Alcohol abuse and alcoholism treatment

Also known as: Alcohol addiction; alcohol dependency

Definition: Alcohol use disorder (AUD), which includes alcohol abuse, alcohol dependence, and hazardous drinking, is a condition in which a person depends on regular ingestion of alcoholic beverages. Individuals with alcohol use disorder are unable to control their drinking and continue to drink even if doing so interferes with their health, interpersonal relationships, or job. Alcohol abuse refers to excessive drinking—enough to cause problems in daily life––without complete dependence upon the substance. According to the World Health Organization (WHO) fact sheet updated in 2022, more than two hundred diseases and injury-related health conditions were associated with the harmful use of alcohol.

Criteria Marking Alcohol Dependency

A wide range of treatment programs are available to persons who are dependent on or who otherwise abuse alcohol; however, many problem drinkers deny that they have a problem or simply refuse to obtain help. A person who meets two or more of the following criteria is considered to have an alcohol use disorder: drinks more or longer than one intends; is unable to stop or cut down on alcohol consumption; needs more alcohol to get the same effect (tolerance); has withdrawal symptoms when less or no alcohol is consumed; spends a lot of time drinking or recovering from drinking; cuts back on or gives up activities that were once interesting, important, or pleasurable because of drinking; continues to drink despite negative consequences with family or friends; has problems at school or work due to drinking; craves alcohol; continues to drink even though drinking causes anxiety or depression or exacerbates another health problem; or gets into dangerous situations while or after drinking. According to the National Institute on Alcohol Abuse and Alcoholism, in 2019 nearly 15 million adults age eighteen and older had AUD. An estimated 414,000 adolescents ages twelve to seventeen had AUD.

Problem Recognition

Many people with alcohol use disorder deny that they have a problem; thus, treatment is initiated by a triggering event or by the urging of another person. A triggering event may be a conviction for drunk driving, a serious health condition (such as pancreatitis or cirrhosis of the liver), or a threat of divorce, job loss, or loss of child custody. A spouse, relative, coworker, or boss may be influential in initiating treatment. However, some alcohol abusers ignore a triggering event or advice from others and sink deeper into alcohol abuse. For example, some women stop drinking if they become pregnant, but some do not, even knowing that their drinking will harm the developing fetus.

Treatment Options

A number of treatment options are available to problem drinkers; these options vary by individual circumstances. In some cases, a brief intervention by a health care professional may be sufficient. Other cases require enrollment in an outpatient program, which includes counseling. More severe cases require an inpatient program. For some alcohol abusers who are not dependent upon alcohol, cutting back on alcohol consumption may be possible and may allow the person to return to a normal lifestyle. Persons with alcohol dependence, as most health care professionals and support groups recommend, should completely abstain from alcohol. However, some experts advocate continued moderate alcohol intake. Despite this alternative therapy, the preponderance of evidence supports complete abstinence.

Often, alcoholics abuse other substances, such as cocaine, marijuana, and prescription drugs, so treatment programs also should include therapy for addiction to these substances. Tobacco contains nicotine, which is highly addictive. Some treatment programs include smoking cessation in their programs, while others focus on the abuse of alcohol and other substances such as narcotics, excluding tobacco.

The following steps are involved in treating alcohol abuse and alcoholism:

Detoxification. For persons with alcohol dependency, detoxification (or detox) is necessary. Sedatives are often necessary to reduce withdrawal symptoms, which include shaking, confusion, hallucinations, or even seizures in severe cases. Collectively, these symptoms are termed delirium tremens (DTs). Withdrawal may require up to one week and usually requires inpatient care at a hospital or a treatment center.

Reprogramming. With the help of health care professionals skilled in alcohol abuse treatment, one can learn new life and coping skills and can formulate a treatment plan. The plan should include behavior modification techniques, counseling, goal-setting, and the use of self-help manuals and web resources.

Psychological counseling. Counseling on an individual or group basis is an essential treatment component. Group therapy is particularly valuable because it allows interaction with other alcohol abusers, and it increases the awareness that one’s problems are not unique. Therapy may include the presence of a spouse or other family members. Family support is a significant component of the recovery process.

Medication. Following medication for detox, long-term pharmaceutical treatment may be used. Oral medications available for treatment include disulferam, acamprosate, and naltrexone. Disulferam (Antabuse), which is taken by mouth, produces unpleasant physical reactions when taken in combination with alcohol, such as flushing, headaches, nausea, and vomiting. Disulferam does not reduce the craving for alcohol; however, acamprosate (Campral) may reduce alcohol craving. Naltrexone (ReVia) also may reduce the urge to drink; furthermore, it blocks the pleasant sensations associated with the consumption of alcohol. One problem with oral medications is this: If a person wants to return to drinking, he or she can simply stop taking the medication.

Follow-up support. Aftercare programs and support groups are essential if the recovering individual is to avoid (or manage) relapses and deal with the necessary life changes to maintain sobriety. Regular attendance at a support group such as Alcoholics Anonymous (AA) is often a component of follow-up care. Follow-up often includes psychological and medical care. Alcoholism commonly co-occurs with other mental health disorders. For these cases, psychological counseling or psychotherapy may be recommended. Treatment for depression or anxiety also may be a part of follow-up.

