Treatment of Alcoholism

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Similar to other diseases, alcoholism can be overcome with proper treatment, prevention, and increased research efforts.  Stated differently, as serious as alcoholism is, fortunately it can be treated. 

The treatment of alcoholism usually entails a combination of doctor-prescribed medications, counseling, education, training, and support to help the alcoholic abstain from drinking alcohol.

An Essential Question:  What is Alcoholism?

Alcoholism, also known as alcohol addiction and alcohol dependence, is a progressive debilitating disease. 

This means that alcoholism gets increasingly worse as the alcoholic continues to drink.  Alcoholism is a disease that has received extensive research and includes the following four identifiable symptoms:

• Physical dependence:  withdrawal symptoms such as anxiety, headaches, nausea, perspiration, and “the shakes” when abstaining from alcohol.
  
  
• Craving:  having a strong urge or need to drink.
  
  
• Tolerance:  the need to drink greater amounts of alcohol in order to feel a “buzz” or to get “high.”
  
  
• Loss of control: an inability to stop drinking after the first drink.  

The Treatment of Alcoholism:  An Overview

Not unlike other diseases and illnesses, alcoholism can be overcome with prevention, quality alcoholism treatment, and increased research efforts.  

By providing more individuals with access to effective alcoholic treatment, the costly drain on society and the financial, physical, and emotional liability alcoholism places on families can be significantly minimized.  

Indeed, recent research strongly shows that successful prevention and professional quality alcohol treatment programs result in significant reductions in heart disease, crime, HIV, cancer, strokes, traffic fatalities, unwanted pregnancy, and child abuse.

Furthermore, quality alcohol and drug treatment improves health, quality of life, and job performance while at the same time reducing drug use, family dysfunction, and involvement with the criminal justice system.

As debilitating as alcoholism is, fortunately it can be treated.  The treatment of alcoholism usually involves a combination of counseling and doctor-prescribed medications to help an alcoholic stop drinking.  Even though most alcoholics need professional assistance to recover from their addiction, research has demonstrated that with support and quality alcoholism treatment, many alcoholics are able to refrain from drinking and restore their lives.

The Treatment of Alcoholism: Withdrawal Symptoms

A wide variety of different techniques exist for treating alcohol withdrawal symptoms.  While some of these treatments use drugs, many, however, do not.  Indeed, according to current research findings, the safest way to treat mild withdrawal symptoms is without drugs.  Such types of non-drug detoxification efforts use screening and comprehensive social support throughout the entire withdrawal process.  Other non-drug detoxification programs, additionally, use vitamin therapy (especially thiamin) and proper nutrition and when treating mild withdrawal symptoms. 

Mild to Moderate Withdrawal Symptoms

The following represents mild to moderate physical withdrawal symptoms that typically occur within 6 to 48 hours after the last alcoholic drink:

• Sleeping difficulties
• Abnormal movements
• Nausea
• Enlarged or dilated pupils
• Clammy skin
• Tremor of the hands
• Looking pale
• Rapid heart rate
• Vomiting
• Loss of appetite
• Pulsating headaches
• Sweating (especially on the palms of the hands or on the face)
• Involuntary movements of the eyelids

Severe Withdrawal Symptoms

The following is a list of severe symptoms that typically occur within 48 to 96 hours after the last alcoholic drink:

• Fever
• Visual hallucinations
• Severe autonomic nervous system overactivity
• Black outs
• Muscle tremors
• Delirium tremens
• Convulsions
• Seizures

The Treatment of Alcoholism:  Traditional Programs

There are a number of traditional alcohol treatment options that are relatively well established.  The following alcoholism approaches and programs will be discussed:  Detoxification, Behavioral Treatment, Therapeutic Medications, Outpatient Alcoholism Treatment and Counseling, Residential Alcoholism Treatment Programs and Inpatient Alcohol Rehab, and Family and Marital Counseling. 

Detoxification.  Alcohol detoxification is the process of letting the body rid itself of alcohol while managing the withdrawal symptoms in a safe environment.  Alcohol detox treatment is typically done under the supervision of a medical doctor and is frequently employed as the first step in an alcoholism treatment program.  Due primarily to the relatively long time-frame for the Detox process, these approaches are typically part of an inpatient alcohol rehabilitation program. 

Behavioral Treatments.  These rehab methodologies focus on initiating change in an alcoholics' behaviors and actions.  Examples include Alcoholics Anonymous, Motivation Enhancement Therapy, and Cognitive Behavioral Therapy.  It can be noted that a study that was recently undertaken by the National Institute on Alcohol Abuse and Alcoholism discovered that each of these behavioral treatment approaches greatly reduced drinking in patients the year after treatment.  Although all of these programs were determined to be "successful," none of them was classified as "the best" alcoholism treatment program. 

Alcoholics Anonymous (AA).  Alcoholics Anonymous is a mutual support program for recovering alcoholics that is based on the 12-step recovery process that is required in order to remain sober.  Assistance and support are provided by the meetings that convene on a regular basis. Is Alcoholics Anonymous the best choice for the treatment of alcoholism? While Alcoholics Anonymous has established itself as an effective therapeutic recovery approach, most practitioners outside of Alcoholics Anonymous, as well as many members within AA, think that Alcoholics Anonymous works best when combined with other forms of treatment such as psychotherapy and medical care.

