Talking about alcoholism/addictions is always a bit of a "mind f**k" because addictions always involve "denial"; they are practically defined by it. There are exceptions, of course, but most alcoholics don't know they are alcoholic; they deny it. "I can stop any time" they say. Surprisingly, that may be true. Alcoholics typically abstain from drinking for days, weeks, months, even years in some cases in order to prove that they can "take it or leave it" and then return to their pattern of destructive drinking and using.
As a part of denial, alcoholics typically ignore or justify or rationalize the destructive, self-destructive and antisocial things they do, and rarely do they associate the problems in their life (relationships, social, professional, financial, medical, emotional, etc.) with drinking and using.
Because of this, it is a very tricky problem to get a handle on. Some stop, most do not, and after decades of research, we still don't what it is that is different about those who stop compared to those who do not.
Take this for what it's worth, but these people seem to know a thing
or two.....it seems to cover most if not all of the standard questions....at lease from a clinical perspective.
Alcohol, Chemistry and Alcohol Addiction Dr. Bill Boggan
What accounts for the ability of some to drink without difficulty in contrast to those who become "addicted"?
Definition of Addiction
Some individuals are more vulnerable than others to becoming addicted. This enhanced vulnerability can be ascribed to genetic (biochemically regulated vulnerability) as well as environmental factors (situational impact). It is also clear that people without an apparent enhanced vulnerability can be addicted to ethanol.
What is the current thinking about biochemical basis of addition?Two general processes contribute to alcohol addiction.
1. A modified reward process where by drinking of alcohol provides an overall positive effect (euphoria or decrease in an unpleasant situation). This is coupled in those vulnerable individuals with a pattern of diminishing or ignoring the negative impacts of over consumption - the hangovers, loss of memory, fights, violence and arrests. The less vulnerable individual equates heavy alcohol consumption as overall unpleasant as result of the negative effects outweighing the positive. 2. Neuroadaptation where by the brain attempts to compensate for something (ethanol) which influences normal functioning.
Types of rewarding (positive) experiences gained after drinking include the taste of the alcohol itself and the feelings (e.g. relaxation) gained after drinking ethanol. One can also gain a positive experience by avoiding negative situations such as those felt in anxiety provoking situations (public speaking, attending a party) or avoiding the effects of withdrawal from ethanol (see below). The rewarding aspects of ethanol use involve the brain’s reward system. This system is comprised of brain structures and circuitry (e.g. ventral tegmental area, extended amygdala and the nucleus accumbens within) that appears to be important in the reinforcing (rewarding) properties of a variety of drugs.
The second process important in addiction has to do with the ability of the brain to adapt to influences, which affect its normal function. The ability is called neuroadaptation. For example, the drinking of one or two beers or one or two drinks (acute intake of ethanol) activates a variety of processes in the body and in particular impacts the functioning of the brain. In order to keep the brain functioning normally, the brain attempts to chemically counteract whatever ethanol is doing to disrupt its action. A simple illustration is the reaction of the body if someone starts pushing it. The natural reaction is to compensate by correcting the balance and attempting to counteract the pressure of the push until the push is gone and the body returns to normal. Interestingly, neuroadaptation also sometimes results in an increased response to the drug (sensitization). Whether there is a diminished response or an enhanced response depends upon a variety of factors including the amount of the compound taken in and the timing of the intake. The development of sensitization to drugs such as cocaine may be more likely with intermittent exposure than with continuous exposure.
Ethanol
1. facilitates the action of the major depressant neurotransmitter in the brain (GABA) and 2. inhibits the action of the major excitatory neurotransmitter in the brain (glutamate).
Ethanol acts at specific sites on a specific subset of GABA and glutamate receptors (protein molecules upon which the neurotransmitters act). By influencing the action of these receptors, ethanol "slows down" the functioning of the nervous system. Thus, ethanol is called a central nervous system (CNS) depressant.
With neuroadaptation, the brain attempts to counteract this depressant effect by increasing the activity of the glutamate system and decreasing the activity of the GABA system. This in part can be accomplished by altering the number or function of the receptors.
GABA and glutamate receptors are only two of a number of key players in the transmission of information from one cell to the next. Activation of receptors is the occasion for intracellular signaling, meaning that a series of events within the cell take place when a neurotransmitter binds to the receptor. Thus, neuroadaptation can also take place at other locations within the cascade of events that take place in the brain.
