There Are Options Even When You Can’t Pay (From About.com: Alcoholism)

During times of economic downturn, we receive an increase in email from visitors to the About.com Alcoholism / Substance Abuse site that read like this:

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This is not exactly hot news, that smoking, drinking to excess, not getting exercise and not eating properly will increase your risk for a variety of health problems. But the new research, conducted by Elisabeth Kvaavik of the University of Oslo, studied the four “bad habits” as a combined health threat.

Of the almost 5,000 people followed in the study, only 314 people had all four unhealthy habits and only 387 people had none of the four.

Four Bad Habits

For the study, the researchers defined the four risky behaviors as:

• Any Tobacco Smoking – Smoking cigarettes, cigars or a pipe.
• Excessive Alcohol Consumption – More than three drinks a day (two for women).
• Sedentary Lifestyle – Less than two hours of physical activity per week.
• Poor Diet – Eating less than three servings of fruits and vegetables daily.

Over the 20 years of the study, 29% of those who had all four risky behaviors died, while only 8% of those with none of the bad habits died.

“These habits combined substantially increased the risk of death and made people who engaged in them seem 12 years older than people in the healthiest group,” said Kvaavik.

Reversing The Trend

The researchers said that reversing these health risks does not require extreme measures. Those who got at least two hours of physical activity per week and those who ate fruits and vegetables at least three times a day, were among the healthiest group in the study.

The problem for alcoholics is that research shows that most of them also smoke, many suffer from not eating a proper diet and exhibit a sedentary lifestyle, according to previous research.

Even many alcoholics who have quit drinking still continue to smoke and many fail to get enough exercise and eat healthy diets. That’s the reason that many alcohol and drug rehab programs include education about exercise and nutrition in their long-term treatment plans.

It’s another example that getting sober is only the beginning for alcoholics to return to a healthy lifestyle. True recovery includes many stages.

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Causes

Alcohol withdrawal usually occurs in adults, but it may occur in teenagers or children as well. It can occur when a person who uses alcohol excessively suddenly stops drinking alcohol. Withdrawal usually occurs within 5 – 10 hours after the last drink, but it may occur up to 7 – 10 days later.

The following is generally considered excessive alcohol use:

• More than 15 drinks per week for men or 8 drinks per week for women
• More than 5 drinks per day for men or 4 drinks per day for women
• Habitual use of alcohol that disrupts a person’s life and routines, regardless of amount consumed
• In this definition, 1 drink has 12 grams of alcohol, and equals approximately 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 90 proof spirits..

The more heavily you drink every day, the more likely you will develop alcohol withdrawal symptoms when you stop drinking. The likelihood of developing severe withdrawal symptoms also increases if you have other medical problems.

Symptoms
Mild-to-moderate psychological symptoms:

• Jumpiness or nervousness
• Shakiness
• Anxiety
• Irritability or easy excitability
• Rapid emotional changes
• Depression
• Fatigue
• Difficulty thinking clearly
• Bad dreams

Mild-to-moderate physical symptoms:

• Headache — general, pulsating
• Sweating — especially the palms of the hands or the face
• Nausea and vomiting
• Loss of appetite
• Insomnia (sleeping difficulty)
• Pallor
• Rapid heart rate
• Eye pupils enlarged(dilated pupils)
• Clammy skin
• Tremor of the hands
• Involuntary, abnormal movements of the eyelids

Severe symptoms:

• Delirium tremens — a state of confusion and visual hallucinations
• Agitation
• Fever
• Convulsions
• Black outs — when the person forgets what happened during the drinking episode

Exams and Tests

The health care provider will check for:

• Rapid heartbeat (tachycardia)
• Rapid breathing (tachypnea)
• Elevated temperature
• Abnormal eye movements
• Shaky hands
• General body shaking
• Abnormal heart rhythms
• Internal bleeding
• Liver failure
• Dehydration
• A toxicology screen may be performed as well as other blood tests.

Treatment

The goals are to treat the immediate withdrawal symptoms, prevent complications, and begin long-term therapy to promote abstinence (no drinking at all).

The person will probably have to stay at the hospital for constant observation. This will include monitoring:

• Blood pressure
• Body temperature
• Breathing
• Heart rate
• Fluid and electrolyte levels (chemicals in the body such as sodium and potassium)
  Many patients are given fluids or medications through a vein (IV).

Withdrawal symptoms may worsen rapidly and may quickly become life threatening. Drugs that depress the central nervous system (such as sedatives) may be needed to reduce symptoms, often in moderately large doses.

Treatment may involve placing the person in a a moderately sedated state for 1 week or more until withdrawal is complete. A class of medications known as the benzodiazepines are often useful in reducing a range of symptoms.

The health care provider will watch closely for signs of delirium tremens.

Hallucinations that occur without other symptoms or complications are uncommon. They are treated with hospitalization and antipsychotic medications as needed.

