While the Opioid Epidemic makes headline news, the number of people who die from Alcohol is six times the number that die from prescription opioid overdose. More people die from alcohol related medical problems than all other addictions combined.
Approximately 40% of adult Americans with an Alcohol Use Disorder also had mental illness issues. Individuals with an Alcohol Use Disorder are up to three times more likely than unaffected individuals to have an anxiety disorder, and nearly four times more likely to suffer a major depressive episode. Post Traumatic Stress Disorder is very commonly associated with alcohol dependence. In turn, co-morbid mental illness complicates substance dependence treatment with higher treatment dropout rates and higher rates and earlier relapses. Treatment of both problems simultaneously increase the chances of recovery.
People who abuse Alcohol are often self-medicating away psychiatric and physical pain.
Alcohol addiction often occurs when people try to “self-medicate” serious psychiatric illnesses. People with both Alcohol Addiction and a Psychiatric Disorder are call Dual Diagnosis.
- Many people drink to cope with psychiatric problems. Long term, this will not work, but will makes matters worse.
- This is why diagnosing and treating co-occurring psychiatric problems is so important in Addiction Medicine.
- Addiction Recovery Models , must address both the Co-occurring psychiatric issues in order to be successful.
- Kittay’s Addiction and Psychiatry Model treats Dual Diagnosis and is effective.
Alcohol Dependence is a diagnosable disease characterized by a strong craving for alcohol, and/or continued use despite harm or personal injury. It can result in harm to one’s health, interpersonal relationships, or ability to work.
What is Alcohol?
- Ethyl alcohol or ethanol is a Central Nervous System Depressant (CND) that is rapidly absorbedfrom the stomach and small intestine into the bloodstream.
- Alcohol dependence is a diagnosable disease characterized by a strong craving for alcohol, and/or continued use despite harm or personal injury. It can result in harm to one’s health, interpersonal relationships, or ability to work;
- Alcohol is a “Gateway Drug”;
- Alcohol is associated with experimenting or recreational use of other drugs particularly non- medical use of Prescription Drugs including opioids, tranquilizers, sleep aids, and psychostimulants;
- The younger a person starts drinking and more consumed, the higher their chances for Prescription Drug Misuse.
Controlled Drinking vs. Abstinence: Severity predicts Relapse
Patients who enter alcohol treatment for the first time often say they would like to find ways to cut back on their drinking rather than abstaining. Research into moderate or “controlled” drinking has shown that this strategy can be successful for patients who have not yet developed a pervasive pattern of alcohol abuse, or who have experienced few negative consequences from drinking. It also helps to be young, female, employed, in a stable social situation, and confident about moderating intake.
As severity of dependence increases, likelihood of patients’ being able to reduce their drinking to moderate levels, and keep it there, goes down dramatically. For the most dependent drinkers, abstinence may be the only option. As severity of alcohol dependence increases, the likelihood of being able to continue drinking moderately for an extended period decreases, according to a study that followed outcomes three to eight years after treatment.
A Standard Drink Equals:
- 12 ounces of beer-one bottle
- 8 ounces of malt liquor
- 5 ounces of wine- one glass
- 5 ounces known as a “shot” of 80-proof distilled spirits or liquor (i.e.: gin, rum, vodka, or whiskey).
- Americans: 10% of all Americans have alcohol dependence disorder;
- Senior citizens: misusing alcohol has reached epidemic levels. Nearly 2.5 million or 17 % may have an alcohol dependence problem;
- Doctors’: rate of alcohol and prescription drug misuse is 5 times higher than the national average and some are practicing medicine while under the influence of drugs, usually painkillers;
- Attorneys’: rate of alcohol dependence disorder is 18% almost double the national average;
- Men & women: with alcohol use disorders are 18 times more likely to report prescription drug misuse than people who don’t drink at all. This can lead to accidental death;
- Children and young adults Alcohol is the drug of choice among youth under the age of 21, with 12% of 8th-graders, 22% of 10th-graders, and 29% of 12th-graders reporting heavy episodic drinking.
Binge drinking is defined as 5 or more alcoholic drinks for males or 4 or more alcoholic drinks for females on the same occasion (i.e., at the same time or within a couple of hours of each other) on at least 1 day in the past month, and is extremely common in all age groups over 18 years of age. 10% of adults are engaged in heavy alcohol use defined as binge drinking on 5 or more days in the past month. It is unclear way some people seem to be able to drink without adverse effects, and others are extremely sensitive to alcohol.
Alcohol is a “Gateway Drug”!
Alcohol is associated with experimenting or recreational use of other drugs particularly non- medical use of Prescription Drugs including opioids, tranquilizers, sleep aids, and psychostimulants. The younger a person starts drinking and more consumed, the higher their chances for Prescription Drug Misuse
Occasional Drinking – Any Concerns?
Many of us drink alcohol occasionally, so when do a few beers or glasses of wine go from acceptable to trouble?
- Two drinks per day for men and one drink per day for women and older people usually indicates an Alcohol Use Disorder;
- Five drinks for men and 4 drinks for women or older people at any time is a danger sign for Alcohol Addiction Disorders;
- drinking the same amount of alcohol, even when differences in body weight are taken into account.
- Certain people should not drink at all, for example individuals who plan to drive, are taking certain over-the-counter or prescription medications, or have medical conditions that can be made worse by drinking;
- People in treatment for other addictions should never drink because alcohol affects the same brain circuits as other drugs and seriously impacts all addiction treatments and recovery outcomes.
- Abruptly discontinuing regular use of alcohol can be very dangerous, leading to serious withdrawal symptom including seizures and even death;
- Detoxification from heavy alcohol use requires close medical supervision and sometimes hospitalization.
