Alcohol Abuse Disorder: Effective Treatment Options

Alcohol use disorder (AUD), commonly known as alcoholism, is a medical condition that affects millions of adults in the United States and can have serious impacts on one's health, safety, and personal relationships. While there is no single cure for AUD, it is a treatable condition, and most people can reduce their alcohol consumption or achieve abstinence with the right support and interventions. Treatment options include medications such as naltrexone and acamprosate, behavioural therapies, support groups, and lifestyle changes. Relapses may occur, but they are a part of the recovery journey, and with persistence and the right support, managing AUD is achievable.

Alcohol use disorder (AUD) treatment options

Alcohol use disorder (AUD) is a common medical condition that can be treated and managed. Treatment options include medication, behavioural therapy, and support groups. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) is working to develop a broader spectrum of treatment options, with the goal of tailoring treatments to individuals.

There are currently three medications approved for AUD in the United States: naltrexone, acamprosate, and disulfiram. Naltrexone is available as a pill or injection and helps reduce the urge to drink. Acamprosate is a pill that decreases the negative symptoms associated with alcohol abstinence, making it easier to maintain. Disulfiram discourages drinking by causing unpleasant symptoms when alcohol is consumed. Other medications, such as topiramate and gabapentin, can also help reduce cravings. All approved medications for AUD are non-addictive and can be used in combination with other treatments.

Behavioural therapy is another important aspect of AUD treatment. This may involve identifying triggers, managing stress, and changing drinking behaviour. Support from friends, family, and support groups can also play a crucial role in recovery. The NIAAA Alcohol Treatment Navigator® is an online tool that helps individuals find qualified treatment providers near them.

It is important to address any accompanying medical and mental health issues, as AUD often co-occurs with depressive disorders, anxiety disorders, trauma- and stress-related disorders, other substance use disorders, and sleep disorders. Treatment for AUD may also involve sustainable improvements in physical health, mental health, relationships, and overall well-being. Abstinence may be the only option for sustained recovery for some individuals.

While recovery from AUD is a journey that takes time and effort, it is possible. Most people with AUD can reduce their drinking or stop drinking altogether, and seeking treatment is an important first step.

Support groups and therapy

Support from friends, family, and support groups is essential in overcoming alcohol abuse disorder. Support groups, such as Alcoholics Anonymous, SMART Recovery, and Women for Sobriety, are a way to connect with others who understand your situation. Your peers can offer understanding, advice, and help keep you accountable. Many people stay in groups for years, and ongoing treatment is often necessary. Relapses are common, but they do not signify failure.

Therapy is also a crucial component of treating alcohol abuse disorder. Cognitive behavioural therapy (CBT) helps individuals change their thoughts and behaviours that lead to drinking. Acceptance- and mindfulness-based interventions increase awareness and acceptance of present-moment experiences. Mindfulness-based skill-building strategies promote flexible responses to triggers that can prompt drinking. Motivational enhancement therapy uses internal strengths to encourage and motivate change. 12-step facilitation therapy is an engagement strategy used in counselling sessions to increase an individual's active involvement in 12-step-based mutual-support groups.

Medication is often used in conjunction with therapy and support groups. The U.S. Food and Drug Administration has approved naltrexone, acamprosate, topiramate, and gabapentin to treat alcohol use disorder. These medications can decrease cravings, make drinking less enjoyable, and block the high associated with drinking.

Managing stress and triggers

Stress is a significant contributor to the initiation and continuation of alcohol use, as well as relapse. It is one of the strongest triggers for relapse, and research has shown that it can increase cravings for alcohol. Therefore, learning healthier ways to manage stress is crucial for maintaining abstinence and preventing a return to alcohol use.

Identify Stressors and Triggers

The first step in managing stress is to identify the sources of stress in your life. These may include general life stressors such as work, relationships, health issues, or financial concerns. Knowing your triggers can help you anticipate and manage stressful situations more effectively.

Exercise

Regular exercise is a powerful tool for managing stress. Physical activity helps to reduce tension and improve mood, providing a healthy outlet for stress relief. Whether it's going for a walk, practicing yoga, or playing a sport, incorporating movement into your daily routine can significantly impact your overall stress levels.

Spend Time Outdoors

Spending time in nature can be incredibly calming and help reduce stress. Take a walk in your neighborhood, go for a hike, or simply sit outside and observe your surroundings. Connecting with the natural environment can provide a sense of peace and perspective, helping to reset and manage stress levels.

