Jacquelyn Buffo

Alcohol use disorder (AUD) impacts many women across the country. In 2019, 8% of women ages 18 to 25 and 4% of women overall met the criteria for an AUD.1 AUD can contribute to many problems and can impact your ability to function on many levels. Alcohol impacts women differently than men. If you are concerned about your girlfriend’s drinking, seeking help early can lower the risk of many problems, including physical and mental challenges and relationship problems. It is important to know that help is available to both you and to her. Addiction can feel lonely and hopeless. Fortunately, there is hope, and you don’t have to go through this alone. [quote] The words “alcoholic,” “alcoholism,” and “alcohol abuse,” are all outdated terms that can contribute to stigma, which is negative beliefs that may lead to discrimination. Research shows stigma can worsen alcohol use disorder (AUD), prevent people from seeking help, and ultimately leads to worse outcomes. AUD is a chronic disease that people can and do recover from. [/quote] What Is Alcohol Addiction? Alcohol addiction, also known as alcohol use disorder (AUD), is a chronic brain disease, and recovering from an addiction is a complex process. It isn’t as simple as “just quitting.” AUD is defined as a medical disease that results in an inability to stop or control your alcohol use despite significant social, medical, or job problems it causes.2 Symptoms of AUD can range from mild to severe and are based on several factors, such as the amount of alcohol used, length of alcohol use, age, and other variables. The symptoms of AUD can present in behaviors, thoughts, and emotions. Because of this, symptoms of AUD can negatively impact others around you. If you love someone who is struggling with an AUD, you understand that addiction doesn’t just affect the person struggling with the disorder, it impacts the entire family. The negative effects of addiction are far-reaching and don’t remain confined to the person with the AUD. Does My Girlfriend Drink Too Much? Only a licensed mental health professional or doctor can diagnose someone with an AUD. But if you think your girlfriend may have a problem with alcohol use, there are warning signs you can look out for. Mental health and addiction professionals use the Diagnostic Statistical Manual of Mental Disorders- 5th Edition (DSM-5), to diagnose the presence of AUD. Some examples of the criteria used to make an AUD diagnosis include:2 Drinking more alcohol than intended or for longer than intended. Cutting back on activities that were once pleasurable and replacing them with drinking or drinking-related activities. Continuing to drink alcohol despite it causing problems in relationships with friends or family. Getting into dangerous or risky situations because of drinking. How to Approach an Alcoholic Partner Loving someone struggling with AUD can leave you feeling confused and powerless. You may be left wondering how to approach your partner and what to say about your concerns. It can feel like you’re walking a tightrope, not wanting to say something that will offend your partner but at the same time feeling desperate to help. The Substance Abuse and Mental Health Services Administration (SAMHSA) recognizes the difficulty loved ones face in communicating their concerns and offers resources to help you start the conversation. First and foremost, your loved one may not be in the best headspace, so it is essential to wait until they’re sober to have a conversation. Other suggestions from SAMHSA include:3 Pick an appropriate time and place. The setting should be private and calm, and the conversation should be conducted when you and your loved one are in a relaxed headspace. Be direct and discuss your concerns from a place of caring and love. Be direct and gentle with your concerns, and check in with your loved ones by asking them how they are feeling. Actively listen to your loved ones and validate their feelings. Don’t blame or judge your loved ones for their feelings. Offer to help. Ask what you can do to help and offer assistance where needed. Be patient. Change takes time, so be sure to set your expectations accordingly. Understanding effective and ineffective ways to talk to your loved one can be the difference between your loved one hearing your concerns or becoming defensive. Below are some strategies to help you be as effective as possible when communicating with your loved one about their addiction. What to Say to Someone with Addiction As previously stated, effective communication with your girlfriend involves being an active listener and validating. Validating is acknowledging your girlfriend’s truth, including her feelings and thoughts. You