Getting help for problem drinking

Sometimes, if you let them, family, whanau and friends can help you with your drinking without needing to involve outside help. Listen to what they have to say to you and see if you can come up with an agreement or a plan to make things different. Perhaps you might agree to drink only on certain days or to reduce your level of drinking on any one day to a certain amount. Perhaps you might need things from those around you to help you change your drinking pattern.

Maybe, in talking it through with others, you might agree that you need some professional help or some outside help. There are a number of people available who can help you with your drinking problems.

Your family doctor will be able to give you advice about safer drinking levels for you, and will be able to assess whether or not your drinking has caused any physical damage.
 
A public drug and alcohol service is available in each region. Those services are free, and anyone is allowed to contact them without a referral, but your family doctor will be able to tell you where local services are located and how you can contact them. There are about 150 alcohol services throughout New Zealand.

If you prefer some anonymity at this stage, you can ring the Alcohol Helpline.

This is a free call and you are contacting trained volunteers who provide information, advice, and some brief counselling if appropriate. They can talk with you about your nearest services. If you wish, the Alcohol Helpline can send you a self-help booklet. 

Alcoholics Anonymous (AA) is a self-help support network available throughout New Zealand for people who want to stop drinking. If you want to meet someone who has recovered from their alcohol problem, you are likely to meet them at AA.

Summary of treatment options

If you want to do something about your drinking, you need to get back the control that has been taken away from you by alcohol. You also need to take responsibility for your own drinking and for any problems your drinking is causing and make the changes that are needed. This might involve a controlled drinking programme or stopping drinking completely, at least for a time.
 
Some people will choose to give drinking away forever. This is a plan of action that you can discuss and work out with your family or whanau, doctor, counsellor, therapist or anyone involved in helping you.
 
Whether you are stopping drinking, cutting down, making other drinking changes or maintaining the changes you have made, there are a number of things you can do to make it less likely that you get back into the old difficulties or problems.

Options include the following:

• Treatment for physical dependence on alcohol, such as detoxification; sometimes taking disulfiram, although this on its own is not a treatment for alcohol problems.
• Treatment of other health problems.
• Counselling and/or support networks.
• Stress management.
• Other complementary therapies that may enhance your life and help you to maintain a non-problematic relationship with alcohol.

Any type of therapy or counselling and support should be provided to people and their families and whanau in a manner that is respectful of them and with which they feel comfortable and free to ask questions. It should be consistent with and incorporate their cultural beliefs and practices.

Detoxification

If you have become physically dependent on alcohol (that is, you show increasing tolerance to alcohol or you have withdrawal symptoms when you stop drinking) you might need a detoxification or detox from alcohol. This means using medications to help you to get through the withdrawal stage. There can be a danger in stopping alcohol suddenly and going into a withdrawal state.

Some people who have been heavy drinkers can have epileptic type fits or delirium tremens (DTs). These are serious complications and the reason that medical supervision is recommended.

Some cases of minor withdrawal can be managed with support and without the use of medications. As long as you don't drink again, the physical withdrawal symptoms will pass and you will start to feel better within four or five days.
 
If your withdrawal is more complicated, or it looks as if you might run into problems if you suddenly stop drinking, a medical detox may be needed. If this is the case, you need to be assessed by a doctor who can prescribe you medication.

If your alcohol dependence is mild to moderate, you have no serious medical problems, and you have good social supports, it may be possible to have a detoxification programme at home.

If your alcohol dependence is severe, you have additional medical problems or few social supports, admission to your local hospital or detox centre may be necessary to have your withdrawal managed.

How does medical detox work?

A medical detox works in the following way. If you drink regularly, the alcohol you drink has the effect of slowing your brain down. If the alcohol is then taken away, the brain rebounds and becomes very overactive. This rebound produces the symptoms of withdrawal you might have - sweatiness, shakiness, fits, confusion and hallucinations.

