People with the syndrome of alcohol dependence range from those who have a couple of drinks every day to those who regularly consume large amounts to the point of intoxication, and experience adverse consequences to their health, relationships, and employment. Definitions of alcoholism, alcohol abuse, and alcohol dependence emphasize different aspects of a person's experience with alcohol. Some focus on the frequency and duration of use. Others note the impairment of health or functioning. DSM-IV, the American Psychiatric Association's standard diagnostic manual, requires both.
There appears to be a genetic component in the etiology of alcohol use, although one's development, upbringing, and environment also play a role. The pathogenesis is complex as well.
However excessive drinking is defined, stopping your alcohol use can be a difficult task. The alcohol itself and the life you lead are intertwined in many ways, and abstinence will require major changes in how you spend your leisure time, your methods of relaxation, and your relationships. There are several aspects to your recovery.
If you possess strong will power and determination, you may be able to stop your alcohol use on your own. If you drink daily, you will probably go through a period of physical withdrawal, with symptoms of restlessness, tremor, anxiety, and insomnia. Many people find it hard to stop on their own and find the support of AA and therapy helpful.
If your use has been heavy, however, you should not try to stop drinking abruptly on your own. In addition to the unpleasant effects listed above, you may experience high blood pressure, rapid pulse, seizures, delirium tremens ("DTs"), hallucinations, and other physical changes. These changes can be dangerous and even lead to death, so medical care is essential. Benzodiazepines are often used during detoxification in order to prevent these serious complications.
Some people are unable to achieve or maintain sobriety even with the help of therapy and AA. You may require hospitalization or residential treatment to prevent you from obtaining alcohol and to give you the intensive support you need to make it through each day.
Once you have attained sobriety, the task is to maintain it. Many people go through repeated relapses. If you relapse, don't castigate yourself. Try to understand what led to the relapse so that you are better able to prevent it in the future. AA and counseling can be enormously beneficial in this regard.
Medications A variety of medications have been tried in an effort to help people maintain sobriety.
Disulfiram This alcohol-sensitizing agent changes the way alcohol is metabolized by the body. If you drink after taking it, acetaldehyde collects in your system as a breakdown product and produces a toxic reaction with symptoms of elevated pulse, low blood pressure, nausea, vomiting, and headaches. In a severe reaction, there can be respiratory and cardiac impairments that lead to death. The intensity of the effects is proportional to the amount of disulfiram and alcohol ingested. The basic idea is that you will avoid alcohol under the threat of these unpleasant reactions.
Disulfiram is rarely used in the treatment of alcohol dependence for practical reasons. It does not change your motivation, so if you want to drink, you just stop
Medications for Alcohol Dependence
Acamprosate (Campral) Disulfiram (Antabuse) Naltrexone (ReVia, Trexan) Benzodiazepines Alprazolam (Xanax) Chlordiazepoxide (Librium) Clonazepam (Klonopin) Clorazepate (Tranxene) Diazepam (Valium) Lorazepam (Ativan) Oxazepam (Serax) Secondary drugs Antidepressants Mood stabilizers taking it. If you use alcohol anyway, it is dangerous. If you are strongly motivated to stop your use, disulfiram provides no additional help. It is primarily helpful for people who are in a residential setting like a hospital or halfway house who want to maintain sobriety, lack the will power to do so, have the disulfiram administered by staff, and don't drink while they are on it.
Acamprosate This anticraving agent affects GABA receptors in the brain and has been shown to decrease the frequency of relapse in people who have achieved abstinence.
Naltrexone This anticraving agent blocks opioid receptors in the brain. Some people who are actively involved in counseling and take naltrexone are less likely to relapse.
Many clinicians who work with people dependent on alcohol are skeptical of naltrexone and acamprosate. After an extended period of dependence on alcohol, maintaining sobriety is a task that requires an ongoing commitment to lifestyle changes that have nothing to do with the effects of a medication. Scientific studies and further use of naltrexone over the next few years will clarify its effectiveness.
Benzodiazepines Named for their chemical structure, this class of medications is generally used in the treatment of anxiety. It is helpful for the acute withdrawal symptoms of alcohol. Some people stay on benzodiazepines past this period, believing they help to maintain sobriety. If you are anxious enough to feel the need for medication after you have withdrawn from alcohol, however, then you need to consider the possibility that you have an anxiety disorder. If you do, then you should vigorously pursue treatment for it, as abstinence is difficult to maintain in the face of intense anxiety.
Benzodiazepines are habit-forming. Cessation after more than four weeks of use produces a characteristic withdrawal syndrome. If you take them for extended periods, you will find that you continue to experience anxiety each time a dose wears off, a mini-withdrawal. Many people find that benzodiazepines are very difficult to stop once they have become dependent on them, a problem that has ensnared millions of people in the United States and many more worldwide. The substitution of benzodiazepines for alcohol merely replaces one addictive substance for another. Abstinence from habit-forming medications should be your goal.
Antidepressants If you feel depressed, you may wonder whether antidepressants will help you to stop drinking. (See chapter 9 for a complete list of antidepressants.) Antidepressants do not change your craving or response to alcohol. However, you may be depressed even apart from your alcohol use. If so, you may derive benefit from treatment of your depression. This treatment may include antidepressants, although many people derive enormous benefit from other treatments as well. If you are depressed, you may find an antidepressant boosts your motivation so that you are more interested and willing to endure the difficulties in achieving and maintaining abstinence.
Mood Stabilizers Used in the treatment of bipolar disorder to minimize wide mood swings (see chapter 8), there is no evidence that mood stabilizers reduce drinking in people without bipolar disorder. Some people with bipolar disorder find a reduced craving for alcohol when they take a mood stabilizer. It is not clear why this is true. Some people have speculated that the alcohol itself soothes the intense mood swings of bipolar disorder. The craving for alcohol is thus reduced when the mood swings are adequately treated with appropriate medication.
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Alcoholism is something that can't be formed in easy terms. Alcoholism as a whole refers to the circumstance whereby there's an obsession in man to keep ingesting beverages with alcohol content which is injurious to health. The circumstance of alcoholism doesn't let the person addicted have any command over ingestion despite being cognizant of the damaging consequences ensuing from it.