Alcoholism is one of the most serious problems affecting all strata of society today. The effects of alcohol misuse may lead to chronic health problems such liver, heart, pancreatic or gastric diseases. Statistics also indicate that drink dependence impacts on crime figures, social problems, car accidents and mental health issues. In the UK alone, according to the National Health Service, over 7% of all hospital admissions are alcohol related. The cost has been estimated at billions of pounds a year with pressures on staff increasing significantly in recent years. Support groups and health professionals continue to press for changes in social drinking habits and greater public awareness of the potential risks of alcohol misuse.

The response to the underlying causes as well as the levels of alcohol dependence has led to a number of diverse and complex programmes becoming available. This is true in both the private sector and government (NHS) health facilities.

The 3 common aims of treatment providers are:

1. To encourage excess drinkers to recognize their condition and seek treatment (‘go into rehab’).
2. Reduce or completely eliminate alcohol misuse.
3. Provide support to prevent relapse.

The choice of rehab treatments and facilities is governed by many factors that may include health, social, family and/or financial concerns.

Government Health Facilities.

Pros:

• In the UK the NHS provides free treatment or, in some cases, funding for private facilities.
• Treatments are usually available in the local area.
• Services within a wider health care facility provide a degree of confidentiality.
• Co-ordinated local support with Social Services and self-help groups.
• Ability to offer acute or emergency medical treatment.

Cons:

• Subject to budget cuts and restrictions.
• Delays and waiting times for treatments or beds for in-patients
• One-to-One therapies may not be possible.
• Insufficient numbers of specially trained medical staff.
• Restricted use of specialist drugs.

Private Clinic or Hospital.

Pros:

• Immediate or rapid access to care facilities.
• Specialized and comprehensive range of treatments.
• Specifically trained health care professionals.
• One-to-one therapies
• Modern drug protocols and specialist treatments available.
• Additional facilities for in-patients e.g. gardens, swimming pool or gym.

Cons:

• High cost of treatments.
• Fees are not always covered by medical insurance.
• Associated health issues might need referring to a government facility.
• May not be in a local area.
• May not offer sufficient out-patient or post course support.

Treatments.

According to the degree of misuse or alcohol dependence treatments are graduated.

1. Assessment. Acceptance of the need for help is the first step in the treatment of alcohol misuse. A doctor or local GP will need to examine advice on the options and refer the patient to the selected health facility for specialist treatment.
2. Intervention. This usually involves a short counseling session (‘brief intervention’)to discuss drinking issues and an outline of the possible consequences of continued misuse. This would also entail positive advice on reducing and controlling alcohol consumption. Treatments and support networks available would also be discussed.
3. Further counseling might follow which could also involve others family members or loved ones who may be impacted by the problem. Issues such as stress levels, financial concerns or the pressures of ‘social drinking’ could be addressed at this stage. An individual programme of gradual alcohol reduction (moderation) or total abstinence would then be planned.
4. In more severe cases of alcoholism and associated health issues in-patient treatments maybe advised or become essential.
5. Detox (‘going into rehab’)is the crucial stage of dealing with advanced dependence. This will mean a time of flushing out alcohol entirely from the body. It is also a stage most difficult for the misuser because of the fear of associated withdrawal symptoms. These can be mild or severe ranging from feelings of anxiety, headaches, sweating and nausea to irregular heart rhythms, feelings of disorientation, hallucinations or – in extreme cases – delirium tremens (‘the DT’s’) or even seizures. With support, detox can be successfully effected at home but usually involves admittance to hospital or a specialist facility for medical supervision during the process. Withdrawal stages vary according to the degree of dependency but lessen after 7 days and onwards. Drug therapy may be given in this time to help the body cope with the changes. These include:
6. Benzodiazepines.Chlordiazepoxide (Librium) and diazepam(Valium) are often used to control muscle spasms, insomnia and anxiety.
7. Naltrexone. Administered to reduce alcohol cravings.
8. Other drugs like Acomprosate and Disulfirum may also be prescribed in withdrawal and to prevent or limit relapse.

The treatment of serious alcoholism means ‘going into rehab’ for typically 30, 60 or 90 day periods. Relapse can be for shorter or longer treatment times. Stages of total alcohol rehabilitation are marked by 1 to 5 ‘dry’ years and rely very much on the support of family, loved ones, support groups and continuing therapy to succeed. It is a long-term commitment.