Alcohol Disorder Treatment

Alcoholism: Definition & Symptoms

Alcohol use disorder is prevalent. It affects one in five college students and over 14 million American adults. As noted in the DSM-5, the diagnostic manual of the American Psychiatric Association, alcohol use disorder is associated with the following symptoms:

• Impaired control over alcohol use (e.g., cravings).
• Social problems, like difficulties at work.
• Alcohol use in risky situations (e.g., driving under the influence).
• Tolerance: requiring more and more alcohol to achieve the same desired effect.
• Withdrawal symptoms: distressing reactions that develop after a big reduction in use.

So, how can this condition be treated? In this post, I discuss psychological and pharmacological treatments (i.e. medications) for alcohol use disorder.

Alcohol Addiction Disorder- Pharmacological treatments

Two medications often prescribed to treat moderate to severe alcohol use disorder include naltrexone and acamprosate. Both have been approved by the US Food and Drug Administration (FDA) for the treatment of alcohol use disorder.

  • Naltrexone (brand name ReVia and Vivitrol) works by blocking opioid receptors, which are stimulated by alcohol. Naltrexone reduces the urge to drink and decreases the pleasurable and euphoric effects of alcohol. Therefore, it decreases the likelihood of heavy drinking.
  • Acamprosate (Campral) also reduces cravings and is particularly helpful for patients who want to maintain abstinence. The exact mechanism of the drug’s action is not known, but it appears to have a stabilizing effect and involves the glutamate and GABA neurotransmitter systems.
  • Disulfiram (Antabuse), another FDA-approved drug for alcohol dependency, works by interfering with the metabolism of alcohol, causing the accumulation of acetaldehyde. As a result, drinking alcohol will produce quite unpleasant effects similar to a hangover, such as a headache, flushing, sweating, nausea, and vomiting. In this way, disulfiram discourages drinking.
  • Other medications sometimes prescribed for the treatment of alcoholism include, among others, topiramate (Topamax) and gabapentin (Neurontin). These medications are typically used to control and treat seizures but have been shown to be effective in the treatment of alcoholism in some studies.
  • Benzodiazepines (e.g., Valium) may also be prescribed as needed, such as when a patient is experiencing severe withdrawal symptoms.

Self-help and Psychological Treatments

Whether to control one’s drinking or to abstain from alcohol permanently, a popular approach is the use of self-help strategies. These include trying to quit on one’s own, connecting with local or national support groups, or attending informal support groups (e.g., in church). Alternatively, one might join a 12-step program, such as Alcoholics Anonymous (AA). Founded in the 1930s, AA is a community-based organization that emphasizes peer support in helping individuals maintain abstinence.

A variety of psychotherapeutic approaches are also available for the treatment of alcohol use disorder. Commonly used therapies include those that facilitate active engagement with 12-Step programs like AA, cognitive-behavioral approaches, and motivational interventions. These treatments help clients resolve ambivalence toward change and find the motivation to stay sober, identify factors and situations that trigger alcohol use—like anger, shame, conflict with others, meeting with drinking friends at a party—learn how to cope effectively, etc.

The choice of therapy depends on a variety of factors, including whether the patient is suffering from multiple disorders. Indeed, dual diagnosis (alcohol use disorder plus another mental illness, like anxiety or depression) is quite common.

The therapist will consider these and other factors as he or she chooses an appropriate therapy modality and/or medications for the patient.
If you have been struggling with alcohol abuse, I hope you can see now that you have many therapeutic options available. With the right treatment, you can feel empowered again, regain control, and live your life with purpose.

Provided by Dr. Anthony Mele. Dr. Mele has provided psychological treatment and executive leadership in a wide range of settings including inpatient and residential drug and alcohol treatment centers and outpatient specialty clinics. Harbor Psychiatry & Mental Health provides outpatient treatment and mental health services to help Orange County, Ca communities with the treatment of substance use disorders.

References
1. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics
2. https://harbormentalhealth.comnewsroom/news-releases/apa-releases-new-practice-guideline-on-treatment-of-alcohol-use-disorder
3. https://pubmed.ncbi.nlm.nih.gov/28658981/
4. https://www.apa.org/topics/alcohol-disorders