Alcohol Addiction » Behavioral Health Treatment, Overcoming Drug & Substance Abuse
Drug addiction — Alcohol abuse — Alcoholic — Smoking cessation —Substance abuse
*this information is not meant to take the place of advice given by your physician. Always discuss your particular health problems with your physician. the following information is based on my opinion and, in most cases my experience as a physician*
You can be helped by reading this page if you have one of the following goals in mind:
- to stop drinking
- to decrease the amount that you drink
- to learn about the different pills or injections used to stop drinking
- to learn about what pills are being used to treat alcoholism in European countries that is not being used here much
- to learn how to help a loved one to stop drinking
- to learn about what HARM REDUCTION means.
ALCOHOL WITHDRAWAL -WHAT IS IT?
You should realize that no matter what happens from this point onward,YOU HAVE ALREADY IMPROVED. By reading this page, you as the patient or you as the supporter have taken a step to regain CONTROL of your lives. Most persons feel better by just doing something, anything except doing the same thing over and over again and failing every time. I do not want to delay our discussion, but the first thing you, the supporter need to be clear on is that if you, the supporter think that the most logical thing to do for the drinker in your life is to just take away all of the alcohol, right now, you should understand that it is potentially very harmful to the drinker to force him to stop cold turkey. He or she will get sick ( withdraw ) and possibly have to go to the hospital. The alcohol dependent person knows this already, they know about the DT's, or delirium tremens (psychosis, seizures, etc.) They have been through abruptly discontinuing drinking many times leading to severe withdrawal from the alcohol. They know they need to stop slowly and gradually ( doctors are trained to give medications that will prevent the withdrawal so that one can just stop drinking). That is why the drinker needs to sneak a drink at thanksgiving dinner or to take an early morning wake up taste to build the alcohol level back up. So he/ she drinks in order just be able to feel like engaging with everyone without feeling or looking sick. So always ask the doctor first before making the decision to treat the drinker on your own. But I digress.
At first, drinking is fun and makes one feel good. Then it becomes, not so much fun and eventually drinking actually becomes a chore. So when my patients tell me that they drink in order to not get sick, I believe them, every time. When a person drinks alcohol everyday, the body becomes accustomed to having a certain level of alcohol on board. The body establishes a dynamic equilibrium between "drinking alcohol and eliminating it out of the body. When that balance is disrupted ( say by not drinking alcohol for a few hours or maybe a day) the drinker feels something. This is usually the opposite feeling to the good feeling obtained from drinking. With every swallow of beer, wine, liquor or alcohol one feels energetic, up, elevated, high. After the high, and in every case, one comes down, and if this has become a habit, one must take another swallow to get up or a buzz, again. This is a cycle and we call it WITHDRAWAL: When a drink is taken you get a relaxed feeling, less anxious, more sociable, heck, persons even like you. This inebriated you, happy, perky, etc. becomes a goal for you. Your stomach feels calm, your energy level is higher than normal. Your appetite is good. Up to a point, the more you drink, the better you feel. But what goes up must come down. When the alcohol wears off you begin to feel a total lack of energy, your stomach is upset, you feel easily agitated, your appetite is goes to near zero. You have aches and pains which were relieved when you drank. Now others do not like this version of you because you are no longer that happy perky person. In fact, you generally feel the opposite of what you feel while drinking. So eventually you learn that if you drink at this point you almost always feel good again. Your withdrawal symptoms are relieved. This is especially true for the mornings when you need a drink just to get your day started. Every time you don't drink, or you withdraw alcohol from your body, you get sick. Or, you go into " WITHDRAWAL". It happens with every artificial mood enhancer, not just alcohol. Scientifically we now know that the high is caused by a chemical that is released in our brain we know as "DOPAMINE". When your treatment starts under the care of a doctor, you should be taught about these chemicals and about how they work in your brain to affect your behavior.
BUT I DONT WANT TO STOP DRINKING COMPLETELY - IS THAT OK?
Sometimes patients are READY to stop drinking altogether, completely. That's great and these patients are a lot less difficult to get to stay in recovery or treatment. But most patients that I encounter are NOT READY to stop drinking entirely. Admittedly these patients are more difficult to treat, but these are my favorite patients to treat. Whatever stage of recovery you are in, you can be helped. The key is to just get treatment started. Even if you only cut down by one drink. That is a beginning . That is a big deal to you. If you can decide to get started and cut down on drinking some, My medication armamentarium should help. In fact, the medication makes one not want to drink as much or not at all. You may start treatment and still drink alcohol. My average patient does. But your ultimate goal should be to not drink or to drink responsibly. So you just have to get into my office to get started. What follows are the medications that are commonly used to treat alcoholism.
NEW, HOW COME I NEVER HEARD OF IT!
