James Regan

Alcohol addiction rehabilitation programs generally involve inpatient or outpatient treatment settings. The former, inpatient/residential treatment programs, are ideal for patients who have relatively more severe alcohol use disorder (AUD) and addiction-related issues or those who lack a safe, stable, and supportive living situation.1 Though there may be some distinctions in terms of exact clinical setting, the range and intensity of treatment offerings, as well as billing details, the concepts of “inpatient” and “residential” have some overlap. Both provide 24-hour supervision and care, while the more intensive inpatient programs may place additional focus on medical services, such as withdrawal symptom management during detoxification.2 Given their varying individual needs, patients entering rehab may at some point have to make a choice between long-term and short-term residential treatment. Many patients stay at a residential treatment facility for 7-30 days, though studies have shown that addiction treatment outcomes may be optimized when patients remain in a program for a substantial length of time—often 90 days or longer.3,4 Inpatient treatment can be especially beneficial for patients who:5 Have severe addictions and a higher probability of relapse. Have unstable, unsafe, or unsupportive living environments. Have co-occurring mental disorders or physical health problems. Need a highly structured routine and more intensive care to manage their addiction. Short-Term and Long-Term Residential Treatment Historically, many short-term residential treatment programs involved a relatively short duration (3 to 6 weeks) of intensive treatment based on a modified 12-step approach.6 Patients who complete such a residential program are encouraged to continue with additional outpatient programming or other forms of aftercare programs to decrease the chances of relapse.6 Long-term residential treatment typically takes place in a non-hospital setting, with varying lengths of stay depending on the specific program.6 One approach to long-term residential care is the therapeutic community (TC) model, in which people may expect to reside and participate in treatment programming for as long as 6 to 12 months, as needed. A therapeutic community may aim to “re-socialize” the patient by providing the opportunity for therapeutic interaction with other residents, staff, and the social context of the program. TCs can help recovering individuals build personal responsibility, accountability, while addressing pertinent psychological and social problems in the process.6 A therapeutic community can help treat individuals from a variety of different demographics with various mental health considerations.6  Often, patients will complete some form of initial residential treatment and, next, step down or move into relatively less intensive levels of care such as outpatient, where they are allowed to live off-site while still receiving treatment.7  Is Detox the Same as Inpatient Treatment? Before much of the work of rehabilitation begins, patients must sober up and allow their body to clear itself of the lingering effects of alcohol through a process called detoxification.8 Though detoxification is an important first phase of rehab, and may take place in an inpatient setting, it is not a substitute for more comprehensive inpatient or residential rehabilitation. On its own, detox is unable to adequately address many of the psychological, social, and behavioral problems associated with addiction.8 Medical detox is often essential for people with severe AUD and significant physiological alcohol dependence, as unmanaged alcohol withdrawal can be dangerous. The detox process often consists of supervision, counseling and, when needed, medication to manage withdrawal symptoms.8 Alcohol Withdrawal Alcohol withdrawal symptoms commonly begin within 8 hours after the last drink, but may not arrive for several days, in some cases.9 Alcohol withdrawal symptoms often peak in severity by 24-72 hours and subside after 4-5 days, though mild effects may last for several weeks.9 Characteristic symptoms of alcohol withdrawal may include:9 Irritability and mood swings. Anxiety. Depression. Insomnia. Bad dreams. Nausea. Tachycardia (fast heart rate). Fever. Excessive sweating. Shakiness and tremors. Seizures. Agitation. Hallucinations and severe confusion. Benzodiazepines (such as diazepam and chlordiazepoxide) are often used to manage alcohol withdrawal symptoms and decrease the risk of dangerous withdrawal complications including seizures.8 One of the main goals of detox (besides ensuring patients’ safety as they withdraw) is to facilitate entrance into a rehabilitation program. Detoxification alone may be insufficient to produce the lasting behavioral changes needed for long-term recovery from alcoholism.8 Individuals benefit from learning positive coping mechanisms and behaviors in the next steps of rehabilitation to better reduce their risk of relapse.3 What to Look for in an Inpatient Rehabilitation Program Addiction is a complex disease, and there is no one solution that will work for all individuals. However, many