“I haven’t had a drink in two months…I used to tell myself, one drink was ok, now I know that won’t work. I guess I am, um, an alcoholic.”
It’s an amazing thing when an individual is able to acknowledge and own up to a negative behavior. With alcohol and drug abuse it is usually a difficult thing to do. Perhaps with alcohol even more so than other recreational drugs, because it is considered, in many cultures so socially acceptable. After all, real men have to be able to drink right? After work happy hour is a normal part of office culture, two for one deal exist everywhere. Alcohol is perhaps one of the easiest liquid amnesia an individual can get. What’s liquid amnesia? Easy, it helps you to forget. If you cannot remember what is wrong in your life, there’s less chance of being upset- goal accomplished. That is, until you either a) do something while intoxicated that wrecks everything, or b) stop drinking. Then, the hard part starts- a reality without alcohol use.
The Components of Alcoholism
So, what defines an alcoholic? That can be summarized with the following four symptoms:
Craving—a strong desire or craving to drink.
Tolerance—needing more alcohol to sustain a “buzz” or “high”.
Physical Dependence—this includes symptoms such as sweating, shaking, nausea, and anxiety – all symptoms of withdrawal.
Loss of Control—not being able to contol the amount of alcohol one drinks.
The reason one can refer to alcoholism as something having symptoms, is because it is considered a disease. Why? Because a true alcoholic continues to drink irregardless of what conspires. This means, aside from dying, one will continue drinking – health issues, family or legal problems will not keep a drinker from his drink.
Why Would Anyone Start Drinking?
There is a risk for alcoholism associated with family history. This is not to say that an alcoholic uncle in the family automatically predisposes one to drinking, it does mean however, that one’s risk is increased. In addition, work and family conflicts, social support groups or lack there of, monetary situations and improper coping mechanisms with life issues can all contribute to use of alcohol.
How Can Alcoholism be Treated?
As with any substance abuse problem, one needs the help of professionals in the form of counseling and for alcohol, possibly controlled detox. There are medications that can help one to detox from alcohol. The reason medications are necessary for alcohol detox is that it can cause one to go into respiratory depression.
Three oral medications can be used during alcohol detoxification.
They are as follows:
Disulfiram - makes one sick after drinking which can help one not drink again.
Naltrexone – used to help lower the chance of alcohol relapse by reducing cravings.
Acamprosate -are currently approved to treat alcohol dependence.
To assist with other symptoms of withdrawal which include the following: shakiness , nausea, and sweating other medications are available and should be considered in addition to constant supervision during the detox process.
How Can You Tell if Someone Has a Problem?
The best way to figure that out if an individual has a drinking problem is by asking questions such as:
• Do you have to drink first thing in the morning to feel stablized?
• Do you feel as though you should cut down your drinking?
• Does your drinknig make you feel bad or guilty?
• Have people annoyed you by criticizing your drinking?
A yes to any of these questions suggests a problem, more than one yes is indivicative of a more severe issue. As with One "yes" answer suggests a possible alcohol problem. More than one "yes" answer means it is highly likely that a problem exists. If you think that you or someone you know might have an alcohol problem, it is important to see a doctor or other health care provider right away. They can help you determine if a drinking problem exists and plan the best course of action.
Who is Affected By Drinking?
Any population can be affected by alcohol use. However, when drinking in excess the people affected go beyond just the drinker. An alcoholic’s behavior affects friends, family and strangers as well.
Alcohol During Pregnancy?
The answer to that question would be no. it has been shown that heavy drinking most definitely affects mothers and their babies. As to whether moderate or light consumption of alcohol is dangerous, there is currently no research stating that it is safe to drink even a small amount, so it is best that pregnant women refrain. Otherwise, one is at risk for causing FAS (Fetal Alcohol Syndrome) which results in learning problems, physical and behavioral problems.
Who is More Affected by Alcohol?
Alcohol affects people of varying age groups and genders differently because of the way the body metabolizes the alcohol. Women and older individuals tend to metabolize alcohol slower and therefore at risk for impairment more quickly than other groups. The elderly population often uses medications, which when combined with alcohol can cause impairment. These things put people at risk for falls, car accidents, and other issues that are related to impaired reaction.
How Serious is Alcoholism?
