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Part-IV: Treatment Options

23. Diagnosing Problem Drinking and Alcoholism

Problem drinking and Alcoholism are a chain with one link leading to the next.

It starts with dependence on alcohol as a crutch for handling emotional and physical problems, which leads to problem drinking that leads to severe

alcoholism.

You can detect such high dependence on alcohol by identifying the common traits of alcoholics:

• It is very difficult for an alcoholic to stop drinking

• He has unbearable physical and psychological symptoms if he stops

drinking.

• He continuously increases his intake of alcohol, which causes a regular increase in his tolerance levels until the later, most serious stages.

• He drinks even when he has to attend to more important matters.

• He drinks through most of his waking hours.

• He does not stop drinking even when he loses his job or income and

despite its detrimental effects on his health and family.

• He has more trouble with law officers.

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• He is careless of his safety and drinks when driving.

Physicians can easily detect alcoholism in patients by such indicators as when you suffer from repeated injuries and other medical problems due to excessive alcohol content in body. Alcoholics are more often liars and do not spell out their habits openly. They deny their alcoholic tendencies and inclinations and try to hide their tendencies and habits for fear of social ostracism.

It is not that important to analyze how much a person drinks. The main thing is how much his drinking habits affect his relationships, family, and employment.

The quantity of alcohol consumed is not the correct yardstick as different individuals have their individual metabolic rates.

The most common, preferred tool for analyzing alcoholism in individuals is the CAGE questionnaire. It consists of four questions and the first letter of each main word in the question spells out C.A.G.E.

1. Has there been any attempt by you to cut down on your drinking?

2. Do others’ comments on your drinking habits ever annoy you?

3. Do you feel guilty about your drinking?

4. Do you need an Eye-opener, a morning drink to begin your day?

Genetic factors also contribute to alcoholic tendencies. Although the CAGE

questionnaire presents a guaranteed accurate result of over seventy-five percent, it has certain limitations as it cannot detect binge drinking or point out those who have not yet experienced any alcoholic consequences.

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AUDIT is an alcohol use disorders identification test which currently provides the best results in alcoholism diagnosis. It can detect dangerous drinking and abuse due to alcoholism and can even identify alcoholics if they are occasional drinkers. This is a paper and pencil test.

Other medical tests-mean corpuscular volume, liver function tests, and gamma glutamyl transferase tests offer only fifty percent successes. They cannot accurately detect alcoholic tendencies.

After having an alcoholic problem identified, your physician can put in more questions to arrive at the extent of alcoholism in the patient. The questions could focus on;

• frequency of drinking,

• drunken driving,

• drinking to overcome anxiety or insomnia and

• counseling sessions of Alcoholic Anonymous, etc.

These questions help in further understanding of the alcoholic’s individual condition and help to suggest the most suitable remedy to overcome it.

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24. Understanding Lab Tests for Alcoholism

There is no single, fully accurate test to determine alcoholism in an

individual. Symptoms discovered by physical examination such as;

collection of enlarged veins near navel,

evidence of injuries,

yellowish skin,

abdominal fluid,

malnutrition and

decrease in size of testis in men

… could point towards alcoholism.

But, laboratory tests, while applicable mainly to chronic alcoholics, are more conclusive as they show the extent of damage to different body organs.

Laboratory tests could be radiologic, invasive, or pathological. These

determine deficiencies and damage to vital organs.

Radiologic tests are only for extreme cases with a history of trauma and hypertension.

Alcoholics are deficient in various vitamins and minerals, which are significant in the development of other associated diseases. Vitamins absorbed through intestine like thiamine and folate become deficient due to the presence of Copyright © 2005 Claire Nash

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alcohol in body. Such excess alcohol also causes deficiencies of magnesium, phosphorous, and potassium. It restricts gluconeogenesis and you become

glucose-tolerant if you already have pancreatic or liver disease.

Pathological Tests

The Gamma-glutamyl transpeptidase test is effective in determining

alcoholism. You just provide a sample of your blood from a vein in your arm to detect presence of gamma-glutamyl transferase. Through this test, you can detect alcoholism in around 35% to 85% cases. This, along with related tests such as ALT, AST, ALP, liver tests and bilirubin levels indicate the current extent of damage and alcoholism. It also differentiates between liver and bone diseases due to high levels of alkaline phosphatase.

