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Alcohol Treatment and Alcoholism

Questions and Answers

What is alcoholism?

Alcoholism is a disease that includes the following four symptoms:

What Percentage of US adults have an alcoholism/ alcohol use disorder (Abuse or Dependence)?
9% ( 5% abuse and 4% dependence) 
 
Is alcoholism inherited?
There is definitely a genetic component to alcoholism
Children of alcoholics are 50 to 60 percent more likely to develop alcohol use disorders than people in the general population.

If I have a family history of alcoholism, can I drink?
You should approach drinking carefully. Avoid underage drinking since studies have shown this is more likely to lead to alcoholism. Restrict drinking to no more than 2 drinks a day for men or 1 drink a day for women. Some people, such as pregnant women, should not drink at all.  

Does alcohol effect women differently than men?
Yes. Women, in general, have a higher risk for problems than men. When a woman drinks, the alcohol in her bloodstream typically reaches a higher level than a man’s even if both are drinking the same amount. This is because women’s bodies generally have less water than men’s bodies. Because alcohol mixes with body water, a given amount of alcohol is more concentrated in a woman’s body than in a man’s. As a result, women are more susceptible to alcohol-related damage to organs such as the liver. 

Does alcohol affect older people differently?
Yes. Older people are at particularly high risk for harmful alcohol– medication interactions. They also are more likely to take a medication that interacts with alcohol. Also, aging slows the body’s ability to break down alcohol, so alcohol remains in a person’s system longer, potentially causing more harmful effects. 

Does drinking at a younger age lead to alcoholism?
The age at which a person first uses alcohol is a powerful predictor of lifetime alcohol abuse and dependence. More than 40 percent of individuals who begin drinking before age 15 will develop alcohol abuse or alcohol dependence at some time in their lives.4 

How can parents deter a child from drinking?
A recent study shows that children whose parents are involved in their lives—holding regular conversations, attending after-school events, listening to their problems—are less likely to drink or smoke. Parents should also learn the warning signs that their child may be drinking (see more Resources

Is any alcohol safe in pregnancy?
No. Any alcohol at all can damage the fetus. 

What happens if I drink while pregnant?
Your baby may develop serious medical problems (fetal alcohol syndrome) including growth deficiencies. Lifetime behavioral and learning problems may develop. 

Can alcoholism cause depression?
Yes. Partly for that reason, there is a higher risk of suicide in alcoholics. In depressed alcoholics, certain medications such as selective serotonin reuptake inhibitors can not only help the depression but can contribute to treatment of the alcoholism itself. 

What is "Hazardous Use" of Alcohol?
This is defined as 5 or more standard drinks per occasion for men and 4 or more drinks per occasion for women. Hazardous use is also drinking at least 14 standard drinks per week for men and at least 7 drinks per week for women. 

What is a "standard drink"?
12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80 proof spirits. 

What are some of the health effects from alcohol abuse?
There are too many to list but some of the most common effects of alcoholism are gastritis, ulcers, hepatitis, cirrhosis of the liver, esophageal varices potentially causing lethal bleeding, pancreatitis and diabetes. Also, hypertension, increased "bad" cholesterol , stroke and damage to the heart muscle (cardiomyopathy). There is an increased risk of cancer of the head/neck, esophagus, stomach, liver and lung. Neurological complications include degeneration of the brain (cerebellum), dementia, blackouts and disordered sleep.  Bottom line: alcohol abuse wrecks havoc on the body. 
 
Can alcohol worsen the side effects of other drugs?
Yes, alcohol can increase respiratory depression (slowing or stopping breathing when sedating drugs are given. Alcohol can worsen the gastric (stomach) effects of non-steroidal anti-inflammatory medications and the hepatic (liver) effects of acetaminophen (tylenol). It also can make many drugs less effective, particularly those metabolized (broken down) by the liver.

What are some strategies for cutting down?

Here are some helpful tips:

  1. Keep track of how much you drink. Write it down on a card or calendar.
  2. Make sure you know the standard drink sizes so you can count drinks correctly. (ie, one standard drink is 12 ounces of regular beer, 8 or 9 ounces of malt liquor, 5 ounces of wine or 1.5 ounces of 80 proof spirits).
  3. Set goals- decide how many days of the week will be "drinking days" and how many drinks you will have on these days.
  4. Drink slowly and space out drinking (drink nonalcoholic drinks between alcoholic ones).
  5. Eat food so alcohol will be more slowly absorbed.
  6. Avoid triggers to alcohol use, such as getting too tired, angry,  or upset. Avoid people or situations associated with alcohol. 

What is alcohol withdrawal?
Alcohol withdrawal involves symptoms that start from 6-12 hours after the last drink. Early symptoms include anxiety, sleep problems, nausea and headache. Physical findings include fast heart rate, sweating, high blood pressure and tremor. Hallucinations can occur, usually within the first 12 hours. Withdrawal seizures can also occur, usually within the first 48 hours. The most serious and life-threatening symptom, delirium, usually occurs between 48 and 72 hours after the last drink. 

