TREATING ALCOHOLISM

Alcohol Addiction Treatment

What is alcohol use disorder?

Alcoholism is now called alcohol use disorder (AUD). The new term more accurately describes a condition that goes through various stages, from alcohol tolerance to dependence and addiction. Alcoholism carries the social stigma of “heavy drinking,” while AUD (alcohol addiction) encompasses the biological side effects of long-term alcohol consumption.

The National Institute of Alcohol Abuse and Alcoholism (NIAAA) defines alcohol use disorder (AUD) as a “medical condition characterised by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences”.

Alcohol use disorder – alcohol addiction – is a brain disorder that can be mild, moderate or severe. People develop a tolerance to alcohol which progresses to dependence and addiction. Long-term alcohol use changes your brain’s structure and function and damages neural pathways, resulting in brain chemistry changes that affect your physical and mental well-being.

Alcohol is toxic to neurotransmitters, chemical signals and electrical impulses in your brain that carry messages to the rest of your body. Prolonged alcohol use causes cerebellum atrophy (brain shrinkage), resulting in ataxia, an irreversible degenerative disease of your central nervous system.

A combination of medical detox, medication, psychotherapy and group support therapy is used to successfully treat alcohol addiction as part of an integrated addiction treatment programme at an inpatient or outpatient centre.

Did you know?
Scientists and clinicians no longer use alcoholism, alcoholic and alcohol abuse. The addiction community has moved away from these terms because they carry a lot of stigmas and cultural biases. The appropriate words to use are “someone with an alcohol use disorder.”

What causes alcohol use disorder?

Alcohol use disorder (alcoholism) is caused by long-term consumption that changes brain chemistry, structure, and functions. The short-term side effect of alcohol is intoxication which alters how you think, feel, judge situations and behave. The long-term impact of alcohol abuse is life-threatening physical and mental health conditions.

Alcohol blocks chemical signals (neurons) between your brain cells, which causes intoxication. Symptoms of intoxication include slurred speech, slow reflexes, poor memory and impulsive behaviour. Alcohol is a depressant substance and inhibits neurons, slowing down their ability to ‘fire’ chemical messages and electrical impulses, which carry information to other parts of your body.

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What causes alcohol tolerance?

When you drink, your brain reward pathways are flooded with dopamine, causing a euphoric feeling. Your brain adapts to repeated alcohol use by shutting down neurons, producing fewer dopamine receptors and increasing dopamine transporters to get rid of excess dopamine in the spaces between your brain cells.

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This stage of alcoholism is known as alcohol tolerance, where your central nervous system adapts to dopamine flooding triggered by your brain’s reward pathways anticipating alcohol in your central nervous system.

What causes alcohol dependence?

A warning sign of alcohol dependence is you experience moderate to severe withdrawal symptoms if you reduce or stop drinking alcohol. In the tolerance stage, your brain adapts to the side effects of alcohol by reducing the impact of dopamine on your brain pathways. You drink more alcohol more frequently to get the same result.

Alcohol is a depressant substance. It slows down brain function and blocks signals passing between neurons (brain cells). To compensate for the depressant effect, your central nervous system increases the production of stimulating chemicals such as serotonin and norepinephrine. When you reduce or stop using alcohol, your body continues to produce these stimulating chemicals, and you stay in a ‘keyed up,’ alert state. This process is experienced as unpleasant and potentially life-threatening withdrawal symptoms.

What causes alcohol use disorder (addiction)?

Prolonged use of alcohol damages your brain in different ways. Neurotoxicity causes neurons to burn out, and damage to brain matter (white and gray) causes your brain to shrink. These brain chemistry changes are irreversible after prolonged alcohol use and cause permanent life-threatening physical and mental health conditions.

Cerebellum atrophy (brain shrinkage) leads to cerebellum ataxia, a medical term for “without coordination.” Ataxia affects muscle control in your legs and arms and makes maintaining your balance and coordination challenges. It also affects your speech, eye movement, fingers and hands. People with cerebellar ataxia develop an ‘alcohol gait,’ characterised by a shuffling walk and uncoordinated arm and leg movements.