Serious enough to kill you. As mentioned prior, just detoxification from alcohol can cause death. Constant utilization of alcohol without cessation will eventually damage the liver which can cause a decrease in clotting factors which can lead to excessive bleeding. The side effects and possible illness of alcohol use could result in an article all of its own, but suffice to say if one has this issue or knows someone that does, immediate attention is required.
Alcohol addiction or alcoholism has several definitions. The definitions may even be conflicting. Historically, alcoholism refers to any condition which results in the continued consumption of alcohol despite recurrent negative outcomes. Medical communities describe alcoholism as a physiological disorder which causes difficulty in controlling alcohol consumption. Another definition states that alcoholics may not be able to perceive the negative effects of their alcohol consumption and therefore continue with their behavior including a compulsion or preoccupation with alcohol. Though the ingestion of alcohol is essential to develop alcoholism, drinking will not necessarily precede addiction. The amount of alcohol and the frequency with which alcohol is consumed changes for each person. Additionally, there are biological components to alcoholism.
Does genetic predisposition have a role in alcoholism?
There is at least one genetic test for an allele that is associated to alcoholism and opiate addiction. Though this allele is more common in individuals with alcohol addiction, there is no conclusive evidence that the presence of this gene is necessary for alcohol addiction. Some researchers argue that the evidence for such alleles is contradictory.
There is a theory that alcohol was discovered and utilized as a replacement for polluted drinking reservoirs in urban society. In this case, death from liver disease was preferred to death by waterborne disease. Over time, this resulted in a selection process of genes that were able to handle more alcohol. Essentially the population changed from being a predominately hunter-gatherer society to more urban. This theory explains why certain groups like Aborigines or Native Americans have a higher alcohol tolerance.
What are the effects of alcohol addiction?
The effects of alcohol addiction range across all aspects of the individuals life. The main effect is the individual drinking alcohol in overabundance at times that they should not thereby causing damage to themselves and possibly others. Some of the potential effects of alcohol addiction include but are not limited to the following:
Physical effects: cirrhosis of the liver, pancreatitis, alcoholic dementia, heart disease, nutritional deficiencies, sexual dysfunction, and death from many sources.
Social effects: Marital conflict and divorce, social alienation because of behavior.
Economic Effects: loss of employment, financial problems such as loss of living quarters, poor judgment,
Legal Consequences: charges for drunk driving or public disorder. There is also the possibility of domestic violence either to spouse or children.
Emotional Consequences: alcohol abuse can effect the individual drinking as well as the recipients of probable abuse. For instance, an alcoholic’s children can experience delays or damage to their emotional development. Friends and family who perceive alcoholism as self inflicted may loose respect for the alcoholic further diminishing his or her social support network.
Is it difficult to withdraw from alcohol use?
Alcohol withdrawal is different from other drugs in that discontinuing use can be fatal. This manifests in the following symptoms: delirium tremens which includes: hallucinations, shakes, convulsions, seizures, and possible heart failure For this reason, withdrawal issues should be controlled by supervised detox.
Alcohol Treatments
Depending on what school of thought is utilized, alcohol treatment may be approached from different angles. Essentially, cessation of alcohol use includes: detoxification, and treatment. Treatment includes managing physical symptoms and behavioral changes which may be attained by therapeutic treatments ranging from psychotherapy to medications. Some of the medications utilized are: Antabuse which when alcohol is ingest results in an adverse reaction on the part of the drinker. Natltrexone is also utilized and works by decreasing physical cravings of alcohol. Life training and social support are usually needed to help individuals continue sobriety. The most popular example of social support for alcoholics is Alcoholics Anonymous.
Does Alcohol Treatment Work?
This depends on the program, if the program is completed and the commitment the individual has to recovery. This is not to say that other factors don’t also come into play. Whether the addict has social support and is aware of what resources are available also determines how effective treatment is as well as the possibility of long term sobriety. According to data collected by the National Institute on Alcohol Abuse and Alcoholism, about a third of alcoholics are sober a year after treatment. An additional forty percent are doing better but still drink and a quarter has relapsed. For this reason, there is no equation that can determine whether or not treatment will work. Each case is a different person and must be approached as a separate case. This means that treatment plans for alcohol treatment should be tailored to the individual in order to procure the best outcome.
What About After Treatment?
