Understanding Alcohol Abuse - Treatment

What Are the Treatments?

The goal of treatment 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

Treatment 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 two stages: discontinuing alcohol use -- sometimes called detoxification -- and recovery. 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 delirium tremens (DT). If not treated professionally, people with DT have a mortality rate of more than 10%, so detoxification from late-stage alcoholism should be attempted under the care of an experienced provider and may require a brief inpatient stay at a hospital or treatment center.

Treatment may involve one or more medications. Benzodiazepines are antianxiety 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 detoxification phase, at which time they are usually tapered and then discontinued. They must be used with care, since they may be addictive.

Disulfiram may be used once the detoxification phase is complete and the person is abstinent. It interferes with alcohol metabolism so that drinking a small amount will cause nausea, vomiting, confusion and breathing difficulty.

Naltrexone reduces the craving for alcohol but is recommended only in comprehensive programs that teach patients new coping skills. 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 detoxification is complete and there has been some period of abstinence. Camporal is the latest addition to control cravings.

Because an alcoholic remains susceptible to becoming dependent again, the key to 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

Poor nutrition goes with heavy drinking: 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 detoxification programs.