Alcoholism And Rehabilitation
Alcoholism, also known as alcohol dependence, is unfortunately a widespread ailment which spans people of all age groups and socioeconomic levels. The health risks of this disease, and alcoholism is a disease, are as widespread as the individuals who contract it. In addition to these health risks, alcoholism is also an influencing factor in another problem plaguing societies, domestic violence.
Thus, alcohol and anger create a sometimes fatal combination. As a result, rehabilitation success rates are vital in the ridding alcoholism and its negative effects from society.
Alcoholism is a disease which can be described by degree. Alcohol dependence describes individuals who have developed a “maladaptive pattern” of alcohol consumption which is characterized by a developing alcohol tolerance, withdrawal symptoms, or hangovers, and the inability to stop drinking. It doesn’t stop there People with alcohol dependence may progress to alcohol abuse which can significantly interfere with their social lives, their work or their interpersonal relationships.
In addition, this abuse can also cause a host of related issues including “major depression, dysthymia, mania, hypomania, panic disorder, phobias, generalized anxiety disorder, personality disorders, any drug use disorder, schizophrenia, and suicide” (Cargiulo 2007). According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), drinking up to 14 drinks in a week for men or seven drinks per week as a woman could indicate alcohol dependence. In addition, the NIAAA estimates that up to nearly 18 million Americans could be considered alcoholics (Lauer 2006).
That amounts to way too many individuals who are addicted to a drug that is both physically and mentally harmful, not to mention the effects on society as a whole. Despite the many mental and physiological problems that are associated with alcoholism, some of the most frightening are the health problems associated with the brain. Evidence exists that shows the damage that alcohol consumption does to the brain. Brain imaging studies have revealed that people with alcoholism have significant differences in parts of their brains than those without alcoholism.
The brain volume is reduced in alcoholics as well as the blood flow to the brain. The reduced blood flow has been linked to a lowering of inhibitions and memory, impaired cognitive function in general and even damage to the corpus callosum (Cargiulo 2007). Thus, alcoholism can directly translate to serious problems with the mind. These problems can lead to long term brain damage. Lesions in the brain form in those with long term patterns of alcohol abuse. This can translate into Korsakoff’s disease which is characterized by motor impairment and thinking impairments which can affect a person’s ability to care for himself.
In the end, the individual may have to be cared for institutionally. Alcohol affects the neurotransmitters in the brain. As the disease progresses to chronic status, the brain cells begin to adapt to the alcohol that seems to reside permanently in the brain. As a result, the brain becomes reliant on the alcohol to work. If alcohol is removed, the symptoms of withdrawal take longer and longer to subside. Ultimately, the brain tissue will rebel, in a way, and the withdrawal symptoms can be severe, even fatal. Once the cells in the brain die, they cannot be regenerated (Shoemaker 2003).
These effects seem to affect males to a greater degree than females. This fact can be explained by differences in drinking patters, choice of alcoholic drinks, rate of alcohol metabolism and the protective effects of hormones such as estrogen (de Bruin, 2005) As such, alcohol dependency and abuse is three times more prominent in men as it is in women even though evidence suggests that for both genders, the numbers are underreported (Cargiulo 2007). As if the physical effects on the body were not bad enough, the behaviors of individuals who are addicted to alcohol are also quite dangerous.
The drinkers find themselves to be less inhibited and more willing to engage in risky behaviors. Many of these behaviors can be characterized as aggressive and violent. In addition to the money that society has to pay for the medical care, it is also very costly to sort through all the social issues that alcoholism may create. Galvani (2004) gives several possible reasons why this risky and damaging behavior may occur in drinkers. Physiological theories argue that ethanol, the drug in alcohol increase aggression biologically.
A theory known as Disinhibition Theory notes the earlier link between alcohol and cognitive function, specifically the portion of the brain mentioned above that regulates levels if inhibition. The Deviance Disavowal theory argues that the abusers use alcohol as a reason for their behavior and consciously drinks so that they can blame the alcohol for their actions. Social Learning theories explain that people will act in a way based on their experiences around others. Therefore, parents and societal expectations can lead to alcoholic abuse and abusive behaviors (Galvani, 2004).
As with many ailments, more than one option for treatment exists. Many of these options can occur in conjunction with others. For years, behavior modification such as one might find in various 12 – Step Program or other similar programs have been the way of choice. These programs focus on the addicts significantly changing the way they behave in society including the people with whom they associate. Either a professional or a group of individuals led by a former addict facilitate the alcoholic’s recovery.
