Understanding Alcohol Use Disorder -- Treatment

What Are the Treatments for Alcoholism?

The goal of treatment for alcoholism is quitting, though some people may be able to effectively cut down. Among alcoholics with otherwise good health, social support, and motivation, the likelihood of recovery is good. After treatment, about one-third of patients show no relapse or symptoms at 1 year. Many more report fewer alcohol-related social and health problems by cutting down alcohol intake. Poor social support, lack of motivation, and psychiatric disorders are all risk factors for relapsing.  For some high-risk patients, success is measured by longer periods of abstinence, reduced use of alcohol, better health, and improved social functioning.

Conventional Medicine for Alcoholism

Treatment has three stages:

  1. Detoxification (detox): Abruptly decreasing or discontinuing alcohol can lead to withdrawal symptoms, usually within 6-12 hours. Typical symptoms include tremors, agitation, and insomnia. Alcohol withdrawal can be dangerous, so if symptoms are severe, you may need medical treatment.

    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. Depending on your support system and environment, both can be effective.

    Maintenance of sobriety: This step's success requires an alcoholic to be self-disciplined. 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.

Detox may involve one or more medications. The mainstay of treatment is benzodiazepines, 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.

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In the rehabilitation and maintenance stages of recovery, there are several medicines used to help maintain 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 can make you feel really sick if you 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.

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Supplemental Tips

Living without alcohol can be an enormous adjustment. Here are some additional ideas that you may find helpful:

  • 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.

 

WebMD Medical Reference Reviewed by Sabrina Felson, MD on March 15, 2017

Sources

SOURCES: 

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders  5th edition, 2013. 

Alcohol Abuse, Psychiatric Annuals 2005. 

Combs, R. Handbook of Addictive Disorders: A Practical Guide to Diagnosis and Treatment, Wiley, 2004. 

Littleton, J. American Journal of Addiction. 2003.

UpToDate. 

National Institute on Alcohol Abuse and Alcoholism.

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