Alcoholism can be a lifelong struggle. Though behaviors are changed, relapse is always a possibility and often occurs. Relapse does not mean an individual is doomed to alcoholism. There are some professionals that hold that relapse is just part of the learning process. Something individuals have to go through to attain full abstinence. In addition to cessation of drinking, long term use of B12 and folate is suggested to treat the effects of chronic alcohol use on the liver. Insulin resistance can also occur as a result of the use of alcohol. There are many other complications that can occur. These are all factors that healthcare professionals must consider when treating the alcoholic. These are also factors alcoholics must consider when continuing this damaging habit.
Naltrexone is not a drug that is new on the scene. This substance was first approved in 1994 by the FDA to assist alcohol abusers safely detox from alcohol. Recently however, naltrexone is being used to treat other conditions. The uses range from its original purpose- alcohol use treatment, to stopping nicotine use decreasing the possibility of kleptomania, heroin and morphine use and even for relief from symptoms of fibromyalgia.
A study conducted recently explores the use of naltrexone in preventing kleptomania. Kleptomania is defined as an individual’s incessant need to steal. It’s often not an issue of what is getting stolen, as kleptomania really has to do with the thrill or excitement an individual feels when stealing. Examples of famous persons who have exhibited kleptomaniac tendencies includes actress Winona Ryder. The study was conducted at the University of Minnesota and included 25 participants, 23 of which completed the study. The study lasted for two months and participants were assessed every two months through self report. Variables measured included anxiety, psychosocial functioning, depression as well as a scale specifically for kleptomania. After eight weeks of treatment for those in the experimental group (those receiving medication) there was a significant decline in the desire to shoplift and actually stealing as well as a decrease in scores of kleptomaniac scales.
Researchers attribute the affect of the drug to the fact that it blocks pleasure centers of the brain which means when an individual steals, he or she will not feel the high associated with stealing. Though other therapy should be incorporated into kleptomania treatment, this was an important finding.
Another study examined the use of naltrexone for alcohol abusers who also smoked. The same principles are in play here, as again, naltrexone’s purpose is to block pleasure receptors in the brain that are activated which substances are used. We already know that naltrexone works to help in alcohol abuse. Many alcoholics, or heavy social drinkers, concurrently heavily smoke. Often, the smoking is triggered by alcohol use. Both of these substances put the user at significant risk of damaging their health permanently. An individual who smokes and drinks alcohol is at a higher risk of dying prematurely from tobacco related complications than alcohol related complications. Since naltrexone is well tolerated, this finding could really assist in long term abstinence to two very serious substance abuse problems.
In terms of heroin abuse, naltrexone use has reduced detoxification from heroin from two weeks, to one day. With further study, heroin detoxification was even reduced to just four to six hours. The implications of this are many. First, it makes it easier for the user, which means he or she will be more likely to try to try to detox. Secondly, is the cost of the detoxification is greatly reduced if an individual only needs to be inpatient for one to two days. It is suggested that uses of naltrexone is best in highly motivated populations as stopping the drug does not have any negative side effects and may result in reduced long term abstinence for those having difficulty abstaining. However, if naltrexone is used for detoxification in conjunction with supportive therapy the results should be long lasting.
Low Dose Naltrexone?
In the case of smoking cessation, naltrexone is prescribed at a dose of 50mg daily. What happens if the dose is reduced to only 5 mg? Well, in the case of a substance abuser, chances are nothing would happen. The naltrexone may not procure any notable change. However, as a researcher at Stanford University recently noted in a study published in Pain Medicine, low dose naltrexone may be useful in the treatment of fibromyalgia, as well as other autoimmune disease including Multiple Sclerosis and Crohn’s disease.
Firbromyalgia is defined as chronic pain in the muscles of the body. These individuals are chronically fatigued and have difficulty sleeping. The discomfort from fibromyalgia which also includes headaches, stomach problems among other things, often prevent these individuals from living full and meaningful lives. The number of people suffering from the disease in the U.S. reaches the millions. Though there are three FDA approved medications for the disorder, they do not work for everyone.
The study was small, conducted with ten women participants. The study participants received the medication for a total of ten weeks. Two weeks they received a placebo pill and eight weeks of low dose naltrexone (LDN). They reported their symptoms on a hand held computer. In six of the ten participants, the LDN given was significantly more effective than placebo at reducing symptoms. Sleep problems, GI symptoms and headaches were also reduced. More research needs to be done, and Stanford is currently organizing to run another larger study on the use of LDN for autoimmune illness. At this point, all the possible uses of naltrexone are not known, however, the studies already conducted and those underway give a sense of hope for assistance in other areas.
