Alcohol Addiction and the Treatment of Alcoholism

Overview:

Alcohol addiction is the most common addiction after nicotine addiction. It goes by several names, Alcoholism, Alcohol Addiction or Alcohol Dependence. Approximately 10% of the population of the United States is susceptible to alcohol addiction. Some of these people do not drink because of being aware of that susceptibility or simply because they grew up in a family where alcohol was a problem and has seen these problems and simply chosen not to imbibe. Other people do not drink because of religious teachings or faith, but often the reason the religion or faith has banned alcohol has its origin in an awareness of the negative consequences of alcohol use.

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Natural History of Alcoholism:

In the past century multiple studies have been done to give us information about the natural history of alcoholism. Two major patterns emerged. In the more common type, the alcoholism was initially marked principally by high tolerance to alcohol evident even in adolescence and the twenties. In the patient’s thirties problems would begin to emerge, but the individual would fight for control. By the early forties, however, it was clear that he or she could not control the alcohol and they would seek treatment. Often they no longer could tolerate the amount of alcohol that it would take to get “high” or “maintain a buzz”, but they couldn’t stop drinking before it caused impairment and this would lead to problems in physical and mental health, relationships, work and the law. The other type of alcoholism was less common and would manifest itself in the late adolescence or early twenties with anti-social activities often done under the influence of alcohol.  In the past 40 years with the increase in drug use in the population, the patterns of addiction to alcohol have become more blurred, because of the effects of these drugs often accelerating the course of addictive illness.

When we try to understand what a person’s risk for alcohol addiction is, the most predictive factor is whether the person has a family history of alcoholism. Adoption studies have shown that it is not the family that one grows up with that predicts the risk of alcoholism, but, the presence of alcohol addiction in the biological parents. This is why it is important that alcohol addiction is seen as an illness and that like any illness, we come to respect the fact that one may inherit a susceptibility to it. The second risk factor for addiction is a high tolerance to alcohol. That is, showing little effect of alcohol indicates that the nervous system easily adapts to the drug. No warning is given to the person that they are drinking at a dangerous level. The person with a high tolerance to alcohol may in fact have a false sense of security and believe that they can control their drinking more than others. However, this “control” is a biological adaptation and has nothing to do with exerting a control over the effect of the alcohol on the person or preventing the appetite for alcohol increasing to beyond where a person can function.

Patients with mental health disorders, also have increased risk for alcohol addiction, in that they may attempt to medicate their mood state with a drug which works temporarily but then creates rebound feelings in the opposite direction when the drug wears off. Alcohol does not treat any mental health disorder. It can disconnect the person from negative feelings for a while, but the feelings will return when the drug wears off. If the alcohol leads to an addiction, then the addiction will prevent the mental health disorder from being effectively treated.

Patients with untreated Attention Deficit Disorder are also at increased risk for addiction. It is not clear why.

Problems from Drinking Occur in 5 Major Categories

Physical: Alcohol is a drug and a toxin. Drugs alter the body’s function. In the liver it may be to cause fatty build up and later scarring and finally cirrhosis. In the brain it may slow down brain functions causing slurred speech, loss of balance and loss of motor and sensory function. Repetitive damage may lead to permanent injury. In the pancreas enzymes that normally should be activated only when they reach the intestine to digest food may be activated while they are still in the pancreas, leading to painful pancreatitis. In the stomach alcohol irritates the lining of the stomach and can lead to ulcers, reflux esophagitis, gastritis and nausea with or without vomiting. Chronic alcohol intake may also lead to gastrointestinal bleeding from the stomach, esophagus or ulcers. Diarrhea and malabsorption and poor nutrition are also physical consequences of alcohol. Alcohol commonly is avoided by people with migraine headaches because it makes the headaches worse. Alcohol causes accidents and fights, so there are multiple orthopedic problems that result from alcohol.

Mental/Emotional: There are direct effects of alcohol on the brain function that include such effects are relaxation and euphoria (when the cortical awareness of problems is inhibited, our emotional alarm circuits are inhibited and certain reward circuits in the brain are stimulated). Alcohol also can affect memory, at times leading to a black out (usually when the blood alcohol is over .25 gm/% (three times the legal limit). In a black out the person may appear to be registering what is being said, but later questioning reveals that no memory of the event or the conversation was formed. When the cortex is inhibited, judgment is lost and the ability to inhibit impulses is lost. Driving reflexes and response times are slowed and judgment is impaired. For some alcohol does not produce much euphoria and instead the person may feel more depressed when they drink, or more sleepy. Anxiety can be worsened by alcohol, even when it temporarily relieves the anxiety, when the alcohol wears off the person may have more anxiety. This is in part due to a physical rebound from the depressant effects of alcohol and the alcohol’s interference with the person’s coping capacity to deal with the problem. Alcohol may also interfere with medication used to treat depression and other mental health disorders. Sleep is often broken due to waking up at night when the alcohol wears off.

Social/Relationship: Two of the most important elements of a relationship are communication and respect. Addictive drugs in general and alcohol in particular damage these two foundations. When a drug alters one’s thinking, memory, and judgment, the people around the person begin to recognize that they are not talking to the person; they are talking to the alcohol. Communication has broken down. When the family talks to the person who is under the influence, they don’t know how much is going to get through. And when they are not listened to, they do not feel respected. When, they find out that the addiction seems to have a greater hold on the person, than they do, they feel rejected. They may try to get back their relationship by being nice or being tough but eventually it may be too painful and they may numb themselves in an act of emotional protection against the perceived rejection. The results of these damaged relationships can be divorce, loss of trust, children becoming afraid of their parent, and neglect of those the alcoholic cares about most.

