Lena Savoie
Alcohol is a leading cause of preventable death, contributing to approximately 88,000 deaths annually in the United States alone. Alcohol use disorder (AUD) is a serious condition, and while effective treatments exist, they are often not practised. This is partly due to the fact that many individuals with AUD do not seek treatment, but also because of a lack of research on the implementation of evidence-based treatments. Treatment options include behavioural healthcare, medications, and participation in mutual support groups. This article will explore the science-based practices available for the treatment of alcoholism and evaluate their effectiveness.
| Characteristics | Values |
|---|---|
| Treatment type | Pharmacological and behavioral treatments |
| Effectiveness | Equally effective when combined and tailored to each patient |
| Treatment gap | Only 1 in 10 people with a substance use disorder receives specialty treatment |
| Treatment focus | Abstinence or reduction in substance use, treatment retention, psychiatric severity, medical problems, legal concerns, family/social relations, job/vocational functioning |
| Treatment settings | Primary care, addiction specialty programs, independent private practice, community clinics |
| Treatment support groups | Alcoholics Anonymous (AA), SMART Recovery, LifeRing, Moderation Management, Secular Organizations for Sobriety, Women for Sobriety |
| Treatment medications | Naltrexone |
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What You'll Learn
Behavioural treatments
Treatment for AUD is offered in more settings than just specialty addiction programs. Primary care professionals can offer brief counselling, and addiction physicians, clinical psychologists, and other licensed therapists provide outpatient care in private practices and community clinics.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has developed the Alcohol Treatment Navigator, which can guide users to providers who offer evidence-based behavioural health treatment near them, as well as telehealth and online options.
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Pharmacological treatments
Alcohol use disorder (AUD) is a major contributor to global disease and a leading cause of preventable death, causing approximately 88,000 deaths annually in the United States alone. While effective treatments for AUD exist, they are not commonly practised. Only a small percentage of services provide evidence-based treatments such as addiction medications or psychosocial therapies.
Primary care professionals can offer medications for AUD along with brief counselling. Addiction physicians, clinical psychologists, and other licensed therapists also provide outpatient care and can prescribe medications to treat AUD.
While pharmacological treatments can be effective, they are not suitable for everyone. Due to the heterogeneity of AUD, it is unlikely that a single treatment will work for all individuals. Therefore, a range of treatment options, including both pharmacological and behavioural therapies, should be offered to patients.
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Support groups
There are also several secular alternatives to AA, such as SMART Recovery, LifeRing, Moderation Management, Secular Organizations for Sobriety, and Women for Sobriety. These groups offer a non-religious approach to recovery and can be beneficial for those who do not connect with the spiritual aspects of programmes like AA. SMART Recovery, for example, is based on scientific knowledge and uses cognitive behavioural therapy (CBT) techniques to help individuals manage their cravings and behaviours.
For family members of people with alcohol abuse problems, there are also support options available. SAMHSA's National Helpline provides a 24/7, confidential information service in English and Spanish for individuals and family members facing substance use disorders. They offer referrals to local treatment facilities, support groups, and community-based organisations. Additionally, there are support groups specifically for teens with alcoholic parents, such as Alateen, which encourage young people to seek emotional support from other adults and their peers.
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Twelve-step facilitation therapy
Alcohol use disorder is a leading cause of preventable death, causing approximately 88,000 deaths annually in the United States alone. Alcoholics Anonymous (AA) is a free, nonprofessional, peer-to-peer, community-based program focused on helping individuals with alcohol use disorder achieve abstinence. Twelve-step facilitation therapy (TSF) is a clinical intervention developed to increase a patient’s active involvement in a 12-step group such as AA. The primary goal of the Minnesota Model, sometimes referred to as 12-step-based treatment, is centred on engaging patients with AA and other 12-step mutual-help organizations in their community.
The first manualized TSF was developed in the early 1990s as part of Project MATCH, a large randomized trial. TSF has been shown to be as or more effective than Motivational Enhancement Therapy and a cognitive-behavioural approach in enhancing abstinence over time. Several clinical researchers have since developed other kinds of TSF interventions that could potentially engage a wider range of patients with substance use disorders.
Over the course of 4 to 12 sessions, depending on the specific type of TSF, the provider encourages and facilitates the patient’s attendance at AA meetings. The provider and patient may track AA meeting attendance and active involvement through logs or journals. During sessions, they may discuss common themes in AA meetings (e.g., spirituality and the purpose of a higher power), explore the patient’s attitudes about these themes, and problem-solve how the patient can overcome any obstacles these themes pose to their engagement. Consistent with the philosophy in AA that substance use is part of an overall syndrome or disease, and that abstinence is the best way to address the problem, Twelve-Step Facilitation providers also strongly emphasize abstinence as a treatment goal.
Manualized (standardized and replicable) AA and similar 12-step facilitation programs produce higher rates of continuous abstinence than other established treatments. Nonmanualized (nonstandardized) 12-step programs perform as well as other established treatments across a variety of alcohol-related outcomes. A recent Cochrane review assessed the effectiveness and cost-benefits of AA and clinically delivered TSF interventions for alcohol use disorder.
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Psychiatry advances
Alcohol is a leading cause of preventable death, causing approximately 88,000 deaths annually in the United States alone. Alcohol use disorder (AUD) is a severe problem, and only a small percentage of individuals with the disorder contribute to the greatest societal and economic costs.
Psychiatry is on the brink of significant advances, with scientific developments in neuroscience, neurobiology, and technologies to map and study brain structures and processes. These advances promise to improve our understanding of the short- and long-term effects of alcohol consumption.
Pharmacological and behavioral treatments for AUD already exist, but more are needed, and several are under development. These treatments are notably underused, with only about 1 in 10 people with a substance use disorder receiving specialty treatment. Basic science and human research efforts must be translated into clinical practice to improve access to effective treatment options.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) offers two types of evidence-based treatment for AUD: behavioral healthcare and medications. These treatments have been shown to be equally effective and can be tailored to improve patient outcomes. NIAAA's Alcohol Treatment Navigator can guide individuals to providers of evidence-based behavioral health treatment, as well as telehealth and online options.
In addition to professional treatment, patients can benefit from participating in mutual support groups such as Alcoholics Anonymous (AA) or secular alternatives like SMART Recovery. Twelve-step facilitation therapy and Mutual Support Group Facilitation are clinical interventions designed to increase patient involvement in these groups, which can facilitate a decrease in alcohol consumption.
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Frequently asked questions
Treatment options include both pharmacological and behavioral therapies. Pharmacological treatments include medications such as naltrexone, which blocks opiate receptors and reduces the pleasurable effects of alcohol and other substances. Behavioral treatments include counseling, 12-step facilitation therapy, and mutual support group facilitation.
Yes, treatments for alcohol use disorder can be effective. However, they are often underused or not commonly practised. For example, only about 1 in 10 people with a substance use disorder receives specialty treatment.
There are several signs that may indicate a problem with alcohol use. These can include drinking alone, drinking in the morning, or experiencing blackouts. If you are concerned about your drinking, it is important to seek professional help.
Treatment for alcohol use disorder is offered in various settings, including specialty addiction programs, primary care, private practices, and community clinics. You can find treatment providers through resources such as the NIAAA's Alcohol Treatment Navigator or SAMHSA's National Helpline.
Yes, recovery from alcohol use disorder is possible. Treatment can help reduce alcohol consumption and improve overall functioning. However, it is important to note that relapse may occur, and ongoing support and treatment may be needed.
