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Alcohol withdrawal Essay

Research shows that every day, more than 700,000 people in the United States receive treatment for alcoholism. Alcohol withdrawal is a serious complication of alcoholism and occurs when alcoholics, dependent on alcohol, abruptly stop drinking. Alcohol or ethanol is a central nervous system (CNS) depressant in that it causes general inhibition of neuronal processes (Jellinek EM 1960). Symptoms of Alcohol withdrawal include anxiety, agitation, general increased reactivity and an increased risk for seizures. The dysphoria of EW symptoms is believed to play a major role in relapse. (Alele and Devaud 2007)

The first step in treatment of the addictions is detoxification that can be achieved via appropriate medications. Benzodiazepines reliably block withdrawal symptoms of alcohol. The major problem in treatment of alcoholism is relapse, and the risk of relapse continues for months and even years after detoxification. Even people, who perform extremely well during inpatient treatment, exhibiting insight into their drug problems during therapy sessions and a firm intention to avoid all persons, places, and things associated with alcohol, usually relapse soon after leaving the program. Thus, aftercare is critically important and should continue for at least a year or longer to prevent relapse (Goldstein DB 1984).

In addition to detoxification, Behavioural treatments, therapeutic medications, outpatient counselling, and counselling are other available treatment options. Detoxification is often combined with one of the other treatment options to achieve better success rate.

Alcoholics Anonymous (AA) is a type of behavioural treatment which constitutes of mutual support program for recovering alcoholics that is based on the 12-steps of recovery that are needed in order stay sober. It is estimated that there are more than 114,000 groups and over 2,000,000 members of AA in 180 countries. Participation in AA or professional treatment program based on the 12 steps of AA is the major treatment approach in the US. Higher level of attendance during AA meetings followed by professional treatment is consistently associated with better outcomes. Not surprisingly, AA affiliation alone with no professional treatment has not been linked with improvement (Treatment 1995).

A study, which evaluated 15 different treatment programs offered through the U.S department of veterans Affairs, indicated that patients in 12-step program were more likely to become abstinent than other patients from other cognitive/behavioural or mixed therapy programs. (Ouimette et al. 1997). These findings were calculated by monitoring patients undergoing treatment in different facilities. The data was used in studies with the consent from the patients. The researchers, recorded variables such as, mean alcohol consumption, alcohol dependence/withdrawal symptom, use of other drugs, depression, anxiety. Other characteristics that are often considered in determining the success of different alcoholism treatment programs are self-efficacy, commitment of abstinence, cognitive coping, behavioral coping, and primary appraisal of harm due to drinking (Treatment 1995).

Success rates of these different experiments are calculated and analyzed by researchers and clinicians. Success rate is often calculated using days in withdrawal and number of occurrences of relapse and the decreasing pattern of alcohol use. In an in patient facility, the patients do not have any access to alcohol and the days in withdrawal can be easily calculated. However patients who are going through treatment from home have easier access to alcohol. Outcomes of these treatments are often based on trust and information from immediate family members. Data collected is usually calculated as percentage or given a numerical value for ease of analysis. No result can be considered significant without running statistical analyses.

The results from these experiments are usually checked to make sure the indication of variation is small and results are significant. For this purpose, significant sample size is always important. Recent research has shown that there is sex- difference in alcohol withdrawal and treatment and thus researchers argue that the results for males and females should be analyzed differently. Thus, it is often seen that the studies either try to have identical numbers of males and females or report the results separately for males and females. Researchers have shown that females show quicker recovery from alcoholism than male among other differences (Alele and Devaud 2007).

Admission to medical detoxification level of treatment requires an assessment by a physician. It usually involves a 3-5 day stay in a medically supervised detoxification treatment center. The program includes counseling, medications, and group sessions. Medical detoxification followed by AA or therapy shows significant success rate. However, medical detoxification with no follow-up has the highest chances of relapse.

Therapeutic medication is another option for treatment of alcoholism. Antabuse (disulfiram) works as a deterrent against drinking by making the person sick if they consume any alcohol. Naltrexone (Revia) blocks the affects of alcohol in the brain and reduces alcohol craving. Acamprosate (Campral) relieves the distress and discomfort alcoholics experience when they stop drinking. Again, most of these are temporary treatments and show a very low success rate if support groups like AA do not follow it.

Overall, there is numerous different treatment option available for alcoholism. However, if the person abusing alcohol is not mentally prepared to quit, treatment is difficult and often impossible. Thus, behavioral treatments like AA and therapy or the combination of these with medication show the highest degree of improvements.

References

Alele PE, Devaud LL. Sex differences in steroid modulation of ethanol withdrawal in male and female rats.J Pharmacol Exp Ther. 2007 Jan;320(1):427-36. Epub 2006 Oct 4. Erratum in: J Pharmacol Exp Ther. 2007 Apr;321(1):421.

Goldstein DB (1984). The effect of drugs on membrane fluidity, Cowan WM, Shooter EM, Stevens CF, Thompson RC ,eds. Ann Rev Pharmacol 24: 43-64

Jellinek EM (1960). The disease concept of alcoholism. New Brunswick, NJ: Hillhouse Press

Ouimette, P.C.;Finney, J.W.; And Moos, R.H. Twelve-step and cognitive treatment for substance abuse. A comparison of treatment effectiveness. Journal of Consulting and Clinical Psychology. 65(2): 230-240, 1997

Treatment of Drug Abuse and Addiction — Part III, The Harvard Mental Health Letter, Volume 12, Number 4, October 1995, page 3.

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