don’t necessarily have to agree or like what your loved one says to validate it. Don’t judge your loved one. If they feel judged, they can become defensive, which can impede communication and recovery. Effective communication statements include:3 “Can we talk? I’ve been concerned about you.” “It seems to me like you are struggling with some things. What can I do to help?” “I feel like you haven’t been your usual self lately. Do you want to tell me what’s going on? I’m here to help and listen” “I love you and care about you.” “How can I best support you right now?” What Not to Say to Your Loved One Common pitfalls that can impact your ability to effectively communicate with your partner about alcohol use can include lecturing and being critical or judgmental. Communicating with your partner doesn’t have to be critical, aggressive, or hostile. Effective communication includes strategies mentioned above, such as offering help and support and expressing concerns from a place of care and concern.4 Things to avoid when communicating with your partner about their alcohol use include:4 Don’t be aggressive, hostile, or negative. Keep a calm demeanor and voice, don’t name-call or judge your loved one, and adopt a perspective of hope. Don’t be confrontational or blame your partner. Remember that words such as “alcoholics” and “drunk” can be harmful. Instead, use factual observations to describe concerning behaviors. For example, “I have noticed that you have been going to the bar instead of going to your yoga class.” Don’t lecture or criticize. Lecturing your partner about past mistakes or what could happen in the future can be triggering and counterproductive for your partner. Don’t enable your partner. Enabling refers to protecting your loved one from the negative consequences of their substance use. Support for Partners of Alcoholics Loving someone with AUD is challenging and can take a toll on your mental and physical health. That’s why you must practice self-care. It is tough to be a source of strength and support to your loved one if you’re exhausted. Counseling and support groups, such as Al-Anon, SMART, and Recovery Family and Friends, can be a source of strength and support for you. Support groups can be a great resource for you to learn how to care for yourself and to learn effective coping strategies to help you effectively deal with your loved one.6 Support groups can also help you to healthily detach from your partner’s alcohol use and stop enabling behaviors.6 Enabling behaviors that protect your loved one from the consequences of their alcohol use can include:5 Lying for them. Making excuses for their behavior. Paying their bills or other financial assistance. Setting boundaries is the opposite of enabling and communicates to your girlfriend what your limits are around her behavior. Using “I” statements is effective in setting boundaries. Examples include: “I will not lie to your friends, family, or coworkers about your drinking any longer.” “I won’t bail you out of jail.” “I will not pay your rent anymore.” Treatment for Alcohol Addiction There are many different treatment options available to your girlfriend, including:7 Detox: Short-term, medical supervision during withdrawal to keep your girlfriend safe and as comfortable as possible while preparing her for the next phase of treatment. Inpatient rehab: 24/7 supervision that focuses on strengthening sobriety and learning how to live in recovery. Length can range from short-term to long-term, depending on the facility and your partner’s recovery needs. Outpatient treatment: This is the least intensive form of treatment. You attend therapy and other treatment sessions on an outpatient basis while adhering to your daily responsibilities at home. The best treatment setting for your girlfriend depends on many factors unique to her, such as the severity of her AUD, her insurance coverage, and her physical and mental health. If you have tried to encourage your girlfriend to get help and she has refused, you could try the CRAFT approach. The Community-Reinforcement and Family Training (CRAFT) approach is a strategy that family members use to help motivate their loved one to enter treatment through contingency management, life enrichment, communication skills training, and motivation building.8 The CRAFT approach works with the family to develop the skills necessary to effectively communicate and motivate the loved one to get the help they need and how to respond when they refuse. How to Find Treatment for My Girlfriend with AUD American Addiction Centers (AAC) has alcohol treatment facilities and programs throughout the country. AAC can help your girlfriend find a suitable treatment program