Alcohol Detoxification Therapy Part - II

So far in the treatment of alcohol dependence (alcoholism), “total abstinence” has been projected as the only one basic option for the alcoholics to obtain their alcohol detoxification and the recovery. Now perhaps, it is for the first that Alcoholics Curewell offers an alternative to that conventional “total abstinence” based alcohol detoxification in the form of the lower-alcoholic beverage drinking. This ZAD-ADCT offers “alcohol as the treatment drug” for the alcohol dependents to successfully obtain their alcohol detoxification and to get rid of the dependence; projecting its “ZAD practice” as the most natural way for them to come out the dependence and getting cured of it (alcoholism) completely. Followings are its principle guidelines and the parameters.

Preliminary

A person in my situation putting forward a “Research Proposal” to conduct the ZAD Alcohol Detoxification Trial Therapy, first of all needs to conduct a “full-time” preliminary alcoholism treatment field survey assessment work. This mainly involves an extensive going around and locating the alcoholism treatments facilities available in a given area where one plans to start this ZAD-ADCT setting. Visit those alcohol detoxification (AW) treatment facilities in particular and meet their personals with appropriate channels. Make a presentation of the ZAD model, under the principal aim of general alcoholism prevention and treatment; Try to convince them that our first priority is to provide, “total abstinence” based alcohol detoxification treatment and only latter to provide the ZAD-ADCT therapy for only to those who fail so willing to take this alternative option. Request them to allow us (me) to participate, study and learn about their alcoholism treatment! Here I expect to encounter some resistance to my ZAD-ADCT ideas from these alcoholism treatment health establishments. It may take a great deal of time and effort on my part to overcome the possible opposition, hostility even to just gain a entry in to these alcohol detoxification facilities. I may need to visit other towns and cities on this purpose. If some of these facilities allow us (me) to participate and study in their treatment for a given period of time then I would consider it to be a big success on my part. It will provide me a great learning opportunity by understanding the realities of the alcohol detoxification (AW) and the conventional alcoholism treatment in general. (This is very important because one should remember that the best way to establish any ZAD-ADCT setup is; first to begin as a conventional alcohol detoxification center and start with providing exclusively “total abstinence” based detoxification, for those who seek the treatment.) Among other things, in this field survey work I am also hoping to get a critical overview of the given situation, to consider the required capacity (resources) to accomplish its forthcoming task. All this may require at least a year of “full-time work” on my part. With its completion, a major part of this “ZAD research proposals” preliminary field assessment (one year full-time) work would be over.

After the completion of the above-mentioned ZAD alcoholism field survey assessment work, the actual ZAD-ADCT project work will begin first with establishing an exclusive total abstinence based alcohol detoxification (AW) treatment facility. It should first start providing exclusively total abstinence based alcohol detoxification (AW) treatments during its first one and a half years. During this period it has to collect the details of the admitted patients alcohol drinking accounts, their problems, their social, economical, marital, educational, age, sex etc., status or backgrounds. Another major task during this project work is to find out in general how many of those who had undergone the alcohol detoxification treatment in this facilities in the fast or previous years have been successfully managed to remain total abstinent? How many of them fail and continue to “relapse” and become alcohol dependents again! Most important of all is how many of them admitted back into the alcohol detoxification treatment more than once. Collecting these empirical data’s are very important because ZAD-ADCT likes to select as many of those who continue to relapse again and again so willing to try some alternative ways to total abstinence.

After the first one and a half years of providing exclusively total abstinence based alcohol detoxification alcoholism treatment, then only this actual ZAD-ADCT therapy will start, it may need a period of one and a half more years as it probably require several more such trials together with its one year after care (follow-up) period. Therefore, the entire project may take around three years to complete (that excludes the first year of my “ZAD research proposals” preliminary field assessment survey, full-time work.). However, most part of the first one and a half years of providing the exclusively total abstinence based detoxification treatment part of the project work can be cancelled if a suitable professional (total abstinence based) alcohol detoxification treatment providing facility and its administrators come forward to share or to undertake this ZAD-ADCT research project work! Ideally, any well established leading international alcoholism clinical research institutions, their professional researchers are best placed to conduct a condensed version of this ZAD-ADCT research experiment. This will save a great deal of time, money and energy in this project together with making it very credible clinical experiments or trials for the future alcoholism research studies.

ZAD-ADCT Three-In-One New Dynamic Approach

As I mentioned somewhere earlier, I had given a rudimentary form of this ZAD-ADCT subject matter in my previous paper[2] under the caption: “ZAD Clinical Therapy For Alcohol Dependence Treatment”. However while giving it a deeper thought in preparation to this sequel paper[1] I realized that under the ZAD perspective it requires a fundamental change that endows in it a renewed dynamic approach to make it suitable and sensible to respond to the existing alcoholism detoxification (AW) treatment grounds (settings) reality.

