ALCOHOLISM - DANGERS, SYMPTOMS, AND TREATMENT - Written by Dean Gustar, Relapse Prevention Specialist

Alcohol is perhaps the most widely used mood-altering substance in the world. In many countries it is perfectly acceptable to drink alcohol and to share it with friends. We use it to celebrate a birth, mourn a loss, to relax, to have fun, to unwind and to socialise. With some exceptions, it is legal in most countries, though usually regulated in some ways - for example, many countries have a minimum age when alcohol can be purchased.

Most people can drink alcohol and enjoy the positive aspects of the substance with little or no negative consequences. However, when we start to examine some of the data around the impact of alcohol on society, a different picture begins to emerge. For some people alcohol can easily become a problematic substance, whether they are drinking every day or binge drinking. Their alcohol use can start to become harmful or hazardous and can cause serious problems, often affecting many areas of their life and presenting a greater risk of developing alcoholism.

Alcoholism vs alcohol use disorder

We are all familiar with the terms 'alcoholic' or 'alcoholism'. When a person is described as an alcoholic, this immediately creates a picture in our minds. Maybe we will think about a homeless person drinking in the park or a drunk driver. It is important to know that the term alcoholic is not a medical diagnosis.

Language can be very emotive. As we all have a preconceived notion of what an alcoholic is, when we use this term to describe a person it can create stigma, shame, or resistance. In medical and therapeutic fields, a range of terms have been developed to describe the behaviour in a way that is more layered and has a range of different categories. If we want to discuss a person's drinking behaviour, then we should be as person-centred and humanistic as possible.

The diagnostic and statistical manual (DSM-V) uses the term Alcohol Use Disorder and gives a range of identifiable symptoms that can be used for diagnosis. The World Health Organization has developed a questionnaire that uses a scoring system to identify the level of harm (or not) of an individual's alcohol consumption. This questionnaire is called the Alcohol Use Disorder Identification Test - commonly known as the AUDIT. The score from a person's AUDIT can help direct them toward the most suitable treatment interventions.

Here are the terms drawn from AUDIT and the DSM:

• Low-risk consumption

• Harmful consumption

• Hazardous consumption

• Dependent consumption

• Moderately dependent consumption

• Severe dependent consumption

• Alcohol Use Disorder

Dangers of excessive alcohol use

Professor David Nutt is a world-renowned Professor of Neuropsychopharmacology. For many years he has studied and researched the impact of alcohol. He is very clear that alcohol is the most harmful drug used today, and has a wide-reaching impact on individual health, on families, and on society. Here are some of the potential health and social consequences associated with alcohol use.

In 2016 5.3% of all deaths worldwide were attributed to alcohol consumption. That is around 3 million deaths. It may seem like scaremongering to list all these consequences and that we want to stop people having fun, but this is no exaggeration. It is very important that we are all educated better around the health consequences of alcohol, so that we can make more informed choices.

Potential problems to the individual and their family

Of course, other dangers exist aside from health problems. Excessive drinking can have other impacts on the life of an individual and their families. For instance, it is estimated that 55% of perpetrators who had committed an act of domestic violence had been consuming alcohol prior to the assault.

Here are some other consequences that may result from unhealthy alcohol use:

• Poor performance at work or education

• Risk of criminal record - drink driving (DUI)

• Anti-social behaviour

• Neglect of family and family duties

• Risk of unsafe sex or sexual abuse (alcohol is the number one date rape drug)

• Poor decision-making

• Poor anger and impulse control

• Social isolation

• Other substance abuse issues

• Other mental health problems

Why do people develop an alcohol use disorder

A question often asked is why some people end up drinking too much alcohol to the point where they develop alcohol dependence. This is a wide-ranging topic that is difficult to summarise in a few paragraphs. To help develop our understanding of this question we must think about what purpose does alcohol serve to the individual.

People who drink alcohol within healthy limitations can offer some clues here. Often, people drink to ease the stress of life. Maybe sometimes, in social situations, a few drinks will relieve any social anxiety. It becomes a bit of a release valve and loosens the person up. And, of course, this means the effect is pleasant.

Because the alcohol gives such a sense of relief when using it as a coping strategy for emotional issues, it can easily become a crutch that a person begins to rely on. It may work very well in the beginning, under moderate drinking conditions. However, as alcohol consumption increases, then it becomes less effective. More alcohol is needed to get the same effects, and then it has the potential to cause more problems than it solves.

