How to Help an Alcoholic with These 6 Scientific Tips

Posted on by Dr Khan

According to Public Health England (1), between 2017 and 2018, 75,787 people in England were in treatment at specialist alcohol misuse services.

However, 30% of these people dropped out before successful completion of treatment. Methods to “rehabilitate” an alcoholic are glamourized by celebrities and in the media. Yet how effective is it really, and what are scientifically proven ways to help an alcoholic?

This article aims to answer this.

In this Article we cover:

  1. Understanding an addict
  2. Provide a supportive environment
  3. Motivational rather than confrontational interventions
  4. Residential rehabilitation
  5. Involve a professional and explore medical options
  6. Avoid co-dependency

1. Understanding an addict

It can be difficult living with an alcoholic or justifying their behaviour when many members of the public believe that addiction boils down to a matter of lack of willpower. However, science proves otherwise.

We decide (and continue) to drink based on the following two factors;

A desire for alcohol’s positive effects (such as lack of anxiety and euphoria)
Avoiding alcohol’s adverse effects, typically by continuing to drink in order to avoid a hangover or withdrawal symptoms.

After prolonged and continued alcohol use, the brain itself starts to undergo changes. In scientific jargon, these are called neuroadaptive changes. Evidence currently developing around these changes (2) is important for one specific reason; it clearly shows that addiction is not because of a “lack of willpower.” Instead, the slippery slope of becoming “an addict” it is far more complex than that.

You may have heard the phrase, “love simply comes down to chemicals.” Every pleasurable activity we as humans experience are secondary to chemicals being released in our brains. So, whenever a person engages in a pleasurable activity, the brain releases a chemical called dopamine into the reward or pleasure centre (also in the brain). Our brain’s impulses react in such a way that we experience a subjective experience of “pleasure.”

But why do human beings need to experience pleasure?

Evolution ensured that we would so that we could consistently repeat activities that are rewarding and pleasurable to us. Imagine if we did not find pleasure in eating food? We would lack that drive or impulse given off from our reward centre and not actively seek out things that bring us pleasure.

This is where drug addiction (and alcohol addiction) becomes involved. Drugs and alcohol interrupt the normal workings of this reward pathway via the following;

Drugs release a massive surge of dopamine upon ingestion/inhalation/injection.
Euphoria results from the large amount of dopamine.
Over time, consistently large releases of dopamine reinforce the reward pathway.
Small amounts of dopamine no longer activate this reinforced pathway effectively.
The user is driven to constantly seek out more drugs and dopamine.

Thus, physical changes cause psychological changes (2). And where there are physical changes, “willpower” cannot change anything.

2. Provide a supportive environment

Understand that it is your support and persistence that is the key factor in helping someone to quit drinking. It has been proven in multiple studies that the following help with individual’s addiction and also expedite their timeous recovery (3):

Spouses or partners
Family members
Peers
Neighbours

If there are difficulties at home, evidence also supports the use of couple therapy and family therapy (4). Always allow an alcoholic to feel less alone, by letting them know that both of you (or a group of you) are tackling a daunting task together. There is strength in numbers.

Additionally, peer support groups, with either abstainers or people in recovery, should be encouraged. This allows someone with an alcohol problem to talk to peers (going through the same motions that they themselves are going through) in a non-judgemental and non-clinical environment. A recent review of the literature (5) showed that these services;

Reduce substance use
Improve abstinence
Significantly reduce relapse rates
Reduce risky behaviours
Improve self-efficacy
Reduce cravings
Reduce feelings of shame or guilt

Examples of these groups in the United Kingdom can be found at recoverystories.info.


[READ] 12 Step Treatment Programme

[READ] Drug Rehab Treatments by Abbeycare


3. Motivational rather than confrontational interventions

Motivate, don’t confront.

For a long time now in the literature and in the practice of clinical psychology, motivation has been identified as the key to change (6). A landmark paper was published by Miller, Benefield and Tonigan (7) that compared therapist styles when counselling alcoholics. In follow-up, it was found that the more the therapist confronted the patient, the more the patient drank. This is because confrontation usually produces an immediate client resistance to change. This kind of style included, but was not limited to, directly challenging the client about their problem, disputing them and being sarcastic.

