $200,000) Miller and Huff state that the international students should be encouraged to “seek information about loans that may be available from their home government.” (Miller & Huff, 2004) Many of the lesser developed nations provide funding and financial support for medical students education but require that the student practice medicine in their home country for some set period of time after graduation for the purpose of repayment of the financial support. It is related by the California Institute of Integral Studies that employment on campus for F-1 visa holders is permitted up to 20 hours each week and 40 hours a week during breaks in the school year however, it is related that these positions are not guaranteed and that work at school positions are very limited in number.

The work of Kargbo and Yeager (2007) entitled: “The Race to Attract International Students” states that: “The U.S. has long been a magnet for the world’s top college students, and many of them…stay in the U.S. after graduation and contribute to the country’s economic competitiveness. By one recent estimate, they help pump more than $13 billion annually into the U.S. economy, and many become lifelong economic contributors by remaining in the U.S. through employment or marriage. For 50 years the U.S. benefited as the number of the valuable international college students rose continuously.” (2007) the following illustration shows the distribution of the total number of student visas issued in 2006 by country.

Distribution of Total Number of Student Visas Issued in 2006 (by Country)

Source: Kargbo and Yeager (2007)

Stated to be the top sending countries of students to the United States during 2006 were the countries of:

1) South Korea;

2) China;

3) India;

4) Japan;

5) Taiwan;

6) Saudi Arabia, 7) Mexico;

8) Turkey;

9) Brazil; and 10) Germany. (Kargbo and Yeager, 2007)

It is becoming more and more difficult for the United States to attract foreign students due to intensification of competition from Australia, Canada and the United Kingdom, which are stated to have “…better national marketing, more specialized programs for foreign students and generally lower tuition costs.” (Kargbo and Yeager, 2007) Additionally many of the governments of foreign countries are putting policies into place that encourage the students to stay in their own country to attain their education. If the United States is to “…retain its position as the destination of the greatest number of foreign students – and the advantage that such students afford in the battle for global economic competitiveness – the U.S. will have to be increasingly proactive in international marketing, simplify visa processing and increase affordable educational opportunities.” (Kargbo and Yeager, 2007)

The work entitled: “International Students and U.S. Policy Choices” written by Stuart Anderson, Executive Director, National Foundation for American Policy states that “The United States has lost its edge in attacking and enrolling international students in U.S. universities. This is particularly troubling in science and engineering at the graduate school level and carries implications for America’s economy, its technological leadership and its role in the world. Obstacles remain that prevent the United States from significantly increasing the enrollment of international students at U.S. universities.” (Anderson, 2007) Anderson identifies several areas in which improvements to policies may ensure “American leadership in international education and a strong scientific and technological foundation for the nation.” (Anderson, 2007) Anderson states that data generated on international college students provides indications that real problems have emerged and specifically that:

Enrollment by international graduate students in the United States and specifically in engineering study programs experienced an 8% decline during the time period between 2003 and 2004 according to report of the Council of Graduate Schools, while a 10% decline in life sciences international graduate students was reported for this same time period;

There was an overall decline of 2.4% between the time period from 2003 to 2004 and stated in an Institute of International Education report;

Between FY 2003 and FY 2004 there was a 25% decline in the number of F-1 visa issued for international students according to a U.S. Department of State report. (Anderson, 2007)

Obstacles of international student enrollment in U.S. colleges are stated by Anderson to include:

1) U.S. Visa Policy;

2) Competition;

3) Cost; and 4) the ability to work in the United States. (Anderson, 2004)

The main reason that international students are denied visas is because receiving a 214(b) visa requires that the applicant prove that they do not intend to stay in the U.S. Because educational options have increased more competition is coming from other countries in this market. Costs associated with the international student attending a U.S. school may often be too great for many international students to afford. Depending upon the outlook for work in the U.S., the international student may or may not attend college in the U.S. Costs for a college education in the United States is however, not the primary barrier.

