The best way to quit drinking

A significant shift in the way we treat alcohol addiction is underway. Patients once forced into rehab or 12-step meetings now have new options, including at home care and treatment with anti-craving medication, nutritional supplementation, hypnotherapy and other alternative therapies. Often, a blended approach is beneficial in overcoming cravings and addressing the underlying reasons individuals drink excessivly. Support is a key component to anyone in recovery and will help ensure long term sucess.

A new member to our message board at www.mywayout.org/community posted a question about how to approach the doctor now that s/he's ready to seek help. "Am unsure what to expect," says C, "are they generally sympathetic?"

It's a valid question and significant concern for those who finally decide to take that first step. No matter what we say about treating alcohol dependence without stigma or shame, the thought of sharing this most painful secret is often terrifying. It's why so many drinkers work around their doctor, buy anti-craving meds online and undergo a self-help program with only themselves available for help. They've heard about patients shunned by providers, unwilling to assist. "Go to a meeting," they're told. Thing is, if they wanted to attend a 12-step program or simply abstain from alcohol they'd have done it by now.

But it doesn't have to be that way - and shouldn't. C's thoughtful questions about what to expect and how to prepare for that visit are often the beginning of a successful health partnership.

Here are some guidelines to help promote a positive experience:

* Identify which of your current doctors are most willing to consider an alternative treatment proposed by you. For example, some patients tell us they are able to work most effectively with their Ob-Gyn because of the long-term, trusting relationship already established.

* Consult a DO, or Doctor of Osteopathy. These fully licensed physicians often embrace a more holistic approach to healing than traditional MDs.

* Many patients have reported success with a mental health practitioner. Doctors of psychiatry are usually more familiar with anti-craving medications or new treatment strategies than their counterparts. Their medical training requires specialization in the prevention, diagnosis, and treatment of addictive disorders.

* If you feel more comfortable with a new physician, look for an addiction specialists in your local Yellow Pages or search online. Look into one of the web based resources such as 4therapy.com, the US Substance Abuse Locator, or - if your goal is controlled drinking - Moderation Management. Instructions on how to use these resources are located in our online community's FAQ.

* Prepare your doc! Download the May 2003 Lancet study if you're interested in using Topamax. Print out information (for providers, not consumers) from Vivitrol and Campral's website. If you plan to follow the My Way Out program, print out the articles from Newsweek Magazine, Wall Street Journal, and wired.com in which it is featured. Bundle the info together in an envelope and drop it off at your doctor's office at least one week prior to your visit. Include a note on the outside stating your doctor wishes to read the material before your appointment.

* Become knowledgeable about tests you may be administered to assess your drinking problem. Popular screening surveys include:

The Cage Questionnaire in which a "yes" response to two of the four questions indicates a problem:

C: Have you ever felt you needed to CUT DOWN on your drinking? A: Have people ANNOYED you by criticizing your drinking? G: Have you ever felt GUILTY about drinking? E: Have you ever felt you needed a drink first thing in the morning (EYE OPENER) to steady your nerves or to get rid of a hangover?

(Our medical director, Dr. Linda Garcia, MD, also asks patients if they've received a DUI.)

The Short Alcohol Dependence Data (SADD) Questionnaire, a more sensitive diagnostic test than CAGE, which is available online here. It helps doctors distinguish between early alcohol dependence and heavy alcohol use.

The Alcohol Use Disorders Identification Test (AUDIT), developed by the World Health Organization. It has been validated by several countries and is recognized internationally. You'll find it here.

The Michigan Alcohol Screening Test (MAST), a tool used widely by courts to determine sentencing for those convicted of driving under the influence or other alcohol related offenses. It's available online, as well.

A number of other survey instruments are listed by the National Institute on Alcohol Abuse and Alcoholism here.