Please take note that, when speaking to an alcoholic, using any of the aforementioned tactics or confronting them directly does not help. The style that instead is proven to work is a supportive, empathic style that uses reflective listening and gentle persuasion (7).

Remember, your task is not to instruct and teach. Your task is to motivate for change. You can leave it up to a therapist, doctor or trained community worker. But you can also incorporate motivational interviewing techniques with the alcoholic you want to help. Here are the basic principles, as suggested by Morrison (8):

Roll with resistance – avoid arguing.
Express empathy – allow the person you are trying to help to be heard.
Develop discrepancy – identifying the alcoholic’s ambivalence, the most important step. This can easily be done by asking someone what the most important things in their life are. For example, someone may say that their children are the most important to them, but because they are struggling with their alcohol problem, they cannot attend to their children’s needs. This creates inner discomfort and may evoke the realisation for change.
Support self-efficacy – support their hope that change is possible by affirming their previous successes and personal strengths.

“Interventions”, which we are all familiar with from any soap opera on television, therefore might or might not be effective, depending on the way you conduct them. However, walking into a room of stony-faced family members or friends is usually confrontational. This makes them therefore ineffective as the person you are trying to help is instantly defensive and resistant.

4. Residential rehabilitation

One of the important questions we aimed to answer in this topic is if “rehab” is necessary or not. We have all seen this concept of “rehab” glamourized by celebrities; they get on a private plane and then take a leave of absence to check into an expensive centre in Beverly Hills or Zurich.

However, this is reality and not all rehab centres serve caviar for dessert.

In the literature, “rehab” is referred to “residential alcohol treatment”. In the United Kingdom (UK), provisions for this is made by the voluntary and independent sector. The National Treatment Agency for Substance Misuse (9) supports these facilities and recognises that “residential rehabilitation is a vital and potent component of the drug and alcohol treatment system”.

Public Health England (1) provides the definition of residential rehab as that of a “structured drug and alcohol treatment setting where residence is a condition of receiving the interventions.” Between 2017 and 2018 in England, a total of 5,980 clients utilized these treatment settings.

A recent observational cohort study (10) was conducted in England and showed 59% of patients completed their treatment successfully in 12 months without relapse for 6 months thereafter. These patients had been withdrawn from an inpatient programme and transferred to a residential rehabilitation setting. Patients with higher levels of success had;

Paid employment
Self/family/peer referral
Longer duration of treatment in the rehab setting
Community-based treatment following discharge

Each rehab centre varies in which model they use to help with detoxification, such as the 12-step model made famous by Alcoholics Anonymous, faith-based or therapeutic community. No research has proven the efficacy of one model over the other as it’s largely an individual preference (5).

What you may be wondering about is cost, and residential settings are more expensive than alternatives; however, evidence shows that the initial costs are largely offset by reductions in subsequent health care and criminal justice costs (11). The good news for people in the United Kingdom is that most people receive at least a contribution from public funds, depending on their pension and income.

Please consult rehab-online as part of Public Health England to find a centre that matches your needs.

5. Involve a professional and explore medical options

You can involve a professional by calling a rehabilitation centre or consulting with a physician, community health worker or psychiatrist. You should never be bearing the full brunt of the addiction on your shoulders alone, lest you burn out.

A general practitioner is often a good place to start. They can advise regarding the options discussed in this article and also perform motivational interviewing themselves on your loved one. Importantly, they can also assist with medical options and medication for alcoholism.

The following medicines are supported by NICE guidelines (4).

Acamprosate
Naltrexone
Disulfiram

Please see How to Stop Drinking Alcohol for Good (Backed by Science) for more information on these medications.

Ask your doctor about the use of these medications and their side-effects. They are all backed by science but bear in mind that whilst NICE supports their use, it also advises using medication in combination with psychosocial interventions (rehabilitation, counselling and peer support), unless these interventions have failed (4).

6. Avoid co-dependency

If you are close to the alcohol user, you yourself are also at risk of falling into the trap of becoming co-dependent. Co-dependency refers to depending on the alcoholic for happiness and approval, and basing your identity and self-worth on this person (12).