It is important to note that nobody actively chooses to become an alcoholic. Nobody chooses to drink to the point that their health, their relationships, and almost every aspect of their life suffers. Nobody chooses to become a prisoner to a substance. Here are some of the factors often cited as being part of the cause of alcoholism. Usually, we would expect to see a combination of some of these factors.

Family history

If there is a history within the family, of alcohol related problems or alcohol misuse, then this can be a factor. Often, behaviours are learned in our social environments and perhaps heavy drinking becomes normalised. Completing a Genogram is a good strategy to help identify how family history may have impacted on how a person drinks alcohol.

Maybe we could also think about genetics when discussing family. There is no "alcoholic gene" as such, but research has suggested some genes may indicate a higher risk factor for a person developing alcoholism.

Trauma

It has become very clear now that there is a link between substance abuse and trauma. Trauma can feel like an open wound and alcohol and drugs can be used to cope. They help to reduce the painful feelings. Trauma can cover a lot of experiences. Sometimes the trauma will have taken place in childhood, sometimes in adulthood.

When discussing trauma, the first thing that comes to mind might be acute trauma (sometimes referred to as 'Big T Trauma') such as, the death of a close family member or being subjected to abuse or violence. There is also 'Little T Trauma,' which can also have a severe impact on our mental well-being and play a role in alcoholism. Examples of this are things like, getting bullied at school, a divorce, or a bereavement.

In childhood, such traumas are classified as Adverse Childhood Experiences (ACEs). These have the potential to cause long-term difficulties, including an increased risk of substance use, depression, and shortened life expectancy.

Underlying mental health conditions

It is very common for people to self-medicate psychiatric disorders with a substance. Sometimes the mental health issue may be undiagnosed. One obvious disorder would be anxiety. Alcohol eases anxiety well, so it is perhaps a natural process, if a person is struggling with high levels of anxiety, for them to seek relief. ADHD is another condition that alcohol can initially reduce symptoms for people by helping to quiet the mind.

We have already talked about the impact of trauma. Post-Traumatic Stress Disorder (PTSD) can sometimes be present in people who have an alcohol use disorder. Postpartum depression is also a factor in some cases. An important phase of treatment for alcohol problems is to identify if there are any underlying mental disorders, and treat them accordingly.

Poor attachment

The author Johann Hari is widely quoted as saying the opposite of addiction is connection. If we think about how alcohol eases social anxiety, we can easily see how it can help a person who feels disconnected from people to feel more at ease and connected. Often, our ability to feel at ease in company stems from the quality of our attachments growing up.

When we are young, we rely on primary carers to support us. Those attachments are important - if something impacts on the quality of the attachment, people can find it hard to trust in the future. They may even internalise the process and somehow believe they are to blame - that there is something wrong with them. This is where the roots of shame are sown.

Often, people with alcohol use disorder feel different to others, they have a sense that they do not fit in - either with family, friends, or colleagues. Alcohol reduces the feelings, and sometimes helps people to feel more at ease. It works to begin with, until a line is crossed and the behaviour around alcohol leads to more shame and more isolation.

So, it is hopefully clear that alcohol use disorders are, in most cases, a solution to an often unknown or undiagnosed set of underlying causes. Initially the alcohol will give some sense of relief and help people to cope more effectively. As the drinking increases, the behaviour becomes self-defeating, and due to the addictive nature of alcohol, to stop drinking is a difficult process that requires the right support.

What are the symptoms of alcoholism?

The American Psychiatric Association and the New York Academy of Medicine published the original “Diagnostic and Statistical Manual: Mental Disorders” in 1952 to establish a unified terminology for mental health diagnoses. The DSM of mental health disorders has a very clear set of symptoms to identify the presence of an alcohol use.

1. Alcohol is often taken in larger amounts or over a longer period of time than was intended

2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use

3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects

4. Craving, or a strong desire or urge to use alcohol

5. Recurrent alcohol use resulting in a failure to fulfil major role obligations at work, school, or home

6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol

7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use

8. Recurrent alcohol use in situations which it is physically hazardous

9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol

10. 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
      

11. Withdrawal, as manifested by either of the following:
    
    

    • The characteristic withdrawal syndrome for alcohol

    • Alcohol (or a closely related substance, such as benzodiazepine) is taken to relieve or avoid withdrawal symptoms

The DSM also suggests that the severity of an alcoholic use disorder can be determined by how many of the eleven diagnostic criteria are met. These levels of severity are often used by professionals to identify suitable treatment options and in understanding the levels of risk.

