When is the time for treatment?
Alcohol-related problems that result from drinking too much, too quickly, or too often are among the major public health concerns in the United States.
Many people have trouble controlling their alcohol consumption at some point in their lives. More than14 million adults aged 18 and over have an alcohol use disorder (AUD),and 1 in 10 children live at home with a parent who has a drinking problem.
Does the treatment work?
The good news is that no matter how serious the problem may seem, most people with AUD can benefit from some form of treatment.
Studies show that about a third of people treated for alcohol problems are free of any symptoms after one year. Many others significantly reduce their alcohol intake and report fewer alcohol-related problems.
Signs of a problem with alcohol
alcohol use disorder (AUD)is a medical condition that doctors diagnose when a patient's drinking causes suffering or harm. The condition can range from mild to severe and is diagnosed when the patient answers "yes" to at least two of the following questions.
Have you in the last year:
There were times when you ended up drinkingmore or longerthan you meant
She wanted more than oncereduce or stop drinkingOr maybe you tried but it didn't work?
I spent onea lot of timedrink? Or get sick or overcome the consequences?
Experiencedlust— a strong need or desire to drink?
I discovered that I drink a lot - or that I'm sick of drinkinginvolved in care managementyourdomzfamily? Or causedfunctionissues? Orschoolmatter?
He continued to drink despite provokingproblemwith yoursfamilyzfriends?
gave upzreducekneeclassesthat were important or interesting to you, or made you drink willingly?
I got into situations a few times while or after drinkingincreased the risk of injury(such as driving, swimming, operating machinery, walking in a dangerous area or having unprotected sex)?
You continued drinking, even though it made you feel baddepressed or anxiousor add toother health problem? Or after you hadamnesia?
Have todrink a lot morethan beforeget the effectYou want? Or it turned out to be yoursregular numberdrinks consumedmuch less effectthan before?
He discovered that when the effects of alcohol wear off, youhad withdrawal symptomssuch as trouble sleeping, tremors, irritability, restlessness, depression, restlessness, nausea, or sweating? Or maybe he felt things that weren't there?
If you have any of these symptoms, your drinking may already be a cause for concern. The more symptoms you have, the more urgent the need to change. A health care professional can perform a formal symptom assessment to see if AUD is present. For an online assessment of your drinking habits, please visitRethinkingDrinking.niaaa.nih.gov.
Treatment options
When asked how to treat alcohol problems, people usually think of 12-step programs or 28-day inpatient rehab, but it can be hard to name other options. In fact, there are several treatments available today, thanks to significant advances in the field over the last 60 years.
Ultimately, there is no one-size-fits-all solution, and what works for one may not work for another. Just understanding the different options can be an important first step.
Types of treatments
Behavioral treatment
Behavioral therapies aim to change consumption behavior through counseling. They are run by health professionals and backed by research that shows they can be beneficial.
Medicines
Three drugs are currently approved in the United States to help people stop drinking or drink less and prevent relapse. They are prescribed by a GP or other health professional and can be used on their own or in conjunction with counselling.
Mutual support groups
Alcoholics Anonymous (AA) and other 12-step programs provide peer support for people trying to quit smoking or reduce their drinking. In conjunction with treatment provided by healthcare professionals, peer support groups can provide valuable additional support.
Due to the anonymous nature of mutual support groups, it is difficult for researchers to determine their success rates compared to health professionals.
Starting with general practitioners
For anyone considering treatment, talking to a primary care physician is an important first step - they can be a good resource for treatment information and medication recommendations. The GP can also:
Assess the patient's drinking pattern
Help in developing a treatment plan
Assess your overall health
Assess whether alcohol medications may be appropriate
Individuals are advised to talk to their doctor about the best form of primary treatment.
Types of professions involved in healthcare
Many health professionals can play a role in your treatment. Below you will find a list of providers and the type of care they can provide. | ||
| Type of service provider | Diplomas and credentials | Type of treatment |
|---|---|---|
Primary Care Provider | MD, DO(doctor of osteopathic medicine), you can also contact aNursezDoctor's assistant | Medications, brief behavioral therapy, referral to a specialist |
Psychiatrist | MD, DO | Drugs, behavioral therapy |
Psychologist | dr. sc, psych. sc., mag. | Behavioral treatment |
A social worker | MSW(master of social work),LCSW(certified clinical social worker) | Behavioral treatment |
alcohol advisor | Other: Most states require some form of certification | Behavioral treatment |
| Individuals are advised to talk to their doctor about the best form of primary treatment. | ||
Treatments carried out by healthcare professionals
Professionally supervised treatments include:
Medicines
Picture
Some people are surprised to learn that there are drugs on the market approved to treat alcohol dependence. The newer types of these drugs work by counteracting the brain changes caused by AUD.
All approved medications are non-addictive and can be used alone or in combination with other treatments. Learn more about themapproved treatments.