effective treatment approaches combine evidence-based behavioral therapy with prescribed medications (e.g., detox medications and, post-withdrawal, acamprosate, disulfiram, naltrexone, when appropriate).4, 10 The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommends considering the following when choosing a treatment facility:10  The different treatment methods offered at the facility and how these are prescribed to the individual. A varied approach is often necessary when treating alcoholism; a rehabilitation center that relies on one method may be less effective than a facility that uses all available approaches. How the facility measures the success of the treatment. Success can be measured by different metrics. Look for treatment outcomes that can be used to compare across different facilities, if multiple programs are available. How the facility deals with relapse. Addiction is a chronic disorder and therefore it is common for patients to relapse after completing rehab. An effective treatment center will address relapse within their programming and may even offer support to getting patients into aftercare programs to prevent relapse once treatment is complete. Relapse does not necessarily mean that rehabilitation was unsuccessful—it may just mean that the program prescribed to the individual needs adjustment. There are several other factors that may influence an individual’s decision as well. This includes: Whether the facility is equipped to treat co-occurring disorders as well as substance abuse. Dual diagnosis is very common among individuals suffering from addiction and studies show that treating all problems simultaneously is more effective than attempting to treat them separately. 5,11 Licensing and certification. Different states, cities, and counties may have different requirements for licensing or certification. For example, all treatment facilities in California must be licensed by the Department of Health Care Services (DHCS).12 There are several other optional certifications a facility may also have, including: Accreditation from the Commission on Accreditation of Rehabilitation Facilities (CARF), which demonstrates accountability and adherence to international standards for excellent care. The American Society of Addiction Medicine (ASAM) Level of Care Certification is given to rehabilitation centers that have been independently assessed and demonstrated the ability to provide evidence-based treatment to patients. If there are alternative therapies provided at the facility. Many patients respond well to alternative therapies as a complement to evidence-based approaches. Alternative therapies may include: Art therapy. Music therapy. Horse-assisted therapy (or equine therapy). Yoga therapy. The amenities provided at the treatment center. These features can make a stay in residential treatment more comfortable for someone in recovery. Location of treatment. Some patients may prefer a facility that is close to home, while others may benefit from putting more distance between them and their home environment. Inpatient Treatment With AAC Often, taking the first step toward rehabilitation can be the hardest part of recovery. Alcohol.org is a subsidiary of American Addiction Centers (AAC), a nationwide provider of addiction treatment facilities, and we understand the need for safe, comfortable and supportive care for those seeking recovery. AAC’s facilities offer a combination of proven therapies and services to meet your individual needs. Here’s what you can expect when choosing an AAC facility: Admissions Upon contacting an admissions navigator, potential patients may be asked for their: Insurance information. History with substance abuse and the severity of the problem. This includes: How much and how often they drink. Whether they use any other drugs in conjunction with alcohol. Their family history with substance abuse. If they have any co-occurring mental health issues or medical concerns. The admissions navigator will verify insurance, explain options for treatment, explain the admissions process and make payment arrangements if needed. They can also direct individuals to other options if insurance won’t cover treatment at an AAC facility. Since addiction treatment works best when it is tailored to the individual, AAC facilities provide specialized rehabilitation tracks for certain groups (available groups may vary depending on location). There are specialized tracks for: LGBTQ+. Veterans and first responders. Faith-based. People with chronic mental illness. Healthcare professionals. People in these programs can benefit from the specialized treatment that these groups provide. For example, studies show that addiction treatment groups with specialized programs for gay and bisexual men fared better in treating those clients than non-specialized groups treating gay and bisexual men.12 The community in these groups is also uniquely supportive of their shared struggles. For instance, veterans may feel more comfortable sharing during group therapy surrounded by people that may have undergone similar traumatic experiences. Treatment Once admitted to