Question: I believe that the sexual abuse I suffered as a child and teen is the reason why I am an alcoholic today. I have decided that I need to get help and I want to go to a rehab but I think I need to address what happened to me in the past if I really want to get better and so I don't think that AA style rehab is what I need. What types of therapies r programs would you recommend I be looking for in a rehab?

Iona Health Says...:

I think it takes courage to seek an answer to the dilemma you face. However, it is well known that before someone can address their issues around trauma, they must stablize any active addiction they have first. With alcohol, you could find it difficulty to stop drinking if you are trying to heal the trauma of child sexual abuse. If fact, bringing up the painful memories of child sexual abuse can make recovery from alcohol very difficult or impossible, and could, in some cases, increase your drinking.

I would encourage you to find a substance abuse professional who has training in childhood trauma or child sexual abuse and obtain an evaluation for treatment. If you go into treatment for alcoholism and stop drinking, you will be more ready and able to address your childhood trauma without relapsing with alcohol. The childhood sexual abuse may be a contributor to your alcoholism, but your alcoholism can prevent you from successfully healing the trauma of your sexual abuse.

Many people in recovery have been physically, emotionally, and sexually abused as children. However, they usually do not attempt to address this until they have maintained soberity for at least6 months to a year from the last time they took a drink.

I wish you every sucess in your recovery and healing journey!

John W. O'Neal, Ed.S, MSW, MA LPC, NCC

Question: How do I know if I am going to have alcohol detox that is serious enough that I am going to need to go to the hospital. I want to do this on my own but my girlfriend is saying we have to go to a detox clinic. I am telling her that I will go but I do not want to unless it is really necessary. Since she will be at home with me while I am going through this she will be there to drive me to the hospital in planet of time if things get too serious. What is a warning sign I should be on the lookout for to let me know it is time to go to the hospital and that things are at risk of getting dangerous?

Iona Health Says...:

Many changes have occurred in providing detox for alcoholism. The main goal is to manage the withdrawal symptoms from stopping the use of alcohol which can put the body into a crisis.

Common symptoms of alcohol withdrawal are identified from mild to moderate psychological symptoms, mild to moderate physical symptoms, and severe and often dangerous symptoms. There are:

Mild to moderate psychological symptoms:

• Feeling of jumpiness or nervousness
• Feeling of shakiness
• Anxiety
• Irritability or easily excited
• Emotional volatility, rapid emotional changes
• Depression
• Fatigue
• Difficulty with thinking clearly
• Bad dreams

Mild to moderate physical symptoms:

• Headache - general, pulsating
• Sweating, especially the palms of the hands or the face
• Nausea and Vomiting
• Loss of appetite
• Insomnia, sleeping difficulty
• Paleness
• Rapid heart rate (palpitations)
• Eyes, pupils different size (enlarged, dilated pupils)
• Skin, clammy
• Abnormal movements
• Tremor of the hands
• Involuntary, abnormal movements of the eyelids

Severe symptoms:

• A state of confusion and hallucinations (visual) -- known as delirium tremens
• Agitation
• Fever
• Convulsions
• "Black outs" -- when the person forgets what happened during the drinking episode

Approximately 95% of people experience mild to moderate symptoms while enduring alcohol withdrawal. Most people go to the hospital for observation and to treat alcohol withdrawal symptoms. To better understand what is provided in hospital-based detox, go to http://alcoholism.about.com/od/withdraw/a/aa040604.htm

My strongest recommendation is to contact a substance abuse professional, in a rehab center or hospital, who will be able to assess what you need in your alcohol detox and treatment. Detox alone will not keep you sober. Treatment in a rehab center will. People who often go into detoxification without treatment will relapse or find a repeated need for more detoxification.

I would like to wish you the best outcome in your treatment. If I can be of further help, please let me know.

Respectfully,

John W. O'Neal, Ed.S, MSW, MA, LPC, NCC

Question: My father is 81 and has moderate dementia. He forgets that he drinks and doesn't think he has a problem, but he has two DUIs and now he is walking to the liquor store and drinking on the way home with the police following him. Is there any hope of finding a treatment center for him or will he have to be arrested before anything can be done to help him?

Iona Health Says...:

Alcohol-related dementia is the 3rd or fourth type of intellectual loss among the elderly. The problem is that it is frequently misdiagnosed and often requires a clear clinical history and thorough physical examination by primary care physicians. Approximately 8% of the elderly have serious drinking problems which are often overlooked by family and healthcare providers, alike. However, it should be noted that Medicare spends more money on alcohol-related problems than on treatment for heart attacks. Because long term heavy drinking damages brain cells or causes long term health conditions which cause brain damage, elderly alcoholics must show sufficient cognitive deficits to meet the criteria for dementia and a significant history of substance abuse to qualify for a diagnosis of alcohol-related dementia diagnosis. For more information concerning this, please visit http://www.alzbrain.org/pdf/handouts/6001.ALCOHOL%20INDUCED%20DEMENTIA.pdf

Another name for alcohol-related dementia is Wernike-Koraskoff Syndrome. What actually causes it is a deficiency of Vitamin B1 (thiamine). The role of thee B1 vitamin is to provide energy to the brain. Without receiving proper nutrition and a required energy source, the brain begins to deteriorate. If this is caught in its early stages, a person can often show improved brain functioning.