Behavioral treatment
Behavioral treatment, also known as alcohol counseling, involves working with a health professional to identify and help change the behaviors that lead to excessive drinking. Behavioral treatment shares some common features, including:
Developing the skills needed to stop drinking or drink less
Help build a strong social support system
Work on setting achievable goals
Dealing with or avoiding triggers that may trigger a relapse
Types of behavioral therapies
Cognitive-behavioral therapythis can be done individually with a therapist or in small groups. This form of therapy focuses on identifying the feelings and situations (called "cues") that lead to excessive drinking and dealing with stress that may lead to relapse. The goal is to change the thought processes that lead to alcohol abuse and develop the skills needed to cope with everyday situations that may lead to problem drinking.
Motivational therapyis carried out over a short period of time to build and reinforce motivation to change drinking behavior. Therapy focuses on recognizing the pros and cons of seeking treatment, creating a plan to change the person's drinking habits, building confidence, and developing the skills necessary to stick to the plan.
Marriage and Family Counseling Centerit involves spouses and other family members in the treatment process and can play an important role in rebuilding and improving family relationships. Research shows that strong family support through family therapy increases the likelihood of abstinence (cessation of drinking) compared to patients undergoing individual counseling.
Brief interventionsare short one-on-one or small-group consultations that are limited in time. The Program Advisor provides information on individual drinking behavior and possible risks. After the client receives personalized feedback, the advisor will work with them to set goals and come up with ideas for change.
Ultimately, the choice of treatment may be more important than the approach used, as long as the approach avoids difficult confrontations and includes empathy, motivational support, and a focus on changing drinking behavior.
What FDA-approved drugs are available?
Some medications have been shown to be effective in helping people stop drinking or drinking less, and in preventing relapse.
Current Countermeasures
The U.S. Food and Drug Administration (FDA) has approved three drugs to treat alcohol dependence, and others are being tested to see if they are effective.
naltrexoncan help people reduce excessive drinking.
acamprosatehelps maintain abstinence.
disulfiramblocks the breakdown (metabolism) of alcohol in the body and causes unpleasant symptoms such as nausea and redness of the skin. These unpleasant effects may help some people avoid drinking while taking disulfiram.
It is important to remember that not all people will respond to medication, but for a subset of people it can be an important tool in overcoming alcohol dependence.
Researchers are working to develop a broader list of pharmaceutical treatments that can be tailored to individual needs. As more drugs become available, people can try more drugs to find out which they respond best to.
"Isn't drug use just replacing one addiction with another?"
This is not an unusual concern, but the short answer is no. All drugs approved to treat alcohol dependence are not addictive. These medications are designed to help treat a chronic condition, just as someone might take medication to control asthma or diabetes.
Looking ahead: the future of healing
Progress continues as scientists search for new and better treatments for alcohol problems. By studying the underlying causes of AUD in the brain and body, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) is working to identify key cellular or molecular structures - called "targets" - that could lead to the development of new drugs.
Personalized medicine
Ideally, healthcare professionals should be able to determine which AUD treatment is most effective for each individual. The NIAAA and other organizations are conducting research to identify genes and other factors that can predict how well a person will respond to a given treatment. These advances may optimize the way treatment decisions are made in the future.
Ongoing NIAAA research - leading to future discoveries
Some drugs already approved for other purposes have shown promise in treating alcohol dependence and drinking problems:
The anti-smoking drug varenicline (marketed as Chantix) significantly reduced alcohol consumption and alcohol craving in people with AUD.
Gabapentin, a drug used to treat pain and epilepsy, has been shown to increase abstinence and reduce binge drinking. People taking the drug also reported less cravings for alcohol and better mood and sleep.
Topiramate, an antiepileptic drug, has been shown to help people reduce their drinking problems, especially among those with a certain genetic make-up that appears to be related to treatment success.
Tips for choosing a treatment
Alcoholism treatment experts advise on what to look for when choosing a treatment program.
In general, you should gather as much information as possible about the program or provider before deciding on treatment. If you know someone with first-hand knowledge of the program, it may be helpful to ask them about their personal experiences.
Here are some questions to ask to help you choose:
What type of treatment does the program or provider offer?
It is important to assess whether the institution offers all currently available methods or uses a single approach. You may want to know if the program or provider offers medication and if mental health issues are being addressed along with substance abuse treatment.Is the treatment tailored to the person?
Tailoring the right therapy to the individual is important to their success. No single treatment will benefit everyone. It may also be useful to determine whether treatment will be adapted to changing needs as they arise.What is expected of the patient?
You will want to understand what is required of you to decide which treatment is best for you.Is treatment success measured?
By evaluating whether and how a program or provider measures success, you can better compare your options.How does the program or provider deal with relapses?
Relapse is common and you want to know how to deal with it. For more information on relapses, seeThe return is part of the process.
When seeking professional help, it is important that you feel respected, understood and trust that the person, group or organization can help you. But remember, it takes time to build relationships with doctors, therapists, and other healthcare professionals.
