Alcohol dependence or alcoholism is a major progressive condition characterized by excessive consumption of alcohol that interferes with the social, psychological, and mental functioning of the individual. The first step towards recovery is to accept that you have an alcohol problem.
- Treatment For Alcoholism
- Continuing Treatment And Care Interventions
- Recovery From Alcoholism
Treatment For Alcoholism
According to research 1, treatment for alcohol use disorders (AUDs) “has made significant advances in the last 20 years.” The treatment for alcoholism depends on the severity of the addiction. It can be challenging to confront addiction and commit to the recovery process. The first step is to acknowledge that the alcoholic behavior is causing hindrances to your day-to-day life. There are several treatment methods to recover and manage the symptoms of alcoholism. Some of these methods are listed below:
1. Psychological Counseling
Counseling and therapy is an important part of the healing process. Coping skills training and relapse prevention is the primary focus of therapy. Some of the psychological counseling methods that are adopted are:
A. Cognitive behavioral therapy
This therapy is used to identify and detect the negative thoughts and feelings associated with alcoholism. Once identified, it is then replaced with positive thoughts to attain the desired outcome. The doctor can also recommend coping strategies in order to manage alcohol cravings. It may also be used to treat any underlying conditions such as depression or anxiety. A 2004 study 2 found CBT to be effective in combination with pharmacotherapies for treating patients with addiction or alcohol abuse. A six-week online cognitive behavioral self-help intervention for adult problem drinkers showed promise in a randomized controlled trial 3 conducted in the Netherlands. Participants who utilized the interactive self-help intervention reduced their drinking behavior significantly more than participants who received an online psychoeducational brochure about alcohol use.
B. Group Counseling
Group counseling involves a small group of people who meet regularly to discuss, interact and provide counsel on similar life events experienced by group members. It is usually led by a group leader or a therapist. Recovering alcoholics or people with alcoholism usually discuss coping strategies and experiences with fellow members. Some of the benefits of group counseling are:
- Giving and receiving support
- Finding solutions for alcoholic behavior
- Improving emotional experiences
- Decreasing social isolation
- Developing good communication skills
- Changing behaviors that trigger your alcoholic behaviors
- Dealing with stress, anxiety and other triggers
- Setting goals and reaching them
Some of the examples of group therapy/ counseling include Alcoholics Anonymous (AA) or SMART program. A 2016 study 4 found that support groups showed promising results in treating patients with addiction.
There are several medications that the doctor may prescribe for managing the alcohol withdrawal symptoms. Some of them are as follows:
Disulfiram is an FDA-approved alcohol dependence medication. This medication interferes with the metabolism of alcohol by inhibiting aldehyde dehydrogenase. This causes flushing, nausea, palpitations, and other severe reactions if one drinks. A 1992 study 5 found significant increases in the number of abstinent days and changes in 6-month alcohol consumption.
Although this medication is not FDA approved, it directly targets the Gamma aminobutyric acid (GABA) and glutamate brain pathways and reduces alcohol cravings. A 2007 study 6 found that topiramate decreased the percentage of heavy drinking days as compared to placebo.
Antidepressants may be prescribed to treat underlying conditions such as depression associated with alcoholism. A 2010 study 7 investigated the effects of sertraline in combination with naltrexone. It was found that alcohol-dependent patients with comorbid depression found greater total abstinence (54%) when naltrexone and sertraline were used in combination.
Naltrexone is an FDA-approved medication for alcohol dependence. This medication helps to block opioid receptors and inhibits the rewarding effects of alcohol and reduces cravings. It is the most researched medication for treating alcohol dependence. A 2010 report 7 evaluated the combined effects of oral naltrexone and sertraline, an SSRI antidepressant. It was found that depressed alcohol-dependent subjects showed a higher abstinence rate (53.7%) when naltrexone/sertraline combination was used than either naltrexone alone (21.3%), sertraline alone (27.5%), or placebo (23.1%).
Acamprosate is an FDA-approved medication that helps in normalizing alcohol levels and the relative changes in the brain. It also helps in reducing physical distress and emotional discomfort people can experience when they stop drinking. A 1997 study 8 found that the percentage of patients with continuous abstinence after 6 months of treatment was almost double for the acamprosate group (40.7%) compared to the placebo group (20.8%).
3. Rehabilitation Centers
Rehabilitation centers are the most structured and organized environments to recover from alcoholism. The treatment program also involves a medical detox wherein the patient must rid their body of alcohol and other toxins under medical supervision. This medical detox is also responsible for addressing the dangers and symptoms of withdrawal. The detox phase is an essential part of the treatment program for any rehab center. There are usually two main facilities of rehabilitation centers. They are:
A. Inpatient Rehabilitation
These centers are used to treat the more severe stages of alcoholism. Inpatient rehabilitation requires the patient to remain in the center for 30, 60, or 90 days. This is the most intensive form of care wherein the patient receives round-the-clock monitoring and treatment in order to ease the withdrawal symptoms of alcohol dependence. A 2018 study 9 found that 59% of patients successfully completed treatment within 12 months and did not require more treatment within six months. It was also pointed out that a longer duration of treatment and provision of structured continuing care is associated with better treatment outcomes.
After completing the inpatient program, the patient may be moved to a partial hospitalization program to avoid relapse. In this phase, the patient lives in a transitional house where they receive counseling sessions and appointments. This program usually lasts around two weeks.