Alcoholics commonly have medical conditions that require treatment. These conditions include hypertension (high blood pressure), diabetes, heart disease, and liver disease (cirrhosis of the liver). Some medical conditions may decrease in severity or resolve with sobriety.

Beyond counseling and medication, other modalities may be helpful. For example, in 2010, researchers released the results of a clinical trial on a unique new therapy that applies electrical stimulation to a major nerve emanating from the brain. The technique, trigeminal nerve stimulation, achieved an average of a 70 percent reduction in symptom severity in an eight-week study period. The technique continues to be studied and holds promise for treating addiction.

Inpatient Treatment

For persons with a serious alcohol abuse problem, inpatient care is often necessary. These programs include detox followed by counseling, group therapy, and medical treatment. A benefit of an inpatient program is that it greatly reduces the risk of a patient gaining access to alcohol or other harmful substances. For anyone who receives inpatient care, regular outpatient follow-up is essential.

Many medical centers include treatment for substance abuse, including alcohol. Stand-alone facilities also can be found throughout the United States and other nations. Some provide care in a basic, clinical setting while others function in a resort-like setting. One well-known facility is the Betty Ford Center (in Rancho Mirage, California), which was founded by former US First Lady Betty Ford. The one-hundred-bed nonprofit residential facility offers inpatient, outpatient, and day treatment for alcohol use disorder and other substance abuse problems. It also provides prevention and education programs for family members (including children) of substance abusers.

Support Groups

Many support groups are available to those who admit they have a problem and who want a life without dependence upon alcohol. Treatment centers may have their own support groups or may refer patients to outside programs. A recovering individual may have to try many different resources before finding the best fit.

Alcoholics Anonymous. The primary goal of the well-known international support group AA is to help individuals with alcohol use disorder stay sober. AA was founded in 1935 by Bill Wilson, a New York stock broker, and Bob Smith, an Ohio surgeon, in Akron, Ohio. Both had been “hopeless drunks.” The organization claims more than two million members. New members are encouraged to avoid drinking but to do so “one day at a time” instead of “swearing off [alcohol] forever.”

AA is established in more than one hundred nations. Active membership in 2022 is reported as more than two million members; members in each group usually meet once or twice a week. Two main types of meeting are held: open and closed. In open meetings, speakers describe how they drank, how they discovered AA, and how AA has helped them. Relatives, friends of members, and anyone interested in the organization may attend. Closed meetings, which are for alcoholics only, consist of group discussions involving questions, shared thoughts, and discussions of personal problems.

AA has no formal government; the membership elects a chairperson, a secretary, and other group officers. The sole function of these persons is to ensure that the meetings run smoothly. No membership dues are assessed. The organization pays for expenses from donations.

Al-Anon and Alateen. Al-Anon (which includes Alateen for younger members) is a support group for friends and families of problem drinkers. The organization estimates that each alcoholic usually impacts the lives of a minimum of four other persons; thus, alcoholism is a family disease. Al-Anon and Alateen are open to affected persons whether or not the alcoholic in their lives is still drinking. Al-Anon and Alateen report more than 24,500 groups meeting in 135 countries and Al-Anon literature is available in more than forty languages. The meetings are anonymous and confidential; no dues or fees are required for membership.

Religious Support

Churches and synagogues often sponsor support for alcoholics. Members can avail themselves of services, which are often integrated with other organizations and social services in the community. Sometimes, a person who has no religious faith can get help by first accepting a religious faith. Although nonsectarian and nondenominational, AA, for example, is a faith-based organization as exemplified by its twelve-step program, which, in part, acknowledges the existence of a supreme being.

Genetic Factors

Significant evidence exists that genetic factors play a part in whether or not a person develops an alcohol use disorder. The interaction of genes and environmental factors that influence alcohol dependence is a complex scientific topic. For most people with alcohol dependence, many factors are involved.

Since 1989, the US-government-funded Collaborative Studies on the Genetics of Alcoholism (COGA) has been tracking alcohol use disorders in families. COGA researchers have collected data on more than 17,702 people. Researchers have found evidence for the existence of several alcohol-related genes. COGA researchers are increasingly convinced that different types of alcohol-related problems are representative of a number of genetic variations. Researchers are using the accumulated data to identify drugs that can help treat an alcoholic based on his or her specific DNA profile. Most drugs on the market for the treatment of alcohol abuse merely reduce alcohol craving. Compliance is a problem too, and these drugs are not effective for everyone.

Recognized genetic factors in developing alcohol use disorder include the following: Children of alcoholics have a high risk of alcohol abuse, a risk that is present even if the children are raised in homes without alcohol abuse; the sons of alcoholic fathers have nine times the normal risk of becoming alcoholics themselves; people with a certain gene become inebriated with just one or two drinks (thus, they are often discouraged from abusing alcohol); if one identical twin is an alcoholic, the other twin has a 76 percent risk of alcoholism; many Asians have genes that cause them to quickly metabolize alcohol (this causes a rapid heartbeat and nausea; thus, reducing their risk of becoming alcoholics); a rare gene present mainly in Finnish people makes them susceptible to severe impulsivity and alcoholism; a dopamine, receptor gene enhances pleasure from alcohol; friends often choose friends with the same genetic variation; and genes regulating neuropeptide Y are linked to stress and withdrawal symptoms from alcohol.

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