Saturday, May 1, 2010

Alcohol Detoxification Therapy Part III

The ZAD-ADCT therapy is a highly pragmatic and dynamic approach having hundreds of strategies that could potentially lead into as many spectrums of results. Any important strategic lessons learned from the first trial can be adapted and used in the next trial! It may require a few more trials to confirm and to arrive at any substantial research conclusions. It would be a very difficult task for anyone to describe all its possible spectrum outcomes in details. Besides, my non-academic, non-professional poor English language skill makes me most difficult to furnish all its details in this manual. Therefore in the earlier Part-II, I have defined its principle guidelines and the parameters, under which in this Part-III I will lay down only the basic strategic approach in this ZAD-ADCT Therapy Manual and leave out all of its elaborate pragmatic details to be worked out by the therapy administrators, conductors (researchers, counselors) at its execution or the practical trial situation.

ZAD-ADCT First Week Day One: A Safe Standard Alcohol Drink Demonstration

Now let us begin with this three weeks long ZAD-ADCT on its first week! The day one (perhaps it may require a night stay before) will start with the usual formalities and the requirement including a nice breakfast. Then at around 8.30 the long awaited ZAD-ADCT therapy begins first with a delicious light-alcoholic drink having 1.2% alcohol content will be served for anyone who likes to drink. Then the first day’s morning ZAD cognitive motivational therapy starts with reiterating the principal preconditions of this three weeks long ZAD-ADCT therapy. I have explained the basic subject matters of it in the beginning of the Part II (“Principle Guidelines”) of this paper; therefore I would not like to repeat it all over again.

One of the most important topic of this first days CMT session starts with, is a practical visual demonstration of the establishments ‘a standard alcohol drink’ designations and its ‘safe drinking level’ counts, face to face with the ZAD safe alcohol drinking designations or denominations. Take five glasses of different sizes; 50ml., 150ml., 350ml., 700ml and., the 1400ml., measurements. Fill the first glass with a standard drink of distilled spirit 1.5 ounces (40 ml) of around 40% alcohol content. In the second glass with a standard drink of wine 5 ounces (140 ml) of around 12% alcohol content. In the third glass a standard drink of beer 12 ounces (330 ml) of around 5% alcohol content. In the fourth a standard drink of delicious low-alcohol beverage 24 ounces (660 ml) around 2.5% alcohol content and finally the fifth glass with a standard drink of very delicious light alcoholic drink (LAD) 48 ounces (1320 ml) of around 1.2% alcohol. It has been well established that the people who consume within three counts of any of these standard alcohol drinks in a day said to be remaining within the safe drinking levels. The details of the establishment’s standard alcohol drinks and the safe drinking levels can be found in the documents of the following references[11, 12].

Now all these five glasses of beverages contains equally the same amount of alcohol, known as “a standard alcohol drink” having around 10gms of alcohol by volume. Therefore according to the contemporary alcoholism prevention and treatment establishments alcohol drinks control, standard and safety monitoring research study (policy) position; all these standard alcohol drinks basically have roughly the same alcohol drink affect on the person who consumes them. None of these standard drinks more dangerous or safer than the others especially for the alcohol dependents. (Please note: the forth and fifth standard alcohol drinks mentioned in here have not yet come up in the establishments standard alcohol drinks list.) However according to the ZAD model, even though all of these drinks contain overall the same amount (around 10gms) of alcohol, the standards of safety or dangers of the drink is basically determined by the alcohol percentage (by volume) contained in the beverages at its consumption levels. As the percentage of alcohol in the volume of the drink (v/v) gets significantly lowered, then from a given threshold, the drink becomes significantly less dangerous and safer as its aims more and more towards the overall drink satiety. For example the 12 ounce (330ml) of 5% alcohol content beer or the 5 ounce (140ml.,) of 12% alcohol content wine are less dangerous and more safer than consuming the 1.5 ounce (40ml) of the 40% alcohol content distilled spirit with little or no titration. Therefore the people who take to consume the standard alcohol drink of a distilled spirit (with little or no titration) becomes very susceptible as they naturally get tempted to consume far more excessive amount of alcohol, than the one who takes to drinking the standard alcohol drink of a beer. Therefore, in general, a standard beer drink is considered much safer than the standard drink of distilled spirit as it contains almost 8 folds less (5%: 40%) alcohol content in it.

