A popular but little-researched model for self-treating alcohol use disorders is self-tapering. This involves people cutting back on their alcohol consumption. Typically, detoxification is accomplished by the use of benzodiazepines, either on an outpatient or inpatient basis; the benzodiazepines replace the alcohol in the body, and then are tapered in a controlled way.
Alcohol withdrawal can be life-threatening. Before the advent of benzodiazepines, one out of six alcoholics who went into severe withdrawal died, said George Koob, Ph.D., director of the National Institute on Alcohol Abuse and Alcoholism. We had asked him about self-tapering, which is promoted by HAMS: Harm Reduction for Alcohol, a self-described “support and informational group for anyone who wants to change their drinking habits for the better.” The group’s acronym, HAMS, stands for Harm reduction, Abstinence, and Moderation Support. We had sent the group’s tapering page (http://www.hamsnetwork.org/taper/) to Koob to review.
“It’s not a trivial undertaking,” said Koob of alcohol withdrawal. “You can have a severe hyperthermic reaction, which can be fatal, or seizures that can be fatal,” he told ADAW. “Very few people die of opioid withdrawal, but you can die from alcohol withdrawal.”
But that is the whole point of tapering, and the HAMS web page says as much: “Alcohol withdrawal is potentially fatal, so if you find yourself starting to experience significant alcohol withdrawal symptoms when you stop drinking then it is important to gradually detoxify from alcohol rather than quitting all at once ‘cold turkey.’” The page then lists recommendations for tapering, which include using beer (which has a lower alcohol content than wine or hard liquor), drinking just enough to keep the withdrawal symptoms (sweats and shakes) away but not enough to get drunk, and drinking fluids to replenish electrolytes.
“Self-tapering can work, but it has to be under situations of tightly controlled access,” said Koob. “Someone has to help, because it takes an incredible amount of self-control, and we know that individuals with alcohol use disorders don’t have a lot of control.”
“I am not familiar with research on the efficacy of a controlled alcohol withdrawal taper versus a medication-assisted taper,” said Katie Witkiewitz, Ph.D., associate professor in the Department of Psychology at the University of New Mexico’s Center on Alcoholism, Substance Abuse, and Addictions. “When I have clients who want to quit drinking, I always recommend a medication-assisted taper under medical supervision,” she said. “Outpatient benzodiazepine treatment is typically sufficient for less severe cases — inpatient detox may be necessary for more severe cases with a history of seizures.”
However, she said that she “can see why an oral alcohol taper would be an attractive option, from a harm-reduction perspective.” But the lack of research to support an alcohol taper would make it problematic.
Kenneth Anderson, who founded HAMS in 2007 after he became disenchanted with Moderation Management, has his own model: he drinks 17 drinks one day a week, not driving and over the course of eight hours. He used to drink a bottle of whiskey — 17 drinks — four days a week. Now he’s down to one 17-drink day a week, which is a definite improvement. But still, it has the potential to create liver damage, said Koob.
“This phenomenon of harm reduction is reinforcing the fact that you can drink yourself to oblivion and get the high alcohol levels, which kill your liver cells,” said Koob. “I’d hate to see his liver enzymes,” referring to Anderson’s weekly 17-drink planned intoxication.
Anderson told us that he goes for regular physicals, and his liver tests are fine.
But Koob said that half of liver disease in the United States is caused by alcohol, and that there’s a shift to younger people getting it — even cirrhosis. At colleges, young people are drinking to the blackout stage, which is 12 to 15 drinks, he said. “It’s not a pretty picture,” Koob told ADAW. “Talk to any liver doctor, and you’ll find out they’re seeing younger and younger patients,” he said. “Anybody who is doing 17 drinks in a sitting should see what their liver enzyme levels look like.”
Many people didn’t know that they could self-taper from alcohol using alcohol before HAMS, Anderson told ADAW last week. “Alcohol works as well as benzodiazepines” for detox, he said. Many people don’t want to go to medical detox because they don’t want it on their medical records, said Anderson.
“Regardless of how much you drink, some people have a predisposition” to liver disease, said Anderson. “It’s not dose-dependent,” he said.
Finally, tapering down one drink a day is too fast for many people, said Anderson. “If someone is determined, and they want to do the taper in four or five days, they could try it,” he said, adding that many people on the HAMS network, which has a Facebook page and other social media, contact him. “They’re highly motivated, or they wouldn’t be looking me up online.”
“We think people should support each other,” said Anderson. That’s why the social media sites for HAMS are so nonjudgmental — whether someone is in the hospital after a four-day binge or someone has decided to go back to AA (anathema to HAMS) because sobriety agrees with them. “I look out every day for the trolls and the spammers,” Anderson said. “I’m not there to tell people what to do. I’m there to offer people options. If you do one and it works, that's fine. If you make up your own approach, that’s fine.”