• mild alcohol use disorder – defined as the presence of 2-3 criteria

• moderate alcohol disorder – defined as the presence of 4-5 criteria

• severe alcohol use disorder – defined as the presence of 6 or more criteria

How can friends and family support?

At the end of the day, we are each of us responsible for our own actions and for taking steps to change. When we have a loved one who's drinking habits are causing serious concern it can be very stressful - especially if they reject help and support. It is difficult to watch someone we love struggling. We must remember that one of the best things to do is make sure you take care of yourself. We must remember the advice about oxygen masks on planes, make sure you put yours on first before you try to help someone else. If you find yourself experiencing any feelings of depression, or anxiety, or some other health issues then make sure you see a professional. Your own self care is paramount.

Often, sharing your struggles with close friends and family can help. Some people find a support group can reduce some of the feelings of uncertainty, blame and shame that we often can feel in these circumstances.

It is important not to personalise the problem. It is okay to set boundaries if we communicate them. Remember, this is a behavioural and a medical issue. Alcoholics are not being wilful or purposefully setting out to hurt everyone. Likelihood is that they do want to change because drinking alcohol excessively to the point of alcoholism is not fun. They may not believe in themselves or the capacity to change.

Do the best you can to educate yourself about alcoholism and about the different treatment options. Keep encouraging the individual. And don't forget it's the behaviour that is the problem, not the person. If the loved one does agree to try to change and enters a treatment programme, if there is an offer of family work then your participation can be important. It can have a profound impact on long-term outcomes.

Changing any behaviour is difficult. It often takes time, and there are often setbacks. These ups and downs are to be expected. Often, setbacks might feel disappointing, but we push through them and learn from each one. Your encouragement during such times is vital.

Treatment options for severe alcohol use disorder

If a person has a severe alcohol use disorder, then generally speaking we would consider abstinence from alcohol as a good option. Abstinence can seem like a daunting prospect for an alcoholic. It means taking away their main coping strategy for life. This decision should be fully discussed and negotiated with the person, with a pragmatic, gentle and evidence-based approach.

Detox

One should not abruptly reduce unhealthy alcohol use without medical advice. There are many risk factors, including seizures, and withdrawal symptoms should be monitored and managed by a medical professional. So, often the first thing to do would be to see a doctor or an alcohol addiction specialist so that current alcohol use can be measured, and suitable treatment options identified.

A medically supervised detox can take place in a hospital, or a specialist treatment centre, or in some instances at home with appropriate medical support. Medication would be used to reduce the impact of any withdrawal symptoms, and vital signs would be regularly monitored to ensure the medical safety of the person.

A detox would normally be the start of a longer phase of treatment and support. Changing long standing patterns of alcohol abuse and alcoholism will require other supportive interventions, both during and after detox.

Residential treatment

Residential treatment can be an excellent option for those who want to change their relationship with alcohol. It is an opportunity to have a full assessment of mental and medical health, an assessment of a person's life history, and their history of alcohol and substance use. Then a treatment plan can be agreed with a full range of interventions to support the client in achieving their goals.

Because addiction affects all aspects of a person's life, residential treatment will have a multidisciplinary team that will work together with the client and their families. Depending on the Residential Treatment Centre, a team may include the following:

• Nurses

• Psychiatrists

• Psychologists and Psychotherapists

• Alcohol and Relapse Prevention Counsellors

• Nutritionists

• Wellness and fitness specialists

• Continuing care coordinators

• Case Managers

Clients reside in the treatment centre and have a full programme of support during the day. As well as having all the support available on-site day and night. It also has the advantage of removing a person from their (potentially) stressful environment and away from triggers that can make a person crave alcohol and be in danger of relapse. They can be away from the distractions of their day-to-day life and fully concentrate on their programme and achieving their goals.