Serum transaminases and alkaline phosphatase tests which are used to detect liver functioning, can also detect the extent of liver damage due to alcoholism.

It is easy to detect relapses through Carbohydrate-deficient transferring tests.

Liver Biopsy

Normally, an elevated liver indicates alcoholism although there are certain exceptions. Liver biopsy commonly reveals Hepatitis C, Wilson's disease, and Hemachromatosis in most alcoholics.

Consultations with liver specialists and different diagnostic procedures such as antibody titers, imaging and biochemical measures can reveal the extent of damage and indicate remedial measures.

Though liver biopsies are uncommon, they will be a major tool for diagnosis of alcoholism in the near future.

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25. How to Treat Alcoholism

Treatment of alcoholism has to be tailored to each individual person.

Initially, you are reluctant to accept that you are an alcoholic until legal, domestic and health problems prompt you to look for treatment options.

Professional intervention and counseling is essential. Treatment starts by evaluating your alcoholic state. Some combination of counseling sessions, residential programs, medications, outpatient programs, self-care and other measures are then prescribed.

The first step to effective treatment must be to determine the extent of your alcoholic dependence.

If you can control your drinking, you only need to reduce it to get rid of the problem. However, sometimes even low alcoholic intake could cause severe alcoholic problems. You then need attention of specialists in the field to overcome drinking habits.

You may find help in;

• self-help manuals,

• setting personal goals to cut down drinking,

• changing your behavioral techniques,

• counseling and

• follow-up treatments.

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Residential Programs

Residential or in-patient treatment programs include individual and group therapy sessions, abstinence from alcohol, attending counseling and lecture sessions of Alcoholic Anonymous, active therapy, work assignments and the vital involvement of family and professionals.

A typical residential program proceeds as -

• Acceptance of Your Alcoholism - Treatment yields best results when you have accepted your uncontrolled drinking habit and have a

constructive interest in eradicating this.

• Detoxification - This is the next step in treatment for alcoholism. You may need sedative medications for around a week to prevent

withdrawal seizures and deliriums.

• Treatment of associated diseases - Alcoholism occurs in close

proximity with high blood pressure, liver diseases, high blood sugar

and heart diseases. You need to undergo medical treatments for any

such diseases which you have developed.

• Common Drugs - Disulfiram is the most common drug used in

treating alcoholism. It does not offer a cure or remove your drinking

cravings, but it causes physiological reactions within your body soon

after you have your drink. It causes nausea, vomiting, headaches, and

flushing, which indirectly leads to abstinence from drinking.

In some extreme cases, people refuse to take this drug and continue

with their drinking.

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• Naltrexone (ReVia) is another drug, which reduces your urge to drink but does not have any physical reactions.

• Psychological Support - Alcoholism causes emotional disorders which can lead to serious psychiatric disorders. Counseling and psychological

support therapy offer remedial measures to counteract this.

• After-Treatment Care - Treatment does not stop with these measures.

Alcoholism needs continuous support for more than a year after the

regular treatment program to overcome the total deep-seated effects of

alcoholism. Numerous aftercare homes and support programs of

Alcoholic Anonymous go a long way in helping you to overcome your

alcoholic tendencies and cravings, manage relapses (if any) and

necessary adjustments to your lifestyle back to normalcy.

Self-Care at Home Programs

You can adopt these programs at your home but you still need help of trained professionals. The physicians and health care professionals help you to

overcome your alcohol addiction and combat withdrawal symptoms

effectively.

Withdrawal symptoms begin around six to eight hours after you stop drinking.

You should not attempt these home programs without professional medical

help as it could lead to dire situations, which could even be fatal.

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Rehabilitation Programs

Severe alcoholics need hospitalization as withdrawal could lead to many

psychiatric and emotional disturbances. You enter rehabilitation programs only after successfully exiting from the withdrawal programs.

You then accept your disease and willingly undergo treatments for sobering down and then start on treatment programs according to your individual needs.

