Excessive alcohol use, either in the form of heavy drinking (drinking more than two drinks per day on average for men or more than one drink per day on average for women), or binge drinking (drinking 5 or more drinks during a single occasion for men or 4 or more drinks during a single occasion for women), can lead to increased risk of health problems such as liver disease or unintentional injuries.

According to the Behavioral Risk Factor Surveillance System (BRFSS) survey, more than half of the adult U.S. population drank alcohol in the past 30 days. Approximately 5% of the total population drank heavily, while 15% of the population binge drank.

According to the Alcohol-Related Disease Impact (ARDI) tool, from 2001–2005, there were approximately 79,000 deaths annually attributable to excessive alcohol use. In fact, excessive alcohol use is the 3rd leading lifestyle-related cause of death for people in the United States each year.

Though the significance, ideas, morals and uses surrounding alcohol have shifted through the centuries, its use has remained constant.

With enjoyment and the respect often associated with alcohol, history reports that there has always been a dark side to a culture that imbibes. Those individuals in the crowd, who insist on over-drinking and don’t seem to notice when they are obnoxiously or quietly destroying themselves and the world around them, ruin the party for everyone. Through over-indulgence these individuals draw attention to themselves, cause laws to be passed and have marched through time as a dilemma. The Egyptians, Greeks, Romans, Chinese and many cultures up to the present have been presented with the dilemma and probably asked the same question that we ask ourselves today; WHAT DO WE DO WITH THESE PEOPLE?

HISTORY OF ALCOHOL ABUSE TREATMENT

While the history books have ample recounts on the evolution of various alcoholic drinks parading through civilization since the stone ages, there is little record of therapeutic attempts to treat alcohol abuse until more recent times. Attempts to deal with over drinking in earlier civilizations were made by leaders of religions or countries, through encouragement of temperance or legal mandates.

It isn’t until the 1700s that we find clear attempts at treatment for alcohol abuse. Interestingly enough, the earliest approaches have some similarities to methods that are considered most successful today. William White, in his book Slaying the Dragon writes that the first “social movement of mutual support” to deal with alcohol abuse occurred with Native American Indians as early as 1772. Similar to Alcoholic Anonymous and other self-help support groups, individuals with negative drinking experiences supported each other through a recovery based on mutual problems.

A similar system of mutual support, but with delineated steps was created in 1935 when the concept of Alcoholics Anonymous was born. How the group of recovering alcoholics supported each other was described in the first book published about AA The Story of How More Than One Hundred Men Have Recovered From Alcoholism in 1939.

MUTUAL SUPPORT AND SELF-HELP

Alcohol addiction treatment is unique to the field of mental health. In fact, there is no other health or mental field where a majority of the help and intervention is managed, organized and led by non-professionals. Alcoholics Anonymous clearly states the role of mutual support in its preamble, which is usually read at group meetings ; “Alcoholics Anonymous is a fellowship of men and women who share their experience, strength, and hope with each other that they may solve their common problem and help others to recover from alcoholism.”

In the second edition of Substance Abuse by Gary L. Fisher and Thomas C. Harrison the authors note that in 1990 there were” over 15 million people participating in 500,000 twelve step groups.” That was 20 years ago and the numbers are probably much higher now, since alcohol abuse has been on the rise in recent years.

Through the years there has been some conflict between what mental health professionals believe is appropriate treatment and those who advocate self –help support groups such as twelve steps. Yet, those treatment programs that are disease based usually recommend that their patients attend 12 step meetings while in treatment or afterwards. For example, the Minnesota Model is a disease model, which utilizes the philosophic beliefs and steps of AA.

There has been such a blending of ideologies throughout the years through this practice, that the 12 step model has come to be associated with the disease concept of addiction. The actual truth is that AA is not affiliated with any particular model of addiction.

While the practice of self-help through recovery is proven to be effective, not all individuals believe or want to practice the AA concept of spirituality or a “higher power”.

