Management of Alcoholism

MANAGEMENT OF ALCOHOLISM.

Should I cut down or completely stop ?
Stopping alcohol is usually the best if you have been alcohol dependant and also if you have a condition such as liver damage. The person has to be committed and determined to stop. Most importantly too is that the person should accept that they have a problem as some people may deny that they do have a problem. The next step is to seek help when necessary in order to curb it.
If you are not alcohol dependant but want to reduce your alcohol intake, here are a few tips:
• Consider drinking low alcohol beers, or at least do not drink 'strong' beers or lagers.
• Try pacing the rate of drinking. Perhaps alternate soft drinks with alcoholic drinks.
• Consider cutting back on types of social activity which involve drinking. Perhaps try different social activities where drinking is not a part. Perhaps reduce the number of days in the week where you go out to drink.
• Resist pressure from people who encourage you to drink more than you want to.

WITHDRAWAL
Alcohol withdrawal refers to symptoms that may occur when a person who has been drinking too much alcohol every day suddenly stops drinking alcohol.

Mild-to-moderate psychological symptoms:
• Jumpiness or nervousness
• Shakiness
• Anxiety
• Irritability or easy excitability
• Rapid emotional changes
• Depression
• Fatigue
• Difficulty thinking clearly
• Bad dreams



Mild-to-moderate physical symptoms:
• Headache -- general, pulsating
• Sweating -- especially the palms of the hands or the face
• Nausea and vomiting
• Loss of appetite
• Insomnia (sleeping difficulty)
• Pallor
• Rapid heart rate
• Eye pupils enlarged(dilated pupils)
• Clammy skin
• Tremor of the hands
• Involuntary, abnormal movements of the eyelids

Severe symptoms:
• Delirium tremens -- a state of confusion and visual hallucinations
• Agitation
• Fever
• Convulsions
• Black outs -- when the person forgets what happened during the drinking episode

Delirium tremens ('DTs')
• This is a more severe withdrawal reaction after stopping alcohol.
• It occurs in about 1 in 20 people who have alcohol withdrawal symptoms about 2-3 days after their last drink.
• Symptoms include: marked tremor (the shakes) and delirium (agitation, confusion, and seeing and hearing things that are not there) and convulsions.
• Complications can develop such as dehydration and other serious physical problems. It is fatal in some cases.







What Is Alcohol Rehab?
Alcohol rehab refers to the medical, psychotherapeutic, educational and social treatment processes required for alcoholism recovery.

Primary Elements of Rehab
• Alcohol Detox. This is the initial part of the recovery process. Detox involves stopping the consumption of alcohol and giving the body the time it needs to cleanse itself of the harmful toxins associated with wine, liquor or beer.
• Counseling. The core of any alcohol rehabilitation programs is counseling. During sessions with a counselor or therapist, the individual learns relapse prevention skills, receives education about alcoholism, and discovers the triggers that cause their unwanted behavior. Counseling in alcohol rehab takes two forms: individual and group sessions.
• Aftercare. When an individual "graduates" from alcohol rehab, they must then return to the outside world. This is not always as easy as it sounds, as individuals face a number of challenges when they return home after treatment, including:
o Temptation
o Stress and distraction.
o A lack of understanding.



Alcohol Rehab and Mental Health Issues
Many alcohol rehab programs have historically strictly provided alcohol rehab without attention to other mental issues. However, given the impact of addiction on other life issues, it is no surprise that mental health complications are very common among those who participate in alcohol rehab programs. In fact, more than 44% of alcoholics have mental health complications prior to the onset of alcohol dependence and many others develop mood-related complications, such as depression and dysthymia, after the onset of the addiction. The finest alcohol rehab centers incorporate mental health treatments in addition to alcohol rehab services in an effort to treat these co-occurring disorders.