However in reality this popular conception of standard beer being safer than the standard distilled spirit may not be as true as it appears to be! First of all the standard beers 5% alcohol content still remains dangerously very high so the people at risk, (young, vulnerable, predisposed particularly the alcohol dependents) by their innate drinking nature quite “inadvertently” (unintentionally) end up in drinking many times more than their allotted “safe alcohol consumption limits” before they realize it. Secondly, describing those alcoholic beverages of around 5% alcohol content (beers, wine coolers, alcopops) as the low-alcohol beverages, in a way gives its drinkers a false sense of safety thus encourages or lure them to consume it sufficiently enough to obtain their full drink satiety underestimating its intoxicating effect. On the other hand the distilled spirit could make these people more apprehensive about its highly dangerous amounts of alcohol that it contains so they rather exercise more caution in indulging into its excessive drinking or the biological drink satiety (bingeing). In this matter I found the following research by; Lintonen, T.; et a.l. (2001)[53] Guarna, J.; et al. (2000) [54] Giacopassi, D.J.; (1991) [55] Klein, H.; et al. (1990) [56] sheds some light on the drinkers perceptions about different alcoholic beverages especially the standard beer, wine and the distilled spirits.

Moreover, there is a important NIAAA pamphlet in this matter titled “Make a Difference”, which seriously warns; Beer and wine are not “safer” than hard liquor. A 12-ounce can of beer, a 5-ounce glass of wine, and 1.5 ounces of hard liquor all contain the same amount of alcohol and have the same effects on the body and mind”. [57]. One can see many such proclamations in the establishments’ promulgations. Interestingly enough the ZAD model despite its claims that the low-alcohol beverages (beer) safer than the high alcohol beverages (distilled spirit) mostly agree with the above NIAAA claim. The 12 ounce can (a standard alcohol drink) of “beer” may contain 8 time less alcohol than the 1.5 ounces of hard liquor (“distilled spirit”) by volume, however its alcohol content remains still dangerously high enough that this beer drink within its 3 counts of the establishments stipulated “safe drinking levels” will not provide its drinkers enough of the drink satiety which they pursue while drinking such beverages. It is precisely for this reason the ZAD model adds the No.4 standard alcohol drink into its list tally and names it as the “SAFE standard low-alcohol beverage (LAB) drink”, which contains around 2.5% alcohol by volume in it. Even though the alcohol content in it only half less than the standard beer (5% to 2.5%) nevertheless around this threshold it could provide quite enough (all-round) drink satisfaction or satiety within the establishments stipulated “safe drinking levels” thus its drinkers would not so easily or inadvertently end up in excessive alcohol while drinking such safe standard low-alcohol beverages.

However our list of standard low-alcohol drink is not complete yet. Because, one can genuinely challenge us back with the same line of argument saying the designated 2.5% LAB also not much safer than the 5% LAB because by opting to drink even the 2.5% LAB the alcohol dependents can still exceed their alcohol consumption far more than the given safe drinking levels! Of course, we give very much credence to the above apprehensions and agree with it to the extent so much so that we further introduce the fifth standard light-alcohol drink (LAD) which contains around 1.2% alcohol in our “ZAD Alcohol Policy”, designating it as “a very safe” standard light-alcoholic drink especially for the alcohol dependent people. However, still one should not take it lightly because even a drink containing as low as 0.5% alcohol (that I mentioned earlier) said to have contains enough of that pharmacological effect on the people who drink it high enough.

To substantiate this Standard alcohol drink demonstration “the ZAD-ADCT: Lower-Alcoholic Beverages (LAB) Research” pointed out in the “Part II” will be added into session. After this mornings ZAD CMT session, the ADCT participant will be led into the first practical LAB drinking session of the day, which begins at around 10.00am! +(Irrespective of it, any appetizing beverage which contains around 0.5% alcohol should be made freely available to the participants from morning till the evening through out this first week. This may need some intensive and careful monitoring.)+ In this; coffee, tea, fruit juices, soft non-alcoholic drinks, snacks along with varieties of the delicious LAB having around 2.5% alcohol content made available and the ZAD participants free to choose any of it, one or more varieties and asked to drink as much as they like. However all the participants asked to first drink a 12ounce of the 1.2% LAD (to have its first drinking experience) before taking to drink this 2.5% LAB. Perhaps, the participants who already had the LAD in the morning will be exempt from it. There should be some custom made 700ml capacity glasses, jugs (mugs) specially arranged for this ZAD-ADCT alcohol drinking session. During this morning session, a most important announcement will be made about the upcoming drinking contest (explained latter) in the evening! At 12.00 noons, the LAB drinking session will be over however the participants are allowed to drink any of the soft or the non-alcoholic drinks through out the day.