and will work with her to create a treatment plan that is specific to her needs and recovery goals. Help is available to you and your girlfriend. Call [phone] to speak with a trained and compassionate admissions navigator today. Our admissions navigators can help answer questions you may have about the treatment process and can even help verify your insurance coverage. You and your girlfriend deserve help and support. Call AAC today. [vob] [accordion title="Treatment"] Aftercare Alcoholics Anonymous (AA) Alcohol detox Alcohol rehab centers Therapy Frequently Asked Questions (FAQ) [/accordion][accordion title="Alcoholism"] Alcoholism Co-Occurring Mental Disorders Comorbid Health Complications Effects of Alcohol How to Help An Alcoholic Interventions Mixing Alcohol and Other Substances Pregnancy Professions and Alcoholism Relapse Prevention [/accordion][accordion title="Helping someone you love"] Helping an Alcoholic Boyfriends Brothers Children Family members Fathers Friends Getting sober Grandparents Husbands Mothers Parents Partners Sisters Teens Wives [/accordion] [sources] Centers for Disease Control and Prevention. (2022). Excessive alcohol use is a risk to women’s health. National Institute on Alcohol Abuse and Alcoholism. (n.d.). Understanding alcohol use disorder. Substance Abuse and Mental Health Services Administration. (n.d.). Supporting a loved one dealing with mental and/or substance use disorders. Jones, L., Mulia, N., & Polcin, D. (2012). Substance users’ perspective on helpful and unhelpful confrontation: Implications for recovery. Journal of Psychoactive Drugs, 44(2), p.144-152. National Alliance on Mental Illness. (n.d.). Maintaining a healthy relationship. O’Farrell, T.J. (2012). Review of outcome research on marital and family therapy in treatment of alcoholism. Journal of Marital and Family Therapy. 38(1), p.122-144. National Alliance on Mental Illness. (n.d.). Treatment settings. American Psychological Association. (2011). Community-reinforcement and family training. [/sources] ...

Almost everyone who drinks alcohol has had the unpleasant experience of “the morning after.” According to the Alcohol Hangover Research Group, technically, hangover symptoms develop when an individual’s BAC (blood alcohol concentration) drops substantially, and the symptoms peak when the individual’s BAC is near zero. According to Scientific American, it is estimated that nearly three-quarters of individuals who use alcohol will experience some hangover effects at one time or another. If you or a loved one is consistently suffering from hangovers, it may be time to seek help. Our admissions navigators are available to speak with you about treatment any time of day. Call our hotline at [phone] to get the information you need to start your journey toward recovery today. Hangover Symptoms According to a review in the journal Alcohol and Alcoholism, controlled studies have listed the following symptoms of a hangover: Impaired cognitive functioning Drowsiness as a result of the effect of alcohol on REM sleep Feelings of general malaise Headache, nausea, stomach ache, and other flulike symptoms Feeling dizzy or faint Extreme thirst, most likely due to the diuretic effects of alcohol Extreme fatigue Other autonomic nervous system symptoms, such as racing heart, jitteriness, and perspiration Potential symptoms of alcohol withdrawal in individuals with serious alcohol use disorders Numerous individual reactions What Causes a Hangover? The causes of hangovers are poorly understood despite numerous explanations and research. According to a review published in the journal Human Psychopharmacology, there may be several different physiological alterations that result in the experience of a hangover in different individuals These pathophysiological alterations include: Increasing levels of acetaldehyde as a result of the breakdown of alcohol Dehydration as a result of alcohol use Metabolic acidosis, a condition that occurs when the balance of bases and acids in an individual’s bloodstream is thrown off, resulting in too much acid in the system Alterations in hormones as a result of alcohol use that decreases the availability of glucose in the system Increased burden on the cardiovascular system as a result of alcohol use Congeners, which are organic molecules that are found in some alcoholic beverages that may also lead to the effects of an alcohol hangover Some of these factors may help to explain why hangovers occur in some individuals. For instance, the production of acetaldehyde is the first step in the metabolic process when the liver breaks down the alcohol in the system, and this substance is extremely toxic. Levels of acetaldehyde can remain elevated in