How to stop drinking

A recent patient of mine who had a failing kidney, a failed liver and a huge drinking problem got me thinking about the recent evidence on helping patients with alcohol dependence. As usual my thoughts took on a life of its own and soon I was researching: The problems aggravated by alcohol, the effect of alcoholism on chronic diseases and the extremely interesting research on why alcoholics can't get on an organ transplant list (because they end up killing the new organ with ethanol).

I remember attending a debate as a medical student at the St Georges Medical School London.

The debate was centred on popular England footballer George Best and his recent liver transplant. He was scheduled to receive a second liver transplant after killing the first one with continued heavy drinking habits. Majority of health professionals in the room were strongly against this while a few debated against the ethics of refusing him a liver transplant.

In the rest of my article I will highlight the recent evidence on treating alcohol dependence. Good news is that research studies have shown that in 60% of patients who receive treatment remain abstinent at three months, and 45% at one year.

What is alcoholism?

Alcohol makes people do stupid things. Alcohol dependence can easily be characterised by a habit of doing stupid things. This is due to the significant intellectual impairment caused by alcohol intoxication. The characteristics of alcohol dependence are due to a mixture of the harmful consequences of repeated alcohol use, a pattern of compulsive alcohol use, and in some people the physiological dependence on alcohol which manifests itself as the symptoms of withdrawal. A diagnosis of alcohol dependence however is only made when they symptoms significantly affect the ability to live a productive life or causes great distress to friends and family.

Complications of alcohol dependence

Alcoholism usually affects work performance, either from hangovers or intoxication while at work. There is also neglect for social and household responsibilities, and frequent absences. The individuals also keep using alcohol despite physical or psychological complications such as depression, liver disease or blackouts. The most significant effect of alcohol is the tendency to accident-prone behaviour, and violence.

Treatment of alcohol dependence

In the treatment of alcohol dependence there are three main treatments components: confrontation, detoxification and rehabilitation.

Confrontation

Confrontation involves helping the patient overcome the denial of their symptoms and convinces them of the adverse consequences of continued drinking, while motivating them into getting treatment. It might involve friends or family planning an intervention with the guidance of a primary care physician.

Detoxification

Once the drinker has been persuaded the next step is detoxification. This involves removing alcohol from the body and protecting the body from the withdrawal effects of alcohol, particularly a nasty shaking of the body called delirium tremens. This usually lasts about five days and treatment involves administering a nervous system depressant like diazepam, then gradually reducing the dosages to avoid the withdrawal symptoms. Rest, social support and adequate nutrition are also as important to the process.

Rehabilitation

Rehabilitation is a combination of efforts to maintain motivation regarding abstinence and maintaining an alcohol free life style. Treatment is a combination of psychotherapy, counselling and drug treatment. The most popular mental interventions are cognitive behavioural therapy and the Alcoholics Anonymous (AA) counselling program. Cognitive behavioural therapy helps drinkers recognise the thought and belief patterns which contribute to their habit and teaches them to cope with the stressful situations which forced them to drink. The Alcoholics Anonymous is a social network that helps drinkers abstains by providing them a social network and teaching a new philosophy for living.

Drug therapy was formerly limited to Disulfiram, an agent which inhibits the normal metabolic pathway of ethanol by blocking the action of the enzyme acetaldehyde dehydrogenase. This results in the accumulation of acetaldehyde, a toxic product that makes the patient ill. This ill-feeling upon drinking contributes to helping the drinker avert the behaviour. The success of this agent however has been limited as it does nothing to prevent the cravings for alcohol which the person has. Fortunately two new drugs are currently in use which reduces cravings: Acamprosate and Naltrexone.

Both drugs contribute to inhibiting an individual's desire to drink. It is important to note that all these medications have significant adverse effects ranging from headaches to severe nausea. Although research has shown that these management methods if well applied will reduce abstinence by as much as 60%. It is important to note that the most important success factor lies in the individual's motivation and the social support of friends and Family.

Alcoholism affects a significant number of Nigerians and its effects are felt by family members and the society at large. Thus it is important for all of us to play a part in helping sufferers conquer this curable condition before it causes irreversible damage.

Dr Dayo Osholowu is a physician with a micropractice based in Lagos. He is also writer and a reviewer for the British Medical Journal.