Normally, such rehabilitation programs continue for around a fortnight. Severe cases need longer treatment periods with specific therapy sessions. These sessions teach you many skills to help you stay away from alcohol. Such skills include -

• Identification of alcoholic cravings and measures to control them

• Changing your habits and lifestyle; adhering to a regular diet and sleep regimen, engaging in other pursuits like games, music, etc

• Overcoming social pressures for drinking by avoiding bars, parties,

risky people and events

• Changing your thinking pattern about drinking to overcome stress or

emotional disturbances

• Developing support programs to talk about your problems

• Effectively managing relapse signals.

Finally, you can undergo several outpatient programs like Motivational,

Behavioral and Facilitation therapies to abstain from drinking.

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26. Medications

Medications and treatments for Alcoholism are used in the two phases of

recovery. The first phase is withdrawal and the other is treatment to cure your addiction.

Withdrawal or Detoxification Process

This process helps to remove the toxic effects of alcohol from your body. It is normally for around a week, depending on the severity of your alcoholism - the amount of alcohol you were drinking daily and for how long you have been an alcoholic. Abstinence from alcohol causes many physical and behavioral

changes. Some mild side effects are diarrhea, nausea, insomnia, body aches, excessive sweating, trembling and high anxiety levels.

With chronic alcoholics, the symptoms are more severe, such as;

• vague illusions when you hear, see, and feel absurdities,

• seizures,

• fever,

• mental confusion about everything,

• high blood pressure,

• extreme craving for alcohol and

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• delirium. Deliriums begin around three to five days after the last drink and last for some days.

If you already have one or more serious ailments such as Wernicke's

syndrome, malnutrition or liver disease, your withdrawal symptoms are more severe and cover a longer period.

Mild alcoholics do not need severe medications. They must take extra fluids to clear away toxins from their body. However, chronic alcoholics need sedatives to combat severe withdrawal symptoms and any severe complications of

medical diseases that they have developed. Benzodiazepines is the most

common drug for combating severe withdrawal symptoms. Their fluid intake with thiamin is intravenous.

Further Treatment for Alcoholism

After detoxification, you need to have medical treatment of your alcoholic addiction. A common medication for alcohol addiction is Disulfiram which causes nausea and vomiting if you drink alcohol.

Common symptoms during withdrawal are chest pain, sweating, fast heartbeat, difficulty in breathing, etc. Such symptoms last from half an hour to several hours.

You should not consume alcohol for a fortnight before starting this medicine.

During your use of this medication, there should not be even slightest hint of alcohol in your body, so you need to avoid foods containing any alcohol and stay away from chemicals with alcohol. The presence of alcohol with this medicine causes severe neurological conditions, visual disturbances and eye pains.

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Many therefore discontinue this medicine to carry on with their alcoholism but disulfiram is now available as an implantable device to be put under the skin.

Other medications which may be used during treatment are acamprosate,

Naltrexone and some antidepressants as selective serotonin reuptake inhibitors (SSRI). Of all, Naltrexone is regarded by many as the most effective with fewer relapses. It does have few side effects like headache, muscular pain, anxiety, nervousness, insomnia, tiredness, nausea, stomach cramps, etc.

Another medicine, Acamprosate, successfully reduces your craving for

alcohol. It restrains the functioning of a chemical in your brain-gamma amino butyric acid (GABA) - to subdue your alcoholic tendencies. Minor side effects of this medicine are headaches and diarrhea.

Antidepressants or Selective Serotonin Reuptake Inhibitors control

neurotransmitter serotonin, reducing your anxiety and depression levels. They cause mild side effects like Diarrhea, Insomnia, Nausea, and Sexual

dysfunction. Such treatment takes effect within a month or slightly more.

Sertraline, Fluvoxamine, Fluoxetine, Citalopram, Paroxetine are some common antidepressants.

Buspirone is a new anti-anxiety drug for alcoholic medication. It is not a sedative like benzodiazepines and does not cause any physical dependence. It needs around a fortnight to a month for effects to settle down. The best way to take this medication is with your food for thorough absorption. Mild side effects could be nausea, vomiting, and headaches.

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All medications should be in combination with active alcoholism counseling.

While taking medications for alcoholism, follow certain basic precautions -

• Be aware of all effects and side effects of each medicine

• Understand different drug reactions and interactions if you are on

multiple drugs

• Take medicines in prescribed dosages at specified times, as directed by your physician

• Immediately report any nagging side effects or if medicine does not

have the proper effect

• Do not stop medication without directions from your physician

• Keep sufficient refills for continuity in medication

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27. Recovering from Alcoholism

- Alternative Treatments

There are many other ways of treating your alcoholic cravings besides

medications.