In a medical detox, you will be given a sedative drug to slow you down, which the doctor will substitute for your alcohol. The amount of the sedative drug can be controlled and then adjusted to cover the period of your alcohol withdrawal.

A medical detox is usually designed to run over five to seven days, the period of time over which you would have had withdrawal symptoms if you had not used a sedative drug.
 
The sedative should not be used for longer than this, even though some people feel they need the medication for longer to feel more normal. In a medical detox, medications are given to prevent unpleasant physical things from happening to you. Continuing to use them would mean you are just substituting a new drug for an old one - alcohol.

The medication most commonly used in a medical detox is diazepam. In the doses used for a medical detox, it is not addictive, but diazepam is a medication that can be addictive if taken for a longer period. Another drug that may be used for detox is chlormethiazole. The chief side effect of either of these medications is sedation (feeling sleepy). Your doctor can adjust the dose to ensure sedation is not a problem. The vitamin thiamine is also given to avoid potential nervous system damage from the detox process.

Once you have stopped your drinking, or have finished your detox, you have made a good start. If you have decided on abstinence, and if you have needed a detox, stopping drinking is probably the easiest option. The craving, or strong desire to return to drinking, might last for a long time. You will need to plan the changes in your life that will replace the dependency on alcohol.

Medication

Medications to reduce alcohol use or reduce the craving for alcohol are only used as part of a comprehensive psychosocial rehabilitation programme.

Disulfiram
Disulfiram is a drug that can sometimes be helpful for people who find it hard to resist the urge to drink. You only need to take disulfiram once a day and, if you take it, it means you will feel sick if you drink alcohol because disulfiram interferes with metabolism of alcohol and causes a build up of the toxin acetylaldehyde.

People who drink alcohol the same day as taking disulfiram are likely to experience a range of uncomfortable symptoms, including flushing, headache, shaky feeling (tremor), racing pulse, dizziness, nausea and vomiting. Generally, the intensity of the reaction is proportional to the amount of alcohol used. The reaction can last from 30 minutes to several hours.

Disulfiram is not a treatment for drinking problems on its own and it only works if you take it every day. For some people, however, it means you only have to make a decision not to drink once a day.
 
Your doctor will need to prescribe disulfiram and check out your general health before you start on it. People who have a history of cardiac problems, liver problems or psychosis should take care using disulfiram. People with these conditions should discuss with their doctor the benefits and risk of taking disulfiram. It is not safe to use during pregnancy.

As disulfiram can affect liver enzymes, your doctor will monitor these with regular blood tests.

The following side effects are occasionally experienced by people taking disulfiram:

• acne or skin eruptions
• drowsiness or fatigue
• reduced sex drive (libido)
• headache
• unpleasant aftertaste (this may mean the dose needs to be reduced).

People taking disulfiram should be careful not to have alcohol in disguised forms, such as in sauces and cough mixtures.

Naltrexone
Naltrexone is a medication that blocks the opioid system in the brain, and for some people, can reduce the craving for alcohol and therefore the risk of heavy drinking. It can also be used in a detox programme. Studies have shown it can result in less of a high when drinking alcohol and can lead to reduced use of alcohol and reduced rates of relapse.

Treatment of other health problems

There is no pill or other drug that can fix your drinking problem or make sure it will never come back.

Get a doctor to check out your physical health. Drinking may have caused a number of health problems and it is very important to get these attended to. Feeling bad might make it difficult to regain control over your drinking. Avoid taking another drug to make you feel better as it only replaces an old problem with a new one. Try not to smoke more than you used to and avoid the use of other tranquillising drugs.
 
The relationship between alcohol abuse and depression is complex. However, if depressive symptoms persist despite a period of abstinence from alcohol, your doctor may prescribe antidepressant medication. Similarly, further treatment may be required in the case of co-existing generalised anxiety disorder, panic disorder or other anxiety-related disorders.

