Many people research how to detox themselves from alcohol.  Keep in mind that there is a huge difference between occasional or sporadic alcohol abuse and true alcohol dependence.  If you abuse alcohol occasionally you can sometime just quit drinking, survive the hangover and recover without any medical intervention.  If you have become alcohol dependent, it is a totally different story.  Alcohol Dependence is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is the American handbook for medical professionals, as meeting at least three of seven criteria within a twelve month period. The criteria are:

1.      Narrowing of the drinking repertoire.

2.      Increased salience of the need for alcohol over competing needs and responsibilities.

3.      An acquired tolerance to alcohol.

4.      Withdrawal symptoms.

5.      Relief or avoidance of withdrawal symptoms by further drinking.

6.      Subjective awareness of compulsion to drink.

7.      Reinstatement after abstinence. 

If three of these criteria are met, you have become alcohol dependent and it is unsafe and potentially life threatening to detox yourself.  Many things happen when alcohol is withheld from a dependent person.  The degree of withdrawal problems will vary for each individual but the common problems incurred will include; dramatic increases in blood pressure, nausea, tremors, headache, dementia and hallucinations, seizures, heart failure and strokes.

Most good intentioned alcohol dependent people swear off alcohol many times and are determined to quit drinking on a daily basis.  Within hours of abstinence, symptoms begin to occur.  The person will have a splitting headache, be sick to their stomach and begin to tremble.  The great majority of these people are unsuccessful in there attempts to quit.  They decide to have one drink to feel better and they are off to the races again.  When the alcohol dependent person has this “one drink” their symptoms abate very rapidly.  The shaking stops, the headache goes away and they feel better.

There was an article in yesterday’s paper about a woman who died while in custody of the Phoenix Airport Police Department.  She was on a flight from New York to Arizona where she planned to enter an alcohol treatment program in Tucson.  She was arrested for disorderly conduct and unfortunately died in a holding cell.  The article was not specific about the cause of death but it was undoubtedly alcohol related.  I suspect that her disorderly conduct arrest was probably due in fact to alcohol induced dementia or delirious tremens (DT’s) which are usually interpreted as extreme intoxication.  When symptoms such as these accompany withdrawal, a stroke or seizure is almost inevitable without medical intervention.  This is a very common story and it often ends in death.

Alcohol detox must be done under medical supervision.  There are two basic types of detox methods ambulatory detox and outpatient detox.  Ambulatory detox can be safely accomplished when done under medical supervision and administration of appropriate detox drugs.  Vital signs must be taken and dosing must be done frequently to safely detox in an outpatient setting.  The alcohol dependent person must be monitored at all times during the detox and cannot be left alone.  The other detox method is done in a hospital setting.  Hospitalized detox is necessary when there is a history of DT’s or in cases where other medical problems are present.Medical protocols for detox patients will vary depending on the person’s specific medical history and severity of dependence.  In all cases, anti-seizure drugs are induced to mitigate the risk.  A variety of other medications will be used to treat symptomatic problems such as nausea, insomnia and anxiety.

In short, there is no way to safely detox yourself from alcohol if you are alcohol dependent.  Do not be fooled by advertising claims or holistic remedies.  It is a life and death situation and cannot be done safely without medical intervention.

The Gateway Drug Theory is best defined as the belief that a lower class drug can lead to subsequent use of harder drugs.  It is also defined as a drug sometimes used in a first or introductory experience.  The two drugs most frequently labeled under this definition are marijuana and alcohol. 

More people enter substance abuse treatment centers each year for treatment of alcoholism than all other substances combined.  It is available, plentiful, easily obtained, legal and socially condoned and in some cases, socially encouraged.  Thousands of people enter treatment each year for cannabis addictions but the numbers pale in comparison.   

Alcohol addiction is progressive in nature.  It takes more and more to achieve the same effect.  As the consumption levels increase, the dependence transcends one of a psychological nature and it also becomes a physical dependence. 

While many who experiment with marijuana never progress to harder drug use, just as many will progress to more addictive drugs.  Some remain with marijuana as their drug of choice and become dependent on marijuana alone.  The most common progression is marijuana to cocaine.  After using cocaine for a period of time, most coke users also become dependent on alcohol and/or benzodiazepines.  The cross addictions normally occur as a result of the users efforts to self-medicate for the sever depression or “crash” that is experienced when coming down from cocaine.  Methamphetamine users have progressive drug use and in most instances it goes form marijuana to cocaine to crack to meth.   

