Treatment for alcoholism, chronic alcohol abuse, alcohol dependency syndrome, alcohol addiction, alcohol misuse and problems with alcohol is much the same whatever we call it. Treatment for alcohol problems, and the associated medical and social morbidity, will vary only according to the severity of those problems.
The catch comes in the basic psychiatric pathology: those who have the greatest problems are least likely to acknowledge them. Denial is seen in its most extreme form when the wino on the park bench believes that he or she merely has a problem with housing and employment. Others believe that their principal problem is the depression that goes hand-in-hand with alcohol problems and which they attempt to treat with medication in the hope of averting the risk of suicide. Alcohol is seen as a comfort rather than as a cause of all the problems.
Treatment therefore has to begin with an assessment designed to get factual information that can be used to counter denial and achieve an accurate diagnosis. This is tricky when the individual who has lost his job, his or her partner and driving licence goes back to the pub for comfort. Assessment therefore needs to gather as much evidence as possible on the various damaging consequences of the individual’s alcohol consumption.
The negative effects of consistently high alcohol consumption can be seen in every aspect of life: professional, personal, marital, financial, social, physical and emotional. No other disease has such wide-ranging damaging consequences.
People who know the individual well, either at home or at work or in a social environment, can also be asked to give an assessment of the individual’s behaviour after he or she has drunk alcohol. If there is a significant change in mood and behaviour, this is cause for concern that there may be a genetic tendency towards alcoholism.
Questionnaires in magazines are usually very wide of the mark. They are made up by journalists who may themselves have something to hide. They would tend to draw the line, distinguishing alcohol problems from customary social use, on the far side of their own behaviour. True assessment has to be made on characteristics that are specific to an addictive tendency and covering a number of addictions and similar disorders.
The twelve significant factors are as follows:
- Being content to drink on one’s own
- Being preoccupied either with drinking or not drinking.
- Using alcohol as a medicine, as an antidepressant, or tranquilliser or sleeping tablet.
- Using alcohol primarily to change the mood rather than for its taste or conviviality.
- Protection of supply: spending time and energy and money on alcohol when it might more appropriately have been spent on something else.
- The inability to predict what will happen after the first drink in any day. Will it stop there, or might it take off into a binge?
- Having a higher capacity than other people. In the late stages, this tolerance is lost.
- Continuing to drink despite significant problems from doing so.
- The tendency to cross-addict into using nicotine or caffeine, recreational drugs, prescription drugs, gambling and risk-taking.
- Alcohol-seeking behaviour: actively looking for opportunities to find it and drink it.
- Alcohol-dependent behaviour: finding it necessary to drink before undertaking some activities.
- Continuing to drink despite the serious repeated concern of other people.
Positive answers to any four of these characteristics indicate the need for assessment by a professional who is specifically experienced in treating alcohol problems.
A negative answer to any of these characteristics may indicate a ‘not yet’. As alcohol dependence becomes more entrenched, progressively more of these characteristics become established.
People often reassure themselves falsely that they do not have a problem by saying, for example, that they do not drink in the morning, or drink spirits, or that they have never been arrested for drunk driving. Many people who have significant problems could still say those three things.
Most people who have significant problems with alcohol, and have toxic effects on the liver and central nervous system, are often still in employment. They may be protected by colleagues who buy into the idea that the drinker is drowning his or her sorrows that were caused by difficulties at home or by stress and trauma elsewhere. The truth is that the individual drinks because he or she drinks. The first drink leads to the next until intoxication. He or she can stop drinking altogether for a time but not stay stopped once the alcohol craving returns.
Many other people have extremely difficult domestic or social issues to confront but they do not resort to alcohol or other mood-altering substances or processes. The justifications, explanations and rationalisations of people with alcohol problems can be as long as the arm that lifts the glass to the mouth.
Significant alcohol problems may be well established in young teenagers long before they have experienced any medical problems or had any hospital treatments. It may be difficult to distinguish binge drinkers who are simply being stupid from those who are in the early stages of alcohol dependence. Some people grow out of their immaturity or stupidity. Others have a progressive illness.
Treatment itself begins with detoxification on a gradual basis, usually over five to ten days. Benzodiazepines, such as Diazepam (Valium) or Chlordiazepoxide (Librium), are used to alleviate withdrawal symptoms of nervousness and shaking, anxiety and cravings for alcohol. Carbamazepine (Tegretol) or Phenobarbitone should be taken to prevent the risk of epileptic seizures occurring as a result of sudden withdrawal after prolonged use. Thiamine (Vitamin B6) should be taken for at least a month to prevent damage to the brain and central nervous system from consistent high alcohol consumption.
Rehab clinics, attended on either an inpatient or outpatient basis, focus on relapse prevention. The first three or five steps of the Twelve Step programme of Alcoholics Anonymous are introduced. Psychological assessments look at childhood and social influences.
Patients are then recommended to become totally abstinent and to attend Alcoholics Anonymous meetings in order to be free, one day at a time, from the otherwise inexorable Rake’s progress towards ultimate decline. Physical deterioration and mental destruction, leading to a dementia such as Korsakoff’s Psychosis, may become irreversible if abstinence is not achieved.
With appropriate professional counselling help in skilled hands, the chronic illness of alcoholism can be relieved on a daily basis with appropriate treatments so that there is little or nothing to show that it ever existed prior to the individual becoming sober and getting into long-term recovery.