* Understand and prepare for your medical exam, which may include:

* A physical examination in which the doctor palpates or taps various parts of your body and listens to sounds your body produces. Vital signs such as blood pressure, heart rate, respiratory rate, and temperature will probably be taken. * A complete health assessment including information about your general and mental health, lifestyle, alcohol use, and family history of alcohol use and/or problems * A gamma-glutamyltransferase (GGT) blood chemistry test to evaluate liver function. Your blood may screened for anemia and electrolyte disturbances, such as low potassium, magnesium and calcium levels. * A carbohydrate deficient transferrin (CDT), a blood test some physicians feel is more sensitive than a GGT in identifying and monitoring problem drinkers * Signs of medical complications due to alcohol consumption, such as abdominal pain, heart problems, alcohol withdrawal or cirrhosis. Additional test may be ordered. * A referral for individual counseling to be undertaken in conjunction with therapy * A short-term prescription for a benzodiazepine such as Valium or Ativan to help manage alcohol withdrawal symptoms, if necessary. The physician should first screen for the presence of other medications to avoid interactions such as over-sedation

* When you meet with your doctor, be as truthful as you can about your alcohol consumption and medical history. Don't withhold any information about medications you're taking. If you are uncomfortable with what may appear on your chart, first ask your physician if you may talk off the record, but don't consider it a guarantee that information won't be noted.

* Assure the physician you're committed to tackling your alcohol dependence within the context of a comprehensive program and you understand you will not be "cured" by a pill. Let him/her know that you intend to follow up. And do so.

* Tell your doctor about your plans to proactively seek support, whether at local 12-step meetings or an Internet-based forum. Point him/her to the MWO website if you plan to follow this program. Leave a copy of the book, or email us at provider@mywayout.org ahead of time and we'll provide a complimentary copy.

* Ask questions. Prepare them ahead of time and refer to them at the end of your exam to make sure everything has been answered sufficiently

* If the physician refuses to honor your request for medication or medical services, insist on a referral to someone s/he believes will help you. Be vigilant and honest about your desire to find a provider. Let him/her know you plan to move forward regardless and that if you leave the visit without support your choices about how to proceed will be limited. It it the physician's responsibility to help you-do not forget this!

* Do not be aggressive, but do not be meek. Remember that this change will benefit your health, your family, your relationships, your future. Prepare yourself mentally for this appointment beforehand. Meditate on it. "Visualize" your confidence and presentation and see yourself leaving the clinic with whatever it is you need to succeed.

We often don't hear from the many patients who quietly seek help and leave their doctors' offices filled with a renewed sense of hope and joy. It happens every day and it can happen for you. If not, you must simply resolve to keep trying until you get the help you need for this serious and progressive condition.

You've made the decision to get help, so don't let anything - or anyone - get in your way. You've lived with this problem long enough.

It's time to get better.

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Excerpted from: "My Way Out, One Woman's Remarkable Journey in Overcoming Her Drinking Problem and How Her Innovative Program Can Help You or Someone You Love" by Roberta Jewell

Copyright 1995 Capalo Press All Rights Reserved

Introduction Let me state up front: I am not a medical doctor. I am not a PhD. I am not a researcher-officially, anyway. In fact, my name is not even Roberta Jewell, but you don't really need to know my name because you're already familiar with my circumstances: you or someone you love has struggled with the debilitating, painful reality of life as a problem drinker.

Where did the problem come from? Well, what are the roots of any addictive behavior? I assume it was primarily genetic in my case: I was adopted as a toddler and understand that both of my biological parents had "drug and alcohol issues" but I don't know the details.

My adoptive parents provided a warm and loving home for my brother, sister and me, and were what I would consider to be social drinkers, the kind I would yearn to become later in life. They used alcohol in moderation. Dad would usually pop open a beer after a long day at the job-typically before starting an after-work second shift building our new house, developing the property in which they'd invested, or simply putting in all the hard hours it took to grow the family business. Mom usually had a cocktail only when we went out for a special occasion.

