Alcohol Abuse vs Alcoholism
The difference between the two is one of degree. Alcoholics have little if any ability to stop drinking. They are addicted. Those who abuse alcohol have some ability to resist drinking. However, both abuse their bodies and those with whom they live and work.
- Signs of Alcohol Abuse
- Alcoholic Symptoms
Repeated Neglect of Responsibilities
Alcoholics and people with alcohol abuse frequently miss work. They show up late and are late turning in assignments. The quality of their work is poor. They neglect job and home responsibilities, break promises and miss appointments because they forgot or are hung over. They have lost enthusiasm for their job and family and often seem confused or overwhelmed.
Alcohol Consumption in Potentially Dangerous Situations
Alcoholics frequently drive after drinking over the legal limit. They operate machinery when they have been drinking and engage in social activities when drunk. Alcoholics frequently mix prescription and non-prescription drugs with alcohol. They also neglect to eat properly.
Problems with the Law
Alcoholics frequently lose their driving privileges because of drinking and driving. They also pick fights and get arrested for disturbing the peace, assault, resisting arrest, and public lewdness.
Using Drink to De-Stress
When alcoholics are under stress at home or work, they frequently turn to alcohol to “smooth off the edges”. They are convinced that alcohol soothes their stress and brings relief. This becomes a habit every time things get the least bit stressful. Paradoxically, drinking creates additional stress or exacerbates the existing challenges in one’s life. Alcohol is also a central nervous system depressant, so that when those diagnosed with depression use it to self -medicate, there is the unexpected reaction of increased depression.
Relationship Problems Due to Drinking
Alcoholics are frequently unreliable so family members learn they can’t count on them. Alcoholics are irritable when they have been drinking because they are hungover and/or they are suffering withdrawal. Hence, they are abrupt and often volatile. There is a strong correlation between alcohol abuse and physical, verbal and emotional abuse of family members.
Alcoholics and those who abuse alcohol find that it takes increasingly more alcohol to satisfy them. They are drinking more than those around them. Others are noticing that they are drinking heavily.
When they are not drinking alcoholics, alcoholics display symptoms of anxiety. They drink to stall symptoms of withdrawal which include: edginess, irritability; shaking; hot and/or cold flashes; exhaustion; inability to sleep; lack of appetite; flu-like symptoms; headaches; depression; thoughts of suicide;
Inability to Stop
Alcoholics cannot stop drinking so they hide bottles, steal alcohol, drink on the job and drink more than they intended to.
Neglect of People/Duties/Responsibilities
Sadly, one of the most pervasive characteristics of alcoholics is their forgetting to do things, breaking promises, not showing up and not doing what they said they would do. Basically, the children, spouses, friends, co-workers and employers of alcoholics learn they will always be disappointed.
Continued Use in Spite of Negative Consequences
In spite of legal problems, ill health, family alienation, job shortcomings, danger of loss of income, accidents and near accidents alcoholics continue to drink. Their friend, co-workers and family drift away and still they drink. They are powerless to stop until they hit rock bottom.
What Types of Treatment Options Available for Alcoholics?
No alcohol treatment program fits all individuals. And because there are so many treatment programs the choices are dizzying. Thus, it is important that an alcoholic assess his needs. Often this requires help. It should come as little surprise that Alcoholics Anonymous is where many alcoholics first turn. While effective for some, AA is not the answer for all. In fact, for many it may not be the best approach. It is important to know your needs and the alternatives available.
- Conventional Medicine
Doctors and other medical professionals will treat alcoholics for their condition only if the alcoholic himself is serious about seeking treatment. Medicinal treatment includes:
At the time of entering treatment, the alcoholic may be in a medical emergency situation which requires detox. The side effects of withdrawal of alcohol from the system may be severe. These could include: seizures, hallucinations, insomnia, and delirium. Antidepressants like Benzodiazepines treat withdrawal symptoms most frequently in the detox stage. These are gradually discontinued. The danger in taking them too long is yet another addiction.
