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How to detox an alcoholic

There is help available for those worried about their alcohol use, but detox isn’t the end of the story

  • The modern mind is a column where experts discuss mental health issues they are seeing in their work

Alcohol use disorder is a problematic pattern of use leading to impairment or distress. Composite: Guardian Design; Westend61/Jose A Bernat Bacete/Getty Images

Alcohol use disorder is a problematic pattern of use leading to impairment or distress. Composite: Guardian Design; Westend61/Jose A Bernat Bacete/Getty Images

Last modified on Thu 25 Nov 2021 02.17 GMT

Almost every day someone will enter my office and ask, “Am I an alcoholic?” or, “Do you think I have a problem with alcohol?” and sometimes, “My partner says I drink too much.”

Alcohol is a drug that has its claws deep in Australian life. If you’re happy, sad, bored, have won a promotion, lost a family member, bought a house or graduated from university, these can all be seen as reasons to drink. Drinking is so common that if a person says they don’t, this lends itself to usually negative and intrusive comments.

The lines become blurred when it comes to deciding if a person has a problem with alcohol and whether they have developed an alcohol use disorder (formerly known as alcohol dependence). This is colloquially known as being an alcoholic – a term we avoid in addiction psychiatry. It’s not surprising to hear that people with AUD are told their drinking is a problem by family, partners or work colleagues. Depending on your upbringing, cultural background and exposure to alcohol, you may believe that drinking a six-pack of beer most days is “normal” and that problem drinking is when you start drinking litres of cask wine daily.

AUD is a term from the Diagnostic and Statistical Manual of Mental Disorder. It’s defined as a problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of 11 criteria within a 12-month period. Some of the criteria are: alcohol taken in larger amounts than intended; having a strong desire to use alcohol; increased time spent obtaining alcohol; tolerance – increasing amounts of alcohol are used to achieve intoxication; and experiencing withdrawal symptoms when alcohol is ceased.

Most people are best served by arranging an appointment with their general practitioner for a formal assessment.

For example, Sarah* is a 35-year-old woman who presented to my office because her fiance, Ibrahim, believes she drinks too much and this is affecting their relationship. Sarah is a lawyer and noticed that she increased her drinking amid work stress and wedding planning. Her drinking increased from one glass of wine to a bottle of wine every night. A critical event was becoming intoxicated at dinner with her friends while out celebrating her engagement, which resulting in her getting into a verbal altercation with a stranger and having to be escorted out of the restaurant. Sarah only sought help when her fiance threatened to call off the engagement. She had tried to quit “cold turkey” but went into acute withdrawals, experiencing insomnia, increased tremors, poor concentration, low mood, nausea and intense cravings for alcohol which led to a relapse.

Sarah is quick to tell me that she does not believe she has a problem with alcohol but is willing to attend sessions if it gets Ibrahim off her back. Furthermore, she claims to only have been drinking heavily for less than 12 months. Unfortunately, her liver ultrasound shows she has a fatty liver (early sign of liver damage) and has probably been drinking heavily for a longer period of time. Sarah tells me she is surprised by this, but does mention moderate drinking in her mid-20s, suggesting a 10-year period of heavy drinking. In addition, her father was a heavy drinker, suggesting a genetic and behavioural component.

The first intervention to consider is a medical detoxification and whether this can be undertaken at home or in a hospital. During this time, withdrawal symptoms are managed with diazepam (valium) and thiamine (vitamin B1). This allows for a period of abstinence from alcohol and allows much-needed supports to be put in place. Unfortunately, many people believe that detox is the beginning and end of treatment, with several clients disengaging from treatment afterwards and high relapse rates.

Most people aren’t aware of the various medications we have for AUD such as Naltrexone, Acamprosate and Disulfiram. Naltrexone works by blocking the mu-opioid receptor, which is responsible for the pleasurable effects gained from drinking alcohol. Acamprosate reduces cravings by modifying responses between excitatory and inhibitory neurotransmitters. Disulfiram (an aversive agent) discourages drinking indirectly by causing unpleasant effects such as sweating, headache, palpitations, nausea and vomiting if a person drinks alcohol while taking it.

