As with similar substances with a sedative-hypnotic mechanism, such as barbiturates and benzodiazepines, withdrawal from alcohol dependence can be fatal if it is not properly managed. Alcohol's primary effect is the increase in stimulation of the GABAA receptor, promoting central nervous system depression. With repeated heavy consumption of alcohol, these receptors are desensitized and reduced in number, resulting in tolerance and physical dependence. When alcohol consumption is stopped too abruptly, the person's nervous system suffers from uncontrolled synapse firing. This can result in symptoms that include anxiety, life-threatening seizures, delirium tremens, hallucinations, shakes and possible heart failure. Other neurotransmitter systems are also involved, especially dopamine, NMDA and glutamate.
With Step 9, individuals are apologizing for their actions while under the influence of drugs or alcohol or for the damages their addiction has caused. Individuals may then attempt to offer restitution and seek forgiveness and reconciliation but need to be aware that they may not receive it. Working through Step 9 helps to set things right so everyone can move on.
While both alcohol abuse and alcoholism are included in the alcohol use disorder diagnosis and involve engaging in maladaptive behaviors in the use of alcohol, abuse of this substance does not include the person having withdrawal symptoms or needing more and more amounts to achieve intoxication (tolerance) unless the person has developed alcoholism.
The effects of alcoholism are far reaching. Alcohol affects every body system, causing a wide range of health problems. Problems include poor nutrition, memory disorders, difficulty with balance and walking, liver disease (including cirrhosis and hepatitis), high blood pressure, muscle weakness (including the heart), heart rhythm disturbances, anemia, clotting disorders, decreased immunity to infections, gastrointestinal inflammation and irritation, acute and chronic problems with the pancreas, low blood sugar, high blood fat content, interference with reproductive fertility, increased risk of cancer of the liver, esophagus, and breast, weakened bones, sleep disturbances, anxiety, and depression. About 20% of adults admitted to the hospital (for any reason) are alcohol dependent. Men are more than twice as likely to be alcohol dependent than women, and smokers who are alcohol dependent are much more likely to develop serious or fatal health problems associated with alcoholism.
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People going through mild withdrawal are monitored to make sure that more severe symptoms do not develop. Medications usually are unnecessary. Treatment of a patient suffering more severe effects of withdrawal may require sedative medications to relieve the discomfort of withdrawal and to avoid the potentially life-threatening complications of high blood pressure, fast heart rate, and seizures. Benzodiazepine drugs may be helpful in those patients experiencing hallucinations. If the patient vomits for an extended period, fluids may need to be given through a vein (intravenously, IV). Thiamine (a vitamin) is often included in the fluids, because thiamine levels are often very low in alcohol-dependent patients, and deficiency of thiamine is responsible for the Wernicke-Korsakoff syndrome.
A study found an association between an increase in attendance to AA meetings with increased spirituality and a decrease in the frequency and intensity of alcohol use. The research also found that AA was effective at helping agnostics and atheists become sober. The authors concluded that though spirituality was an important mechanism of behavioral change for some alcoholics, it was not the only effective mechanism. Since the mid-1970s, a number of 'agnostic' or 'no-prayer' AA groups have begun across the U.S., Canada, and other parts of the world, which hold meetings that adhere to a tradition allowing alcoholics to freely express their doubts or disbelief that spirituality will help their recovery, and these meetings forgo use of opening or closing prayers. There are online resources listing AA meetings for atheists and agnostics.
In order to effectively recover from an addiction, professional help in the field of substance abuse is only part of the equation. Often times, recovering individuals additionally need the support of others who are also recovering from addiction. This is where support groups can provide a critical element needed to bring success to an individual's recovery process.
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People have been brewing and fermenting alcoholic drinks since the dawn of civilization. Consumed in moderate amounts, alcoholic beverages are relaxing and in some cases may even have beneficial effects on heart health. Consumed in excess, alcohol is poisonous and is considered a drug. It is estimated that between 18 million -- or one in 12 adults -- in the U.S. abuse alcohol or are chronic alcoholics. Nearly 100,000 Americans die each year as a result of alcohol abuse, and alcohol is a factor in more than half of the country's homicides, suicides, and traffic accidents. Alcohol abuse also plays a role in many social and domestic problems, from job absenteeism and crimes against property to spousal and child abuse.
Whether you choose to go to rehab, rely on self-help programs, get therapy, or take a self-directed treatment approach, support is essential. Recovering from alcohol addiction is much easier when you have people you can lean on for encouragement, comfort, and guidance. Without support, it’s easy to fall back into old patterns when things get tough.
"Learning basic Twelve Step philosophy and language can open the lines of communication," continued Cathy. "Once you understand some Twelve Step principles, concepts such as powerlessness, spiritual awakening, higher power and making amends, they will seem less like cult mantras and more like the simple guides they are intended to be." A Twelve Step program is one that adapts the Twelve Steps of AA to fit the particular needs of a mutual-help group. Narcotics Anonymous, Al-Anon, Alateen, Gamblers Anonymous, Nicotine Anonymous, and Adult Children of Alcoholics are examples of groups with a Twelve Step foundation.
Naltrexone is a competitive antagonist for opioid receptors, effectively blocking the effects of endorphins and opioids. Naltrexone is used to decrease cravings for alcohol and encourage abstinence. Alcohol causes the body to release endorphins, which in turn release dopamine and activate the reward pathways; hence in the body reduces the pleasurable effects from consuming alcohol. Evidence supports a reduced risk of relapse among alcohol-dependent persons and a decrease in excessive drinking. Nalmefene also appears effective and works in a similar manner.
AA meetings do not exclude other alcoholics, though some meetings cater to specific demographics such as gender, profession, age, sexual orientation, or culture. Meetings in the United States are held in a variety of languages including Armenian, English, Farsi, Finnish, French, Japanese, Korean, Russian, and Spanish. While AA has pamphlets that suggest meeting formats, groups have the autonomy to hold and conduct meetings as they wish "except in matters affecting other groups or AA as a whole". Different cultures affect ritual aspects of meetings, but around the world "many particularities of the AA meeting format can be observed at almost any AA gathering".
"When I first told my family I was going into treatment, they were stunned," said Cathy, a recovering alcoholic. "I wanted to talk, needed to talk, but none of us had the right words yet. Now, five years later, I realize that it doesn't really matter how perfectly you say something. You have to risk saying the wrong thing and just start communicating.
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Non-12-step support groups provide a secular alternative to the 12-step programs and may be more comfortable for those not wanting to place such an emphasis on a higher power for recovery. Non-12-step groups sometimes involve fewer group sharing scenarios—which can provide some relief for those individuals who aren't as comfortable sharing sensitive personal information in group settings. Below are a few examples of non-12-step programs:
Twelve-step methods have been adapted to address a wide range of alcoholism, substance-abuse and dependency problems. Over 200 self-help organizations—often known as fellowships—with a worldwide membership of millions—now employ twelve-step principles for recovery. Narcotics Anonymous was formed by addicts who did not relate to the specifics of alcohol dependency.