Ever correlate eating habits with alcohol consumption? No? Well, most people probably don’t. If you didn’t correlate these two seemingly different variables, then consider a study that was conducted by the National Institute of Health in 2006. Researchers found that there was a positive correlation between poor eating habits and an increase in alcohol consumption. Likewise, there was a positive correlation between a positive eating habits and a decrease in alcohol consumption (positive correlation implies a strong relationship between two variables. i.e. when one variable rises, the other one does as well). To be more specific, low alcohol consumption meant small amounts of alcohol, it did not necessarily refer to the frequency in which alcoholic beverages were drunk. The importance of this study is two fold. Poor eating habits may be a predictor for possible alcoholic leanings and this is a good indicator for alcohol rehabilitation.
Are There Nutritional Behaviors Specific to Alcohol Consumption?
Want beer? Well, one must have a snack to accompany the drink right? The natural choice- pizza. This combo is common to most Americans. Every once in a while, this meal choice is acceptable, however, pizza and beer may lead to more issues than one might think. Alcohol tends to be a calorie laden beverage. Unfortunately, these calories are not ones that can effectively be used by the body. There is also a positive correlation between an increase in carbohydrate consumption and a decrease in protein intake. The end result is weight gain and a nutritional deficit. It is unclear as to why individuals consuming alcohol crave carbohydrates, but studies show that these are the foods leaned towards. In fact, individuals with higher alcohol consumption tended to have a higher calorie diet then individuals with less of a tendency to drink.
So What Does Alcohol Do To The Body?
There are approximately nine thousand calories per gram in alcoholic beverages. None of these calories, as noted above, provide the proper nutrients for the body. (Necessary nutrients include carbohydrates, proteins, fat, vitamins, and minerals- all of which should be consumed in the proper quantities.) The body however, may think that its needs have been met as it is not identifying the types of calories consumed. What results is a deficiency of the necessary nutrients for the body to function properly. When large amounts of alcohol are consumed, the body senses that its caloric needs have been met. This produces a decreased demand for other foods which can result in a malnutritive state.
The gastrointestinal system is also affected by alcohol and is one of the reasons that poor nutrition can occur. To begin, alcohol is an irritant to the GI system and can cause inflammation and even ulceration to the lining of the intestines and the stomach. The result of this is poor absorption of nutrients and in plain English, an upset stomach. In addition, alcohol consumption also interferes with storage and metabolism of necessary components for survival. An example of this is mal absorption of vitamin B12 which, when not present, can lead to pernicious anemia. What does this mean? B12 is not absorbed when the intrinsic factor is not present and this is not secreted when the GI tract is irritated. Pernicious anemia results in a decrease in red blood cells which manifests itself in pallor and fatigue. The repercussions of such a disorder however, are more than can be observed with the naked eye.
In addition to the malnutrition issues that drinking itself can cause, alcoholics run into the possibility of other problems like heart disease. It is widely known, that alcohol is correlated with liver damage. What most people don’t realize however is that high blood triglycerides present occur because the liver is over producing them due to alcohol use. Long term use of alcohol can also lead to kidney damage.
There are many other effects of alcohol usage which include but are not limited to the following: birth defects, brain damage, and a link between drinking and breast cancer.
Long Term Recovery and Nutritional Education
When information like the above is gathered, it’s difficult to decipher which came first, the chicken or the egg. Meaning, do alcoholics have awful eating habits and therefore drink or does the drinking cause the improper eating. It’s hard to tell. Having said that, one thing is certain. As with any type of addiction, alcoholics need to make a behavioral change. Long term recovery from alcohol use includes in this behavioral change, better eating habits both to fix the damage that has been done and to promote a long term withdrawal from alcohol use.
One study analyzed the differences between substance abuse centers that provided nutritional services to those that did not. The results of the study suggest that there are more positive outcomes in those centers where nutrition services are offered. In fact, the ASI (Addiction Severity Index) utilized indicated that there were better outcomes in three prominent areas: psychiatric, medical and family/social indexes. The researchers in this study also found that centers that provided nutritional counseling also provided an abundance of other services (counseling, integrative therapies such as acupuncture ect.) which assisted in a well rounded recovery. In fact, the researchers also point out that addiction is much like other chronic illness such as heart disease and cancer and thus requires the same kinds of all encompassing treatments.
