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Answers to Commonly Asked Questions on Alcohol
and Drug Addiction
Find answers to your mental health questions from Ramsay Health Care specialists
The Diagnosis and Treatment of Alcohol and Other Drug Addictions
How does a person first know when they need treatment?
A: A person may first know they need treatment when they receive or become aware of the consequence of
their drinking or drug use. Certainly you don’t have to have a fully established and severe addiction to get a
consequence from a single episode of drinking or drug use, but it is often when things start going wrong
that a person realises that they might need some help, of course, if we’re looking at the development of an
addiction, frequency of use will often indicate the person has more and more opportunity for things to go
wrong and that’s when they start to see things piling up on them and they will often seek help.
Interestingly, in my observation it’s often the people around the individual with the problem who will start
to notice things before the individual who is developing an addiction will be fully aware of, and there’s also
a very well recognised phenomenon called denial within the emergent alcoholic or drug addict, where
whether it’s at a conscious level or not they are just unwilling or unable to accept there’s actually a problem
there, so the people around them will become concern before the person with the problem is fully aware of
it.
How do you know if someone is addicted to Alcohol or Drugs?
A: Addiction is probably a diagnosis best made by a mental health expert. I think instinctively if we have
concerns about someone’s drinking or drug use and that can certainly involve in encouraging someone to
seek an expert opinion. An established addiction usually indicates a person needs to work towards a
complete absonant long term, whereas if a person for example is drinking or using drugs in a way where
maybe causing harm, they may actually learn to moderate or use in a safer way, so it’s fairly much
establishing the extent or severity of the problem; that’s what enables good treatment planning and good
advice, so I think a formal diagnosis is best made in the hands of a expert.
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What can someone do if they think someone they know has an Alcohol or Drugs
addiction?
A: So if you are worried about another person’s drinking or drug use, it is best option is to put your cards on
the table, to let them know precisely what it is you are concerned about, to let them know precisely what
you have observed that give you those concerns. It fairly clear though in addiction treatment settings that
people really will not alter their behaviour around these things until they can see good reason for doing
that. You may have seen intervention TV shows for example and sometimes on television these work well,
but in reality sometimes they can work very badly. There’s a clearly identified process which is called stages
of change, and if an individual isn’t even at a stage where they are contemplating their drinking or drug use,
trying to force them to do something about it just becomes a source of conflict and these can be difficult
choices when you are worried about someone, so I certainly recommend that you express your concerns,
you provide them with options for examples, see the GP is often a good start point to start that, really you
can’t control someone addictive problem.
What are some common treatments for Alcohol and Drug Addiction?
A: If we think about the available treatments for alcohol and drug addictions, certainly as a medical doctor
I’m always interested in the treatments that will be based on good scientific evidence. So we can say first of
all physiological treatment such as cognitive behavioural therapy has an evidence based for the treatment
of addiction. There is good evidence, particularly with long term follow up for twelve step management of
addiction, and these are organisations such as Alcoholics Anonymous, Narcotics Anonymous, and the
fellowship of self-help network which is worldwide. In recent years, we now have availability of
medications, which broadly speaking we call anti craving medications can actually damp down physical
cravings for alcohol or drugs, or in some cases we can have what we call and impulse control effect, which
can assist individuals not to act on the desire to use drug which is driven by craving.
What is the most effective treatment for Alcohol and Drug Addiction?
A: Really there is no one most effective treatment for addiction. The fact is that because addiction plays
out really across the breath of a person’s experience, their biology, their behaviour but also their social
functioning and networks, really all these domains need to be looked at and assisted if necessary. What we
do know though from long-term follow up of addiction patients that this is very much a long term process.
Once a person has crossed that line biologically, behaviourally into a fully blown substance dependency,
really its long-term abstinence from that and any other drug that’s required, and so it indicates a person is
going to require long term treatment. We maximise support, maximise treatment at the front end of
recovery, it really those first few months that are critical and we generally tend to combine treatments
whether that’s medication based with the anti-craving medications, but also psychological treatment and
we do encourage the twelve step support as well. It appears addiction is best treated amongst other people
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with the same problems, so commonly there’s the twelve step meeting in a group setting; group therapy is
very commonly used as a follow up treatment as well.