A typical Residential Treatment Programme would usually include some of the following interventions:

• Medically supervised detox

• Medical and Psychiatric Assessment

• Psychotherapy - including Cognitive Behavioural Therapy

• Trauma focussed psychotherapy

• Nutritional counselling and dietary guidelines

• Family counselling

• Psychoeducational workshops

• Relapse Prevention Counselling

• Continuing Care support

• Fitness and wellness support

Medication

During an alcohol detox a benzodiazepine will be used to reduce the risk of seizures and keep the body and mind as calm as possible. The National Institute on Alcohol Abuse and Alcoholism identifies three FDA approved medications that are also recommended to support individuals to stop or reduce drinking, and to prevent relapse. These medications are:

• Naltrexone can help people reduce heavy drinking by reducing the desire for alcohol

• Acamprosate makes it easier to maintain abstinence and is recommended for use alongside therapeutic support such as therapy or counselling.

• Disulfiram - also sometimes referred to as Antabuse. Disulfiram blocks the breakdown of alcohol by the body, and causes uncomfortable physical effects, such as nausea when people drink while taking it

It is important to remember that not all people will respond to medications and they should always be used alongside behavioural counselling interventions.

Self-help or mutual aid groups

Some people find support groups such as Alcoholics Anonymous or SMART Recovery a good place to get immediate non-professional support. Such groups can play a really important role in a person's recovery journey. Alcoholics Anonymous meetings take place across the world. They are non-professional and made up of people who identify as alcoholic and have a desire to stop drinking.

Many people quit drinking and remain sober through the support of such programmes. They can also be a strong component of support during and after, and alongside other forms of treatment.

Treatment options for mild or moderate alcohol use disorder

For people who have mild or moderate alcohol use disorder they need to decide whether they want to reduce alcohol consumption and try a controlled drinking regime or aim for abstinence.

They can find that the support of a local dedicated alcohol professional or alcohol service may be able to guide them to consume alcohol in a controlled manner and reduce the harms and consequences of their drinking. Often, an individual psychiatrist or psychotherapist can be part of the process.

If controlled drinking is manageable, this can reduce pressure all around. However, if the person finds that they are still drifting into alcohol abuse or cannot stick to simple guidelines, then perhaps more intensive support is required, or further discussion may be needed regarding abstinence.

SMART Recovery groups can also support a person who wishes to gain control over their alcohol consumption. These groups also take place online if there is not such a group in your area.

https://www.smartrecovery.org/

How we will treat you

At the Kusnacht Practice, we have developed our programme for the treatment of Alcohol Use Disorder based on effective evidence-based interventions, alongside our experience and expertise of working with clients who have alcohol addiction. We believe in having a person-centred approach to our work. We understand that the relationship with the client can help form the foundation to recovery. We work with the client in establishing goals, treatment plans and boundaries, each step of the way.

The first steps of the programme will be with our dedicated Medical and Psychiatric Teams who will work to ensure that all current and potential medical issues, and any existing mental health issues are diagnosed and addressed. They will plan an appropriate detox regime and setting - ensuring the safety of the client and managing withdrawal symptoms. This important phase of alcohol treatment creates a safe platform for the other teams - psychiatry, psychotherapy and BIO-R® nutrition and lifestyle - to engage with and support the client.

It is important for families and loved ones to know that there is no quick fix. Often residential treatment is one of the early phases of a much longer continuum of care. We will work with our clients and their families to establish an aftercare programme to help to maintain the gains made in treatment, and to navigate the potential ups and downs on the recovery journey.

The Kusnacht Practice is renowned for its absolute, dedicated attention and precision, honesty, and transparency in a warm and empathetic environment for all. With the pure waters of Switzerland’s Lake Zurich lapping on its nearby shores and among nature and clean air, the treatment centre offers a holistic, 360-degree, mind, body and soul rebalancing and restoration. Its state-of-the-art facility combines Swiss standards of excellence, luxury and cutting-edge, innovative technology with world-renowned medical expertise, compassion, and sensitivity. Each patient is treated uniquely and privately in their own sumptuous, five-star residence and provided with the highest standards of professionalism, care, and discretion.

We have successfully treated many alcohol dependent individuals. We will provide a safe, kind, and friendly environment where discretion and privacy are key. And our tranquil location and luxurious surroundings will help you relax and focus on your well-being, a place where we can concentrate on nothing more than improving your health and to support you onto a path of recovery.

Our experienced team of experts and professionals will seek to scratch beneath the surface to identify the roots of your issues. We wish to give you back control of your life and to learn coping strategies for a more content future - for you and your loved ones. Our treatment plans are unique and absolutely personalised, but simply opening up about your problem to a discreet professional is a big first step - alongside other therapies, naturally. We will organise everything for you and with no detail overlooked.

Written by Dean Gustar