an individual system for hours after they have consumed alcohol. The substance is broken down to acetic acid by acetaldehyde dehydrogenase, and the efficiency and speed of this process is known to have a significant genetic component to it. For instance, Asians have a slower metabolic breakdown of alcohol than many other groups. High concentrations of acetaldehyde lead to more severe hangovers, and individuals with inefficient metabolisms that break down alcohol more slowly are less likely to become problem drinkers due to the adverse reactions they incur as a result of using even moderate amounts of alcohol; this explanation has been used to explain why fewer Asians have alcohol use disorders compared to other groups. In addition, the drug Antabuse (disulfiram) that interferes with the metabolism of alcohol in an individual’s system, resulting in a significant buildup of acetaldehyde and an extreme reaction, including nausea, vomiting, headache, flushing, etc., is used to discourage drinking in individuals with alcohol abuse issues. According to numerous sources, such as a review in the journal Current Drug Abuse Reviews, congeners are present in many different types of alcoholic beverages as a result of a byproduct of fermentation or added as flavoring or color enhancers. The ethanol in alcoholic beverages is not sufficient to produce most of the hangover effects that people experience, but the addition of congeners may aggravate hangovers. Congeners include numerous substances depending on the beverage, and research indicates that they may have an effect on the symptoms of a hangover. Dark liquors have a higher concentration of congeners than clear liquids. Research has shown that darker liquors are reported to produce worse hangover symptoms than clear liquids regardless of the alcohol content in the beverage. Methanol, a type of congener, is formed during fermentation, and its presence in alcohol can vary substantially depending on the distillation technique; thus, less expensive liquors, wines, etc., may be associated with higher levels of methanol. High levels of methanol are associated with more severe hangovers, metabolic acidosis, and even the slower breakdown of ethanol in the system, which could affect the severity of an individual’s hangover. Finally, according to the book Alcohol and Cardiovascular Disease, some other factors that may influence hangover severity include individual demographic factors, such as personality, gender, overall health, and age. The use of tobacco or other drugs while drinking can worsen the symptoms of a hangover. Physical activity while drinking alcohol may lessen hangover effects (e.g., dancing). A person’s general quality of sleep will also affect the severity of a hangover, such that individuals who are “light sleepers” may be more likely to develop hangover symptoms of higher severity. Hangover Cures According to a review in the journal Human Psychopharmacology: Clinical and Experimental, there is no real effective “cure” for a hangover other than time (letting the symptoms wear off) or to avoid alcohol use altogether, although some approaches may affect some symptoms to a small degree. From a prevention standpoint, some people actually regard hangovers as a potentially useful form of deterrence to alcohol abuse and the development of alcohol use disorders. According to the book The Science of Drinking: How Alcohol Affects Your Body and Mind, there are various well-known treatments for hangovers. The infamous “hair of the dog” approach that consuming more alcohol (e.g., having a Bloody Mary) will relieve the symptoms of a hangover is based on the belief that a hangover is actually a form of alcohol withdrawal. However, research indicates that this approach is more likely to produce an alcohol use disorder. Various food recommendations, such as eating fried foods or drinking tomato juice, are actually not effective. Taking a sauna or steam bath to “sweat it out” may actually be a dangerous practice due to dehydration. The use of oxygen has been reported to speed up the metabolic rate and reduce alcohol symptoms; however, research has indicated that this is not the case. The use of vitamins, such as vitamin B6, has not been shown to be effective except in some cases where extremely high doses may have a mild effect (see below). The use of caffeinated beverages, such as coffee, has not been demonstrated to affect the severity of an alcohol hangover. Although caffeine does have stimulant effects, which may result in an individual feeling a little more energetic and less “cloudy,” it is also a diuretic that can result in further dehydration. Numerous “miracle cures” are constantly being advertised. These “cures” are based on anecdotal evidence and should not be taken seriously. There may be substances in some of these “miracle cures” that can be potentially harmful, especially herbal substances that are manufactured in countries overseas, such as China and India, where there is little supervision on what goes into them. There may be some strategies that can assist in recovery from an alcohol hangover, but their effects are most likely minimal. According to a review in The Annals of Internal Medicine, remaining hydrated before or during drinking, or before going to bed, may assist in flushing out toxins and reducing the symptoms associated with dehydration, such as dry mouth, headache, thirst, etc. An article in the journal Current Drug Abuse Reviews reported that the use of nonsteroidal anti-inflammatory drugs (e.g., aspirin or Tylenol) can reduce certain symptoms, such as headache, muscle ache, etc., but they do not prevent hangovers. However, abuse and overuse of these drugs is associated with potential damage to the liver. Using other medications for specific symptoms may reduce their severity, such as anti-nausea medication. The use of extremely high doses of synthetic vitamin B6 (e.g., from a substance known as pyritinol) may have some minor effects, but there are significant risks in taking extremely high doses of the substance that include acute pancreatitis and even liver damage. Thus, the cure may be as potentially harmful as the use of alcohol. How Long Do Hangover Symptoms Last? The only surefire way to decrease the symptoms of a hangover is to let them run their course, drink plenty of fluids, relax, and take it easy. For most people, the symptoms of a hangover are resolved within 24 hours after they have stopped drinking. There are some practical strategies that may reduce the intensity of hangovers. Pay attention to the type of alcohol one consumes. Alcohol hangover severity may be reduced to some extent with the use of clear alcoholic beverages. Pay strict attention to the amount of alcohol one consumes. Consuming less alcohol will result in less severe hangovers. As mentioned above, remaining hydrated may have some utility in dealing with dehydration. Know your body and know your limits. Simply do not use alcohol. The bottom line is quite simple: There are no reliable cures for hangovers due to alcohol use and abuse other than waiting for the symptoms to subside on their own or simply not engaging in the use of alcohol. ...

Via different (though sometimes overlapping) mechanisms, both alcohol and drugs can have profound effects on the brain.1 While each substance may have a somewhat differential effect on various neural functions and the physiological processes that they control, certain combinations may result in dangerously synergized intoxicating effects, which can lead to serious adverse consequences for the user.27 Alcohol also affects our feelings, sometimes in conflicting ways, such as causing sentiments of happiness and excitement as well as sadness and depression.2 These effects can be short- or long-term. Some instant behavioral and cognitive outcomes include delayed response times, slurred speech, trouble walking, and diminished memory.3 Long-term consequences of alcohol abuse can be more severe and even irreparable. These can include physical health problems like cirrhosis of the liver and cognitive problems such as memory loss. OxyContin, an opioid generally prescribed for significantly severe pain conditions. As their primary indication for treatment, opioid agonist medications like OxyContin bind to and activate opioids receptors in throughout the brain and spinal cord to alter the perception of pain signaling.4 However, the full spectrum of physiological effects does not stop there, as oxycodone use may also impact vital respiratory and cardiovascular processes. Since alcohol itself is a CNS depressant, it also its own physiological impact on important processes such as breathing and cardiovascular function. Because on their own, both can have dangerous side effects, when combined, they create more severe and possibly life-threatening outcomes.5 Statistics on Alcohol and Opioid Use Given the staggering prevalence in opioid and alcohol abuse,6,7 the potentially devastating health risks posed by this combination of substances deserves closer attention. U.S. & Global Alcohol Facts As of 2018, alcohol is the third leading preventable cause of death in the United States, leading to an estimated 88,000 fatalities a year.20 Globally, 3 million deaths from harmful use of alcohol occur every year, representing 5.3% of all deaths.21 Overall 5.1% of the global burden of disease and injury is attributable to alcohol.21 1 million