Life Health & Wellbeing

Wednesday 12 December 2018

How do you stop drinking?

Author and journalist Suzanne Harrington has been sober for nearly 13 years. She looks at the top five treatments available for alcohol abuse

Alcoholism is entirely treatable
Alcoholism is entirely treatable

It's Alcohol Awareness Week, and we Irish are probably more aware than most, given how the World Health Organisation found that we come second out of 194 countries - Austria is first ­­- in the global binge-drinking stakes. And as 24pc of us don't drink at all, that's a lot of martinis between the rest of us. According to a Health Ireland survey in 2015, around 7pc of us are 'alcohol dependent', which works out at between 150,000 to 200,000 Irish citizens with drink problems. There are 20 million in the US, but it's the EU which has the world's highest concentration of alcoholics, with even 'normal' drinkers consuming double the global average. And in Ireland, we live in a culture where it is still more acceptable to drink alcoholically, than it is to seek help for drinking alcoholically.

As anyone who has ever been on the wrong end of alcoholism knows - either because you are an alcoholic yourself, or are in close proximity to one - it's the opposite of fun drinks with friends. It's miserable drinks by yourself, because by the time you realise you have a problem and need to stop, your alcoholism will have painted you into a corner. It's a condition of obsession and craving, loneliness and isolation. Zero fun.

So how, if you have reached this unfun place, do you reverse out of it? While it is acknowledged that there is no cure for alcoholism - you cannot zap it with chemo, or medicate it like depression, or grow out of it, nor will it ever plateau or level off, because it is chronic and progressive and ultimately wants you dead, the same as any other disease - the good news is that it's entirely treatable. Abstinence is the most widely accepted solution, but how do you stop? And how do you stay stopped?

 

Treatment Centre

Aka rehab. Essential if you are physically addicted to alcohol, because detoxing alone is dangerous and hard - you can suffer seizures, DTs, etc, even if you get past the overpowering cravings, shakes and anxiety. Depending on how deeply your addiction has taken hold, you may need anything from a short physical detox to months spent rewiring yourself in a highly structured environment.

Pros: You are in a safe, supportive place surrounded by people who know what they are doing. Your physical detox will be safely managed, and your mental obsession with alcohol comprehensively addressed.

Cons: Hard to access. Can be cripplingly expensive. You need to be totally ready or it's a waste of time and money. And if you don't keep up your recovery work when you leave, the chances of relapse are high.

 

The 12-Step Recovery

Alcoholics Anonymous is the world's oldest recovery programme - before it was set up by two US alcoholics in 1935, the options were the psych ward, jail or death. The 12 Steps, written by its founders, are now used in other 12-step fellowships to address addictions and behaviours relating to drugs, food, sex, gambling, debt, co-dependency etc.

According to the Betty Ford Foundation, the success rate of AA - based on a survey of 6,500 of its US members - shows that 35pc were five years or more sober, 34pc were between one and five years sober, and 31pc were under a year. Given how AA does not keep records, however, it's hard to quantify success rates on an ongoing basis. (For an accessible intro to what the 12 Steps actually are, Russell Brand's, Recovery: Freedom From Our Addictions is a good place to start.)

Pros: It's global, it's free, it's run by alcoholics for alcoholics. There are no surnames used, details taken, or membership fees, which means that it's run on altruism and without hierarchy or paid employees at grass-roots level (every meeting is self-supporting and autonomous, based on AA 'traditions' - all you need to set up an AA meeting is two alcoholics and a copy of the set text, known as the Big Book). You can walk into a meeting anywhere, anytime, and become part of a solid support system.

Cons: Popular misconceptions are that it is a religious programme, because 'God' is mentioned quite a bit in the 12 Steps, which can put people off. Also, that it is old fashioned, cult like, prescriptive, and the coffee is terrible.

Disclaimer - 12-step recovery has kept me sober for nearly 13 years, and I'm agnostic; it's home to atheists and as well as believers of all types, and promotes spiritual well-being rather than any particular idea of 'God', although the culture of the location may influence this - I've heard of meetings that begin with the Lord's Prayer).

 

SMART Recovery

Self-Management and Recovery Training (Smart), an international non-profit organisation which began in 1992, uses the same format as 12-step recovery (abstinence based, mutual support groups) but without "stigmatising" terminology, so no mention of 'alcoholic', 'addict', or - as it not spiritually based - 'God'. Its literature promises to evolve alongside scientific findings around addiction, as science itself evolves.

Pros: It uses rational emotive behaviour therapy, taken from CBT, and motivational interviewing techniques, taken from motivational enhancement therapy, so would suit those who don't want to "hand over" their lives to "a power greater than themselves", as in 12-step recovery.

Cons: Not as universal as 12 Step recovery. There are 1,500 Smart weekly meetings around the world, compared with 117,000 AA meetings.

- See also Women For Sobriety, Lifelong Secular Recovery.

 

Sinclair Method

Standard treatment protocol for alcoholism in Finland, pioneered by US doctor David Sinclair in Helsinki, who was influenced by Ivan Pavlov (of salivating dogs fame). Sinclair hypothesised that alcohol creates reinforcement in the brain, in a similar manner to opioids, and so introduced a treatment where you take a pill (an opioid antagonist) before drinking. This basically blocks the pleasurable feeling you get from booze, so over time, the desire to drink fades by 'tricking' the brain.

Pros: Has shown 80pc success rate in moderation / abstinence within six months.

Cons: It's mostly in Finland. You still put alcohol into your body, so if you have liver damage or similar, it's not going to help.

 

Medication

Unlike depression, there is no 'magic' bullet in pill form for alcoholism. The pharmaceutical industry would love if there was, but none of its offerings has proved foolproof or massively successful. Also, anecdotally it's still common for GPs not to understand the basics of alcoholism, often telling patients to "cut down" or "control" their drinking - alcoholics cannot do this. We differ from normal drinkers in that we do not have an "off button". Hence abstinence being the ideal.

According to a five-year study by Colombia University, "misunderstandings about the nature of addiction and the best ways to address it, as well as the disconnection of addiction medicine from mainstream medical practice, have undermined effective addiction treatment".

Antabuse (disulfiram): The most famous and least subtle one, which blocks the enzyme we use to metabolise alcohol. One sniff of booze after taking this medication and you will be violently, hideously sick.

Selincro (nalmafene), ReVia, Vivitrol (naltrexone): Block the effects of alcohol in the brain, reducing cravings over time - think Pavlov's dogs in reverse. Pills or implants. No effects if taken without alcohol.

Campral (acamprosate): Can help with PAWS (protracted withdrawal symptoms), once acute withdrawal has been managed, by only in conjunction with peer support / talking therapies.

Conclusion: You can try lots of things to treat alcoholism. Moving house, changing jobs / partners / friends / drinks, 'controlled' drinking (for alcoholics, there is no such thing, which makes it a stressful and futile exercise). Addiction counselling and medication can help, but remember - alcoholism does not go away. It is not curable.

That's why peer support is the best long-term option - nobody understands alcoholism like another alcoholic. And you might just make some of the best friends you will ever meet.

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