Online Alcoholism & Addiction Counselling

The UK National Health Service has officially recognised the effectiveness of online therapy.

Cognitive Therapy is now being offered via private chatroom as part of the NHS services, in an attempt to provide for people who find it difficult to come to a clinic for conventional counselling.

An online chatroom can be used as a private space where a person can get support and therapeutic help from a professional. This is especially useful for people with alcohol or addiction problems, who may be too embarrassed to see a therapist or counsellor face to face. You don’t have to take time to get to someone’s clinic, they can come to you via your computer.

In all other respects, the nature of online therapy or counselling is the same – the same techniques are used, the same issues dealt with. If you’re not sure how this would actually help, read more about how online therapy works.

So you’ve stopped drinking, or maybe you’re just not doing it every day now, and you want to know how to prevent yourself from relapsing, or (if you want to keep it simple) how to make sure you don’t drink today.

Relapse prevention requires some planning, specifically -

• what situations might I encounter that could make me want a drink? (my triggers)
• how might I deal with my feelings sober?
• what action can I take instead?

You need to identify your internal triggers (like boredom, frustration, loneliness, anxiety etc.), and your external triggers (like arguments, bars, other people drinking etc.). Can any of these triggers be avoided? If so, plan how to do that. For those that can’t be avoided, you’ve got to learn to deal with them some other way.

So, what do these triggers mean to you? What beliefs do you hold about them that lead you to drink? A few common beliefs might be -

• “drinking helps me get rid of stress”,
• “drinking makes me more confident”,
• “some people drink more than me, so that makes it ok for me to drink as much as I do”.

What thoughts go through your head when you’re exposed to these triggers? You may not even be aware of these thoughts, they’re so habitual, so you’ll have to listen carefully to your internal dialogue here.

Once you’ve got an idea what some of your automatic thoughts are, you need to learn to challenge them. So for example, the next time you’re feeling stressed and you think “a drink would relax me” you might then say to yourself “yes, it does, but it’ll make me even more nervous and stressed tomorrow”.

Relapse prevention is just knowing about your habits

Of course by the time you’ve got to this stage, you’re probably craving a drink, and you’re thinking about how to get some. You might be arguing with yourself – part of you doesn’t want to get drunk again. You’ve told yourself you’re not doing it any more (or today at least). So here’s when you might start looking for permission, to make it ok:

• “just this time won’t hurt”,
• “I’ll be able to hide it, so no-one will know”,
• “I’m not at work tomorrow, so it doesn’t matter if I’m hungover”
• “I can’t cope with this craving, so I might as well just get on with it”

As far as behaviour goes, we’ve already mentioned avoiding triggers, but another option is distracting yourself (look at our earlier article on ‘how to cope with alcohol cravings‘). Other things you might do are more general – make some new friends, find new things to do with your time, get into the habit of some exercise. Most importantly – find some support, people you can talk to about what’s troubling you.

Try going through our worksheet on Relapse Prevention Strategies.

Remember though, a binge does not mean failure, you just made a mistake, try not to think “oh well, I’ve failed, so obviously I’ll never beat this, I might as well just keep drinking…”

Anxiety ruins many people’s lives, and lessens the enjoyment of it for most of us. It’s focus can be anything, from the seemingly trivial to the life threatening.

Of course the solution that many people find is through alcohol. This can provide temporary but undoubtedly effective relief – allowing us to relax again and get on with life without being so preoccupied. But alcohol does not actually allow us to deal with our anxiety or manage the situations provoking it, so we fail to develop our resources.

Anxiety arises as a result of our interpretations of a situation as being in some way threatening or unpleasant. This is then combined with our perception of our ability to cope with that threat.

For example, two people are experiencing the exact same event – the possibility that they will lose their job. The anxiety prone person might think -
“but I’ll never find another job, I’m not good enough. I won’t have enough money, I won’t be able to cope – I’ll lose my house”. Obviously thoughts like that will tend to create anxiety.

The other person facing the same situation might think -
“I can get another job easy enough, I’m adaptable. Money might be a bit tight for a while, but I can cope with that”.

So if the first person can learn to adjust their perception of their abilities, they might not get so anxious, and they might not feel the need to drink so much alcohol as a result. Those perceptions and beliefs happen so automatically, we often forget that we have a degree of choice over them.

