Alcoholism

Alcoholism is probably one of the most common mental disorders universally. Worldwide, statistics indicate that individuals with drinking has been escalating. It is not known why someone becomes an alcoholic but has been associated with other substance abuse, smoking, anxiety and depression. Even though excessive drinking is associated with serious health affects, it is often unrecognized and neglected. Despite the vast numbers of individuals who consume alcohol, the diagnosis of alcoholism remains under diagnosed and under treated.

 

The major reason for this is that individuals deny that they have a problem. In the hospital, it is very rare for patient to admit to drinking alcohol, even socially. The stigma of being labeled as an alcoholic is shameful and seen as a loser. Because the diagnosis of alcoholism disease is never made, the opportunity to treat the individuals is lost. All too often numerous individuals are treated symptomatically for alcohol-related conditions without recognizing the underlying problem. Close to a million Americans are treated for alcoholism on a daily basis and the numbers are increasing annually. For the past 3 decades, the majority of treatments have been empirical and the success of the treatments has never been verified by clinical trials.

 

The numerous methods developed in the treatment of alcohol addiction include the use of medications, psychological, social, behavioural methods and self help groups- all designed to help achieve abstinenece from alcohol. The initial approaches to alcohol treatment were all based on self help and over the years the 12-step self help program has become the gold standard. Other treatments include brief interventions by visiting the primary care physician or trained nurses. Behavioral and psychosocial support therapies have evolved over years and generally involve long term therapy. Over the last 2 decades, motivational enhancement therapy and involvement of the non drinking spouse therapy have evolved and produced good results. Of course, over the past 4 decades, pharmacological approaches to alcoholism treatment have made some progress, but the ideal drug still remains to be discovered.

There are numerous signs of alcoholism that you are able to detect. Ranging from alcoholism physical symptoms to emotional signs, it is possible to see when the effects of alcoholism are changing a person. Common signs of alcoholism include: • Repeated episodes of intoxication • Recurrent nausea, sweating • Periodic blackouts • Mood swings ranging from depression, lack of sleep to anger • Seizures • Stomach upset, bloating • Tremors • Lack of concentration • Difficulty holding jobs • Unsteady walking, frequent falls • Personal neglect • Poor nutrition • Heavy smoking • Violent behavior

Drinking excessive alcohol may be enjoyable but is definitely associated with serious complications. Heavy drinking can lead to destruction of the liver and significant brain damage. Not all of these changes are reversed with cessation of alcohol consumption. Women who drink are also at risk for giving birth to babies with serious physical and mental problems (fetal alcohol syndrome). These infants have such severe intellectual deficiency that they have already been imparted with major strikes in world where only the fittest survive.

The majority of individuals with alcohol dependence initially always deny that they have a problem and are reluctant to undergo therapy. Agreeing to undergo alcoholism treatment usually occurs after the individual encounters health, family, employment or legal problems. Depending on the situation of the individual, various treatments are available to help with alcohol dependence. The initial part of the alcoholism addiction treatment involves evaluation, a brief intervention and either an in/outpatient program or counseling.

Unfortunately there is no magical alcoholism cure. The only way to fight alcoholism is to enroll in an alcoholism treatment program. Before alcohol treatment can begin, one has to determine if the individual is alcohol dependent through an alcoholism test. For some who drink socially and are in control over their drinking, treatment may simply require reduction of drinking. For those who have no control over their drinking the best treatment is abstinence. To maintain abstinence, the best approach is to be included with alcohol abuse therapists. These specialists can help develop specific-tailor made treatment plans, which may include objectives, behavioral modification skills, use of self-help manuals, counseling and follow-up care at a treatment center.

There are numerous non-drug residential alcoholism treatment institutions and include therapy to maintain abstinence, individual and group therapy, participation in alcoholism support groups (such as Alcoholics Anonymous), educational seminars, spousal involvement, work assignments, physical and non physical activity therapy. Most of these residential programs have professional counselors and staff involved in the treatment of alcohol dependence. All individuals undergo a complete physical and medical assessment prior to therapy. The essence of all residential programs is to commence detoxification and treatment of withdrawal symptoms that may occur. Hard-hitting psychological counseling and psychiatric treatment is offered to individuals, couples and their families. The principal emphasis of all residential programs is on recognition of the problem and motivation for abstinence. Individuals who are unable to fulfill these basic criteria usually do not succeed with therapy.

