Treatment of Alcohol and Drug Addicts

Alcoholism can destroy the life of an alcoholic and devastate the alcoholic's family. But it also has overwhelming consequences for society. Consider these statistics from the National Council on Alcoholism and Drug Dependence: *In 1988, alcoholism and problems related to it cost the United States an estimated $85.8 billion in mortality and reduced productivity; *Fetal alcohol syndrome, caused by a woman's drinking during pregnancy, afflicts five thousand infants a year; it costs about $1.4 billion annually to treat the infants, children and adults afflicted with FAS; *More than twenty thousand people die annually in alcohol related car accidents.

(Institute of Medicine, 1989) Clearly alcoholism harms society in numerous ways and it is in society's best interest to find effective treatments for alcoholics. The primary goal of all treatments for alcoholism is to get the alcoholic to stop drinking and refrain from abusing alcohol in the future. The paths to this goal are diverse. Several factors - biological, social and psychological - influence why an individual becomes an alcoholic. So treatments vary, depending upon why the alcoholic drinks and what the physician or therapist believes is the best method for recovery. Some treatments focus on the physical addiction of alcoholism. Others emphasize the alcoholic's social or psychological cravings.

Alcoholics Anonymous and Rational Recovery are two support groups that help alcoholics recover. Other alcoholics benefit from one-on-one therapy with counselors, who may help patients understand drinking and change their behavior. Finally for some alcoholics, the most effective treatments are those that combine medical treatment with counselling. Such treatments enable the alcoholic to more easily break the physical addiction to alcohol as they evaluate their social and psychological reasons for drinking. Two of these treatments are: Nutritional Therapy and Network Therapy.

Nutritional Therapy

"Alan Dalum was 37 years old and thoroughly convinced he was soon going to die. Dalum was not dying of cancer, heart disease or any other illness from which one can leave the world with dignity. Dalum was dying of alcoholism." (Ewing, 1978) Just when he lost all hope for recovery, Dalum discovered a center that emphasized the importance of biochemical repair in alcoholism recovery using nutrients and herbs. Upon learning that Minneapolis, where he lived, had one of the only programs in the country that employed such methods, Dalum decided to give the Center's six - week, outpatient program a shot.

The Health Recovery Center (HRC) in Minneapolis claims a 74 percent success rate (patients still sober one year later) and differs from conventional programsin several significant ways. First, it focuses on uncovering and treating physiological imbalances that may be causing alcohol cravings and throwing the entire body out of whack. For example: hypoglycemia is a common imbalance found in up to three quarters of alcoholics. The center's philosophy is simple "Until the body begins getting the essential nutrients it needs, recovery cannot begin." (Ewing, 1978) They believe that no amount of talk will stop the cravings, anxiety, depression, mental confusion and fatigue that result from alcohol's biochemical and neurochemical damage. "There is not time to obsess over past traumas when you're dying of a major disease. Why do people persist in believing that the damage done by excess ingestion of alcohol can be undone with psychological methods alone?" (Ewing, 1978) The Health Recovery Center is devo ted to the restoration of bodies, minds and spirits that have been ravaged by alcohol.

Such restoration begins the moment a new patient walks through the door. After the staff physician takes a thorough medical history and performs the initial physical exam, the patient is hooked up to an IV solution, out of which drips high doses of ascorbic acid (vitamin C, a powerful detoxifier), calcium, magnesium, B vitamins (which help eliminate withdrawal symptoms), evening primrose oil (a natural anticonvulsant) and a full spectrum of amino acids including glutamine (an alternative form of glucose that significantly diminishes cravings). While conventional programs frequently numb new patients with drugs like Librium and Valium to help ease withdrawals (and later must wean patients off of them), HRC's formula is entirely natural. "The sum total of it all is that people go from consuming half a quart of alcohol a day to consuming none at all - without drugs." (Ewing, 1978)

Following the IV, HRC patients are supplied with bottles of the vitamins and minerals they have been deficient in for so long and put on a diet that is free of sugar, salt, caffeine and most importantly, nicotine. This is because tobacco is cured with cane, beet and corn sugars, which may not only cause intense cravings in those with hypoglycemia (and render them incapable of getting the condition under control), but may also stimulate allergic/addictive reactions in those sensitive to sugar and corn, two of the most common hidden food allergies. "Sensitivities to corn, yeast, barley and other foods commonly found in alcoholic beverages are the reason some patients cannot stop drinking." (Ewing, 1978)