Alcoholics Anonymous (AA), is an organization most known for its success rates for alcoholics’ recovery. It is available to anyone who desires its services. Lately increasing research evidence has found that a 12-step program affiliation is not only effective on its own, but even more effective along with professional, medical treatment, including residence based programs. The truth is, “Involvement with AA is consistently and positively associated with improved drinking outcomes, replicated across a large volume of studies using a variety of treatment methods” (Cloud, Zeigler and Blondell, 2004).
The reason for this success is the three core items of AA: identification of self as a member, the number of steps completed, and the quantity of meetings attended (Cloud, Zeigler and Blondell, 2004). It can be a tiring process for an already worn individual. Because so many of these types of programs rely on frequent attendance by the alcoholics. One study sought to find the correlation, if any, between the duration of treatment and the level of intensity of the treatment. Moos and Moos (2003) conducted a study of 276 alcoholics who began formal treatment for alcohol abuse.
These patients were involved with out-patient programs, residential programs, or a combination of the two. The average length of treatment was 20. 7 weeks, and the average intensity, or number of contacts, was 2. 8 contacts per week. These researchers first note that the individuals who had longer duration of treatment usually had less intense treatment. They found that patients who had a short treatment duration, which is considered 1-8 weeks, were more likely to abstain from alcohol than those who received no help whatsoever.
If the treatment lasted for nine weeks or more, then the patient was even more likely to abstain from alcohol. This seems to suggest that the longer the treatment duration, the better the individual may respond to the treatment (Moos and Moos, 2003). However, recently the question has arisen as to whether or not recovering alcoholics must completely abstain from alcohol or not. Most programs, such as AA, or other groups perhaps affiliated with churches or in-patient and out-patient residential programs, build potential and motivation for success on complete life changes.
These changes includes huge behavior shifts which focus on completely eliminating alcohol. Unfortunately, many people do not seek treatment because they don’t want to completely give up the occasional beer or social glass or wine. Humphries, Weingardt, and Hoyst (2005) agree and have encouraged programs like Moderation Management which do not force individuals to part with alcoholic beverages forever. Allowing a choice of goal may be one effective way to increase the numbers of people willing to enter alcohol treatment.
It is estimated that as few as 10% of individuals with alcohol use disorders attend treatment; more flexible goals may appeal to a wider range of these people. There is also evidence that therapy can move people toward choosing a realistic drinking goal for themselves (Humphries, Weingardt, and Hoyst, 2005). On one side of this debate are those that argue in favor of abstinence. They say that the disease controls the individual and that this person will definitely lose control of they are exposed to alcohol, even a small amount . (Humphries, Weingardt, and Hoyst, 2005).
Never drinking again is the surest way to “cure” this disease. Alcohol recovery patients are constantly reminded that they are and always will be an alcoholic, just like a diabetic always will be a diabetic. Opponents to the abstinence-only argument argue that people and their problems with alcohol are all different with different times of drinking and different levels of drinking. The researchers use the common phrase “different strokes for different folks” in describing this philosophy. While they agree that some problems require abstinence, but they allow that other individuals could moderate their drinking and still improve.
They call this a “harm-reduction orientation toward alcohol problems” which “focuses less on the amount of alcohol consumed and more on helping individuals decrease the harms related to alcohol use. Although abstinence may be desirable, it is not the primary measure of successful outcomes” (Humphries, Weingardt, aned Hoyst, 2005). Some of the personal demographics of individuals who are more likely to experience success on non-abstinent programs include younger people, those with social and psychological stability, those who are regularly employed, and those who believe that they can seriously manage a moderate drinking program.
However, if the patients are pregnant, experiencing liver problems, or are in the advanced stages of alcoholism, they may be forced to consider only the abstinence route (Humphries, Weingardt, and Hoyst, 2005). Another reason that some people avoid seeking treatment for alcoholism is their reluctance to commit to residential or in-patient treatment. Luckily, recent studies have indicated that outpatient treatment is effective in treating alcoholic dependency. Studies of this type have reported abstinence rates of 34-59% for 6 months post-treatment, 48 % for 19 to 24-month post-treatment and 52% for the 49-month post-treatment mark.
In Bottlende and Soyka’s study of 2005, their rates were slightly higher for the six month mark at 64% abstaining, and 14 % significantly reducing their alcohol intake with a 22% rate of serious relapse. Perhaps, if people understood that they could get good results with a outpatient program, they would be more inclined to seriously consider treatment. Additionally, alcoholics do not need lengthy terms of treatment. Perhaps a brief commitment would do the trick for many with alcohol problems.