The most fundamental change introduced in it first of all is that; instead of segregating it into three separate (Inpatient, Outpatient, Home) Alcohol Withdrawal (AW) detoxification therapy settings, we combine all these three settings into a single ZAD-ADCT composite dynamic form. Also, to correspond to these three settings we make it a three-week long therapy instead of its originally assigned four-week long period. The starting first week therapy will be conducted in the in-patient settings in which the basic alcohol detoxification (AW) treatment undertaken along with its principle ZAD Cognitive Motivational Therapy (CMT). After the completion of this first residential week the ZAD participants (patients) will be discharged and sent home only to return in the evening every day in the second week for the “out-patient LAB drinking therapy” sessions basically in which their full days exposure to the “loss of control” due to their LAB drinking will undergo a severe test. Finally in the third week the participants will be left to conduct their LAB drinking at their own home settings. They may be asked to meet in the evening couple of times in the week for the consultancy sessions or the staff members will be meeting them at their home or contacting them with the phone calls. At the end of the third week the formal ZAD-ADCT Therapy course will be over. This three-in-one new dynamic approach not only enable it to gain the advantages of all these three settings but it will also shorten the time period as well as drastically reducing the overall cost.

After the successful completion of this three weeks ZAD-ADCT therapy, there will be a three months period of the ZAD practice “follow up” in which those candidates asked to meet every week to monitor the progress while maintaining their daily drinking dairy. Thereafter they may still require a less intensive observational period till the end of the year in which the “ZAD Flexible Practice”[3] may be introduced depending on their confidence. During this observational period, once in a month meetings can be organized to deal with any issue that may arise and share the experience with one another to take care and to keep in track with all its records. Of course, the association of these people may continue, perhaps selected as the speakers for the future ZAD-ADCT motivational sessions as a life long mission.

ZAD-ADCT Principle Precondition

The principle precondition of the ZAD-ADCT is that; first of all to clearly inform all its intended candidates (participants) beforehand that this is a composite three weeks long therapy. In its first week they will be treated in the inpatient setting in the second week they will be sent into the outpatient treated setting and in the third week they will be settled in their own home settings. Afterwards the follow up of the therapy continued for the period of one year. Most important of all for them to know is that; this ZAD-ADCT therapy is only for those alcohol dependent people who genuinely seeks to find out, through this LAB drinking method whether they are capable of cutting, reducing or tapering down their alcohol consumption to a moderate safe, low-risk levels while continue enjoy the pleasures of their alcohol drinking through out their life, which mean getting completely “CURED’ of their alcoholism, instead of them being relegated into the total abstinence recovery state for life long! In here, first of all they should keep an open-mind (without any bias) and willing to accept the basic conditions of drinking sufficiently enough of the “safe standard lower-alcoholic drinks” containing between 2.5% to 1.2% alcohol content by volume (v/v) in it. Now the basic purpose of all this is to find out whether it is possible for them to successfully get alcohol detoxification and triumphantly come out of their alcohol dependence (especially the physical one) while continue to enjoy the pleasures of their low-alcohol drink. Here the participants should be aware that these LAB drinking potentially can turn anyone intoxicated, if they drink it in sufficient amounts but at the same time it is a test for them to examine and to find out as to what extent their overall drink desire satiety can reduce their overall alcohol drug desire and the “loss of (impaired) control” in a situation where they “attempt” to reduce or cut down their overall alcohol consumption. In general they should first basically undergo the experience the physical/biological and psychological effects of the LAB drink satiety in their overall alcohol consumption before getting intoxicated by it. They should drink neither to please (prove) us or to displease (disprove) us but as much as they want or desire without any other reservations or apprehensions.

It is also important to mentions to the selected participants that those who may fail in this ZAD-ADCT and become alcohol dependent, should be promptly advised to return back to the total abstinence detoxification treatment (also the patients who display untoward, uncooperative or incompliant behavior get removed from the therapy). By the way, here it is worth mentioning that there will be no second chance for them into this ZAD-ADCT, like that of the conventional total abstinence based alcohol detoxification treatment because they had already underwent its training (therapy) therefore can always practice it simply at their home environment if they ultimately decide!

ZAD-ADCT Patients Selection and Screening Modalities

In my previous paper[2] I have explained that the basic diagnostic criteria for the alcohol dependent patients to get admission into this ZAD Clinical Therapy is the ICD-10[8] or the DSM-IV[9] classified norms. In addition the CAGE, AUDIT, MAST and other such diagnostic instruments may help to verify their diagnosis. Moreover, the person should be drinking daily an average of 6 or more drinks to get qualified into this clinical trial therapy. Most importantly, to exploit its full potential in today’s alcoholism treatment and to subject it to a severe test, we would like to select mainly those who have been admitted for getting alcohol detoxification treatment more than once and have some history of relapse, constantly failing in their total abstinence resolve and falling back into dependence. Nevertheless, as mentioned before, those alcohol dependent people who have known to reject or never to really accept the total abstinence option in their recovery for whatever reasons but at the same time “attempt” or “try” to reduce their alcohol consumption, will be exempted from this last rule.

