Alcoholism is a chronic, progressive disease, which can injure, cause disability or even death. Alcoholism is acknowledged to be a public health crisis resulting in significant social, health and economic burdens on society. Incidence rates are high: World Health Organization estimates that 140 million people throughout the world suffer from alcohol use disorder (AUD). National Institute of Health estimates that approximately 16.6 million adults have an alcohol use disorder.
Below are criteria for the disorder. According to the DSM 5 (Diagnostic and Statistical Manual of Mental Disorders), a person suffering from AUD demonstrates some or many of the following:
- tolerance (the need for increasingly greater amounts of alcohol to achieve intoxication, or a lesser effect using the same amount)
- withdrawal (experiencing symptoms of withdrawal and/or drinking to avoid withdrawal symptoms)
- alcohol is consumed in larger amounts, or over a longer period of time, than was intended
- persistent desire or unsuccessful efforts to lessen or control use
- a great deal of time spent in activities necessary to obtain, use, or recover from the effects of alcohol
- important social, occupational or recreational activities are given up, or reduced
- cravings or urges to use alcohol
- continued drinking despite ongoing physical or psychological problems
Some alcoholic patients claim that they do not drink daily, yet admit to binge usage. Binge drinking is defined as a pattern of consuming 4 to 5 drinks – depending on gender – within a 2-hour period, bringing the blood alcohol concentration (BAC) levels dangerously high. Binge drinkers often proclaim, “I can stop any time I want!” The proof is in the pudding, however – they continue to return to binge drinking, which may have severe consequences. They are unable to control or stop this pattern.
“I can control my drinking – I can limit myself” is another rationalization frequently made by alcoholics. And while it’s true that some people are able to limit their alcohol consumption, many cannot. What often begins as mild to moderate alcohol use quickly morphs into daily, problematic drinking, binge use, or heavy drinking. What started as a glass of wine after dinner may lead to two, or a couple of drinks at social gathering lead to more frequent and greater consumption. Soon, a dangerous pattern of alcohol misuse has developed and spiraled out of the person’s control, accompanied by physiological and behavioral changes that fuel the disorder’s progression.
Alcohol use disorder is considered a medical condition and is an addiction. The person suffering from AUD usually becomes preoccupied with drinking, unable to control the amount of alcohol s/he drinks, or how frequently, despite the physical, emotional, and social consequences involved in consumption.
What causes alcoholism?
Most researchers believe that alcoholism is caused by a combination of a number of factors such as biological causes, which include a person’s unique physiology and genetics. Some studies suggest that 9% of the general population is predisposed to alcoholism based on genetic factors. Studies have also shown that children who are born to alcoholic parents are four times more likely to become alcoholics than children who are not from alcoholic backgrounds.
Psychological make-up is another factor. For instance, risk factors include poor coping skills and lack of impulse control, poor stress-reduction skills and the presence of psychological disorders (e.g., depression and anxiety). Finally, a person’s socio-cultural environment is a factor. Individuals learn values and beliefs from family and the surrounding culture – these include either the use or misuse of alcohol.
What are some common effects of alcohol use disorder?
Alcohol use disorder is known to affect the gastrointestinal system, sleep cycle, liver, heart, pancreas, blood, and/or nervous system, and potentially result in epilepsy, polyneuropathy, alcoholic dementia, mood disturbances, increased chance of cancer, nutritional deficiencies, sexual dysfunction, and harm to the reproductive system. Additionally, women who drink while pregnant have an increased risk of delivering a baby with Fetal Alcohol Syndrome.
Other signs of alcoholism may include:
- broken capillaries (small blood vessels) on the face
- raspy voice
- trembling hands
- chronic diarrhea
- enlarged veins just under the skin around the navel
- fluid in the abdomen
- a yellowish tone to the skin
- decreased testicle size
- poor nutritional health
Severe cognitive problems are not uncommon in alcoholics. Approximately 10% of all dementia cases are alcohol-related, making alcohol the second leading cause of dementia. Alcoholics may also suffer from co-occurring psychiatric disorders, especially anxiety and depressive disorders, with as many as 25% of alcoholics presenting with severe psychiatric disturbances. It isn’t always clear, however, which problem occurred first. Did the patient’s alcohol use disorder precede the psychiatric order, (e.g., depression or anxiety? Or was the alcohol use a misguided – albeit bona fide – attempt to treat the disturbing symptoms of anxiety and depression?
Patients who suffer from both alcoholism and a psychiatric disorder are referred to as “dual-diagnosis patients.” Milestones is one of the premier programs in America with regard to this specific treatment niche. Our staff excels at treating substance use disorders as well as mental health issues. Dual diagnosis treatment programs are predicated on the understanding that if the alcoholism is not addressed, the co-occurring psychiatric disorder will likely continue, and vice versa – if the underlying psychiatric disorder is not addressed, the disease of alcoholism will likely continue to progress.
How is alcoholism treated?
The first treatment intervention for alcoholism is detoxification, during which the patient is abstinent while harmful chemicals are removed from her/his system. For the patient’s safety, it is vital that a reputable, licensed clinic or physician supervise the detoxification phase. The detox process may take between 4-7 days, during which the patient may be prescribed specific medications to address, or prevent, delirium tremens (or “DTs”), which may result in uncontrollable shaking, panic attacks, and hallucinations, and/or other withdrawal symptoms, including seizures.
