16. Getting professional help
Some professional support is available free, but in other instances you will need to pay to get help. Do some research into what help is available locally. You can find out about your local alcohol team by looking under any of these sections in Yellow Pages: Addiction – rehabilitation & treatment; Clinics; or Counselling & advice. You can also find out what is available by searching online. The alcohol team should be able to provide help with stopping drinking, cutting down, counselling, support and advice. They may also support the drinker’s partner or relative.
Counselling can be free, from your GP or local specialist alcohol treatment service. Hopefully, whomever you seek help from will be approachable and offer friendly and non-judgmental advice. You may be able to refer yourself, or your doctor could refer you. Or you may choose to see a private counsellor or psychotherapist. They usually charge between £25 and £45 per hour. If you do not feel you can open up and make progress with the first therapist, try a different one. Research shows it is the client-therapist relationship that is the most important factor for therapy to be successful.
Ring Drinkline: 0800 917 8282 (calls are free, and will not appear on your bill, except for mobiles). Drinkline offers information and advice to anyone concerned about his or her own or someone else’s drinking. They can provide information on local alcohol specialist health, social care or support services. They can send free alcohol information leaflets.
A detoxification helps control the withdrawal symptoms when you give up alcohol. Withdrawal symptoms occur as your body goes into the shock of not getting any alcohol. The period of detox allows your body to get rid of the toxins and get used to not having alcohol.
If you drink heavily everyday you are probably dependent on alcohol. If you want to stop drinking you need to seek professional help from your local alcohol advisory service or substance misuse team, or visit your GP. They can advise you about how to get a prescription to alleviate some of the withdrawal symptoms, or refer you for a hospital detox. The main withdrawal symptoms are:
the shakes, ranging from mild trembling of the hands to severe shaking of the whole body
rapid pulse (over 100 beats per minute shows you are withdrawing quite significantly)
feeling irritable, restless, and sensitive to noise. Some people feel a sense of dread, especially on waking; some feel anxious, frightened and paranoid
nausea, retching, diarrhoea, sweating, headaches
increased or decreased appetite, or cravings for foods
disturbed sleep patterns, restlessness.
If your alcohol specialist and your GP agree it’s suitable, you may be able to detox. at home. You will probably be prescribed Librium (Chlordiazepoxide), usually taken for 10 days. On the first day the dose will be largest, and you will take a progressively reduced amount each day. It is dangerous to drink whilst taking these tablets. They are sedatives and alcohol exaggerates the effects. You will also be prescribed vitamin B compound and perhaps vitamin C as well. You need to rest and stay at home for the first few days. Someone should be around to take care of you and support you. Treat yourself to your favourite non-alcoholic drinks (but try not to have too much caffeine) and food. Try to eat little and often. Although you need to rest, you also need to do something to distract yourself from cravings. Get some good films, books, magazines, music or extra channels on the TV. Practise a relaxing hobby or craft. Try other ways to relax: talk to a friend, listen to a relaxation CD, or have a bath with some relaxing oils in.
You will take the same medication and vitamins as the home detox. You will need to rest and find relaxing things to do. In some areas there is a long waiting time for a hospital detox.
Preparation for a detox.
This would preferably be counselling, discussing:
how you will cope without alcohol
how to avoid and cope with them
how you will fill your time
how you can look after and reward yourself.
Hopefully, you will also find support from your friend, relative or partner who cared for you during and after the detox.
After the detox
Most people try to stay abstinent for at least a few weeks after a detox. Some people then try to practise controlled drinking, some successfully, some not. Relapses happen to many, but they do not mean you have failed. Hopefully, you learnt something from the relapse and are even more determined not to drink. Some people take Campral, prescribed by the doctor, to help overcome their cravings (see tip 18). Keep as busy as possible; physical tasks are generally better than mental tasks for taking your mind off drinking.
A doctor can prescribe this drug if the person wants to abstain from alcohol. If you take antabuse and then drink any alcohol it makes you feel very ill. Symptoms may include: nausea, vomiting, tachycardia (increased heart rate), palpitations, breathing difficulties and facial flushing.
Antabuse should be taken after a detoxification. Some GPs are not prepared to prescribe it because of the severe effects if alcohol is drunk. Implants of antabuse in the stomach are also possible, but this approach rarely used. There is no evidence that antabuse helps people significantly cut down on alcohol over the long-term.
This drug is prescribed to help reduce the cravings for alcohol. It is recommended that it should be taken after detoxification, for up to a year. If a relapse occurs the dose should be continued, as it appears to reduce the pleasurable affects of drinking. Research studies have shown that relapses are shorter and less alcohol is consumed if Campral is being taken.