Anderson relates that Robert Gelfond, CEO of MagiQ Technologies in New York is reported as stating that “We’ve seen foreign scientists try to get here to do research and can’t get in who not only go elsewhere but are so upset they say they will not come to the U.S. now under any circumstances…Clearly we are losing our ability to attack talented people, since the word has spread about the difficulties of getting into the United States. Individuals have to plan their lives and can’t afford to spend months and months putting everything on hold only to discover they won’t be able t come to America after all.” (Andersen, 2007) the international student’s contribution has been noted by the National Academy of Sciences in the May 2005 report entitled: “Policy Implications of International Graduate Students and Postdoctoral Scholars in the United States” which stated conclusions that: “International students contribute to U.S. society not only academically and economically, but also by fostering the global and cultural knowledge and understanding necessary for effective U.S. leadership, competitiveness and security.” (Anderson, 2007) Additionally stated was that should the United States “maintain overall leadership in science and engineering, visa and immigrations policies should provide clear procedures that do not unnecessarily hinder the flow of international graduate students and postdoctoral scholars.” (Anderson, 2007)

In a ‘Symposium Overview” entitled: “In America’s Interest: Welcoming International Students – the Role of Higher Education” it is stated that: “Educational systems are developing rapidly in many parts of the world, and worldwide competition for international students has increased and become much more aggressive. These and numerous other factors have created a complex new environment for the U.S. higher education and have contributed substantially to recent decline in the U.S. share of the worldwide flow of international students.” (in America’s Interest: Welcoming International Students – the Role of Higher Education, 2007) the symposium was attended by “more than seventy respected leaders in higher education.” (in America’s Interest: Welcoming International Students – the Role of Higher Education, 2007) Recommendations which arose from the symposium are stated to be geared toward a reversal in the decline of international students in the United States. The main points that were stated include those as follows:

1) Best practices exist for recruitment of students “can be found by looking abroad to competitor institutions, looking to domestic colleagues at other institutions and looking within the campus administration itself. Novel and proven approaches in the areas of recruitment, admissions, retention, and enrollment should be examined and possibly adapted to new contexts.” (in America’s Interest: Welcoming International Students – the Role of Higher Education, 2007)

2) Institutions were called upon to “proactively collect data on their international students to assist with the identification of issues and barriers to international student recruitment.” (in America’s Interest: Welcoming International Students – the Role of Higher Education, 2007) This information can be utilized in assisting universities in the refinement of the recruitment approaches and in the conveyance of messages to prospective international students in order to ensure the efficacy and accuracy as to the target population’s context.

3) There must be a focal point on each campus that works in coordinating the efforts of institutions and to make sure that the effort does not become “too diffuse or disjointed.”

4) Retention programs are stated to be just as critical as recruitment programs and requires that institutions work to be sure that these student’s education experience is positive.

5) International recruitment efforts must be ongoing even when the numbers do not cause concern in order to ensure that the international students continue to seek education in the United States.

Efforts for reducing financial barriers that impede international student’s access to college education in the United States are focused toward six common problems, which include the following:

The need for closer coordination with internal and external stakeholders that play a critical role in student financing;

Overcoming internal and external policy barriers that inhibit the development of sound financial solutions for international students;

Development of more effective communication strategies abroad;

Allocation of more resources and energy to international student marketing campaigns;

Surmounting the myriad political barriers that institutions face when looking to gain outside support for assistance programs; and Developing effective strategies for creatively utilizing alumni to support incoming international students.

The Symposium recommendations include those as follows:

1) Institutions should use “collective bargaining power with lenders to find ways to overcome the perception of risk that U.S. financial institutions have with respect to international students.” (Ibid)

2) Colleges should give consideration to developing payment plans for international students in order to assist them in paying educational costs over time and without penalties.

3) Programs, to assist in the direction of the cost of higher education should be developed with a focus on international students. Examples are stated to include home-stay programs.

4) Sponsors are often associated with many efforts at a university however, in the past this venue has not been considered in connection with international students and could make the provision of diverse types of sponsorship to assist the international student.

6) Endowment fund development should be considered by college students in order to support international diversity. (Ibid, paraphrased)

The following chart illustrates the enrollment rates of international students in the United States during the years 1989 to 2004.

