Hazardous drinking

If you are concerned that you are drinking hazardous amounts of alcohol it is likely that you will be referred to a short counselling session that is known as a brief intervention.

You may also be invited to a brief intervention if you experience an alcohol-related injury or illness, which could suggest your drinking is at hazardous levels.

A brief intervention lasts around 10-15 minutes and usually consists of a series of steps.

Firstly, the counsellor will provide feedback on the short term and long term risks associated with your individual pattern of drinking while emphasizing that it is your responsibility to reduce that risk.

Then the counsellor will provide advice on ways you can reduce your alcohol consumption. For example, you may be told to keep a ‘drink diary’ so you can accurately record how many units of alcohol you drink a week, and then try to lower the amount.

Or if most of your drinking is done on a social basis, the counsellor can provide advice on how you can continue to socialise while reducing your alcohol consumption, such as alternating alcohol with soft drinks, or choosing low-alcohol drinks such as spritzers or low-strength lager.

Then the counsellor will discuss what additional support is available for you if you require it, such as self-help groups or specialist alcohol services.

The session will end with the counsellor discussing any emotional issues you may feel about trying to reduce your drinking, such as apprehension or anxiety, while providing support about how to cope better with these emotions.

Harmful drinking

If you are drinking harmful amounts of alcohol you will first have to make the decision whether you want reduce your alcohol intake to a moderate level (moderation) or quit alcohol altogether (abstinence).

Obviously, abstinence will have a greater health benefit, though often moderation is a more realistic goal, or at least, a first step on the way to abstinence.

Ultimately the choice is yours, though there are circumstances where abstinence is strongly recommended. These are:

• if you have liver damage,
• if you have other medical problems that can be made worst by drinking, such as heart failure,
• if you are taking medication that can react badly or unpredictably with alcohol, such as antipsychotics, and
• if you are pregnant or are planning to become pregnant.

Abstinence may also be recommended if you have previously tried to achieve moderation and failed.

If you do choose moderation as a treatment goal you will usually be referred to counselling session that is known as an extended brief intervention. This is similar to a brief intervention except it is slightly longer and more in-depth.

You will probably be asked to attend further sessions so your progress can be monitored and further treatment and advice provided if necessary.

You may also receive regular blood tests so the state of your liver can be carefully monitored.

See below for information on available treatments to achieve abstinence.

Dependent drinking

As with harmful drinking, you will need to choose between moderation and abstinence.

Moderation may be a realistic goal for people with mild to moderate dependency. Abstinence would usually be recommended for people with moderate to severe dependency.

Treatment to achieve moderation is carried out in much the same way as for harmful drinking.

Though whatever your level of dependency it is recommended that you spend a period of time free from alcohol, so your body can recover from the effects of alcohol, and in cases of moderate to severe dependency, you can break the cycle of drinking alcohol to avoid withdrawal symptoms. This is known as detoxification or ‘detox’.

Detoxification

How and where you attempt detoxification will be determined by your level of alcohol dependency.

If your level of dependency is low to moderate you should be able to detox at home without the use of medication as your withdrawal symptoms should be mild.

If your level of dependency is moderate to severe and your consumption of alcohol is high (over 20 units a day) and/or you have previously experienced withdrawal symptoms you should be able to detox at home though you will be given the option of taking medication to help ease withdrawal symptoms. A type of tranquiliser called chlordiazepoxide is usually used for the purpose.

If your levels of dependency are severe it is usually recommended that you are admitted to a hospital or clinic to detox. This is because there is a risk you could experience more severe withdrawal symptoms, such as seizures and hallucinations, so you may require specialist treatment.

You will find that the withdrawal symptoms are worst for the first 48 hours. Withdrawal symptoms should then gradually improve as your body begins to adjust to being without alcohol. This usually takes 3-7 days from the time of your last drink

You will also find that your sleep is disturbed, such as waking often during the night, or having problems going to sleep. This is perfectly usual and your sleep patterns should return to normal within a month.

During detox you should drink plenty of fluids, usually 3 litres a day. Avoid drinking excessive amounts of tea or coffee as this make sleep problems worse and cause feelings of anxiety. Water or fruit juices would be a better choice.

You should try to eat regular meals even if you are not feeling hungry. Your appetite will return gradually.