During this phase of treatment, the alcoholic is given drugs and counselling follow detox or begin the medical treatment. Several medicines are used in the recovery phase. Common ones are: Disulfiram, Naltrexone, Topiramate, and Acamprosate. Side effects can include nausea, vomiting, blurred vision, irritability and insomnia. Doctors monitor use and side effects carefully.
Maintenance of Sobriety
It is our perception that alcoholics are never “cured”. They are in abstinence and hopefully will stay that way. Sustained recovery requires a combination of factors, including ongoing support such as Alcoholics Anonymous or alternatives; as well as family, colleagues, and friends; and a mentor or sponsor. There is no one size fits all intervention to maintain sobriety.
- Self-Help/Support Groups
For those struggling with alcohol issues, peer support groups can be invaluable. Everyone has experienced what the alcoholic is suffering and provide enormous non-judgmental support. There are several places to turn.
Perhaps the most well-known and readily available, AA runs group support groups in several locations in most towns, cities, and villages. Meetings occur throughout the day making it easier for people to fit them into their schedules. There are also meetings for family and friends of alcoholics. The 12 step program has shown good success. AA calls on the help of a sponsor—himself a recovering alcoholic who is available 24/7—and a “Higher Power”.
Secular Organizations for Sobriety
SOS is an international organization. It has a science-based, self-empowerment way of leading to the goals of abstinence and recovery. SOS tasks the alcoholic with his own recovery and success.
Self-Management and Recovery Training
SMART is a program whose goal is abstinence from alcohol or drugs through self-empowerment and self-directed and self-initiative. The individual is the focus of the recovery.
Refuge Recovery was created by Noah Levine, himself a recovering addict as a mindfulness based, Buddhist oriented alternative to 12 step programs.
Individual – The advantage of individual counselling is that the program for alcoholics is that they can discuss their individual problems and challenges one-on-one with a trained professional knowledgeable in the field. The clinician will be versed in both mental health and addiction oriented dynamics and will provide structure and education for making healthier decisions to maintain sobriety.Group – Because many alcoholics encounter the same problems, symptoms and fears group counselling often provides a safe environment for exchanging ideas and sharing strategies. A clinician with a background in issues related to the addict’s needs will facilitate; offering communication, group dynamics, boundary setting and other recovery oriented skills.
Family – Alcoholism is a family problem. The alcoholic’s problems and behaviors affect all members of the family. Likewise, an alcoholic’s rehabilitation is dependent on their support. It is also a multi-generational disease, so various members may still be using while the client is attempting to remain sober.
- Home Treatment
Abstinence is the greatest hurdle for alcoholics. Home treatment seeks to change a lifestyle so the alcoholic avoids people, places, and events that are triggers to his drinking. That often means seeking new friends, new activities and new venues all at once. This is a drastic step. Suggestions include church or volunteer opportunities, a new hobby, or renewed hobby that may have gone by the wayside as a result of drinking, exercise, and fitness programs. Joining a self-help group and/or seeking counseling are also highly recommended.
- Intensive Outpatient Program
Intensive Outpatient Programs (IOP) provide alcoholics with several hours per week—often ten or fifteen hours during three or four days a week. Patients are in a structured environment involving a structured program like the 12 Steps. Clinical treatment programs run by trained professionals help alcoholics individually or in small groups work toward achieving and maintaining sobriety.Patients get help with identifying triggers, devising strategies and communicating effectively, finding positive ways to deal with stress, and living a healthier lifestyle.
As expected, IOP programs are more costly than group or individual counseling because of the intensity, setting and staff required.
- Partial Hospitalization Programs
Partial Hospital programs offer treatment tailored to the alcoholic’s specific needs. The environment is both supportive and structured. For example each morning, the patient might attend group sessions designed to teach healthy living skills. In the afternoon, they might attend two more groups with breaks and a lunch hour between morning and afternoon sessions. Patients also meet individually with their physician and counselor. This Monday to Friday program has a backup support for patients who run into difficulties at night or on week-ends. As is so with the IOP, there are a myriad of topics that are covered which enhance sober living.