B. Outpatient Rehabilitation
This facility is less strict than inpatient programs. In this program, the patient can avail treatment in the morning and doesn’t have to remain in the facility. They usually require the patient to spend 10 to 12 hours a week at the facility. These sessions usually focus on:
- Individual therapy
- Group counseling
- Coping mechanisms
- Alcohol and drug abuse education
This program is most effective for people with a mild addiction. Outpatient programs require less time to complete than inpatient programs. A 2004 study 10 found that the initial phase of treatment has increasingly been shifted from inpatient settings to day hospitals or intensive outpatient programs. This method is both cost-effective and less disruptive to the patient’s life.
Continuing Treatment And Care Interventions
Dealing with alcoholism can be challenging. A 1994 study 11 found that patients who fail to achieve several consecutive weeks of abstinence during the initial treatment stage have poorer long-term outcomes than patients who do achieve abstinence. Hence, continuing care interventions is a crucial part of the recovery process after completion of the rehab program. A 2003 study 12 has examined the efficacy of continuing care after completing inpatient therapy. Some of the care interventions are as follows:
- Self-help groups
- 12 step oriented group counseling
- Individual therapy interventions
Recovery From Alcoholism
Recovery is quite challenging and is a lifelong process. There may be relapses or temptations but it is essential to take the determination to remain sober. With therapy, medications, or availing rehab facilities, it is possible to recover from alcoholism. However, it is essential to keep in mind that alcoholism may also pose a variety of complications that may require medical attention.References:
- Huebner, R. B., & Kantor, L. W. (2011). Advances in alcoholism treatment. Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism, 33(4), 295–299.
- Carroll KM, Fenton LR, Ball SA, Nich C, Frankforter TL, Shi J, Rounsaville BJ. Efficacy of disulfiram and cognitive behavior therapy in cocaine-dependent outpatients: a randomized placebo-controlled trial. Arch Gen Psychiatry. 2004 Mar;61(3):264-72. doi: 10.1001/archpsyc.61.3.264. PMID: 14993114; PMCID: PMC3675448.
- Carroll, K. M., & Kiluk, B. D. (2017). Cognitive behavioral interventions for alcohol and drug use disorders: Through the stage model and back again. Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors, 31(8), 847–861. https://doi.org/10.1037/adb0000311
- Tracy, K., & Wallace, S. P. (2016). Benefits of peer support groups in the treatment of addiction. Substance abuse and rehabilitation, 7, 143–154. https://doi.org/10.2147/SAR.S81535
- Chick J, Gough K, Falkowski W, Kershaw P, Hore B, Mehta B, Ritson B, Ropner R, Torley D. Disulfiram treatment of alcoholism. Br J Psychiatry. 1992 Jul;161:84-9. doi: 10.1192/bjp.161.1.84. PMID: 1638335.
- Johnson BA, Rosenthal N, Capece JA, Wiegand F, Mao L, Beyers K, McKay A, Ait-Daoud N, Anton RF, Ciraulo DA, Kranzler HR, Mann K, O’Malley SS, Swift RM; Topiramate for Alcoholism Advisory Board; Topiramate for Alcoholism Study Group. Topiramate for treating alcohol dependence: a randomized controlled trial. JAMA. 2007 Oct 10;298(14):1641-51. doi: 10.1001/jama.298.14.1641. PMID: 17925516.
- Pettinati HM, Oslin DW, Kampman KM, Dundon WD, Xie H, Gallis TL, Dackis CA, O’Brien CP. A double-blind, placebo-controlled trial combining sertraline and naltrexone for treating co-occurring depression and alcohol dependence. Am J Psychiatry. 2010 Jun;167(6):668-75. doi: 10.1176/appi.ajp.2009.08060852. Epub 2010 Mar 15. PMID: 20231324; PMCID: PMC3121313.
- Poldrugo F. Acamprosate treatment in a long-term community-based alcohol rehabilitation programme. Addiction. 1997 Nov;92(11):1537-46. PMID: 9519495.
- Eastwood B, Peacock A, Millar T, Jones A, Knight J, Horgan P, Lowden T, Willey P, Marsden J. Effectiveness of inpatient withdrawal and residential rehabilitation interventions for alcohol use disorder: A national observational, cohort study in England. J Subst Abuse Treat. 2018 May;88:1-8. doi: 10.1016/j.jsat.2018.02.001. Epub 2018 Feb 7. PMID: 29606222.
- McLellan AT, Meyers K. Contemporary addiction treatment: a review of systems problems for adults and adolescents. Biol Psychiatry. 2004 Nov 15;56(10):764-70. doi: 10.1016/j.biopsych.2004.06.018. PMID: 15556121.
- Carroll KM, Rounsaville BJ, Nich C, Gordon LT, Wirtz PW, Gawin F. One-year follow-up of psychotherapy and pharmacotherapy for cocaine dependence. Delayed emergence of psychotherapy effects. Arch Gen Psychiatry. 1994 Dec;51(12):989-97. doi: 10.1001/archpsyc.1994.03950120061010. PMID: 7979888.
- Baskin TW, Tierney SC, Minami T, Wampold BE. Establishing specificity in psychotherapy: a meta-analysis of structural equivalence of placebo controls. J Consult Clin Psychol. 2003 Dec;71(6):973-9. doi: 10.1037/0022-006X.71.6.973. PMID: 14622072.