adults—9.8 million men and 5.3 million women ages 18 and older—had an alcohol use disorder (AUD) in 2015.20 In 2015, only 6.7% of adults who had AUD in the past year received treatment.20 6 million people ages 12 and over reported binge drinking in the month prior to the 2017 National Survey on Drug Use and Health (NSDUH).22 U.S. & Global Opioid Facts According to the 2017 NSDUH, an estimated 2 million Americans misused prescription painkillers for the first time within the past year.22 1 million people had an opioid use disorder between 2016-2017.7 More than 130 people died each day from opioid overdose from 2016-2017.7 17,087 people overdosed from commonly prescribed opioid pain medications between 2016 and 2017. 7 Opioid-related emergency room visits increased 30% from 2016-2017. 6 In the U.S., both the sales of and deaths related to prescription opioids have quadrupled since 1999.6 People are 40 times more likely to develop an addiction to heroin if already addicted to prescription opioid painkillers.6 Combining Oxy and Alcohol How the effects of both alcohol and OxyContin are felt will be influenced by several factors, including age, gender, body weight, and the presence of any tolerance. Common side effects of alcohol use include:2,27 Memory loss. Irregular or slowed breathing. Slow reaction time. Difficulty processing sensory information. Depressed mood. Increased risk for suicide. Motor incoordination, resulting in slurred speech, difficulty walking, etc. Impaired judgment and decision-making. Opioid side effects, including some that resemble those of alcohol use, include:8,27 Drowsiness. Fatigue. Respiratory depression or arrest (slowed or stopped breathing). Confusion. Dizziness. Decreased energy levels and strength. Dry mouth, nausea, and vomiting. Constipation. Itching and sweating. Short-Term Side Effects Alcohol may enhance the effects of some concurrently-taken drugs; this includes both prescription and illicit drugs. 9 Short-term side effects of combining OxyContin and alcohol can include: 10 Sedation. Drowsiness. Impairment in motor skills. Impairment in the ability to operate a vehicle. Memory problems. Unusual behavior. Difficult or slowed breathing. Respiratory arrest. Increased risk of overdose. Long-Term Health Risks Chronic use of both alcohol and OxyContin can also have serious long-term consequences. Health risks of heavy alcohol use alone include:2 Chronic liver inflammation and damage. Cirrhosis. Increased risk of liver cancer. Gastritis. Atrophy of the brain. Memory loss. Chronic hypertension. Cardiac arrhythmias. Increased vulnerability to acquiring cancer in the stomach, pharynx, mouth, and esophagus. Combined with OxyContin use, those long-term effects can also include: Increased risk for risk of aspiration and/or asphyxiation which could lead to injury or death due to reduced cough reflexes and increased risk of vomiting when highly intoxicated.9 Increased risk of being unable to breathe due to a reduction in respiratory drive. 9 Along with their individual short- and long-term side effects, using alcohol in combination with OxyContin or other opioid pain relievers is a very dangerous combination. Because these drugs suppress areas in the brain that control vital functions such as breathing, consuming alcohol could produce an overdose by intensifying their individual effects.27 Specialized Treatment Programs For Polysubstance Use When a person is physically dependent on either alcohol or OxyContin, or both, a medical detox program may be needed to allow for withdrawal management in a safe, stable, and medically-monitored environment. Withdrawal symptoms can be significant and include both physical and emotional symptoms; medical detox avails certain medications to alleviate some of these potentially-unpleasant symptoms, decrease the risk of experiencing certain withdrawal complications and, even, decrease cravings as an individual embarks on their recovery efforts.28 The acute alcohol withdrawal syndrome can be life-threatening because of the potential for seizure development. Some individuals are at risk of developing an extreme presentation of alcohol withdrawal known as delirium tremens (DTs), which can include hallucinations, severe mental confusion, fever, and seizures.29 It is not always easy to predict who is at risk for severe and/or complicated alcohol withdrawal, but may be even more of a challenge in cases of polysubstance use. Opioids and alcohol are two substances that should not be stopped "cold turkey" due to the likelihood for significantly unpleasant, and potentially dangerous withdrawal symptoms.28 When two or more substances are combined, such as alcohol and OxyContin, withdrawal can be even