This post is dedicated to all those who turn to alcohol as a quick fix.
Unless you want your liver to look like the one in the image below, efforts must be made to nix this nasty quick fix!
No one is born an alcoholic, it is purely environmental. It is in fact a learned social behavior that can be explained with the help of Social Learning theory by Albert Bandura according to which “people learn from one another via observation, imitation and modeling”. This theory encompasses attention, memory and motivation, i.e. attention to the positive effects of alcohol (elevated social status, stress reliever), memory of the events and changes when under the influence of alcohol and motivation to repeatedly use alcohol to achieve a subliminal state or acceptance into a gathering (a mental reward). The brain’s reward system is a group of structures — including the amygdala and the hippocampus — that reinforce beneficial experiences, are involved in memory and complex decision-making and have been implicated in the development of substance use disorders as is the case with alcohol.
HOW DOES ALCOHOL BECOME A QUICK FIX?
A first time user gets fascinated by the quick albeit temporary release from reality that alcohol offers, and thereby starts to drink frequently as a release from any kind of painful experience s/he undergoes. Alcohol also offers an almost instant means of getting accepted into a popular social circle in the modern times. With time, the individual’s dependency on alcohol increases so much so that s/he goes from being a first time user, to a recreational user to finally being addicted. This process can be explained in the immortal words of Epicurus, the ancient Greek philosopher “nature has placed mankind under the governance of two sovereign masters, PAIN and PLEASURE”. This explains that a person in pain often seeks pleasure through various means and if there’s a fast-acting means to acquire pleasure even if it comes with its cons, the person is all game for it.
So how does harmless social drinking develop into chronic alcoholism? E.M.Jellinck (1971) an authority on alcoholism has formulated 4 stages of alcoholism that explain how alcoholism develops. They are as follows:
- Pre-alcoholic phase: This initial phase lasts from two months to two years. The beginner who drinks for social reasons or merely on account of curiosity finds that it relieves him/her of anxiety, tensions, stress and strain, bodily aches etc. and as a result learns to use alcohol as a relief measure. This curiosity can be linked to observing an older family member using the substance, to the media that paints rosy pictures of substance use, to peer pressure etc. Gradually s/he begins to experience an increased tolerance for alcohol and needs a larger and larger amount to reach the same state of sedation as s/he did before with smaller quantities of alcohol.
- Prodromal phase: In this phase alcohol is used more as a drug, less as a social beverage. There is also the onset of behavioral phenomena such as preoccupation with drinking (where and when will I have my next drink? How will I pay for it?), sudden blackout episodes during periods of drinking and considerable memory impairment i.e. one may remain conscious but later be unable to recall the events faced while drinking.
- Crucial phase: In this phase the alcohol dependency increases to such an extent that there’s danger of losing everything one values such as family, friends, health, wealth, job etc. The individual withdraws from social environments and turns into a recluse. Drastic decrease in sexual drive, hostility towards others and signs of health deterioration are the signs that can be visible in this phase named crucial aptly since if at this phase nothing is done to curb this alcoholism then it becomes next to impossible to do so.
4.Chronic phase: In this phase the alcoholic individual only lives to drink and substantial amount of organ damage has set in. In case alcohol is not available then s/he is ready to consume anything offering the same effect as alcohol such as drinking/sniffing aftershave lotion, whitener, mouthwash, fuel etc. In a recent news article it was reported how some Australian children under the age of 10 have been stealing aviation fuel from planes parked on remote airstrips post being denied access to alcohol. The factor that differentiates this phase from the crucial phase is that even a small amount of alcohol induces an intoxicate state. Also, in the phase the individual has given up on life, takes no pride in appearance, neglects personal hygiene and unless an intervention is made, is unlikely to give up drinking.
For information on disorders caused by excess alcohol consumption please click on this link: ALCOHOL INDUCED DISORDERS
HOW TO NIX THE FIX? MISSION: NO QUICK FIX NOVEMBER
Since alcohol consumption is a learned behavior, changes in behavior can help treating chronic alcoholism. The most popular treatments for alcoholism are the 12-step program or the 28-day rehab program. However there are a variety of treatments available today due to the past 7 decades of research. Every individual is different and there is no one size fits all solution. It’s of paramount importance to first develop an idea of all available treatments. The following are some treatments and therapies that have been proven to reduce and manage the issue of chronic alcoholism:
- Starting with a primary care doctor to evaluate whether a patient’s drinking pattern is risky, evaluate overall health and assess if medications for alcohol may be appropriate.
