The Diagnostic and Statistical manual of the American Psychiatric Association (1968) defines alcoholism as drinking that chronically interferes with physical, personal or social functioning.
Alcoholism is further divided into 3 categories:
* Episodic Excessive: refers to intoxication as frequently as four times per year.
* Habitual Drinking: refers to 12 intoxication per year or under the influence more than once per week.
* Alcohol Addiction: is based on either
1. Presence of physiological withdrawal symptoms,
2. Daily drinking
3. Heavy drinking for a period of three months.
Antecedent and consequent events usually fall into one or a combination of the following:
* Situational: Beer Advertisement, neighborhood tavern.
* Social: coaxing from friends to have a drink, discussion of exciting drinking episode by others.
* Emotional: depression, boredom, impatience, loneliness.
* Physiological: chronic back pain, headaches, withdrawal symptoms.
TREATMENT ISSUES- CRAVING
Under the disease model of alcoholism, the concept of craving plays a central explanatory role in the etiology of the problem and the treatment goal. In the most comprehensive definition of craving presently available, Ludwig and Wikler (1974) suggest that it is a hypothetical construct, “representing the psychological or cognitive correlate of a conditioned withdrawal syndrome.”
TREATMENT GOALS- ABSTINENCE OR CONTROLLED DRINKING
Under the disease model of alcoholism the only treatment goal available for alcoholics has been total abstinence.
Factors to be considered by treatment providers and clients in recommending or selecting a treatment goal include the following:
1. The client’s physical condition: may be such that any further drinking would be contraindicated.
2. The social support system: available to the client in his natural environment needs to be clearly evaluated and actually involved in the decision making process.
3. The client’s expectations: regarding treatment success under his goal choice need to be evaluated.
TREATMENT
Complete abstinence from alcohol has to be the centerpiece of a successful treatment strategy.
PSYCHOTHERAPY
1. When psychotherapy focuses on the reasons that the person drinks, it is more successful than when it focuses on vague psychodynamic issues.
2. Specific focus is on the motivating forces behind drinking, the expected results from drinking and alternate ways of dealing with the situations.
3. Involving an interested and cooperative spouse in conjoint therapy for at least some of the sessions is highly effective.
4. In early encounter the therapists needs to be active and supportive because alcoholics often anticipate rejection and may misinterpret a therapeutic role as rejecting.
5. The therapist must also deal with alcohol as psychological defense, the removal of the emotional and intellectual barriers between the patient and the therapist.
6. Depression can be countered by the active, supportive role of the therapists.
ALCOHOL ANONYMOUS AND AL-ANON GROUPS
AA is a voluntary supportive fellowship of thousands of people with alcohol related disorders. Physicians should refer to alcoholics to AA as a part of a multiple treatment approach.
INDIVIDUALISED BEHAVIOR THERAPY
a. Self confrontation of videotaped drunken behavior.
b. Stress management technique.
c. Behavior change sessions.
d. Discrimination training for controlled drinking.
OPERANT CONDITIONING
It focus on rearranging consequences of drinking so that excessive alcohol consumption is punished and more appropriate behavior is reinforced.
SOCIAL SKILLS TRAINING
Difficulty in dealing with social pressures and interpersonal encounters frequently serves as a direct antecedent to substance abuse.
Specialized assertive technique is developed to teach alcoholics to refuse drinks under social pressure from friends. Refusal skills were taught through the combined use of specific instructions, role playing, videotaped modeling of the appropriate behavior, and structured practice.
SELF MANAGEMENT SKILLS
The patient is trained to be his own behavior therapist, analyzing behavior interactions, planning appropriate modification strategies and implementing his plan of action. Three major aspects of these skills are:
a. Rearranging environmental cues or life routines to decrease the likelihood of excessive drinking.
b. Utilizing thought control processes to modify cravings to drink.
c. Rearranging the social and environmental consequences of drinking behaviors and non drinking alternatives to drinking so that the latter replace the former.
CASE
Mr. Mohan Singh, 40 years of age, came with pain in right hypochondrium. On taking history, it came out that he is a chronic alcoholic, taking 4-6 pegs daily and almost 6 days a weeks from last 10 years. Similar kind of pain developed 1 week before. At that time he consulted a physician who gave him some painkillers and advised him ultrasound abdomen. The report showed enlargement of liver with changes of fatty liver and LFT showed SGOT 55 and SGPT 60. But this time the pain is more severe in intensity is intolerable and is worse after eating.
The patient has a good appetite and he feels hungry quite often. Many a times he tries to resist it as he feels heaviness in the abdomen after eating. He likes to take hot food as it relieves him temporarily. The stools are often constipated and always unsatisfactory. The patient has a constant dream of accidents. Other physical generalities are non-specific.
Mental Generals – The patient is kind hearted, never likes to be alone but is anxious in the company of strangers or when he meets new people. Patient usually avoids doing mental or physical exertion.
On totality of symptoms, the constitutional medicine came out to be Lycopodium.
16 Feb 2004 Plantago 30, 3 doses
Mag Phos 6X, SOS for pain.
SBL’s Liver tonic/1 tsp/tds.
Given a specialized counseling session about alcohol abstinence.
23 Feb2004 Patient reduced the amount of alcohol to 3-4 pegs daily and 4 days a week although he was advised to quit completely. He developed nausea and vomiting.
Lyco 200, 3 doses, empty stomach.
SBL’s Liver tonic.
He was again given a counseling session.
8 March 2004 Patient was improved and he even reduced the amount to 1-2 pegs about 3-4 days a week.
Nausea was continuing but vomiting was relieved. He also complained of drowsiness and lethargy
Lyco 1M, 3 doses, empty stomach.
SBL’s Liver tonic.
Counseling was also given.
22 March 2004 Patient was improved.
There was no nausea and drowsiness and lethargy was also improved.
He reduced the amount to 1-2 pegs, about 2-3 days a week.
SBL’s Liver tonic.
5 April 2004 Patient was improved.
The amount was reduced to 1-2 pegs, 1-2 days a weeks.
Lyco 1 M, 3 doses, empty stomach.
19 April 2004 Patient was improved.
The amount of alcohol was reduced to 1-2 pegs in 15 days.
SBL’s Liver tonic.
26 April 2004 Patient was improved.
He complained of slight pain in right hypochondrium.
Lyco 1 M, 3 doses, empty stomach.
USG and LFT advised.
3 May 2004 Patient feeling better with no complaints.
Tests showed that liver fatty changes are same but the size reduced to normal and SGPT 22 and SGOT 25.
SBL’s liver tonic x 1 month.
18 May 2004 No complaints.
Sac lac tds x 1 month.
By:
Dr. Rachna K Singh, Homoeopathic Consultant to Escorts Heart Institute And Research Centre and Dharamshila Cancer Hospital And Research Centre.
A large number of research based projects are ongoing under Dr. Rachna and her team in these institutes with homoeopathy. Some of the ongoing projects are in Hypertension, Diabetes mellitus, Angina, Cardiac failure, Post surgical complaints, Chronic hiccups, Gangrene, Anxiety neurosis, Depression, Insomnia and De-Addiction. The work in hypertension has been widely appreciated worldwide and Dr. Rachna K Singh was invited to present the paper on ‘Efficacy Of Homoeopathy In Hypertension’ at Royal College Of Physicians, London in Nov 2003.
The work on Alcoholism has been conducted at EHIRC along with kind involvement of the clinical psychologists and cardiologists.