These anti-craving medications are most effective when combined with psychosocial interventions, ranging from brief interventions (usually delivered by GPs), motivational interviewing, cognitive behavioural therapy, case management and residential rehabilitation programs. In addition, there are self-help groups such as Alcoholic Anonymous, Al-Anon (a support group for friends and family of people who have alcohol dependence) and self-management and recovery training, also known as Smart Recovery. This has roots in cognitive behavioural therapy (CBT) and is an alternative for people who are uncomfortable with the religious aspects of AA.

How to detox an alcoholic

When you have a friend or relative who has an alcohol dependency problem, being there to support them is often the first thing on your mind. You want to help them get the help that they need, and support them while they are receiving treatment too. Knowing how you can help, when it’s appropriate to say something, and what sort of support is most helpful for them isn’t always easy. If you want to help someone you love who you think or know is an alcoholic, it’s important to educate yourself about how you can help them.

How to Help an Alcoholic

Whether an alcoholic seeks help for their addiction is ultimately up to them, but that doesn’t mean that their loved ones can’t help and support them. From encouraging them to get treatment to supporting them while they are in recovery, you can be there for someone in their time of need. If you want to know how to help an alcoholic in the UK, you might begin by checking NHS resources. However, you can soon discover that it is often necessary to look at other options to find the right support. Private treatment options are available, and researching alcohol addiction treatment programmes will help you to be a support to your loved one.

When and How to Talk to Someone

One of the most difficult things about how to support an alcoholic is that you may be unsure about when and how to talk to them. Talking to someone with alcoholism can be especially difficult if they are in denial or haven’t recognised that they have an unhealthy relationship with alcohol. You might question whether it’s your place to say something and be wary of the reaction that you could receive.

You might decide that it’s time to talk to someone if you think they have a problem with alcohol. It’s important that you’re sure they could have an alcohol abuse issue, which is why you should take some time to understand the signs and symptoms of alcoholism before broaching the subject.

There are a few things that you can keep in mind when speaking to someone if you think that they have an alcohol addiction. You should try to talk to them with kindness and avoid being accusatory. Remain positive and supportive as much as you can, and be prepared to listen with compassion. However, you can discuss the events when their drinking may have had a negative impact on either them or others. Being able to suggest treatment options is also helpful, but you might need to allow your friend or relative some time to process what you have to say. It’s not a good idea to be too forceful because it could simply cause a negative reaction.

Educate Yourself About Alcoholism and Treatments

Being educated about alcoholism and treatments for alcohol will put you in a good position to support someone with an alcohol addiction. If you want to know how to help an alcoholic friend or family member, it’s best to get your information from experts who understand addiction. There are plenty of resources online, and you can also reach out for advice from doctors and treatment providers.

You should take the time to understand alcoholism as a mental illness, and the effects it can have on people’s lives before talking to someone who you suspect has a problem with alcohol. If you want to support someone who has confided in you about their addiction, you should also spend some time researching. However, it is important to listen to what they have to say and what help they might request from you too.

If part of your research is helping to find treatment options, you might present some options that you think are best, including inpatient and outpatient options. However, it is ultimately up to the person you are helping to choose a treatment path that they feel will work for them.

Can You Help Someone Who Doesn’t Want Help?

Some people want to know how to help an alcoholic in denial or how to help an alcoholic who doesn’t want help. You might be wondering if this is possible to do. It is possible to help someone who might not have accepted that they have a problem with alcohol yet if you are able to approach them in the right way. However, you need to give them time to come to terms with their problem and avoid pushing them too hard. In the end, you can’t force someone to get help. They need to want help, and you can be there to make it easier for them to access it.

How to Help an Alcoholic During Recovery and Treatment

You can also provide support for an alcoholic while they are going through treatment and recovery. You can help them to find the right treatment option to meet their needs, and help them to engage with their treatment. Whether you want to know how to help an alcoholic parent, how to help an alcoholic spouse, or how to help an alcoholic friend, you can offer them your support. One thing that you can do is learn about the treatment that they are receiving and take the time to understand how it works.

You can also help someone during treatment by listening to any requests that they might have. This could include asking you to attend counselling sessions or family events where they are receiving treatment. It could be listening to their experiences or accepting apologies that they want to give you.

It’s also important to take care of yourself if you want to be there for someone who is in recovery. Being the friend, spouse, child or another family member of an alcoholic can be difficult, and it’s hard to be there for them if you don’t also ask for help when you need it. You can be part of a support system for someone who wants treatment for their alcoholism, but it’s also important for you to have a support system.