It didn't seem like a problem for me in high school or college-it was called partying back then and everyone did it. My grades were good and I saved my fun for the weekends, just like other kids. Looking back, I think I enjoyed drinking more than many of my peers, but I was generally enthusiastic about most things and it certainly didn't seem like cause for concern.

I married a man who liked to drink as much as I did by the time I was in my mid to late twenties-it had pretty much become a daily affair, and frankly I was more comfortable with someone who didn't make me feel guilty about it. We were together six years before we started a family, so we enjoyed our time fishing, camping, running a new business, and spending time with friends. Drinking not only didn't interfere with our life; it seemed to enhance it.

By the time our babies came along, it had become clear to me that abstinence was not going to be easy, but I gave it my best shot. I held out for the entire term of the first pregnancy, but despite what I knew about alcohol passing into breast milk, I started drinking an occasional cocktail at night while nursing.

When I became pregnant a second time, I again forced myself off the booze-at least for the first three months, which I knew were most critical. I allowed myself an infrequent glass of wine or light cocktail towards the end of my pregnancy when the cravings got the better of me.

When my baby was born with a serious genetic disorder, I was absolutely devastated, and convinced it was all my doing-that one of those drinks had somehow caught up with me-even though a world renowned expert in the disease assured me that wasn't the case.

Our third child was not planned and arrived unbelievably soon after the second (healthy as a horse, thankfully). But it didn't take long before I found it was all I could do to keep the bottle at bay. I was bending under the pressure of raising three young children, dealing with the burdensome debt of a business failure, nurturing a youngster with a rare and painful disability, and managing the early symptoms of clinical depression.

I retreated further into the numbing effects of alcohol, which seemed to relieve the agonizing pain and stress of my everyday life, if only temporarily.

But I hid it well. As everyone around me marveled at my strength and fortitude, I found solace at night in the sweet drinks I sipped from my endless supply of eight dollar bottles of vodka.

Over the next decade or so my family situation improved significantly. I worked ceaselessly to find help for our son's condition. My work paid off, and he benefited dramatically thanks to new advances in medical technology I was able to track down.

I also embarked upon a new career path, eventually earning an executive management position, and then other rewarding opportunities came my way. Our finances slowly crept into a healthier state, and my husband, who agreed to work part-time and manage the household-having always been a superior and more agreeable housekeeper, cook and children's chauffeur-provided solid and endless logistical support to the kids and me. Despite our ups and downs, he was always my rock and a source of endless strength and humor.

One thing that did not change, however, was my drinking. It actually grew worse. My tolerance for liquor had increased and I seemed to need more drinks, or stronger ones.

Some mornings my head ached from the previous evening's round of drinking. At times, I even drove my car when under the influence, and occasionally either missed a day of work, or watched my productivity suffer because I couldn't concentrate. I found myself making promises to the kids that alcohol prevented me from keeping, and I fought with my husband or simply became irrational.

Although I was still pretty good at hiding my problem from those around me, I feared it was only a matter of time before I did something very stupid after too many drinks.

I was slowly becoming somebody I despised.

I'd tried to stop, or at least slow down, so many times. Over the years, it seemed as if I'd read every book on the subject and investigated every possible conventional and non-traditional recovery therapy I could get my hands on.

Anyone who knows me well would tell you that I'm a proficient researcher-particularly when it comes to medical matters, a skill I developed when I was desperately trying to find help beyond the conventional and ineffective treatment that traditional medicine offered our second child. Dozens of family members and friends since have called upon me to help them investigate a wide range of afflictions and diseases, and I'm very proud of what I've helped uncover and the positive impact it has had on the lives of the people I care about.

But nothing I had found was helping me solve my own serious health problem, which continued to deteriorate.

Then an incredible turn of events changed my life. After nearly 20 years of aggressively conducting all that research, I was graced by what I can only describe as some sort of supreme serendipity, and the solution to my problem dropped perfectly and profoundly into my lap.

For more information please visit www.mywayout.org.

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