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Fraser Trevor Fraser Trevor Author
Title: They then took up drinking. And drink they did. They got drunk. They got sick. They got hung over. But, do you know what? They did not become addicted. They could stop at any time without any trouble whatsoever. The problem wasn’t character. It was chemistry.
Author: Fraser Trevor
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Alcoholism is a devastating disease. I say disease because it is just that: a disease. It is not a character flaw or a weakness of personal...
Alcoholism is a devastating disease. I say disease because it is just that: a disease. It is not a character flaw or a weakness of personality. We have hard evidence for a biochemical basis for alcoholism. The first inkling of a biochemical basis was the observation of spouses (usually wives) of alcoholics. These non-alcoholic spouses would nag, beg, plead, threaten and cajole the alcoholic spouse to stop drinking. Obviously, he did not stop. After years of butting their heads against a brick wall, they decided,”if you can't beat ‘em, join ‘em.”
                They then took up drinking. And drink they did. They got drunk. They got sick. They got hung over. But, do you know what? They did not become addicted.  They could stop at any time without any trouble whatsoever. The problem wasn’t character. It was chemistry.
                The search for the biochemical basis of alcoholism was on. At least two chemicals have been identified: DHIQ and GABA. Awareness of these brain chemicals helped, but it did not help enough. It did, however, help the medical profession approach alcoholism as a disease and not a character flaw.
                Spotting alcoholism can be easy or difficult. Anyone with a DWI is an alcoholic until proven otherwise (please, spare me your sob stories of how you've just got “carried away “that one night). Doctors have developed a brief four point questionnaire if alcoholism is suspected. It goes by the acronym CAGE.
                C             Have you ever Cut down on drinking?
                A             Are others Annoyed by your drinking?
                G             Have you ever felt  Guilty about your drinking?
                E              Do you need a morning Eye-opener?

                From my experience, it is not so much WHAT a person says, it is HOW they say it. If I am in any way suspicious I will offer the patient a formal evaluation. If they accept, they probably DON’T have a problem. If they decline my invitation, that increases my suspicion that they DO have a problem. (Denial is part of the syndrome)
                Medical science has whittled down the main symptoms of alcoholism to four: 1) craving 2) physical dependence 3) loss of control 4) tolerance to alcohol's effects.
                If the CAGE questionnaire made you sit up and take notice and the above symptoms hit home, then you, my friend, could very well be an alcoholic. In my practice, one of the things I have learned is that it is not WHAT you drink, or HOW MUCH you drink, it's “Do bad things happen when you drink?” Do you become belligerent, hostile, short tempered, angry, and violent? Or do good things happen? Do you tell stories, relax, become more talkative, tell more jokes, and become friendlier?
                Big difference, eh?
                Which are you?
                In addition to the social costs of alcoholism, there are extensive physical effects, none of which are good. The following is a but a partial list: withdrawal syndrome, ketoacidosis, liver disease ( including but not limited to cirrhosis), neuropathy, Beriberi,  pellagra, central pontine myelinolysis, fetal alcohol syndrome, dementia, increased risk of injury and death from accidents, suicide, and homicide, infertility, alcoholic psychosis, pancreatitis, and cancer(many forms).
                Most alcoholics must hit bottom before they seek help.  “Bottom” has a different definition for every alcoholic. One will say, “I've got my family -- I'm not an alcoholic” Another, after his divorce says, “I've got my job -- I'm not an alcoholic.” The next one says, “So what if I was fired -- I still have my home.” The next one says, “I don't care if they foreclosed, I've still got my car -- I'm not an alcoholic.”
                How low can one go before denial no longer works as a defense? It is different for everyone. I would like to see a great deal more intervention before the alcoholic hits skid row with literally nothing more than the clothes on his back.