Alcohol Misuse During Pregnancy
- Alcohol use during pregnancy may result in early onset of labor, low birth rates, neonatal withdrawal syndromes and longer infant hospital stays;
- The damage caused by prenatal alcohol use includes serious, short and long term physical, behavioral, and learning problems in babies;
- Alcohol use during pregnancy can cause Fetal Alcohol Syndrome.
Medical Consequences Of Alcohol Misuse
Alcohol affects every organ in the body and people who drink are at risk for cardiac arrhythmias, impaired immune system, decreased bone density, peripheral nerve damage, gastrointestinal bleeding, heart failure attack and strokes.
Liver Disease and Cirrhosis
The liver is a vital organ that removes toxins and other harmful substances from your blood. Alcohol is a toxin and in the process of removing it from the body, the liver is damaged. Initially drinking causes Fatty Liver Disease, buildup of fat in liver cells, and over time leads to Cirrhosis or permanent loss of liver cells.
The good news is, Cirrhosis is not a progressive disease. If you stop drinking, any cirrhosis you have will not get worse. Your liver is a big organ and you have more liver than you need. People can lose 30% or more of their liver in a car accident and still lead normal lives. So if you stop drinking before the amount of cirrhosis is severe you can still lead a normal life. Your doctor can do an ultrasound to see if you have cirrhosis, and estimate what percent cirrhosis you may have.
One study looked at 2,945 alcoholic dependence people and they found that 15% were depressed before they began abusing alcohol. 26% were depressed while they were using alcohol, and 15% remained depressed once they had stopped drinking for an extended period. In other words alcohol misuse almost doubles the risk of depression.
Aging and alcoholism produce similar deficits in memory, intellectual (i.e., cognitive) and behavioral functioning. Alcoholism may accelerate normal aging or cause premature aging of the brain resulting in dementia. The frontal lobes of the brain are especially vulnerable to long-term heavy drinking. Research shows that shrinkage of the frontal lobes increases with alcohol consumption and is associated with intellectual impairment in both older and younger subjects.
Drinking is a major risk factor for cancers of the gastrointestinal tract including the esophagus, stomach and the liver. These cancers are especially difficult to diagnose and treat.
Medications Used In Alcohol Treatment
There are several medications that we use to help treat Alcohol Use Disorders. Some are used when the plan is to reduce alcohol use to a more controlled and safer level defined as ≤1 standard drink per day for women and ≤2 per day for men, and others for complete abstinence, no alcohol use at all. Often combinations of medications are used to achieve the best results.
- Vivitrol® – Naltrexone – A once-a-month injection given by your doctor; very patient convenient and since it is not a pill, you can’t skip your dose helping to prevent relapse. Patients who have a family history of Alcohol Use Disorder or strong cravings, or both, may benefit most. This non-habit forming medication can be used to treat co-occurring prescription opioid or heroin addiction.
- Revia® – Oral Naltrexone – acts in the brain to reduce craving. This is the same medication found in Vivitrol, but taken in a daily oral form.
- Campral® – Acamprosate –works by reducing craving for alcohol. It is most beneficial patients who have increased anxiety, physical dependence, negative family history of alcohol problems, and late age of onset (age >25) of alcohol problems.
- Antabuse® – Disulfiram -discourages drinking by making the person taking it feel sick after alcohol use so they avoid drinking.
- Topamax® Toparimate- increases “safe drinking” as defined above. It acts in the brain by reducing craving for alcohol and helps control some alcohol withdrawal symptoms
- Neurontin® Gabapentin- often combined with-naltrexone, it reduces cravings and alcohol consumption, delaying relapse, and improves sleep.
- Baclafen® – promotes abstinence, reduces the risk of relapse, and alleviates cravings and anxiety.
Importantly, medicines are also prescribed to treat any anxiety, depression, sleep of medical problems and importantly co-occurring psychiatric illness.
The vast majority of alcohol addictions can be safely and comfortably treated outpatient, and do not need inpatient care.
Your Individual Evaluation & Treatment Plan for Alcohol Addiction includes:;
- Addiction, Medical and Psychiatric Evaluation
- Medically Supervised Home Outpatient Detoxification;
- Medication to treat of Alcohol Craving and Use;
- Evaluation and Treatment of Co-occurring Medical Disorders and Poly-Addictions;
- Medication Management of Anxiety, Sleep and/or Co-Occurring Psychiatric Disorders;
- Psychological, Social and Family Interventions;
- Cognitive Behavioral Restructuring of Stresses and Cues.
- Relapse Prevention.
Treatments are individually tailored for safety, comfort and effectiveness to minimize withdrawal symptoms and avoid medical complications. Medications are prescribed to help prevent cravings, reduce use and prevent relapse. Medications target the brain’s reward systems, and the way nerve cells communicate restoring balance in brain chemistry. Psychiatric problems and symptoms are medically treated as necessary.
Dr Kittay specializes in the treatment of:
- Dual Diagnosis: Addictions and Co-occurring Psychiatric Disorders;
- Poly -Drug Dependency: Addictions to more than one substance;
- Substance Use Disorders in women during pregnancy and post-partum;
- Drug and Alcohol use associated with Anxiety, Depression And Sleep Disorders;
- Addictions related to the treatment of Medical Problems;
- Addictions related to the treatment of Pain Problems;
- Medical disorders related to addictions and high risk behaviors;
- Male Sexual Dysfunction related to Substance Use;
- Substance related suicidal thoughts and behaviors;
Addictions treated include:
- Opioids: Prescription Pain Pills, Heroin, Fentanyl
- Anxiety Medications: Xanax, Klonopin, Ativan, Valium
- Sleep medications: Ambien, Lunesta, Sonata
- Stimulants: Cocaine, Methamphetamine, Adderall