The Trumpet Medical Advisor
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Patricia Naeder, RN, BS.
February, 2011 Edition ew3
LOOKING AT ALCOHOL DEPENDENCY
Dependence on Alcohol usually happens very slowly and then advances through two stages.
Alcoholism is a chronic disease like cardiovascular disease. The longer the drinking goes on, the more damage it does to the individual’s organs and mind, and the more difficult it is to overcome, but there is an answer.
Alcohol is the number one drug problem in the United States.
Alcoholism may start by trying to relax by having a few drinks, or trying to get to sleep by having a few drinks, or trying to make some discomfort go away by drinking with others, or alone.
Over time it becomes an addiction. The body builds up a tolerance and comes to depend on the alcohol drug. The person becomes helpless to stop drinking.
Alcoholism is a dangerous, and difficult to treat, chronic disease.
Q- Why do people start drinking? A- Usually for relief and relaxation.
Q- Why do people keep on drinking? A- Usually because they cannot stop self medicating with alcohol. Their body is addicted.
There are many physical and psychological issues that are behind self medicating with, and subsequent dependence on alcohol. Here are some of the common reasons:
1- Some people start drinking to calm themselves down because they are anxious.
2- Others, to blot out mental pain from unhappy events that have befallen them, and they are sad and depressed.
3- Some people feel uncomfortable without drinking because of their type of brain circuitry and a chemical brain imbalance of one or more of the 4 major brain chemicals; Dopamine, Serotonin, Epinephrine (adrenaline) and nor-epinephrine.
4- Many people drink to relieve physical pain or discomfort of any kind, not realizing that their body is becoming addicted.
5- Others use alcohol to relieve twitching or tics as in tourette’s syndrome with the accompanying OCD.
6- After a while alcohol becomes the "go to" fix instead of using medications or psychological therapies such as talk therapy.
An imbalance among the 4 main brain chemicals can cause any of the following: anxiety, depression, obsessive compulsive disorder (OCD) or disconnect with reality (psychosis, schizophrenia, schizo affective disorder) and the accompanying hallucinations. One can still function but life would be much better and the symptoms would go away with medications which correct, or “tweak” the brain neurotransmitter chemicals.
There are four main brain chemicals:
- Adrenaline (epinephrine)
- Nor epinephrine
When one or more of these chemicals is too low or too high it can cause symptoms of:
- Obsessive compulsive disorder (OCD)
- Hallucinations, which can be visual or auditory. One can hear whispers and/or voices.
- Seeing patterns, geometrics and/or faces and many variations on these.
- And more
These symptoms can be easily treated with today’s medications. Anti-anxiety meds such as valium or xanax. Serotonin re-uptake inhibitors for OCD compulsions. Anti-psychotic meds such as risperdal for hallucinations.
Combine these meds with talk sessions, or just use talk sessions alone, along with support meetings.
This replaces self medicating with alcohol which causes many serious physical and psychological problems. Besides being addicting and destroying your body, alcohol can induce psychosis.
Q- What does alcohol do for the person? A- It temporarily takes their problems away, BUT in their place the alcohol eventually destroys the person’s body, mind, family, job, social life and their entire life. Life revolves around the next drink. It doesn’t have to be that way.
I will describe alcoholism and then the treatments and the way out of it.
There are two main stages in alcoholism:
1- Alcohol abuse or self medicating.
2- Alcohol dependence, or addiction.
Alcohol abuse or self medicating is when the person finds a reason to drink all the time. This interferes with their life. They are late to work, or fail to fulfill obligations due to drinking. Other people ask them if they are drinking too much. They may have DWIs or behaviors or legal problems that stem from drinking. They may center their daily life around drinking.
Alcohol dependence/addiction is when:
- Drinking more and more alcohol is needed to achieve the desired effect.
- Withdrawal symptoms happen when drinking is stopped or slowed down. These symptoms are hand tremors, palpitations, sweating, anxiety, insomnia, nausea, vomiting or other physical symptoms. The body “hooks on” to the physical effects of alcohol.
- The person uses alcohol to avoid these withdrawal symptoms. One tip-off that a person is an alcoholic is if the person drinks in the morning. This is to avoid withdrawal symptoms such as hand tremors.