Perhaps that is the important thing to remember when considering substance abuse treatment. Substance abuse recovery includes, of course, abstaining from alcohol but is also just a behavioral change. This change affects with whom someone interacts with, how they carry themselves, what activities they engage in and of course their diet as well. A program that recognizes the importance of all these variables, as the above research suggests, should promote long term abstinence, not only from the pork rinds that go so well with the football game on TV, but also the beer can that accompanies it.
In the United States, when one thinks of binge drinking the first thing most people think of is a fraternity toga party. There is much debate over what actually defines binge drinking. The definition of binge drinking that is most often acknowledged is drinking twenty five or more drinks for men and eighteen drinks or more for women on one occasion. Binge drinking is usually associated with intoxication and being in a large group of people. However, people around the world may have a different perception of what binge drinking consists of. Different behaviors, different liquors, and difference of opinion as to what is considered acceptable will define binge drinking.
Australia
A culture of binge drinking is prevalent among many communities, for example at high schools, universities, at parties, amongst some Aboriginal groups and in sporting clubs. Those who are able to consume large amounts of alcohol are often held in high regard by their peers. Binge drinking and getting drunk to a point of complete loss of control may not only be accepted but encouraged. Drinking to this extent often begins, in a minority of social circles, at as young as 13 and 14, and may be very widely practised and accepted by most by age 16 or 17. This is the main advantage of binge drinking in Australia; it is passed off by the younger generations as "being Australian" and is seen as a perfectly normal cultural practice for some.
Canada
University students are often found binge drinking. It is common for drinking to be accompanied by hostile behavior. During the first week of orientation which is known as ‘frosh’ week, college students are known for binge drinking. In fact, many university towns and cities in Canada include drinking sub cultures.
Europe
As a general rule, European children have exposure to alcohol much earlier than American children, with the approval of parents. In most countries, the drinking age is eighteen, and in many restaurants as well as other jurisdictions adolescents can order certain alcohols with a parent’s supervision. Diluted wines and other mixed drinks may also be given to children as well. In several countries including: Denmark, Germany, Portuagal, Austria, the Netherlands, and Belgium the legal drinking age is sixteen. It is generally believed that binge drinking is less prevelant in the southern part of the continent— France, Italy and the Mediterranean.
Russia
In Russia, binge drinking or ‘zapoy’ usually consists of two days of continuous drunkenness. Close to fifty percent of working age Russian men are killed by alcohol abuse.
Spain
Big bottle drinking or ‘botellon’ is something that youth between sixteen and twenty four often do. Drinks are purchased in stores and taken to wide open spaces where friends sit, drink and listen to music. Most drink three to five drinks in less than five hours which consists of binge drinking..
United Kingdom
In the majority of Europe, alcohol is to be consumed with a meal over the course of an evening. In the UK however, alcohol is drank quickly and in massive quantities usually leading to drunkenness. In fact on a given night out, young adults are pressured into not only drinking but getting drunk. UK officials have begun to regard this as a more serious issue because of the number of casualties that have occurred related to binge drinking. In 2003 the cost of binge drinking in the UK was estimated as twenty billion pounds. In January 2005, one million admissions to UK accident and emergency units were alcohol-related.
New Zealand
Eight or more drinks in one session are considered to be binge drinking in New Zealand. The drinking age in New Zealand was recently dropped from twenty to eighteen. The argument being, at eighteen individuals are able to serve in war and vote, as well as other adult activities so drinking should be no different. This lead to more problems as opposed to alleviating concerns as more underage drinkers would ask their counterparts to buy them liquor.
South Africa
The most prevalent age for binge drinking in South Africa is between eighteen and thirty five years of age. The word 'Phuza' in Zula is translated as drink is often used to describe ‘Phuza Thursday’. In the event that someone is hung over one might say he or she is ‘Phuza face’.
United States
University students are often characterized as having a propensity for drinking even though the drinking age in the U.S. is twenty one. Athletes and fraternity/sorority members are the stereotypical heavy drinks, especially at football games, after final exams and on spring break when there were typically no rules enforced. An explanation for binge drinking behavior, is university students are on their own for the first time without parental supervision and drinking is considered the cool thing to do. It is arguable that the twenty one year old drinking age is the reason why youth drinks more. There are just as many arguments against the lowering the drinking age.