Support Groups and Therapy

Support groups and therapy can be invaluable in managing stress and triggers. Sharing your experiences with others who understand your struggles can provide a sense of community and reduce feelings of isolation. Additionally, therapy can offer professional guidance and strategies to cope with stress and triggers effectively.

Pharmacological Management

In some cases, medication can be a crucial component of managing stress and triggers. The U.S. Food & Drug Administration has approved naltrexone and acamprosate for alcohol use disorder treatment. Other medications, such as topiramate and gabapentin, can also decrease cravings. Consult with a healthcare professional to determine if medication is an appropriate part of your treatment plan.

Stress Reduction Techniques

Explore various stress reduction techniques to find what works best for you. This may include practices such as meditation, deep breathing exercises, journaling, or engaging in relaxing activities like reading or listening to music. These techniques can help calm the mind and body, reducing the negative impact of stress.

Medication and side effects

Medication is often used in conjunction with talk therapy and support groups to treat alcohol use disorder (AUD). While medication can help, it does not cure the disorder. There are several medications used to treat AUD, including:

• Acamprosate: This medication is for people in recovery who are no longer drinking and want to avoid drinking. It is typically started on the fifth day of abstinence and taken in tablet form three times a day. It is most effective after about five to eight days.
• Disulfiram: This medication treats chronic alcoholism and is most effective for those who have already stopped drinking or are in the initial stages of abstinence. It is taken in tablet form once a day and should never be taken while intoxicated or within 12 hours of drinking alcohol. Unpleasant side effects such as nausea, headache, vomiting, chest pains, and difficulty breathing can occur as soon as 10 minutes after drinking alcohol, even in small amounts. Disulfiram is contraindicated for those who are elderly, pregnant, or have cardiac disease, liver dysfunction, psychosis, or cognitive dysfunction. It should also not be taken with metronidazole.
• Naltrexone: This medication can reduce the relapse of heavy drinking and binge drinking and helps patients achieve abstinence. It blocks the euphoric and sedative effects of opioids and prevents feelings of euphoria.
• Buprenorphine: This medication is used to treat opioid use disorders and suppresses and reduces cravings for opioids.
• Methadone: This medication is also used to treat opioid use disorders and reduces opioid cravings and withdrawal while blunting or blocking the effects of opioids.
• Topiramate, baclofen, and gabapentin: These are considered second-line medications, as the evidence base for their use in treating AUD is smaller.
• Thiamine: Heavy alcohol consumption can result in thiamine deficiency, which can lead to alcohol-induced brain damage. Thiamine supplementation is often given to patients who continue to drink or are being treated for alcohol withdrawal, although the appropriate dose is unclear.

It is important to note that medication use should be accompanied by therapy and support to effectively treat AUD. Cognitive-behavioral therapy can help change thinking and behaviors that lead to drinking, while motivational enhancement therapy uses internal strengths to encourage and motivate change. Additionally, 12-step programs such as Alcoholics Anonymous and other support groups can provide valuable support during the recovery process.

Relapse and recovery

Relapse is a common part of the recovery journey from alcohol use disorder. It is not a sign of failure or weakness but a continuation of old coping patterns that need to be replaced with new ones. Relapse can be defined as the resumption of alcohol use after a period of recovery or abstinence. This is distinct from a lapse, which is a brief or temporary return to alcohol use followed by a quick return to recovery goals.

Many factors can trigger a relapse, including personal challenges, emotional and psychological issues, and social or economic problems. To prevent relapse, individuals should be aware of their triggers and develop a strong support network of friends, family, and professionals. They should also engage in meaningful activities that build a positive self-image and pride. Additionally, it is important to address any accompanying medical and mental health issues, as these can increase the risk of relapse.

If a relapse occurs, it is important to intervene and reintegrate treatment-oriented behaviours. This may include reaching out to friends and family, speaking with a counsellor, or seeking medical support. Relapse can be an opportunity to learn more about triggers and develop new coping skills. It may take multiple attempts before an individual successfully maintains their recovery goals, so it is important to be patient and supportive throughout the process.

Treatment options for alcohol use disorder include medication and behavioural therapy. Medications such as naltrexone, acamprosate, topiramate, and gabapentin can help reduce cravings and manage the disorder. Behavioural therapies, such as 12-step programs or individual therapy, can also be effective in changing long-standing patterns and promoting recovery.

Overall, recovery from alcohol use disorder is a journey that takes time and effort. Relapse is a common part of the process, and with the right support and treatment, individuals can resume their path towards recovery and maintain long-term behavioural changes.

Frequently asked questions