Obstacles to abstinence

I am a 47-year-old male working in a comfortable position at a PR firm. I am married, have two kids, and have a loving family. My life is pretty fulfilling except for the fact that I battle an addiction. I have been enamoured by alcohol since I was in college, and it has only grown by leaps and bounds. My job requires me to socialise and take my clients out for drinks, and in general, too, I resort to seeking solace in alcohol in good times and bad. I recently decided to try to quit all together, partly at the behest of my partner and partly on my own accord, but I had the worst two nights, following which I had to jump back to find comfort in the bottle. I was shivering and restless; I was awake all night and felt ants crawling up and down my body. I have never had any issues with alcohol and am now on the fence about quitting all together. Please guide me.

I am sorry to hear that you are battling this issue. Welcome to the first step towards change and ending the cycle of dependence. The act of thinking about quitting and wanting to give it a go is truly an important first step.

Prochaska and DiClemente are two psychologists who developed the Transtheoretical Model of Behaviour Change, which states that before someone actually tries to kick an addiction, they go through the following five stages:

* Precontemplation: The individual is not yet considering changing their behaviour;

* Contemplation: The individual is considering changing their behaviour but has not yet taken any action;

* Preparation: The individual is preparing to take action and may have taken some initial steps towards behaviour change;

* Action: The individual has made significant changes to their behaviour and is actively working to maintain these changes;

* Maintenance: The individual has successfully maintained the behaviour change for an extended period of time and is working to prevent relapse.

Sometimes, an additional step that happens is called ‘relapse’, meaning an inability to sustain the change, and the cycle begins all over again.

Alcohol dependence syndrome (as per ICD-10) or Alcohol Use Disorder (as per the 2013 DSM-5) is a condition characterised by a strong craving for alcohol, a loss of control over alcohol consumption, and physical and psychological dependence on alcohol. It is characterised by:

* Tolerance: increased tolerance to alcohol, meaning that more alcohol is needed to achieve the desired effects;

* Withdrawal: withdrawal symptoms when alcohol consumption is stopped or reduced;

* Harmful use: continued use of alcohol despite negative consequences such as health problems, relationship issues, or job loss;

* Time wasted: spending a lot of time drinking or recovering from its effects;

* Priority: Giving up important social, occupational, or recreational activities in favour of alcohol use;

* Cut down: unsuccessful attempts to cut down or stop drinking;

* Risky: Drinking larger amounts or for a longer period than intended and in risky situations, such as while driving or operating machinery;

* Continued use of alcohol, even when aware of the negative physical and mental health consequences.

Notice that the word ‘addiction’ has now been replaced by terms such as ‘dependence’ and ‘use disorder’. This is an effort to remove the negative connotation associated with addiction.

A quick way to know if you may be dependent is to complete the CAGE questionnaire. A simple screening tool used to identify potential alcohol problems. The questions are:

* C: Have you ever felt you should cut down on your drinking?

* A: Have people annoyed you by criticising 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 a person answers ‘yes’ to two or more of these questions, it suggests that they may have an alcohol problem, and should seek further evaluation by a psychiatrist.

What you recently underwent when you quit cold turkey (suddenly and completely) is called an alcohol withdrawal.

Alcohol withdrawal can vary in severity and onset time, and it can begin with stopping or even reducing the amount of alcohol taken.

It has certain features like:

* Tremors, especially in the hands;

* Insomnia, or other sleep disturbances;

* Autonomic hyperactivity;

* Gastrointestinal disturbances (e.g., nausea, vomiting, diarrhoea);

* Hallucinations (visual, auditory, or tactile);

* Psychomotor agitation (e.g., restlessness, pacing);

* Anxiety, agitation, or irritability;

* Seizures, in severe cases.

What should you do to prevent withdrawal?

Don’t be deterred by the fact that your last attempt didn’t go well. You can try again under the direction of a professional this time. Some individuals benefit from a short-term admission to a hospital, while others do well from the comfort of their homes.

If you are motivated to quit:

* Make a plan: Rome wasn’t built in a day, and neither was this dependence;

* Patience: Keep your focus on the eventuality. You may be tempted to go off the waggon many times, but keep your eye on the prize of sobriety;

* Medication: There are medications that can be given to prevent a withdrawal from occurring. They ensure to reduce tremors, normalise your sleep, and improve your physiological response, making it easier to cut down or stop drinking altogether. These medications are often the group benzodiazepines, and are to be used cautiously and under the guidance of a psychiatrist. Eventually, anti-craving medicine may be needed to help reduce the craving for alcohol;

* Hydration: to maintain the equilibrium of electrolytes, ample hydration is necessary.

* Prevention of injuries: At times there can be withdrawal seizures, and it is necessary to ensure safety from falls, tongue bites, etc;

* Family support: It goes a long way to having a supportive family that can ensure regular treatment;

* Group support: AA (Alcoholic Anonymous) is an organisation that helps find peer-to-peer support for those battling alcohol issues;

* Therapy: Motivational enhancement therapy is a mainstay with a trained therapist;

* Lifestyle changes: It is essential to change lifestyles, especially to promote movement and activity and avoid the trap of paraphernalia related to addiction.

Send your questions to help@dreradutta.com