- Inpatient Residential Treatment Facilities
Inpatient residential facilities provide round-the-clock patient treatment and care. Depending on patient needs and what the facility offers the program may be thirty, sixty, ninety days or longer.
While in residence patients get counseling, medical treatment, health and nutrition education, coping strategies, trigger recognition, and effective communication skills.
Selecting the facility that best meets the alcoholic’s unique needs is important. Those with a longstanding history of substance abuse may need the structure and intensity of an inpatient treatment program. The cost of these programs is higher but they do include accommodation and meals as well as twenty-four-hour care by trained professional.Insurance plans may cover varying lengths of stay.
- Sober Living Program
Sober Living Program provides halfway houses for those leaving residential treatment programs. The reason for this is based on research. The National Institutes of Health learned that time spent in sober-living houses for alcoholics from inpatient treatment markedly increases their success rate over those who returned from residential treatment directly to their former life style. The latter group faces a high chance of relapse. Sober-living homes bridge the gaps from residential care to unrestricted environment. Compulsive alcoholics are far more likely to revert to their old patterns of almost immediately upon discharge without a “halfway house” of some sort. This form of treatment may be covered by insurance, while a recovery house, which is less stringently supervised, is not. In each of these settings, regular meetings (such as 12 step or alternatives occur, residents are expected to maintain the house with shared chores, as well as secure employment to support themselves.
- Brief Intervention
As the name suggests, brief interventions are short individual counseling sessions designed to assist people who are dependent on alcohol. Using assessment tools, they are usually intended for those who drink in harmful or abusive ways. Imagine first aid for addiction, which can last minutes, with minimal follow-up
Brief intervention rates highly in studies of the effectiveness of treatment programs. This may be because of its more moderate demands. It could also be because of the type of alcoholic who uses this intense and short term modality. It may also provide the wakeup call required to change the pattern before the person decompensates.
If drinking continues, despite this method, then a higher level of care would be recommended.
The intervention which has the greatest success rate depends on the patient. Other non-patient factors include:
- What is the severity of his alcohol abuse?
- What are his personal needs, demands, and preferences?
- Does he have related or co-occurring medical or psychiatric problems?
- Are there other mitigating factors like cost, distance, home responsibilities?
- Personal commitment to making the program work.
Determining Your Specific Needs
The first step is to assess where you are and how your behavior affects others. As you engage in a ‘cost/benefit analysis’, you will be better able to determine how the abuse of alcohol or addiction to it is impacting on your life and whether the you wish to mitigate the effects of this behavior by engaging in treatment.
Assessing Individual Needs – Ask yourself:
- Have I ever made a commitment to stop your drinking and been unable to keep this promise so for any length of time?
- Do others seem bothered or uncomfortable about my alcohol intake? Do they make comments about my behavior when I am intoxicated?
- Have I ever rationalized that I “quit” or “cut back” on my alcohol consumption by switching from “hard liquor” to beer or wine or by decreasing my consumption?
- Have I ever used a morning alcoholic beverage as a “pick me up” or “hair of the dog”?
- Do I envy others who can drink without it being an issue?
- Have I had trouble at school or work because of my drinking?
- Has my drinking caused trouble at home or in my social circle?
- Do I ever sneak drinks or arrive at a social function buzzed so other have no idea how much alcohol I am actually consuming?
- Do I tell myself and others that I can quit anytime?
- Have I missed school or work or a social function because I was too drunk or hungover to be there?
- Do I rationalize or minimize the choice to drink, because “everyone is doing it?”
- Do I self-medicate when symptoms of anxiety or depression arise?
- Have I incurred legal consequences as a result of my drinking?
- Is it impossible to imagine a life without alcohol?
- Are my social circles primarily or solely comprised of those who drink or use drugs?
