Vivian Marlowe
Alcohol use disorder (AUD) is a condition where one cannot stop drinking despite the negative impact on their health and safety. Treatment for AUD can vary from medication to therapy, support groups, and 12-step programs. The US Food and Drug Administration has approved certain medications to reduce cravings, and therapy can be tailored to the individual. Online self-guided programs and e-health tools are also available. Treatment success is an ongoing process and may include setbacks, but studies show that most people with AUD recover, reducing their drinking or stopping altogether.
| Characteristics | Values |
|---|---|
| Treatment Options | Medication, therapy, support groups, 12-step programs, 28-day inpatient treatment, online self-guided programs |
| Medication | Naltrexone, acamprosate, topiramate, gabapentin |
| Therapy | Behavioral therapy, counseling |
| Support | National helplines, local support groups, community-based organizations, youth support groups |
| Relapse | Relapse is common, persistence is key |
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What You'll Learn
- Treatment medications: Naltrexone, Acamprosate, Topiramate, and Gabapentin
- Therapy: Behavioural treatments, counselling, and support groups
- Relapse: Setbacks are common, and planning is required to prevent drinking
- Withdrawal: Medical help is required to manage withdrawal symptoms
- Treatment options: 12-step programs, 28-day inpatient treatment, and online self-guided programs
Treatment medications: Naltrexone, Acamprosate, Topiramate, and Gabapentin
Alcohol use disorder (AUD) is characterised by compulsive drinking and loss of control despite adverse consequences. Treatment typically involves medication and behavioural therapy. The US Food and Drug Administration (FDA) has approved the use of naltrexone and acamprosate for the treatment of AUD. Topiramate and gabapentin are also used to treat AUD, although they are not yet approved by the FDA for this purpose.
Naltrexone
Naltrexone blocks the parts of the brain that "feel" pleasure from alcohol and narcotics. By blocking these areas, naltrexone reduces the need to drink alcohol, making it easier to stop drinking. Unlike disulfiram, another medicine used to treat alcoholism, naltrexone does not induce sickness if alcohol is consumed while taking it. However, it is important to note that naltrexone interacts with narcotics, and patients should refrain from taking any narcotics at the same time, including codeine, morphine, and heroin. Naltrexone is also not recommended for pregnant people and should not be taken while breastfeeding. Common side effects include nausea, headache, constipation, dizziness, nervousness, insomnia, drowsiness, and pain in the arms, legs, or stomach.
Acamprosate
Acamprosate is used alongside counselling and social support to help people who have stopped drinking large amounts of alcohol to avoid drinking again. Long-term alcohol consumption alters the way the brain works, and acamprosate helps the brain function normally again. It is important to note that acamprosate does not prevent withdrawal symptoms, and it has not been shown to work in individuals who have not stopped drinking or those who also overuse other substances. Acamprosate does not cause an unpleasant reaction if alcohol is consumed during treatment, but individuals should continue taking the medication and contact their doctor. Acamprosate may be prescribed for other uses, and individuals should inform their doctor and pharmacist of any other medications, vitamins, supplements, or herbal products they are taking. Acamprosate may increase the risk of depression and suicidal ideation.
Topiramate
Topiramate is an anti-seizure medication traditionally prescribed for epilepsy that has been investigated for the treatment of AUD. While it is not yet approved by the FDA, studies suggest that it may be a promising treatment for reducing heavy drinking and craving and promoting abstinence. Topiramate may work by reducing dopamine release in reward-related regions of the brain when individuals are exposed to alcohol or alcohol cues.
Gabapentin
Gabapentin is another agent that has been studied for the treatment of AUD. It shows promise as a treatment for alcohol withdrawal that can be continued through early abstinence without the addictive potential of benzodiazepines, which are the standard treatment for alcohol withdrawal. Gabapentin is thought to affect drinking behaviours during early abstinence by normalizing GABA and glutamate activity. However, concerns have been raised about its recreational use to achieve euphoria and its misuse by vulnerable populations.