Enrollment Rates of International Students in the U.S. (1989-2004)

Source: In America’s Interest: Welcoming International Students – the Role of Higher Education, 2007

The following table lists the international student by enrollment by program of study for the years 1999 through 2004.

Source: In America’s Interest: Welcoming International Students – the Role of Higher Education, 2007

International student enrollment is stated to be highest in the countries of the United States, the United Kingdom, Germany, France, Australia, and Japan. The following table illustrates the enrollments in colleges in these countries of international students from 1999 to 2004 and the percentage change of enrollment during that time period in each of these countries.

International Student Enrollment in the Top Six Host Countries 1999-2004

Source: In America’s Interest: Welcoming International Students – the Role of Higher Education, 2007

It is reported that international student enrollment has grown worldwide over the past five years and while the United States “continues to be the destination of choice for the largest group of students, the international student market is changing and a number of countries are now challenging U.S. dominance as the leading host country. The work of Anderson makes recommendations as to what should be changed in order to continue to attract international students to the United States. The objectives as set out by Anderson include the following:

Elimination of the visa requirement for those students intending to attain a master and Ph.D in the United States. Elimination of the 214(b) of the Immigration and Nationality Act and specifically changing the requirement of students to state intent to leave the U.S. upon graduation “would be a logical extension of the law…” (Anderson, 2007)

The U.S. should “streamline the process for international graduate students in science and engineering. International students earned approximately 60% of 2002 doctorates in the U.S. making it in the best interest of the U.S. that as many of these graduates as is possible and feasible “stay and work in the private sector.” (Anderson, 2007) Anderson states that policy options exist that can be pursued in making it easier for the international students with advanced education degrees to remain in the U.S. under lawful permanent residence. Another visa category being created for international students is also an option according to Anderson (2007).

Policy and processing difficulties could be addressed through appointing a single Administration official for coordination of policy and the role of “Ombudsman” relating to international students issues.” (Ibid) Anderson states that this: “…would lead to a logical setting of priorities to balance security and other interests.” (Anderson, 2007)

United States universities have a need to increase marketing efforts in others countries in order to attract international students to universities and colleges in the U.S.

The U.S. government, businesses and universities need to work in collaboration on the strategy necessary in conveying the message that the U.S. is the best place for educational attainment. (Anderson, 2007; paraphrased)

Summary and Conclusion

It is clear that United States colleges and institutions must strategically plan for marketing recruitment and retention of international students. Policies are self-defeating in the area of obtaining U.S. visas for international students and make requirements of being issued visas that work against educational policy and the country’s utilization of the talent upon graduation from the college or university. Anderson and others have stated the required actions that must be taken by the United States if international student enrollment is to increase once again and if the United States is to keep their competitive edge over other countries and development of educational programs that cater to the international student. International students are assets of the United States and should be treated as such with government policy and educational policy working in coherent cooperation and this is not presently the case. Overcoming the barriers that presently exist for international college students will require the collaborative effort between government, business and education institutions, and this will be accomplished only in an ongoing effort while keeping in mind that in today’s globalized world there is little room for discriminative policy and procedure and particularly in the colleges and universities.

Bibliography

Is the U.S. Right for You (2007) the Princeton Review. Online available at http://www.princetonreview.com/college/research/articles/international/usright.asp.

Altback, P. (1997) the Coming Crisis in International Education in the United States. International Higher Education, Summer 1997. Center for International Higher Education Boston College. Online available: http://www.bc.edu/bc_org/avp/soe/cihe/newsletter/News08/text2.html

Miller, EJ; and Huff, J (2004) International Students and Medical Education: Options and Obstacles. The Advisor, Vol. 24, 1. National Association of Advisors for the Health Professions.

Kargbo, a. And Yeager, M (2007) the Race to Attract International Students. Analysis and Perspectives. 22 March 2007. Education Sector. Online available at http://www.educationsector.org/analysis/analysis_show.htm?doc_id=470283.

Anderson, Stuart (2007) International Students and U.S. Policy Choices.

Students on the Move: The Future of International Students in the United States. (2006) Issue Brief October 2006. Executive Summary.

Financial Aid and Funding for International Students