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Treating Alcohol Use Disorder

Alcohol use disorder (AUD) is a term used to refer to drinking that causes harm and distress. This is a pattern of alcohol use that leads to problems in controlling your drinking, always thinking about alcohol, continuing to have alcohol even when you know it is causing problems, needing to drink more and more to achieve the same high, or experiencing withdrawal symptoms when you start to decrease or stop drinking alcohol. Alcohol use disorder is classified as a mental and physical dependence on alcohol. If you or someone you know has Alcohol use disorder (AUD), the good news is that there are several treatment options available for this condition, and your doctor will be able to help you choose the correct treatment option for you. Read on to find out everything about treating alcohol use disorder.

What is Alcohol Use Disorder (AUD)?

Alcohol use disorder (AUD) is a condition that involves problems controlling your drinking. This is a chronic illness that can have symptoms like an intense need to use alcohol, even when you know that it is causing problems.(1, 2, 3, 4) You are preoccupied with alcohol, and you need to drink more and more to achieve the same high. Symptoms also include going through intense periods of withdrawal once you stop having alcohol. People with alcohol use disorder are known to experience the following:(5, 6)

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  • Drink alcohol compulsively/excessively.
  • They are unable to control how much they drink.
  • They tend to feel irritable, anxious, or stressed when not drinking.

There are several types of treatments available for the treatment of alcohol use disorder, and your doctor will be the best person to guide you on which treatment would be the best one for you. Doctors typically recommend detoxification, medication, or some relapse prevention training.

What are the Treatment Options Available for Alcohol Use Disorder?

There is no cure for alcohol use disorder, and the road to recovery can often be a long and challenging process that requires various therapies and treatments. Doctors usually recommend that your treatment plan for Alcohol use disorder (AUD) should be individually customized and based on the criteria developed by the American Society of Addiction Medicine Criteria, along with personal circumstances.(7, 8, 9) These may include:

  • History of alcohol use dependency and alcohol withdrawal conditions
  • Other underlying psychiatric or medical conditions
  • Physical and social environment
  • Whether or not the patient has an interest in the treatment options
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If you want to take the first step to receive treatment for alcohol use disorder, you must make an appointment with your doctor. Your doctor will ask you several questions to determine the severity level of your alcohol dependency. The answers to these questions will also help your doctor choose the best possible treatment option for your individual needs.(10)

Depending on your situation, your therapist or doctor may recommend one or more of the following treatment options for Alcohol use disorder (AUD):

  • Detoxification
  • Medications
  • Relapse prevention training (this may include behavior modification and therapy)

Let us take a closer look at each of these treatment options.

  1. Detoxification

    Most treatment plans recommended by doctors for treating alcohol use disorder start with a detoxification program. Such a program focuses on helping treat the withdrawal symptoms that afflict a person after they stop drinking alcohol.(11)

    Detoxification is typically performed at an inpatient therapy treatment center or at a hospital. It usually takes one week to complete the detoxification program. Since the symptoms of physical withdrawal from alcohol can be fatal, your doctor is likely to prescribe medications to help prevent the following:

  2. Behavioral Modifications and Therapy

    Your doctor may recommend that you either attend one-on-one therapy or go to group counseling. There are many benefits of therapy when you are undergoing treatment for alcohol use disorder. Working with a therapist can help you determine your thought pattern, feelings, and behaviors and can help you get to the root cause of your alcohol use disorder. Some of the other benefits of therapy or treating Alcohol use disorder (AUD) include:(12)

    • Helps practice self-awareness.
    • It helps you formulate coping strategies for your alcohol dependency.
    • It helps you express yourself without the fear of judgment.
    • It helps you learn how to create healthier behaviors to help stop/limit the dependency on alcohol.