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Therapy: Behavioural treatments, counselling, and support groups
Behavioural treatments for alcohol use disorder (AUD) involve working with a healthcare provider to identify and change the behaviours that lead to alcohol problems. This can include developing the skills needed to stop or reduce drinking, such as learning how to manage cravings and adopt healthier coping strategies. Behavioural treatments share certain features, including:
- Motivating yourself and building and maintaining your motivation to remain sober
- Understanding what triggers your urge to drink
- Managing your behaviour, thoughts, and feelings
- Recognising that challenging emotions may arise and learning to accept yourself to avoid a relapse
Cognitive-behavioural therapy (CBT) is a widely preferred treatment for AUD. CBT combines therapeutic techniques from both cognition and behaviour to help individuals recognise and resolve distorted patterns of thought, which often influence their behaviour, leading to their alcohol use disorder. CBT is a problem-focused therapy, meaning the goal is to find healthy solutions to current problems rather than focusing on the underlying reasons for these problems. CBT can be carried out in solo or group sessions and typically lasts for 5-20 sessions.
Counselling, or alcohol counselling, can take place in an outpatient setting with regular office, virtual, or telehealth visits. It can also be done in an intensive outpatient setting or as part of inpatient treatment. Counselling can be done in tandem with cognitive therapy, which helps individuals gain more control over their thoughts. Counselling can also be used to handle high-stress situations and provide additional mental health support.
Support groups for people with AUD are an effective solution. Alcoholics Anonymous (AA) is a well-known support group that has helped millions of alcoholics stop drinking. In support groups, peers can help each other remain sober and commit to alcohol abstinence. Listening to others' experiences with alcohol abuse can help build the confidence needed to maintain sobriety. Support groups can also help lower the chances of engaging in high-risk behaviours.
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Relapse: Setbacks are common, and planning is required to prevent drinking
When seeking treatment for alcohol use disorder (AUD), it is important to remember that setbacks and relapses are common. AUD is a chronic relapsing disorder, and persistence is key to recovery. Treatment is an ongoing process that may include medication, therapy, and support groups. While medication can help address withdrawal symptoms and decrease cravings, therapy and support groups can provide valuable tools for changing drinking behaviour and connecting with others going through similar experiences.
However, despite these treatments, relapses may still occur. A relapse refers to a return to drinking after a period of abstinence or controlled drinking. It is a common setback that can happen for a variety of reasons. For example, individuals may start drinking again to cope with stressful events such as job loss, divorce, or the death of a loved one. Relapses can also occur due to the pervasive nature of alcohol in society, easy access to alcohol, or exposure to triggers and cravings.
To prevent relapses, it is important to develop a comprehensive plan that addresses the underlying causes of drinking and provides strategies for managing cravings and triggers. This may include identifying high-risk situations, developing healthy coping mechanisms, and creating a strong support system. By planning ahead and being prepared for challenging situations, individuals can increase their chances of maintaining abstinence or controlled drinking.
Additionally, it is crucial to have realistic expectations and understand that relapses are a normal part of the recovery process. Instead of viewing a relapse as a failure, it can be reframed as an opportunity to learn and grow. Each relapse provides valuable information about triggers, cravings, and the effectiveness of current treatment strategies. By analysing what led to the relapse and identifying any warning signs that may have been missed, individuals can develop new strategies to prevent future relapses and strengthen their recovery.
In conclusion, while setbacks and relapses are common in the treatment of AUD, they can be managed through proper planning and persistence. By understanding the underlying causes of drinking, developing healthy coping mechanisms, and seeking support, individuals can reduce the risk of relapses and maintain their progress towards recovery. Remember, recovery is an ongoing process, and each relapse presents an opportunity to learn, adjust, and continue moving forward.
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Withdrawal: Medical help is required to manage withdrawal symptoms
Alcohol withdrawal can range from mild to severe symptoms. It occurs when a person who has been drinking heavily on a regular basis suddenly stops drinking alcohol. Withdrawal symptoms tend to occur within 6 to 12 hours after the last drink, but can also occur days later. Symptoms include headache, mild anxiety, insomnia, upset stomach, heart palpitations, increased blood pressure, high body temperature, tremors, and hallucinations. More severe cases of withdrawal can lead to delirium tremens (DTs), which can be fatal.