The afternoon lunch break comes at around one o clock. After the lunch the participants will be allowed to have some relaxation or rest period, say up to 3pm.Thereafter the evening’s motivational sessions will begin. Such motivational sessions or classes conducted twice in every day during the entire week in the mornings and in the evenings in the allotted hours before the beginning of the LAB drinking sessions. These motivational sessions can be broadened into games, entertainment, training (perhaps computers, internet, science topics) any other preferable or suitable activities, like which employed in the conventional detoxification treatments. From 5.00pm onwards the evening LAB drinking sessions of the first day will commence. It begins with the drinking contest announced in the morning and everybody asked to participate. This is also to check their overall drinking capacity so all those who consume above a given amount of the drink will get qualified to the next round and those who consume the maximum amount of the beverages in the prescribed time period of say 10 to 20 and 30 minutes will receive first second and third prizes in cash. (Health precautionary measures should be kept in place during this contest). From 5.30 pm onwards the usual 2.5% LAB drinking sessions will resume and continue until 7.00 pm. Then if needed another drinking contest (optional) of exclusively soft (non-alcoholic) can be held for 10 minutes with three more prizes! From 7.10pm the usual 2.5% drinks will be resumed and at 9.00pm the first days LAB drinking sessions will draw to an end. During the entire evening drinking session appropriate kinds of appetizing snacks should be provided so all will happily participate in this LAB drinking therapy. At 9.00 or 9.30pm a satisfying dinner will be served, perhaps now heavy and bombarded with the full days drink and food satiety experience, at around 10.00pm perhaps it is time for bed. As a precautionary measure a physician or doctor will be kept in place to deal with any problems of excessive consumption and other health emergency purposes.

As the therapy approach at the end of the day, its administrators (overseers, researchers, counselors) should put together and analyze the participants all the drinking accounts. How much amount of alcohol each of the individual able consume on the day and the difference between each other when presented with such kind of delicious and inspiring LAB drinking environment with such opportunity and the contest. – Studying what kind of impact the drinking contest will have on their overall alcohol drinking behavior —Examining the alcohol dependent behavior who had the overall drink satiety whether still desire and indulge into excessive alcohol consumption --- What role the appetite or the delicious taste play on their overall alcohol consumption. – What can the alcohol dependents learn or we can teach them from this first day of their LAB drinking experience. Most importantly the therapy overseers should maintain the detailed accounts of every individuals amount of beverage consumption and other records, compare it with their old drinking records and to analyze it in some detail! Lots of data will emerge from this first day’s ZAD-ADCT experiment alone for the future alcoholism treatment research as a whole.

We don’t know yet in such a real practical ZAD-ADCT therapy situation how much amount of drink and the alcohol each of the individual alcohol dependent would like or able to consume. However if put on to compete, we assume that mostly all of them able to consume at least around 100 ounces (2.75 liters) of the 2.5% alcohol content beverage on this day which amounts to a total of 40grams of alcohol, which already exceeds the safe alcohol consumption limit for a person in a day. ---- Perhaps many will make it over to tthe binge drinking (six drinks or more) amounts! --- The interesting fact of this days drinking experiment may be; this is their average daily alcohol consumption for most of the days but its enjoyment and experience could be simply incomparable. --- This LAB drinking demonstrated the individual’s overall drinking capacity in a day or in a drinking session. --- Now comes the critical question; suppose, if these participants were given a standard 10% or 5% alcohol content beverage in the place of this 2.5% alcohol content with all the other conditions remaining the same then what would have been their overall total amount of alcohol consumption at the end of this day? – It would have surely increased to two to three folds or more and proved very costly. --- This day’s their drinking behavior definitely proves that by taking to the lower alcohol content beverage (LAB) drinking, absolutely reduce their overall alcohol consumption to an great extent. — This could be an excellent method when they genuinely try (attempt) to control and cut-down their overall alcohol consumption. --- There are many more lessons that can be learned from this first day’s drinking therapy experiment and its overall experience.