Having faced the seriousness of your drinking problem, the next step is to survey available alcohol treatment programs for one that best matches your needs.
What to Look for in an Alcohol Treatment Program
Survey the many alcohol treatment programs using information from your doctor, your AA mentor and by doing a computer search using a search engine like Google. When you have found what is available within your budget and distance and needs. This might then be an appropriate time to put your data on a spreadsheet.
Look at the top choices using these filters:
- Is the program accredited and/or licensed by its state?
- Is the program run by licensed addiction professionals with significant experience in the field?
- Does this program match my identified needs?
- How effective has this program been in the past? Does this facility have credible data on its success rate?
- What type of follow-up exists?
- Does the program have access to round-the-clock backup and support?
- Is this treatment facility a reasonable distance from my home?
- Can I talk to anyone who has successfully completed this treatment program?
- Is there something that especially appeals to me about this program or this facility or this staff?
- Does this facility interface with support services in my community?
- Is the program covered by medical insurance or employee assistance program?
- Is the facility clean, tidy, and cheerful?
- Is there ongoing assessment that is used to adjust treatment when needs change?
- Is behavior counseling part of the program?
- Does the program seek to get to the root of what is causing my drinking?
- What strategies does this program use to encourage me to stay in treatment?
- Does the program incorporate medication to increase the chances of success?
- What steps does the program take to discourage relapse?
- How does the program support me in case of relapse?
- Are there services offered to my family to help them deal with both my alcoholism and my rehabilitation?
- What follow up/after care do the recommend?
- Do they encourage a comprehensive approach that includes physical, emotional, mental and spiritual components?
- Does the program reinforce personal responsibility for choices?
- Does it present the idea that recovery is an ongoing process that requires time and attention, but that it is not the sole focus of one’s life, since that in and of itself can become an addiction?
Comparing Alcohol Rehab Treatment Success Rates
There are several measurements of the success of an alcohol rehab program. Hard data includes numbers of recovering alcoholics that remain sober after specific time periods. These data are usually collected via surveys, reports from follow-up facilities, Alcoholics Anonymous memberships and other numerical counting strategies. Researchers have tracked the progress of recovering alcoholics within a treatment program and across several treatment programs in an attempt to discover which treatment programs are most effective, what percentage of recovering alcoholics remain sober after treatment, and how long recovering alcoholics remain sober.
Softer data include interviews with recovering alcoholics, alcohol treatment center personnel, families and colleagues of alcoholics.
Researchers have discovered several things about treatment programs. For example: The recovery rate for alcoholics is similar to the numbers of those who recover from type 2 diabetes, hypertension, or asthma.
Researchers have also tracked the progress of alcoholics who have returned to productive, sober lives at work, in their families and in their communities. What they discovered is that most who complete alcohol treatment programs stop using alcohol and decrease their negative behaviors that went with inebriation.
Treatment measures that tend to keep alcoholics sober after leaving treatment include drug therapy like methadone treatment, behavioral therapy and support group membership.
However, individual treatment results vary greatly depending on the extent and nature of the recovering alcoholic’s problems. Treatment success is also largely affected by the appropriateness of treatment. Other factors include whether related services exist and how they are used, and the quality of interaction between the recovering alcoholic and treatment providers, family and friends.
Alcoholism like asthma, hypertension, heart disease and diabetes is a chronic disease. Thus the success of its treatment program is dependent on several factors.
The good news is that alcoholism, like other chronic diseases, can be managed. At the early stages, treatment helps alcoholics counteract those powerful, disruptive effects of the disease on the body, the brain, the mental health and behavior of the alcoholic so he can regain control of his life. Because alcoholism is a chronic disease, relapses are common and may be recurrent. Like other chronic ailments alcoholism has both physiological and behavioral components. The treatment program that best addresses both these aspects of the disease for the individual alcoholic will be the one which is most successful for him.