“Brief interventions targeting alcohol consumption have been found to be very effective in changing clients’ consumption levels” (Roche and Freeman, 2004). One study cited by these researchers noted that heavy drinkers were likely to reduce the amount of alcohol they consumed six and twelve months after a brief intervention as compared with similarly heavy drinkers who received no interventions whatsoever: A WHO study conducted in eight countries involving over 1600 participants found that brief interventions reduced daily alcohol consumption on average by 17% and intensity of drinking by 10%.
Brief interventions also reduce the number of alcohol-related problems, health-care utilization and associated treatment costs and the number of emergency department admissions. Brief interventions are also highly cost-efficient due to the minimal cost of the intervention and the breadth of scope for prevention of more serious and more costly problems (Roche and Freeman, 2004). However, the same benefits were not noted for women or for low consumers of alcohol who occasionally drank at very hazardous levels, also known as binge drinkers.
Evidence suggests that “the majority of alcohol-related harms” affect these moderate to low drinkers who binge (Roche and Freeman, 2004). This study just shows that people do react differently to alcohol. One huge area of research in alcohol rehabilitation right now is in the area of gender. The above study mentioned that women do not receive the same level of benefits from brief interventions as men receive. This has led many researchers to fill the research gap between studies that focus on only males or on mixed genders and females. While women have a lower rate of substance abuse, those that are alcoholics suffer just as men do.
In fact, women actually suffer more severe effects in some cases than men do. For example, women have more alcohol related health issues, “mental disorders, death rates, quicker addictions and greater social isolation and stigma” (Najavits, Rosier, and Nolan, 2007). This is unfortunate because women have become increasingly more addicted to alcohol at younger and younger years of age. However, studies also indicate that while in treatment, women show more rapid improvement and are more able to control impulsive behaviors that are so problematic for men (Najavits, Rosier, and Nolan, 2007).
Of course, one rehabilitative method that is often overlooked in the search to rehabilitate alcoholics is the pharmacological method. While drugs are frequently use to aid in helping alcoholics avoid painful and dangerous withdrawal symptoms, others are now being marketed as treatment methods themselves. One such drug is Acamprosate which is a synthetic compound with a similar structure to that of the neurotransmitter GABA and the neuromodulator Taurine” (Scott, Figgitt, and Keam, 2005).
Once the patient is detoxified, Acomprosate helps the patient maintain abstinence in the place of rehabilitation programs. This way, individuals can maintain his social and professional life. Several studies found this to be true a year after use had begun “irrespective of disease severity or the type of psychosocial support” (Scott, Figgitt, and Keam, 2005) the patient received. Also, the drug appears to pose few tolerance issues such as nausea, diarrhea or the like. A second prescription medication is available for the treatment of alcoholism.
Naltrexone has also produced very positive results in promoting abstinence among recovering alcoholics. This drug has also had several positive research trials and works better in conjunction with behavioral therapy. One way this drugs works is to result in a reduced urge to drink and negative physical side effects if it is taken in conjunction with alcohol (Rohsenow, 2004). Alcoholism is a horrible, addictive disease that leads not only to medical problems such as brain and liver problems, but also to psychological problems, social problems and even violent behavior.
The disease affects individuals differently, and new approaches are always being considered to treat each sufferer. While abstinence only and residential programs seem to have prevailed in the past, the new approaches are leaning to more brief, outpatient programs and interventions that support both abstinence and moderation when it comes to alcohol consumption. These new programs also take into account differences that result from race and gender. With hope, this disease will soon be tamed, or even eradicated, with better and better rehabilitation programs.
. References Bottlender, M. & Soyka, M. (2005). Efficacy of an Intensive Outpatient Rehabilitation Program in Alcoholism: Predictors of Outcome 6 Months after Treatment. European Addiction Research 11 (3): 132-137. Cargiulo, T. (2007). Understanding the health impact of alcohol dependence. American Journal of Health-System Pharmacy 64: S1-S17 Cloud, RN, Ziegler, CH, & Blondell, RD. What is Alcoholics Anonymous Affiliation? Substance Use & Misuse 39(7), 2004: 1117-1136 Galvani, S. (2004). Responsible disinhibition: Alcohol, men and violence to women.
Addiction Research & Theory 12 (4): 357-371 Humphreys, K, Weingardt, KR, & Horst, D. Prevalence and predictors of research participant eligibility criteria in alcohol treatment outcome studies, 1970-98. Addiction 100(9), Sep 2005: 1249-1257 Moos, RH & Moos BS. Long-term influence of duration and intensity of treatment on previously untreated individuals with alcohol use disorders. Addiction 98 (3), March 2003: 325-337. Najavits, LM, Rosier, M, & Nolan, AL. (2007). A New Gender-Based Model for Women’s Recovery From Substance Abuse: Results of a Pilot Outcome Study.
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