If you are taking medication to ease withdrawal symptoms then you should not drive or operate heavy machinery as the medication will probably make you feel drowsy. You should only take your medication as directed.

Detox can be a stressful time. Ways you can try to relieve stress include:

• listening to music,
• walking, and
• taking a bath.

If you are detoxing from home you will receive regular visits from a health visitor, and be given relevant contact details for other support service, so if you require additional support it can be made available.

Abstinence

There are a number of different treatment options available to help you achieve abstinence. Different treatment options often differ in effectiveness depending on each individual, so if you feel that a certain treatment option is not working for you, then you should discuss alternative options with your care team and/or your doctor.

Medication

There are currently two licensed medications that can be used in the treatment of alcohol misuse:

• acamprosate, and
• disulfiram.

Acamprosate

Acamprosate is used to help people who have successfully achieve abstinence from alcohol from relapsing. Acamprosate is usually used in combination with counselling.

Acamprosate works by affecting levels of a chemical in the brain known as gamma-amino-butyric acid (GABA). GABA is thought to be partially responsible for inducing a craving for alcohol.

Side effects of acamprosate include:

• nausea,
• vomiting, and
• itchy skin.

Disulfiram

Disulfiram (sold under the brand name ‘Antabuse’) is a medication that can be used if you are trying to achieve abstinence but are concerned that you may relapse, or have experienced previous relapses.

Disulfiram works by making you have a series of extremely unpleasant physical reactions if you drink any alcohol, such as:

• nausea,
• chest pain,
• vomiting, and
• dizziness.

The unpleasantness associated with these reactions should deter you from drinking any more alcohol.

Aside from alcoholic drinks, it is important to avoid all sources of alcohol as these could also induce an unpleasant reaction. Products that may contain alcohol include:

• aftershave,
• mouthwash,
• some types of vinegar, and
• perfume.

You should also avoid substances that give of alcoholic fumes, such as:

• paint thinners, and
• solvents.

You will continue to experience unpleasant reactions if you come into contact with alcohol for a week after you finish taking Disulfiram. So it is important to maintain your abstinence during this time.

Side effects of disulfiram include:

• drowsiness,
• fatigue,
• nausea, and
• bad breath.

Counselling

Self-help groups

Many people with a dependence on alcohol find it useful to attend self-help groups, the best known being Alcoholics Anonymous.

Alcoholics Anonymous believe that alcoholic dependence is a chronic and progressive incurable disease for which total abstinence is the only solution.

Alcoholics Anonymous is based on a 12-step programme that it designed to help you overcome addiction, which include the following points:

• You admit that you are powerless over alcohol and your life has become unimaginable.
• You recognise that you need a power greater than yourself to restore your strength.
• You examine past errors in your life with the help of a sponsor (an experienced member of the group).
• You make amends for those errors.
• You learn to live a new life with a new code of behaviour.
• You help others who have an alcohol dependence.

Twelve step facilitation therapy

Twelve step facilitation therapy is based on the 12-step programme devised by Alcoholics Anonymous, except you work through the 12-steps, one-on-one with a counsellor, rather than as a group.

Twelve step facilitation therapy may be a preferred treatment option if you feel uneasy or unwilling to discuss your problems in a group setting.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is a type of talking therapy that emphasises a problem-solving approach to alcohol dependence.

CBT’s approach to alcohol dependence is to identify unhelpful and unrealistic thoughts and beliefs that may be contributing towards your alcohol dependence, such as:

• ‘I cannot relax without alcohol’,
• ‘My friends would find my boring if I was sober’, or
• ‘Just drinking one pint can’t hurt’.

Once these thoughts and beliefs are identified, you will be asked to base your behaviour on more realistic and helpful thoughts, such as:

• ‘Lots of people have a good time without alcohol, and I can be one of them’.
• ‘My friends like me for my personality, not for my drinking’ and
• ‘I know I cannot stop drinking once I start’.

CBT also helps you identify triggers that can cause you to drink such as:

• stress,
• social anxiety, and
• being in ‘high-risk’ environments such a pub, club or restaurant.

The therapist will then teach you how to avoid triggers that are avoidable, and cope effectively with triggers that are unavoidable.

Family therapy

Alcohol dependence does not just impact on an individual but can also affect a whole family.

Family therapy provides the opportunity for family members to:

• learn about the nature of alcohol dependence, and
• provide support to the family member who is trying to abstain from alcohol.

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