Unfortunately alcohol consumption tends to exacerbate anxiety levels subsequently – firstly by causing disruption to the nervous system, secondly by creating situations likely to induce further worry. A spiral of increasing use causing increasing anxiety can develop.

Anxious people tend to have a central belief about themselves as being helpless – they underestimate their ability to cope. Although, they are often aware that their fears are exaggerated.

Five key questions can be used to challenge the initial perception of threat and the appraisal of your coping ability:

• What alternative interpretations could I make about this situation?
• What concrete, factual evidence do I have to back-up or deny these beliefs?
• What is the worst that could really happen, and how would that ultimately affect me?
• What positive action can I take to manage this?
• What are the pros and cons of me continuing with these negative thoughts I’m having?

Coupled with some simple relaxation techniques like keeping aware of your breathing, you can soon lessen your anxiety to a tolerable level. If you can adjust the way you interpret the world, and thus not feel so worried about it, then you may not need to drink so much alcohol to cope.

This is the best account I’ve ever read of an alcoholic going through rehab and struggling with his subsequent recovery. It’s honest, compelling and darkly humorous.

It’s not for the faint hearted though – he graphically details his most debauched binges, his most horrific withdrawals and embarrassing bed-wetting episodes. But he balances this with some wonderfully insightful thoughts about the recovery process, about Alcoholics Anonymous meetings and of course, about his time in a detox and rehab centre.

Augusten Burroughs is a very clever writer, and he engages you from the first page, by the end you feel like you know him inside out. If you’re struggling with alcohol, or you’re thinking about going through rehab, you seriously should read this first.

If you fancy a copy for yourself, here’s the page on Amazon.com where you can get it.

Is there an alternative to Alcoholics Anonymous? Do the 12 steps really work? These are questions that most alcoholics will ask when they decide that they want to change.

Alcoholics Anonymous (AA) originated in Akron, Ohio in the 1930′s from religious individuals grouping together to solve their alcoholism. The 12 steps soon emerged as a formula for all addicts to follow if they were to stay sober.

From the very beginning, complete abstinence was seen as the only answer. Of course this does work for some people, but clearly not for everyone.

Figures for how effective the 12 step recovery process is are impossible to find. Estimates suggest only about 5% of people who attend meetings regularly stay sober for more than a year. Not much more than the placebo effect really.

However, AA and NA (Narcotics Anonymous) do develop networks of community support, which is undoubtedly very positive. The support given is from other addicts or alcoholics of course, not trained professionals. And by their very nature the meetings are public access, anyone can attend, so they are clearly not anonymous (especially when you are required to state your name).

The main objection many people have to the philosophy is its rigidity, and there are references to relinquishing personal responsibility. The reams of cheap slogans don’t help much either.

Ok, so anyone who hasn’t seen them before must be wondering, what are these 12 steps then? Here you are – Read the rest of this entry »

George W. Bush has very compassionately decided to declare that September is National Alcohol and Drug Addiction Recovery Month, 2006.

That’s wonderful Mr. President, after thirty years of your ‘War on Drugs’, you’ve decided your country needs to focus on treatment and recovery too.

And for a whole month!

If you are trying to cut down your alcohol use, even if you are mostly successful, there will inevitably be times when you will relapse and have a binge. Don’t be put off by this, you haven’t failed. What is important here is to learn from your mistakes and work out how you could do things differently next time.

What was it about that situation that caused you to drink more than you intended? Was it a particular trigger that you couldn’t avoid (birthdays or a bereavement for instance)? Or was it a trigger that has caught you out before? If so, you need to work out some different ways to deal with it.

Many relapses occur as a result of the beliefs you may hold about alcohol. For instance if you believe that you “can’t cope with these feelings” and so you “need a drink otherwise you’ll lose the plot”, or if you believe that the only way you can be sociable is after a drink, then obviously these beliefs will tend to make you relapse.

The beliefs you have about your cravings or urges will also determine how easy it is to avoid relapse. So again, if you believe that once you get a craving, it won’t go away until you have a drink, then every craving you get becomes very risky. Similarly, if you believe that you don’t have the mental strength to cope with your cravings, then of course you probably won’t. Your beliefs are self-fulfilling.