SAMHSA (Substance Abuse and Mental Health Services Administration) offers a comprehensive view on the aforementioned topics.
When it comes to cost, a lot depends on the type of treatment, the length and the intensity. The price of addiction rehab in America has increased markedly in the last 10 years. In 2005, the average investment in a treatment program was less than $1500. Now rehab facilities charge in excess of $10,000 for comprehensive care.
This dollar amount, however, must be considered against the cost of loss of work due to alcoholism, medical fees for alcohol-related illness, and the overall debt incurred as a result of one’s drinking habit.
In addition, there are “soft costs” including stress to family and friendships.
What is involved in the Costs?
The expense involved in treatment includes counseling, medication and any accommodations and meals in a residential or inpatient treatment program. In addition, the costs of a fully qualified group of professionals and facility fees must be considered. Alcohol rehab treatment programs can be free or they can charge thousands of dollars a month depending on the program and facility.
Alcohol rehab treatment programs can be free or they can cost thousands of dollars a month depending on the program and facility.
How Much Can You Afford?
This first question should be: What type of treatment do you require. The next question is: What will your medical insurance and/or your employee assistance benefits pay. Based on these two answers, you need to look at the additional out-of-pocket costs. They may be surprisingly low.
The other consideration is: Can you afford not to get help?
Rehab Costs vs. Addiction Costs
Addiction to various substances including alcohol has a high cost to the individual as well as society. In 1998, the cost of alcoholism to USA was $186.4 billion. Substance abuse costs our in American are well over $600 billion annually. Treatment costs actually reduce these costs. The cost of an alcohol addiction treatment program has been shown to reduce both medical health and social costs by significantly more than their costs. A report by the US Department of Health and Human Services estimates that the benefits of providing treatment outweigh the costs 7 to 1. Rehab is an investment. Every $100,000 tax dollars spent on alcohol treatment programs saved American tax payers $487,000 in 1998. This figure can only be higher now.
Treatment is much less expensive than alternatives like court and incarcerating costs. For the individual, the cost of an alcohol rehab program is far less than loss of work due to being drunk, hungover or sick due to alcohol-related conditions. Absence from work due to alcoholism frequently ends in job termination.
If medical insurance does not cover the cost of an alcohol rehab program, check with your work benefits. Many of them have an employee assistance program that covers the cost of addiction treatment, mental health, and counseling not covered by medical insurance.
Other alternatives include low-cost or no-cost rehab programs such as brief intervention and group support programs. Church groups, charities and nonprofit organizations may provide free alcohol treatment services in your area for those who need financial assistance. Check to see if there is a sober living housing facility funded by a nonprofit or religious organization in your community. These are sometimes provided to individuals who are really serious about getting and staying sober and, consequently, changing their lives. These are available throughout the USA in various locations. The rehab services offered through these sober-living homes are usually free.
Check with the treatment center where you want to go. They may also agree to a payment schedule that is within your budget.
Why Inpatient Rehab Centers Work
Inpatient rehab centers get the individual away from the temptations of drinking. He has no source of alcohol. He is in a sheltered environment where his activities are monitored 24/7.
Inpatient rehab also distances the alcoholic from the things and people and events which trigger his drinking. In the absence of triggers such as friends, work, stressful events, bars, and enablers, the alcoholic has less chance of relapse.
Inpatient care provides counselling by trained alcohol rehab specialists. Moreover, support is there 24 hours a day. Inpatient centers provide a structured, supportive environment where the alcoholic can focus on his problem and learn coping strategies for the triggers than cause him to drink. Inpatient facilities offer the recovering alcoholic a “running start”. By the time he gets home, he is on the road to recovery. He is sober and he has gathered numerous coping strategies that can be utilized immediately and on an on-going basis. He has learned what triggers his drinking and what he should avoid.
The inpatient treatment program provides trained psychiatrists who work with the patient to uncover root causes for his alcoholism. Most inpatient treatment programs have follow-up or aftercare services. Many have halfway facilities which offer the recovering alcoholic the chance for gradual reintegration into his previous environment.
