Treatment options for alcohol dependency

Alcohol is our favourite social drug. Many people use alcohol in moderation, without causing any physical or psychological harm, but for some people, heavier drinking can be a serious condition, leading to a range of illnesses.

This article is written by Ian Drever, Consultant Psychiatrist, Priory Hospital Woking, Surrey.

It is estimated that about one in thirteen people in the UK are dependent on alcohol, with several million more drinking above recommended limits, putting themselves at risk of numerous medical conditions.

A variety of treatment options for alcohol misuse are available, ranging from self-help groups to individual therapy, medication, residential detox and rehabilitation.

Alcohol risks 

In order to reduce the risks of drinking, Department of Health guidelines recommend that men should drink no more than 3-4 units of alcohol per day, with women drinking no more than 2-3 units per day. One unit is defined as 7.9 grams of pure alcohol, which is roughly equivalent to half a pint of beer, a 25ml (pub) measure of spirits, a 50ml (pub) measure of fortified wine such as sherry, or a small 125ml glass of 8% wine.

Drinking beyond these levels for any sustained period can lead to a range of serious medical conditions. These include:

• cirrhosis of the liver

• pancreatic disease

• heart muscle disease (cardiomyopathy)

• blood and nutritional deficiencies

• high blood pressure and stroke

Drinking can also cause a range of psychiatric and social disorders, such as:

• depression

• relationship breakdowns

• suicide and self-harm

• seizures, shakes and hallucinations

• memory damage and personality change

Alcohol dependency 

For someone with alcohol dependency, having a drink can take precedence over all other activities. Typically, many of the following features will be present:

• a strong desire to drink alcohol

• difficulty controlling the use of alcohol

• persistent alcohol use, despite being aware of the harmful effects

• increasing tolerance to the effects of alcohol

• withdrawal features when going without alcohol

Alcohol dependence may remain undetected for many years, sometimes only generating illness features once significant health damage has been done.

An effective way of checking whether there may be features of alcohol dependence or misuse is to take the CAGE questionnaire:

1. Have you ever thought that you should Cut down your drinking?

2. Have you felt Annoyed by others commenting on your drinking?

3. Do you ever feel Guilty about your drinking?

4. Do you ever have a drink in the morning as an Eye-opener?

If you can answer 'yes' to two or more of these questions, then it is likely that you may be drinking at harmful levels, and you may wish to consider consulting your GP, or seeking specialist treatment.

Treatment options 

The first step in seeking treatment, as with any addiction, is to acknowledge that a problem exists.

Self help

For some people, information from self-help books and websites can be enough to help them reduce or stop drinking on their own. Some references and further resources can be found at the end of this article.

Groups

For other people, the structure of meetings provided by organisations such as AA (Alcoholics Anonymous) can be a powerful means of bringing about change and maintaining abstinence from alcohol. Many groups also offer mentoring services, designed to offer individual support and advice, particularly at challenging times in a recovery.

Individual psychology

There are a multitude of factors which can underpin excessive alcohol consumption, such as earlier life experiences or current stresses. One-to-one sessions with a psychologist or other alcohol treatment professional allow the in-depth exploration of the factors leading to alcohol use, and can help to uncover relevant past history. Often, this is an ongoing process over a period of months, and may include exercises such as keeping a mood or alcohol diary. Using the knowledge gained from this process, personalised treatment plans can then be formulated, implemented and monitored. Individual treatment also offers the benefits of treatment within a confidential therapeutic setting.

Medication

Excessive drinking can lead to a number of nutritional deficiencies, particularly in B-vitamins, so these are often supplemented in a treatment programme. For longer-term treatment, there are some medications which can help maintain abstinence. Acamprosate (Campral) is a compound which, when used in conjunction with psychological treatments, can enhance the success rate of staying off alcohol. Disulfuram (Antabuse) is another compound which can help maintain abstinence, as it causes a severe reaction if alcohol is consumed whilst taking the medication, but this carries its own risks, and it is generally only used in highly specific circumstances.

Detoxification

When someone has been drinking heavily for a prolonged period, it can be dangerous to stop drinking suddenly, as this can precipitate a withdrawal reaction, with potentially serious consequences, such as seizures (fits). In these circumstances, medication is used to take away the effects of alcohol, and allow the body to clear the alcohol. Typically, a medication called chlordiazepoxide (Librium) is used, in gradually reducing doses, over a period of five to ten days, allowing a gentle, safe and rapid detoxification process. After this time, all traces of alcohol will have left the body, and the next stage of alcohol treatment - rehabilitation - can then take place.

Residential Rehabilitation

The gold-standard of alcohol treatment is a period of residential rehabilitation. The duration of stay can vary, but is typically at least four weeks. By making a commitment to step away temporarily from the demands of daily life, and to focus purely on one's own recovery and wellbeing, a powerful process of discovery, self-awareness and empowerment can take place. A number of specialist units around the country offer such treatment, some of them using a 12-step programme, which is an integral part of the Alcoholics Anonymous treatment model. Although the thought of spending time away from home may feel daunting, many people describe a period of residential rehabilitation as being one of the most positive experiences in their life, allowing them to finally achieve freedom from alcohol. In addition, being part of a therapeutic community, in which everyone is focused on the same goals, encourages mutual support and the sharing of experiences, as well as the formation of lasting friendships.

Profile of the author

This article was written by Dr Ian Drever MB ChB, MRCPsych, a Consultant Psychiatrist at the Priory Hospital Woking. Dr Drever has a special interest in the diagnosis and residential treatment of alcohol dependence. He is a member of the Royal College of Psychiatrists (MRCPsych), is fully registered with the General Medical Council (Registration 3481590) and is on the GMC Specialist Register.

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