Work: Often the alcoholic will hang on to the job while other things are being let go. Eventually, the job will be in jeopardy for the same reasons that other relationships and his or her health are in jeopardy. Employers want people who are able to do their job, to be creative, and to be present at the job. Alcohol damages this. The alcoholic may say, “I never missed work”. But, often that occurred with the reality of arriving at work hung over, still under the influence from the night before or not really being clear. Loss of the driving license can also disable some people’s working ability if their job involves driving.

Legal: DUIs are a prominent reality of the effects of alcohol. There can be loss of child custody, restraint orders and child and spousal abuse. Assaults are often also the result of alcohol use. Continued drinking in spite of legal problems indicates alcoholism.

CAGE Questions:

  1. Has the person tried to Cut down their drinking?
  2. Does the person get Annoyed if he/she is asked how many drinks he/she has had?
  3. Has the person felt Guilty about something they did while drinking?
  4. Does the person drink in the morning?(Eye Opener)
  • Answering positive to one of these questions is a warning signal.
  • Answering positive to two or more questions indicates a high probability that the person has alcohol addiction/abuse.
  • Answering positive to three or more questions indicates that addiction is present.
There are three major stages of treatment for alcohol addiction.

  • Detoxification
  • Initial Treatment
  • Ongoing Recovery

Detoxification is a step that is taken when a person’s nervous system has adapted to the alcohol to the extent that if he or she were to just stop drinking alcohol, the body would have a withdrawal syndrome which might involve:

  • Shakes, morning dry heaves, and/or
  • Seizures, and/or
  • Delirium, Confusion and hallucinations

Detoxification is most effectively and safely treated by giving gradually reducing doses of sedative medication over the course of several days as the body adjusts to being off alcohol. The person may need other medical treatment to correct other physical problems related to the alcohol use at this time as well.

A physician is the best person to make the determination as to how much help a person might need with detoxification. At Recovery Road Medical Center we have board certified physicians who can assist the patient in getting the appropriate form of detoxification. After the patient has had an intake evaluation with the counselor, the physician is called to discuss the need for detoxification.

Detoxification may require a hospital or can be done in an outpatient setting with close medical monitoring. The physicians at Recovery Road Medical Center are able to assist with both inpatient and outpatient detoxification.

Alcohol Treatment is a retraining process. It is not just an educational process. It involves the development of new ways of reacting that need to become automatic. New reactions need to be developed in a variety of settings and situations. At present, there is no treatment that can return a person who has lost control over alcohol back into a controlled drinker. Instead, recovery involves changes in the following areas:

New ways of reacting include:

New social and recreational activities that do not involve drinking
New rewards in a person’s life
New ways of reacting to feelings that do not involve drinking
New coping skills that do not involve drinking
New roles in one’s family that do not involve drinking
New non-drinking friends
New ways of thinking about oneself that do not involve drinking.

We do not expect a person to have confidence in themselves when they start treatment. The only way to show motivation for treatment is to show up for treatment and do the exercises and follow the instructions for retraining that are provided. Overtime confidence in a new way of reacting will develop.

Alcoholism treatment is carried out in a variety of settings depending on how much structure is required to keep the addiction in check while the person is developing new skills. In some cases, treatment involves developing an aversion to the alcohol.

Medications are also used in alcoholism treatment. Antabuse(disulfiram) is used to prevent impulsive drinking, as the alcoholic knows that if they drink within 3 days of use of Antabuse they can get very sick. Campral(acamprosate) is used to help the nervous system restabilize when it has been used to being on alcohol chronically. Revia(naltrexone) is used to blunt the rewarding effects of alcohol, so that if a person does start to drink while in treatment it is less likely to turn into a larger binge. By themselves, however, medications do not bring on new ways of reacting. But, blocking the rewarding effects of alcohol can begin the brain to look elsewhere for reward and to break the hold that the alcohol has on the person’s thinking.

The physicians at Recovery Road are able to prescribe all these medications to assist with recovery.

Ongoing recovery is necessary for the maintenance of new ways of living and reacting. When athletes achieve a certain level of skill, they recognize that they need to continue to practice what they have learned or they will lose their skills. Because the disease of alcoholism involves a very primitive part of the brain that only learns through experience, the recovering person has to continue to practice the new recovery skills to maintain sobriety.

Patients generally maintain these skills by participating in ongoing recovery groups such as the 12 step programs. The Twelve Steps Programs are not affiliated with any treatment program. It is a self help group which has been guided by a series of principles since its founding in 1932. Its first step involves acknowledging that the person cannot control alcohol and that his or her life has become unmanageable. This is stated not as a criticism, but as a respectful acknowledgment of the power of the addiction and the awareness that future efforts to control the drug are doomed to failure. The next 11 steps focus on developing a new spiritual basis for recovery. Members are expected to get a sponsor who will help them go through the steps.

Intervention: is sometimes necessary when it is clear to those around the alcoholic that he or she needs help but the alcoholic is resistant. The process was developed by a minister named, Vernon Johnson in Minnesota who observed how some families were able to be successful in getting people into treatment, while other families who cared just as much, were not successful. There are specific professionals who are available to help families intervene successfully in getting their loved one into treatment.