It has been historically shown (13) to enable the behaviour of an alcoholic and, in some instances, become co-alcoholics. This is because co-dependency means;

You manage their problems for them, when he or she should be doing it without you.
You let them get their way most of the time.
You may lie to keep them out of trouble.
You don’t allow your partner to face the reality of being an alcoholic.

If you feel that any of these signs apply to you, refer to the previous subsection and always seek help from a profession.

The psychology behind this also becomes rapidly twisted as a person who is co-dependent may even start to resent an alcoholic seeking help for his addiction, and the co-dependent may subconsciously attempt to sabotage these efforts (12).

Takeaway message…

You would not have clicked on this article if it did not apply to your life and loved ones in some way or another. Maybe the person you want to help is in complete denial, or maybe they are already on the road to recovery.

The bottom line is that you need to understand the science behind why an addict cannot control themselves in order to lessen the anger you may feel towards them. Your support, at the end of the day, is tantamount and will be the one factor guiding them to recovery.

Don’t be confrontational and always seek out help from a professional; whether you go via the route of a general practitioner, support group or rehab centre, all have proven benefits. However, never let yourself get burned out. A carers job is just as important as the monumental task that faces an alcoholic on recovery.

Getting Help 


Getting help early can prevent experiencing severe consequences of drinking or disrupting the lives of loved ones.

Call our local number 01603 513 091

 


References 

  1. Public Health England. 2018. Adult Substance Misuse Statistics from the National Drug Treatment Monitoring System (NDTMS): 1 April 2017 to 31 March 2018. Available: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/752993/AdultSubstanceMisuseStatisticsfromNDTMS2017-18.pdf
  2. Koob, G.F., & Le Moal, M. 2008. Addiction and the brain antireward system. Annual Reviews in Psychology 59:29–5.
  3. Kelly, S.M., O’Grady K.E., Schwartz R.P., Peterson J.A., Wilson M.E., & Brown B.S. 2010. The relationship of social support to treatment entry and engagement: the community assessment inventory. Subst Abus 31(1):43–52. doi: 10.1080/08897070903442640.
  4. National Institute for Health and Clinical Excellence. (2011). Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence, NICE clinical guideline 115 (NICE, London) Available: http://www.nice.org.uk/guidance/CG115
  5. Tracy, K., & Wallace, S.P. 2016. Benefits of peer support groups in the treatment of addiction. Subst Abuse Rehabil 7: 143-154. doi: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5047716/
  6. Miller, W.R. 1999. Enhancing motivation for change in substance abuse treatment. Treatment Improvement Protocol Series, No. 35. Rockville, MD: Center for Substance Abuse Treatment.
  7. Miller, W.R., Benefield, R.G., and Tonigan, J.S. 1993. Enhancing motivation for change in problem drinking: A controlled comparison of two therapist styles. Journal of Consulting and Clinical Psychology 61(3):455–461
  8. Morrison, T. 2010. Assessing parental motivation to change. In J. Horwath (Ed.),The child’s world: The comprehensive guide to assessing children in need (2nd ed.). London: Jan Kinglsey Publisher.
  9. National Treatment Agency for Substance Misuse. Residential drug treatment services: good practice in the field. London; 2012.
  10. Eastwood, B., Peacock, A., Millar, T., Jones, A., Knight, J., Horgan, P., Lowden, T., Willey, P., & Marsden, J. 2018. Effectiveness of inpatient withdrawal and residential rehabilitation interventions for alcohol use disorder: A national observational, cohort study in England. Journal of Substance Abuse Treatment 88: 1-8. doi: https://doi.org/10.1016/j.jsat.2018.02.001
  11. Sheffield Hallam University. Residential Treatment Services: Evidence Review. 2017.
  12. Alpine Springs Rehabilitation & Recovery. 2018. The Relationship Between Codependency & Alcohol Abuse. Available: https://alpinespringsrehab.com/blog/complex-relationship-codependency-alcoholism/
  13. Cotton, N.S. 1979. The familial incidence of alcoholism: a review. Journal of Studies on Alcohol, 40(1), 89–116.