What is detoxification?
A: Detoxification is the process whereby a person is safely supported using with medication through the
process of stopping using their drug of choice, so particularly if a person has become physically dependant
on the substance. What that means is, once they stop using the substance regularly they are like to get
rebound physically withdrawals and some withdrawal states can be very severe. Alcohol withdrawal for
example if it’s severe and untreated can be life threatening, so usually in a hospital detoxification setting
the patient is carefully and closely monitored by nursing staff and we use medication to safely assist that
person through the process of coming off their drug of choice.
How long does treatment for addiction last?
A: Treatment for addiction, some people would say, it lasts for ever. Although intensity of treatment is
maximised at the beginning. The hospitals I work in, typically people will come into hospital for a three
week period, where they’re initially medically detoxified, but then, there is an inpatient rehabilitation
program where they are taught new strategies to deal with their drinking or drug use triggers, they are
taught to manage their cravings, but very importantly we look at a follow up program for every individual,
because if we are talking about what for many people is a big change in their life in terms of, for example
ways they may relax themselves, the way they may socialise, or celebrate, or ways they may deal with
unpleasant emotion. I their learning of healthier strategies, if they have been turning toward drink or drug
as their primary, apparent solution to this, it takes a while for these things to become natural for them, to
live in a healthier manner, so people do usually require a lot of support initially.
What advice about healthy living during treatment would you give to someone with
an addiction?
A: Within the addictions treatment community is a concept of a recovery. Recovery is quite a different
concept from simple abstinence, so if a person is abstinent it just means that person has stopped using that
drug, whatever it maybe. A true recovery is the person seeking wellness physically, emotionally and socially
and an important part of recovery program is healthy eating, regular exercise, is making sure that they get
adequate and healthy sleep. All of these things are priorities for those making a transition out of addiction
to healthy living.
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What happens during relapse?
A: If we look at the statistics, unfortunately relapse is common amongst people who have developed an
addiction and that might sound depressing, but I think in fact, it’s a good thing to be aware of, because
people need to plan their contingences around that. The reason that relapse is common I think is, several
things, first of all if it’s a big change in person’s life, routine, in how they are addressing their emotion, in
their social life’s it takes some time for living, often dramatically differently to feel natural. Well habitually
in our responses to certain environments, emotions so relapse we really define as when somebody has
started using their drug of choice again, essentially has lost control of it again as well. So we see for most
individuals very rapidly reinstitution all of their feature of addiction once they start using the drug again and
for some people it’s almost immediate, other people may chip away at it for days or weeks, but essentially
relapse is when person is back where they started from. Some people will have a thing called lapsed which
is slightly different phenomenon that is where for whatever reason they have some sort of, I guess we
would call it a slip up where they may use their drug of choice or other drug on an isolated occasion then
they will stop, but of course this is not something to ignore, because if we do ignore it, really stokes the fire
for them to lose control down the track, then it’s a matter of getting things settled and sorted for them
again.
What we are advised to do when a person relapses?
A: One part of what we call discharge planning from our inpatient program is preparing for the eventuality
or possibility of a relapse, and I think people particularly in a relationship or family situation its actually
worthwhile having that discussion prior to leaving the initial point of treatment, so that involves really
having an agreed action plan should relapse occur; that can be different for different individuals of course,
depending on the nature of their condition, what tends to happen when they are using the drug and what
facilities are available, you know at a practical level, but usually the best advice we can give is that if a
relapse has occurred, the sooner the person re-enters addiction treatment the better. The useful rule of
thumb is, let remember it is very hard to have a complex negotiation with an intoxicated individual, so often
the best thing that can be done is to try an ensure the individuals safety and then the discussion needs to
happen once the person has sobered up.
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