Campral is not a miracle treatment; it may or may not help with cravings and reduce relapses. It should be used alongside other treatments, such as counselling or attending AA.
You may have heard of the prescribed drug Hemenevrin. It used to be given to ease withdrawal symptoms, but due to the dangers of people drinking on this medication, it is rarely prescribed now.
Librium (Chlordiazepoxide) is the drug usually prescribed during an alcohol detox. Vitamin B and perhaps vitamin C may also be prescribed.
Research supports the use of this prescribed drug, which appears to block some of the pleasurable effects of alcohol. It helps prevent relapse in those trying for abstinence. It is not yet licensed for use in the UK, but some specialist clinics offer it.
Helps the liver eliminate toxins. This can help if you are detoxing, but it won’t help with liver problems.
Kudzu, or ge-gen, is a quick-growing vine that grows in Japan, China and the southern United States. Extracts from the root have been used in traditional Chinese medicine for centuries. It is taken for many conditions including allergies, migraine headaches, diarrhoea, and to reduce cravings for alcohol. In an experiment, hamsters were given alcohol until they were dependent on it. These ’alcoholic‘ hamsters showed less interest in alcohol if fed kudzu extract. However, in scientific studies, kudzu has not been so helpful to alcohol-dependent humans and failed to help people remain abstinent from alcohol.
Other herbal treatments that may help to relax you or help improve mood include: valerian, ginkgo biloba, and St John’s wort. All are available from health food shops or chemists.
Try auricular acupuncture. It may help with cravings, making you feel calm and giving a sense of well being, thus helping reduce alcohol and drug dependency. It usually involves five needles being placed painlessly in the outer ear, then relaxing for 35–45 minutes. It is offered by many drug and alcohol treatment agencies. NADA (National Acupuncture Detoxification Association) have shown auricular acupuncture helps with cravings for alcohol, withdrawal symptoms, relapses, in-patient detox. admissions, anxiety, insomnia and agitation.
Although hypnotherapy has had some success with cocaine addiction and tobacco smoking, there is no conclusive evidence that it works for alcohol addiction.
21. Rehabilitation and Residential Treatment Centres
Due to the expense and commitment required, most people are treated in the community. However, some people do feel they need this intensive treatment away from home and temptations.
Some centres offer a detox and then a programme that usually lasts between six weeks and two years. Others offer the programme to people who have already detoxed. Stays at these centres are expensive: prices start at £400 per week. Funding is available, but there is often a difficult and lengthy process involved to get it (apply through your local alcohol treatment service). Some places require you to be a Christian; some are for men or women only. Abstinence has to be adhered to, and people who have drunk alcohol will be asked to leave.
The programme involves intensive therapy: individual counselling and group therapy, plus AA meetings, and possibly other therapies such as drama or art therapy. Many are 12-step programmes (AA philosophy). Others are based on cognitive behavioural therapy, social learning or offer a therapeutic community. Some describe their philosophy as ‘eclectic’. Eclectic therapy combines useful and relevant parts from many therapies and theories.
Make an appointment with your GP, or practice nurse, to take a sample of blood for testing. Book an appointment to talk about the results a week or so later. The results may give you an early warning, so you can cut down in time to prevent permanent physical damage from drinking. Further blood tests or a scan may be necessary if there are abnormalities.
Liver damage: excess alcohol intake causes too much fat to be stored in the liver (known as ‘fatty liver’), as well as in other places. This makes the liver inflamed (alcoholic hepatitis). A very high intake of alcohol over a long period leads to irreversible damage (cirrhosis), and can cause liver failure, which is life threatening.
Other signs detectable in the blood include blood clotting abnormalities; reduced levels of immunity; bone marrow damage and vitamin deficiencies.
Various blood testing kits can be bought on the internet. These are not reliable enough to recommend, and it is better to ask your GP for a test so you can discuss the results in person.
Blood tests performed (in bold) include:
The transaminase enzymes (ALT and AST) are high when the liver is damaged or inflamed, both in early and late liver disease. But these may also be normal in spite of an unhealthily high alcohol intake. The enzyme Gamma GT is a give away, as it is raised in few conditions other than alcohol abuse.
If the liver is severely damaged, the flow of bile into the gut is blocked, and the level of bilirubin in the blood rises until the skin is discoloured yellow. This is called jaundice, and can occur during a spell of alcoholic hepatitis, when there has been a high intake for a relatively short time, and the damage is reversible; or when cirrhosis has developed and the liver is no longer able to function normally. The enzyme alkaline phosphatase can rise even before the jaundice appears.
Liver failure results in reduced production of important chemicals, mainly proteins, such as antibodies and clotting factors. Infections and a bleeding tendency are the result. Healing times are slower too.