The ZAD-ADCT Day Two

Now let us enter into the second day of this trial. After breakfast, at 8.30am, this day’s therapy begins usually with the CMT session. After presenting them with yesterdays facts (compiled by the therapy conductors at the end of the previous day) the participants will be asked about their first days LAB drinking experience and what did they learned from it. --- At 10.00 am this (second) day’s morning LAB drinking session will be commenced. --- First of all, the participants will be asked to drink a 12 ounce (330ml) of the 1.2% delicious light-alcohol drink thereafter 2.5% LAB will be served. However the major strategic change of this days drinking is that the 2.5% LAB mainly contains plain water or the carbonated soda water. --- Also the delicious snacks and the dishes particularly in this LAB drinking sessions will be withdrawn (to make the drink less appetizing) for this day. However the delicious 1.2% LAD made available in this drinking session up to 12.00 am. In the evening also a long, single LAB drinking session from 5.00pm to 9.00pm carried, providing the same morning LAB without any change. ---However perhaps (optionally) the delicious 2.5%LAB drinking session conducted in between the hours (6.00 to 6.30 or 7.00 pm) if needed one may announce about this beforehand in the morning or evening. –The drinking session ends at 9.00pm. --- A modest dinner will be served thereafter.

To be brief; the second days LAB drinking accounts (amounts) of each individual and their drinking behavior (how much they desire) carefully noted down and the data analyzed also their total alcohol consumption compared to the previous day by the therapist (conductors, administrators) in the day. --- What kind of impact the appetite or the delicious taste presence and absence have on their overall alcohol drinking desire and the total alcohol consumption. ---- How much of their desire for the alcohol drink get dampened or reduced by removing its appetizing taste component. --- Perhaps it would be wise to notify at the end of the second day that tomorrow (on the third day) all the good delicious LAB drinking will return back but only in the evening session. However in the morning only the delicious non-alcoholic beverages or the soft drinks will be provided.

ZAD-ADCT Day Three Four Five Six and Seven

The major landmark change in the drinking strategy deployed in the third day is that the LAB in the morning drinking session will be withdrawn from this day onwards. (Nevertheless, the non-alcoholic beverages having around 0.5% alcohol made available all the time from morning to evening). Another important thing to notice is; from the day three of this therapy, its providers will get more time to conduct those most important CMT secessions as the morning LAB drinking sessions completely cancelled and also in the evening it may be delayed for an hour or so. Perhaps this is the right time to introduce the main cognitive motivational topics that I have been discussing in the “ZAD-ADCT Cognitive Motivational Therapy” section of the Part II of this paper. Therefore, I will skip all those subject matters; also to explain it here is, simply behind the scope of this paper.

Apart from canceling the morning LAB drinking session another important change will be brought in this third days drinking therapy is that in the evening LAB drinking session in its first and last hour (from 5.00pm to 6.00pm and from 8.00pm to 9.00pm) the same delicious 2.5% LAB drinks are supplied but on the middle two hours (6.00pm to 8.00pm) only the 1.2% alcohol beverages should be allowed. It is better to provide some positive, recreational activities between these middle hours to make the passing time easy. Overall, it will be left to the therapist (administrator’s) decision to bring in any of their innovative strategies (perhaps, introducing the non-alcoholic drinks having around 0.5% alcohol can be one of them) that can make these drinking sessions livelier so to make it more effective and successful.

From here onwards, I will be outlining only the main drinking strategic changes brought in the day aimed at reducing the overall alcohol consumption while compensating, substituting or replacing it with the overall LAB drinking pleasure. The great change of the fourth day is that the LAB drinking session will only start at 7.00pm and end at the usual 9.00pm. However the non-alcoholic or the 1.2% light-alcohol drinks may be made available from 5oclock to 7oclok. Here the ZAD-ADCT therapy administrators should primarily keep in mind that undertaking the participant’s alcohol detoxification and removing alcohol dependence (at least the physical one) is the primary objective or aim, as it approaches near the last days of the first week of this therapy.