Due to the potentially life-threatening nature of alcohol withdrawal, medical help is required to manage the withdrawal symptoms. Doctors can prescribe medications to address these symptoms and make the process safer and less distressing. Treatment programs typically include detox, where doctors may manage withdrawal with medications for two to seven days. Trained specialists will also help individuals better understand their habits and patterns of behaviour, and commit to new ones. This could include anger management classes or nutrition advice. Counseling may also be involved, which may involve one-on-one sessions with a social worker or therapist to help deal with mental health issues or past traumas.
The severity and length of alcohol withdrawal vary based on many factors, such as body chemistry, existing physical or mental health conditions, medications, and the use of other substances. Age greater than 65 and a history of delirium tremens or alcohol withdrawal seizures are factors that increase the risk of severe alcohol withdrawal.
It is important to note that overcoming alcohol use disorder (AUD) is an ongoing process that can include setbacks. Relapses may occur, and persistence is key. Treatment should be tailored to the individual, and it is important to understand the different options available to decide on the best course of treatment.
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Treatment options: 12-step programs, 28-day inpatient treatment, and online self-guided programs
Treatment options
12-step programs
Alcoholics Anonymous (AA) is a popular 12-step program and one of the most common forms of recovery support. AA is a peer-led, self-help recovery program that emphasizes spiritual growth and encourages members to turn their lives over to a "higher power" as part of the healing process. Members attend regular group meetings where they offer mutual support, share experiences, and work through the 12 steps.
The 12 steps are:
- Admit we were powerless over alcohol—that our lives had become unmanageable.
- Come to believe that a power greater than ourselves could restore us to sanity.
- Make a decision to turn our will and our lives over to the care of God, as we understood Him.
- Make a searching and fearless moral inventory of ourselves.
- Admit to God, to ourselves, and to another human being the exact nature of our wrongs.
- Be entirely ready to have God remove all these defects of character.
- Humbly ask Him to remove our shortcomings.
- Make a list of all persons we have harmed and become willing to make amends to them all.
- Make direct amends to such people wherever possible, except when to do so would injure them or others.
- Continue to take personal inventory, and when we are wrong, promptly admit it.
- Seek through prayer and meditation to improve our conscious contact with God as we understand Him, praying only for knowledge of His will for us and the power to carry that out.
- Having had a spiritual awakening as the result of these steps, try to carry this message to alcoholics, and to practice these principles in all our affairs.
The 12 steps are guided by 12 traditions, which help maintain the integrity and unity of the program. While AA has helped many people, its spiritual foundation and abstinence-based model may not appeal to everyone. Other 12-step programs include Narcotics Anonymous, Cocaine Anonymous, Crystal Meth Anonymous, Marijuana Anonymous, Gamblers Anonymous, Overeaters Anonymous, Sexaholics Anonymous, and Debtors Anonymous.
28-day inpatient treatment
28-day rehab programs are short-term inpatient treatment options that can help people begin their recovery journey. Patients live onsite for the duration of the program and receive 24/7 monitoring, support, and treatment. The benefits of these programs include receiving medical detox in a safe, supportive, and distraction-free environment, and learning skills to cope and avoid relapse. Treatments offered include medications and behavioural therapies such as cognitive-behavioural therapy (CBT) and motivational interviewing (MI).
Online self-guided programs
Online self-guided programs are another treatment option for alcoholics. These include digital self-help programs like CheckUp & Choices, which help build motivation and skills to change drinking habits. They can include alcohol screeners, feedback, options for making a change, and skills training for moderating or abstaining from drinking. Online mutual support groups are also available, and some recovery groups have bustling online communities. Online treatment options have become more widely available since the COVID-19 pandemic.
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Frequently asked questions
The U.S. Food & Drug Administration has approved naltrexone and acamprosate as alcohol use disorder treatments. Topiramate and gabapentin can also decrease cravings in some people. Doctors can prescribe medications to address withdrawal symptoms and make the process safer and less distressing.
Behavioral treatments are aimed at changing drinking behavior through counseling. Support groups are another way to connect with others who understand your situation.
Studies show that most people with this condition recover, meaning they reduce how much they drink or stop drinking altogether. However, people do relapse, and it is rare for someone to go to treatment once and never drink again. Persistence is key.
There is no one-size-fits-all solution, and matching the right therapy to the individual is important to its success. Your healthcare provider can help you evaluate the pros and cons of each treatment setting.
