Tuesday, November 21, 2017

Alcoholism: There’s no cure, but there is a test

Addiction and Recovery

By Bob Gaydos
Living in a world in which seemingly anything one might want is just a click away, it’s easy, maybe even natural, to assume there are quick fixes for everything. A robot for every chore. A cloud for every data storage problem. A pill for every illness.
Not yet. Sorry, alcoholics, there is still no pill that cures alcoholism.
It’s not for a lack of trying, to be sure. While research continues to find the magic pill, thus far the U.S. Food and Drug Administration has approved three medications to treat what is referred to clinically as alcohol use disorder or alcohol dependence. The FDA says the medications are non-addictive. According to the National Institute on Alcohol Abuse and Alcoholism, they are:
  • Naltrexone, which is used to treat opioid addiction, but some researchers say can also help people reduce heavy drinking. It is available in pill and long-acting injectable form. Researchers say it acts in the brain to reduce the craving for alcohol in those who have already stopped drinking. However, treatment with naltrexone is not enough on its own. NIAAA says the medication was reported to be effective when combined with counseling, psychotherapy, and alcoholism support groups.
  • Acamprosate, which the Substance Abuse and Mental Health Services Administration (SAMSHA) says makes it easier for some who have already stopped drinking to stay stopped by reducing withdrawal symptoms such as anxiety, insomnia and restlessness, that may follow lengthy abstinence. Of course, counseling, psychotherapy, and alcoholism support groups might help in these cases also.
  • Disulfiram (Antabuse), which blocks the metabolism of alcohol by the body, causing unpleasant symptoms such as nausea, headache, sweating and flushing of the skin. The idea is you will get so sick if you drink alcohol while taking Antabuse you won’t want to drink alcohol. Or, as some alcoholics decide, you won’t want to take Antabuse. It’s the nature of the disease.
There are complications, starting with the fact that each individual is different, meaning some medications might work for some and not others. For example, according to SAMSHA: “Patients with liver damage usually cannot use either naltrexone or disulfiram. However, because acamprosate is not metabolized in the liver, patients with liver damage can safely take the medication.” All the medications have a variety of possible side effects.
Also -- and here’s the major stumbling block for many with a serious alcohol problem -- for each of the treatments the optimal recommended situation is that the person is abstinent at the beginning and is committed to recovery. That may mean detox and, for many, in-patient or out-patient treatment. It also means being honest with your doctor and rehab counselors about your goals, actually being willing to stop drinking and not looking for a quick fix for your problems.
Having a primary care doctor who has more than a cursory understanding of alcohol and drug abuse is an excellent starting point, especially if medication-assisted treatment is to be involved. This doctor must screen patients to determine the level of alcohol use, assess the need for or appropriateness of medication-assisted treatment, develop a treatment plan, choose an appropriate medication and monitor patient progress. If your doctor is unable or unwilling to do all this and you want to try medication-assisted treatment, he or she should refer you to one who is.
But remember, none of these drugs cures alcoholism. They are designed to help manage a chronic disease by discouraging or reducing alcohol intake. That’s obviously crucial, but on its own is not necessarily recovery, which is generally defined as avoiding the trouble associated with drinking as well as avoiding the alcohol itself.
This being a disease of the brain, it is recommended that some kind of counseling or support group accompany the use of these medicines.
It’s also important to know that, while there may not be a magic pill to cure alcoholism, there is a way to help determine a diagnosis of alcohol use disorder. The NIAAA offers a test that you can take:
In the past year, have you:
  • Had times when you ended up drinking more, or longer than you intended?
  • More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
  • Spent a lot of time drinking? Or being sick or getting over the aftereffects?
  • Experienced craving — a strong need, or urge, to drink?
  • Found that drinking — or being sick from drinking — often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
  • Continued to drink even though it was causing trouble with your family or friends?
  • Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
  • More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
  • Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
  • Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
  • Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating? Or sensed things that were not there?
Your score: Mild: The presence of two to three symptoms. Moderate: The presence of four to five symptoms. Severe: The presence of six or more symptoms.
Be honest with yourself and -- as the test suggests -- acknowledge your drinking’s effect on others. That’s key, whether you call it alcoholism or alcohol use disorder and whether you use some pill to treat it or not.

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