- The person continues to drink even knowing that alcohol is causing or worsening their problems.
- The person cannot stop drinking at will.
- A great deal of time is spent with drinking attached, or when hangovers are a routine part of life. Drinking to celebrate, drinking with or without meals, when sad, when out for dinner. Everything is accompanied by drinking.
- Drinking alone.
- Drinking more than one intends. Loss of control.
- Alcohol rules the person rather than the person ruling the alcohol.
- These are signs that it’s time to see an addiction M.D. specialist who will help with detoxification. They will help by using relaxing sedation and other medications to safely transfer the person to the world of sobriety where the person will be in charge of their life again.
Causes of alcoholism are many:
- As mentioned above, stress, anxiety, panic attacks, depression, OCD rituals such as hand washing, cleaning, counting and other compulsions.
- Physical ailments such as chronic pain, muscle spasms, tourettes syndrome with its involuntary tics, and disabilities of all types will lead a person to look for relief with alcohol, instead of with effective medications.
- Recent research has indicated a Dopamine receptor gene that if inherited might increase the chances of becoming an alcoholic.
- The 4 main brain chemicals control how we feel mentally and physically. When they are out of balance we seek to fix them. Alcohol, unfortunately, does do a good job of that, but it destroys the body and mind in the process.
- The factors that lead one to use alcohol for relief are multiple. With a little insight and some talk therapy with a Psychologist it is not that difficult to find the causes. Then begin the process of treating them with effective medical therapies such as medications and/or talk sessions to lead a healthier life.
Symptoms of chronic Alcoholism disease, and its progression:
1- Using the drug alcohol, to medicate oneself starts slowly.
2- As mentioned above alcohol makes psychological and physical ailments “go away.” Many “blackout drunks” are so miserable that they just can’t stand reality. It is understandable, but there are better alternatives than alcohol.
3- Alcoholics have real and intense problems. They find that alcohol, a readily accessible drug, does an effective job of eliminating the feelings that are so uncomfortable, unacceptable or unbearable.
4- Mental pain is blotted out with alcohol, but destroys the person in the process.
5- Schizophrenics try to silence the sounds and voices in their heads, and/or the visions that they see, with alcohol. Ironically, excessive alcoholic intake can cause hallucinations. They are aware that these sounds and sights are abnormal so they try to drink them away. When in reality we have medications such as risperdal and many more that will do a better job without destroying their body and mind further.
6- Alcoholics usually go unrecognized in the early years because they are excellent at hiding the amount and frequency of their drinking, and they are in denial to themselves. They justify their alcohol intake.
7- By the time an alcoholic is discovered to be in trouble, by family and friends, they are in an advanced stage and need expert addiction specialists; Doctors, Nurses, detox, Rehab, and talk sessions and strategies to help them recover.
8- There is an expression among alcoholics - ‘How do you know when an alcoholic is lying? Their lips are moving.’ It is too frightening and painful for those dependent on alcohol to deal with giving up such a comfort. They are terrified, and need to be handled, with great care, by Professionals.
Late Stage alcoholic symptoms:
Alcoholics that are not treated, eventually move into the late stages of alcoholism with some of the following symptoms:
a. Brain shrinkage. Forgetfulness. Short term memory loss. Confusion
b. Wernicke’s encephalopathy (abnormal brain functioning)
c. Korsakoff’s dementia, central pontine myelinolysis (brain degeneration)
g. Heart Disease. Usually enlarged heart (cardiomyopathy)
h. Heart palpitations leading to arrhythmia and possible sudden death
i. Liver failure from all those years of having to deal with metabolizing so much alcohol (cirrhosis). This can be fatal
l. Peptic ulcers
m. Gastrointestinal bleeding, and
n. The destruction of the nerve branches throughout the whole body (neuropathy)
One test that a physician does is to have the alcoholic close their eyes and they brush a tissue across various parts of their body to see if the person feels it. Invariably in the advanced stages of alcoholism, when the physician brushes the tissue across the feet and lower legs, there is no feeling at all!
The alcohol has destroyed their nerve branches. This applies to the entire body including eyes, brain, organs, etc.
Denial prevents alcoholic dependent people from seeking help.