The fifth day’s 2.5% LAB drinking session comes at the same time as the previous day i.e. from 7.00pm to 9.00pm but the major change this time will be; behind every standard alcohol drink of the 2.5% LAB they should drink one standard alcohol drink of 1.2% Light Alcoholic Drinks (LAD) if they want to drink their next quota of the 2.5% LAB. That mean; after consuming 24 ounces (660ml) of the 2.5% LAB they should consume 48 ounces (1320ml) of the 1.2% LAD if they want to drink their next 2.5% LAB. In this days CMT session the participant should be introduced to the Moderate Controlled Drinking models[12, 58], some of their strategies [59] especially the Moderation Management [60] that I had explored in the “ZAD Clinical Therapy” part of my previous paper[2].

The sixth day’s LAB drinking session can start any time between 5.00 pm to 7.00 pm and end up at 9.00 pm. However the main strategic change introduce in here is only the 1.2% LAD made available in this entire LAB drinking session. As we are just one day short of completing this first weeks inpatient therapy, which calls for some close scrutiny and inspection of their alcohol detoxification and removal of its physical dependence at least. Most critically, the primary results of this ZAD-ADCT therapies evidence will start emerging at this stage. First of all it had put to test the establishments substance “dependence” diagnostic (ICD-10, DSM-IV) doctrines first two primary symptoms or the syndrome. According to which, it will not be possible for any of these alcohol dependents (participants) in general to cut-down or to reduce their alcohol consumption down to any significant levels in this entire therapy week as they continued to drink any amount of the given LAB as much as they like in its stipulated LAB drinking sessions. So due to their “often strong, sometimes overpowering” [8] ‘psychoactive drug desire’ cravings and “not being able to stop drinking once drinking has begun”[9] combined with their “impaired (loss of) control” symptoms or syndromes they would not be able to control, reduce or cut down their excessive alcohol consumption and to get rid of most of their physical alcohol dependence at the end of this first weeks ZAD-ADCT therapy, if the establishments “substance dependence” doctrines basically holds true. All of which basically implies or advocates that the “total abstinence” is the only option for the alcohol dependence people to come out of their dependence and to obtain their recovery. But On the other hand, if these alcohol dependent participants in general had succeeded in significantly reducing their overall alcohol consumption and get rid of most of their physical dependence at the end of this one week therapy, then it will fundamentally question the validity of (and probably will refute) the “establishments” above mentioned basic symptoms or syndrome of their “substance dependence” diagnosis doctrines. At the same time it will vindicate and prove the validity of the ZAD basic position that claims (even though it is too early to assert) that people can successfully come out of their alcohol dependence by effectively opting for this low-alcohol beverages.

Finally arrives the 7th day of this ZAD-ADCT. As every body knows it is the last day of this first week inpatient therapy. Preferably a Sunday and make it a special day celebration. The evening LAB drinking sessions get starts at 5.00pm. Here the day fifth and the day sixth LAB drinking strategy may be used in some combination i.e. from 5.00 pm to 7.00 pm day fifth LAB drinking strategy used and from 7.00 pm to 9.00 pm only 1.2% (day sixth) LAD will be made available. ---However the greatest importance of thhe day should be given to its cognitive motivational session. ---Tomorrow morning they will be discharged and sent home to return back to their duty. --- Let them imagine if they had taken the total abstinence oriented alcohol detoxification treatment option at the beginning of this week then they would have been kept inside for still three more weeks as they have been considered to be too weak, genetically “unfit” to face the outside world of alcohol. --- During this time they would have been grilled more and more about the total abstinence and totally deprived of the pleasure of their alcohol drinking and the associated enjoyment through out these weeks while anticipating a bleak future of total abstinence and of course commanded never take to the alcohol drinking through out their life. However this ZAD-ADCT would not consider them weak, vulnerable or unfit within a week of this therapy. It had never deprived or completely blocked their way to enjoy the pleasures of the LAB in any day, in this entire fast week. --- During this first week of their involvement into this LAB drinking therapy they had been exposed to the wide range of the drinking pleasures learned a great deal of lessons, gained lots of knowledge out of this LAB drinking experience. It is like putting aside their old reservations, breaking down the drinking barriers, exploring new drinking avenues and getting comfortable with the LAB drinking. Now they know for sure that an alcohol drink does not necessarily or automatically trigger in them the intense drug desire, craving or “impaired (loss of) control” and its subsequent alcohol dependence. ----They had totally turned this “loss of control” trigger mechanism on its opposite direction (up side down) by reversing the entire addiction process in the fast one week and triumphantly came out of it, which the world thought impossible for them to achieve. --- It is fairly common to see the so-called alcoholics to prove themselves that they are entirely capable of remaining total abstinent, which is been considered to be most difficult for them to achieve. --- However on the other hand they consider themselves simply “unfit” or impossible for them to cut down, reduce and minimize their alcohol consumption within the safe drinking levels to one or even half drink (a gulf) a day. Now the world around watching us will be amazed at seeing +within a week+ we are proudly taking this pioneering victory march. Here some of them may be quite confident that they are capable of reducing their alcohol consumption even to a single (even less) standard drink a day. These ZAD-ADCT participants, going to be “recognized” in the future as people accomplishing this new great feat. Now it is entirely up to them to prove to the outside world that they can totally control their alcohol drinking by adapting to this LAB or LAD (ZAD) drinking practice and to earn their historical place, name, fame and all its benefits through out their life. Now finally they can have a mission in their life to help the other affected people to overcome their alcoholism with their own testimony as against the others. At the end of the day there will celebration dinner for the successful completion of the first week of their therapy.

