The Athlete

Drug Abuse

Alcoholism Treatment

Denial
Denial on the part of the alcoholic or compulsive drinker is the biggest hindrance to beginning treatment. One reason that denial is so common with the use of alcohol is the long time it can take for social or habitual drinking to advance to abuse and addiction (10 years on the average). Denial also occurs because alcoholics have no memory of the negative effects they experienced while in an alcoholic "blackout." Thus they don't believe that alcohol has harmed them. Further, alcohol impairs judgment and reason in all users, making them less likely to associate any problem with their drinking.

Detoxification
For a heavy drinker physical withdrawal is very uncomfortable but usually not dangerous. Symptoms can often be handled by aspirin, rest, liquids, and any one of hundreds of hangover cures that have been handed down from generation to generation.

For the alcoholic the potentially life-threatening symptoms of withdrawal can be medically managed with a variety of sedating drugs, e.g., barbiturates, benzodiazepines such as chlordiazepoxide (Librium®), paraldehyde, chloral hydrate, and the phenothiazines. There are natural lithium supplementsĀ that have shown success in many alcoholics as well. Since several of these drugs are addictive, they should be used sparingly and on a very short-term basis. Normally tapering is done on a 5-7 day basis but can be extended to 11-14 days.

Figure 9-1. Since alcohol dependence takes a longer time to develop than dependence with other drugs, admissions for treatemtn grow later in the life of an alcoholic, peaking after the age of 45 (SAMHSA/TEDS, 1999).

Along with emergency medical care, withdrawal and detoxification can be handled through emotional support and basic physical care, such as rest and nutrition (thiamin, folic acid, multi-vitamins, amino acids, electrolytes, and fructose). Many of the problems will start to abate with detoxification but for the long-term drinker, some damage is irreversible: liver disease, enlarged heart, cancer, and nerve damage among others (Wiehl, Galloway, & Hayner, 1994).

Initial Abstinence
A common treatment for initial abstinence is the use of Antabuse®, a drug that will make people ill if they drink alcohol. This is used for about 6 months or longer to help get alcoholics through initial abstinence when they're most likely to relapse. A more important part of this process is encouraging them to go to Alcoholics Anonymous meetings or other support group meetings in addition to individual therapy. One procedure is to have the user go to 90 Alcoholics Anonymous meetings in 90 days (called a "90/90 contract").
In 1996 naltrexone (Revia®) was approved by the FDA for the treatment of alcohol addiction. When used during the first 3 months of the recovery process, it decreased alcohol relapse by 50% to 70% when combined with a comprehensive treatment program. Unfortunately naltrexone can be hard on the liver and needs to be used under strict supervision.

Long-Term Abstinence & Recovery
In treatment one often encounters someone known as a "dry drunk." This means that the person is not actually drinking alcohol but still has the behavior and mind-set of an alcoholic. Thus the purpose of this stage of treatment, besides avoiding relapse, is to begin healing the emotional scars, confusion, and immaturity that had kept the person drinking for so many years.

Many treatment centers advertise 30-day drying out programs, implying that detoxification is the key to recovery rather than being a small initial step in a long process. As with all addictions, working on recovery throughout one's lifetime is necessary to prevent relapse. Brain cells have been permanently changed by years of drinking, so the recovering alcoholic is always susceptible to relapse.

Table 9-1. Medications in development for treatment of alcoholism*
Drug
Brand Name
Current Medical Use
Proposed Use
Theoretical Action
Status
acamprosate
Campral™
alcohol craving
calcium channel blocker, dopamine, GABA and glutamate modulation
approved in parts of Europe
gamma hydroxy butyrate (GHB)
alcohol and opioid addiction
naturally occuring inhibitory neurotransmitter like GABA
clinical observation
isradapine
Dynacirc®
antihypertensive
alcohol addiction
calcium channel blocker
clinical observation
ketamine
Ketalar®
anesthetic
alcohol addiction
mechanism unknown
studied in Russia
nalmefene
alcohol and opioid addiction
opioid antagonist with no liver toxicity
Phase II
nifedipine
Adalat® and Procardia®
vasospastic angina
alcohol, opioid, amphetamin
calcium channel blocker, increased dopamine to mitigate withdrawal and craving
clinical observation
verapamil
Calan®
angina
alcohol, opiates, amphetamine, benzodiazepine and marijuana addiction
calcium channel blocker
clinical observation

Information on Drug Abuse:

Drug Abuse Home Page

Information on Alcohol:

Alcohol Home

History

Overview

Alcohol Problems

Alcoholic Beverages

Epidemiology of Alcohol Consumption

Absorption, Distribution and Metabolism

Alcohol Effects

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