Back From the Drink

Treatments for alcoholism that work.

By Jill Neimark, Claire Conway, published on September 01, 1994

The new approach to alcoholism puts practicality before ideology.What works? Keeping motivation high, for starters. And it's not even necessary to admit you are an alcoholic to curb drinking.

Each year it kills 40,000 Americans. It can damage and destroy every organ in the body, scarring and pocking the liver until it looks like a lump of drying lava, laying waste to the heart, pancreas, arteries, throat, and stomach, snuffing out receptors in the brain. Every year alcoholism costs our country over $80 billion, is implicated in 30 percent of suicides and 46 percent of teen suicides, and is a factor in one of four hospital admissions. No wonder it has long been decried as not far removed from original sin.

Yet like the music of Greek sirens, alcohol has also been the hymn song of poets, monks, philosophers, and soldiers. It is a ritual substance in most religions, intimately linked to God and altered consciousness. It is the supreme seductress: "For not even the gates of heaven, opening wide to receive me," wrote author Malcolm Lowry of a bar in Mexico, "could fill me with such celestial complicated and hopeless joy as the iron screen that rolls up with a crash. All mystery, all hope, all disappointment, yes, all disaster, is here." Or, as Rabelais put it: "I drink for the thirst to come. I drink eternally.... The soul can't live in the dry."

What other substance has so mesmerized and polarized us as alcohol? It has a long and illustrious role in our culture, from social lubricant to lethal intoxicant. There are those who contend that culture itself owes its existence to alcohol -- that the first primitive, agricultural societies sprang up around the farming and ferment of hops. Experts advocate a glass or two of wine daily, citing wine's healthful antioxidants and significant potential to reduce heart disease. Yet the same experts call for an astounding 25 percent reduction in alcohol consumption. Sound confusing? Not surprising. Alcohol is one of the most potent pharmacologic agents around, one whose effects seem as protean as human nature itself.

For that reason, perhaps, it has taken the maturation of neuroscience and psychology to give us a realistic glimpse into alcohol use and abuse -- and the picture is no longer black or white. Researchers are now beginning to ferret out the causes of alcohol addiction, of liquor's fiery path across the cells of the brain, its social underpinnings and cultural power -- as well as new, innovative, and flexible treatments for this condition.

"There's tremendous excitement, a watershed feeling, as if something is just beginning to happen," notes Henry Kranzler, M.D., a psychiatrist at the University of Connecticut who has pioneered new pharmacologic approaches to alcoholism. "This field now is at the same place that the treatment of depression was 30 or 40 years ago. We're really beginning to understand this condition, to develop promising medications and psychosocial interventions."

THE SHIFTS ARE PROFOUND. Perhaps most important, according to Dennis Donovan, M.D., a psychiatrist and director of the Alcohol and Drug Abuse Institute at the University of Washington, is the willingness to look at the goal of treatment for alcoholism as far more than abstinence or the lack of it. "Abstinence is no longer the gold standard, it's simply one standard."

There is a growing understanding among mental health experts that alcohol abuse occurs on a continuum and must be treated thusly. According to Steven Liljegren, Ph.D., clinical director of Child and Adolescent Services at Brookside Hospital in Nashua, New Hampshire, traditional alcohol treatment programs work for less than half of drinkers. An unprecedented multisite study called Project MATCH, involving over 80 therapists, is now underway to match patient characteristics with different kinds of therapy. Researchers are discovering that, while some former alcoholics require unequivocal abstinence, others can drink in moderation.

As the field moves away from an absolutist, all-or-nothing view, the definition of treatment success, too, is widening. Some of the new findings sweeping the field include:

o Alcohol is not, as was long believed, simply a chemical sledgehammer. It seems to act specifically on neurotransmitters and receptors, primarily GABA, the prime inhibitory neurotransmitter in the brain, and one that accounts for much of alcohol's effects. This discovery may lead to new medications for helping drinkers overcome the condition.

o Most alcoholics do not have preexisting psychiatric conditions. However, about 20 percent are suffering from psychiatric disorders that they may be attempting to medicate with alcohol, and which are beginning to be treated with the latest psychotropic drugs.

o Social support -- whether from friends, family, therapists, or self-help groups -- is crucial to recovery. In fact, peer and family support may be the "missing link" that allows some alcoholics to quit on their own, without any formal treatment, according to Donovan. Social support can be provided by contact with recovering people, access to self-help groups, and a family that helps the drinker to readjust to life without substances. Social support does not mean that the family should keep on protecting the alcoholic when he or she is in trouble; it means creating enthusiasm in both the drinker and the family that a life without alcohol is possible.