Abstinence or Moderation Programs

abstinence or moderation programs

There are some moderation programs that are also abstinence programs. It’s up to the client to choose, and as with the moderation only programs, when one finds it impossible to control his drinking, it helps confirm for the alcoholic that quitting is the only thing left.

Since busting denial is a significant part of recovery (denial tells the addict/alcoholic they can handle this – there is no problem), abstinence or moderation may be a reasonable place to start for some. Recovery can’t be achieved as long as one is harboring denial. These programs are covered in greater detail in the Recovery Support Options, but here is a brief list of those dual function support groups.

HAMS (Harm Reduction Abstinence and Moderation Support)

HAMS uses a combination of methods for either abstaining or moderation programs. To do this they use peer support, meetings, education (they have their own book), and online support to meet members where they’re at, rather that forcing clients to label themselves. They claim non-judgemental support, or “harm reduction.”

Behavioral Therapy Associates

This psychologist based treatment uses information compiled by healthcare professionals to determine what does and does not work. Their program uses online courses augmented by therapy. They were the ones who pioneered the Drinker’s Check List developed for military personnel to asses their drinking. College students also commonly use the list.

My Way Out

This method may be used for both moderation or abstinence programs. They use pharmaceutical, herbal, amino acids and hypnotherapy as adjuncts to treatment, as well as placing an emphasis on diet and exercise. Meetings and online support are added options. The program may be used with other 12-step programs.


Chemical Options

This heading isn’t outlining one specific program for abstinence or moderation programs, but rather to address chemical interventions that claim success in moderating (or ending) one’s alcohol or drug consumption.There are no guidelines per-se of who these herbal or pharmaceutical treatments will help (some don’t seem to differentiate the moderate drinker from the alcoholic in their claims), but instead jump right into touting varying levels of success. Some of these pharmaceuticals address drug use, while others are specific to alcohol.

Abstinence or Moderation Programs: Pharmaceuticals

Topamax (Topiramate) – A medication initially used to treat diabetes, then used as an anticonvulsant, it was discovered that Topamax also shows promise as a treatment adjunct for treating alcoholism.

It is known that using alcohol deadens the area of the brain that controls inhibitions (GABA – the main inhibitory neurotransmitter), but alcohol also increases glutamate (an excitatory neurotransmitter) and dopamine (somewhat similar to adrenaline, this neurotransmitter works with the brain processes that regulate motor skills, emotional response and the experiences of pleasure and pain).

Topimax blocks the glutamate receptors and increases the GABA, essentially giving one back the ability to exercise more control while neutralizing the mood enhancement characteristics.The results of this combined effect have worked in decreasing alcohol cravings and withdrawal symptoms. Some have used this as a way to cut down on heavy drinking bouts. As a treatment, Topamax is a pharmaceutical and must be prescribed by a doctor. As with Naltrexone, this works best with cognitive and behavioral intervention.

Naltrexone – An FDA approved anti-craving medication, when used in conjunction with cognitive and behavioral treatment has shown promise in helping one to moderate the consumption of alcohol. This drug effectively reduces craving and blocks the pleasure responses (euphoria) that result from consumption, making it easier to resist taking that drink. Naltrexone is pharmaceutical and must be prescribed.

Acamprosate (Campral) – Approved by the F.D.A in 2004, Acamprosate is another drug that works to balance neurotransmitters once one has detoxed from alcohol. While the exact mechanism isn’t quite known (this one isn’t an opioid antagonist so it doesn’t block the high), Acamprosatehas been used for decades in Europe.Again, because the brain’s neurotransmitter systems adapts to chronic alcohol use, once the alcohol is removed the whole system is thrown out of whack. That malfunction creates the hyperexitatory state (the insomnia, anxiety and restlessness associated with withdrawal) that Acamprosate seems to relieve by normalizing brain activity.

This drug does not block the euphoria as Naltrexone, so they may be used together to enhance effectiveness. Acamprosate is not metabolized by the liver, so it may be safer for those who have liver disease in conjunction with their alcoholism. As with all the pharmaceuticals, this needs to be prescribed by a physician and works best with concurrent support.Ondansetron (Zofam) Ondansetron – Commonly used to combat the nausea experienced by chemotherapy patients, but researchers have discovered that in much lower doses, it may be especially effective in treating those with early-onset alcoholism (those who experience drinking problems before age 25). This drug appears to work by effecting one’s Serotonin, which along with dopamine is believed to create the craving for alcohol.

Early onset alcoholics tend to be biologically predisposed and can be harder to treat. Their relapse rate and antisocial tendencies have proven challenging when it comes to the standard behavioral techniques, according to the National Institute on Alcohol Abuse and Alcoholism (IAAA), who funded the study that discovered the additional use of this drug. Again, this is RX only and needs a doctor’s supervision.