Once someone has become dependent on any substance to a point that treatment is necessary, they must realize that they are much more vulnerable to the potential addiction to other addictive substances.  Many treatment centers report that clients return with relapse problems that are not their original drug of choice.  They might have completed treatment for alcoholism and relapse on opiates or cocaine. 

Addicts must realize that once they have crossed the line and become physically and mentally dependent to a mind altering substance that they can just as easily become addicted to a new drug.   

Virtually all relapses begin with alcohol.  It is very difficult to get people who have never had a problem specifically with alcohol to understand that it is very dangerous to drink if you have ever had problems with other substances.  They often say that they rarely drink and they really don’t enjoy the taste.  The problem surfaces when the person consumes alcohol and reduces their inhibitions and ability to make rational decisions.  Most jokes start with “This guy in a bar…” or “This drunk…”  There is a reason for this.  When people drink they do things that they would not normally do when sober.  Drug relapses usually happen after a couple of drinks.  People who were successfully treated for drug dependence often become alcoholics.  Alcohol is also a mind altering substance and is the most common drug available. 

There is another common misconception with recovering alcoholics.  Many think that they can enjoy N/A beer.  These products are marketed under many brand names such as O’Doul’s, Sharps, and a host of others from virtually every brewery.  While these brands contain a reduce alcohol content, they still contain alcohol.  The small amounts of alcohol combined with the real beer taste often lead to relapse.  A normal beer sold in

America will have an alcohol content of approximately 5% with some such as Sam Adams Double Bock ranging as high as 8%.  N/A Beer usually has an alcohol content of about .5%.  While they are sold as non-alcoholic beverages, they contain alcohol and can easily trigger a relapse. 

Addict or alcoholic, it is a much safer plan to avoid all alcoholic beverages.  “Non-alcoholic” beverages will lead to a relapse for virtually any alcoholic and alcoholic beverages will be a major contributor in most drug relapses.

Many of the people who enter and complete treatment each day are still dealing with unresolved grief that creates a great sense of emptiness and a void that is extremely difficult to fill.   

Someone very close to us has died and left a big hole.  We keep fondly remembering the wonderful times that we had with our friend.  No one has ever been closer, more dependable or understood our thoughts and feelings more. 

We are constantly reminded of the great times and the fun we had.  We can’t go to the ball park without remembering all the smiles and laugher we enjoyed together.  We miss them on our fishing trips and somehow it just isn’t the same without them being there.  The Super Bowl and NASCAR will never again be enjoyable without that special someone by our side.  The great times we had at the clubs dancing like a couple of fools. 

If you haven’t figured it out yet, I am talking about our old friend alcohol.  For people recovering from alcohol dependence this is a huge problem and is the precursor to most relapses.  Everything we have done in our adult life has centered around alcohol and we don’t have any idea how to enjoy life without it. 

It seems that the older you are and the longer your love affair with alcohol, the more difficult the problem.  Most alcoholics started drinking at a reasonably young age and most of their adult memories are centered around events where alcohol was present and usually abused.  For some the problems came soon in our drinking careers, for others it took longer.  When we finally got sober, we didn’t quite know what to do or how to have fun. 

Young alcoholics face an even greater challenge, especially if they are single.  It seems that in our society most functions for young, single adults revolve around alcohol.  You take a case of beer water skiing.  You go to the sports bar with your buddies to watch the game.  You go to the club to meet members of the opposite sex.  How do you participate in these activities without drinking?  Won’t you stand out like a sore thumb?  Our non-alcoholic friends can do all these activities without getting smashed or drinking to excess. 

We feel somehow cheated that we cannot drink and have fun like everyone else.  What we often fail to realize is that we are not like everyone else.  With a little introspection we realize that we are different.  If you are an alcoholic, can you ever remember leaving an unfinished drink at a bar?  A half full glass of wine at the table of the restaurant?  Pouring out a beer that got warm?  Of course you can’t because it never happened.  That is why we can’t drink and have fun like everyone else.  Everyone else doesn’t even think about alcohol or if they have drained the last drop from the container.  They can take it or leave it. 

Most that have entered treatment have a great deal of anxiety and fear.  They don’t really understand how or why they ended up spiraling out of control.  The realization of fact that you will never be able to drink again is huge and it is a life changing event.   