Numerous behavioural approaches to alcohol dependence treatment include psychological therapy. The primary component of these therapies is motivational enhancement therapy. This therapy is designed to help the individual beocme more responsible and develop a change in his/her life style. Various forms of counseling are available and may involve cognitive behavior therapy to help cope with distorted/abnormal thoughts and help develop a sense of control over these thoughts and feelings. The majority of psychological therapies often involve the non alcoholic spouse as most studies show that couple participation increases the likelihood of abstinence from alcohol. Behavioural –marital therapy is a combination of an approach to drinking treatment while strengthening the marital relationship through sharing, teaching and communication skills.

The most common self help group in the treatment of alchohol dependence is Alcoholics Anonymous (AA). This is one of the most common and easily available group in any community. Alcoholics usually get involved with AA before seeking professional help, as a part of it, or as aftercare following professional treatment. Although anecdotal data on the success of AA are plentiful, results indicate that inpatient treatment, a combination of professional treatment and AA, achieve better results for more people than AA alone. The reason why AA has been beneficial as a treatment for alcohol addiction includes isolating the individual from his social network of alcoholic friends, providing psychological/social support, teaching coping skills and structured behaviour treatment.

Some indiviuals receive counselling from primary care physicians and trained nursing professionals. This consists of numerous office visits and counseling. The majority of these brief interventions help those with acute alcoholic crises. Following the brief intervention, all individuals are recommended to enter specialized treatment programs if the alcohol consumption continues.

Statistics do reveal that 30-50% of alcoholics do abstain at least a year after behavior and psychotherapy, but relapse is also frequent. Clearly more effective long term treatments are required to prolong the abstinence. Disulfiram (Antabuse) is an alcohol-sensitizing drug which has been around for at least 40 years. It was the first drug used for aversion therapy. It provides a strong deterrent to alcohol. It is not a cure and does not decrease the craving for alcohol. If taken before an alcoholic drink, it causes a severe reaction that includes nausea, vomiting, facial flushing and headaches. The drug is rarely used today as the severe reaction is not tolerated and most alcoholics are reluctant to take it. Naltrexone (ReVia), is an antagonist of morphine and has been found to decrease the urge to drink. As is the case with all addiction disorders, however, naltrexone is only effective if taken on a regular basis. Acamprosate (Campral) is a drug that decreases alcohol cravings and helps maintain abstinence from alcohol. Unlike disulfiram, naltrexone and acamprosate has fewer side effects and does not produce serious nausea and vomiting if alcohol is consumed.

 

 

Recently, the Food and Drug Administration (FDA) approved the first injectable drug to treat alcohol dependence. Vivitrol, a drug similar to naltrexone is administered by an intramuscular injection in the buttocks monthly. It has been shown to decrease the urge to drink by blocking neuro receptors/transmitters that may be coupled with alcohol dependence. Vivitrol has no effect on the withdrawal symptoms due to alcohol. The drug is recommended for use by alcoholics who are undergoing psychosocial therapy and have not consumed any alcohol in the recent past.

 

The drug is also available as a pill, but it has been found that the injectable formulation is easier for individuals recovering from alcohol dependence and only has to be administered once a month. Depression and anxiety are two most common associated disorders seen in alcoholics. Both these conditions can lead to alcoholism but sometimes they may be a result of alcohol abuse. A succinct history will reveal the existence of these two disorders which can be treated with drugs. Fluoxetine (Prozac) has been found to be effective in decreasing depressive symptoms and the level of alcohol consumption in depressed alcoholics. Even though some drugs may reduce alcohol drinking, it is highly recommended that individuals enter in aftercare programs and prop up groups to help prevent relapse and encourage motivational behavioral and life style changes.

Research supports the idea of using drugs as an adjunct to the psychosocia/behavioural therapy for alcohol abuse and dependence. However, additional clinical trials are needed to identify those patients who will most likely benefit from such an approach, to determine the most appropriate medications for different individuals, to develop optimal dosing formulas, and to create strategies for improving patient compliance with medication protocols. With continued research on the effect of alchohol on the brain and behaviour, hopefuly this will lead to the magic pill. Drugs to decrease alcohol craving are around but specific medications are still missing. In the meantime, combination of drug therapy and the use of behavioural therapies are the best hope for recovery of the individual -and the lives of loved ones-who suffer from alcohol abuse and dependence.