In the ensuing six weeks, HRC patients meet once weekly with a nutritionist, once weekly for individual therapy with one of HRC's five certified counselors, and daily for group sessions, at which they talk openly about such subjects as anger, humor and insecurity. Such sessions are purposely not like conventional twelve step meetings, at which participants are expected to talk about the power they believe alcohol has over their lives. Rather, both the group and individual sessions focus on the here and now. "We call it rational management therapy. First we make a list of the client's goals, long and short term, and map out ways they can achieve them. We decide together what they need to work on and we try to get them to do things that will make them feel good about themselves." (Ewing, 1978)

In sharp contrast to the AA approach, HRC counselors try to instill in patients the belief that they are in control of their destinies, that they have power over alcohol rather than the other way around. Network Therapy Twenty years ago, Marc Galanter was appointed as a career teacher in alcoholism and drug abuse by the National Institute on Mental Health. Galanter found nothing on the technique of resolving a drinking or drug problem for a patient who came to the doctor's office. Since then, researchers in addiction have begun to develop a systematic understanding of how drug and alcohol dependence wreak their effects on thinking and behavior. But there are still very few descriptions of a comprehensive approach that the therapist can apply to addicted patients. "Few therapists venture beyond recommending to alcoholics that they attend AA or take a long break from job and family and go away to a rehabilitation hospital." (Stepney, 1987) Marc Galanter developed an approach that engages the support of a small group - some family, some friends - to meet with the substance abuser and a therapist at regular intervals to secure abstinence and help with the development of a drug free life.

The majority of Galanter's patients (77 percent) achieved a major or full improvement. They were abstinent or had virtually eliminated substance use and their life circumstances were materially improved and stable. Marc Galanter named his therapy network therapy. Family and peers become part of the therapist's working team, not subjects of treatment themselves. "Social supports are necessary for overcoming the denial and relapse that are so compromising to effective care for the substance abuser." (Stepney, 1987) Together, the group develops a regimen to support the recovery, one that includes individual sessions as well as meetings with this network. The therapist continues to meet with the network while the abuser focuses on ways to protect continued abstinence and on the psychological issues that would allow the achievement of full recovery. As time goes on, the abuser's abstinence is secured, the network sessions are held less frequently and individual therapy continues. "A social network is apparently a necessary vehicle to stabilizing the cognitive components of patients' recovery, to allow them to deal with the reality they need to see and to provide the support essential for accepting the new reality." (Newman, 1987) The purpose of network therapy is then to create an atmosphere that will allow an alcohol or drug abuser to experience relief from distress by participating and moving towards a drug free outlook. After initial sobriety has been achieved, network sessions often acquire a social quality.

In order to act out a pattern of behavior that is clearly self-destructive, addicts must adopt a pattern of denial. This denial is supported by a variety of distorted perceptions: "persecution at the hands of employers, failings of a distraught spouse, a presumed ability to control the addiction if wanted." (Newman, 1987) This cognitive set is not only unfounded, but it is also at variance with the common sense views of the drug free family and friends. Because of this, intimate and positive encounters with them in the network produce an inherent conflict between addicts' views and the views of network members. The addict must resolve this conflict, or cognitive dissonance, in order to feel accepted in the group. The network therefore creates an ongoing pressure on the addict to relinquish the trappings of denial.

Typically, addicts deal with this conflict by defensive withdrawal, but if their network is properly managed, cohesive ties in the group will engage them and draw them into an alternative outlook. Gradually, they come to accept that their distress can be relieved by a change in attitude, as denial and rationalization are confronted in a supportive way. Over time, engagement in the network allows an addict to restructure the perspective in which the addiction has been couched. For addicts, both healthy and faulted attitudes have long coexisted in conflict with each other and the cognitive dissonance produced by these contradictions has driven them into a defensive stance. In a proper, supportive context, a constructive view premised on abstinence and on acknowledgment of the harmful nature of drug use can emerge. Addicts can experience a "conversion" of sorts, perhaps gradual, but real nonetheless. (Johnson, 1980)

There is hardly any disorder more complicated and difficult to treat than alcohol/drug dependence. Perhaps because alcohol dependence is so complex, it has attracted various professions and approaches, each having its own notion of etiology and treatment. The point is that treatment needs to be conceptualized for the patient as a long term process of years with the principle task for recovery being to provide the most effective treatment for a given person with a given problem. But until and unless researchers find a specific biological cause and cure for alcoholism, treatments will continue to vary, depending upon the alcoholic and the therapist.