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The term "alcoholic" is often used loosely to describe individuals who are preoccupied with the desire to consume and abuse alcohol, but it in fact specifically applies to someone who struggles with alcoholism which is actually very different and condition which is far more serious and life threatening. There are different patterns of drinking and someone's level of alcohol abuse and dependence can fall into several different categories, with the most advanced and serious being alcoholism.
Alcohol abuse is the first initial pattern of drinking that can begin to result in adverse outcomes. Someone who is consistently involved in alcohol abuse will inevitably begin to experience consequences because of their drinking, and will continue to abuse alcohol despite these consequences. If this pattern continues, it will develop into an even bigger problem because the person will soon become alcohol dependent which presents ever further problems and consequences for the drinker. Someone who develops alcohol dependence will need increased amounts of alcohol more often to experience the desired effects, and will constantly crave alcohol.
Alcohol dependent drinkers continue to drink despite the knowledge of potential harm this will cause to themselves and others. Sadly, they find it impossible to stop drinking because of their dependence which results in withdrawal symptoms when they attempt to do so. This becomes a daily cycle of abuse just to feel "normal", and drinking becomes a temporary escape from life and from the consequences that have been caused by drinking. Couple all of these factors together and this is how alcoholism inevitably develops, which is life-threatening problem because of the physical and psychological toll that this cycle of abuse can take on a person.
In some circles, alcoholism is considered and treated as a disease. This theory cites that the causes of alcoholism include factors such as biology, genetics and the person's mental health. The research which suggests alcoholism is a disease indicates that genetic predisposition to alcoholism make a person 50% more likely to become an alcoholic. But even the research which backs up this idea also suggests that individuals are still responsible for their actions, and other factors also come into play including environmental factors which can also predispose someone to abusive drinking and eventually lead to alcoholism. For example, someone who is around others who are abusing alcohol are more inclined to mimic these behaviors, particularly children of alcoholics. So all of these factors must be taken into consideration when trying to understand and address the problem of alcoholism.
So with all of this in mind and whether you believe you are treating a disease or not, the initial challenges encountered in the treatment of alcoholism have to do with the dependence that the individual is experiencing. When someone with alcoholism stops drinking, certain chemical responses to abrupt alcohol cessation in the brain cause an overexcited central nervous system. This can happen to such a degree that an alcoholic is at risk of withdrawal symptoms which could put them in danger if they aren't having the alcohol withdrawal process overseen and managed by treatment and detox professionals. Most individuals who are experiencing alcoholism and hence severe dependence to alcohol won't persevere through such symptoms because they can be so grueling and harsh, and relapse under the physical and mental pressure. Because abrupt cessation of alcohol once someone has become severely dependent can cause spikes in both heart rate and blood pressure and the aforementioned CNS hyperactivity, it isn't worth the risks involved to attempt quitting cold turkey on one's own and always much safer in a professional detox setting.
Because so many individuals can be predisposed to alcohol abuse and alcoholism because of environmental factors, being in a professional detox setting when coming off of alcohol can make it a much smoother transition into a treatment setting to address the actual problem. The dependence is never the actual cause of the problem, only a symptom of it. Unless the individual can receive help in discovering what factors in their lives caused their alcohol abuse and ultimately their alcoholism, they will always be predisposed to future alcohol abuse and alcoholism. Because 80-90% of individuals treated for alcoholism relapse, it is important that anyone experiencing alcoholism receive treatment in the most appropriate setting for their circumstances and for as long as necessary.
Treatment that has been shown to help individuals with alcoholism most successfully are those programs which help identify and effectively address environmental stressors and things which induce temptation to abuse alcohol and other substance. Social pressure is something that many alcoholics have to find effective coping mechanisms for if there is any hope for permanent abstinence. Many alcoholics go back to the same lifestyle and relationships which very likely caused the problem in the first place, so it is no surprise why so many relapse. So effective treatment of alcoholism must include making abrupt and crucial changes in one's lifestyle and cutting off anything or anyone which encourages, contributes to or enables one's alcohol use and abuse.
Because many of the important changes that alcoholics must make to lead a healthy, alcohol-free lifestyle can be difficult to make even under the best circumstances, treatment settings can greatly impact the outcome of a person's decision to stop using alcohol. Socially, it can take a long time for someone to be able to adjust to a newly abstinent life, and there are a lot of pressures they will experience for quite some time that they may not have a handle on right away. This is why meetings and support groups are often not enough, and why so many individuals who don't receive treatment in a more intensive setting relapse continuously throughout their lives. Newly abstinent alcoholics fare far better when they are in a structured and supportive environment, until they are stable socially, mentally, physically, and otherwise. So when attempting to overcome and treat alcoholism, it is important to understand that there is no overnight solution and individuals will need to be surrounded by a robust support system and ideally in a full-time treatment facility or other intensive program which helps alcoholics specifically until they can stabilize fully.
So aside from moderate and less intensive solutions which may be more helpful as an aftercare solution or as a continuum of care such as support groups and meetings, individuals with alcoholism can receive safe professional detox services and then transition into an inpatient facility or residential program that specializes in the intensive treatment of alcoholism. These programs deliver either short term treatment or long term treatment, but for alcoholics at least 90 days of treatment at centers and programs which provide long term treatment plans are the programs which give clients the best chance at avoiding future relapse. Because of the nature of alcoholism and the damage chronic long-term alcohol abuse can do to someone's body and mind, you don't want to set them up for failure by putting them in a situation that isn't highly effective at addressing alcoholism with proven rates of success. It will take a concerted and dedicated effort on the part of family members, friends, and treatment professionals to help someone resolve alcoholism but it can be accomplished with perseverance and the most appropriate treatment option.