Alcoholism Treatment
What is alcoholism?
Alcoholism is a chronic, progressive disease, which can injure or even kill the alcoholic patient in a variety of ways. It is, unfortunately, quite common: the World Health Organization estimates that 140 million people throughout the world suffer from alcohol dependence. Other studies indicate that approximately 18 million Americans are alcohol dependent.
Let’s take a look at the criteria for alcohol dependence. According to the DSM-IV (the Diagnostic and Statistical Manual of Mental Disorders), the alcohol dependent person must demonstrate the following:
- tolerance (you need more alcohol to achieve intoxication, or you get less effect using the same amount)
- withdrawal (you experience symptoms of withdrawal and/or you drink to avoid withdrawal symptoms)
- alcohol is consumed in larger amounts, or over a longer period of time, than was intended
- a persistent desire or unsuccessful effort to cut down or control use
- a great deal of time spent in activities necessary to obtain, use, or recover from the effects of alcohol
- important social, occupational or recreational activities are given up, or reduced, because of alcohol
- you keep drinking despite ongoing physical or psychological problems
Some alcoholic patients claim that they do not drink daily though freely admit to binge usage. Binge drinkers often state, “I can stop any time I want!” The proof is in the pudding, however – they continue to return to binge drinking, which may have severe consequences. They cannot stop their bingeing.
“I can control my drinking - I can limit myself” is yet another oft-heard rationalization by alcohol dependent patients. While it’s true that some people are able to limit their alcohol consumption, many cannot. They will tell themselves they will only have a glass of wine after dinner, but this will often lead to two glasses of wine after dinner, a few shots of vodka at a party (“It was a celebration, it was only that one time”), and so on, until the person is drinking on a daily basis.
Let’s be clear: alcohol dependence is an addiction. The person suffering from this illness usually becomes preoccupied with drinking, unable to control the amount of beer, wine or liquor he drinks, or how often he drinks, despite the physical, mental and legal risks involved in alcohol consumption.
What causes alcoholism?
Most experts believe that alcoholism is caused by any number of factors, including social environment, stress, emotional health and genetic predisposition.
With regard to the latter, some studies hold that 9% of the general population is predisposed to alcoholism based on genetic factors. Studies have also shown that children who are born to alcoholic parents are four times more likely to become alcoholics than children who are not from alcoholic backgrounds.
What are some common effects of alcohol dependence?
Alcohol dependence is known to affect the gastrointestinal system, sleep cycle, liver, heart, pancreas, blood, and/or nervous system, and potentially result in , increased chance of cancer, nutritional deficiencies, , and harm to the reproductive system (women who drink while pregnant run the risk of producing babies who suffer from Fetal Alcohol Syndrome).
Other signs of alcoholism may include:
- broken capillaries (small blood vessels) on the face
- raspy voice
- trembling hands
- chronic diarrhea
- enlarged veins just under the skin around the navel
- fluid in the abdomen
- a yellowish tone to the skin
- decreased testicle size
- poor nutritional health
Severe problems are not uncommon in alcoholics. Approximately 10% of all dementia cases are alcohol-related, making alcohol the second leading cause of dementia.
Alcoholics may also suffer from co-occurring psychiatric disorders, especially anxiety and depression disorders, with as many as 25% of alcoholics presenting with severe psychiatric disturbances. It isn’t always clear, however, which came first, the chicken or the egg. Did the alcoholic patient develop a psychiatric order, such as depression or anxiety? Or was the alcohol use an attempt to self-medicate the anxiety and depression?
Patients who suffer from both alcoholism and a psychiatric disorder are referred to as “dual diagnosis patients.” Milestones is one of the premier programs in America with regard to this specific treatment niche. Our staff excels at working with chemical dependency as well as mental health issues. Note that if the alcoholism is not addressed, the anxiety, depression or other psychiatric disorder will more than likely continue, and vice versa - if the underlying psychiatric disorder is not addressed, the patient will probably continue to self-medicate.
How is alcoholism treated?
The first phase of alcohol treatment is detoxification, during which the patient is abstinent while harmful chemicals are removed from his system. It is vital that the alcoholic detox with the help of a reputable, licensed clinic or physician. The detox process may take between 4-7 days, during which the patient may be prescribed specific medications to address, or prevent, delirium tremens (the “DTs,” which may result in uncontrollable shaking, panic attacks, and hallucinations), and/or other withdrawal symptoms, including seizures.
The patient will be medically assessed, monitored, and if necessary, treated for high blood pressure, elevated blood sugar, liver problems, and heart disease, all of which are frequently found in alcohol-dependent patients. How long, and how much alcohol the patient has been drinking, will dictate the ease and success of the withdrawal process.
After detox, it is advised that the patient seek a minimum 30 day stay at a treatment of good standing center, such as Milestones, where the staff will address the alcoholism in a three-pronged manner – psychotherapy, medication, and recovery.
Psychotherapy
The Milestones approach utilizes Pointing Out Patterns®, a blend of evidence-based modalities, including cognitive-behavioral therapy, motivational interviewing, Rogerian, and brief psychodynamic therapy. This essentially means that the clinical staff will help you get to your deepest issues – past trauma, coping style, belief system, and negative patterns of thought, emotion and behavior.
For example, “Joe,” an alcoholic with lots of anxiety, tends to flare up and verbally assault others, including his wife and two children. We treat his alcoholism and anxiety, but also tackle his displaced anger and attacking interpersonal style.
How do we do this? Through compassionate truth-telling by staff and peers, as well as written and behavioral exercises. Joe must refrain from drinking, of course. He must also find ways of self-soothing, through medication, meditation, or other means. But it is imperative that he learn new ways of dealing with others. His old ways resulted in constant job and relationship failure, which in turn led to poor self-esteem and anger. In fact, the anger was a big reason why he’d drink – an attempt, in his own words, to “drown out the flames inside.”