 

Download this article as a PDF 

How to Stop Drinking Alcohol for Good (Backed by Science)

Posted on by Dr Khan

image of hand rejecting alcoholThere’s a worldwide epidemic on our hands, and it’s at the bottom of your wine glass. The World Health Organization (1) estimates that nearly three million deaths each year are related to alcohol use.

The National Health Service (NHS) produced its own statistics in 2018 (2) which showed a rise in the death toll due to alcohol; an 11% increase since 2006.

 

If there is ever a good excuse to stop drinking, this is it! We have reviewed the literature to provide you with evidence-based information about how to best stop drinking.

Before we dive into the article, let’s establish if you as the reader (or anyone you may know) have potential problems with alcohol. The NHS (3) recommends not drinking more than 14 units of alcohol a week.

A unit is roughly equivalent to just less than a small glass of wine, a single small shot of spirits or half a pint of a beer/cider. You could be abusing alcohol if you drink more than this, or by answering affirmatively to any of the following in the CAGE questionnaire (3):

  1. You feel you need to Cut down on your drinking.
  2. You get Annoyed if other people criticize your drinking.
  3. You feel Guilty about your drinking.
  4. You need an Eye-opener first thing in the morning to get rid of a hangover.

 

If any of these apply to yourself or someone you may know, then read on; these are ways to help you stop drinking for good.

 

In this Article…

  1. Understanding dependence and addiction is the first step
  2. Tackle from multiple angles
  3. Changing behaviour and avoiding external temptation
  4. Seek out peer support
  5. Reward yourself – the right way
  6. Healthy lifestyle, healthy you
  7. Suppress withdrawal symptoms
  8. Appreciating the positive health benefits

Understanding dependence and addiction is the first step

We have referenced this in another article on this blog, How to Stop Drinking Alcohol for Good (Backed by Science). Please take a moment to read through the mechanism of the reward pathway in the brain, to understand how addiction is related to a compulsive need to seek out dopamine to stimulate this reward pathway.

In summary, however, addiction is caused by physical changes in the brain that lead to psychological changes (4). These physical changes in the brain are not something that can be controlled by simply having “willpower.” The good news is that you can, so to speak, “re-programme” these changes in your brain. The bad news? You need to commit to wanting to change. The following points in the article describe different ways that help you stop drinking.

Tackle from multiple angles

An alcohol user in recovery has two broad options;

  1. Medication to alleviate symptoms of withdrawal and cravings
  2. Psychosocial approaches

 

However, it’s not a one-method-fixes all approach. Remember what we just covered in the previous subsection; alcohol addiction is related to both physical and psychological changes.

The evidence in the NICE Clinical Guidelines (5) shows that, in general, psychosocial approaches should be offered to all individuals who misuse alcohol. For those people where such approaches have not worked or those who are mildly dependent, medication may be an add-on treatment option.

“Psychosocial approaches” refers to a broad variety of tools and therapy to help an individual abstain from alcohol. It refers to treating a person’s psychological and social issues at hand, rather than simply taking medicine to combat disease. This is offered by community groups, peer support groups and therapists.

Nonetheless, if a patient, for whatever reason, does not wish to undertake psychosocial interventions and understands the risks and implications of taking medication only, they cannot be denied this.

The bottom line, however, is the following; if you truly want to stop drinking for good, you need to take home multiple suggestions from this article rather than just one.


[READ] Treating Alcohol Addiction at Home

[READ] Alcohol Addiction Treatments Options


Changing behaviour and avoiding external temptation
Social temptations

Changing behaviour and avoiding external temptation

Changing behaviour sounds difficult and, spoiler alert, it is difficult. Very difficult.

We create behavioural patterns, or habits, by behaviour we choose to enforce and repeat. We can change this behaviour, of course, but often it is done best with the help of a trained professional.

Behavioural therapy is offered often in a rehabilitation (or “rehab”) setting, but can also be offered by a trained psychologist or community health worker. We encourage you to read our article How to Help an Alcoholic – Is Alcohol Rehab Required? in order to find out more information and links to various rehabilitation services.

One of the most effective interventions that can be offered by a trained professional, according to the literature, is Cognitive-Behavioural Therapy (CBT), which posits that even though we may not be able to change our circumstances, we can change the way we think about them (5). It also includes strategies to prevent relapse and coping skills. It is a well-established and, most importantly, evidence-based treatment for multiple substance disorders causing a statistically significant effect on reducing substance-use rates (6). Be sure to ask your therapist or friendly professional about this therapy.