If I need alcohol detoxification, do I have to go to the hospital?
Inpatient treatment is usually necessary for moderate to severe withdrawal symptoms now or in the past, or if you have other significant medical problems along with alcoholism. Patients with a history of multiple previous detoxifications, recent high blood alcohol levels, pregnancy and limited social support normally are treated in the hospital.  Otherwise, outpatient treatment is normally safe and effective for most patients. 

What medications will I be given to help me comfortably detox from alcohol ?
A number of medications can be used, most often benzodiazepines such as chlordiazepoxide (librium). Carbamazepine (tegretol), an anticonvulsant medication, has also been found to be very helpful for controlling withdrawal symptoms and reducing the risk of delirium tremens (DT's). 
 
Why is thiamine (vitamin B1)given during treatment of alcoholism?
Chronic alcoholics are normally deficient in thiamine. There is a risk of severe memory loss (Wernicke's Syndrome) if thiamine is not replaced. 

Once I stop drinking (ie, become abstinent) are there medications used to prevent relapse?
Yes, both naltrexone and acamprosate (campral) are FDA approved for alcohol dependence and topiramate is used as well, although not specifically FDA approved for alcoholism uses. 
 
Are there medications to reduce heavy or binge drinking?
Yes- although FDA approved specifically for abstinent alcoholics, naltrexone, acomprosate, and  topiramate have been used successfully to decrease heavy drinking and binge drinking.  

How does naltrexone work?
The exact mechanism is not known but naltrexone is thought to block the release of dopamine when alcohol is used. Dopamine is a "feel good" chemical so cravings and the "reward" of drinking is reduced. 

How does acamprosate work?
Acamprosate is thought to reduce withdrawal symptoms by reducing the affecting the GABA excitatory system in the brain. 

Should I take both naltrexone and acamprosate together?
There is no scientific evidence that taking both gives any advantage to taking just one. Some patients do respond better to one or the other medications so both can be tried. 

What is Vivitrol?
Vivitrol is the brand name of an extended release formulation of naltrexone that was approved by the FDA for alcoholism treatment  in 1994. This medication is given intramuscularly and "lasts" for a month. 

What are side effects of acamprosate (campral)?
There are relatively few side effects except temporary diarrhea in about 10% of patients. There are also no significant drug interactions. 

When is Naltrexone not safe to be given?
Naltrexone should not be given if a patient is on long-term opiate (narcotic) treatment for pain since it could put a patient into opiate withdrawal. Also, naltrexone should not be given if a patient has hepatitis or liver failure. Pregnant patients should not take naltrecone. 

What are the most common side effects of Naltrexone?
Nausea and dizziness. 
 
What is Antabuse?
Antabuse (disulfiram) is a medication used to treat alcoholism that works by the "aversion" principle in that it causes a very severe, unpleasant reaction if alcohol is consumed with it. It can be very helpful to maintain abstinence if a family member or significant other ensures that the patient actually take the Antabuse on a daily basis. 

Do I have to agree to abstain (stop completely) to get treatment?
No, but results are better if that is the goal. 

How long should I stay on medications for alcoholism?
The risk of relapse is highest in the first 6 to twelve months. Most patients will stay on medications at least this long but treatment longer than a year is common as well. 

Are medications enough or do I need counseling too?
Studies have shown that counseling for alcoholism, whether individual or group is important - medications alone are usually not sufficient. 

What type of behavioral treatment is effective for alcoholism?
Both cognitive-behavioral counseling and motivational enhancement are useful. Cognitive-behavioral counseling teaches how to avoid putting yourself in risky settings and techniques to avoid relapse as well as how to cope with stresses that increase the risk of alcohol use. 

What are the twelve steps of AA? 

  1. We admitted we were powerless over alcohol -that our lives had become unmanageable.
  2. Came to believe that a power greater than ourselves could restore us to sanity.
  3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
  4. Made a searching and fearless moral inventory of ourselves.
  5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
  6. Were entirely ready to have God remove all these defects of character.
  7. Humbly asked Him to remove our shortcomings.
  8. Made a list of all persons we had harmed, and became willing to make amends to them all.
  9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
  10. Continued to take personal inventory and when we were wrong, promptly admitted it.
  11. Sought though prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
  12. Having had a spiritual awakening as the result of these steps, we tried to carry 

Do I have to be religious or spiritual to participate in Alcoholics Anonymous?
No - the only requirement is a desire to stop drinking. 

What if I don't like to talk in groups?
There is no requirement to speak in an AA meetings. If asked, simply decline. 

What if I can't stay sober- can I still come to AA?
Yes, many members become sober after coming to AA for a period of time. 

Does AA work?
Yes, studies have shown that alcoholics who attend AA are more likely to be abstinent at one year, 5 years and even 8 years. 

How do I find an AA meeting?
Go to http://www.aa.org/ or call (212) 870–3400  

What is Al-Anon?
Al-Anon is a support group for relatives and friends of alcoholics. Al-Anon helps participants learn healthy ways to relate with alcoholics in daily life.

How do I find an Al-Anon meeting? Call 1-888-425-6666