The National Survey on Drug Use and Health found binge drinking is most prevalent in the following states: Colorado, Iowa, Minnesota, Nebraska, North Dakota, South Dakota, Wisconsin, and Wyoming. The survey found that the lowest binge-drinking rate in the U.S. was in Utah.
Close to a million Americans are treated for alcoholism on a daily basis. 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 visiitng 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 is still remains to be discovered.
Alcoholism Treatment
The majority of individuals with alcohol dependence initially always deny that they have a problem and are reluctant to undergo therapy. Agreeing to undergo alcohol 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 treatment involves evaluation, a brief intervention and either an in/outpatient program or counseling.
Principles of Alcohol Dependence Treatment
Before alcohol treatment can begin, one has to determine if the individual is alcohol dependent. 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.
Non Drug Residential treatment programs
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 this basic criteria usually do not succeed with therapy.
Psychological, Behavioural and Social 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 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 pycholigcal 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 strenghtening the marital relationship through sharing, teaching and communication skills
Self-Help Programs
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, will 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.
Physician intervention
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 ineterventions help those with acute alcoholic crises. Following the brief intervention, all individuals are recommended to enter specialized treatment programs if the alcohol consumption continues.
Drug treatments
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 to day 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 have fewer side effects and do 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.
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.
Conclusion
Research supports the idea of using drugs as an adjunct to the psychosocia/behaviourall 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 develop 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.
Korsakoff’s syndrome, which is also known as amnesic-confabulatory syndrome or Korsakoff’s psychosis, is caused by a deficiency of thiamine or vitamin B1 in the brain. The disorder is named after the Russian neuropsychiatrist, Sergei Korsakoff, who discovered and popularized the theory.
How does Korsakoff’s syndrome manifest itself?
There are six major symptoms of Korsakoff's syndrome:
* Anterograde Amnesia - a loss of memory of what happens after the injury that caused the amnesia.
* Retrograde Amnesia - where events prior to the injury-causing one are forgotten. To a large degree, anterograde amnesia remains a mysterious ailment because the precise mechanism of storing memories is not yet well-understood, although scientists know which regions of the brain are involved.
* Apathy- individuals don’t have interest in things for very long and seem indifferent to change.
* Little content is offered in conversations and a lack of insight.
* Confabulation – are memories that are invented to fill in gaps of memories. These gaps are usually associated with blackouts.
Other signs that are associated with Korsakoff’s include: ataxia, tremors, paralysis of eye muscles, coma and lack of insight into the severity of the condition.
How does this occur?
Causes
There are several conditions or behaviors that can lead to Korsakoff’s including:
Chronic alcoholism which is automatically correlated with vitamin deficiency and malnutrition is a precursor to Korsakoff’s. As alcohol can irritate and inflame the stomach lining, thiamine deficiency can occur.
Other dietary deficiencies causing Korsakoff’s include prolonged vomiting, eating disorders, or from the effects of chemotherapy. This can also occur in pregnant women due to a condition known as hyperemesis gravidarum, which is extreme morning sickness. Mercury poisoning has also been known to cause the disorder.
What is the mechanism in the brain that causes Korsakoff’s?
The symptoms mentioned above are caused by a deficiency of vitamin B1 or thiamine. This is thought to cause damage to the medial thalamus of the brain as well as damaging parts of the hypothalamus. In addition, thiamine deficiency can lead to an overall cerebral atrophy. This disorder involves neuronal loss, or damage to the neurons. In addition, gliosis can occur which is damage to the cells which support the central nervous system. The lack of thiamine and malnutrition can lead to the hippocampus decaying, leaving holes that cause ones short term memory to transfer into long term memory (see anterograde amnesia).
How is Korsakoff’s treated?
As the individual is lacking thiamine, treatment takes place by replacing the missing vitamin. Thiamine is replaced by intramuscular or intravenous injection. In addition, the proper nutrition or hydration is required. Irregardless of how much of the thiamine is replaced, the amnesia and brain damage that are caused by the disease do not respond to thiamine replacement. Even if treatment is successful, it often takes two years for some sign of recovery. In cases where recovery is achieved, it is slow and may not be complete.