A new and emerging therapy is Mindfulness-Based Relapse Prevention (6), which reduces cravings by increasing a client’s awareness of external triggers to drink. After all, sometimes, we are not always aware of the situations and people that lead us to increase drinking. It also increases tolerance to these triggers. So that, even if we are in those situations, the need to drink is lessened. Unfortunately, there have only been a few randomized controlled trials evaluating this technique to date and more research will be needed.

However, the above-mentioned principles can still be incorporated into your everyday life without physically attending therapy. Namely, by avoiding external triggers. In other words:

  • Avoid people and situations where drinking is encouraged
  • Try to start recognizing situations (and the people involved) where you are most likely to drink

Seek out peer support

Don’t walk the lonely road of recovery alone. It has been proven that people who undertake alcohol abuse recovery without an adequate support system soon relapse (5). If you can think of someone who can provide you with this support, involve them in your recovery. You have a much better chance at success, statistically speaking. Or, reach out to the following support networks:

  • Self-help groups
  • Couple or family therapy

 

An example of a well-known self-help group is Alcoholics Anonymous but there are many others that can offer help. Whilst the jury is out on some of the evidence surrounding Alcoholics Anonymous’s methods (for example, its 12-step programme), the importance of a self-help group is rather the environment it provides, wherein assistance from peers helps to aid recovery and provide much needed mutual understanding (5). Examples of these groups in the United Kingdom can be found at recoverystories.info.

Behavioural couples’ therapy, particularly where one person has an alcohol use problem and the other does not, has been shown to reducing drinking in multiple clinical trials (5). Similarly, if there are unresolved conflicts in a family or interpersonal relationship, family therapy has also been shown to reduce drinking and alcoholism (5).

Reward yourself – the right way

As we previously learned in this article, alcohol use directly affects the part of the brain which makes decision related to perceived “rewards”. Thus, it stands to reason that if we change how we reward ourselves, we depend less on certain inputs like alcohol in order to create that surge of dopamine.

In counselling, motivational interviewing is the evidence-backed tool (5) which employs this exact logic in order to try to empower the client to elicit change. A trained interviewer will often reframe their clients’ problem in certain ways. Take a moment to think about what the following statement from a therapist implies;

“After a stressful day at work, you may need to reward yourself in the evenings.”

What does this imply?

  • Alcohol can act as a reward
  • But there are various other alternative “rewards”

 

Now, think about your favourite activities that help you settle down and reward yourself.  Think about the activities you no longer take time to do because you are drinking instead. Are you ready to allow yourself to reward yourself with them, rather than a bottle of wine?

Healthy lifestyle, healthy you

Evidence from existing studies (7) suggests that exercise is a useful adjunctive tool to help one stop drinking. Science points to a dual action of physical activity on alcoholism;

  1. It may lessen the negative effects of alcoholism on health.
  2. It acts centrally on the neurotransmitter and dopamine systems involved in the mechanisms of addiction.

 

So, we become healthier and we repair some of that physical damage done to our brains caused by drinking. However, there is no current evidence on the optimal intensity, duration, frequency and type of physical activity.

A healthy diet is also important. There is now growing research (8) which promotes a diet of the following;

Limiting sugar and junk food. This is because low blood sugar/glucose induces craving for alcohol. Sugar causes your blood glucose to soar and then quickly drop, inducing cravings for more sugar and alcohol.

Increasing whole grains and fruit. These digests more slowly and keep glucose levels more stable. Thus, you crave sugar and alcohol less.

Increasing L-glutamine-containing foods. L-glutamine decreases cravings for alcohol as well as replacing nutrients lost because of alcohol abuse. Such foods include: almonds, Cheddar cheese, sunflower seeds, free-range poultry, low-fat yoghurt and avocado.

Increasing dopamine-enhancing foods. As we know, this replaces the dopamine in our brain’s reward centre and thus prevents alcohol withdrawal. Tyrosine, a dopamine precursor, is abundant in protein-rich food such as chicken, avocado and turkey. Ripe bananas, strawberries and blueberries help trigger dopamine release.

