THE LONG CLIMB OUT OF THE BOTTLE

Specialized treatments for alcoholism range from nutrition to stress
management to biofeedback

If you find yourself diving into a bottle, what does it take to climb
out?

Guts, for starters. And resolve. The admission that you need help. And
the knowledge that nothing comes easy.

What it doesn't take is surrendering all your choices.

If you think treatment for alcohol abuse is still tied up in one
rigid, authoritarian regime, think again. Kicking the habit these days
may involve everything from nutrition and stress management to
high-tech biofeedback aimed at helping re-pattern a brain fixated on
craving.

This does not make it easy. It does not erase all the painful
decisions that have to be made. It does not take away the turmoil the
body must go through. But it does indicate some acknowledgment that
individuals - from single mothers with small children to successful
business managers - face different problems in seeking help.

``There's more effort to match people's needs and wants,'' says Gloria
Chaim, clinical director of the addictions program for special
populations at the Centre for Addiction and Mental Health. ``There are
more options.''

Some of these options are highly controversial, including the
so-called harm reduction approach, which aims at controlling rather
than eradicating substance abuse.

Abstinence may still be the best route for some. ``But if someone
absolutely refuses one treatment, we say: `What are the other
options?' '' says Chaim. That may mean, for example, helping a binge
drinker learn when it's safe to drink with appropriate limits.

``We support and embrace all models, including harm reduction,'' says
Carolin Jack, program co-ordinator at Women's Own Detox Centre.
``People are different. For someone who doesn't believe in God, a
12-step program won't work.

``We see success as a woman coming through that door, even for one
day.''

In many ways, the battle against alcohol abuse may appear to have been
eclipsed in recent years by all the media attention given to crack
cocaine or heroin.

``Cocaine is illegal. It costs a lot more and it's more damaging in
the short term,'' says Chaim.

Alcohol may be legal and cheaper but the damage it does over the long
term is equally devastating, as the people in the front lines of
treatment programs know only too well.

In 1996, when the Addiction Research Foundation undertook a
comprehensive study of the cost of substance abuse in Ontario, it put
the cost of alcohol abuse at $2.9 billion a year, including $1.6
billion in lost productivity and more than $500 million in law
enforcement costs.

Other studies in the U.S. and Canada show alcohol to be involved in
roughly 60 per cent of reported cases of child abuse, 40 per cent of
reported rapes, 65 per cent of fatal accidents and 80 per cent of suicides.

The high human cost is one very good reason treatment programs are
broadening out.

Many still swear by the traditional Alcoholics Anonymous
12-steps-to-abstinence, embracing belief in a higher power.

``It's the simplicity of the whole program that makes it so
acceptable,'' says John, a member of AA's public information
committee. (Last names are never used in AA.) ``People will turn away
from anything too difficult.''

At the Renascent Foundation, which also believes in the 12-step
program and operates three residential homes in the Toronto area, ``we
don't believe in moderation,'' says Peter Brewitt. (Yes, he adds,
before the irony is even questioned, his name used to appear right
under Brewers' Retail in the phone book.)

``We work at getting them through denial in a warm relaxed atmosphere.
It's not clinical,'' says Bill Gillilan, public education director.
``We get them eating properly and help them learn how to deal with
stress.''

Renascent, staffed with people who have ``been there,'' also offers
counselling and support to the families of those with dependency problems.

Whatever the treatment approach, however, there is a growing
recognition that addressing the broader needs of people seeking help
can be a key ingredient of success.

The aim is to find a way to serve people in different communities,
people with something in common, be it sexual orientation, age,
cultural heritage. The issues may be different for different
populations.

Some single mothers, for example, who don't want to go into a
residential program because they can't get child care might be able to
succeed in a program that lets them go home at night, Chaim says.

``When women have children with them, we really wrack our brains to
make sure the kids have a safe place to go,'' says Jack of the Women's
Own centre.

Being respectful of diverse needs also means establishing links with
community groups that understand the role played by different cultural
heritages.

The Centre for Addiction and Mental Health has been working together
with a number of groups, including the Chinese and Polish
communities.

There's a special program for African Canadian and Caribbean youth and
the Donwood Centre also has a Lesbigay program, which started in 1997.