Alcohol Rehab Process-Has 2 focal points:
i. Physical dependency(treatment involves managing alcohol withdrawal symptoms in a safe manner)
ii. Psychological dependency(treatment involves teaching the alcoholics new ways of interacting in an alcohol-free environment)

Alcohol Rehab Approaches

A. Detoxification

I. Getting rid of alcohol from the body while managing the withdrawal symptoms in a harmless atmosphere
II. Also a process by which heavy drinker’s system is brought back to normal after being used to having alcohol in the body on a frequent basis.
Precipitous withdrawal from long-term alcohol addiction without medical management can cause severe health problems and can also be fatal. Alcohol detoxification is not a treatment for alcoholism but it is the first step done in a rehab program under the supervision of a medical practitioner. After detoxification, other treatments must be undergone to deal with the underlying addiction that caused the alcohol use.

B. Behavioral Rehab such as Alcoholics Anonymous(AA), Motivation Enhancement Therapy and Cognitive Behavioral Therapy(CBT)

I. AA- it is a voluntary fellowship of people suffering from alcoholism who seek to become sober through mutual self-help by meeting in local, independent groups to share their experiences, strengths and aspirations with each other in the hope that they may solve their mutual problem and assist others in their quest to recover from alcohol dependence
II. Motivation Enhancement Therapy- encourages patient to develop a negative view of their abuse along with a desire to change their behavior
III. CBT- it’s a psychotherapeutic approach that aims to influence dysfunctional emotions, behaviors and cognitions through goal-oriented, systematic procedure





C. Therapeutic Medications-client/patient taking doctor prescribed medicine
Types of drugs:

I. Benzodiazepines- to treat alcohol withdrawal symptoms
There are two types: a) long lasting benzodiazepines(used in reducing tremor and agitation eg “Diazepam or Chordiazepoxide”)
b)short acting benzodiazepines(used in treatment of seizures eg “Lorazepam intravenously”)This drug can cause a physical dependence and a benzodiazepine addiction to develop and upon cessation of long term use a “benzodiazepine withdrawal syndrome” can occur. To avoid this take short courses at low doses.

II. Disulfiram(Antabuse)
• drug used to support the treatment of chronic alcoholism by producing an acute sensitivity to alcohol
• it produces discomfort if present in the system when alcohol is consumed
• the drug elicits negative effects such as dizziness, vomiting, nausea if alcohol is ingested
• Antabuse has been proven to help prevent relapses and is effective mainly because it is such a strong deterrent

III. Naltrexone
• Minimizes both the craving for alcohol and the ‘high’ produced by its consumption

IV. Acamprosate
• Reduces the craving for alcohol in people who have stopped drinking
• Maybe prescribed to people after a successful detox to help them stay off alcohol

V. Vitamins
• Particularly vitamin B1 (Thiamine). Deficiency of it may cause Wernicke-Korsakoff Syndrome. Learn more about it here.
• Chronic alcohol consumption can result in thiamine deficiency by causing:
o Inadequate nutritional thiamine intake
o Decreased absorption of thiamine from the gastrointestinal tract
o Impaired thiamine utilization in the cells




D. Outpatient Alcohol Treatment and counseling
• There are various approaches that teach alcoholics how to become aware of the situational and psychological ‘hot button’ that trigger their drinking behavior
• Also they learn of different ways in which they can cope with circumstances that do not include the use of alcohol
• Individuals attend treatment during the day and return home (or to a sober living facility) in the evening.
• Better suited for individuals who are the head of household or have work and school that need to be attended.
• A good choice for individuals who have a non-life threatening form of alcohol addiction

E. Residential Alcohol Treatment Program and Inpatient Alcohol Rehabilitation
• Patient moves into a dorm and receives round the clock care. 24/7 care is better for more serious cases of alcohol addiction.
• It offers a supportive atmosphere and a structured environment in which the patient can begin to focus and learn how to restructure his/her life and develop new habits.
• Programs educate the family as well as alerting them to patterns that might have enabled the patient to take up drinking


In addition to these standard treatments, alcoholics are aided by alternative treatment such as acupuncture and hypnosis.


References
1.http://www.about-alcohol-rehab.com/
2. http://www.patient.co.uk/showdoc/40025148/
3. http://encyclopedia2.thefreedictionary.com/alcoholism
4. http://www.drug-rehabs.com/alcohol_rehab.htm
5. http://www.michaelshouse.com/alcohol-rehab/
6. http://www.patient.co.uk/showdoc/27000115/
7. http://www.nlm.nih.gov/MEDLINEPLUS/ency/article/000764.htm