However one should not to forget that this is not the end of the therapy. It still needs importantly two more weeks to complete. For the next complete week they should drink sufficiently enough amounts of the soft or the non-alcoholic drinks that has been provided to them from morning up to the evening time and refrain from the alcoholic beverages during this time. We are looking forward to them to come and join the LAB safe drinking sessions every day evening time from 6.00pm to 9.00pm. In these evenings they will be provided with enough of the LAB between 2.5% to 1.2% to drink from 6.00pm to 9.00pm in such a strategic manner mainly to remains within the prescribed safe drinking limit.

ZAD-ADCT in the Second Week

Entering into the second week of the ZAD-ADCT therapy the participants will be asked to meet every day in the evening from 6.00pm to 9.00pm safe LAB drinking sessions. (While their cousins in the other room attending their total abstinence (AA) evening meetings.)--- Here they have to evolve their own individual LAB drinking strategy to minimize their alcohol consumption, which suits them the most. --- Its long-term objective perhaps once-in-a-while to achieve literally the Zero Alcohol Drink for a day. A simple way to achieve it would be while beginning of the LAB drinking first take a glass of non-alcoholic (0.5%) or the light (1.2%) alcohol drink and then only go for this 2.5% LAB and repeat this drinking pattern in the evening drinking session! As the days progress, increase the portion the non-alcoholic and the LAD drink towards achieving the Zero Alcohol Drink Objective. Perhaps the Contingency Management' [52] motivational approach may help. However one need not make such achievement (but if any one achieves, it would be greatly appreciated) maintaining the safe alcohol consumption levels will be quite enough. --At 9.00pm a light evening meal will be served, after which it is time for every body to go home. --- Perhaps all should be given a quota of soft or the non-alcoholic drinks to carry home and asked to drink enough of it if needed during the daytime. --- A vehicle should be arranged to reach everybody to their home at night. --- Perhaps there are many such small strategic moves and incentives in the earlier stages of the ZAD-ADCT that may make the difference between its success and failure.

At the last day of this second week (which will be another Sunday) make it a full day session! --- In the morning their BAC levels will be checked (optional) followed by an analytic study comparing themselves with their total abstinence following fellowship cousins. --- Extend on the last Sundays Motivational sessions. Organize games sports and other activities. --- However tell them now they should prepare to enter into the third week of this therapy that will be conducted at their own home territory. --- During this third and the final week they should visit the center once in every two day evening to see how they are doing and to collect their two days quota of non-alcoholic (which may contain around 0.5% alcohol) drinks. Probably the staff members will visit or phone call their home daily or once in every two or three day to find out the whole therapy progress of this week.

ZAD-ADCT Final Third Week

The candidates entering the ZAD-ADCT third and final week needs to conduct their LAB Drinking at their own residential (home) environment. However as a motivational incentive, they will be supplied with a given daily quota of non-alcoholic (0.5%) beverages with a set of LAB drinking glasses as a presentation. However they have to make their own arrangement for its alcohol part if they want. --- (Perhaps they may be shown where to get the 1.2% LAD if they want.) They have to visit the center or the staff members will to visit or make phone call to their home once in two or three days in this week as informed before. --- All they have to do is first to remain within the safe alcohol consumption limits and to further minimize the portion of alcohol in their drink as much as possible and if feasible accomplishing literally the zero (non) alcohol beverage drinking.