BACLOFEN - (this is by far the most effective off label treatment, in my opinion) an inexpensive pill that can be prescribed, off label ( search "off label" ) only by a physician, is now used for the cure of alcoholism. Let's talk about this drug first. The use of Baclofen for the treatment of alcoholism is relatively new to the US. Historically we have used Baclofen as a muscle relaxer for patients stricken with types of nerve and muscle diseases and others. Several years ago a physician was given an article from a major New York newspaper about its use for alcoholism. after failing all other treatments, he tried it on himself. It worked after a bit of tweaking. We have Dr. Aimeson to thank. Baclofen use is not new to the UK or FRANCE and ITALY for the treatment of alcoholism. In fact, Baclofen is an approved medication for use on an individual basis for alcoholism in France ( the country of origin for its discoverer.).
By taking Baclofen, as directed by your physician, you will significantly cut down on drinking alcohol, and more than likely even stop drinking completely ( if that is your goal ), in my opinion. I am confident in my opinion because I currently treat patients, off label, with Baclofen, for alcoholism, right in my office.
In the case that you are wondering if this is too good to be true, or why you haven't heard of it before, congratulations on asking the right questions. Whilst studies are ongoing in this country, some have been completed in other countries. In particular in France,Italy and in the UK. The studies can be found online. You can find them yourself, but I would like to offer one bit of medical evidence. As you know animals do not lie. That is, if you perform a test on an animal and in some way can ask the poor creature how it felt afterwards to get an indication on the treatments effectiveness you will get a truthful answer. It may come in the form of showing general playfulness, suppressed response to, let's say, pressing on its sore spot, or behaviorally ( the best choice) . That is, what does the animal prefer? if you put alcohol in a bowl and water in another, and you are using alcohol preferring mice, did the rodent now prefer the alcohol or the water or neither? We scientist know that the genetically breed rat will always prefer the alcohol. Using Baclofen, the mice stopped preferring the alcohol! NOW THATS PROOF. It worked with a COCAINE experiment too ( but that discussion is on another page).
So, in essence, what does Baclofen do? BACLOFEN MAKES YOU INDIFFERENT TO ALCOHOL, PATIENTS TELL ME AFTER TAKING BACLOFEN " DOC, I CAN TAKE IT OR LEAVE IT, I Will only take ABOUT ONE DRINK THESE DAYS. While taking Baclofen, Drinking becomes a "rare" event for the patient.
VIVITROL / NALTREXONE / ANTABUSE / REVIA / CAMPRAL / PROZAC / ZOFRAN(off label) / TOPOMAX (off label)
WILL ANY OF THESE PILLS HELP ME STOP DRINKING?
Just to name a few, these medications are also used to help stop alcohol consumption. They have been found to be effective. You can swallow a pill, or take an injection. The injection is given monthly. The pills are taken daily. They both will turn off, somewhat, your desire to drink alcohol by blocking alcohols effect somewhat. As long as you take the pills or receive the injection, your urge to drink may/will be significantly reduced.
Most insurance carriers should/will pay for Vivitrol, but some insurers will need a little persuading from your doctors office staff and/or the medical director. The Revia is generally paid for. With the affordable care act, treatment for alcoholism is covered and insurances and are not supposed to deny coverage. That means medications, doctors visits, inpatient and outpatient care are all covered.
Vivitrol and Revia have strong points and work quickly to help you stop drinking. They do not make you sick if you drink alcohol while using them. They are not deterrents like Antabuse. The Revia is taken one tablet daily, everyday as long as you need to take it. Vivitrol is injected deep into a muscle once a month. There are other medications used to treat alcoholism but studies show that they are not as effective long term.
by taking Revia by mouth once daily, one should feel less intoxication and fewer cravings. DOES IT WORK? Quick answer: for 3 to 6 months you should drink less with it. Revia is NOT found to be a good long term treatment. I believe this is a good HARM REDUCTION medication for the short term. It is easy to use and fairly known. But you can't take it if you have HEPATITIS. COUNSELING IS NEEDED WHILE TAKING THIS MEDICATION.
VIVITROL (EXTENDED RELEASE NALTREXONE)
Vivitrol is an extended release Naltrexone. It is deposited deep into a muscle by injection. This is done by a doctor right in his office. It works by the same mechanism as the pill form with the difference being it does not have to be taken every day. one injection per month should help you fight the use of alcohol. It is very expensive though. Costing at least $1000 per injection. That is per month. That is worth it, but a lot to afford for most persons. Insurance does cover it though.
PROZACProzac may be used in the treatment of alcoholism. This is not a common treatment though. Likely to be used by a psychiatrist who has given you a double diagnosis of depression and alcoholism or other mental disorder. The thing to know here is that, in the majority of cases alcoholism does not exist as a medical problem alone. Some thing in ones life has caused a need to seek relief of suffering, mentally, by self medicating yourself not under the direction of a doctor. Say You just feel anxious all the time. Then one day you discover that a drink you had made it easier to socialize at a party, or something. Ah, now your the relaxed person that everyone wanted you ( or you wanted ) to be. It was simple. Drink calmed you down every time. That is until it got out of control. now you find that you can't relax or get rid of anxiety unless you drink. So a doctor may need to give you something for your anxiety/depression and the drinking. Prozac may be a good choice for you to try.