For those who appreciate the value of self- help mutual support groups, yet don’t feel comfortable with AA philosophy, there are alternatives such Many Roads, One Journey, Women for Sobriety and Save Ourselves. Narconon also has a treatment protocol that utilizes the experience and dedication of individuals who have successfully recovered against a background of exact program steps.

IN PATIENT AND RESIDENTIAL

While there are different philosophic and clinical approaches to addiction, there are also many settings in which treatment can take place. An apparently popular one is the 28 day in-patient or residential approach. The choice of 28 days is not researched base, but economically driven by insurance companies. The advantages are twenty four hour supervision, structure and removal from the everyday stresses of life, while the client is immersed in treatment. The disadvantages are learning to live life in an artificial and protective setting where the client will have no trouble maintaining abstinence. However, once in the real world, with very little clean and treatment time under their belt, the client may relapse. According to studies, the longer the treatment, the more chance there is for success, so the likelihood of success of this model increases with longer program times.

PARTIAL HOSPITILIZATION AND DAY TREATMENT

The advantages of treatment in free standing centers is these programs are less expensive and the client’s life is less artificial, as they spend their evenings at home. This facilitates figuring out what the barriers are to the client’s success at abstinence so they can be worked on during treatment.

There are risks to this type of treatment. The client returns home at night to a household that is possibly using drugs, increasing the risk of relapse during treatment.

OUT PATIENT

These programs are usually part-time for 3 or 4 days a week. This type of program would be appropriate for someone who has attended treatment, but still needs support as they are going back to work and getting back into life. The main advantage to this type of treatment is that the client can return to life activities like school and work, while at the same time, still have the support and supervision occasioned by such a schedule.

USE OF MEDICATION

Most of the above described treatment modalities don’t include the long-term use of medication as part of the treatment. In fact AA takes a stand against substituting one addictive drug for another.

The use of medication is often necessary in the beginning stages of treatment in order to prevent medically dangerous situations associated with withdrawal which can include seizures and delirium tremens.

The recurring theme and element of success is the utilization of recovering addicts in the process of alcohol recovery, no matter the model being used. Self-help and mutual support are at the bottom of any successful treatment. However, in order to bring more safety to clients in treatment and indeed more prestige to those individuals who have dedicated themselves to the difficult task of guiding others through recovery; it is important that these counselors receive appropriate training. There are organizations that will certify such individuals, providing that they have met the proper training and on-site experience.

The empathy, motivation and dedication of these people along with the right training are the best ingredients for a successful addiction counselor, no matter the modality of treatment.

Matt Hawk writes about drug and alcohol education and awareness for the Narconon drug rehab network. 

Drinking is a problem if it causes trouble in your relationships, in school, in social activities, or in how you think and feel. If you are concerned that either you or someone in your family might have a drinking problem, talk to your doctor. If you rink everyday with every meal, you probably should check with your doctor. Also drinking is a cutural thing. In Japan, every man is expected to drink after long hour at work. So their alcoholics probably need much higher dose to qualify as an alcoholic.

Often families, friends, and health care workers often overlook their concerns about older people drinking. People often think the symptoms of alcoholic in older people are just part of aging. But the problem is that as people get older, their body’s tolerance to alcohol also changes. They might get drunk easier and faster than they did before.

Drinking too much alcohol over a long time can:

• Lead to some kinds of cancer, liver damage, immune system disorders, and brain damage
• Worsen some health conditions like osteoporosis, diabetes, high blood pressure, and ulcers
• Make some medical problems hard for doctors to find and treat. For example, alcohol causes changes in the heart and blood vessels. These changes can dull pain that might be a warning sign of a heart attack.
• Cause some older people to be forgetful and confused. These symptoms could be mistaken for signs of Alzheimer’s disease.

Source: National Institute on Aging

Before you enroll in any programs,  the setting, length of care, philosophical approach and your or your loved one’s needs should all be considered before a decision can be made. There’s one particularly important question to ask before signing up a treatment. That is:

Does the program accept your insurance? If not, will they work with you on a payment plan or find other means of support for you?

If you have to pay out of your own pocket, it can be expensive and add more stress into your situation.