Testing and treatment for other medical problems associated with use of alcohol is necessary.

Disorders related to the use of alcohol include:

• Alcoholic liver disease
• Blood clotting disorders
• Brain disorders such as Wernicke-Korsakoff syndrome
• Heart disorders such as alcoholic cardiomyopathy
• Malnutrition
• Nerve damage (alcoholic neuropathy)
• A drying-out period is recommended after withdrawal is complete. No alcohol is allowed during this time. Permanent and lifelong abstinence from alcohol is the best treatment for those who have gone through withdrawal.

Rehabilitation for alcoholism is often recommended. This may include social support such as Alcoholics Anonymous, medications, and behavior therapy.

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By Buddy T, About.com Guide

There is a saying in the 12-step programs that recovery is a process, not an event. The same can be said for Step 4 — more will surely be revealed.

Made a searching and fearless moral inventory of ourselves.

Whether we come through the doors of Alcoholics Anonymous or Al-Anon Family Groups chances are we bring a lifetime of “stinking thinking” with us. Frankly, it takes awhile for the “fog” to begin to lift, so that we begin to see ourselves and the world around us more clearly.

If we have sincerely completed the first three steps and have truly made a decision to turn our will and our lives over to the care of God as we understood Him, then it is time to put that principle into action. We must find the courage to take a fearless look at ourselves and become willing clean up the garbage we find.

In order to proceed, we must identify the problems and get a clear picture of how our behavior effected ourselves and others around us. That picture is not always in focus for newcomers early in recovery, but as we continue to hang around the rooms, listening and learning from others, and keeping an open mind, we find more layers of the “onion” being peeled away.

Tools to Help

We are not perfect, and never will be in this life. That is the reason there are no graduation services held at 12-step meetings! But if we continue to participate, carrying the message to others, and listening to what they have to share, we can continue to grow and make spiritual progress. That’s why they say, “Keep Coming Back!”

There are tools available to help in the 4th step process. There is a 4th Step Guide available online for A.A. members and Al-Anon has its Blueprint for Progress: Al-Anon’s Fourth Step Inventory which can be ordered online.

But the greatest help available in doing Step 4 is available from a power greater than ourselves, as visitors to the bulletin board here at the About.com Alcoholism site have demonstrated in their shares on this step, as our study of the 12 Traditions and 12 Steps continues.

More about Step 4

Ask for Help

“Leaving God out of my plan was my mistake, with His help all is possible.”

Humble Yourself

“It is worth every second of pain I had to go through to come out on the other side… out of the darkness.”

Being Honest

“Looking in the past has made me understand now more than ever why I did marry an alcoholic.”

A Journey

“I went to that ACOA meeting, and after only 10 minutes the brick wall had fallen down.”

Daily Inventory

“Once we take these steps it doesn’t mean that we are done, I have to take a moral inventory of myself everyday of my life.”

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Antabuse works by causing a severe physical reaction if alcohol is consumed while taking the drug. The longer the drug is taken, the more effective it becomes and the more severe the reaction. Antabuse needs to be taken daily.

Antabuse Treatment for Alcoholism

Antabuse is intended to be used by people who have already stopped drinking for at least 12 hours. The negative reactions it produces when someone taking it consumes alcohol can vary widely.

Long-Term Antabuse Treatment Shows Big Results

A nine-year study of chronic alcoholics in Europe, where alcohol-deterrent drugs such as Antabuse are more widely used than in the United States, revealed that the psychological effects of long-term treatment, along with the physical effects of Antabuse, can produce abstinence rates of more than 50 percent.

Are There Other Medical Treatments for Alcoholism?

There are other medications designed to help people stop drinking, or more specifically, not start again. They work in different ways than Antabuse.

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The research was conducted by Kaiser Permanente Center for Health Research of thousands of members enrolled in their Northwest health plan in Oregon and Washington. Risky drinking was defined as those who drank three or more drinks a day, those who consumed five ore more drinks in one setting (four for women) and those who were identified as at-risk drinkers using a screening tool.

Poor Attitude About Health

The study found that heavy or at-risk drinkers:

• Had less collaborative relationships with their doctors.
• Were more liked to dislike going to the doctor.
• Were less confident they could change their health practices.
• Were more likely to think health is a matter of good fortune.

“The main finding here is that risky drinkers also engage in other behaviors–such as relieving stress with alcohol and cigarettes, not wearing seatbelts, unhealthy eating and not regularly seeing their doctors–that put their health at risk,” said study lead author Carla Green. “Physicians should not only be concerned about patients’ heavy drinking, but also these other health-related practices.”
Moderate Drinkers More Healthy

Surprisingly, the study also found that moderate drinkers exhibited better health practices than life-long abstainers, former drinkers, light drinkers (less than one drink a day) and heavier drinkers.