    Behavior modification might also be necessary for people who are dependent on alcohol. Such individuals may need to learn skills and develop coping strategies to help avoid alcohol once they leave the treatment center or go back to their familiar environments.(13)

    Your doctor is likely to refer you to other treatment programs or a counselor to help you learn such skills and coping strategies. In many cases, cognitive behavioral therapy is used to help people get back to their lives without being dependent on alcohol.(14)

  3. Finding Support Groups

    Support groups have been found to be especially helpful when you are getting treated for alcohol use disorder.(15) Being a part of support groups help you come in touch with other people who are also facing the same type of challenges as you. They can therefore help answer any questions you may have, provide encouragement, and further point you to other support resources that may help you in the treatment process. However, it is important to realize that support groups are not for everyone, and they might not be helpful to some people, especially those who prefer to keep their problems to themselves or are introverted.

    There are many types of support groups that are specially designed to tackle alcohol dependency. There are also many support groups for family and friends that are helping their loved ones deal with alcohol use disorder. Some of these groups include:

    • Alcoholics Anonymous
    • Al-Anon (especially for the friends and family of people living with alcohol use disorder)
    • National Association for Children of Alcoholics
    • Alateen
    • National Institute on Alcohol Abuse and Alcoholism
    • National Council on Alcoholism and Drug Dependence
    • Your local area’s alcoholic support group
  4. Medications

    There are many medications that doctors prescribe for the treatment of alcohol use disorder.(16) These may include:

    • Naltrexone: This is a class of drugs that blocks the feel-good effects that alcohol is known to have on your brain. When you do not experience these good feelings, you will be less inclined to have a drink.(17)
    • Acamprosate: This medication helps fight against alcohol cravings by restoring the balance of several chemicals in the brain.(18)
    • Disulfiram: This is an alcohol-sensitizing medicine that works by making you sick whenever you drink alcohol. So if you have alcohol while taking this drug, it will cause nausea, headaches and flushing. However, this medication is today the least preferred drug for treating alcohol use disorder as the side effects can be dangerous for some people and also because it doesn’t really treat the basic symptoms of Alcohol use disorder (AUD).(19)

    Naltrexone is usually the most commonly prescribed medication for alcohol use disorder, and it is available in the form of an injection or an oral tablet. Vivitrol is the injected form of the drug that your doctor will administer to you once a month. This option is considered to be more convenient and reliable than oral pills, especially if you are someone who may forget or be unwilling to have a pill every day.

What is the Long-term Outlook for Alcohol Use Disorder?

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Alcohol use disorder can take a toll on your body as well as your family and friends. The illness affects the body physically, causing many types of complications. For example, Alcohol use disorder (AUD) can increase the risk of the following:

Alcohol dependency is also usually accompanied by various mood or mental health conditions such as anxiety or depression. Alongside getting treatment for alcohol use disorder, you may also need to take medical assistance for any other complications you experience.

Conclusion

Treating alcohol use disorder is a lifelong journey as you may experience many relapses and temptations, but this is to be expected, and it is completely normal. It is also not uncommon for people to slip in and out of sobriety during their treatment process. Many people tend to recover from alcohol use disorder the first time itself, while others may need to undergo various attempts at treatment. Remember, though, that the more you try and stick with the treatment, the better are your chances of success.

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References:

  1. Kranzler, H.R. and Soyka, M., 2018. Diagnosis and pharmacotherapy of alcohol use disorder: a review. Jama, 320(8), pp.815-824.
  2. Grant, B.F., Harford, T.C., Dawson, D.A., Chou, P.S. and Pickering, R.P., 1995. The Alcohol Use Disorder and Associated Disabilities Interview schedule (AUDADIS): reliability of alcohol and drug modules in a general population sample. Drug and alcohol dependence, 39(1), pp.37-44.
  3. Tapert, S.F., Cheung, E.H., Brown, G.G., Frank, L.R., Paulus, M.P., Schweinsburg, A.D., Meloy, M.J. and Brown, S.A., 2003. Neural response to alcohol stimuli in adolescents with alcohol use disorder. Archives of general psychiatry, 60(7), pp.727-735.
  4. Witkiewitz, K., Litten, R.Z. and Leggio, L., 2019. Advances in the science and treatment of alcohol use disorder. Science advances, 5(9), p.eaax4043.
  5. Gowin, J.L., Sloan, M.E., Stangl, B.L., Vatsalya, V. and Ramchandani, V.A., 2017. Vulnerability for alcohol use disorder and rate of alcohol consumption. American Journal of Psychiatry, 174(11), pp.1094-1101.
  6. King, A.C., McNamara, P.J., Hasin, D.S. and Cao, D., 2014. Alcohol challenge responses predict future alcohol use disorder symptoms: a 6-year prospective study. Biological psychiatry, 75(10), pp.798-806.
  7. Criteria, A. and Criteria, A., 2022. About the ASAM Criteria. [online] Default. Available at: <https://www.asam.org/asam-criteria/about-the-asam-
  8. criteria#:~:text=The%20ASAM%20Criteria’s%20strength%2Dbased,of%20care%20across%20a%20continuum.> [Accessed 8 January 2022].
  9. McKay, J.R., Cacciola, J.S., McLellan, A.T., Alterman, A.I. and Wirtz, P.W., 1997. An initial evaluation of the psychosocial dimensions of the American Society of Addiction Medicine criteria for inpatient versus intensive outpatient substance abuse rehabilitation. Journal of Studies on Alcohol, 58(3), pp.239-252.
  10. Mee-Lee, D., Shulman, G.D. and Fishman, M.J., 2013. The ASAM Criteria. Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions, 3rd ed, p.2013. Kampman, K. and Jarvis, M., 2015. American Society of Addiction Medicine (ASAM) national practice guideline for the use of medications in the treatment of addiction involving opioid use. Journal of addiction medicine, 9(5), p.358.
  11. 2022. [online] Available at: <https://www.hackensackmeridianhealth.org/en/Services/Behavioral-Health/Addiction-and-Substance-Use-Disorders/Alcohol-Detox> [Accessed 8 January 2022].
  12. Shen, W.W., 2018. Anticraving therapy for alcohol use disorder: a clinical review. Neuropsychopharmacology reports, 38(3), pp.105-116.
  13. Campbell, E.J., Lawrence, A.J. and Perry, C.J., 2018. New steps for treating alcohol use disorder. Psychopharmacology, 235(6), pp.1759-1773.
  14. Naqvi, N.H. and Morgenstern, J., 2015. Cognitive neuroscience approaches to understanding behavior change in alcohol use disorder treatments. Alcohol Research: Current Reviews, 37(1), p.29.
  15. Spithoff, S. and Kahan, M., 2015. Primary care management of alcohol use disorder and at-risk drinking: Part 2: counsel, prescribe, connect. Canadian family physician, 61(6), pp.515-521.
  16. Winslow, B.T., Onysko, M. and Hebert, M., 2016. Medications for alcohol use disorder. American family physician, 93(6), pp.457-465.
  17. Yoon, G., Petrakis, I.L. and Krystal, J.H., 2019. Association of combined naltrexone and ketamine with depressive symptoms in a case series of patients with depression and alcohol use disorder. JAMA psychiatry, 76(3), pp.337-338.
  18. Ho, M.F., Zhang, C., Zhang, L., Wei, L., Zhou, Y., Moon, I., Geske, J.R., Choi, D.S., Biernacka, J., Frye, M. and Wen, Z., 2021. TSPAN5 influences serotonin and kynurenine: pharmacogenomic mechanisms related to alcohol use disorder and acamprosate treatment response. Molecular psychiatry, 26(7), pp.3122-3133.
  19. Fuller, R.K. and Gordis, E., 2004. Does disulfiram have a role in alcoholism treatment today?. Addiction (Abingdon, England), 99(1), pp.21-24.

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