Alcohol use disorder (addiction) is characterised by permanent brain damage, particularly severe cerebella damage. Alcohol destroys connective brain fibres known as white matter, which link the little brain (cerebellum) to your central nervous system and the big brain (cerebral cortex). Long-term alcohol use leads to chemical changes, affecting normal function in the striatum, which controls voluntary muscle movement.

Did you know?
The National Institute of Alcohol Abuse and Alcoholism (NIAAA) defines one standard drink as:

  • 355 millilitres (1.5 cups) of regular beer (5 percent alcohol)
  • 266 millilitres (1 cup) of malt liquor (7 percent alcohol)
  • 148 millilitres (3/4 cup) of unfortified wine (12 percent alcohol)
  • 44 millilitres (1/4 cup) of 80-proof hard liquor (40 percent alcohol)

How is alcohol use disorder (addiction) diagnosed?

Individuals are diagnosed with alcohol use disorder (AUD) if they meet specific criteria specified in the Diagnostic and Statistical Manual of Mental Disorders(DSM-5). The severity of the condition depends on how many of the eleven criteria a person meets. You will receive a diagnosis of AUD (alcohol addiction) if you meet two out of the eleven criteria in 12 months.

11 signs of alcohol use disorder (alcoholism)

  • You drink alcohol in larger amounts or over a longer period than you intended.
  • You have a persistent desire to reduce or stop drinking alcohol, but repeatedly fail.
  • You spend a lot of time seeking out alcohol, drinking alcohol, or recovering from its effects.
  • You crave or have a compulsive need to drink alcohol.
  • Repeated alcohol use leads to failure to fulfill important obligations at school, work or home.
  • You continue to drink alcohol despite having persistent or recurrent social, financial or relationship problems caused or exacerbated by your drinking habit.
  • You avoid or give up attending social, work or recreational activities because of alcohol use.
  • Recurrent alcohol use lowers your inhibitions and puts you in risky, hazardous situations.
  • You continue to drink alcohol despite knowing the damage it is causing your physical and psychological well-being.
  • You have high alcohol tolerance, as defined by either of the following:
    • a need for markedly increased amounts of alcohol to achieve intoxication or desired effect
    • a markedly diminished effect with continued use of the same amount of alcohol.
  • You experience alcohol withdrawal symptoms if you reduce or stop drinking alcohol, as defined by either of the following:
    • the characteristic withdrawal syndrome for alcohol
    • alcohol or a closely related substance is taken to relieve or avoid withdrawal symptoms.

Source: Psychology Today
 
AUD severity is graded mild, moderate or severe:

  • mild: meet 2 to 3 out of 11 criteria
  • moderate: meet 4 to 5 out of 11 criteria
  • severe: meet 6 or more out of 11 criteria

Read more: DSM-5 ǀ American Psychiatric Association

Signs and symptoms of alcohol use disorder

Prolonged alcohol use has a detrimental effect on your physical, mental and emotional well-being. Symptoms can be mild, moderate or severe and potentially life-threatening and fatal.

Short-term side effects of alcohol addiction (AUD)

  • shaking, trembling hands
  • headaches
  • nausea, vomiting
  • poor reflexes, slow reaction time
  • slurred, slow speech
  • blurred vision
  • poor muscle coordination, stumbling, unsteady gait
  • memory loss, blackout
  • erratic, risky behaviour, lowered inhibitions
  • mood swings
  • aggression, irritability, violent behaviour

Long-term side effects of alcohol addiction (AUD)

  • depression, anxiety
  • tremors
  • cerebellum atrophy (brain shrinkage)
  • cerebellum ataxia (loss of balance and coordination)
  • impaired immune system
  • gastritis
  • diabetes
  • heart disease
  • stroke
  • liver disease
  • cancer (breast, liver, mouth, bowel)

Alcohol withdrawal symptoms

Alcohol withdrawal symptoms vary extensively, depending on how much you drink and whether you have developed alcohol dependence. Alcohol shakes are a mild form of withdrawal, while delirium tremens are a severe form that can lead to life-threatening, even fatal, seizures.