Psychosocial treatments

Support networks and/or counselling
There are going to be times when you will feel like drinking again. You are probably going to have a lot of spare time on your hands and there might be occasions when you start to forget why you stopped drinking. If people see you are starting to make changes, many will be happy to try to help you.

There may be some members of your family, whanau or friends whom you would like to spend time with, talk to about how you are feeling, or who could support you through the times when you have bad cravings for alcohol. Ask them for help. See if you can get a team on board who can help you beat your drinking problem. If you are seeing a counsellor or you are in therapy, try to involve your team in this.

Alcoholics Anonymous (AA) can be a good form of support for many people who are giving up their drinking. The people at AA will understand how you are feeling as they have also been there. They will be able to give you good advice on how to make sure you do not drink again. AA can arrange a buddy system to give you extra support.

There is also an organisation called Al-Anon. This is for the families and whanau of people with drinking problems. Family or whanau members can get support and help from Al-Anon even if you do not go to AA.

Do not feel ashamed to seek the help of drug and alcohol counsellors. They should not judge or lecture you and can help by providing support and advice on cutting down or giving up drinking. They can help you develop new skills to help you cope with the problems you are having, as well as help to identify and sort out some of the things which may have led to you developing a problem with alcohol.

Triggers for drinking

You will come across a number of situations that trigger the feelings of needing to have a drink. People who have been drinking for a long time usually have a life that is built around drinking. The people you know usually drink. The places you go to are usually associated with alcohol. Your responses to a number of feelings are usually associated with having a drink.

You and your support team and/or your counsellor will need to look at ways in which you can make these patterns different. Think about the different things you could do instead of having a drink and have a plan in place for the next time you are faced with a situation in which you would usually have had alcohol.

Stress management

Look for better ways of controlling your stress levels. One part of this will involve sorting out other situations that exist in your life that are not as good as they might be. If these are not dealt with, they might be triggers for you to increase or start drinking again. Are there any family or whanau relationship, legal, job, or social problems that you need to do something about? Use the people in your support group, your counsellor, and/or people from outside agencies to start sorting these things out.

Think of things you can do when you start to feel stressed and think of the best ways for you to relax. If you feel very tense, your doctor or your counsellor could suggest a relaxation technique for you or suggest some relaxation tapes. Make use of these practices if you find them helpful.

Complementary therapies

The term complementary therapy is generally used to indicate therapies and treatments which differ from conventional Western medicine and which may be used to complement, support or sometimes replace it.

There is an ever-growing awareness that it is vital to treat the whole person and assist them to find ways to address the causes of mental health problems rather than merely alleviating the symptoms. This is often referred to as an holistic approach. 

Complementary therapies often support an holistic approach and are seen as a way to address physical, nutritional, environmental, emotional, social, spiritual and lifestyle needs.
 
Many cultures have their own treatment and care practices that many people find helpful and which can often provide additional benefits to health and wellbeing.  Rongoa Maori is the indigenous health and healing practice of New Zealand.  Tohunga Puna Ora is a traditional healing practitioner. Traditional healing for many Pacific Islands' people involves massage, herbal remedies and spiritual healers.

In general, meditation, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress.

Complementary therapies can include using a number of herbal and other medicinal preparations to treat particular conditions. It is recommended that care is taken, as prescription medicines, herbal and medicinal preparations can interact with each other. When considering taking any supplement, herbal or medicinal preparation it is advisable to consult a doctor to make sure it is safe and will not harm your health.
 
Women who may be pregnant or breastfeeding are advised to take extra care and to consult a doctor about any supplements, herbal or medicinal preparations they are considering using, to make sure they are safe and will not harm their own or their baby's health.

See also: Alcohol - effects from drinking
Alcohol - do you have a problem?
Alcohol - acknowledging problem drinking

Support groups

See the support organisations (which include helplines) under Further information and support below.

Original material provided by the Mental Health Foundation of New Zealand, 2002. Edited by everybody, June 2005.