Moderate drinkers had generally better health, had better health-related attitudes and practices and were more likely to seek routine medical care.

“Even after taking these other health-related attitudes and practices into account, there was still a small but independent relationship between moderate drinking and better self-assessed health,” said co-author Michael Polen in a news release. “Previous research has linked moderate alcohol drinking with cardiovascular benefits, so that might be the underlying reason moderate drinkers report better health. It’s also possible that there are additional factors we didn’t measure that account for this positive relationship.”

The study was published in the journal Addiction Research & Theory.

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If your medication’s packaging contains a warning against mixing it with alcohol, that warning is there for a reason. Mixing alcohol with some medications — even hours after taking the medication — can cause a wide range of reactions, including nausea and vomiting, headaches, drowsiness, fainting, or loss of coordination. Mixing alcohol with some medications increase the risk for internal bleeding, heart problems, and difficulties in breathing.

More Than One Danger

Many medications contain more than one ingredient, and all of them can interact with alcohol differently. Some medications contain alcohol themselves, which can increase your blood-alcohol level if you are also drinking.

Drinking alcohol itself can make driving a vehicle or operating machinery more dangerous. Mixing alcohol with certain medications can put you at even greater risk. Research has shown that mixing alcohol with medications is even more dangerous for women and older people.

Medications That React With Alcohol

Following is a list of some kinds of medications that can interact with alcohol, the type of reactions they can cause and their brand names. This is by no means a complete list of all medications that can react with alcohol; these are some of the more popular medications.

The links below will take you to an expanded description of each drug, its side effects, uses and other possible interactions.

Allergy, Cold and Flu Medications

Possible Reactions: Drowsiness, dizziness; increased risk for overdose.
Brand Names: Alavert, Allegra, Allegra-D, Benadryl, Clarinex, Claritin, Claritin-D, Dimetapp Cold & Allergy, Sudafed Sinus & Allergy, Triaminic Cold & Allergy, Tylenol Cold & Flu and Zyrtec.

Chest Pain, Coronary Heart Disease Medication

Possible Reactions: Rapid heartbeat, sudden changes in blood pressure, dizziness, fainting.
Brand Names: Isordil (nitroglycerin).

Anxiety and Epilepsy Medications

Possible Reactions: Drowsiness, dizziness; increased risk for overdose; slowed or difficulty breathing; impaired motor control; unusual behavior; liver damage and memory problems.
Brand Names: Ativan, Klonopin, Paxil, Valium, Xanax and herbal preparations (Kava Kava).

Arthritis Medications

Possible Reactions: Ulcers, stomach bleeding, liver problems.
Brand Names: Celebrex, Naprosyn, and Voltaren.

Blood Clot Medication

Possible Reactions: Occasional drinking may lead to internal bleeding; heavier drinking also may cause bleeding or may have the opposite effect, resulting in possible blood clots, strokes, or heart attacks.
Brand Names: Coumadin (warfarin).

Cough Medications

Possible Reactions: Drowsiness, dizziness; increased risk for overdose.
Brand Names: Robitussin A–C, Delsym, Robitussin Cough.

Depression Medications

Possible Reactions: Drowsiness, dizziness; increased risk for overdose; increased feelings of depression or hopelessness in adolescents (suicide).
Brand Names: Anafranil, Celexa, Effexor, Elavil, Lexapro, Luvox, Norpramin, Paxil, Serzone, Wellbutrin, Zoloft and herbal preparations (St. John’s Wort).

Diabetes Medications

Possible Reactions: Abnormally low blood sugar levels, flushing reaction (nausea, vomiting, headache, rapid heartbeat, sudden changes in blood pressure).
Brand Names: Glucophage, Micronase, and Orinase.

Enlarged Prostate Medications

Possible Reactions: Dizziness, light headedness, fainting.
Brand Names: Cardura, Flomax, and Minipress.

Heartburn and Indigestion Medications

Possible Reactions: Rapid heartbeat, sudden changes in blood pressure (Reglan); increased alcohol effect.
Brand Names: Axid, Reglan, Tagamet and Zantac.

High Blood Pressure Medications

Possible Reactions: Dizziness, fainting, drowsiness; heart problems such as changes in the heart’s regular heartbeat (arrhythmia).
Brand Names: Accupril, Capozide, Cardura, Catapres, Cozaar, Hytrin, Lopressor HCT, Lotensin, Minipress and Vaseretic.

High Cholesterol Medications

Possible Reactions: Liver damage; increased flushing and itching, increased stomach bleeding.
Brand Names: Advicor, Altocor, Crestor, Lipitor, Mevacor, Niaspan, Pravigard, Vytorin and Zocor.

