Schopick Psychiatry

The holidays have recently passed, and with them many rounds of parties and entertaining. Undoubtedly, alcohol was consumed, as it is at most festive occasions. However, for some families, these situations are troubling if a loved one has trouble with alcohol.

What is alcoholism?

Alcoholism is a chronic disease that can affect people of all ages and social strata. The signs include someone having trouble controlling their drinking, being obsessed with alcohol, continuing to drink even when it makes them ill, and having to increase the amount they drink to get the same effect. An alcoholic also has trouble staying away from drinking, and experiences physical withdrawal when he or she tries to stop.

What are the treatments for alcoholism?

Currently, the most popular treatments include detoxification and withdrawal, followed by learning new behavioral skills and psychological counseling. Detoxification and withdrawal is usually done at a treatment center or hospital where medication can be administered to control withdrawal side effects. Behavioral treatment programs are administered by alcohol treatment specialists and typically include goal setting, techniques for changing behavior, self-help manuals, and support visits with counselors. Counseling and therapy–individually or in a group setting–can help alcoholics better understand why they have a problem with alcohol and address the psychological aspects of their addiction. Alcoholics Anonymous (AA) is the most widely recommended program.

While these programs can be very successful, in some cases, the addiction is so strong that these efforts have little or no effect, or they may work for a short while, and then the person relapses. This cycle may repeat again and again.

Can medication help with alcoholism?

The answer is “yes,” in many cases. There is no magic cure for alcoholism. It is a complex disease and the reasons people drink are varied. Some drink due to anxiety or suffer from post-traumatic stress disorder, others may have a genetic predisposition toward alcohol or are coping with depression. However, over the years, researchers have studied the brains of alcoholics and have found that certain drugs, combined with therapy, can help ease patients away from their addiction.

Currently, there are three different drugs that are being used to help combat alcoholism. Two reduce the craving for alcohol, and the third causes the patient to become physically ill if he consumes alcohol.

What are the medications and how do they work?

Naltrexone and acamprosate reduce the craving to drink. Naltrexone also blocks the good feelings that alcohol causes. The third drug, Antabuse, helps prevent alcoholics from drinking because it causes a strong physical reaction–nausea, vomiting, headaches–if the patient consumes alcohol; however, it doesn’t reduce the cravings. Treatment centers, such as the Hazeldon Center, are now using naltrexone and acamprosate as a regular part of their program. These medications help alcoholics get through that critical 12 to 18 months when they are most apt to relapse. It is believed that if they can remain sober during this period, then they have a better chance of the behavioral and psychological therapies taking hold, and ultimately, making a long-term recovery.

Summary:

Because alcoholism is a complex disease, any treatment program should encompass counseling and ongoing support. Alcoholism frequently has psychological issues at its core, so therapy is important. Alcoholics also often suffer from other mental health disorders, such as depression, anxiety or post-traumatic stress disorder; treating these as well as the disease of alcoholism is critical. Support groups, such as AA, play a vital role in helping alcoholics continue and maintain their recovery by advising on lifestyle, behavior, and just being there when times are difficult. All of these remain essential parts of an alcoholism recovery effort, but if medication has not been tried, it is something to consider.

We have all had nights when sleep will not come, but for some people not being able to sleep is a chronic condition–they suffer from insomnia. People with insomnia may have a hard time falling asleep even though they are tired, or they may wake up in the middle of the night and then lie awake for hours, unable to return to sleep. Sometimes insomniacs do sleep, but the sleep is unrefreshing and they wake up feeling as drowsy and fatigued as if they had experienced no sleep.

Understanding Insomnia

Insomnia is NOT about failing to get eight hours of sleep at night. Rather, it is the inability to get the amount of sleep you need to feel rested. We all need different amounts of sleep, so insomnia is defined by the quality of your sleep and how you feel after sleeping–not by how many hours of sleep you get, or even by how quickly you fall asleep. If you only sleep five hours but feel great you don’t have insomnia.

Insomnia usually is not just a sleep disorder; typically, there are other causes at the root of the problem. Insomnia is often the symptom of other issues that are interfering with your ability to sleep. These issues may range from having too much caffeine during the day to medical conditions to psychological issues.

Symptoms of Insomnia

These are typical symptoms of insomnia:

* Difficulty falling asleep even if you are tired
* Waking up repeatedly during the night
* Difficulty falling back to sleep once you have woken up
* Not feeling rested after sleeping
* Needing to rely on sleeping pills or alcohol to fall asleep
* Waking up too early
* Feeling drowsy, tired and irritable during the day
* Having trouble concentrating during the day

Common Causes

Many of us experience temporary insomnia–the kind that lasts just for a few days and then goes away. Usually this type is due to nerves over something at work, a relationship issue that is later resolved, jet lag, or some other brief hiccup in our routine. But when insomnia continues for weeks and months, then it is time to talk with your doctor.

Insomnia can be caused by psychological problems, medications, medical conditions, and sleep disorders.

• Psychological causes: Depression, anxiety, chronic stress, bipolar disorder, post-traumatic stress disorder.
• Medications: Antidepressants, cold and flu medications with alcohol, pain relievers with caffeine, diuretics, corticosteroids, thyroid hormone, high blood pressure medications
• Medical causes: Asthma, allergies, Parkinson’s disease, hyperthyroidism, acid reflux, kidney disease, cancer, chronic pain, and others.
• Sleep disorders: Sleep apnea, narcolepsy, restless leg syndrome

Cures for Simple Causes of Insomnia

• Look at your behavior–are you consuming too much caffeine (soda, coffee, energy drinks)? Try cutting back.
• If you are using alcohol or sleep aids to fall asleep, cut back. These actually disrupt sleep over the long term. Try warm milk to soothe you.
• Shut off your brain at least an hour before bed–no Internet, no TV, no computer, and no vigorous exercise within two hours of bedtime. Unwind with a relaxing book, meditation, etc.
• Keep your bedroom dark, cool and quiet. Try white noise machines, sleep masks or earplugs if need be.
• Don’t smoke–especially at night–nicotine will keep you awake.
• Keep your bedroom only for sleep and sex–not work or other activities.
• Make sure you get good exposure to natural light during the day, but minimize your exposure to artificial light at night. Maintaining this balance will help your body’s natural wake/sleep cycle.

When the Cause Is Psychological

Ask yourself the following questions; if you answer “yes” to any of them, it may be helpful to see a psychiatrist for help with your insomnia issues.

• Am I under a lot of stress?
• Am I depressed? Do I feel devoid of emotion and hopeless?
• Do I have chronic feelings of anxiety or worry?
• Have I experienced panic attacks?
• Have I undergone a traumatic experience?

If the cause is chronic anxiety, depression, chronic stress, post-traumatic stress disorder, and the like, then you should consult a psychiatrist. These conditions can be treated with consultations, medication, or other therapies.
A therapist can also instruct you in relaxation techniques that can help you cope better during the day and unwind at night. These may include:

• Deep breathing techniques
• Progressive muscle relaxation
• Meditation
• Visualization
• Positive responses to self-defeating thoughts

When to Get Help

If you answered “yes,” to the questions listed under “When the Cause Is Psychological” then you should consult with a psychiatrist. Professional insomnia treatment is also advised if you experience the following:

• Your insomnia is causing problems at work, home or school.
• Your insomnia hasn’t responded to self-help tips like those listed under “Cures for Simple Causes of Insomnia”
• Your insomnia is getting worse, occurring almost every night

Nature intended our minds and bodies to rest. If you are chronically unable to get restful sleep, get help. A good night’s sleep can be an amazing restorative to your mental and physical health.