By the way, it is very important also to know that its screening procedures promptly disqualifies those patients having some extreme or severe health conditions. First of all, it would exclude all those alcohol dependent patients who are in an emergency or life threatening situations or having chronic disease like liver, heart, kidney etc. ‘Patients should be also excluded if they are currently in delirium tremens, actively psychotic, suicidal or had severe memory difficulties [19], or those having a history or violent or threatening behaviors or having co-dependence on other strong psychoactive drugs like; heroine, cocaine, designers drug etc. Also the persons having some grave socio-economic, (unemployment, marital, homeless etc.) problems may be excluded or kept out of this ZAD-ADCT program at this beginning stage.

This screening procedure necessarily needs to inquire some detailed accounts of the patients fast drinking patterns! This may come in the form a fill-in questionnaire. First to know some details about their social, economical, marital, educational, age, sex etc., status or backgrounds. Since how many years he/she has been drinking and facing the alcohol problem? The kind of alcoholic beverage (spirit, wine, beer) they were consuming during these time of alcohol dependence? Their favorite drinks any in particular? What are the alcoholic beverages that they usually consume? How many days in a week in average they drink? What time of the day that they usually take to their drinking and how long their drinking session usually lasts, how many drinks they usually (in average) consume in these each sessions. How much do they titrate to make their drink lower alcohol content while they drink it? What are their reasons for doing or not doing it? What place or environment where they usually conduct their drinking? Home, bars, alone, friends, company? In the fast year particularly in the last month or weeks what is his/her daily average alcohol consumption? How many days exceeding the safe drinking limits? How many days or incidence of binge drinking? This questionnaire session conducted once earlier in the preliminary part. Such detailed accounts of the patient past alcohol consumption not only useful in understanding the background history of the patient alcoholism but also become very useful in the future follow up and the observational period to determine the rate of success or failure or the long term overall outcome of this treatment.

Here I should also add that while getting admitted into this therapy, the Blood Alcohol Count (BAC) levels of the patients may need to be checked and monitored whenever required during the first, second and the third weeks of the trials to check the progress of the alcohol detoxification for the physical evidence and for the research study documentation.

ZAD-ADCT: Lower-Alcoholic Beverages (LAB) Research and Selections

Low-Alcohol Beverages, the LAB or the LAD, which contains in between 2.5% to 1.2% alcohol content by volume, plays the pivotal role in the entire ZAD model. Basically its “drink satiety” immediately as well as in the long run replaces and substitutes the pharmacological drugs, which are used in the conventional alcoholism treatments. The entire ZAD-ADCT stands on this LAB drinking foundation. Therefore first of all a very careful attention should be paid in the selection of the ZAD promulgated low-alcohol beverages benchmark between 2.5% to 1.2% alcohol content standards and it should also combined with varieties of taste/flavors, which stimulates the participants drinking appetite. While selecting these LAB’s it should be also kept in mind that such kind of beverages conveniently available for them for drinking in the future at their home environment.

The ZAD theory [13] in its core essence contends that; ‘the human habit of drinking alcohol (apart from its drug desire) originates from their biological need (desire) for the drink: ‘the ”thirst” (re-hydration), “taste” (intake of suitable nutrition’s, calories) and the “stomach” (its fuel or food carrying capacity) satiety”. --An 18^th century poet Edward Rowland Sill writes: “At the punch-bowl’s brink, Let the *thirsty* think, What they say in Japan: First the man takes a drink, Then the drink takes a drink” [26]. I think this passage points out some very deep hidden message about the principle role played by the “thirst” which is most of the time overlooked in the matters human alcohol drinking. First the alcohol drink draws the *thirsty* in for a drink but then comes its fatal entrapment. The alcohol part of the drink due to its diuretic effect could make them still more and more thirst for the drink. So; “First the man takes a drink, Then the drink takes a drink”. Of course loosening the inhibitions due to its drug effect is another factor that perhaps the author had in his mind in writing “the drinks takes a drink”. Now coming to its *taste* factor. There are many research findings that suggest that a liking for sweets (sweet tooth) a strong appetite or taste in humans are tied or a marker to alcoholism. Appetite-Linked Gene[27] A liking for sweets[28], Sweet tooth, a marker for alcoholism[29], which I mention as some of its research report references. A research conducted by: Baker-T-B; and Cannon-D-S. (1982) concludes: “The drinking patterns of human alcoholics appear to be consistent with taste mediated learning principles”[30]. This principle taste/flavor factor of alcohol can be also used (manipulated) into its aversion (disulfiram) to suppress its oral consumption. The experiments on Animal models could reveal more on this subject matters. Finally coming to the principle of the persons *stomach* factor its given capacity or its condition that ultimately determines the persons total amount of the beverage consumption, reflected in the “binge drinking”. Therefore under these above principle guidelines, select varieties of novel tasting sweet combined delicious low-alcohol (between 2.5 to1.2 percent) beverage for those alcohol dependent (alcoholic) people to be used in this drinking therapy. Perhaps some of it may follow the examples of the newly marketed designer drink popularly known as “alcopops” [31, 32, 33] that may be of some interest in this matter if it suits it well. Some of these beverages (including the non-alcoholic and the soft drinks) may be made of the taste and flavor (smell) of high standard alcohol, which may appeal or trigger their drinking appetite.