more unpredictable than with either substance alone; in such an instance of polysubstance withdrawal, medications are quite likely to be needed to manage difficult withdrawal symptoms. A medical detox team familiar with compound withdrawal syndromes will work carefully to monitor for and medically manage withdrawal symptoms and decreasing the likelihood of complications such as seizures, agitation, and other acute withdrawal-related health issues. Medical and mental health professionals on staff at a medical detox program will monitor vital signs and apply various interventions to stabilize a person in early recovery as prepare to continue on with additional addiction treatment. When polysubstance abuse or co-occurring disorders are present, a residential addiction treatment program is a frequently sought treatment setting, as it may be best equipped to provide 24/7 monitored care, structure, encouragement, and support.30 Individuals are able to focus fully on recovery and their overall health and wellbeing in a comprehensive inpatient addiction treatment program. A specialized addiction treatment program may use a combination of therapy, counseling, support groups, holistic measures, and medications to boost overall wellness and sustained recovery.30 Further Reading on Mixing Alcohol With Other Opiates Codeine Dilaudid Fentanyl Heroin Hydrocodone Hydromorphone Lortab Methadone Morphine Norco Oxycodone Percocet Tramadol Vicodin [sources] [1]. U.S. National Library of Medicine. (2014). Neurotransmitters in alcoholism: A review of neurobiological and genetic studies. [2]. National Institute on Alcohol Abuse and Alcoholism. (n.d.) Alcohol's Effects on the Body. [3]. National Institute on Alcohol Abuse and Alcoholism. (2004). Alcohol alert. [4]. National Institute on Drug Abuse. (2007). Prescription drugs. [5]. University of Michigan. (n.d.). The effects of combining alcohol with other drugs. [6]. Center for Disease Control and Prevention. (2016). Alcohol and drug use. [7]. U.S. Department of Health and Human Services. (2018). The opioid epidemic by the numbers. [8]. Center for Disease Control and Prevention. (2017). Prescription opioids. [9]. Weathermon, R. & Crabb, D.W. (1999). National Institute on Alcohol Abuse and Alcoholism. Alcohol and medication interactions. Alcohol Research & Health. 23(1), 40-54. [10]. National Institute on Alcohol Abuse and Alcoholism. (2014). Mixing alcohol with medicines. [11]. American Society of Anesthesiologists. (2017). Mixing opioids and alcohol may increase likelihood of dangerous respiratory complication, especially in the elderly, study finds. [12]. U.S. National Library of Medicine. (n.d.). Substance abuse treatment for persons with co-occurring disorders. [13]. National Institute on Alcohol Abuse and Alcoholism. (n.d.) Treatment of co-occurring alcohol and other drug use disorders. [14]. U.S. National Library of Medicine. (2004). Alcohol withdrawal syndrome. [15]. U.S. National Library of Medicine. (2019). Alcohol withdrawal. [16]. U.S. National Library of Medicine. (2018). Opiate and opioid withdrawal. [17]. U.S. National Library of Medicine. (2009). Co-occurring disorders in substance abuse treatment: Issues and prospects. [18]. U.S. National Library of Medicine. (2016). Facing addiction in America; The Surgeon General’s report on alcohol, drugs and health: Chapter 4. [19]. Sullivan EV, Harris RA, Pfefferbaum A. (2010). Alcohol's effects on brain and behavior. Alcohol Res Health. 33(1-2):127–143. [20]. National Institute on Alcohol Abuse and Alcoholism. (2018). Alcohol Facts and Statistics. [21]. World Health Organization. (2018). Alcohol. [22]. Substance Abuse and Mental Health Services Administration (SAMHSA). (2018). 2017 National Survey on Drug Use and Health. [23]. MedlinePlus. (2019). Substance Use Disorder. [24]. American Psychiatric Association. (2013). Substance Use Disorders. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). 483-484. [25]. Center for Substance Abuse Treatment. (2005). Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs. Treatment Improvement Protocol (TIP) Series, No. 43. Chapter 12. [26]. Carroll K. M. (2004). Behavioral therapies for co-occurring substance use and mood disorders. Biological psychiatry, 56(10), 778–784. [27]. National Institute on Alcohol Abuse and Alcoholism. (2018). Understanding the Dangers of Alcohol Overdose. [28]. Bayard, M., Mcintyre, J., Hill, K.R., Woodside, J. Alcohol Withdrawal Syndrome. American Family Physician 69(6): 1443-1450. [29]. Rahman A, Paul M. (2018). Delirium Tremens (DT). U.S. National Library of Medicine. [30]. National Institute on Alcohol Abuse and Alcoholism. (2018). Common Comorbidities with Substance Use Disorders. [/sources] ...