Inpatient rehab offers the individual the time and resources to fill his schedule with healthy hobbies and activities that drinking once occupied. Most alcoholics do not eat or live well. Inpatient rehab gives them healthy lifestyle choices and a chance to increase their vitality.
How Effective are Inpatient Rehab Centers?
In terms of the number served who stay sober and the length of time they manage to do so, there have been many studies and little agreement on the effectiveness of inpatient rehab. The success rate appears to vary greatly from facility to facility. Differences also exist in how the study was done and the numbers of patients in the study.
Comparison with other Treatment Methods
In a landmark study, Hester and Miller (2002) concluded that the six alcohol treatment methods were: brief interventions by a competent, trusted healthcare professional, motivational enhancement using counselling, medical intervention using Acamprosate, community support using the patient’s social connections, self-change manuals, and the medical intervention using Naltrexone.
Alcoholism is a chronic disease. Relapses are disappointing yet common. Jane Brody reports in her New York Times February 4, 2013 article “Effective Addiction Treatment” that only about 1 in 10 substance abuse addict gets treatment and that the treatment programs too often fail to keep them sober. She charges that: “Many of these programs fail to use proven methods to deal with the factors that underlie addiction and set off relapse.”
Which is Better? Inpatient or Outpatient Facilities?
No one alcohol treatment is better than another. Which is most effective depends on the specific needs and personality of the patient. In this chapter we have examined the benefits of an inpatient treatment program. The quality of the program and whether it addresses the root causes of the alcoholism seems to be an important factor.
Beyond Recovery: What Next?
You’ve successfully completed your inpatient rehab program. That is definitely cause for celebration. But, the battle is far from won. This is a very important step but it is but one lap of the race. When you complete rehab, the success of your staying sober depends on the follow-up services offered by your inpatient facility and your willingness to involve yourself in support services and groups.
Sober Living offers halfway house facilities that bridge the gap between the treatment center and your home.
Group support is offered by such mutually-supporting people as Alcoholics Anonymous.
Many of the inpatient treatment facilities have staff, group counselling and regularly scheduled check in sessions and workshops designed to help you stay sober.
In addition, there are things you can do to help yourself stay sober.
- No matter what after care service, group or facility it is, find one that suits your individual needs and personality and schedule and stick with it. This is your lifeline. Commitment to your recovery is essential in order for it to succeed. Make it as important as drinking once was.
- Keep yourself busy. Having time on your hands is just inviting relapse. Find a new hobby or continue one you started in treatment. Volunteer your time and talents to give back to your community. Implement healthy family activities like running, walking or biking. This is a win win win win situation. You are exercising, spending time with the family, modelling a healthy lifestyle and keeping yourself away from alcohol.
- Eat healthy, exercise, and get at least eight hours of sleep each night. If you take care of yourself those alcohol cravings are less frequent and less severe.
- When you feel yourself slipping use your support system to hang on.
- Follow the relapse prevention training you learned in rehab. Be rigorous and uncompromising about it.
- If you relapse, do not fall back on self-destructive habits. Instead, call your AA sponsor or the contact person from your inpatient rehab treatment facility. Remember: Alcoholism is a chronic disease. Treat it the way you’d treat any chronic disease. You are never “cured”. There will always be the possibility of relapses. Take one day at a time.
- Don’t bottle things up. Open and honest communication is critical. Talk to your counselor. Share how you are feeling with your sponsor. Let your family share your concerns and celebrations. Be forthright with them about how they can help.
- Develop a support network of family, colleagues, friends, and neighbors. Lean on them when you need to. They will help you through the rough patches.
- If someone is an enabler or a trigger discuss this with them. If their behavior continues to be destructive to your staying sober, distance yourself. You cannot afford to lapse.
- Make effective use of the strategies you were taught to avoid relapse.
- Create a reading list of books about recovery.