Here I should warn people not to mistake the concept of these lower-alcohol beverage (LAB) by assuming that it is not simply possible for the drinker in general to drink enough amount of these beverages that could provide any real pharmacological of intoxicating effect. As a matter of fact, they should know that these LAB drinks having between 2.5% to 1.2% alcohol range could potentially turn anyone intoxicated if they decide to consume it in sufficient amounts of their drinking capacity. To make this clear, an Australian Govt. Report of Investigation about the alcoholic beverages stipulates: An “alcoholic Drink means any beer, wine, spirits, cider or other spirituous of fermented drinks of an intoxicating nature, and is generally understood to refer to drinks of 1.15% or more alcohol by volume. The view of the Commonwealth Department of Health is that drinks of less than 1.15% alcohol by volume should be classified as “very low alcohol” drinks[34]. Although the researchers allow quite a liberal dose of alcohol content; Holford, N.H.G (1997) 2.75% [35]., Magnusdottir, K., et, al. (2000) 2.25% [36]., Skog-O-J (1988) 2.2% [37] while deliberating in their low or light alcohol drink research. Nevertheless the alcohol control or policy-making bodies impose a very strict limit over the alcohol content of the low or light alcoholic beverages. In addition to the above mentioned report, another report from Europe named: Innovation in Europe: Research and Result confirming the status of the low-alcohol beverages, states: “Drinks are described as "low alcohol" if they contain less than 0.5% alcohol and alcohol free if they have less than 0.05% alcohol content” [38]. Alarmingly enough, it is possible for a person to consume more than the amount of a standard alcohol drink by consuming these 0.5% beverages in a drinking session. The House of Commons Hansard debate on Licensing Low Alcohol Drinks bill Clause 1 on this account states: “Low-alcohol liquor not to be intoxicating liquor for the purpose of the Licensing Act 1964” [39] under which those parliamentarians argue that the alcoholic beverages which contains even less than 0.5% alcohol content up to0.1% levels should be considered dangerous to the vulnerable sections of population specially to the young children. Therefore one should know that the ZAD promulgated LAB benchmark having between 2.5% to 1.2% alcohol content could rate pretty high in these standard of its intoxicating effect. It is precisely because of this reason the ZAD model stick to the benchmark standard of between 2.5% to 1.2% alcohol content beverages as its “safe standard lower-alcohol drink” so the critics would not dismiss it as having no “intoxication” effect, so the alcohol dependent people would not like these LAB because they don’t get the alcohol intoxication, high, or the inebriation from drinking it.

The great ability of the LAB to modify (lower or increase) the amount of the alcohol content in it whenever needed in its ZAD-ADCT therapy is its biggest strategic advantage. This also provides a special provision to increase the alcohol content in order to bring a relief for those alcohol dependents who suffer from some severe Alcohol Withdrawals (AW) in their first days in the ZAD-ADCT. In some exceptional cases such patients can be discreetly given up to 5% alcohol content beverages as the first two or more drinks if it deemed necessary to substitute or replace all those pharmacological drugs like Benzodiazepines etc. [16, 25] used in the conventional alcohol detoxification (AW) treatment. Thereafter in the subsequent drinks the alcohol content can be lowered down to the 2.5% levels and then further reduced to 1.2% as the days progress into the week. By the way, the standard alcohol percentage of the lower alcohol beverages (LAB) need not be always exactly 2.5%, at times it can be strategically a little less say 2.0% or further lowered even to 1.15% as the situation of the treatment demands.

Besides these low-alcohol beverages the soft or non-alcoholic drinks also plays most important role in the ZAD-ADCT therapy that we will know latter when we deal into its manual. Nevertheless, here beforehand one should never underestimate the power of even the non-alcoholic beverages popularly called as non-alcoholic de-alcoholized[40] alcohol free [41] near beer[42] butter beer[43] etc. Although they are named as non-alcoholic nevertheless they can still contain up to 0.5% alcohol in them! Therefore most of the alcoholism prevention and treatment concerns still consider them as dangerous for example; the “Alcohol Beverages addiction Information Center” warns: ‘it is unsafe to any one with an alcohol problem, who has been advised to stop drinking, so they should completely avoid drinking even the low-alcohol beverages’[44]. According to the National Council on Alcoholism’s position statement: “these beverages contain alcohol they are unsafe for alcoholics, alcohol abusers, pregnant women, and women considering conceiving a child….those who choose abstinence should avoid drinks labeled “nonalcoholic” or “de-alcoholized” as they may contain up to 0.5 percent alcohol” [45].

