There are many options for treatment for alcohol use disorders. They depend in part on the severity of the patient’s drinking.
Treatment options include:
Behavioral therapy, which may include individual sessions with a health professional and support groups Medications
Guidelines encourage primary care doctors to do “brief intervention” to help patients who are alcohol abusers (but who may not yet be alcohol dependent) reduce or stop their drinking. In these interventions, your doctor may give you an action plan for working on your drinking, ask you to keep a daily diary of how much alcohol you consume, and recommend for you target goals for your drinking. If your doctor thinks that you have reached the stage of alcoholism, he or she may recommend anti-craving or aversion medication and also refer you to other health care professionals for substance abuse services.
The ideal goal of long-term treatment for alcohol dependence is total abstinence. Patients who secure total abstinence have better survival rates, mental health, and marriages, and they are more responsible parents and employees than those who continue to drink or relapse. To achieve this, the patient aims to avoid high-risk situations and replace the addictive patterns with satisfying, time-filling behaviors.
Because abstinence is so difficult to attain, however, many professionals choose to treat alcoholism as a chronic disease. In other words, patients should expect and accept relapse but should aim for as long a remission period as possible. Even merely reducing alcohol intake can lower the risk for alcohol-related medical problems.
Alcoholics Anonymous (AA) and other alcoholism treatment groups express concern about treatment approaches that do not aim for strict abstinence. Many people with alcoholism are eager for any excuse to start drinking again. There is also no way to determine which people can stop after one drink and which ones cannot.
Evidence strongly suggests that seeking total abstinence and avoiding high-risk situations are the optimal goals for people with alcoholism. A strong social network and family support is also important. Families and friends need to be educated on how to assist, and not enable, the drinker. Support groups such as Al-Anon can be very helpful in providing advice and guidance.
Inpatient care is usually reserved for patients whose alcoholism places them in danger. Inpatient treatment may be performed in a general or psychiatric hospital or in a center dedicated to treatment of alcohol and other substance abuse. Factors that indicate a need for this type of treatment include: Coexisting medical or psychiatric disorder
Delirium tremens (a neurological condition associated with withdrawal that involves uncontrollable trembling, sweating, anxiety, and hallucinations or other symptoms of psychosis) Potential harm to self or others Failure to respond to conservative treatments Disruptive home environment
A typical inpatient regimen may include the following stages:
A physical and psychiatric work-up for any physical or mental disorders Detoxification — this phase involves initiating abstinence, managing withdrawal symptoms and complications, and ensuring that the patient remains in treatment On-going treatment with medications in some cases Psychotherapy, usually cognitive behavioral therapy An introduction to AA Some — but not all — studies have reported better success rates with inpatient treatment of patients with alcoholism. However, newer studies strongly suggest that alcoholism can be effectively treated in outpatient settings.
People with mild-to-moderate withdrawal symptoms are usually treated as outpatients. Treatments are similar to those in inpatient situations and include: Psychotherapy or counseling Medications that target brain chemicals involved in addiction Social support groups such as AA Cognitive therapies Involvement of family and other significant people in patient’s life The current approach to outpatient treatment uses “medical management” — a disease management approach that is used for chronic illnesses such as diabetes. With medical management, patients receive regular 20-minute sessions with a health care provider. The provider monitors the patient’s medical condition, medication, and alcohol consumption.
After-Care and Work Therapy. After-care uses services to help maintain sobriety. For example, in some cities, sober-living houses provide residences for people who are trying to stay sober. They do not offer formal treatment services, but the people living there offer each other support and maintain an abstinent environment. Factors That Predict Success or Failure after Treatment
About 25% of people are continuously abstinent following treatment, and another 10% use alcohol moderately and without problems. Relapse is common and intensive and prolonged treatment is important for successful recovery, whether the patient is treated within or outside a treatment center.