Additional remarks
Treatment environment – inpatient or outpatient?
In addition to choosing the type of treatment that is best for you, you also need to decide whether the treatment is inpatient (you would stay in a facility) or outpatient (you would stay at home during treatment). Hospital facilities tend to be more intensive and more expensive. Your doctor can help you weigh the pros and cons of each.
Cost can be a factor in choosing a treatment method.Evaluate coverage on your health insurance plan to determine how much your insurance will cover and how much you'll have to pay. Ask different programs if they offer rolling payments - some programs may offer lower rates or payment plans for people without health insurance.
Continuous process
Overcoming alcohol addiction is an ongoing process that may include relapse.
The importance of perseverance
Because AUD can be a chronic, relapsing condition, perseverance is key. It's rare for someone to go to treatment once and never drink again. More often than not, people have to repeatedly try to quit or cut back, experience relapses, learn from them, and keep trying. For many, ongoing medical supervision is essential to overcoming a drinking problem.
The return is part of the process
Relapse is common in people who have overcome alcohol problems. People with drinking problems are most at risk of relapse during periods of stress or when exposed to people or places associated with drinking in the past.
Just as some people with diabetes or asthma may experience a worsening of their condition, returning to drinking can be seen as a temporary obstacle to full recovery rather than a complete failure. Seeking professional help can prevent relapse - Behavioral therapies can help people develop skills to avoid and overcome triggers such as stress that can lead to drinking. Most people benefit from regular check-ups with their doctor. Medication can also discourage drinking during times when people are more likely to relapse (e.g. divorce, death of a family member).
Mental health problems and alcohol use disorders
Depression and anxiety often go hand in hand with heavy drinking. Research shows that people who are addicted to alcohol are two to three times more likely to experience major depression or anxiety in their lifetime. For drinking problems, it's important to seek treatment for any accompanying medical and psychological problems.
Tips for friends and relatives
Caring for someone with an alcohol problem can be very stressful. It is important to find a way to take care of yourself while trying to help a loved one. It can be helpful to seek support from others, including friends, family, community, and support groups. If you develop your own symptoms of depression or anxiety, consider seeking professional help. Remember that your loved one is ultimately responsible for dealing with the disease.
However, your participation can make a big difference.Based on clinical experience, many health professionals believe that the support of friends and family members is important in overcoming alcohol problems. But friends and family may not be sure how to provide the support they need. The following groups of family and friends may be a good starting point.
Remember that changing established habits is difficult, it takes time and repetitive effort.We usually experience failures along the way, learn from them and move on. AUD is no different. Try to be patient with your loved one. Overcoming this state is neither easy nor quick.
Pay attention to your loved one when they feel better or are just trying.Too often we are so angry or discouraged that we take it for granted when things get better. A word of thanks or recognition of success can go a long way.
Professional help
your doctor.Primary care and mental health practitioners can effectively treat AUD by combining new medications with brief counseling sessions. To help clinicians, the NIAAA has developed a guide for younger patients,Alcohol screening and brief intervention for young people: a practical guide. This guide and other resources are available athttps://www.niaaa.nih.gov/health-professionals-communities.
AUD Specialists.For details about addiction treatment options, talk to your doctor, health insurance company, local health department, or worker assistance program. Other sources include:
Specialists in the field of medical and non-medical addictions
American Academy of Addiction Psychiatry
www.aap.org
401-524-3076
American Psychological Association
www.apa.org
1-800-964-2000 (ask for state reference number to find addiction psychologists)
American Association of Addiction Medicine
www.asam.org
301-656-3920 (ask for state branch phone number)
NAADAC, Association of Addiction Professionals
www.naadac.org
1-800-548-0497
National Association of Social Workers
www.helpstarthere.org(search for social workers specializing in addictions)
Healing devices
Addiction treatment center locator
www.findtreatment.samhsa.gov
1-800-662-HELP
Mutual support groups
Alcoholics Anonymous (AA)
www.aa.org
212-870-3400
Moderation management
www.moderacja.org
212-871-0974
A.A. World
www.aasecular.org
323-693-1633
SMART recovery
www.smartrecovery.org
440-951-5357
Women for sobriety
www.womenforsobriety.org
215-536-8026
Groups for family and friends
Al-Anon family groups
www.al-anon.alateen.org
1-888-425-2666 for appointments
Adult children of alcoholics
www.adultchildren.org
310-534-1815
Sources of information
National Institute on Alcohol Abuse and Alcoholism
www.niaaa.nih.gov
301-443-3860
National Institute for Drug Addiction
www.nida.nih.gov
301-443-1124
National Institute of Mental Health
www.nimh.nih.gov
1-866-615-6464
Research shows that most people who have problems with alcohol can reduce their drinking or stop drinking altogether.
There are many ways to improve. It's important to find your own.
Understanding your treatment options—from behavioral therapies and medications to peer support groups—is the first step. It's important to stay committed to the method you choose.
Ultimately, treatment can increase your chances of success.