Alcohol withdrawal sometimes requires urgent medical attention. Regular, heavy drinkers can experience symptoms of withdrawal within 6 to 48 hours of their last drink. Symptoms include tremors, weakness, nausea, sweating, seizures, hallucinations, anxiety, an increased pulse, and elevated blood pressure. If the person does not receive treatment, life-threatening delirium tremens can develop 2 to 10 days after the patient stops drinking. Symptoms of delirium tremens include anxiety, hallucinations, confusion, inability to sleep, nightmares, depression, fever, and agitation. Symptoms of withdrawal often develop after patients are hospitalized for other conditions. Without intervention, withdrawal symptoms prompt many patients to return to the bottle.
Doctors typically order medications, vitamins, and fluids to manage withdrawal symptoms. Withdrawal symptoms can be unpleasant and, in the case of delirium tremens, life-threatening. Tranquilizing drugs such as benzodiazepines help to keep the patient calm. Beta blockers and calcium channel blockers may be added to the treatment plan to control elevations in blood pressure and heart rate. Vitamins help combat nutritional deficiencies common in people who drink excessively. Fluids replace liquid lost due to alcohol's diuretic effects. Only about one-quarter of alcohol-dependent patients require drugs to treat withdrawal.
Some patients require hospitalization for complications of alcohol abuse. Many alcoholics have medical, psychiatric, and social problems that are severe enough to require hospitalization. Some of the more serious complications include heart failure, pancreatitis, gastrointestinal bleeding, and hepatitis. In addition, some alcoholics require hospitalization because they can no longer care for themselves.
At the first signs of alcohol-related difficulty, seek support or treatment to stop drinking. Changing habits to stay sober presents an extreme challenge to alcoholics, and many relapse within weeks. Treatment programs improve the odds of long-term sobriety. About 20% of alcohol-dependent patients kick the habit without medical or psychological treatment.
Monitor your drinking habits by keeping a log. Try to detect causes for and consequences of your drinking patterns. Doing so will help you learn alternate ways of coping with the people, places, situations, and feelings associated with heavy drinking.
Do not use alcohol to treat insomnia or emotional problems.
Insomnia is normal after alcohol withdrawal, and will improve over subsequent weeks. Try relaxation techniques, meditation, exercise, and hobbies to modify your behavior and decrease anxiety so you can sleep better.
Establish realistic goals for yourself and don't push beyond your limits.
Abide by a set bedtime and wake-up schedule, and avoid caffeine and napping.
Encourage your family to seek counseling or self-help groups like Al-Anon or Al-A-Teen.
Your doctor is the best source of information on the drug treatment choices available to you.
If an alcohol problem is caught early (before dependence occurs), treatment may consist of education, abstinence recommendations, and reassurance. Doctors often are the first to recognize an alcohol problem. By calling symptoms to the patient's attention while informing the person of the potential physical, social, and emotional dangers of excessive drinking, alcohol abuse can often be stopped early.
Inpatient and outpatient substance abuse treatment programs are available to help alcohol abusers quit drinking Table 09. Inpatient and outpatient substance abuse treatment programs typically include alcoholics anonymous (AA) group sessions. Alcoholics anonymous is a free self-help group where people help each other stay away from alcohol. Formal treatment programs, inpatient or outpatient, cost money and involve professionals who intervene to help the alcohol abuser give up drinking, improve coping skills, make lifestyle changes that promote abstinence, and address underlying psychological issues. Alcohol abusers must want to stay sober before any treatment will work. As a legal drug, alcohol is easy to obtain, and temptation is always present. Developing routines and making friends with people who do not drink increases the chances for participants' success.
Table 9. Psychosocial Therapy Options for Alcohol Abuse
Alcoholics Anonymous (AA) Free therapy program that uses a supportive approach to follow 12 steps to work through during recovery. Particularly effective in economically disadvantaged, isolated, or lonely patients or for individuals from a heavy-drinking social background. 12-Step Facilitation Program Formal approach incorporating AA and other 12-step programs. Cognitive Behavioral Therapy (CBT) Aims to teach the patient by role-play or rehearsal to recognize and cope with high-risk situations for relapse, and to recognize and cope with craving. Motivational and Enhancement Therapy (MET) Based on motivating patients to use their own resources to change their behavior. Found to be the most effective approach in patients with high levels of anger.
Programs advocating moderation exist, but abstinence remains the most accepted treatment option. Experts consider moderate drinking to be two or fewer drinks per day for men, and one drink per day at most for women and older adults. Patients often cut back, but slip up and are not successful at limiting their intake, leading to more problems. Therefore, abstinence has become the recommended approach to treatment.
A growing fetus can be damaged if the pregnant mother consumes alcohol. Babies born to mothers who drink may suffer from mental retardation, hyperactivity, and behavioral problems. Some will be born with improperly formed organs. The amount of alcohol needed to cause damage is not known. Expecting mothers, or women who are trying to become pregnant, should abstain from drinking alcohol.
Older adults who drink increase their risk for falls and other accidents, and may experience a worsening of existing medical conditions. People's bodies process alcohol differently as they age. The brain becomes more susceptible to alcohol's depressant effects, and the amount of alcohol needed to produce a "high" feeling decreases. Alcohol can increase blood pressure, and may aggravate ulcers and other ailments.
Before dependence occurs, patients face a favorable prognosis. Physical or psychological dependence decreases your odds of achieving sobriety. Early diagnosis and intervention raises the rate of success by 50% to 90%.
It is difficult for many patients to overcome alcoholism. Most people tend to fall back into old, comfortable alcohol habits unless they receive adequate treatment and support. Alcoholics Anonymous provides that assistance to millions of people. Studies have shown that more than 60% of middle-class alcoholics remain sober for at least one year after completing treatment.
Your chances of remaining sober increase the longer you avoid alcohol. The majority of alcoholics relapse within one year. Some develop an alternating pattern of drinking and sobriety. The longer a person stays sober, however, the greater the odds that he or she will remain free of alcohol.
Alcoholics who continue drinking do not live as long as those who stop. Continuing to drink can shorten an alcoholic's life by an average of 15 years. Heart disease claims most alcoholics, followed by cancer, accidents, and suicide.
Recovering alcoholics must make a lifelong commitment to maintain sobriety. You should continue to be in contact with treatment professionals for six months to one year after all you quit drinking. Monthly follow-up is very effective for reinforcing abstinence and avoiding future problems. Your treatment sessions should address the challenges involved in living without alcohol, filling your time with nondrinking activities, forming friendships with people who do not drink, and managing stress.
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