Just as there is adaptation upon the presence of something new, there is neuroadaptation when the compound leaves the brain. Thus, through neuroadaptation the brain is able in many instances to up-regulate (increase) or down-regulate (decrease) its function to compensate for the presence or absence of ethanol. (It should be recognized that the body and the brain have an amazing ability to adapt and only in extreme situations or after damage, such as seen in alcoholism, do the regulatory processes fail). If a person chooses to drink more regularly (chronic intake), the brain attempts to adapt to the increasing amounts of ethanol. Generally, neuroadaptation can take place up to a point. After chronic consumption and ongoing adaptation, it will now take more ethanol to produce the same effect as the first drink. When this is the case, tolerance has developed and substantial adaptation has taken place. If the person now chooses to quit drinking the body tries to return to its original state in doing so causes a number of withdrawal signs including tremors, seizures, nausea, and negative emotional states. Since further drinking will delay, diminish, or prevent withdrawal, the person often chooses to drink again. Even if the person stops drinking, the neuroadaptations that took place in the brain may persist for a period of time well beyond the time when ethanol is no longer present in the body. It has been speculated that these may be the source of the urges to drink again. For most people it is relatively easy to modulate ethanol intake. Depending upon the vulnerability of the individual, as drinking progresses regulation of drinking becomes more difficult. Simultaneously, the ability of the brain to adapt is diminished or lost. Systems become increasingly disregulated, perhaps due to damage, so that in the brain communication and coordination diminishes or fails. This is particularly true after repeated withdrawals from ethanol, since the severity of withdrawal increases. Perhaps this is the reason for saying the drink appears to take on a life of its own.
"First the person takes a drink, then the drink takes a drink, then the drink takes the person".
In general there appears to be an overall loss of control. The individual has lost control over drinking and neuroadaptive mechanisms have been overwhelmed. Thus alcoholism can be characterized as a disease with takes over the body and brain.
About Alcoholism from the National Institute of Alcohol Abuse and Alcoholism (NIAAA)
The environment associated with drinking is now known to play a crucial role in the addictive process. The environment associated with the drinking becomes associated with the positive attributes of drinking. Thus, it common knowledge that if one always drinks in a particular bar, or with cigarette in their hand, or with a certain group of friends, then the bar, cigarette, and friends can trigger the urge to drink. This is because the bar, cigarette, and friends have become cues associated with drinking and can trigger the brain reward system in a manner somewhat similar to that seen with the ethanol. Attempts to help alcoholics return to normal functioning must include understanding of the important role of cues in addiction.
Reference:
Tenth Special Report to the U.S. Congress on Alcohol and Health, June 2000. U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism.
''After chronic consumption and ongoing adaptation, it will now take more ethanol to produce the same effect as the first drink. When this is the case, tolerance has developed and substantial adaptation has taken place. If the person now chooses to quit drinking the body tries to return to its original state in doing so causes a number of withdrawalsignsincludingtremors, seizures, nausea, andnegativeemotionalstates. Since further drinking will delay, diminish, or prevent withdrawal, the personoftenchoosestodrinkagain. Even if the person stops drinking, the neuroadaptations that took place in the brain may persist for a period of time well beyond the time when ethanol is no longer present in the body. It has been speculated that these may be the source of the urges to drink again. '' Vicco.
Very good post Vic...I have friends in this unfortunate situation....
Regarding Secular approaches to recovery from alcoholism and substance abuse
Good Morning, all,
The link to Secular Recovery below no longer works, and the project is on the "back burner" for the foreseeable future. It was a project of my, along with six other web projects constituting literally hundreds and hundreds of hours of work which had to be abandoned primarily due to my technical ignorance and some serious technical blunders that got me on Google's sh*t list. It has been a couple of years now, and I only just discovered the embarrassingly simple thing I did wrong to create catastrophic failure of so much blood, sweat and tears!
The objective of SecularRecovery was to be an "umbrella and networking organization" designed to be inclusive of the many, relatively small and disparate organizations who approach recovery from alcoholism and substance abuse without religion. The "market share" of all of the secular approaches combined is a tiny-but-important segment of the overall recovery community. The AA group in KKC sounds very moderate in their approach ("moderate" in terms of religion, not in terms of drinking!!!) which is great. Of the approximately 150,000 meetings world-wide, there are undoubtedly many such moderate groups. Secular recovery appeals not only to hose who are atheist, agnostic, "free thinkers", humanist, but also to religious people who feel that recovery and religion are separate issues.
There no secular meetings anywhere in the region that I am aware of, unfortunately. However, here are some links to to three of the most successful and important in the "movement." The good ones consider themselves as "friendly alternatives" to AA, and do not set themselves up in opposition to 12 Step Programs in any way, except to the extent that they prefer to separate religion from recovery. Here are the links if anyone is interested. Some of them have online forums and e-mail discussions groups and other interactive facilities. As you will see, unfortunately, there are not nearly enough (live) support group meetings for those who want them:
Let me say in closing that due to the limited reach of these secular recovery organizations to provide live, F2F (face-to-face) support, AA, NA and other 12 Step Organizations are still "the only game in town" for the vast majority of people struggling with alcoholism, substance abuse and addiction issues. As I said, the KKC AA groups gives the impression of being rather moderate in it's religious emphasis which really great news. But even if that were not the case, I urge anyone who is atheist, agnostic, secular, non-religious (or however you may describe your belief system) to please NOT allow some philosophical quibble stop you from attending AA meetings, recovering and getting your life back. Get well, first! Quibble, if you must, later! Most recovering alcoholics and addicts need live, F2F support meetings in order to get well, and to reinforce the idea that, so called "moderation" is non-negotiable and not an option. Use the online resources of the secular groups described here to reinterpret the religious message if it rubs you the wrong way, and also the book that Tony mentioned in another post about sounds good.
