Pharmacology and Alcoholism

Pharmacology and alcoholismPharmacology’s making it easier to stop drinking. As anyone familiar with alcoholism knows, getting alcohol out of the body is only the bare beginning. The reason alcoholics often return to drinking is due to the psychological obsession with alcohol, the ongoing craving for alcohol even after the body has been detoxified.

The alcoholic will crave alcohol long after detox, and this is why support groups like Alcoholics Anonymous are important. It also helps when the recovering alcoholic has support from family and friends, from a physician, and, often, from ongoing counseling. If the recovering alcoholic starts nutrition and exercise plans, both will help the recovering person get past the mental obsession. After a few months, the brain will heal and the recovering alcoholic will not longer crave alcohol — it could happen even earlier, as we’re all different.

Now, pharmacology might offer one more tool to the recovering alcoholic to assist in that early, difficult part of recovery. It’s a medicine that’s usually prescribed for asthma. Here is an excerpt from Medical Daily:

Giving up alcohol isn’t the hardest part of overcoming alcoholism — the subsequent cravings are what lead most to relapse. A new study from UCLA may have a way to better address these cravings. According to the research, a drug commonly used in Japan to treat asthma also has the unexpected side effect of quelling a desire for alcohol by reducing the pleasurable effects of drinking. The findings could one day make the drug a candidate for use in alcohol abuse treatments.

According to a study now published online in  Neuropsychopharmacology, the drug ibudilast significantly lowers user’s cravings for alcohol and helps to improve their mood when confronted with alcohol which they are not allowed to drink. In addition, the drug seems to alleviate user’s depression, a condition very common in heavy drinkers.

Recovering alcoholics need all the help they can get. Hopefully, this asthma medicine can be turned into an approved medicine for the treatment of alcoholism. It’s hard to describe the obsession with alcohol that tortures the alcoholic mind — it confounds loved ones, friends, employers and even medical professionals. It seems insane for a person to crave something that’s killing them, but this is the nature of alcoholism — now, hopefully, there’s more help to deal with this chronic brain disease.

Alcohol is a depressant


A brain trick

Alcohol is classified as a depressant drug, but there’s more to it. Alcohol produces a stimulant effect in small amounts for most normal drinkers. Alcoholics, however, develop tolerance and are able to drink much more than the normal drinker, thus extending the stimulant effect. Regarding the multiple roles played the drug alcohol, this is from a Forbes article:

We hear many different things about how alcohol affects the brain and body, most notably that it is a depressant.  That’s only part of the story. Alcohol is a depressant, but it’s also an indirect stimulant, and plays a few other roles that might surprise you.

Alcohol directly affects brain chemistry by altering levels of neurotransmitters — the chemical messengers that transmit the signals throughout the body that control thought processes, behavior and emotion.  Alcohol affects both “excitatory” neurotransmitters and “inhibitory” neurotransmitters.

The more a person drinks the more the brain is tricked — first, the brain reacts to the increase in dopamine, a brain chemical that produces good feelings, then, at the same time, the more a person drinks the more the alternate, depressant effect takes over causing all the negative effects of alcohol, slurred speech, loss of balance, impaired judgment, loss of inhibitions, and a shut down of the central nervous system if enough alcohol is consumed.

Most people learn how to balance the competing effects of alcohol, therefore avoiding most of the negative effects of alcohol. The alcoholic, though, gradually increases tolerance, extending the feel-good, dopamine effect of alcohol, then gradually becomes psychologically and physically dependent on alcohol. The mean  trick with alcohol is that it eventually damages the liver and the alcoholic can’t extend the feel good period because the live is not breaking down alcohol properly. The alcoholic quickly reaches the negative effects but continues trying to capture the magic, then drinks just to feel “normal” for awhile, because going without alcohol is too painful. The physical withdrawals from alcohol get progressively worse for the alcoholic, thus the dilemma. Also from the Forbes article:

Over time, with more drinking, the dopamine effect diminishes until it’s almost nonexistent. But at this stage, a drinker is often “hooked” on the feeling of dopamine release in the reward center, even though they’re no longer getting it.  Once a compulsive need to go back again and again for that release is established, addiction takes hold.  The length of time it takes for this to happen is case-specific; some people have a genetic propensity for alcoholism and for them it will take very little time, while for others it may take several weeks or months.

It’s needless to say that that alcoholism is confusing and frustrating for a person who never intended to experience this terrible existence. Treatment is necessary as alcoholism progresses, and the sooner alcoholism is recognized and treated, the better for all concerned.