After you come out of your withdrawal period, you can undergo different

therapeutically corrective methods to combat your alcoholic cravings. These complement medications and produce positive results in alcoholics within a short period. Alcoholism is normally an after-effect of stress of any kind.

Therefore, different de-stressors like massage, therapies, meditation, etc. bring about vast changes in your behavior and inclinations.

These alternative treatments are;

1. Motivation Enhancement Therapy - A professional therapist helps you realize that your problem of alcohol addiction needs immediate treatment to overcome its negative effects on you and your family. He guides you through various constructive stages and brings a positive, even life-saving, change in your behavior.

2. Acupuncture - Inserting hair like needles into your skin to reduce or stop your alcoholic cravings. This helps to reduce withdrawal symptoms, anxiety levels, depression, fatigue and stress. It puts you on a permanent path for recovery from alcoholism.

3. Couples Therapy – This therapy involving your spouse accelerates treatment and ensures permanency of your new condition.

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4. Cognitive Behavior Therapy - Sometimes alcoholism is due to traumatic events or psychological stress. Through this treatment, your therapist analyzes the root cause of your stress and trauma as well as its impact on your behavior which led to alcoholism. The therapy aims to set right all such psychological disorders and relieve you of your trauma so you let go of your alcoholic habits and inclinations. You learn to exercise greater control over your feelings and behavior.

5. Aversion Therapy - This therapy aims at combating alcoholism with aversive responses brought about by medications to avert your alcoholic

tendencies. Most often, such aversions are nausea and vomiting. After some time, alcohol itself ignites such aversions and you refrain from drinking totally.

This therapy is most effective but does not appeal to many people.

6. Nutritional and Herbal Therapy - Adjusting to eating nutritious food can speed up your recovery process and herbs like lavender, chamomile, yarrow and peppermint help your vital organs to rebuild their cells and improve your health.

7. Counseling as a Therapy - Alcoholics need constant reassurance and gentle pressure to make them realize the magnitude of their addiction and the serious, negative consequences of the addiction. Various support groups like Alcoholic Anonymous conduct several meetings between recovering alcoholics to

provide mutual support for enhanced recovery. Such therapy involves twelve step programs, which highlight the destructive power of alcoholism on your life and looking for help from a superior power to overcome this addiction.

This realization helps you realize how your drinking has been the main cause for mental tension and pain in your immediate family. The program also

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involves your family members as you slowly try to make maximum amends

for your deplorable behavior during your intoxication.

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28. Nutritional Treatment for Detoxification

and Recovery from Alcoholism

Proper, adequate nutrition for your body ensures faster recovery from all ailments and, specifically, alcoholic addiction. It plays an important role from detoxification to treatment to prevention of relapses.

Different molecules of cells function differently and need different treatment.

It is not advisable to follow the same treatment to combat all ailments due to alcoholism. The effect of alcoholism on different body parts varies and, therefore, recouping and recovery need to follow different patterns, too.

Otherwise, you might cause more harm than benefit and lead to delay or lack of recovery from alcoholism.

Nutritional therapy aims at understanding the molecular setup of cells and treating them appropriately, according to their individual cellular structure before alcoholism affected them.

This therapy does not stress what to eat or not. Instead, it addresses which food or drink is best suited for your health. Altogether, it affects genetic and metabolic functions of your body. Therefore, greater stress is put on how much and what you absorb from your food. Alcoholics often suffer from

gastrointestinal irregularities. The high alcohol content of your ravaged body does not allow satisfactory absorption of nutrients into your system and your health suffers.

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needs to start after a total assessment of your nutritional status. Treatment will be ineffective if you have suffered from different nutritional deficiencies due to excessive alcoholic addiction for a long time.

If your body lacks specific nutrients or vitamins, you need a supply of those vitamins to bring a balance in your body functions. Thereafter, you need to follow the treatment for your alcoholism.

Otherwise, you do not benefit from the treatment for alcoholism nor for your nutritional deficiencies.

Taking Control of Alcohol by Claire Nash - HTML preview

Part-IV: Treatment Options

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