By all these above mentioned alcoholic beverages standards where even the so called non-alcoholic beverages which may contain 0.5% alcohol is considered as unsafe or dangerous to the people at risk due to its drug desire and the “impaired (loss of) control” factor. Under this condition the alcoholic drinks containing around 2.5% to 1.2% alcohol content (by volume) could prove fatal to them also in respect to the ICD-10[] and the DSM-IV diagnostic criteria implications! In fact people in general are quite capable of consuming far over the safe drinking levels i.e. excessive, intoxicating or inebriating amounts of alcohol by consuming these 2.5 to 1.2% range of the lower alcohol drinks if they decide or if the alcohol drinks makes them “impaired” or “loose control” while they take to drinking these alcoholic beverages. The worlds famous media CNN report of alcoholics drinking 30 to 35 beers (around 12 liters) daily evening [46] months even years together! An European historical research record state: Brewery workers in Munich used to drink 8 to 10 liters of light beer daily[47]. Therefore now in this ZAD-ADCT therapy, all these conventional alcoholism establishments contentions and those doctrines and dogmas of alcoholic drinks stimulating the alcohol dependent peoples “alcohol drug desire, craving” and bringing out the “loss of control” manifestation in them will be put to a real test.

Finally to sum up, the ZAD-ADCT therapy LAB selection basically stands on the principle of drink (thirst, taste and the stomach) desire satiety of the alcohol dependent to reduce their overall alcohol consumption. It considers the beverages having between 2.5 to 1.2 alcohol percentages as its “benchmark” of the “safe standard lower-alcohol drinks”. Nevertheless these beverages still could have dangerously high enough intoxicating or inebriating effect on its drinkers. Even the beverages having the alcohol content as low as 0.5% could make its alcohol pharmacological effect felt and could be successfully used in this therapy! By the way, the title: “Zero Alcohol Drink (ZAD)” now seems perfectly fits to it, as it is a relative term that at its higher end it represents the “lower or light” alcohol drinks (2.5to 1.2%) and on its bottom line it could virtually mean the non-alcoholic beverages (ranging from 0.5 to 0%.) as its name prudently suggest!

ZAD-ADCT Cognitive Motivational Therapy (CMT)

The ZAD-ADCT Therapy in essence consists of two basic components. The main one is its concrete physical/biological ZAD “drink satiety”, which involves the practical LAB drinking, feeling, sensing, experiencing session. The second one is its psychological or behavioral component that we call “ZAD cognitive motivational therapy” (CMT) or its “session”. In my previous paper[2] I have named latter as; “Motivated Drinking Behavioral Change in the Choice of the Alcohol Beverage” (MDBCCAB) but now in this paper I simply call it as; the CMT. Although this ZAD cognitive motivational component considered as secondary to its “LAB drink satiety” component, nevertheless the successful outcome of the ZAD-ADCT therapy will mostly depend upon this ZAD presentations, expositions or administration of this CMT. A well prepared skillful and inspiring behavioral therapist or the psychologist (CBT, MET etc. specialists) can make it a great success while an unskilled, uninspiring, unprofessional may mess it up in a total failure.

The basic requirements (mentioned above in ‘principle precondition’) of this ZAD-ADCT motivational therapy is the alcohol dependence participants should have a genuine desire to enjoy the pleasures of the lower-alcoholic beverage drinking aimed at its all round drink satiety to find out whether it reduces their overall alcohol consumption to enable them to get rid of their alcohol dependence. Most important of all, they should keep an open-mind to find out whether this LAB drinking alternative is more preferable, acceptable, (with its pleasurable and enjoyable factors) for them to come out of their alcohol dependence and getting completely cured of their alcoholism instead of them being relegated to the dogmatic option of total abstinence for life long recovery at the dire threat of its disease relapsing again. To make them to understand more about this ZAD-ADCT perspectives the following main cognitive motivational sessions or the study classes needs to be conducted.

The basic lesson of this entire motivational therapy is to make every one clear that; this therapy is NOT about confining some alcohol dependent people in a place and supplying them with a strictly limited amount of alcohol by which trying to prove that they have achieved control over their alcohol consumption. This is basically about re-cognizing or understanding the humans natural biological needs that provides us pleasures or enjoyment with its fulfillment. Here our main objective is to explore the best ways to enjoy the pleasures of these human biological needs to its fullest (satiety) extent within the safe limits and once own given (available) means, without endangering the self. Someone may like a particular pleasure of life more than the other. However the matter of the fact is when one gets in more and more amounts of the pleasure consumption after a given levels, the particular pleasure starts radically declining, dissipating and starts degenerating. If stuffed more, it turns into a grotesque pain in its consequence. Now after undergoing the repeated suffering of its painful consequences sooner or later one may take an extreme decision of resorting to its “total abstinence” depriving themselves entirely form that particular pleasure. Sadly enough then it will also result in the constant battle against its desire, craving a nagging pain in life, which majority of the times (statistically within a year) treacherously leads them into its tragic “relapse” so the return of all its disastrous consequences. This vicious cycle may repeat in the life over and over again and lead to a tragic end!