The Damaged Alcoholic Mind

psycholical effects of alcoholismScience is learning more and more about the biological damage to the brain caused by alcoholism, and there are more and more medical treatments to help ameliorate the damage. The biological damage is the easiest to understand. The alcoholic mind is harder to understand. What’s difficult to deal with is the lingering psychological damage caused by alcoholism and past behaviors under the influence. This post is about alcoholism, but most of it pertains to addiction to other drugs such as opiates, cocaine, benzos, etc.

Once an alcoholic has been abstinent from alcohol for a period of time, the psychological damage is easier to assess. During active alcoholism and early withdrawal, alcoholics are often misdiagnosed psychologically. Alcoholism causes strange, irrational behavior (rational to the alcoholic, but irrational to others), and most alcoholics are anxious or depressed due to the consequences of alcoholism. The depression is also due to the fact that alcohol itself is a depressant.

The recovering alcoholic can experience intense, painful and persistent feelings of shame, fear, anger, depression, and any other feeling known to man. If these persistent emotions and states of mind are not dealt with, sobriety becomes an unbearable experience. If the painful, confusing, disorienting emotions and the uncomfortable states of mind are not dealt with, the recovering alcoholic is at risk for relapse. Most often, group therapy, counseling, support groups and behavior changes are enough for the painful emotions to subside, but if the depression or anxiety continues, a doctor who understands addiction should make appropriate recommendations — there might be a dual problem of alcoholism and depression or alcoholism and anxiety or alcoholism and some other mental health problem.

In treatment we help clients deal with their emotions and states of mind as they relate to alcoholism. Once the alcoholic (the drug addict of any sort) accepts their condition and understands that changes are necessary, the combination of talking therapy and a plan of action enables the person in recovery to perceive his/her reality as it is, and to begin changing that reality. If a person is going to change they must first acknowledge the starting point.

Often, the starting place is not pleasant, to say the least. The person in recovery doesn’t like admitting that they’ve hurt and alienated loved ones, wasted their savings, lost another job, have a DUI on their record, but reality is reality and nothing much can change if the person denies reality or blames other people, places or things. There’s a misunderstanding among much of the public regarding the disease concept of alcoholism — many people think that calling alcoholism a disease, which it is regardless of what the public thinks, is a cop-out and that it lets the alcoholic off the hook for responsibility. I hear non-alcoholics say all the time that no one poured the alcohol down the alcoholics throat. This is a simplistic way to perceive the problem.

What we do in treatment is educate our clients about the chronic brain disease of addiction, then the clients are responsible to do something about the problem and to answer for past behaviors. No one is getting off any hooks — in fact, it’s quite a rigorous and emotionally exhausting process dealing with past actions and the present consequences from years of irrational behavior and impaired judgement.

When the alcoholic understands the condition of alcoholism, then they can do something about the condition. If the alcoholic is simply condemned, berated and shamed, the problem only gets worse – if the person doesn’t understand that alcohol, and how alcohol affects their brain, is the main problem, they might try to do the right thing but continue to lose control of the alcohol and create more problems for themselves and others. The alcoholic who doesn’t understand his/her condition might stop drinking for awhile, start feeling better, straighten out problems, then think that they can drink responsibly again because they’ve become responsible and clear-headed. In fact, when family and friends tell someone in treatment that the disease concept is a cop-out and that the person only has to tighten up and control their drinking, they’re setting the person up to drink more and to continue the progression of alcoholism.

Recovering from alcoholism is difficult, but it’s worth the effort. Recovery requires abstinence, first of all. A recovering alcoholic has to understand their condition regardless of whether others understand or not. The reason Alcoholics Anonymous is so effective for long term treatment of alcoholism is that other recovering alcoholics understand what alcoholism and recovery are about. The average person, although they might have good intentions, doesn’t fully understand. The family member or friend can help, though, just by understanding they don’t understand.

Alcoholics drink every day

alcoholism treatment

Facts about alcoholism

Another myth about alcoholism is the idea that to be an alcoholic you have to drink every day. There are different types of alcoholics and different stages of alcoholism.

Not every alcoholic drinks every day, although most alcoholics in the late stages of alcoholism drink daily as long as they can physically withstand the consequences. Some alcoholics, though, are periodic drinkers. A periodic drinker who is also an alcoholic will go on what’s been termed “benders”. The periodic might drink to excess for 4 or 5 days then suffer the hangover and withdrawals to stay sober for 2 weeks or a month, then go on another bender for another 4 or 5 days.