2.Pharmacotherapy- the U.S. Food and Drug Administration (FDA) has approved three medications for treating alcohol dependence, they are: Naltrexone which can help reduce heavy alcohol consumption since it’s an opioid. The opioid blocks the positive reinforcement effects of alcohol and allows the person to stop or reduce drinking. The patient takes the medication about an hour (and only then) before drinking to avoid side effects that arise from chronic use. Acamprosate is thought to stabilize the chemical balance in the brain that would otherwise be disrupted by alcohol withdrawal. Studies find that acamprosate works to best advantage in combination with psychosocial support and can help facilitate reduced consumption as well as full abstinence. Acamprosate should not be taken by people with kidney problems or allergies to the drug. Diarrhea is the most common side-effect. In over three to twelve months it increases the number of people who do not drink at all and the number of days without alcohol. It appears to work as well as naltrexone. Disulfiram is another drug that blocks the breakdown (metabolism) of alcohol by the body, causing unpleasant symptoms such as nausea, vomiting and skin flushing. These unpleasant effects can help some people avoid drinking while taking disulfiram. This was commonly used up to a decade ago and was aptly called “aversion therapy”.
The question might arise that “isn’t taking medications just trading one addiction for another?” The simple answer to this question is “NO” since all the medications approved for treating alcohol dependence are non-addictive. They are designed to help manage a chronic disease just like those designed to manage diabetes, hypertension and asthma.
3. Mutual support groups– Alcoholics Anonymous and various other 12-step programs provide tremendous peer support for people trying to quit or cut back on alcohol consumption. Combined with professional-led treatments and therapies these mutual support groups offer a valuable added layer of support.
4.Behavioral treatments are aimed at changing drinking behavior through counseling. This is helpful since alcoholism is after all a learned behavior. Learning to unlearn detrimental behaviors is the rationale of this form of treatment. These are led by competent counselors, therapists, healthcare professionals etc. and have proven to be beneficial by a number of published studies. Behavioral treatments possess features like:
- Developing skills to stop/reduce drinking
- Helping build a strong social support system
- Working to set reachable short term and long term goals
- Coping with or avoiding triggers that might cause relapse
Cognitive behavior therapy (CBT) – This form of therapy focuses on identifying the feelings and situations (cues) that lead to heavy drinking episodes in order to manage it and avoid relapse. The main goal here is to change the thought processes that lead to excessive drinking and developing skills necessary to cope with everyday situations that might trigger alcohol abuse. Griffith Edwards (pioneer in addiction medicine) has stated that the following thought should be addressed and tackled- “alcohol is a pervasive fact of life, but an extraordinary fact-pleasurable and destructible, anathematized and adulated, and deeply ambiguous, the genie in the bottle”.
Motivation enhancement therapy (MET) – This therapy is conducted over a short period of time to ensure adherence to the skills learnt in CBT. It emphasizes the pros and cons of seeking treatment, forming a plan for making changes in one’s drinking, building confidence, and developing the skills needed to stick to the plan. It can be said as that therapy which drives an individual to betterment.
Marital and family counseling– This incorporates spouses and other family members in the treatment process and can play an important role in repairing and improving family relationships. Studies show that strong family support through family therapy increases the chances of maintaining abstinence, compared with patients undergoing individual counseling.
Ultimately, choosing to get treatment is more important than the approach used, however since alcohol is a learned behavior, only a change of behavior can make a permanent dent in maintaining abstinence. Rehabilitation centers offer all forms of treatment customized to suit every individual’s needs. Pharmacotherapy offers biological assistance, behavior treatments offer psychological assistance and support groups offer social assistance therefore creating a holistic, three-pronged treatment and management regimen.
Shoutout to soul-brother and foul-weather friend Mr. Srinandaka Yashaswi for requesting today’s topic. A Gargantuan thank you for always being there!
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Also check out: MISSION: NO QUICK FIX NOVEMBER