Infection Medications

Possible Reactions: Fast heartbeat, sudden changes in blood pressure; stomach pain, upset stomach, vomiting, headache, or flushing or redness of the face; liver damage.
Brand Names: Flagyl, Nizoral, Nydrazid, Seromycin and Tindamax.

Muscle Pain Medications

Possible Reactions: Drowsiness, dizziness; increased risk of seizures; increased risk for overdose; slowed or difficulty breathing; impaired motor control; unusual behavior; memory problems.
Brand Names: Flexeril, Soma, Antivert, and Atarax.

Nausea and Motion Sickness Medications

Possible Reactions: Drowsiness, dizziness; increased risk for overdose.
Brand Names: Antivert, Atarax, Dramamine and Phenergan.

Pain, Fever and Inflammation

Possible Reactions: Stomach upset, bleeding and ulcers; liver damage; rapid heartbeat.
Brand Names: Advil, Aleve, Excedrin, Motrin, and Tylenol.

Seizure Medications

Possible Reactions: Drowsiness, dizziness; increased risk of seizures.
Brand Names: Dilantin and Klonopin.

Severe Pain Medications

Possible Reactions: Drowsiness, dizziness; increased risk for overdose; slowed or difficulty breathing; impaired motor control; unusual behavior; memory problems.
Brand Names: Darvocet–N, Demerol, Fiorinal, Percocet and Vicodin.

Sleep Medications

Possible Reactions: Drowsiness, sleepiness, dizziness; slowed or difficulty breathing; impaired motor control; unusual behavior; memory problems.
Brand Names: Ambien, Lunesta, Prosom, Restoril, Unisom and herbal preparations (chamomile, valerian, lavender).

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A 20-year study of 719 adults as found the social factors both predict and sustain heavy drinking among older adults.

A study conducted by the Department of Veterans Affairs Health Care System in Palo Alto, California examined the link between heavy drinking in older adults and their social and financial resources.

Social Factors and Drinking

The study found that adults are more likely to engage in high-risk drinking if:

• Have more financial resources.
• Engage in more social activities.
• Have friends who approve of drinking.

For the sake of the study, heavy drinking was defined as more than three drinks per day or more than 14 drinks per week, otherwise known as high risk drinking.

Choosing Friends Who Drink

“Our findings show that, one, certain social factors may enhance the chances of an individual engaging in high-risk drinking and, two, once high-risk drinking has developed, social choices may be made to facilitate continuing this behavior,” said lead author Rudolf H. Moos in a news release.

But the research also found that older adults who engage in high-risk drinking tend to choose friends who are more likely to drink and approve of drinking.

The study also found that men may be more susceptible to social factors than women, when it comes to heavy drinking. Having more money and friends who drink were more closely linked to men than women who were older heavy drinkers.

Problem Does Not Go Away

Another finding of the research was that alcohol problems do not go away as people grow older. When the researchers completed their 20-year study the people in the group were 75 to 85 years old and 20% of them still engaged in high-risk alcohol consumption.

If you are an older adults and are concerned about your level of drinking, avoiding certain social activities and your friends who drink, may help you in trying to cut down or moderate your drinking.

If you try to cut down on your drinking and find that you cannot do so, you may need to quit altogether. If so, there are many resources available to help you quit and maintain abstinence.

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There is not a lot of scientific research regarding alcohol use and cognition among the elderly. In fact, such studies are rare. A new study conducted in Brazil focused specifically on cognitive problems caused by heavy alcohol use among 1,145 people who were 60 years old or older.

Heavy Alcohol Use Among Elderly

The first surprising finding of the study was the high rate of heavy alcohol use among the group. They found that 8.2 percent of the 419 men and 726 women studied were heavy drinkers, or drinking at levels that are considered high risk.

“We found that heavy alcohol use among the elderly people we investigated was high at 8.2 percent and affected principally men from low socioeconomic levels,” said corresponding author of the study, Marcos Antonio Lopes in a news release.

But the real surprise of the study was the finding that heavy drinking affect the cognitive function of women more than men. The relationship between heavy drinking and cognitive function lost in men was not statistically significant.

Cognitive Loss Greater for Women

“However, the effects of heavy alcohol use on memory and other cognitive functions were more evident in women,” said Lopes. “Our findings suggest that alcohol use does not have a linear relationship with cognitive decline.”

In other words, women who continue to drink heavily into their senior years run the risks of losing cognitive function and are more prone therefore to falls and significant memory loss.

Source: Lopes, M.L., et al. “Prevalence of Alcohol-Related Problems in an Elderly Population and Their Association With Cognitive Impairment and Dementia.” Alcoholism: Clinical and Experimental Research. 26 Jan 2010

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The four stages of rehab described here – treatment initiation, early abstinence, maintaining abstinence and advanced recovery – were developed by the National Institute on Drug Abuse for its “Principles of Drug Addiction Treatment: A Research Based Guide” resource for healthcare providers.

Click here for the complete story.

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