The final day of the ZAD-ADCT will be the last day of the third week, a Sunday. Make it a full day session. --- This marks the beginning of the “ZAD Practice”. From here onwards the participants of this ZAD-ADCT therapy, basically enters into the ZAD practice. --- The essence of this ZAD “practice” or method importantly summed up in the “principle key notes”, which I reiterate in the next section. --- One of the surprising outcomes of the ZAD practice happens to be that it is the most natural and the best way to achieve “total abstinence”. --- This happens mainly because as the ZAD practice quite effectively reduces and removes their physical dependence on alcohol which in turn results in eliminating their biological/neurological and the psychological desire or craving for that drug. ---Therefore the total abstinence becomes a viable, inviting prospect for the people who choose this option for whatever reasons. --- We are happy whenever this happens, immediately or on the longer run. --- However one should know that it is fundamentally different from its parallel running dogmatic counterpart conventional ‘total abstinence based recovery’. --- I have explained more on this matter in the earlier “ZAD-ADCT Cognitive Motivational Therapy” section of this paper.

The overall success of the ZAD-ADCT can be determined if it results in the following three long-term outcomes: 1. There comes a marked or significant reduction in the person’s incidence of excessive alcohol consumption (binging) or the alcohol misuse, harm reduction as a whole. 2. Always remain within safe light drinking or the minimum alcohol consumption levels. 3. Maintaining mostly a highly minimized alcohol levels or the non-alcoholic beverage consumption mainly aimed at the biological drink satiety. All of these may take at least a year of follow-up monitoring or the observational period to find out.

The greatest accomplishment of the ZAD practice is that it can eventually transform the alcohol drinkers into model social drinkers. This is the absolute proof of a person getting completely cure of their alcohol addiction or alcoholism! --- This has clearly happened in my case now in its seventh year. (I am rather apprehensive about it now because I may be loosing the health benefits associated with the moderate drinking.) --- Of course, the overall objective of it is to make the alcohol dependent people the safe, low-risk, controlled, moderate alcohol drinkers that they can continue to enjoy the pleasures of their alcoholic beverages throughout their life neither becoming alcoholics nor the powerless total abstinence recovery seekers!

Nevertheless, it should be made clear in this final session that we don’t foster any such grand illusion that every one who undergo this therapy will come out of the alcohol dependence. --- Many may fail and resort to their old habit of excessive alcohol consumption. --- However, still all hopes are not lost, they may eventually return back to this ZAD practice when they realize that it is time for them to receive the alcohol detoxification and its treatment. --- They have already learned its procedure and undergone its experience and acquired its essential skills, hence it is for them to choose between the ZAD practice or the conventional total abstinence detoxifications where they can have as many admissions! --- Nevertheless the ZAD-ADCT left in them an indelible LAB drinking experience in life and has exposed them to this “ light alcohol-drinking model”. In this direction a research report by Collins, R.L.; et al. (2001) comments; ‘individuals…drink less when exposed to a light drinking models’[62]. Another research conducted by Caudill-B-D; et al. (1980) remarks: ‘Alcoholics drinking behavior can be modified by the social influences of modeling that also cast doubts on the loss of control hypothesis’. [63]. Apart from this, the ZAD model under its alcohol control policy puts forward a proposal for some “Safe Drinking Bars”[61], which aims to serves exclusively the lower-alcoholic beverages having between 2.5% to 1.2% alcohol content and the non-alcoholic beverages to the alcohol dependent (addicted, alcoholic) people to enable them to reduce their overall alcohol consumption and to come out of its dependence when the ZAD-ADCT not available for them for whatever reasons.

Finally the success or failure of ZAD-ADCT simply cannot be determined at the end of its three weeks. --- It calls for a minimum of one year of follow up or the observational period to confirm its result for the purpose of its research. --- In this connection the participants should be given a glimpse of the future work-out, which has been explained briefly in the next “ZAD-ADCT Follow up section”. Perhaps ensuring a study supply of non-alcoholic (around 0.5% alcohol) beverage to a fair price or any other such motivational apparatus that may contribute in facilitating their ZAD practice will be highly appreciated at the end.

PS. Continued Part IV on the previous blog post.

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