Prevention of Korsakoff’s
The best way to avoid this syndrome is by making sure that a thiamine deficiency does not result. As the most common cause of thiamine deficiency in the Western world is alcoholism it should be quite clear that alcohol in excess should be avoided. It should be made clear that this deficiency does not result in an absence of thiamine in the diet, but rather a resistance on part of the body to properly absorb the nutrients. Alcohol can cause inflammation of the stomach and the intestines which is where nutrients are soaked in. At one point in time, thiamine was added to alcoholic beverages; however, it did not assist alcoholics. The addition of alcohol has been blocked by the U.S. governments as some political groups attest that adding thiamine to alcohol would further encourage excess drinking.
In addition to the effects of thiamine deficiency, alcohol is neurotoxic which means with time, the neurons (part of the brains framework and ‘communication’ system) can become damaged; specifically focusing on the hippocampus. This is the area responsible for short term memory and spatial thinking. When one consumes alcohol, the body releases cortisol, a stress hormone. In excess, it has been found that cortisol cause further damages to the hippocampus which may be irreversible if present for a long period of time. Using alcohol in moderation will not cause Korskoff, however, continued use can cause all of the effects mentioned above including dementias. This may give one something to think about before picking up that first or second glass of wine, or bottle of beer.
It is widely acknowledged that alcoholism can lead to health problems. The question that can be posed here however, is does anyone know and understand to what extent heavy drinking can affect the body? How about for specific at risk populations? For instance, what happens when pregnant women drinking alcohol? Is eating well, sleeping eight hours a night and maintaining low stress levels enough to maintain a healthy pregnancy? Though all of these factors are important, there are specific vitamins that are needed to ensure a healthy pregnancy and subsequently a strong baby. One such component being emphasized by the medical community and organizations like the Centers for Disease Control is folic acid.
What are Neural Tube Defects?
The two most common types of neural tube defects are spina bifida and anencephaly. Neural tube defects consist of birth defects of the brain and spinal cord. In spina bifida, the fetal spinal column doesn't close completely during the first month of pregnancy. Nerve damage usually occurs which tends to result in at least some paralysis of the legs. In anencephaly, a good portion of the brain does not properly develop. Babies with anencephaly tend to either be stillborn or die shortly after birth.
What is Folic Acid?
Folic acid is a vitamin in the B family. The human body utilizes B vitamins in order to make new cells. For this reason, folic acid is something that every person needs. For women who are attempting to get pregnant folic acid is even more essential. If there is enough folic acid in a woman’s body prior to pregnancy, this nutrient can help to prevent birth defects of the type discussed above. Specifically, folic acid can prevent birth defects present in the baby’s brain and spine. According to the Centers for Disease Control and the United States Public Health Service every woman who could become pregnant is urged to incorporate at least 400 micrograms (400 mcg) of synthetic folic acid every day.
How Does One Know What Enough Folic Acid Consists Of?
A simple way to make sure that the proper nutrients are being consumed is by taking a vitamin that already contains folic acid. Most vitamins and folic acid pills in the United States contain the daily value, or the one hundred percent requirement, of folic acid that one should consume. When in doubt one can always check the label to make sure of what the daily value is. The other way one can get enough folic acid, is to eat cereal that is enriched with folic acid. This can be easily checked by making sure that the box says one hundred percent folic acid on the side of the box.
When Does Folic Acid Need to be Implemented into the Diet?
Neural tube defects occur during the first few weeks of pregnancy- usually by the 28th day of pregnancy to be exact. For this reason and since most women don’t even know they are pregnant at such an early stage, folic acid consumption, as well as other nutrients, needs to be implemented before an individual becomes pregnant. When one thinks of pregnancy, the reasons for this should be obvious. Think of the female body as an incubator. If it is not clean and properly padded, therefore functioning to the best of its ability, proper ‘cooking’ of the embryo will not occur. In addition, remember that folic acid assists in proper cell growth. When an egg and sperm unite to become an embryo, the main function is cell division. Without enough folic acid in the individual’s system, the proper division of cells will not occur, thus resulting in neural tube defects, among other things.
So What is the Link Between Folic Acid Deficiency and Alcoholism?
Chances are, if an individual is heavy into drinking, he or she probably isn’t the most health conscious person. This means meals are not eaten regularly or when they are, the actual nutrient value is debatable. So, to begin with an alcoholic probably isn’t taking in as much folic acid as is recommended. In addition to starving the body of proper nutrition, a few other things can occur. Liver damage usually results, as well as kidney damage. In addition to these things is a reduction in the metabolism of folic acid by the liver, thereby rendering the consumption of folic acid useless. This occurs because the intestines tend to be damaged by alcohol. When this damage takes place, the small intestines in particular can be harmed. Since this part of the body is necessary for nutrient absorption, a deficiency results.
