What Are the Treatments for Alcoholism?
The goal of treatment for alcoholism is abstinence. Among alcoholics with otherwise good health, social support, and motivation, the likelihood of recovery is good. Approximately 50% to 60% remain abstinent at the end of a year's treatment and a majority of those stay dry permanently. Those with poor social support, poor motivation, or psychiatric disorders tend to relapse within a few years of treatment. For these people, success is measured by longer periods of abstinence, reduced use of alcohol, better health, and improved social functioning.
Conventional Medicine for Alcoholism
Treatment for alcoholism can begin only when the alcoholic accepts that the problem exists and agrees to stop drinking. He or she must understand that alcoholism is curable and must be motivated to change. Treatment has three stages:
- Detoxification (detox): This may be needed immediately after discontinuing alcohol use and can be a medical emergency, as detox can result in withdrawal seizures, hallucinations, delirium tremens (DT), and in some cases may result in death.
- Rehabilitation: This involves counseling and medications to give the recovering alcoholic the skills needed for maintaining sobriety. This step in treatment can be done inpatient or outpatient. Both are equally effective.
- Maintenance of sobriety: This step's success requires an alcoholic to be self-driven. The key to maintenance is support, which often includes regular Alcoholics Anonymous (AA) meetings and getting a sponsor.
Because detoxification does not stop the craving for alcohol, recovery is often difficult to maintain. For a person in an early stage of alcoholism, discontinuing alcohol use may result in some withdrawal symptoms, including anxiety and poor sleep. Withdrawal from long-term dependence may bring the uncontrollable shaking, spasms, panic, and hallucinations of DTs. If not treated professionally, people with DTs have a mortality rate of more than 10%, so detoxification from late-stage alcoholism should be attempted under the care of an experienced doctor and may require a brief inpatient stay at a hospital or treatment center.
Treatment may involve one or more medications. Benzodiazepines are anti-anxiety drugs used to treat withdrawal symptoms such as anxiety and poor sleep and to prevent seizures and delirium. These are the most frequently used medications during the detox phase, at which time they are usually tapered and then discontinued. They must be used with care, since they may be addictive.
There are several medicines used to help people in recovery from alcoholism maintain abstinence and sobriety. One drug, disulfiram may be used once the detox phase is complete and the person is abstinent. It interferes with alcohol metabolism so that drinking a small amount will cause nausea, vomiting, blurred vision, confusion, and breathing difficulty. This medication is most appropriate for alcoholics who are highly motivated to stop drinking or whose medication use is supervised, because the drug does not affect the motivation to drink.
Another medicine, naltrexone, reduces the craving for alcohol. Naltrexone can be given even if the individual is still drinking; however, as with all medications used to treat alcoholism, it is recommended as part of a comprehensive program that teaches patients new coping skills. It is now available as a long-acting injection that can be given on a monthly basis.
Acamprosate is another medicine that has been FDA-approved to reduce alcohol craving.
Finally, research suggests that the anti-seizure medicines topiramate and gabapentin may be of value in reducing craving or anxiety during recovery from drinking, although neither of these drugs is FDA-approved for the treatment of alcoholism.
Antidepressants may be used to control any underlying or resulting anxiety or depression, but because those symptoms may disappear with abstinence, the medications are usually not started until after detox is complete and there has been some period of abstinence.
Because an alcoholic remains susceptible to relapse and potentially becoming dependent again, the goal of recovery is total abstinence. Recovery typically takes a broad-based approach, which may include education programs, group therapy, family involvement, and participation in self-help groups. Alcoholics Anonymous (AA) is the most well known of the self-help groups, but other approaches have also proved successful.
Nutrition and Diet for Alcoholism
Poor nutrition goes with heavy drinking and alcoholism: Because an ounce of alcohol has more than 200 calories but no nutritional value, ingesting large amounts of alcohol tells the body that it doesn't need more food. Alcoholics are often deficient in vitamins A, B complex, and C; folic acid; carnitine; magnesium, selenium, and zinc, as well as essential fatty acids and antioxidants. Restoring such nutrients -- by providing thiamine (vitamin B-1) and a multivitamin -- can aid recovery and are an important part of all detox programs.
At-Home Remedies for Alcoholism
Abstinence is the most crucial -- and probably the most difficult -- step to recovery from alcoholism. To learn to live without alcohol, you must:
- Avoid people and places that make drinking the norm, and find new, non-drinking friends.
- Join a self-help group.
- Enlist the help of family and friends.
- Replace your negative dependence on alcohol with positive dependencies such as a new hobby or volunteer work with church or civic groups.
- Start exercising. Exercise releases chemicals in the brain that provide a "natural high." Even a walk after dinner can be tranquilizing.