It is a SSRI (there are other SSRI's that may be helpful as well ) or generally a mood enhancer. It increases the seratonin level. The studies revealed that its use had inconsistent results leading to some increase in non drinking days and a little less consumption of alcohol. But the clear benefit was with those patients who had coexisting depression or mood disorder.
This OFF LABLE TREATMENT is a SSRI antagonist ( or works against the seratonin receptors. It had some positive results as well. There were reduced reduced reporting of drinking, reporting of fewer drinks, and reports more days in abstinence. But it was mainly effective in persons who had not been drinking for a lot of years.
This is a somewhat effective medication. Results of studies show that patients drink less for the short AND long term, and they relapse less. It is a lot safer to take if you continue to drink, or if you relapse. But one should not take it if one has cirrhosis of the liver.
Like other anti convulsants ( drugs mainly used for seizures) Topamax have SOME effectiveness. It manipulates dopamine in the brain and reportedly reduces cravings for alcohol. It is shown to work better than taking nothing for drinking, it reduces the number of drinks and the number of drinking days. BUT, it can have a good deal of side effects. Not my first choice but better than nothing.
Most persons already know about Antabuse. Been around for 40 years. Studies do NOT show that it is very effective ( high relapse rate, patients quit often). It is designated a DETERRENT to consuming alcohol. When alcohol is consumed, a chemical reaction in the blood causes a build up of a byproduct of the alcohol which causes one to become very ill temporarily. It happens every time one drinks alcohol. So if your memory is still good, you will not want to drink alcohol. If one uses this deterrent medication it should be known that other substances contain alcohol and these will make you sick as well. If you are going to use Antabuse be sure to check your liver health first through a blood test.
Studies show that the best choices for preventing relapse are Campral and Revia or Vivitrol. But again, my bias is Baclofen ( off label).
HARM REDUCTION AND ALCOHOLISM
There are other medications to use if you wish to stop drinking altogether. They are designed for those who want to become abstinent. Some persons really don't want to stop drinking completely, they just want to decrease the amount of drinking. Usually that is because they have reached a stage where something inside is telling them that it is not OK to drink too much or to drink in excess.
Using alcohol sometimes, drinking less, one reduces the total amount of alcohol intake ( better to drink one beer instead of a case of beer). This is a well studied and well known practice of HARM REDUCTION. For some I do recommend abstinence and harm reduction. If i think alcohol is detrimental to your health, i will advise you to remain abstinent. it is your choice. Another way to look at harm reduction is that if you drink less alcohol, you do not feel the effects as you would if you drank a large amount of alcohol. So you will spend more time less inebriated and with more clear mentation. This change in itself will lead to "better decision making". Which could mean drinking less and less and eventually, who knows, to no drinking at all.
Those suffering from alcoholism and those persons who are intimately supportive of the patient will inevitably need help from a therapist. Ideally that should be a psychoanalyst of some sort. But realistically you will likely find yourself having sessions with a professional counselor ( a service that is provided in my office). To be clear, even though inseparable, I am primarily concerned about your physical well being first . I need to get you feeling better physically. To feel better you will need to get the alcohol level lower ( or to zero ) and keep it there. There are blood tests to ghetto check your liver, pancreas, kidneys, thyroid gland, just to mention a few organs. We have to make sure you are not anemic, you have enough vitamins floating around. If you look at a person who has been drinking too much one can just see the physical changes ( and changes not in a good way either). When I Observe a patient that I have treated for alcoholism and is now better, one can see how much more healthy he appears. Once you are physically feeling better, then with some talk therapy, your mental state should improve ( less irritable, less anxiety, etc.) I don't want to get into the nuts and bolts of counseling here. But I would like to explain why counseling is intimately connected to you, and your social situation ( your family ) in recovery. Treatments given by the doctor and counseling sessions cannot be separated. They both are needed nearly simultaneously.
My patients get better after taking the pills to stop drinking after only a short period of time. They drink less or stop completely, eat better, sleep better and feel good. So they then ask the "question if I am already on the right track and getting better then why do I need to spend time sitting and talking to a counselor, I am going to be fine. I am better". In fact, the loved ones, or supporters, almost always agree that the patient is OK now and that He/She should be allowed to get back to a normal life without all of those medications and spending money and time at the doctor's office.
They just want to move on and not have to take any medication. AND SOME DO! They just turn the page and go it alone. Some cut down significantly and get in great control of their drinking and lives. Is this harm reduction? Yes. You are drinking less and your life is nearly back on track. But is this the end of treatment or end of the story? Unfortunately it is not! But give credit where credit is due. You have worked hard to get even to this point, as others will bear witness to. But at this point you should ask yourself " how long will this last?". Just think about this question realistically. If one has spent a long time drinking , years, 24/7 is it reasonable to get ones body used to not doing something in a short period of time. One may change for a short period of time but that is probably all. Eventually a relapse will occur, realistically speaking. But with support from family, friends, your doctor, counselors, one will stay in recovery for a longer period of time. But when is recovery over? Well. that is a question, or a discussion for you and your counselor. And it is not a simple question , How long do you stay in recovery? until you have not been drinking f a while, until your having no more relapses, for the rest of your life. When does recovery end?ΔTop of Page