What are Symptoms of Folic Acid Deficiency?
• shortness of breath
• heart palpitations
• weakness
• glossitis (inflammation of the tongue)
• nausea
• anorexia
• headache
• fainting
• irritability
• forgetfulness
• pallor
• slight jaundice
• progressive fatigue
How Can Folic Acid Deficiency be Remedied?
First and foremost, any individual thinking about pregnancy needs to eliminate all alcohol from her diet. This can be done by joining a group like Alcoholics Anonymous, or attending a center specialized in alcohol/drug detox. It is probably best to take the comprehensive route and go to such a center. Alcohol detoxification can take a long time. So, though one may have stopped drinking, it is probably best to wait a while and allow the body to heal itself before thinking about pregnancy. In order to find out exactly what nutrients should be taken and in which amounts it is best to consult a medical professional as actual dosages will vary on a person to person basis.
When one realizes that no matter how much they may know about theoretical drug and alcohol problems, it is still possible to be staring in the face of a full on alcoholic and not know it until after the fact. Alcoholism and drug problems, much like other chronic illnesses, are not things one can identify just by looking at someone’s face. However, if one pays attention there are probably warning signs that are indicative of a substance abuse problem. However subtle the signs may be, they are usually consistent. A story, with not so subtle signs, may be in order to properly illustrate the point:
George is a 30 year old junior marketing executive. He shares an apartment with his brother and is not in a relationship. George has a very active social life. Almost every night of the week, George can be found at some sort of festivity that is at a bar, club or restaurant. At all of these occasions, liquor is present. George often jokes about how he must look like an alcoholic because in most pictures he is holding a drink. In addition, the woman he has begun a flirtation with finds that every time she calls him he is drinking. She thinks nothing of it, since this man must just enjoy one or two social drinks. The fact that he drinks every night does not flag him as an alcoholic in her eyes. They have spoken on the phone scores of times, spent time together and been in constant communication for a two month period. In addition, he really is such a nice guy. He casually mentions that his mother has asked him to promise not to drink. They laugh about how parents often refuse to view their children as adults.
One night before George goes out with his new lady friend, he tells her a few stories. One included waking up one morning after a night of drinking with blood on his shirt. The caveat being he had no idea where the blood came from. On another occasion, upon being shoved by a young woman in a club after drinking for a while, George pushed her back and the woman went flying across the room. George admits that at this point, he realized he did not know what his alcohol limit was. He stated this in past tense; these events had happened about a year prior and since then, George had allegedly altered his drinking habits. This statement was made as George pulled out two small bottles of vodka. One was for himself, one for his lady friend. When she declined the offer of drink, he downed both bottles himself.
Two hours later at the club the couple had gone to, George has drunk two beers and was ready for a shot of tequila. He, at this point, is holding his liquor well. However, once the shot of tequila comes into play, George succeeds in alienating his new friend. He spills salt all over the bar, begins dancing sloppily and says more than a few insulting things to his date. By the end of the evening, the young lady wants nothing more to do with him. George can’t understand why.
George is in a state of denial about his drinking problem. The main issues here include the following:
• An inability to stop drinking
• Inability to see conflicts arising subsequent to drinking
• Spending excessive money on drinking to the point of putting oneself in a financially precarious position
• Jeopardizing existing relationships
• Damaging potential future relationships
• Does not correlate his poor decisions with the outcomes they procure
• Not understanding the concern those around have for him and his poor behavior
George continues to drink excessively, regardless of the concern expressed by his family and friends. He holds that he does not have a problem and does not seek help. In the long term, George is never able to find a more secure job position or maintain a serious romantic relationship with any woman he meets. The issues here are many. George’s inability to stop drinking will also eventually erode his body functioning. This will result in a financial strain both on George, his family and society. The most common health risks for alcoholics include strain on the liver and kidneys.
Should George ever decide he wants to stop drinking, what he may not realize is detoxification from alcohol unsupervised can be life threatening. The purpose of writing down George’s story is his experience may be able to help someone you know. If you read this anecdote and see a bit of yourself in it, or someone you know, please contact someone who can help you.