The problem is what alcohol does when the drinking begins. Alcoholism also has stages. No one goes straight to late stage alcoholism when they first start drinking, so there might be years in which the alcoholic can control his/her drinking to a certain point, then lose control at another point. Some have called this controlled and uncontrolled drinking. If a person has to exert energy to “control” drinking, this could be a symptom of alcoholism. Normal drinkers don’t have to exert energy to control their drinking — they can take it or leave it.

An alcoholic’s drinking increases in frequency as the alcoholism progresses and it becomes harder and harder to control. Many alcoholics deny they have a problem because they can stop for periods of time. In order to diagnose alcoholism it takes a number of signs and symptoms, so the ability to control the drinking in the early and middle stages doesn’t mean the person is not an alcoholic. Below from is a list of stereotypes regarding alcoholics and how stereotypes are not always valid:

The usual stereotype of an alcoholic includes a list of characteristics including:

* Someone who doesn’t have much money.
* Drinks cheap alcohol – often from a paper bag.
* Is unable to hold down a job and may even be unemployable.
* They are usually estranged from their family.
* Physically or verbally aggressive.
* Someone who drinks every day.
* Someone who drinks alcohol as soon as they wake up.
* They frequently suffer from blackouts where they can’t remember what has happened.
* They have made a mess of their life.
* They will probably be wearing cheap clothes and have poor personal hygiene habits.
* They enjoy drinking alone.

While there are certainly alcoholics who do fit in with at least some of the characteristics of the stereotypical alcoholic the majority do not. In reality an alcoholic can:

* Have plenty of money and nice possessions.
* Only ever drinks expensive beers or wines.
* Is highly successful in their career and their work colleagues respect them.
* Are loved by their family and friends.
* Never become aggressive when alcohol. They may even be able to completely hide the fact that they have been drinking.
* They are able to stop drinking for days at a time.
* Never drink in the mornings.
* Never experience blackouts – or at least don’t remember experiencing them.
* Are highly respected in their community and thought by many to be a successful person.
* Wear expensive clothes and are always well groomed.
* Rarely drink alone.

Alcohol withdrawal

Delirium tremens

The downside of alcohol

Most people think about heroin when they think of withdrawals. We’ve all seen the movies about the heroin addict sweating and writhing in pain. There are also movies that show the reality of alcoholism, but most people see only  commercials that highlight the positive aspects of alcohol. Even when people know about alcohol withdrawal, they usually associate it with skid row bums. I’ve seen a bank owner worth tens of millions of dollars in life threatening withdrawals and countless other examples of alcohol withdrawal far away from skid row.

Actually, withdrawal from alcohol is more dangerous than opiate withdrawal. Opiate withdrawal is normally not life threatening, but alcohol withdrawal is life threatening — no alcoholic should try to quit cold turkey. Alcohol withdrawal can be so dangerous they have a medical term for it — Alcohol Withdrawal Syndrome (AWS). Below are symptoms of AWS:

  • Anxiety
  • Tremors
  • Nausea and/or vomiting
  • Headache
  • Increased heart rate
  • Sweating
  • Irritability
  • Confusion
  • Insomnia
  • Nightmares

The most serious type of AWS is delirium tremens (DTs)

  • Extreme confusion and agitation
  • Fever
  • Seizures
  • Tactile hallucinations (e.g., itching, burning, and numbness)
  • Auditory hallucinations (e.g., hearing non-existent sounds)
  • Visual hallucinations (e.g., seeing non-existent images)

It’s best to get medical help if you’re addicted to alcohol and have been drinking for a long period of time. Even if you have been drinking in binge patterns, the symptoms can progress over time. This is from MedLine Plus:

If you have mild-to-moderate alcohol withdrawal symptoms, you can often be treated in an outpatient setting. You will need someone to commit to staying with you during this process and who can keep an eye on you. Daily visits to your health care provider are often needed until you are stable.

Treatment usually includes:

  • Sedative drugs to help ease withdrawal symptoms
  • Blood tests
  • Patient and family counseling to discuss the long-term issue of alcoholism
  • Testing and treatment for other medical problems linked to alcohol use

It is important that the patient goes to a living situation that helps support them in staying sober. Some areas have housing options that provide a supportive environment for those trying to stay sober.

Permanent and life-long abstinence from alcohol is the best treatment for those who have gone through withdrawal.

If you have a problem with alcohol, you should let your physician know and ask for help.