Family interventions can help even if the alcoholic is resistant. Once they are detoxified and into a long term maintenance regimen they can develop the motivation to live a sober life.
Alcoholism interferes with the person’s whole life. Their family, work and social life are all impacted. There are tests to gage alcoholism. Remember that alcoholics are either in denial, or frightened that someone will take their alcohol away. They may be determined not to give it up, or helpless to give up their alcohol. This is why the successful long term treatment of alcoholism is only approximately 50%.
TESTS for alcoholism: The CAGE, TACE and the MAST.
Tests for Alcoholism require honest answers from the alcoholic or their family. For example:
- The CAGE test: Answering yes to 2 or more of these questions indicates a likelihood of alcoholism.
o Have you felt you should cut down on your drinking?
o Have people annoyed you by criticizing your drinking?
o Have you felt bad or guilty about your drinking?
o Have you ever had to drink first thing in the morning to “steady your nerves” or get rid of a hangover? (eye-opener?)
The doctor draws blood to evaluate liver function (ALT) anemia (low RBCs,) and electrolyte levels (potassium, sodium, magnesium, and calcium can be abnormal) Alcohol causes electrolyte imbalance.
Potassium abnormality can cause sudden death through heart arrhythmia.
Then these conditions will be treated first to start the person back on the road to a healthy life.
TREATMENT for Alcoholism:
“Cold turkey” never works. Just deciding to stop drinking rarely works. The person can have seizures, delirium, hallucinations, and confusion and even death. Detoxification should only be done by a Physician.
If the drinker becomes shaky after one day without alcohol they need to be detoxified under the care of an M.D. addiction specialist, in the hospital for a few days. Then to rehab, then stay in an out-patient Rehab maintenance program for support, education and skill building.
Treatment. Withdrawal and recovery from alcohol is in 3 stages:
2- Rehabilitation by identifying the causal issues and fixing them with medications, talk therapy, a new strategy of living and support.
3- Maintaining an alcohol free life with medically healthy treatments for their daily issues and challenges.
Detoxification can be done in three days in the hospital under the care of a Psychiatrist who has devoted their life to studying the human mind and body. Usually anti-anxiety drugs such as lorazepam are used. This is a smooth and uneventful process.
Rehabilitation begins on the day that detox is over. The person admits themselves to a program that specializes in addressing all of the reasons that they were using alcohol to medicate themselves. Each ailment is remedied with the appropriate medication or psychological talk session. Coping skills and problem solving are learned.
This is accompanied by learning to identify their own list of physical and mental issues. Then they attach the appropriate acceptable healthy treatment to them.
Some skills to be learned:
1- Learn to identify and control the urge to drink.
2- New skills in social settings. Their own set of sober rules.
3- Better overall health, such as healthy eating.
4- Avoiding triggers for drinking. Such as a New Years Eve party. Go to a Sober New Years Eve with other recovered alcoholics, or stay home and go to bed.
5- Learn how to challenge alcoholic thinking such as “I need a drink to deal with this stress.” No, they need to use their other options. They can take their medication and/or avoid the stressful person. They can surround themselves with supportive people. They can use their new problem solving and coping skills.
6- Learn to remove toxic and vexatious people from their life whenever possible.
7- Develop a toolbox of mechanisms to deal with both their physical and psychological identity.
8- See their physicians and therapists regularly. Remember these people joined the “helping profession” for a reason. They want to help, and just as importantly, they know how to help! Use them.
9- Learn to identify and avoid negative, narcissistic, self- centered emotional vampires.
10- They learn to organize their days around healthy sober living. They learn to create a beautiful life for themselves and to be determined to follow it.
11- Create their own set of rules for living free. They learn to use their own name for their new custom made Rules for Living, i.e. Call them “Bobs Rules” or “Liz’s Rules” so they have control of their new life, not allowing alcohol to make the rules for them!
12- Learn to deal with their emotions during talk sessions. These new mechanisms will replace alcohol as a new way of healthy living.
13- They create a new team for themselves! Their Physician, Psychologist, Nurse, a confidant, a sponsor at A.A., a nutritionist, a health club coach!
