Alcoholism

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1) Do I need inpatient detox first?     The answer is maybe. We first start with a phone or office interview to determine, how much and for how long you have been drinking? Have you ever stopped drinking successfully? Have you ever had withdrawal seizures, hallucinations or other severe withdrawal that required hospital admission? We will also need to know what other medical problems you have, what medications you take, and if you use any illegal drugs. We can then decide what level of care is appropriate and safest for you, and if you need inpatient detox we can assist you with that first, and then transition you to our outpatient treatment program. 

2) Do I need to stop drinking before I start treatment?     No. Often it is actually safer to start our program first and then gradually lower your alcohol consumption, as we work to decrease your cravings and control your anxiety. If you have stopped though, we can medically assist you to safely detox at home and control your symptoms.

3) What medications do you use?     Depending on your circumstances, we choose from an array of medications to accomplish our goals. We use medications that 1) target the GABA receptors which help promote calmness and relieve anxiety; 2) block the dopamine surge you get from drinking, which inhibits the reward pathway and retrains your brain to not crave alcohol; and 3) lower glutamate levels, which is an excitatory neurotransmitter that is elevated from chronic alcohol use and stress. 

If you are a daily drinker, naltrexone using The Sinclair Method is the most effective. This requires taking a pill every day 1 hour before you start drinking. This begins to decrease the pleasure you get from drinking and decrease your cravings. If anxiety is the main reason you drink, baclofen is a great choice as it dramatically decreases anxiety as well as decreasing cravings. It is taken 3 times a day and slowly titrated up over time until you achieve the desired effect. Traditional antidepressants may also be started. Gabapentin is another great choice to decrease cravings, reduce anxiety and relieve insomnia.  Other effective medications are topamax, campral and N-acetyl cysteine. In some cases we also use ketamine infusion therapy which has been shown to decrease substance abuse, as well as rapidly relieve anxiety and depression.

4) How does your Concierge Medicine approach increase success rates?     Treating alcoholism is a complex process, and not as simple as taking a pill. Once you begin to decrease your alcohol intake, or stop drinking all together, we will need to treat many other symptoms, often anxiety, depression and insomnia. We likely will add medications or titrate up your dose to accomplish these goals. In addition you will start weekly individual counseling sessions in our private office, and develop a close relationship with your treatment team. If you prefer we can provide these services through phone conversations or face time for your convenience. All of our concierge clients will have the cell phone numbers of our Dr as well as your therapist, both of whom will be available 7 days a week within reason. We will communicate closely and frequently in the first few weeks of your program to ensure your safety and comfort. In addition we encourage you to bring your loved ones to counseling as their support and understanding can be very beneficial. Having this kind of access to an experienced team is invaluable to your long term success.

5) How cost effective is the Concierge Medicine program?     When taking into account the money spent on alcohol, decreasing health, lost revenue from work and damaged relationships, the cost of participating in our program is well worth the money. And if you are like many others who have spent tens of thousands of dollars on inpatient detoxes and rehabs, with little or no long term success, this will possibly be the greatest investment you have ever made. Call now to invest in yourself, and start your Initia Nova, or New Beginning.

6) What is the Moderate Drinking Program?     For many people that struggle with alcoholism, the disease controls their life. It often interferes with relationships, work and can cause legal troubles like DUI. Most of these clients need to strive for complete abstinence from alcohol. But there are many other people that still function well in work and their relationships, and can safely enjoy alcohol, but are starting to realize that they drink more than they would like. Some only drink on weekends, but drink excessively. Others have noticed that they are starting to drink almost daily and desire to reduce the amount and frequency that they drink. If you or your loved ones are noticing that your alcohol intake is becoming a bit too excessive, our Moderate Drinking Program might be right for you. We have several medication options combined with counseling to help you achieve a safer way for you to enjoy alcohol.

 

Watch Claudia's keynote TEDx talk at TEDx London Business School