There are many different forms of help for people with alcoholism.  We can break these down into four categories:

• MEDICAL HELP
• PSYCHOLOGICAL HELP
• SOCIAL HELP
• SPIRITUAL HELP

When you are planning your route to a life free from the disease of alcoholism, you will need to make a judgement about which kinds of help you need, and in which order you get them.  Making a good decision about this depends on a number of different factors, and we will help you to make these good decisions in later sections.

For a moment, it is vital to male a single, central decision, by answering a question, which will set the basic course towards your recovery.

ARE YOU PHYSICALLY ADDICTED TO ALCOHOL?

If you are physically addicted to alcohol, then this means two things:

1. At some point you will require a medicated detoxification in order to cease drinking safely.
2. The research evidence shows that B you are highly unlikely to ever be able to drink any alcohol again, without relapsing to alcoholic levels of drinking.  In other words, your aim should almost definitely be to become tee-total/abstinent/permanently dry.

Now this may well come as disappointing news, but these are the hard facts of the matter:

Let’s consider point 1 – the need for a medicated detox:

• To cease drinking suddenly without a medicated detox if you are physically addicted can be fatal.
• To cease drinking suddenly without medicated detox if you are physically addicted may lead to permanent brain damage, and permanent memory loss.
• To cease drinking suddenly without medicated detox if you are physically addicted to alcohol may lead to epilepsy and fits.
• Approximately 50% of all alcoholics have evidence of brain damage, and this has probably been mostly caused by trying to stop drinking suddenly on occasions during their lives.
• The provision of a medicated detox reduces the risks of all these things happen to almost zero.

WHY DO ALL THESE PROBLEMS OCCUR, JUST BECAUSE I’VE BECOME PHYSICALLY ADDICTED ALCOHOL?

In alcohol withdrawal the brain is in an overactive state which results in  the whole body (including the brain) being triggered into a state of emergency – similar to that which occurs if you have a great fright – sweating, trembling and tremor, high heart rate, high blood pressure, nausea, vomiting, diarrhoea etc.  When the person is heavily alcohol dependant, the overactive brain state may be so sever that epileptic fits occur (discharged electricity in the brain).  Fits can sometimes lead directly to death, and in other cases cause fatal injuries.  Apart from fits, the overactive state may become so severe that the brain is no longer able to understand properly what is going on around it, and delusions (e.g. paranoid thoughts), and hallucinations (seeing things that aren’t there) may occur.  If this syndrome occurs (Delirium Tremens), then death occurs in 10% of cases that go untreated.  Additionally, the overactive state of the whole body results in more energy being burned up; this in turn can use up vital supplies of vitamins which are essential for brain functioning.  In some cases, loss of these vitamin supplies can lead to death, and in other cases to devastating permanent memory loss (Wernicke-Korsakoff syndrome).

Now, there is a medically safe alternative to detox, which would prevent all these problems and risks.  That alternative is – to cut your drinking down slowly but surely over a period of several weeks.  The problem is that you are highly unlikely to manage to do this, if you’ve already become physically addicted to alcohol.  That’s the Catch 22.  It is in the very nature of the addiction, that you will probably not be able to cease drinking in this manner, if you have already become physically addicted to alcohol.

In our practice, we do not advise people who are physically addicted top alcohol to try this (slow but sure cut down of drinking over several weeks) unless they are very determined that they wish to give it a go.  And simply because we know  that we’ll all be back to square one in several weeks time;  we routinely include a medicated detoxification as part of the plan, as long as the –patient is prepared to go along with this (most are).

Having said that we do not advise you against trying this (slow but sure cut down over a period of at least several weeks)  it IS a medically safer alternative to a detoxification – if you want o, then give it a go – a few of you will succeed, but the large majority will not.  If you choose this route to dry out, and you succeed, then we congratulate you.  If you find after several weeks that you have  made no progress, then please start reading this book again from that point.

But please remember this – do NOT attempt to stop drinking suddenly without a medicated detoxification – to do so will almost definitely fail (you will start drinking again), and may cause you irreversible damage in the meantime.

HOW DO I KNOW IF I AM PHYSICALLY ADDICTED TO ALCOHOL?

In this modern day world of theory and technological advance, many specialists seem to have forgotten the central importance of a vital distinction in addiction – that of psychological addiction versus physical addiction.  For people with alcoholism this distinction has huge practical implications – if you are physically addicted to alcohol to cease its use suddenly may be fatal.  If you are not physically addicted, but are psychologically addicted it would be safe fro you to stop drinking suddenly, and you are also more likely to be able to achieve on-going ‘controlled drinking’ in the future – more on this later.