Baclofen – This anti-craving medication was originally designed as an agent to treat muscle spasms, commonly prescribed for those with Multiple Sclerosis, but has been prescribed to quash cravings for alcohol. Some promise has been shown in the treatment of alcoholism based on it’s anti-craving and anti-withdrawal properties.There is a tolerance factor, so one may need to up doses to achieve a continued effect, and there are also withdrawal symptoms similar to those of benzodiazepines and alcohol, so discontinuance should be supervised.

Antibuse – This drug is the granddaddy of chemical intervention when it comes to treating alcoholism. Chemically know as Disulfiram, this drug works by making one experience extreme discomfort if one drinks while taking this medication. It was the first medication to be approved for the treatment of alcoholism. When alcohol is broken down by the body, it first metabolizes into acetaldehyde (a toxic substance responsible for hangovers) before being further oxidized into acetic acid.

Antabuse – Prevents acetaldhyde from oxidizing further, so it increases the presence of the toxic drug in one’s system. How sick one will get depends on how long the drug has been taken (the longer it’s taken the more effective it is) and how much alcohol one has consumed. Either way, the effects are never pleasant.

Though it has been used for many years as an alternative or adjunct to treatment, it’s effects haven’t proven to do much. It’s often prescribed as an enforcement of some consequence related to alcohol, but many return to old patterns once the drug is no longer prescribed.Suboxone (Buprenorphine, Subutex) – This medication is mostly used to treat opiate addiction, but is well known enough to mention in the context of other pharmaceutical addiction treatments. Suboxone produces only a slight euphoria while treating withdrawal, giving it an advantage over Methadone. Once ingested, this drug fills the same receptors as opioids do, effectively blocking one’s addictive substance from occupying the same space.Suboxone is what is called a partial opioid agonist (agonist means producing an action), meaning the addict won’t get the high, but the craving will disappear, causing the addict to only feel somewhat normal.

Better than that, once Suboxone fills the receptors, should the addict use on top of that (entertaining the idea of relapse) he still won’t get the high since the Suboxone is parked there for 24 hours and won’t allow the full opioid (drug of choice) to replace it.Taking more won’t affect it’s blocking properties so, unlike Methadone, the addition of another opioid won’t get you the “desired” high. Suboxone produces a much milder euphoria, so there’s less chance of abuse, though it has been reported that some become addicted to Suboxone by taking more than is prescribed. Still, most who use the drug as prescribed can let it go as their physician dictates.

Methadone – Due to an opium shortage in Germany, Methadone was developed as a synthetic alternative to morphine in 1937 by the Germans to help soldiers with pain and mood elevation. Unfortunately, what it really did was create lethargy and an unwillingness to fight, so it’s use was quickly abandoned.It was first used in the U.S. In 1947, when the drug was given it’s current name. It was thought that Methadone would produce a milder high and reduce the death rate and transmission of Hepatitis, HIV and other diseases spread through sharing needles used to inject heroin, since Methadone could withstand the human digestive system and didn’t need to be injected.

Like Antibuse is the granddaddy of chemical intervention for alcoholism, Methadone was the first such approach addressing opiate addiction. It was meant to be a harm reduction measure rather than a cure, as methadone is said to be even more addictive than heroin and causes even more severe withdrawal symptoms. It’s use has been a cause of controversy since overdoses – usually when the drug is mixed with another opiate or benzodiazepines – continue to be a problem. Still, as an alternative to heroin for pregnant women, those incarcerated or on parole, it’s harm reduction and legal availability make it’s use feasible in some situations.

Herbal Supplements

Last Call – Uses a botanically-based liquid, Sobrexa, which one mixes with water and drinks several times per day. The manufacturer claims the supplement was developed over a 16-year period and works with one’s brain chemicals to eliminate cravings.Eight weeks is all it should take to moderate or conquer your addiction, and then you have the option to continue using the product or not. This program boasts an 85% success rate and has been in use since 1993, though the product was packaged as an at home system for consumers in 2010.

NaturaClear – An herbal supplement designed to minimize withdrawal symptoms and help one achieve abstinence or moderation programs. Said to work in as little as 15 minutes to ease cravings, NaturaClear claims to eliminate insomnia, tension, irritability, weight gain, nervousness, and the fatigue that are common side effects experienced while detoxing.Taking a capsule twice a day for 90 days should do the trick. NaturaClear works by boosting serotonin, dopamine, norepinephrine and GABA, all neurotransmitters (brain chemicals) involved in mood enhancement.

The claim is that once chemicals are balanced (90 days) one should not need to drink excessively again. These supplements are combinations of natural herbs, so there is no prescription needed and have no withdrawals when one stops taking them. Price ranges from 39.99 for sober fast capsules (said to eliminate hangovers or help one to sober up fast) to $199.99 for a year’s supply for those who have been an alcoholic for 5 years or more.Their take is that the longer one drinks, the longer it takes to break down and correct the chemical imbalance caused by alcohol, so one needs to use the product longer.As with any supplement, one should consult a doctor or pharmacist to be sure the ingredients are safe and don’t conflict with other medications or illnesses.

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