Understanding Alcohol Abuse -- Treatment
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, and confusion of delirium tremens (DT) and in some cases can 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.
Another medicine, naltrexone reduces the craving for alcohol but, as with all medications used to treat alcoholism, 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.
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