This is true not only for alcoholics but all substance abusers.  Alcohol is always the gateway drug to relapse on the drug of choice for non-alcoholic addicts.  People that have a different drug of choice have a couple of drinks and their inhibitions are lowered.  In their altered mental state it is easy to rationalize using their drug of choice.  Most relapses start this way.  “One little joint never hurt anyone.”  “I can do one line or smoke one little rock without having a problem.”  “My back really hurts today; I think I can take a couple of Vicodins without getting addicted again.”  “I never had a problem with Xanax before.”  As Emeril would say “Bam” and we are off the wagon and under the wheels.  We hear these stories every day.   

We never seem to remember the bad things that we experienced during active addiction.   Most that have entered treatment have just as many bad memories of drinking or drugging as we do good memories.  We just choose not to remember the bad things, which is normal for all thought processes.  If it were not this way we would never try anything a second time.  When you learned to ride a bike and fell and hurt yourself you didn’t quit because you recalled the rush of going fast and the wind in your face.  Alcohol and drug addiction are no different.  We remember only the fun times we shared with our dear friend. 

When you become drug or alcohol dependent you normally have more bad memories than good.  In time, these memories fade, which again is a normal thought process.  You don’t remember the damaged relationships, the DUI’s, the throwing up, the shaking, and the total inability to perform normal functions.  When we remember going to the game and enjoying a dozen beers we rarely remember being bent over the bumper of the car in the parking lot throwing up later the same evening.  We don’t remember having to get up and have a drink to stop shaking so we could shave or put on makeup.  We don’t remember counting pills before a weekend trip to make sure we would not go into withdrawal.  We don’t remember getting a secret credit card and a P.O. Box so we could make online pharmacy dope purchases.  We don’t remember going to a questionable area of town looking for illegal drugs and putting ourselves at risk of being seriously injured or killed.  We don’t remember driving home with one eye shut so that we didn’t see two of everything or driving around drunk with our kids in the car.  We don’t remember having phone conversations, not remembering them and then having to fake our way through a conversation while trying desperately to remember.  These are but a few of the glamorous memories we alcoholics and addicts all share.  The list could go on for pages and the examples would get a lot worse. 

What we have to understand is that we are not like other people.  They are not alcoholics or addicts and do not experience the same things that we do.  They are not dependent and alcohol or drugs do not even occupy their thoughts. 

While we do not have to put ourselves in a position where drugs are being used, the case is different with alcohol.  Alcohol is socially accepted and encouraged in almost all areas of life.  We as alcoholics and addicts have to understand that if we choose to have a drink, we will end up in the same situation again and again.  The brain will heal and the resentment and cravings will abate but it takes time.  Sooner than you think the thoughts of using will leave and you will learn how to enjoy life sober.  Everything in your life will improve.  You will feel good physically, be mentally alert and sharp and friendships and relationships will once again blossom.  Stay strong, smart and remember that you and only you are in control of your own destiny.  It is possible to have fun without being high. 

When you look in the mirror, what do you see? For many addicts and alcoholics the picture is not a pretty one. Years of substance abuse usually has a catastrophic effect on the self image of the individual.

With addiction comes a lot of baggage. Addicts live a life of deception during their active use. The circumstances are different for each individual but they all culminate in a self-image that has been severely impacted. Many programs don’t address this problem, which I consider one of if not the most important components of a successful recovery and acquiring an attitude that will help the addict avoid relapse.

Virtually all addictive substances take a major toll on the addict’s ability to think clearly and process information. You will find that the use of alcohol and all drugs of abuse are progressive in nature, meaning that the frequency and quantity of use accelerates the longer the individual is actively using. For many addicts their drug of choice is not always available and they are forced to fend off withdrawal with drugs that are more easily available or socially acceptable. We often see poly-substance addiction in treatment. An example would be a cocaine user. Cocaine is not readily available in some instances and often the user is in an atmosphere that the use of their drug of choice would be prohibitive. To help cope with the extreme depression or withdrawal symptoms the cocaine addict often resorts to benzodiazepines or alcohol. As these situations become more frequent the addiction to cocaine also becomes benzodiazepine or alcohol dependence.

Addicts will go to extreme measures to protect their addiction. All addicts and alcoholics have events in their addicted life that makes them have feeling of self-loathing or be disgusted with themselves. Alcoholics have to hide their addiction to loved ones and the people they work with. They cannot go extensive periods without alcohol without going into withdrawals so they hide bottles and 99.9% of the addicts that enter treatment have switched to Vodka to avoid the alcohol on their breath being detected. Many times they have put themselves and others, including their family, at risk by operating vehicles or other dangerous activities while under the influence. They will use multiple liquor stores so as not to appear to have a problem and will drink heavily before going to a social event where alcohol use would be inappropriate.