a facility, patients are: Greeted by staff upon arrival and shown to their rooms. Given admissions paperwork to complete. Given a health and psychiatric evaluation to determine if medical detoxification and other safety measures need to be taken. Prepared for their personalized treatment plan in a conversation with staff, who will go over the details and schedule. While treatment methods can vary greatly based on the needs of the individual, one of the benefits of an inpatient program is that it entails a daily routine and complete immersion in a setting that supports recovery. Patients in residential treatment at an AAC facility have a set schedule, with time set aside for a variety of programs throughout the day, including: Group and individual therapy. Coping skills education. Relapse prevention classes. Alternative therapies. After Completing Treatment with AAC Since recovery is a lifelong process, many patients benefit from support maintaining sobriety after they leave inpatient treatment. Aftercare, or continued care, is important for all people in recovery, but it is especially vital that people with any co-occurring social, medical, or mental health issues continue to receive therapy and medication if necessary.7 The Center for Applied Behavioral Health Policy at Arizona State University outlines 5 pillars of effective aftercare. These include:13 Coping strategies to help a person in recovery deal with social and emotional pressure. Relapse prevention. The opportunity to receive education or vocational training is essential to continued care. Continued therapy is needed for patients to create and respect boundaries for themselves and others. Patients must learn to take part in sober activities and create relationships. Aftercare for some may mean transferring to a partial hospitalization program or other outpatient level of care following initial inpatient or residential rehabilitation. For others, self-help and peer support groups provide valuable aftercare support; the most well-known form being 12-step programs such as Alcoholics Anonymous.7 Many treatment programs will recommended that patients remain in  aftercare programs for at least 1 year, though adolescents may benefit from longer durations of continuing care.14 Patients that complete residential treatment at an AAC facility often benefit from other forms of support as well, such as an alumni network that many treatment centers provide. These programs allow individuals in recovery to stay in contact with their peers and often hold sanctioned events and meetings in which alumni and their family members can participate. Discuss Your Treatment Options If you’re ready to seek treatment for alcoholism, American Addiction Centers can help. Our admissions navigators are available 24/7 to discuss your treatment options with you and all calls are 100% confidential. We know the choice to get sober isn’t easy, but we’ll be with you every step of the way and can answer any questions you may have about treatment, addiction, life after rehab and long-term recovery support. It's important that you find the best treatment option for you in order to prevent relapse in the future. Will insurance pay for treatment? Find out now: [vob] [sources] [1]. National Institute on Alcohol Abuse and Alcoholism. (n.d). Why do different people need different options? [2]. National Institute on Alcohol Abuse and Alcoholism (n.d.). What types of alcohol treatment are available?  [3]. Substance Abuse and Mental Health Services Administration. (2015). A Treatment Improvement Protocol No. 45. Rockville, MD. U.S. Department of Health and Human Services. [4]. National Institute on Drug Abuse. (2018). Principles of effective treatment. [5]. National Institute on Drug Abuse. (2019). Treatment approaches for drug addiction. [6]. National Institute on Drug Abuse. (2018). Types of Treatment Programs. [7]. Substance Abuse and Mental Health Services Administration. (2006). Treatment Improvement Protocol No. 47. Rockville, MD. Center for Substance Abuse Treatment. [8]. Hayashida M. (1998). An overview of outpatient and inpatient detoxification. Alcohol health and research world, 22(1), 44–46. [9]. U.S. National Library of Medicine. (2020). Alcohol withdrawal. [10]. National Institute on Alcohol Abuse and Alcoholism. (2014). Treatment for alcohol problems: finding and getting help. [11]. National Institute on Drug Abuse. (2020). What are the treatments for comorbid substance use disorder and mental health conditions? [12]. National Institute on Drug Abuse. Substance Use and SUDs in LGBTQ* Populations. [13]. Patton, D. and McDowell, T. Substance Abuse Aftercare Treatment. Arizona State University, Center for Applied Behavioral Health Policy. [14]. Substance Abuse and Mental Health Administration. (2014). What is Substance Abuse Treatment? A Booklet for Families. HHS Publication No. (SMA) 14-4126. [/sources] ...