However, the nature has endowed us humans with a great gift of “wisdom” that allows us to use the various substances or activities to fulfill the need and to enjoy the pleasure to its fullest (satiety) extent without getting into any of its negative effects, harm (abuse) or dangers. However tragically we stop exploring this great wisdom of nature and blindly follow the dogma of Total Abstinence”. But instead of surrendering to this total abstinence one can also effectively prevent the excessive consumption and its related harms or dangers of a particular pleasure reinforcing substance or activity paradoxically in the natures wisdom of SATIETY! According this natures discretion the best way to combat or prevent the excessive consumption of any particular substance is to combine (mix) it with more of its related or substitute pleasure providing substance, so this renewed product or activity can reduce or remove the excess or the dangerous portion of that particular substance or activity (partly or fully) replacing it with other benevolent pleasure providing substances, primarily to obtain its all round satiety and the health benefits! Unfortunately we close our mind and simply ignore, forget or dismiss it when we need it the most! This is especially true in the human biological desire (need) for the pleasures, food, drink, and sex. Therefore, the best way to prevent any human desire for excess pleasure when it turns malevolent or harmful is to replace, substitute or compensate it with the similar kind of pleasure providing substance or activities, which are safe and benevolent, guided by the wisdom of the open mind, instead of surrendering to the dogmatic “total abstinence” dictum.

For instance, in the matters of food take the particular substance sugar. It is commonsense for the people having problems with high sugar diet to replace it with the low sugar diet, even with the artificial sweeteners. The same can be said about the high fat diet. Of course the sugar, fat (protein) even the alcohol each may have their unique pleasures, nevertheless each have their own pleasure substitute substances capable of replacing or compensating it more or less provided one remains open-minded. In fact the substitute can be far more pleasurable, enjoyable and beneficial to the health as a whole if one accepts it with an open mind. On the other hand its total abstinence could be a nagging pain of depravity in life and we have only one life to live. Sex is the another highly compulsive subject where the excessive harmful indulgence (abuse) and its dangerous consequences can be prevented or avoided by using many of its available substitute that could provide far better pleasure enjoyment if one keeps an open-mind about it. When total abstinence is not an option for whatever reasons, one can find a safe alternative way to enjoy those pleasures (say condom among other things) instead directly exposing oneself to its deadly disease. It will be a big topic to elaborate so now here I only take our present issue of the excessive alcohol consumption and the best natural way to prevent it while continue to fully enjoy the pleasures of its drinking.

Of course we totally agree that the “alcohol drinking” the way it has been practiced today, the irresponsible way the alcohol policy makers allowing such high alcohol content (%) beverages as “standard alcohol drinks” of ‘safe drinking limits or levels’ without the proper safety precautions, could potentially lead the “people at risk” (young, vulnerable, predisposed) into its excessive alcohol consumption. Tragically enough, even their third standard alcohol drink of beer (12 ounce around 5% alcohol) which contains the lowest alcohol percentage in their recommended list of standard alcohol drinks, in fact positively and treacherously leads particularly the alcohol dependent (alcoholic) people mostly into its hazardous, harmful or the excessive use, termed as the “impaired (loss of) control” whether they like it or not, if they start its drinking.

Alcoholism; whatever may be its causes, genetic disease, psychosocial or behavioral disorders as claimed by the establishment. But one thing is very certain; in general these alcohol dependent people fully aware of the dangers of their excessive alcohol consumption and they “try” to limit control or cut down their alcohol consumption. But the main problem they encounter when they start consuming these establishments listed standard alcohol drinks; they some how loose the grip over their drinking and not able to stop or control their immediate instinct for drinking more of it thus become unsuccessful or fail in their attempts, which is basically termed as the “impaired control” in the diagnosis of alcoholism in the establishments leading alcohol dependence doctrines (ICD-10[8], DSM-IV[9]). What generally happens when the alcohol dependent people take to drinking these standard alcohol drink is; when they reach more or less at their stipulated count of the safe drinking levels or consumption limits, the person/s genuinely decides or “promises” for the moment this will be the last drink. However after they finish it, their biological desire for the drink still keeps them nagging for more of the drink for its satiety so they once again decide to take one more last drink but as they finish it up yet again the same nagging biological drinking urge or desire keeps reemerging, (the diuretic effect of alcohol can further aggravates their thirst) so again and again they fall into this drinking trap! When this repeats, out of exertion and with their increasing impaired inhibitions they become quite sloppy thus leave it entirely to their bingeing satisfaction or the drink (stomach) satiety. This happens mainly due to their innate (biological or call it genetic) drinking desire has not been satiated and they still have this physical/biological and the psychological capacity to drink more, so they continue to consume the alcoholic beverage that is available on their table! All of which gets manifested in their “loss of control” drinking behavior, as they are not much particular whether it is a spirit, wine, beer, high or low alcohol, or what else! What they instinctively want is a last drink that is been conveniently available for that moment by the courtesy of the establishment alcohol control policy making bodies (in consultation with the alcohol beverage industry?) stipulated standard alcohol (between 40% to 5%) drinks and as the result they end up in excessive alcohol consumption! Now this is where the alcoholism prevention treatment establishments appear in the scene and proclaim that the alcohol dependent people cannot cut down, reduce or stop their alcohol beverage drinking due to its triggering their “strong and some times overpowering drug desire” (craving) and their ‘impaired or loss of control’! They say, it does not matter whether they consume the high alcohol content or the low-alcohol content, if they take to the lower alcoholic beverage in the given standard alcohol drinks then they continue to consume it so much so that they will winds up with excessive alcohol consumption. Therefore one must completely give up their false presumptions (“denial”) and accept that the ‘total abstinence’ from any of the alcoholic beverages is the only remaining recovery option for them! Here I refrain from any more of my criticism on the establishment’s concerned doctrines or dogmas described in my previous paper[2]. So to cut it all short in this ZAD-ADCT we prove that opting to drinking the lower-alcohol beverage of between 2.5% to 1.2% can definitely prevent the people at risk (particularly the alcohol dependent) from excessive, harmful alcohol consumption. This is the above mentioned “satiety wisdom” bestowed on us by the nature to fully enjoy the pleasures of alcohol drinking without falling into its “loss of control” factor. In other words, here we claim that the alcohol dependent people by adapting to this LAB or the ZAD alcohol drinking method can indeed successfully reverse the entire process of their alcohol dependence or its addiction.