Drug users also put themselves in harms way to obtain their drugs. The obvious would be a heroine user that has to obtain the drugs for dealers on the street. The less publicized are the pain and anxiety medication users that have multiple doctors prescribing them medications and are buying from numerous online pharmacies.

When you are an addict you can often see no way out and feel hopeless. Your self-image is that of an alcoholic or addict. As self-esteem is lowered, most perpetuate the problem by accelerating their use and their distorted image of themselves becomes a self fulfilling prophecy. They see themselves first and foremost as an alcoholic or addict.

When the dependent person enters treatment at a typical treatment facility they are detoxed to remove the mind altering substance from their body safely. They then enter the psychological treatment stage which usually consists of minimal counseling and a great deal of 12-step work. Traditional Alcoholics Anonymous style of treatment mandates the addict to take a moral inventory of themselves. During this process the individual has to recall all of the inappropriate conduct that occurred during their life as an addict. In most cases this style of treatment reinforces the addict’s self-image of being a loser and a person that is terminally flawed. Self-esteem is rarely worked on and is not even on the agenda in most treatment programs.

Addicts and alcoholics are no different than any other people. They have just had events in their life that they found difficult or impossible to deal with and resorted to mood altering substances in their efforts to self-medicate the problems away. Their self-medicating efforts resulted in a physical addiction. The normal perception of the alcoholic is that of a homeless person who is dirty and mentally deranged and drug addicts are perceived as being emaciated junkies that rob and kill to support their habit. Nothing could be further from the truth.

Effective treatment must include extensive work on rebuilding a positive self-image. Most addicts and alcoholics are good, caring, loving people that simply developed a substance abuse problem. They are fathers, mothers, brothers, sisters, husbands, wives, employers, employees, coaches, teachers, healers, spiritual leaders… For them to regain control of their lives and maintain long term sobriety, the issue of self-perception must be dealt with. Positive reinforcement of the good aspects of their life is critical in helping them focus on a healthy recovery.

While you can get sober at the urging of a loved one, you must care enough about yourself and hold yourself in high enough esteem not to relapse and return to the life of self destructive addiction.

An alarming number of people who have elected to have gastric bi-pass are finding that they are experiencing problems with other addictions, alcoholism being one of the primary manifestations. Some studies have indicated that as many as thirty percent of these people are experiencing what is termed “addiction transfer”. The term addiction transfer simply means that they have traded their compulsive addiction to food for another unhealthy addiction such as alcohol, drugs or gambling.

This concept is not new in studies of addicts. This type of behavior is explained as the individual seeking a new substance to fill an inner void. The fact is that a large number of these people haven’t had any therapeutic help in addressing the issues that were perpetuating their eating disorder. Many sought comfort in food and when the stomach is dramatically reduced in size that is no longer an option. In order to fill this void many turn to alcohol, which brings with it a whole new set of problems.

There are many physiological explanations for this phenomenon. It is thought that the brain’s pleasure center for these people was stimulated by food. When they consumed something that they enjoyed they stimulated their dopamine system. Dopamine is a neurotransmitter that produces pleasurable feelings when rewards are presented. It is believed to provide a teaching signal to the sections of the brain that are responsible for acquiring new behavior. Thus, the person would seek a pleasurable sensation by eating. This behavior is now being transferred to another behavior that produces the same dopamine release and emotional sensation.

One of the primary problems with alcoholism for the bariatric patient is one of a physical nature. After the surgery, the stomach is very small and the way that alcohol is metabolized is severely impacted. Alcohol is normally contained in the stomach when it is consumed where it is partially metabolized with the aid of the enzyme alcohol dehydrogenase. It is release slowly into the intestines. The length of time that the alcohol stays in the stomach is impacted by the much smaller stomach and more of the alcohol enters the intestines where it is absorbed rapidly due to the large surface area of the intestines. This causes intoxication at an accelerated pace, some studies have indicated almost twice as fast. Alcohol triggers the same dopamine release that the patient formerly received by eating. The alcohol induced dopamine release becomes the new addiction and alcohol dependence rapidly develops.

When the decision is made to have bariatric surgery the patient should consult with a psychotherapist and get the help necessary to modify compulsive behavior and treat any underlying issues that may be present. If therapy is not part of the treatment, the resulting and desired weight loss will occur but the danger of addiction transfer is substantial.