What is Comorbidity? A comorbidity is when 2 or more illnesses are present within a single person, which can be medical or psychiatric conditions.1 This includes substance use disorders such as alcoholism, or an alcohol use disorder.1 According to the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC), alcohol increases the risk of over 200 diseases and health conditions, including:2,3 Colon, liver, mouth, breast, throat, and esophagus cancer. Dementia. Various cardiovascular problems. Gastrointestinal issues. Liver disease. Weakening of the immune system. While two or more conditions may occur in a person, it does not necessarily mean that one caused the other, even when one comes first.1 At times, alcoholism and a comorbid condition can be caused by unknown, separate conditions.1 Other times, it may simply be a coincidence.1 Regardless of the cause, alcohol misuse and medical or psychiatric comorbidities often worsen each other’s symptoms.1 Learn more about how patients suffering from alcoholism and other chronic medical conditions are at an increased risk of worsening current disorders or cause new ones to develop. Find more information on mental health comorbidities that are commonly seen with alcoholism here. Chronic Pain and Alcoholism According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), up to 28% of people with chronic pain use alcohol to relieve their symptoms.4 Similarly, between 43% and 73% of people with alcohol use disorder (AUD) report having chronic pain.5 Chronic pain may be caused by numerous sources, including the natural aging process, injuries, as well as underlying diseases, such as fibromyalgia, cancer or rheumatoid arthritis.6 Extended periods of alcohol use can actually induce symptoms of pain as well as exacerbate chronic pain, making it worse over time.4 Chronic alcohol use may also contribute to the development of small-fiber peripheral neuropathy, which manifests in different ways, including weakness and pain in the feet or hands.4,7 Though alcohol use has been shown to alleviate certain types of pain in clinical studies, alcohol’s use as a means for effective pain management may be short-lived, as regular alcohol use will eventually lead to tolerance, where an individual must consume more alcohol to get the same desired effect. This could put a person at risk of binge drinking, which is typically considered as 5 drinks for men and 4 drinks in for women in a 2-hour time period, or heavy drinking, which is considered more than 4 drinks on any day for men or more than 3 drinks for women.8 These levels of drinking may put individuals at risk for a number of other alcohol-attributable illnesses and injuries, including an alcohol use disorder.8 Alcohol consumption can also cause dangerous reactions when paired with both narcotic and over-the-counter pain relievers or sedatives, which can also reduce perceptions of pain. For example, mixing alcohol with:4,9 Prescription opiates heightens many of the drug’s sedative, analgesic and reinforcing effects which may lead to a physical dependency on the drug and increase the risk of overdose. Benzodiazepines, which are sometimes prescribed for the treatment of pain, have an additive effect on depressing the body’s central nervous system, leading to decreased mental function, slow and difficult breathing, and/or a loss of coordination. Acetaminophen (Tylenol) can lead to acute liver failure. Aspirin can increase the risk of gastric bleeding. In addition to the dangers associated with mixing substances, withdrawal and detoxification from alcohol increases pain sensitivity, making detoxification especially difficult for people suffering from chronic pain. Comorbid Medical Conditions Commonly Seen with Alcoholism Alcohol's effects extend to nu merous organs and body systems. Alcohol may not directly cause a person's comorbid medical disorder, but it may contribute to its development and/or worsen the symptoms and course of it. Alcohol’s effects on the body include: Diabetes High alcohol consumption and binge drinking has also been shown to increase the risk of Type II diabetes.10 In addition, alcohol abuse has shown to worsen blood sugar control in both Type I and Type II patients, regardless of diet.11 In patients with a healthy diet, long-term alcohol use raises levels of blood sugar, while it has the opposite effect on patients that are poorly nourished.11 Both have serious consequences such as ketoacidosis (which may cause a diabetic coma) or hypertriglyceridemia (which may cause pancreatitis or a hardening of the arteries).11 Diabetics who are heavy drinkers are also at an increased risk for medical complications such as:11 The buildup of acid in the blood. Disturbances in fat metabolism. Nerve damage. Eye disease. Cardiovascular diseases. HIV/AIDS Chronic heavy drinkers have an increased risk of contracting and spreading sexually communicable diseases like HIV, which may be due to impaired judgement and risky sexual behavior.12 Alcohol abuse also negatively affects the efficacy of HIV/AIDS detection and treatment in various ways, including:12,13 Causing someone to postpone getting tested or seek treatment. Early detection and intervention with HIV/AIDS is crucial in effective treatment. Making it harder for patients to follow the complex and strict treatment regimen required for treating HIV/AIDS. Damaging the liver which can lead to an HIV