Motivation Enhancement Therapy(MET) is a systematic therapeutic approach that is almost exactly the opposite of Alcoholics Anonymous, philosophically speaking, in that it uses motivational techniques to elicit the client's change processes.  Some of the main characteristics of MET are the following:

• Providing feedback regarding the personal risks or damage associated with the abuse
• Receiving clear advice to make healthy changes
• Therapist empathy
• Providing the client with a number of alternative change options
• Helping the client achieve self-efficacy or a sense of optimism
• Emphasis on taking personal responsibility for positive change  

Cognitive Behavioral Therapy (CBT).  There are several forms of cognitive behavior therapy.  Most of them, however, share the following characteristics:

• CBT is based on an educational model that views most emotions and behavioral reactions as learned responses.  Thus, the therapeutic goal in to help the client unlearn undesirable reactions and emotions and replace them with new and more positive ways of feeling and reacting.
• CBT uses the Socratic Method that is based on the asking of questions for insight.
• Homework is a central feature of CBT.
• CBT is a mutually shared effort between the therapist and the client.
• In CBT, a solid therapeutic relationship is necessary but not the primary focal point for effective therapy.
• CBT is structured and directive.
• CBT usually has therapeutic sessions that are briefer and fewer in number than most other forms of therapy.
• CBT approaches are based on the cognitive model of emotional response.  That is, if we change the way we think, we can act and feel better, even if the situation doesn't change.
• CBT is based on stoic philosophy.  CBT does not tell clients how they should feel.  Rather, this form of therapy focuses on helping clients learn how to think more logically and effectively.
• CBT theory and techniques rely on the Inductive Method.  This method has clients look at their thoughts as hypotheses (or suggested explanations) that can be tested and questioned.  If clients discover that their hypotheses are incorrect, they can then change their thoughts and feelings to be more in line with reality.  

Therapeutic Medications.  Numerous alcoholism researchers claim that alcohol dependent individuals who cannot continue their sobriety need to receive therapeutic medications to manage and treat their alcohol withdrawal symptoms.  Not only this, but individuals who are addicted to alcohol are less likely to experience possible brain damage and/or seizures when they receive various alcoholism medications.

Current alcoholism research shows that the drugs most likely to produce effective results when treating alcoholism withdrawal symptoms are the benzodiazepines.  Examples include the longer-acting benzodiazepines such as Librium and Valium and the shorter-acting benzodiazepines such as Ativan and Serax .  Traditionally, medical doctors have used a progressive decrease in doses over the time-frame of the withdrawal process when using benzodiazepines.  Additionally, since the shorter-acting benzodiazepines do not remain in the person's system for an excessive amount of time and due to the fact that they allow for measurable and observable dose reductions, more than a few alcoholism researchers have asserted that intermediate to short half-life benzodiazepines need to be used when treating withdrawal symptoms. 

Another aspect of alcoholism treatment with therapeutic medications focuses on various prescribed drugs such as naltrexone (ReViaT) or disulfiram (Antabuse) that are administered by a doctor in an effort to help prevent the individual from returning to drinking after he or she has experienced a relapse and ingested alcohol.  Simply put, in this intervention approach, doctors prescribe drugs to treat a person's dependency.  For example, antabuse is a drug given to alcoholics that triggers negative effects such as vomiting, dizziness, nausea, and flushing if alcohol is consumed. Not surprisingly, antabuse is effective precisely because it is a such a strong deterrent.  Naltrexone (ReViaT), from a different perspective is effective because it targets the brain's reward circuits and reduces the craving the client has for alcohol.

Outpatient Alcoholism Treatment and Counseling.  These approaches usually employ counseling that teaches alcoholics how to become aware of the psychological and situational "hot buttons" that trigger their drinking behavior.  Equipped with this information, alcoholics can then learn about different ways in which they can cope with circumstances that do not include the drinking of alcohol.  These treatment approaches to alcoholism, unlike the detox programs, are usually offered on an outpatient basis. 

Residential Alcohol Treatment Programs and Inpatient Alcohol Rehab.  If there's a need for alcohol AND drug abuse treatment, if outpatient and support-oriented programs such as Alcoholics Anonymous are ineffective, if an individual needs alcohol poisoning treatment, or if the individual's withdrawal symptoms are extreme, the person typically needs to enroll into a hospital or a residential alcohol treatment facility in order to receive inpatient alcohol rehabilitation.  Such programs are earmarked for alcoholism inpatients and usually include doctor-prescribed medications to help the alcoholic through detox and through the alcohol withdrawal process in a safe manner.

Family and Marital Counseling.  Due to the fact that the recovery process is so intimately related to the support the alcoholic receives from his or her family, a number of alcohol dependency programs include marital counseling and family therapy as essential aspects in the treatment protocol.  Such therapeutic approaches, furthermore, may also provide clients with much needed community resources such as financial management courses, parenting classes, legal assistance, childcare courses, and job training classes.

The Treatment of Alcoholism: Alternative Approaches

Although the research findings are inconclusive, there are many alternative treatment programs for alcohol abuse and alcoholism that are becoming more available and widely used. Examples of such "natural" forms of alcoholism treatment include the holistic and naturalistic approaches employed by Traditional Chinese Medicine, "Drumming out Drugs" (a form of therapy that employs the use of drumming by clients), and various vitamin and supplement therapies.  As encouraging as these alternative programs have been, additional research, however, is needed to evaluate their effectiveness and to find out if they offer long term alcoholism treatment success. 

The Treatment of Alcoholism:  Conclusion