3 to 6 hours after your last alcoholic drink

  • headache
  • shaky, trembling hands
  • anxiety, agitation
  • nausea, vomiting
  • sweating, hot flushes
  • goosebumps
  • insomnia

12 to 48 hours after your last alcoholic drink

  • paranoia
  • hallucinations
  • mood swings, anxiety, depression
  • uncontrollable tremors, shaking
  • profuse sweating
  • hypertension
  • seizures

48 to 72 hours after your last alcoholic drink

  • delirium tremens (DTs)
  • delusions, hallucinations
  • rapid heartbeat
  • confusion, disorientation
  • heavy sweating
  • chills, fever
  • high blood pressure

Can you go ‘cold turkey’ if you are a chronic drinker?

No, it is dangerous to go ‘cold turkey’ on drinking alcohol if you have a chronic addiction. Sudden alcohol cessation (SAC) occurs when your body goes into shock from being deprived of alcohol. The syndrome happens in the early stages of alcohol detox and can be a life-threatening, even fatal, event.

Severe consequences of SAC include:

Delirium tremens

  • confused, disorientated
  • hallucinations
  • highly agitated, restless
  • extremely sensitive to sound and light
  • very sleepy, coma-like state
  • seizures

Heart distress or failure

  • irregular heartbeat
  • racing heartbeat
  • cardiac dysrhythmias
  • cardiac arrest

Did you know?

The phrase ‘cold turkey’ describes the goosebumps a person with alcohol dependence gets when they reduce or abruptly stop drinking alcohol and experience alcohol withdrawal symptoms. Your skin looks like the bumpy skin on a cold turkey in the fridge.

How is alcohol use disorder (alcoholism) treated?

Alcohol use disorder (alcoholism) is a treatable mental health condition. The sooner you seek help for alcohol addiction, the better. Your best chance of recovery from alcohol addiction is participating in an integrated treatment programme at an inpatient or outpatient facility. An integrated approach includes medical detox, medication for withdrawal symptoms, psychotherapy and group support.

Medical detox
Medical detox in a hospital is recommended to help you cope with unpleasant, life-threatening alcohol withdrawal symptoms. Your body can go into toxic shock during the alcohol detox process. You’ll be carefully monitored and given medication to ease the symptoms while your body works hard to rid itself of toxins and waste products after prolonged use of alcohol.

Medication
Medication is often necessary to help you cope with severe alcohol withdrawal symptoms, prevent seizures, and purge toxins from your system. Typically, patients are given benzodiazepines such as valium, Ativan or Librium. Anti-convulsant drugs are used to reduce the risk of fatal seizures. Benzodiazepines are highly addictive; the doctor will closely monitor your intake, and you are weaned off them after the alcohol detox process.

Psychotherapy
Psychotherapy – talk therapy – forms part of a comprehensive treatment plan for cocaine use disorder at an inpatient or outpatient addiction care facility.
Cognitive behavioural therapy (CBT) is one of the most popular talk therapy methods used to treat substance use disorders. It focuses on a person’s behaviour and how they think, feel and view themselves relative to the world around them. CBT explores the relationship between your beliefs, thoughts, feelings, and behaviour and the divide between what you want and do in certain circumstances (trigger moments).

Other popular psychotherapy methods include:

Psychodynamic therapy
Psychodynamic therapy focuses on how certain relationships and life events affect your current feelings, choices and behaviour. The aim is to help you understand and acknowledge repressed emotions, negative feelings and resolve internal mental conflicts to improve your self-esteem, relationships and quality of life.

Dialectical behaviour therapy (DBT)
DBT is similar to CBT, but the goal is to provide people with coping skills to regulate their emotions, make better choices, handle stress, improve relationships and improve their quality of life. DBT was developed initially to treat borderline personality disorder and is now used to treat various mental illnesses, including substance use disorder.

Humanistic/experiential therapy
Humanistic therapy focuses on the whole person and their nature rather than their behaviour. The aim is to identify positive attributes and boost your ability to heal, grow, and self-actualise through self-exploration. Humanistic therapy is effective for people with depression, anxiety, panic disorders, low self-esteem and self-harming tendencies.
 
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