The presence of physical addiction to alcohol is ascertained by the occurrence of ‘withdrawal symptoms’ when you have not had a drink for a period of time.  If you suffer from ANY of the following when you have not had a drink for a period of time, then you are likely to be physically addicted to alcohol.

If you can answer yes to ANY of the following then you are likely to be physically addicted to alcohol:

• I get sweaty if I go without a drink for too long.
• I get a tremor, or shake if I go without a drink for too long.
• I feel sick or vomit if I go without a drink for too long.
• I feel panicky, anxious and agitated if I go without a drink for too long.

WHAT DOES ‘WITHOUT A DRINK FOR TOO LONG’ MEAN?

Withdrawal symptoms typically commence somewhere between 6 and 24 hours after the last drink.

Some people who are physically addicted may have their last drink at say midnight, and then be able to go the whole of the next working day without drinking.  By the time they get home they are feeling agitated and in need of a drink.  If they do not drink, their levels of agitation increase.  Within 15 minutes or so of their first drink the levels of agitation decrease and they will then continue to drink for the rest of the evening until they go to bed.  The pattern will be repeated the next day… and the next day…. This pattern of physically addicted drinking is typical of those with a minor level of physical addiction – however, such a person will probably NOT be able to cease drinking without a detox, and to do so would place them at risk of memory loss and other damage.  Equally, in time, their level of drinking is likely to slowly but surely increase, gradually increasing the degree of their physical dependency to alcohol.

At the other end of the spectrum, a person might have their last drink at midnight and then be awake by 6am sweating profusely.  If they haven’t had a drink by 8am, their hands will start to shake and they will feel nauseous.  If they haven’t had a drink by 10am they may be vomiting, and by 3pm they will be starting to have hallucinations of insects walking on the walls.  By 5pm they will have lost touch with reality, and by 7pm they may have suffered an epileptic seizure.  If at any time during these events they find a supply of alcohol, and start to drink, then all the above symptoms will calm down and disappear within an hour or so of continued alcohol use.  This pattern is typical of people who are severely physically addicted to alcohol.

Most people who are actively seeking help for their problems are nearer the milder end of the spectrum (i.e. the first example), or somewhere between the two.  This is because such people still have their faculties about them and are able to actively seek help.  Those who have let things develop to the extent of the second example really seek help for themselves – by the time things have progressed this far the mind id only able to focus on one thing – finding a supply of alcohol to stay OK for the next few hours.  Occasionally we will see such patients in casualty when they have turned up in ‘crisis’.  Usually they are severely depressed and suicidal at such times, and it is such feelings of desperation that have led them to turn up.

Of course, these lucky enough to have concerned relatives (or relatives that can no longer tolerate their behaviour), may be referred for help at any time in the progression of this disease.  It is usually the case that others recognise the existence of a problem developing before the individual themselves.  The important point to take away is that wherever you are along the spectrum of development of addiction to alcohol, it is ONLY LIKELY TO GET WORSE.  This again is part of the addictive process – one slowly drinks more and more to get the same effect (an effect known as ‘tolerance’)  – levels of drinking slowly but surely build up.  The only meaningful response to dealing with this situation is to SEEK HELP – and of course, if you are still reading by this time then that is exactly what you are doing, right now.

OTHER WAYS OF ESTABLISHING WHETHER OR NOT YOU ARE PHYSICALLY ADDICTED TO ALCOHOL

Now, if you remain uncertain whether or not you are physically addicted to alcohol there is another means of attempting to establish this:

MAKING AN ESTIMATE BY CALCULATING THE NUMBER OF UNITS OF ALCOHOL YOU ARE DRINKING IN A TYPICAL WEEK:

This is a relatively unreliable way to determine whether or not you are physically addicted to alcohol.  However, it can provide further confirmation for you if you remain a little uncertain regarding your need for detoxification.  The reason it is a little unreliable is because people’s bodies very so much from one to another.  One person may be able to deal with less alcohol than another, just because of the way they have been born.  In particular, there is not doubt, that on average, women more easily suffer from adverse effects of alcohol use tahn do men – including becoming physically addicted more quickly and with less regular alcohol use than men.

As a rule of thumb, a man drinking more than 100 units of alcohol weekly is likely to become physically addicted in good time, and a woman drinking more than 70 units of alcohol weekly is likely to become physically addicted in time.

You can work out your daily units of alcohol consumption by using the following calculations:

(Litres of drink consumed in a day) TIMES (‘% abv”) of the particular drink EQUALS (units of alcohol).

