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.

Dual Diagnosis

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.

Who’s Using?

• 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.

Binging

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.

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.