The blood is affected at quite low levels of alcohol abuse. The bone marrow produces red blood cells that are abnormally large (High MCV). Anaemia (low Haemoglobin) can be the result of poor diet, with low intake of iron, VitaminB12 or folic acid.
Blood test results
The table below provides a key to blood test results. More detailed information about test results can be found in the extra info section (here).
23. Enlist the help of friends and family
Telling friends and family that you have a problem with alcohol may be a big step. But it will probably be a major step towards beating the problem. Identify friends who drink less than you, and spend more time with them.
Go and stay with friends or relatives who do not drink. Try to retain some of their lifestyle on your return home. If some people encourage you to drink, have a word with them. If they persist avoid them for a while, until you can say no firmly enough.
24. Let prescribed medications take effect
If your drinking is out of control, it may be because you are depressed. Drinking can be interpreted as a misguided form of self-medication that blots out unwanted feelings of melancholy and despair – at least temporarily. But what came first, the depression or the drinking?
If you’ve been prescribed with anti-depressants, it’s important to remember that alcohol interacts badly with other medications. Alcohol is a depressant drug, which affects the nervous system. Many people feel depressed, anxious or paranoid after periods of heavy drinking. Prolonged alcohol abuse can lead to long-term mood changes, which may not respond to prescribed drugs.
Mixing alcohol with anti-depressants may make you sleepier, affecting your driving and other tasks. Your co-ordination may be affected, making accidents or a fall more likely. MAOI anti-depressants react to tryamine, which is a by-product of fermentation, so beer and wine must be avoided. A rise in blood pressure can occur after only one drink. If you are taking an SSRI there are fewer risks, although some manufacturers warn not to drink alcohol. No reactions with alcohol have been found with citalopram (Cipramil) or fluoxetine (Prozac), but you need to follow the manufacturer or doctor’s advice.
Drinking alcohol in moderation whilst taking lithium seems to be OK, but check it out with your specialist.
Medication for psychosis: the sedative effects of the drugs are exaggerated by alcohol. Chlorpromazine (Largactil): some people have had a severe reaction.
Medication for anxiety, panic attacks and sleeping problems: again, alcohol increases the sedative effects of the medication. Buspirone can be taken, as it does not appear to exaggerate the effects of alcohol.
Others: the antibiotic metronidazole (Flagyl); most antihistamines; drugs for epilepsy; Warfarin. Follow your GP’s or the manufacturer's advice.
25. Are stress and anxiety some of your triggers?
If you cut down or become abstinent you have to find another way of coping with stress other than reaching for the bottle. Learn how else you can cope. Most people find talking about problems helps. Try relaxation tapes. Counselling or cognitive behavioural therapy (CBT) may help. Your GP may be able to refer you to a counsellor for a few sessions, or you could find a private therapist (costs from £25 per hour).
Counselling or CBT may help with positive thinking. For example, you could think of time alone in the house when everyone else has gone out as a lonely experience, bringing back feelings of abandonment. Alternatively, you could enjoy it as a quiet time for you to spend as you please, not worrying about anyone else. This is an example of how you can change your perspective on a situation by trying to think about it positively.
AA are self-help groups for those who feel they have lost control of their drinking. Some people fear they have to ‘share’ their life story with the group, but that is not the case. You can tell the group when you are ready, or never. Some meetings are ‘open’, so you can go with a friend or family member. Members are given a sponsor or mentor, who supports them through abstinence, cravings and lapses. Most large towns and cities have a meeting every day. Try different groups; if you do not like the first one you go to, there is bound to be several in any area. The make-up of groups varies; some have more women members, while others attract younger people.
Some people feel AA has saved their life, while others feel the meetings, and the 12-step philosophy, are not for them.
The Serenity Prayer
This prayer is said at the end of every AA group meeting:
‘God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.’
27. Buy some self-help books
Or borrow some from the library. It’s very difficult to know which ones to choose, so look at a few. 50 Self-help classics, by Tom Butler-Bowden, reviews 50 self-help books, so you could read that first. Suggestions for further reading are given here.
28. Don’t isolate yourself – get help
Many people socially isolate themselves by drinking heavily.
Some people stay up late drinking by themselves. Many people drink in secret, hoping their family won't notice they've had a drink. This also isolates them. If you can set a goal of not drinking on your own, or not keeping it a secret, that would be a very good goal. Some people who drink heavily feel they cannot tell anyone, but discussing the problems will help. Getting help greatly improves your chances of changing your drinking and usually relieves the burden and stress. Have you started to plan your life around drinking? Do you turn down invitations because you won't be able to drink there? Is drinking stopping you from pursuing other interests? Now is a good time to tackle drinking so it doesn't stop you from leading a more fulfilling life.