14- They learn to recognize the signs that they may relapse, and how to conquer them. Relapse is common. They need to resolve to fight back. They need to be reminded that they are in a fight. Learn to be a warrior! If they have a relapse, learn to put it behind them as a blip. Do not use it as an excuse to fall back. Calling a member of their support team right away is the best way to get right back on track.
15- They need to remember that getting better uses many resources: Medicine, Psychology, Nutrition, Health Clubs and socializing with the right people in the right environment. Build an iron curtain against their mortal enemy….alcohol. Replace it with living a great life!
Maintaining an alcohol free life:
Once an individualized program is developed the alcoholic carries it forward through life with the determination that this recovery will be permanent. Any and all substitutions for alcohol need to be incorporated into daily life. Also a Psychiatrist for medication, and a Psychologist who specializes in addiction should be used for long term maintenance.
~ ~ Alcohol was once their answer, but alcohol always becomes the dictator that destroys them physically and mentally. It must be conquered and kept at bay. ~ ~
Use one of the following for maintenance on an out-patient basis:
1- The Twelve-Step Therapy A.A.
2- Motivational Enhancement Therapy (best for those in denial).
3- Cognitive-Behavioral Coping Skills in talk therapy sessions.
Medications can be prescribed for recovering alcoholics to address the myriad of physical and psychological issues that they used to treat with alcohol.
- Anti-anxiety meds
- Serotonin re-uptake inhibitors for OCD
- Anti-psychotic meds
- Anti- inflammatory meds for physical pain
There are also a class of medications that can be prescribed that will make a person sick, and vomit, if they drink while they’re on them. These should only be used under a physicians care.
The drawback here is that the alcoholic is so intensely drawn back to alcohol (relapse) that if they do drink while on the medication, it can make them too sick and can be dangerous for them. They need to discuss this with their team.
- National Institute on Alcohol Abuse and Alcoholism
- American Council on Alcoholism
1000 E Indian School Rd.
Phoenix, Az 85014
- Alcoholics Anonymous has local chapters in every town. It is the world’s best club! Lifelong friends are made there, and lives are saved every day there. It doesn’t matter who you are. Millionaires have found their best and most loyal lifelong friends there!
- Crisis hot lines are available in all hospitals. Just call the hospital main line or go to the emergency room. Help is waiting.
To those who are suffering from alcoholism disease, or have someone that you’re trying to help. Tell them this:
Remember that you don’t have to allow alcohol to rule your life. All you need is the determination to get better, as your admission ticket to an alcohol free life. The experts are waiting to help you.
There are better treatments and medications for your problems!
Don’t let alcohol win over you. Call an addiction M.D. and get started with your detox. You will be treated with respect. You will be comfortable. You will be given sedation and your issues will be addressed.
You will be in charge of your life for the first time in a long time. From detox, go right into a good Rehab program and use the counselors there. Design your own program, focusing on what led you to drink in the first place, and get the right therapies. Demand the right answers. Fight for yourself and a healthy life. Create your anti-alcohol team and use them.
Recovery is possible! Write down a list of reasons why your life would be better without alcohol. Don’t forget the information that you just read in this article. Alcoholism is a dead-end. It doesn’t have to be that way. There is relief for everything that ails you. Alcohol is not the answer. It is making your problems worse.
Take whichever bits and pieces of medical science that applies to you. Build a program for yourself. No one program fits everyone. Use all the help that works for you and leave the rest behind, and you will succeed. Design it yourself, and use the medical team to help you implement it. Being in charge is important because up until now alcohol has been in charge of your life. Take over!
I know people who have been in recovery for 30 years. Once you’ve substituted alcohol with the right medical and psychological advances of today, you will lead a sober and healthy life!
Be determined. Be in charge. Ignore amateurs. Use the addiction community experts, but most of all notify your family that you’ve decided to find the best treatments and solutions for YOU!
You can do it. Recover and live free!
Good Health to You!
column is for informational purposes only, and represents the opinion,
and reporting of the author only. Any discussions with the Author should
be presented to your own personal Physician for his/her Professional
opinion. It is not meant to substitute for seeing one's own Medical
Doctor, Psychiatrist, or Psychologist for Professional care.
This article is copywrited by the Author.