In general, if we question the alcohol dependent people if they have ever before “thought” of trying these lower-alcoholic beverages to reduce their overall alcohol consumption? Many may answer “yes”. So the next question is how many of them have really put it into practice to get rid of their alcohol dependence? Did they have the convenient LAB arrangements and the step-by-step ZAD reduction strategy in place? Did they have any idea how much lower the alcohol content they mean by their lower alcohol drink? Anyway, what was the final out come of such LAB drinking? Did they end up drinking more and more of it so the final tally of their alcohol consumption remained the same or even went up more? Or they have never really attempted it so far because of the establishments propaganda that implies that the ‘alcohol dependent people will anyway consume excessive amount even if they adopt to such a LAB drinking so it is not worth trying. After all what were their conclusions? Probably almost all of them will agree that they have never thought or attempted such a LAB drinking method to control, reduce or cut down their alcohol consumption before in their life.

Now lets us hypothetically investigate, what would happen when the alcohol dependent people opt to drinking the lower alcoholic beverages in order to cut-down their overall alcohol consumption. Suppose an alcohol dependent in a day average, used to drinking around 36 ounces (roughly 1.0 liter) of 10% alcohol content by volume (this also accounts distilled spirit titration) strong beverage which amounts roughly a total of 6 standard alcohol drinks mostly in the evening time, which is considered as excessive or binge drinking. So the person decides to cut-down his/her overall alcohol consumption at least to the half if possible by opting for lower alcoholic beverage say around 5%. What happens next according to the establishment’s argument is that; the person would end up consuming 72 ounces (roughly 2.0 liters) of that appetizing alcoholic beverage, which also amount to six standard alcohol drinks. Therefore they draw the conclusion that this whole idea of taking to the lowered alcohol drinking in order to reduce once overall alcohol consumption will ridiculously end up in a total failure. So their final assertion will be; “total abstinence” alone is the only recovery option for the alcohol dependent (alcoholic) people. Now wait a minute! The original idea is attempting or trying to cut down the alcohol consumption from the 6 drinks to around 3 drinks in a day by consuming the appetizing LAB, which is the original decision that is agreed upon! Now if the person able to consumes 72 ounces of the alcoholic beverage, then why shouldn’t it’s alcohol content once again reduced to its half (2.5% by volume) in their attempt or try to cut down or reduce their overall alcohol consumption from that standard six to a standard three. Do they think the same thing will repeat once again so the dependent people now will drink double that quantity 144 (around 4 liters) or even 200 ounces (around 6 liters) of this 2.5% LAB beverage day after days, months and years together for life long? Then why not reduce the alcohol content further to 1.2%. After all what really prevents them in reducing the alcohol content from the standard 5% to its half say the safe 2.5% or the safest 1.2%? At this alcohol percentage levels, quite enough of the intoxicating effect of the alcohol still remains and people still prefer for such LAB drinks. The “Innovation in Europe”: Research and Result document states: ‘As consumers health consciousness has increased in recent years, the consumption of beverages with low levels of alcohol also increase …Drinks are described as “low alcohol” if they contain less than 0.5% alcohol and alcohol free if they have less than 0.05% [38]. Another document from: Centre for Addiction and Mental Health; Toronto comments: “Low-alcohol beverages have become more popular in North America as people become more responsible about their health and the consequences of drinking and driving” [44]. So far to our search for the research finding in the area of Low-alcohol drinks overwhelmingly provides the evidence that the LAB (around 2.5% alcohol content or less) drinking in general enables people to reduce their overall alcohol consumption [48, 49, 50, 51] I have also put together many such empirical evidence in “The ZAD Empirical Evidence Surveillance” section of my previous paper[2]. Now if any one argues that it would be fundamentally different with the alcohol dependent people then we will be soon going to find it out at the end of this ZAD-ADCT therapy.