As part of the Milestones program, we facilitate psycho-educational groups around relapse prevention, relapse management, stress reduction, anger management, and medications. Patients are taught about their drinking triggers, offered substitute behaviors, and learn ways to self-soothe and deal with anxiety and resentments.
Medications
Addiction psychiatrists are well-versed in prescribing medications to address underlying psychiatric disorders, as well as medications that specifically address alcoholism, including Antabuse, Naltrexone, Vivitrol, Campral, and Topomax. We work hand-in-hand with addiction psychiatrists to ensure the best possible outcomes for our clients.
may be a deterrent to drinking. While it will not cure alcoholism or remove the compulsion to drink, it will produce flushing, nausea, vomiting and headaches if the patient does in fact drink.
reduces the urge to drink, blocking the high provided by alcohol. It is used after the patient has stopped drinking, and works by by decreasing the craving for alcohol. Naltrexone usually has no psychological effects. Patients do not feel high or low while taking it. Furthermore, it is not addicting.
, a version of Naltrexone, is injected in the buttocks once a month by a health care professional. It may reduce the urge to drink by blocking neurotransmitters in the brain thought to be associated with alcohol dependence.
is an anti-craving medication that may help the patient to combat alcohol cravings and remain abstinent from alcohol. It is the first new medication approved for the treatment of alcohol dependence in a decade. helps reduce the physical distress and emotional discomfort (e.g., sweating, anxiety, sleep disturbances) associated with remaining alcohol-free.
has been found effective in helping alcoholics quit, or cut back, on the amount they drink. In one study, heavy drinkers were six times more likely to remain abstinent for a month if they took the medication, even in small doses. In another study, those who received Topomax had fewer heavy drinking days, fewer drinks per day and more days of continuous abstinence than those who received the placebo. Topamax works by reducing the brain chemical dopamine so that drinkers no longer get any pleasure from consuming alcohol.
Recovery
At Milestones, we encourage our patients to explore various paths to recovery, such as Alcoholics Anonymous and Narcotics Anonymous. Transportation to 12 step meetings is provided by our tech staff. Getting a sponsor and doing step work are supported and promoted by our staff, as well.
12 step meetings are free to everyone, and are available virtually anywhere in the world. They have proved their worth time and again in their 75 years of existence. We believe in the efficacy of the 12 step model.
For those who do not like 12 step, other groups are available, including LifeRing Secular Recovery, Rational Recovery, SMART Recovery, and Women For Sobriety. In addition, some patients maintain their sobriety through a spiritual, or religious, program, i.e., meditation, Buddhism, Native American, Christianity, Judaism, Islam, etc.
Why do they call alcoholism a family disease?
An alcoholic affects all family members. The patient may lie and steal from other family members, miss important dates, anniversaries, and appointments, disappoint spouses, parents, siblings, and other relatives, or otherwise cause their loved ones stress and anguish.
What to do, if your husband, wife, son, daughter, brother, sister, or grandchild suffers from alcoholism?
First and foremost, you must take care of yourself. Attend an Al-Anon meeting, make an appointment with a drug and alcohol counselor or psychotherapist, and/or join a support group.
Second, if the patient is unwilling to get help, give thought to hiring a professional to perform an intervention. Qualified people with experience in this area are available to assist you. We will be able to provide you with appropriate referrals, if you like.
The interventionist will guide the process, helping you put the intervention together and directing its timing. The interventionist will also make arrangements for the patient to admit into a reputable treatment center at the conclusion of the process.
Third, take it easy on yourself. Do not blame yourself for your loved one’s disease. Alcoholism happens. Self-blame will not make it any better, and in fact, will make the situation worse.
Take positive and effective actions. Do your best to assist your loved one with the problem, and if necessary, hire a professional to get involved. But do not blame yourself for your loved one’s disease. You wouldn’t blame yourself if they suffered from diabetes, gastritis, or a broken arm, would you?
We hope the information contained in this article has been of help to you. Please feel free to contact us at Milestones Ranch Malibu with any questions or comments you may have.
All the best,
Dr. Seth C. Kadish
Reference Articles:
Alcohol Abuse and Alcholism:
http://www.medicinenet.com/alcohol_abuse_and_alcoholism/article.htm
Severity of Psychosocial Stress and Outcome of Alcoholism Treatment:
http://www.psychosocial.com/addiction/add1.html
Alcohol and Depression:
http://www.soberrecovery.com/articles-library/alcoholism-depression.html
Treatments for Alcoholism:
http://www.soberrecovery.com/articles-library/Treatments-Alcoholism.html
Alcohol Portrayal on Television Affects Actual Drinking Behaviour:
http://alcalc.oxfordjournals.org/cgi/content/full/agp003v3
Special Issue on Alcohol and Brian Damage
(scroll down to download free pdf of the full article)
http://alcalc.oxfordjournals.org/cgi/content/full/44/2/105
The Efficacy of Motivational Interviewing as a Brief Intervention For Excessive Drinking:
A Meta-Analytic Review:
http://alcalc.oxfordjournals.org/cgi/content/full/41/3/328
Frontal Lobe Changes in Alcoholism:
A Review of theLiterature:
http://alcalc.oxfordjournals.org/cgi/content/full/36/5/357
Drinking and Motivations to Drink Among Adolescent Children of Parents with Alcohol Problems:
http://alcalc.oxfordjournals.org/cgi/content/full/41/1/107
Alcohol Impairs Speed of Information Processing and Simple and Choice Reaction Time and Differentially Impairs Higher-Order Cognitive Abilites:
http://alcalc.oxfordjournals.org/cgi/content/full/35/2/197
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