 This is what can be done for your father in a step-by-step methodology:

1. Enroll the assistance of knowledgeable physicians and mental health professionals who have worked with alcoholism.
2. Increase your father’s intake of the B vitamins, especially B1 (thiamine). Go to this link for a list of B1 enriched foods: http://www.healthaliciousness.com/articles/thiamin-b1-foods.php
3. Use the strategy of preventing your father from drinking and increase his B1 intake.
4. Have your father thoroughly assessed with treatment recommendations for his alcoholism, dementia, and any associated medical problems, e.g., anorexia nervosa, malnutrition, etc.
5. Develop strategies with a physician, the police, the liquor store(s) and mental health professionals to prevent you father from drinking.
6. Enlist the services of mental health professionals or caseworkers to help you and your family work through family issues surrounding your father’s serious deterioration and progressed alcoholism.
7. To provide adequate assistance to your father, it is important that you provide self-care for yourself and other involved family members.
8. Lastly, consider going to Al-Anon where families and friends learn about alcoholism, ways to support the recovery of the alcoholic and, to learn self care. A local meeting can be found at: http://www.al-anon.alateen.org/

For more information about alcohol-related dementia, please go to this website which offers more detailed information: http://www.zarcrom.com/users/alzheimers/odem/al7.html

I hope this response has been adequate to meet your need and concern for your father. Please know that it is important for the family to understand that your father may be genetically predisposed to alcoholism and other family members may also be susceptible. Therefore, it is critical that the family become informed and utilize the professional services of those cited above.

If I may be of further service to you and your family, please contact me at your earliest convenience. Best of luck to your father and your intervention(s) with him.

Respectfully,

John W. O’Neal, Ed.S, MSW, MA, LPC, NCC

Question: I am about to finish a 60 day residential alcohol addiction treatment program. My counselors are recommending that I move into a sober living house after my graduation from here. They have arranged for one that will accept me to be there with my son. Right now he is staying with my sister. I am kind of torn about what to do. I miss him like crazy. He is 7. And I also cannot really ask my sister to take him for any longer than she already has since it is hard for her to get him to school everyday since she has to drive him there herself. But I am very worried that the sober living home will not be a great environment for my son to be exposed to. I know that everyone is supposed to be sober but at the end of the day it is just a bunch of strangers. On the other hand if I go back to my old place there is a lot of temptation around me and I am not sure if I am ready for that, and I have to admit that I was not a very good mom to him when I was drinking, so the most important thing is that I stay sober. He is 7 so he is old enough to see what is going on. Is he going to be OK staying with me in a sober living home or is it going to be harmful to him in some way? I want to be a better mom to him from now on so I don’t want to put him in a bad situation, but if I start drinking again that will be even a worse situation for him. I am not sure what to do.

Iona Health Says...:

Congratulations on completing your 60 days of residential alcohol addiction treatment program. To remain in treatment indicates that you are willing to do whatever you need to do to become clean and sober, have accepted the support of the treatment staff and other recovering residents. In my professional opinion, I have rarely seen clinical people recommend a certain level of treatment unless it meets the standards of the American Society of Addiction Medicine: http://www.asam.org/publications/patient-placement-criteria/ppc-2r

I would recommend that you ask the counselors “what relapse concerns do they have for you?” if you were to go home or to a lower level of treatment. You may also want to ask other residents what they think you need to do to continue in early recovery and about relapse concerns that they may have. I would ask you to ask your sponsor, temporary or not, what her recommendation would be for you. Remember, in recovery, we don’t make decisions for ourselves. We use the fellowship and those we are paying to help us.

If your 7 year old son staying with your sister is posing a problem, you may want to explore other options for your son. Again, this is an issue which can be covered with your treatment staff; particularly the facility’s family therapists. Your sister taking care of your son, until you are able to, is her contribution to your recovery and your family staying intact. As a family therapist, who has worked with small children and their recovering parents, I have found that the children prefer that the parent continue treatment, get “well,” and then return home. So many of the children have been exposed to the parent’s alcohol abuse, which often has scared them, which makes them strong proponents for change/recovery in the family. If your son has been exposed to your drinking or the others’ drinking, it could be a positive benefit to see you with others who have made a conscious decision to stop drinking. I have not seen harm perpetuated upon children when they understood that the parent has been successful in residential treatment, graduates to a sober house for a while, and then if successful again, graduates again and returns home. Children want to see their parents “sober” and like other kids’ parents; i.e., at home, loving and taking care of them. I do think your home environment being a trigger for you must be addressed sooner than later.