Keep a small amount or no alcohol at home. Don’t keep temptations around.

Drink slowly.

When you drink, sip your drink slowly. Take a break of 1 hour between drinks. Drink soda, water, or juice after a drink with alcohol. Do not drink on an empty stomach! Eat food when you are drinking.

Take a break from alcohol.

Pick a day or two each week when you will not drink at all. Then, try to stop drinking for 1 week. Think about how you feel physically and emotionally on these days. When you succeed and feel better, you may find it easier to cut down for good.

Learn how to say NO.

You do not have to drink when other people drink. You do not have to take a drink that is given to you. Practice ways to say no politely. For example, you can tell people you feel better when you drink less. Stay away from people who give you a hard time about not drinking.

Stay active

What would you like to do instead of drinking? Use the time and money spent on drinking to do something fun with your family or friends. Go out to eat, see a movie, or play sports or a game.

Get support.

Cutting down on your drinking may be difficult at times. Ask your family and friends for support to help you reach your goal. Talk to your doctor if you are having trouble cutting down. Get the help you need to reach your goal.

Watch out for temptations.

Watch out for people, places, or times that make you drink, even if you do not want to. Stay away from people who drink a lot or bars where you used to go. Plan ahead of time what you will do to avoid drinking when you are tempted.

Do not drink when you are angry or upset or have a bad day. These are habits you need to break if you want to drink less.

DO NOT GIVE UP!

Most people do not cut down or give up drinking all at once. Just like a diet, it is not easy to change. That is okay. If you do not reach your goal the first time, try again. Remember, get support from people who care about you and want to help. Do not give up!

Source: National Institute on Alcohol Abuse and Alcoholism

Why do you want to drink less? There are many reasons why you may want to cut down or stop drinking. You may want to improve your health, sleep better, or get along better with your family or friends. Make a list of the reasons you want to drink less.

2. Set a drinking goal.

Choose a limit for how much you will drink. You may choose to cut down or not to drink at all. If you are cutting down, keep below these limits:

Women: No more than one drink a day

Men: No more than two drinks a day

A drink is:

• a 12-ounce bottle of beer;
• a 5-ounce glass of wine; or
• a 1 1/2-ounce shot of liquor.

These limits may be too high for some people who have certain medical problems or who are older. Talk with your doctor about the limit that is right for you.

Source: Alcohol Abuse and Alcoholism (NIAAA). Reprinted with permission.

• Do you drink alone when you feel angry or sad?
• Does your drinking ever make you late for work?
• Does your drinking worry your family?
• Do you ever drink after telling yourself you won’t?
• Do you ever forget what you did while you were drinking?
• Do you get headaches or have a hang-over after you have been drinking?

If you answered “yes” to any of these questions, you may have a drinking problem. Check with your doctor to be sure. Your doctor will be able to tell you whether you should cut down or abstain. If you are alcoholic or have other medical problems, you should not just cut down on your drinking–you should stop drinking completely. Your doctor will advise you about what is right for you.

Source: National Institute on Alcohol Abuse and Alcoholism (NIAAA)

Considering that about one–third of American women report regular alcohol consumption (1) and 2.3 percent, or 2.5 million women, meet the criteria for alcohol dependence (2), it is clear that research to better understand the effects of alcohol in women is critical.

Source: National Institute on Alcohol Abuse and Alcoholism Publications Distribution Center

Not everyone who drinks regularly has a drinking problem, and not all problem drinkers drink every day. You might want to get help if you or a loved one:

• Drink to calm your nerves, forget your worries, or reduce depression.
• Gulp down drinks.
• Frequently have more than one drink a day. (A standard drink is one 12-ounce bottle or can of beer or a wine cooler, one 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled spirits.)
• Lie about or try to hide drinking habits.
• Hurt yourself, or someone else, while drinking.
• Need more alcohol to get high.
• Feel irritable, resentful, or unreasonable when not drinking.
• Have medical, social, or financial worries caused by drinking.

Source: http://www.nia.nih.gov/HealthInformation/Publications/alcohol.htm