The patient will undergo medical assessment, be monitored, and if necessary, treated for the sequelae common in alcoholics: high blood pressure, elevated blood sugar, liver problems, and heart disease. The frequency, duration, and amounts of previous alcohol use will dictate the ease and success of the withdrawal process.
After detox, it is advised that the patient commit to a minimum 30-day stay at a residential treatment center, such as Milestones, where the staff will address the alcoholism in a three-pronged manner – psychotherapy, medication, and recovery.
Psychotherapy
The Milestones approach utilizes a blend of evidence-based modalities, including cognitive-behavioral therapy, motivational interviewing, dialectical behavior therapy, solution-focused therapy, Popping Patterns, Rogerian, and brief psychodynamic therapy. Clinical staff at Milestones are skilled and experienced in helping clients access and address past trauma, coping- and stress- management styles, limiting belief systems, and negative patterns of thought, emotion and behavior.
As part of the Milestones program, we facilitate psycho-educational groups about relapse prevention, relapse management, stress reduction, anger management, and medications. Patients are helped to identify their drinking and other high-risk triggers. Healthy behaviors are modeled, taught and role-played in the supportive and safe group environment. There is also an emphasis on skill-building for healthy communication, regulation of emotions and self-soothing techniques.
Medications
Addiction psychiatrists are well-practiced in prescribing an appropriate medication regime to address underlying psychiatric disorders, as well as medications used specifically to treat or reduce the symptoms of alcoholism, including Antabuse, naltrexone, Vivitrol, and Topomax. Every client’s treatment team includes an addiction psychiatrist for treatment and ongoing consultation in order to ensure the best possible outcomes for our clients.
Antabuse may be a deterrent to drinking. While it will not cure alcoholism or remove the compulsion to drink, it will produce flushing, nausea, vomiting and headaches if the patient does in fact drink.
Naltrexone reduces the urge to drink, blocking the high provided by alcohol. It is used after the patient has stopped drinking, and works by decreasing alcohol cravings. Naltrexone usually has no psychological effects. Patients have neither an elevated nor dysthymic mood while taking it. It is not habit-forming.
Vivitrol, a variant of Naltrexone, is administered once a month by a health care professional via injection. It may reduce the urge to drink by blocking neurotransmitters in the brain thought to be associated with alcohol dependence.
Topamax has been found effective in helping alcoholics cease or reduce alcohol consumption. In one study, heavy drinkers were six times more likely to remain abstinent for a month if they took the medication, even at small doses. In another study, those who received Topomax had fewer heavy drinking days, fewer drinks per day and more days of continuous abstinence than those who received the placebo. Topamax works by reducing the brain chemical dopamine, so that consuming alcohol no longer produces pleasure.
Long-term Recovery
As an adjunct to Milestones’ intensive residential treatment and as part of aftercare, we encourage patients to explore various group support organizations, such as Alcoholics Anonymous and Narcotics Anonymous. We believe that the peer support, sense of community and universality found in many group recovery settings contribute to successful long-term recovery. Our technicians provide transportation to 12-step meetings. Engaging a sponsor and doing step work are supported and promoted by our clinical staff, as well.
12 step meetings are free of cost to everyone, and are available almost daily in cities and towns worldwide. The 12-step model is an accessible, no-cost option that has helped countless people in the recovery community for the past 75 years.
We also recognize that 12-step is neither suitable nor desirable for everyone. For those who do not like 12 step, other groups are available, including LifeRing Secular Recovery, Secular Organizations for Sobriety, Celebrate Recovery, Rational Recovery, SMART Recovery, and Women For Sobriety. In addition, some patients maintain their sobriety through the support and structure offered by spiritual or religious programs, i.e., meditation, Buddhism, Christianity, Judaism, Islam, etc.
Why is alcoholism considered a family disease?
An alcoholic’s behavior affects all family members. The patient may lie to and steal from other family members, miss important dates and appointments, neglect obligations, disappoint spouses, parents, siblings and other relatives, or otherwise cause their loved ones stress and anguish.
What to do, if your husband, wife, son, daughter, sibling, or other relative suffers from alcoholism?
First and foremost, you must take care of and seek support and education for yourself. Attend an Al-Anon meeting, make an appointment with a drug and alcohol counselor or psychotherapist, and/or join a support group.
Second, if the patient is unwilling to accept help, consider hiring a professional interventionist. Qualified people with experience in this area are available to assist you. We can provide you with appropriate referrals, if you like.
The interventionist will guide the process, helping you organize the intervention and direct its timing. The interventionist will also link services by making arrangements for admission to a reputable treatment center at the conclusion of the process.
Third, take it easy on yourself: avoid self-blame and personalization. Do not blame yourself for your loved one’s disease. Alcoholism is a medical condition with high incidence rates. Take heart in the fact that there are established, evidence-based treatments available for your loved one, as well as helpful family support, counseling, and psychoeducation to aid the whole family system.
Take positive and effective actions. Do your best to assist your loved one with the problem, and don’t be afraid or embarrassed to ask for help. If necessary, hire or consult a professional to help facilitate and guide you through the process.
We hope the information contained in this article has been helpful. Please feel free to contact us at Milestones Ranch Malibu with any questions or comments you may have. Call: (800) 791-6859 for assistance.