infection spreading faster. Increases the susceptibility of a person with AIDS getting tuberculosis, hepatitis C, pneumonia, and AIDS-related brain damage and dementia. Studies have shown that HIV/AIDS patients with alcohol use disorder that give up drinking have more successful outcomes than those who do not.13 Cardiovascular Conditions and Diseases Excessive drinking has complex effects on the cardiovascular system and can worsen existing cardiovascular conditions.14 Conditions that may be caused or influenced by alcohol use include coronary heart disease, cardiomyopathy, stroke, hypertension, and peripheral arterial disease.15 Along with unhealthy diets, tobacco use, and a lack of physical activity, alcohol use is one of the main behavioral risk factors of heart disease and stroke.14 Other physiological effects due to excessive alcohol use include oxidative stress, changes in circulation, inflammatory response, mitochondrial dysfunction, cell death, and anatomical damage to the cardiovascular system.15 However, many cardiovascular diseases can be prevented or improved by addressing the behavioral factors that may have led to these conditions in the first place (i.e., abstaining from or limiting the amount of alcohol consumed).14,15 Liver Damage and Disease Liver disease is one of the possible severe medical consequences of chronic alcohol use.16 The liver may become inflamed and/or scarred over time with consistent alcohol abuse.16 Conditions such as alcoholic hepatitis, fibrosis, fatty liver, cirrhosis or even liver cancer may develop. 16,17,18  However, not all heavy drinkers will develop alcoholic liver disease; but the chances go up the longer you have been drinking and the more your drink.16 For many people, fatty liver disease is the first sign of a potentially larger problem with this vital organ.18 It’s important to note the symptoms of liver disease in order to prevent further damage or seek treatment early on. Some symptoms may include:19 Weight loss. Fatigue. Nausea and vomiting. Fever. Appetite loss. Jaundice (yellowing of the skin and eyes) Fluid build-up in the belly. Bleeding in the intestines. Liver cancer. For the liver to fix some of the damage caused by alcohol, individuals must quit drinking altogether.19 A treatment program may be required or encouraged if the damage is attributable to heavy and uncontrollable drinking. Though the scarring from cirrhosis is sometimes partially reversible, when liver tissue loss is severe enough, the damage may be permanent.19 Pancreatitis and Gastrointestinal Issues When alcohol is consumed, it passes through the gastrointestinal (GI) tract first and gets absorbed into the bloodstream.20 The gastrointestinal system is uniquely susceptible to the damaging effects of alcohol.20 Excessive alcohol use is associated with injury to all parts of the GI tract, with chronic pancreatitis being a significant cause of illness and mortality.6,20 Alcohol use can lead to a number of complications and GI diseases:20,21 Disrupt the movement of stomach muscles and impedes gastric acid secretion. Inhibit the ability of the intestines to pass food along. Prevent the absorption of nutrients in the intestines. Cause gastroesophageal reflux disease by slowing esophageal movement. Inflame the intestines and changes the composition of microorganisms and impedes the immune system of intestinal mucosa, which lines the intestinal tract. Can lead to esophageal, gastric, oropharyngeal, and colon cancer. Endocrine and Reproductive Issues Alcohol use disorder has been associated with harmful effects on bone health, specifically decreased bone mass and an increased risk of skeletal fractures. Excessive drinking also increases the risk for developing osteoporosis later in life.6,22 Chronic heavy drinking impedes calcium absorption and diminishes production of vitamin D, further weakening bones.22 People with AUD disproportionately suffer hip and vertebral fractures when compared with the general population.22 Alcohol abuse also affects hormone production in both men and women.22 People with alcohol use disorder often have high levels of cortisol, which causes bone breakdown and slows bone development.23 In men, alcohol may inhibit testosterone production, which is vital in producing osteoblasts (the cells that stimulate bone formation).22 Alcohol consumption also may make a woman’s menstrual cycle irregular, reducing estrogen levels and putting them at a higher risk for osteoporosis.22 In pregnant women, a higher incidence of miscarriages, placental abruption, preterm deliveries, and stillbirths can occur in those with higher intakes of alcohol.6 As few as 1 to 5 drinks a week in a Danish study and about one drink a week in an American study was associated with infertility.6 Brain and Central Nervous System Conditions Alcohol also negatively impacts brain function well beyond the temporary impairments of drunkenness. Chronic heavy drinking can lead to cognition and memory problems.23,24 The most serious effect of alcohol on the brain is Korsakoff's syndrome, an inability to remember recent events or to learn new information.1 In the U.S., this type of