***************************
Rex
Hi Rex and others. I just noticed what you said about the KKC AA group. I have to say that there is absolutely no religious emphasis in our meetings. Out of all the foreigners that have been to our meetings, I can think of only ONE that practiced a religion but that was OUTSIDE of our meeting. The Thai meetings are a bit different where many are practicing Buddhists but again that religion is kept out of the AA meetings.
The AA Preamble
ALCOHOLICS ANONYMOUS is a fellowship of men and women who share their
experience,
strength and hope with each other that they may solve their common
problem
and help others to recover from alcoholism. The only requirement for
membership
is a desire to stop drinking. There are no dues or fees for A.A.
membership;
we are self-supporting through our own contributions. A.A. is not allied
with
any sect, denomination, politics, organization or institution; does not
wish to
engage in any controversy; neither endorses nor opposes any causes. Our
primary
purpose is to stay sober and help other alcoholics to achieve sobriety.
Hello, I was just going to let it go as I am leaving back to the states tomorrow. I would like to know about any alcohol detox centers(hospital based). I have this uncle here-Thai, such a nice guy when not drinking(one of the few family members I can speak to in english when he is not drunk). We live out about 26km from town. His eyes are jaundice, and he is delirious at this point, not eating. He needs a locked facility and Dr.(name) observation/ meds for a safe detox first, then work on recovery. At this point he doesnt know which end is up. He has been sober in the past-and from what the family says until the new year doing well-then of course the sister who drinks moves home and they have been drinking since. So anyway, a good detox center/hospital/psych hospital? This may be covered elsewhere, but I have such a bad connection-it is hard and slow to search. Thank You, Mike
This is the address of the Drug and Alcohol addiction unit in Khon Kaen , the phone number is :
Phone at center: 043-345 391-2, ext 311 or 314
NEED TO LOCATE MEETING ON MAPศูนย์บำบัดรักษายาเสพติดSoon Bam Bat Rak Sa Yaa Sep DtitCenter for Treatment of Drug Addiction775 Moo 19, Amphur Muang, Changwat Khon Kaen775 หมู่ 19 อำเภอศิลา จังหวัดขอนแก่น
Location:
ศูนย์บำบัดรักษายาเสพติด
775 หมู่ 19 อำเภอศิลา
จังหวัดขอนแก่น
and if you check this site out you will find local phone number anmeeting details for AA in Khon Kaen , also the Nationwide number in English and Thai
Wow, David! Thanks for posting this. I searched my hard drive and couldn't find it for some reason. I hope this facility is appropriate for Mike's uncle. In any event, if he is jaundice, it is a medial emergency, and he should hospitalized even if there is not an appropriate detox facility for
him.
*********************
Googling around I just happened to find this site for
I don't know anything about it and am quite frankly astounded that we have something like this in KKC. They list alcohol and addictions as issues they treat. I am pressed for time this morning, I wonder if Pete or someone would be interested in checking this place out (or checking out the website more carefully) and posting something here? Thanks, lah!
KhonKaen Mental Health Clinic ( Dr.Pat Clinic ) Working hour : Mon – Fri : 12.00 - 13.00 ( Online Clinic ) Sat – Sun : 10.00 – 18.00 ( 1st and 3rd week of the month ) Address 23/118 Chatapadung Rd., Naimuang, Muang, Khonkaen 40000 For appointment please call 043-327993, 086-6312437 www.facebook.com/Dr.Pat Clinic-Khon Kaen
I'm currently working in the Faculty of Public Health at KKU. I'll ask around and post any useful information that emerges.
As Rex says, the urgent thing is for Mike's uncle to be seen by medics at a regional hospital, such as Khon Kaen Hospital. His general physical condition sounds bad and may well , of course, have nothing to do with alcohol overuse.
As Peter says, poor old uncle could be jaundiced from any number of things, some of them quite nasty. However, the "circumstantial evidence" for overuse of alcohol, either proximate or secondary is pretty compelling. I hope he gets the help he needs. :o{
The following information was supplied to me by a senior nurse via KK University. There is an alcohol problems clinic at Srinagarind Hospital (the University Hospital). The clinic is located in the psychiatric outpatient area (OPD 7) and operates every Friday morning. Patients need to visit or telephone the department (043-363001) for an appointment before attending the clinic. Thais who are covered by bah tong (30 baht scheme) will need a referral letter from their primary hospital before making the appointment.
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