The % abv is the alcohol content of the particular drink you are consuming – it is always recorded on the label of the can or bottle of the drink – have a look.  ‘abv’ stands for ‘Alcohol – by – volume’.  To work out how many units of alcohol you are drinking you may need d to know the ‘% abv” of the different types if alcohol you are drinking.

As a rough approximation, 3 beers = just over 1 litre.

• Beer varies from 3% abv to 16% abv.
• Wine is typically 12% abv.
• Spirits are typically 40% abv
• Liqueurs are usually in the region of 15 – 20% abv

EXAMPLE 1:

So for example, if you are drinking 4 beers of Castle Lager daily, and nothing else, then your total units will be:

4 beers = 1,36 litres (plus a little extra). % abv of Castle = 5%.  This total daily units = 1,36 TIMES 5 EQUALS 6,8.  Thus total weekly units = 47,6 units.  As such you are unlikely to be physically addicted if you are male, although you well doubtless cause yourself damage if you contune to drink at these levels for a period of time.

EXAMPLE 2:

If you are drinking 1 bottle of spirits daily, and nothing else then you total units will be:

1 bottle EQUALS ¾ litre (Sometimes 1 litre). % abv of spirits usually equals  40%.  Thus, ¾ TIMES 40 = 30 units daily.  Thus total weekly units will be 210 units – you are highly likely to be physically addicted drinking at these levels.

There are two important points to take away when calculating units:

1. As far as your physical health is concerned, there is no known difference between drinking spirits and drinking wine or beer.  It is nothing to do with the type of drink you use.  It is everything to do with the total amount of actual alcohol that you consume – this is calculated by units.  Don’t fall into the trap of telling yourself that you “only drink beer / wine” and thus are not alcoholic – what kind of drink you use has absolutely nothing to do with it.
2. Don’t fall into the trap of underestimating your units by using the old fashioned estimates.  The old estimates of units – “one unit = half a bottle of beer or one glass of wine” are completely out-of-date.  The reasons for this are due to the ‘drinks industry’.  There has been a slow but sure increase in the amount of alcohol in commonly drunk beer and wine (% abv), and a slow but sure increase in the size of wine glasses in pubs and wine bars / restaurants.  Whereas in times-gone-by a typical bottle of bitter was 3% abv, it is now the case that commonly consumed lagers (Castle and Heineken) are in the region of 5 % abv.  Equally wine has increase from 8 or 8 % abv to 412 or 13% abv.  In the meantime, wine glasses have increased in size.  If you go out these days and order a large glass of wine, you are probably drinking approximately 3 units per glass (a large difference from the old 1 unit per glass).  In effect if you are female and are drinking more than 3 large glasses of wine per night, then you are at risk of becoming physically addicted to alcohol in due course.  If you are male and are drinking more than 6 beers of Castle Lager or Heineken per night, then you are at risk of developing physical addiction to alcohol in due course.

SO IN SUMMARY:

1.  Determine whether or not you are physically addicted to alcohol by considering whether or not you suffer from alcohol withdrawal symptoms.  If you are clear you suffer from such symptoms you will need a medicated detoxification.

2.  If you remain in doubt, then complete the questionnaire above (SADQ) and calculate your score.  Scores greater than 4 indicate probably physical addiction to alcohol and the nede for a medicated detoxification.

3.  If you need further convincing, then calculate your weekly alcohol consumption in units:  greater than 70 units weekly for a woman, and 100 units weekly for a man, is likely to lead to physical addiction to alcohol in due course (remember this is a rough estimate only and varies from individual to individual).

4.  Don’t fall into the trap of under-estimating your units.

Chapter Two looks at another point raised above:  if you have become physically addicted to alcohol you are unlikely to ever be able to drink again without relapsing to damaging levels of alcohol consumption.  Bad news…. but not to be ignored…. if you wish to avoid ending up back at square one.

CONCLUSION

You have now reached the end this chapter and should be able to answer the question:

’ARE YOU PHYSICALLY ADDICTED TO ALCOHOL?’

If you are, then you must plan for alcohol detoxification at some point in the future.  Alcohol detoxification is NOT a cure for alcoholism in itself – it is a way of getting from drinking to NOT drinking safely and effectively.  It is highly unlikely that you will achieve this safely without a detoxification.  Once you have ascertained the need for a detoxification, there is more work to do.  This work is mainly about ‘how to stay off’ rather than how to ‘get off’.

If you are NOT physically addicted to alcohol, then  from a ‘medical perspective’ you do not need a detoxification to stop alcohol use.  By this, we mean that you would be unlikely to cause yourself physical damage by ceasing alcohol use suddenly.  However, you may choose to use detoxification as a way to stop alcohol user comfortably and effectively, especially if you have tried but failed to cut down your drinking.