A new family of drugs is now available to treat alcoholism, just as physicians began treating depression with medication a decades ago. Several anti-craving meds have been introduced and will radically change the way physicians help their patients. These drugs typically work on mid-brain receptors to ease withdrawal, blunt craving and dull the euphoria associated drinking. When used in conjunction with a comprehensive program of counseling, nutrition and support, they can be very effective. Some medications, like Naltrexone and Acamprosate, are approved by the FDA for this purpose. Others, like Topiramate, Rimonabant, or Baclofen are prescribed off label to help patients begin a program of alcohol cessation.
Do an honest self assessment about your drinking. Consider using the “C.A.G.E.” assessment. C: Have you ever felt you needed to cut down on your drinking? A: Have people annoyed you by criticizing your drinking? G: Have you ever felt guilty about drinking? E: Have you ever felt you needed a drink first thing in the morning (eye opener) to steady your nerves or to get rid of a hangover? If you answer yes to any of these questions, you probably need to seek help. Other signs of alcohol addiction include the inability to control how much you drink, withdrawal symptoms such as shakiness or anxiety if you stop drinking, sleep disruptions and physical symptoms such as fluid buildup, poor wound healing and gastrointestinal bleeding. The sooner you seek treatment, the better.
Research anti-craving medications because this approach is relatively new to many health care providers. Ultimately, you will want to work in partnership with your clinician in determining which medicine is most appropriate based on your health status, possible drug interactions, side effects, and other factors. Review as much information as possible about each of the anti-craving medications you can find, including clinical studies regarding their use and efficacy. Search online magazine and newspaper articles about their use, effectiveness and side effects. Do not base your opinion on the experience of other individuals, but collect as much comprehensive information as you can before visiting your doctor. Depending on the physician you visit, you may be more knowledgeable about the specific medication in which you are interested.
Make your appointment. Treatment for alcoholism does not require a highly skilled addiction specialist, but it is helpful to have a trusted health care provider who will listen to you. Seek someone you are comfortable with and whom you believe will respect your wishes. Patients often prefer to see a doctor outside of their normal caregiver. If this is the case, you may wish to consider visiting a mental health practitioner because they are often more comfortable prescribing medications to treat addiction. Whomever you see, be honest about your health situation, but understand the information–unless otherwise indicated–will be noted in your medical records.
Expect a knowledgeable doctor to run any number of tests, which may include a physical exam, a GGT (blood chemistry test to evaluate liver function), a CDT (a more sensitive blood test) and an evaluation for signs of complications due to alcohol consumption such as abdominal pain, heart problems, withdrawal or cirrhosis.
Be prepared to receive a referral for individual counseling or group-based meetings to be done in conjunction with therapy. Support is a critical part of the process. If you are unwilling to visit a local therapist or a 12-step group, consider visiting an online alcohol recovery forum, where you may participate anonymously. If possible, find someone who is starting a similar regimen and “buddy up”. This can be enormously therapeutic.
Consider accepting a short term prescription for a benzodiazepine such as Valium or Ativan if your doctor feels it is necessary. It is often helpful for late stage alcoholics to manage withdrawal symptoms. Your physician should first screen for the presence of other medications to avoid interactions such as over-sedation.
Follow the directions for your medications carefully and report any disturbing side effects at once. If you are overly sensitive to the medication, you may have to reduce the initial dosing to minimize unwanted effects. Read the material provided with your medicine for all potential side effects, even those your physician may not have mentioned. Monitor your health closely.
Try and create as successful an environment as possible. Remove all alcohol from your house. Encourage the support of partners or others in the home and emphasize the importance of this endeavor if they are not already aware of it. If necessary, do not attend social functions early on if you feel they will provide too much temptation. Stay away from associates with whom you normally drink. Enroll in evening classes, join a volunteer group, or partake in other activities that will keep you busy. Many people report the “witching hours” between 5 and 8 p.m. to be the most difficult. If that is the case for you, try and change your schedule, at least early on, so you are preoccupied during those hours.
Consider medication as only *one part* of an important, multi-faceted therapy. At this time, you should also be focusing on restoring your body’s mental, emotional and physical health. If you do not exercise regularly, this is an excellent opportunity to begin, as you will occupy time once filled drinking, while you promote the release of endorphins and lift depression. Improve your diet by increasing whole grains, vegetables and fruits and reduce sugar, which will further curb your craving for alcohol. Drink lots of water. Begin a program of improved dietary supplementation, focusing on vitamins, minerals, amino acids and herbs that will help restore, rejuvenate and maintain a healthy, alcohol-free lifestyle. Save time each day for relaxation, positive visualization, self-hypnosis, and other helpful strategies to reprogram behavior. Focus on eliminating drinking triggers and look into the future to “see” the healthy individual you will become.