What you need to do now is find out what your beliefs are, and more importantly how accurate they are. This means testing out your beliefs by looking at the evidence. Most of our problems in life arise from inaccurate beliefs about ourselves and how the world works. But this is where you might need a counsellor or a therapist, because it’s very difficult to be objective and impartial about your own thoughts.

» Try this test to see what your negative beliefs about alcohol or drug use might be.

» Then try this one to examine what your beliefs about cravings are.

For most people with some sort of alcoholism, their over use of alcohol has arisen from too many unpleasant emotions in their lives.

As such, understandably they yearn for the good feelings usually associated with positive life experiences. These feelings are immediately available through alcohol, so excessive use can take hold. As many an alcoholic has said -

“I just wanted to feel normal…”

The important thing here is that most of the time alcoholics do not feel normal, they feel like something is wrong. Sometimes it’s because a part of their personality is not being expressed fully, they are suppressing a part of themselves which may have been buried for years, for so long they have probably forgotten it was a part of them.

What often happens though is that when drunk, these suppressed or forgotten parts of us come out to play – sometimes this is enjoyable, and sometimes not. But the way people behave when they are intoxicated can be very informative. It can tell us a lot about the ‘how’ and ‘why’ of the addiction.

These two aspects of an addict’s personality – ‘the straight’ and ‘the addictive’ are very often in conflict with each other. They don’t like the other part, they don’t trust them and they fear each other.

To move forward, there has to be a truce. An acceptance and understanding of both parts of the self. You need to recognise what the positive qualities are about both. Then maybe some of the guilt and self-blame can subside…

» Read this related article on Addiction and Mental Health.

Cocaine use is on the increase apparently – nearly 350 000 people use cocaine every month in the UK alone. This is due to a number of factors – reduced cost, increased supply and a certain tolerance in society towards drug use, especially cocaine with its ‘celebrity’ status.

Unfortunately of course, with increased cocaine use generally there comes an increase in the number of people becoming addicted, especially to crack. Health and support services are doing their best to respond to this, but there are as yet no commonly used pharmaceutical substitutes to aid withdrawal (unlike heroin, which has a whole range).

Having said that, research suggests that a new anti-epilepsy drug (Vigabatrin) has shown effectiveness in blocking cocaine cravings.

Contrary to popular opinion, cocaine is also far more damaging than heroin. The range of physical complications is huge – from gastrointestinal perforation (ouch) or haemorrhage to heart attacks, lung damage (especially from smoking crack) or respiratory failure, strokes and seizures. It’s not a pretty picture. BBC NEWS – Cocaine stomach problem warning.

Then there’s the psychological side-effects like paranoia, depression, anxiety, panic attacks, auditory hallucinations, sleep disturbance, sexual dysfunction and irritability or aggression.

On top of the problems associated with cocaine on its own, whilst high users will also tend to smoke and drink alcohol far more than they would normally. The combination of cocaine and alcohol produces Cocaethylene, which causes more cardiovascular damage than either drug alone. Alcohol also increases the toxicity of cocaine on the liver.

Recovery from cocaine addiction is no easy task, due mainly to the enduring physiological nature of cravings. However, natural herbal supplements have been found to reduce such cravings.

Cognitive behavioural therapy or counselling is also particularly effective in breaking those associations which produce cravings and hence relapse. So don’t give up hope if you are already using too much cocaine, dramatic changes are not impossible, but they do take some hard work.

Coping with cravings is the key to tackling alcoholism. If you can manage to not give in to your cravings, or you can adapt so that you don’t get so many cravings in the first place, then there is no more addiction is there?

How you view your own cravings will determine how much power they have over you. If you believe that a craving won’t naturally go away once it has started, or if you think that the only way to deal with a craving is to drink, then of course you will be fairly powerless over them. This is the cognitive component of your addiction.

Making yourself aware of what things in your life tend to give you cravings, and therefore how you might avoid those situations, becomes a vital skill. For those ‘triggers’ that you can’t avoid, you can learn how to deal with them differently.

Lets say there are four types of cravings:

• a reaction to withdrawal symptoms
• escaping from unpleasant feelings (boredom, depression, anxiety etc.)
• a response to a learnt association (people, places etc)
• enhancing a positive mood

Each type requires a different approach to deal with it. And each person’s approach will be unique to them.

There are six recognised methods for dealing with cravings when they occur:

Read the rest of this entry »