Suppress withdrawal symptoms

We can suppress withdrawal symptoms effectively with prescribed medication. Remember, this is not a stand-alone treatment option.

NICE guidelines (5) support the use of the following medications:

Acamprosate – reduces withdrawal symptoms such as anxiety and insomnia

Naltrexone – reduces alcohol cravings

Disulfiram – discourages drinking by making a patient feel ill after the ingestion of alcohol

 

NICE recommends using medication in combination with psychosocial interventions or if psychosocial interventions have failed. Acamprosate and naltrexone are generally recommended first and foremost; however, disulfiram can be offered if a patient would prefer it. However, one needs to understand that disulfiram has harmful and unpleasant side-effects, such as the extremely unpleasant and amplified hangover effects after drinking alcohol, liver damage, skin rashes and cardiovascular problems (9). Always be sure to ask your doctor if it is the right medicine for you.

Appreciating the positive health benefits

Research proves that excessive alcohol intake can cause (10):

  • Liver disease
  • Heart failure
  • Hypertension
  • Stroke
  • Pancreatitis
  • Increased breast and gastrointestinal cancer risk
  • Neurological complications
  • Unintentional injuries

 

The good news, however, is that if you quit before the onset of one of these diseases, a study has shown that there is no significant difference in the number of diseases or health status between former drinkers and people who have never ingested alcohol (11). So, the sooner you stop, the more likely it is that you can prevent any further damage to your body.

Takeaway message…

At the end of the day, your biggest opponent is your own brain. Note how “brain” is mentioned rather than “mind”, as the fallacy that quitting an addiction is simply a matter of willpower must end. Take advantage of now having the scientific knowledge behind knowing why it’s so difficult to quit; this will, in turn, help you replace alcohol’s positive effects and banish its negative effects. After all, there are so many other things in this world that we should be rewarding ourselves with.

 


Getting Help

Getting help early can prevent experiencing severe consequences of drinking or disrupting the lives of loved ones.

Call our local number 01603 513 091

 


References:

  1. World Health Organization (WHO). 2004. WHO global status report on alcohol 2004. Available: https://www.who.int/substance_abuse/publications/global_alcohol_report/en
  2. NHS Digital. 2018. Statistics on Alcohol, England, 2018. Available: https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-alcohol/2018
  3. 2018. Alcohol misuse. Available: https://www.nhs.uk/conditions/alcohol-misuse/
  4. Koob, G.F., & Le Moal, M. 2008. Addiction and the brain antireward system. Annual Reviews in Psychology 59:29–5.
  5. National Institute for Health and Clinical Excellence. (2011). Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence, NICE clinical guideline 115 (NICE, London) Available: http://www.nice.org.uk/guidance/CG115
  6. Kiluk, B.D, & Carroll, K.M. 2013. New Developments in Behavioral Treatments for Substance Use Disorders. Curr Psychiatry Rep 15(12). doi: 1007/s11920-013-0420-1
  7. Manthou, E., Georgakouli, K., Fatouros, I.G., Gianoulakis, C., Theodorakis, Y., & Zamurtas, A.Z. 2016. Role of exercise in the treatment of alcohol use disorders. Biomed Rep 4(5): 535-545. doi: 3892/br.2016.626
  8. Arun, A., Vijayalakshmi, S., Arun, K., & Srivastava, C. 2016. An alternate diet approach to quitting alcoholism. International Journal of Pharma and Bio Sciences. 7(4). doi: 10.22376/ijpbs.2016.7.4.b511-516.
  9. com. 2018. Anatabuse for Treating Alcoholism. Available: https://luxury.rehabs.com/antabuse-disulfiram/
  10. 2018. Cardiovascular benefits and risks of moderate alcohol consumption. Available: https://www.uptodate.com/contents/cardiovascular-benefits-and-risks-of-moderate-alcohol-consumption
  11. Park, J., Ryu, Y., & Cho, S. 2017. The Association Between Health Changes and Cessation of Alcohol Consumption. Alcohol Alcohol 52(3): 344-350. doi: 1093/alcalc/agw089

 


Download this article as PDF