The research shows that for sustained abstinence, the recovering alcoholic needs to stay in some form of treatment for at least 180 days. This would be mean that you have would need to stay in some level of treatment for another 120 days. This can be a sober house, outpatient, aftercare, etc. Returning directly home without some level of treatment, in place, is usually not recommended.

I would like to ask you if you can afford to relapse. What would this do to your child? How would this affect your other relationships? Could a relapse threaten your position as your son’s primary caregiver? Can your relationship with your son assume more damage from your alcoholism?

My final recommendation is for you to understand and accept what your professional counseling staff is recommending. Remember the three rules of an alcoholic family are: “Don’t talk, don’t trust, and don’t feel.” To recover, we must learn to talk or ask, trust, own and express our feelings appropriately

I hope you find this helpful or reaffirming in some way. Your son is a lucky boy to have a mother like you who is willing to face down the demon of alcoholism. Best of luck to you, your family and recovery! If you need any other assistance from me, please let me know as soon as you are able.

Remember….hang with the winners,

John W. O’Neal, Ed.S, MSW, MA, LPC, NCC

Question: I have an opportunity to work overseas in the Middle East starting just before Christmas. I would be working in a fairly remote area and there would none, or almost no alcohol available. I have always been a very heavy drinker but I have been drinking very hard for the last 7 or 8 months, basically all the time. I know I need to stop and going to place without alcohol seems like a good way to go about it. I think I need some help with the detox (I am already waking up shaking in the night) so I plan to get all my stuff together and then a couple of weeks before I leave I’ll do a rehab detox and about a week of inpatient treatment and then it will be pretty much straight from the rehab to the plane to a country without alcohol. Does this sound like an OK plan? Is there anything obvious I am missing that will cause me problems?

Iona Health Says...:

Let’s name this challenge so we can better discuss it: Alcohol Dependence with Tolerance and Withdrawal Risk. You are correct by indicating that using alcohol is against the dictates of Islam in the Middle East. However, if you are a Westerner and living on an American or European installation, alcohol may still be available to you. The question becomes “Are you alcohol dependent?” If so, you may be able to do ambulatory detox (outpatient) to avoid withdrawal symptoms, like “shaking at night.” Medically, this shaking is referred to delirium tremens which is significant sign of alcohol withdrawal.

First, I must admit that I do not have a clear picture whether, or not, you want to stop drinking for the benefit of a job and/or long-term recovery. If you are considering long term recovery, I would recommend that you obtain a full substance abuse assessment so a determination can be made regarding the level of treatment (outpatient, intensive outpatient, residential or inpatient treatment) which would be most helpful and appropriate for you. There is good evidence that many people who have attained sobriety have utilized Alcoholic Anonymous, Smart Recovery groups, involvement in spirituality (e.g., churches), and/engaged in cognitive behavioral therapy after detox. By searching the Internet, you can find many online resources if you Google any of all of these resources cited above.

Rapid Alcohol Detox and Rehab

With your time limitation, please be advised that many treatment centers have been very successful in rapid alcohol detox and rehab. These programs allow patients to detox themselves from alcohol under medical supervision, typically use a Librium detoxification regime, and begin their recovery in the comfort of their own home. Once an individual is detoxed from alcohol, many patients take Naltrexone or use Naltrexone implants for alcoholism treatment which proves to be a cost-effective intervention which decreases alcohol cravings and increase the chances of recovery.

One of the leading rehab facilities, the Coleman Institute does an excellent job explaining the challenges of alcohol detox and recovery (http://www.thecolemaninstitute.com/alcohol-addiction-rehab-recovery.aspx ). I am offering this resource as one of many clinics around the country which offer this service. I would caution you by stating that staying motivated to stop drinking requires strong effort, education, and support. For anyone to maintain sobriety, he or she will need some form of social/emotional support, such as AA, therapy, sponsorship, working the 12 Steps, and a supportive group of friends and family. Addiction is a disease marked by increased tolerance, continual use despite consequences, withdrawal, decrease in functioning in most major areas of life, and loss of control. Many addiction specialists consider addiction a disease of feelings. Many alcoholics and addicts manage their feelings through the use of alcohol and/or drugs and can be considered chemical coping. I recommend that you consult with another substance abuse professional who can address many of the concerns so often faced in detox and rehab.

I wish you well in your overseas work and pursuit of sobriety. If I can be of further assistance, please let me know.

John W. O’Neal, Ed.S, LPC, NCC