alcohol-related brain damage makes up approximately 10% of adult dementias.1 However, with abstinence, milder attention and memory deficits may improve gradually.1 Many of the mechanisms by which alcohol damages the brain are still unknown; however, researchers have discovered that excessive consumption stifles the central nervous system, kills brain cells, and contracts brain tissue.25 Epilepsy is a common comorbidity with alcohol use disorder.26 In fact, when compared to the general population, patients with an alcohol dependency are estimated to be 3 times as likely to have epilepsy.26 Heavy alcohol consumption has also been shown to increase the risk of seizures in epileptic people.27 Treating Comorbid Medical Conditions and Alcohol Use Disorder Research shows that treating individuals with substance use disorders and co-occurring physical or mental health issues have better outcomes when an integrated approach to treatment is taken.28 In other words, simultaneous treatment of alcoholism as well as a person’s chronic pain is more effective than a singular focus on one or the other.28,29 If you or a loved one is suffering with alcoholism, consider reaching out to an American Addiction Centers (AAC) admissions navigator for information about treatment. Alcohol.org is a subsidiary of AAC, a nationwide provider of addiction treatment centers. Our facilities are well-equipped to provide treatment for people dealing with addiction alongside both physical comorbidities and co-occurring mental disorders. Call us to learn more about our approach to treatment, get more information on our facilities or speak to someone about your insurance coverage. All calls are 100% confidential and there is no obligation to make a decision right away. [sources] [1]. National Institute on Alcohol Abuse and Alcoholism (1991). Alcoholism and Co-occurring Disorders. Alcohol Alert. 14(302). [2]. World Health Organization. (2018). Alcohol. [3]. Centers for Disease Control and Prevention. (2021). Alcohol Use and Your Health. [4]. National Institute on Alcohol Abuse and Alcoholism. (2013). Using alcohol to relieve your pain: what are the risks? [5]. Witkiewitz, K., & Vowles, K. E. (2018). Alcohol and Opioid Use, Co-Use, and Chronic Pain in the Context of the Opioid Epidemic: A Critical Review. Alcoholism, clinical and experimental research, 42(3), 478–488. [6]. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer. [7]. Julian, T., Glascow, N., Syeed, R., & Zis, P. (2019). Alcohol-related peripheral neuropathy: a systematic review and meta-analysis. Journal of neurology, 266(12), 2907–2919. [8]. Centers for Disease Control and Prevention. (2019). Binge Drinking. [9]. Schmitz A. (2016). Benzodiazepine use, misuse, and abuse: A review. The mental health clinician, 6(3), 120–126. [10]. Calsson, S., Hammar, N., Grill, V., & Kaprio, J. (2003). Alcohol Consumption and the Incidence of Type 2 Diabetes. Diabetes Care. 26(10): 2785-2790. [11]. Emanuele, N. V., Emanuele, M. A., & Swade, T. F. (1998). Consequences of alcohol use in diabetics. Alcohol Health and Research World. 22(3): 211–219. [12]. National Institute on Alcohol Abuse and Alcoholism. (n.d.). HIV/AIDS. [13]. National Institute on Alcohol Abuse and Alcoholism. (2002). Alcohol and HIV/AIDS. [14]. World Health Organization. (2017). Cardiovascular diseases. [15]. Piano M. R. (2017). Alcohol's Effects on the Cardiovascular System. Alcohol Research: Current Reviews, 38(2), 219–241. [16]. MedlinePlus. (2019). Alcoholic liver disease. [17]. Centers for Disease Control and Prevention. (2018). Liver Cancer. [18]. National Institute on Alcohol Abuse and Alcoholism (NIAA). (n.d.). Alcohol’s Effects on the Body. [19]. Johns Hopkins Medicine. (n.d.). Alcohol-induced liver disease. [20]. Christiane Bode, Ph.D., J. Christian Bode, M.D. (1997). Alcohol’s Role in Gastrointestinal Tract Disorders. Alcohol Health & Research World, Vol 21, 86-83. [21]. Bishehsari, F., Desai, V., Forsyth, C. B., Keshavarzian, A. Magno, E., & Swanson, G. (2017). Alcohol and Gut-Derived Inflammation. Alcohol research: current reviews. 38(2): 163–171. [22]. National Institute on Alcohol Abuse and Alcoholism. (2018). What people recovering from alcoholism need to know about osteoporosis. [23]. National Institute on Alcohol Abuse and Alcoholism. (2003). What Happened? Alcohol, Memory Blackouts, and the Brain. [24]. National Institute on Alcohol Abuse and Alcoholism. (2001). Cognitive Impairment and Recovery from Alcoholism. [25]. Mukherjee S. (2013). Alcoholism and its Effects on the Central Nervous System. Current Neurovascular Research. 10(3): 256-62. [26]. McIntosh C., Chick J. (2004). Alcohol and the Nervous System. Journal of Neurology, Neurosurgery & Psychiatry. 75(3): 16-21. [27]. Ghaeni, L., Hamerle, M., Holtkamp, M., Kowski, A., & Weissinger, F. (2018). Alcohol Use and Alcohol-Related Seizures in Patients with Epilepsy. Frontiers in neurology. 9(401). [28]. National Institute on Drug Abuse. (2020). What are the Treatments for Comorbid Substance Use Disorder And Mental Health Conditions? [29]. National Institute on Drug Abuse. (2018). Principles of effective treatment. [/sources] ...