                In my travels, I have come to realize that there is not just one disease called alcoholism. It comes in a variety of forms. One of the more interesting is binge drinking. How does one stay sober for weeks or months at a time and then let loose with a drinking binge? Then there are the closet drinkers. These people seem to have things under control until there is a crisis. One such patient I recall needed surgery. I did the preop evaluation and he admitted to being a “social drinker.” Fine. No problem.
                The operation went well. The first post operative day also went well. On the second day, he was noted to have a low-grade temperature, tremor, and rapid heartbeat. He was contrary, argumentative, easily angered, and frustrated with the hospital routine. After checking for a wound infection, chemical imbalance, pulmonary embolism, myocardial infarction, etc. etc., it became apparent that he was in the throes of alcohol withdrawal. Protocol was instituted, chemical dependency counselors consulted, and the patient was offered treatment. This man had kept his disease under wraps for decades -- until circumstances beyond his control led to the diagnosis.
                Another very common scenario is the person who retires and no longer has the societal inhibitions on drinking imposed on him by the workplace.
                In terms of treatment, many and various approaches have been used.
                One of the first treatments used was called aversion therapy. The alcoholic (drunkard in those days) was under 24-hour supervision for up to a week at a time. During his “treatment”, he could do what he wanted to do, eat what he wanted to eat and drink as much as he wished. The catch was that everything he drank had to be an alcoholic beverage of some sort. Everything he ate had to be soaked in alcohol. At the start of the treatment, he was given enough alcoholic beverages to induce intoxication. He was kept in this state for the duration. The idea was to make him so sick of alcohol that he would not touch another drop for the rest of his natural life. Controlled studies were lacking. I'm sure some were helped. I am equally sure that the treatment failed some people. This method is archaic, inhuman, unscientific and possibly lethal.
                Alcoholics Anonymous was founded in 1935 by two alcoholics who not only admitted that they were powerless over alcohol, but did something about it.  It works, but not for everyone. Cognitive behavioral therapy similarly has a hit or miss record. Rarely, an individual can stop his or her drinking using willpower alone.
                A variety of medications have been developed in order to assist with abstinence. The properties of disulfiram (also known as Antabuse) were suspected in the 1930s. Clinical studies were done in the 1940s. FDA approval was obtained in 1951. Antabuse works by causing a severe reaction if combined with alcohol. Symptoms include flushing, sweating, dizziness, headache, nausea and vomiting, and abdominal pain. The effect of mixing alcohol with Antabuse is similar to a hangover to the nth degree. If a patient is able to take Antabuse on a regular basis, refraining from alcohol becomes easier - especially if one experienced a reaction.
                Campral received FDA approval for alcoholism in 2004. The precise mechanism of action is unknown, but it is known to affect brain receptors known as GABA. I may have prescribed it once or twice, but the feedback I got from talking with patients is that the side effects were such that I thought the risks exceeded the benefits.
                In 2008, Dr. Ameisen published a book extolling the virtues of high-dose baclofen for reducing the cravings which alcoholics have for the beverage. Baclofen is a muscle relaxer used mainly for the spasticity of multiple sclerosis and other conditions. Baclofen also works on GABA receptors. Last week, a patient came to my office and requested this medicine. I started with a low dose and will follow up with her. The jury is still out, but perhaps baclofen is the magic bullet we have all been looking for.
                Regardless of the method one uses to obtain a cure, just stopping drinking is not enough. This sometimes results in what is termed a “dry drunk”. In this condition, although the patient does abstain from alcohol, he or she still feels miserable and has not properly learned how to be happy with other things in life -- things other than alcohol.
                Anti-depressants are often used as adjunctive therapy for the alcoholic. Keep in mind that they are part of the whole package and not a treatment in and of itself.
                Whether you quit on your own, join a support group, go for structured out-patient treatment or opt for the full in-patient program, the important point is that you have taken the first step on the road to recovery. The road is long and difficult. You may stumble along the way.  It will probably be the most difficult thing you have ever done in your entire life. But if you are able to get on the road and stay on the road, it will also be the most satisfying thing you have ever done in your life. Good Luck.
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