A lot of planning went into developing the program, says Pam Rogers,
acting co-ordinator of lesbigay programs and services at the Donwood.

``Bars are one place where lesbians and gays can be themselves. We
help people realize there are other ways of belonging.''

The program can also help refer anyone who is not ``out,'' in terms of
sexuality, to a safe treatment program that can be attended
anonymously outside his or her community.

Teaching new ways of belonging, feeling connected, spans the gamut of
treatment techniques.

``There's always a positive intention behind substance abuse - to ease
the pressure, cut the anxiety, feel better,'' says Mark Cummings,
chief of stress management at the Donwood. ``The trick is to develop
other techniques to achieve the same result.''

Learning how to manage stress and cravings is all part of keeping mind
and body connected to the present instead of rehashing the past and
worrying about the future, Cummings says.

Techniques like computerized biofeedback, which can measure the
physical changes associated with, say, particular emotions, cravings
or compulsive behaviour, can help change brain patterns.

Part of what Cummings and others like him do is teach people how to
use the body to regulate the mind and vice versa.

The aim is to try to use as many non-drug treatments as possible -
including electronic or laser acupuncture to help manage headaches or
cravings, biofeedback to help change ingrained behaviour, magnetic
therapy, shiatsu massage, audio tapes that boost confidence and raise
self-esteem. But the major emphasis is on things people can do
themselves after they've left treatment.

That includes diet and exercise, a theme emphasized in a string of
self-help books, among them one by Susan Powter, the loud-mouth
queen-of-lean, who takes on alcoholism (her own and others') in her latest
book Sober . . . And Staying That Way: The Missing Link In The Cure For
Alcoholism (Fireside/Simon & Schuster, $19.25).

Powter is down on Alcoholics Anonymous, the medical establishment and
sugar. She is high on using diet to stop the craving for alcohol.

``The alcoholic is generally considered to be a moral degenerate who
chooses a life of abasement and through lack of willpower and maturity
allows himself to lose his job, his family and his self-respect,'' she
writes.

``Physiology not psychology determines whether one drinker will become
addicted to alcohol and another will not.

``There is no way that I would suggest that we get rid of what has
worked for some. The problem seems to be in reconciling the decades of
research, the millions it doesn't work for.''

A lot of people are promoting diet as a new thing in the battle
against alcohol abuse but the Donwood has had a nutrition program for
years, says Trish Dekker, chief dietitian.

The body can process only so much alcohol, she says. Beyond that, even
if you're eating well, it's so busy trying to process the alcohol, it
can't process food properly.

Fat builds up in the cells of the liver, enlarging it. Eventually
these cells get so full of fat, they explode. The scar tissue
resulting from these explosions is cirrhosis of the liver.

If your liver is at the enlarged stage, the damage can be reversed,
Dekker says. But once the cells start exploding, the scar tissue is
permanent.

Alcohol also increases the risk of cancer and causes cellular damage
that affects the DNA, the very essence of our genetic makeup, Dekker
says.

There are no quick fixes, she adds. Some of the trendiest treatises on
alcohol abuse recommend cutting out particular foods, often sugar.

But Dekker believes anything that doesn't teach balanced nutrition can
be dangerous.

Other trendy treatments, such as attempting to detoxify by putting
tubes in the rectum to flush the bowel, called a colonic, also can be
dangerous, she says.

``Two or three years down the road, you may end up with a lower colon
so badly damaged, you need an ileostomy.''

The hardest part about deciding you need help managing alcohol is to
make that first call, says Gloria Chaim.

Find someone you can rely on to support you - a school guidance
counsellor, a friend, someone you trust and feel comfortable with, she
says. And if one thing doesn't work, don't turn away. Say this is not
the approach for me, Chaim advises. Persevere.

In the Toronto area, you can reach the Metro Addiction, Assessment and
Referral Service at (416) 599-1448 and the Centre for Addiction and
Mental Health at (416) 595-6128.

The Donwood Institute, at 175 Brentcliffe Rd., near Eglinton Ave. E.
and Laird Dr., has information evenings every Wednesday at 6 p.m.

Anyone who needs help or knows someone who needs help can go and
listen.

Afterwards, you can simply disappear - no questions asked. Or you can
ask for more information, make contact, book an assessment. Everything
is done in confidence.