Another important topic that should be taken into study during this ZAD-ADCT motivational sessions is; the dogmatic argument of some of those so called recovering alcoholics proclamations of their intense or overwhelming drug desire that sets on their “loss of (impaired) control”. They may strongly argue that theirs is a genetic malfunction or a behavioral disorder therefore their biological drink desire satiety (LAB) never going to subdue or dampen their drug desire and stop their loss of control. They may further argue that: ‘taking to the lower-alcohol beverage will be simply a waste of time and money that they would rather prefer to consume some more of the alcohol drinks than spending it on making their alcohol drink appetizing, delicious and lowering its alcohol content. It is very difficult to convince those people having such rigid mindsets. Suppose, if they are sick and prescribed to take some medicine to come out of their sickness would they argue that it is simply waste of time and money to spend on the medicine instead they are happy with carrying on more with their disease. Analogically, LAB drinking is like a person who wants to enjoy the pleasures and the benefits of driving vehicles but at the same time realizing the extreme dangers involved in his/her driving therefore takes up all the safety precaution wears the safety belt and fits some mechanical technique in his vehicle that limits or controls (breaks) its speed as an insurance policy! Of course he or she needs to pay for the product that protects him/her from all those risks or dangers instead of totally abandoning (abstinence) the pleasures or benefits of the driving. However some people may adamantly argue I don’t wont seat belt or the speed limit “control” mechanism and the insurance cover, to the vehicle, instead I will totally give up driving any vehicle for life because it is extremely dangerous for me and I am simply “powerless” over it! It will be almost impossible to convince these people and we only wish good luck to them. Nevertheless one can just imagine the consequences of their decision when these people encounter the need of driving a vehicle for whatever reasons. Of course they may have their own rational to defend their position so we don’t argue with it any further.

However the above critique somehow seems to have some valid reason as they basically question the effectiveness of the LAB drinking in the prevention and treatment of alcoholism. Their argument perhaps, is that the alcoholics alcohol drug desire its craving, and the “loss of control” never will subside, or get mitigated by whatever quantities of the LAB they may consume, with all its maximum amounts of drink satiety they may experience. For example even after consuming lots of the LAB in a drinking session (say, in a 3 to 4 hours drinking around 200 ounces or 6.6 liters which in itself accounts for more than 8 standard drink in the 2.5% low-alcohol beverage in volume.) the alcoholics “loss of control” over the alcohol consumption will not subside. Perhaps the alcoholic may not drink one more of this LAB drink however if they were presented with the opportunity of a distilled spirit drink (perhaps they will actively seek to it) then they will immediately drink it to satisfy their drug desire. This argument seems to have some valid points on its surface but what it essentially lacks is the commonsense. -- Now let us take two similar kind of alcohol dependent persons, give the first dependent the amount of two standard alcohol drink in the form of around 40% alcohol content (distilled spirit) beverage (3 ounce in total) with little or no titration; to the second dependent give the same two standard alcohol drink (distilled spirit) but mix it with a total of 48 ounce delicious alcohol beverages in which the alcohol content get lowered to the 2.5% by volume. To cut it all short; the alcohol drink desire, its craving and the “impaired (loss of) control” of the first dependent who drinks this two standard alcohol drink in the form of the distilled spirit with little or no titration will be significantly more, still get aggravated by the alcohols combined diuretic thirst effect. On the other hand the second dependent persons alcohol drink desire will get significantly reduced or mitigated as the result the two standard alcohol drinks mixed in a total of 48 ounce (11320 ml) of the delicious beverage that together provides the overall biological drink desire satiety. Finally here it is not the question, whether the alcoholic still has the physical, biological or the stomach capacity ability to drink the high alcohol content drink after obtaining the drink satiety with the LAB, the question here is whether enough amount of the LAB could effectively reduce or dissipate the alcohol dependents immediate drug desire, craving and the “impaired control” while he/she is trying or attempting to cut down (ICD-10, DSM-IV, CAGE, etc. diagnostic criteria) their overall alcohol consumption, or not.

There are many such fundamental ZAD cognitive motivational topics that need to be addressed in this first week’s therapy session. Besides that a discussion on the ZAD book its perspective papers and some of its other literatures which are available in the Alcoholics Curewell website[10]. Most importunately the preceding the ZAD Alcoholism Research Papers[1, 2] may be taken for discussion on this CMT. However the scope and limitation of this (its sequel) paper does not allow me to enter into those topics in here. By the way in the ZAD-ADCT one-week inpatient stay there will be ample time and opportunities to explore into these topics at its CMT sessions! Apart from the above motivational topics, one may also successfully use the “positive-reinforcement” motivational approaches or techniques like the “Contingency Management”[52] in these three weeks ZAD-ADCT and even beyond this therapy.

PS. Continued Part III on the previous blog post.