Best Treatment Services for People with Alcohol Use Disorder

In the United States, it is legal for anyone 21 and older to buy and drink alcohol. Although alcohol can lead to intoxication, many people drink a beverage or two with a meal, with friends, to celebrate a special occasion, or to relax, and do not struggle with any associated mental or physical health problems.

Unfortunately, millions of other adults and thousands of adolescents in the U.S. struggle with alcohol abuse, which can lead to alcohol use disorder (AUD). 

HOW TO FIND A TREATMENT CENTER FOR CHRONIC ALCOHOLICS

When looking for a rehabilitation program that treats alcohol use disorder, there are some questions you can ask yourself to help you find the best place.

When looking for a rehabilitation program that treats alcohol use disorder, there are some questions you can ask yourself to help you find the best place. 

• Do you need help staying away from alcohol? This can determine if you need an outpatient or inpatient program.
• Do you need to have flexible hours so you can spend time at work or with your family? This is another way to determine if you need outpatient or inpatient treatment.
• What type of therapy does the program offer? Are these tailored to individual needs?
• Where is the treatment program located? Driving long distances can be inconvenient, making program retention more difficult.
• Is treatment success measured?
• Is there financial assistance, and how is payment managed?
• What associated programs are offered, like medical help, spiritual or religious services, or nutrition counseling?
• How is relapse handled by the program?

Various organizations and nonprofits are dedicated to helping those who are struggling with alcoholism. A few of these are outlined below.

• Alcoholics Anonymous: Often viewed as the original approach to helping people end alcohol use disorder, this is also one of the largest peer support organizations in the world. Millions of people meet every day around the globe to support each other in ending alcohol abuse.
• The Amy Winehouse Foundation: Created by the family of singer Amy Winehouse, who tragically died from alcohol poisoning, this nonprofit supports children at risk of addiction.
• Angels at Risk: This nonprofit focuses on children in families struggling with addiction to alcohol or drugs because this environment puts these children at risk themselves.
• Faces and Voices of Recovery: This large nonprofit is dedicated to supporting people in recovery from alcohol and drug addiction, along with their friends, family, and community.
• Gearing Up: This nonprofit is focused on women recovering from addiction, abuse, and incarceration by supporting them in social activities focused on physical fitness.
• The Herren Project: Founded by former professional basketball player Chris Herren, this nonprofit helps people navigate recovery from substance use disorders (SUD) including alcoholism.

• Shatterproof: This nationwide nonprofit aims to help individuals and families who struggle with addiction and the devastating effects of this disease.
• To Write Love on Her Arms: The focus of this nonprofit is helping people overcome addiction to drugs and alcohol, as well as manage co-occurring disorders like depression, anxiety, suicidal thoughts, and self-injury.

Additional organizations can be found through the Substance Abuse and Mental Health Services (SAMHSA) online treatment locator and hotline, and NIAAA’s Alcohol Treatment Navigator. Several states offer free treatment programs or government support, and many hospitals have financial services to help manage the costs of addiction treatment. Federally, Medicaid may help pay for some treatment programs, and veterans can work through VA hospitals to overcome substance abuse problems.

Treating alcoholism is of paramount importance. Without treatment, this chronic illness will get worse and lead to long-lasting physical and mental harm—even death. If you have concerns about your own behaviors toward alcohol, or a loved one’s potential drinking problem, start the process by reaching out for help today.

EXCESSIVE DRINKING VS ALCOHOL USE DISORDER

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that 86.4 percent of survey participants who were 18 and older reported that they drank at some point in their lives. It also found that 70.1 percent of participants drank at least once in the past year and 56 percent drank at least once in the past month.

While none of these forms of drinking are problematic, they do show how prevalent alcohol consumption is in the U.S. Because so many people are exposed to any level of alcohol consumption, the percentage of people who drink excessively is also high. In 2015, 26.9 percent of people reported binge drinking in the past month and 7 percent reported heavy drinking.

Binge drinking is defined as:

• Four or more drinks in a two-hour period for women.
• Five or more drinks in a two-hour period for men.

Heavy drinking is defined as:

• Seven or more servings of alcohol per week for women, or one serving per day.
• Fourteen or more servings of alcohol per week for men, or two servings per day on average.

Binge drinking and heavy drinking do not necessarily mean that someone has an alcohol use disorder, but consistently high drinking levels can indicate that someone might be struggling with AUD. According to the 2016 National Survey on Drug Use and Health (NSDUH), about 15.1 million people in the U.S. ages 12 and older struggled with AUD that year, which represents about 5.6 percent of that age group, or 1 in 18 adolescents and adults. NIAAA reports that, in 2015, only 6.7 percent of adults with AUD received the treatment they need. This was about 7.4 percent of men and 5.4 percent of women who needed treatment. About 5.2 percent of adolescents who needed AUD treatment got it.

On average every year, 88,000 people die from alcohol-related complications, which range from drinking and driving to liver failure. 

WHAT IS THE CLINICAL DEFINITION OF ALCOHOL USE DISORDER? 

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) combined alcoholism and alcohol dependence into one set of 11 criteria. These are similar to the criteria used to diagnose other forms of addiction. At least two of these criteria must occur consistently for a period of 12 months.

1. You regularly drink too much or drink for longer than you intended.
2. You wanted to cut down or stop drinking more than once, but you were not able to.
3. You spend a lot of time drinking or a lot of time being sick from drinking too much.
4. Your drinking habits or being sick after drinking too much interferes with your ability to spend time with loved ones or go to work or school.
5. You experience intense cravings when you stop drinking or when you are not able to drink regularly.
6. You continue drinking even though you know it causes problems with friends and family.
7. You stop going to fun events or participating in desirable activities because you prefer drinking.
8. You repeatedly get into situations during or after drinking a lot in which you are likely to get hurt, such as driving while drunk.
9. You keep drinking even though you suffer from mental, emotional, and physical problems that are related to drinking, like depression or ulcers.
10. You feel like you need to drink more now to achieve the same level of drunkenness you used to experience.
11. You experience withdrawal symptoms when intoxication wears off.

When two or three of these symptoms are present, the AUD is considered mild. The presence of four to five symptoms is considered a moderate AUD, and the presence of six or more meets the criteria for a severe AUD. Alcohol abuse leads to consistent intoxication, physical illness, mood swings, changes to hygiene, as well as sleeping and eating habits. Someone struggling with alcohol use disorder may keep a lot of alcohol around, hide alcohol in various places, or find excuses to drink more often. They may be in several accidents or end up in jail for driving under the influence (DUI).

On a long-term basis, excessive drinking and AUD can cause many serious problems.

• Chronic high blood pressure
• Heart disease
• Blood clots, strokes, or pulmonary embolism
• Digestive problems
• Liver disease and failure
• Damage to the brain, causing memory loss and cognitive problems
• Financial instability
• Troubled personal relationships
• Cancer of the mouth, esophagus, colon, liver, or breast

If you feel anxious or stressed when you are not drinking, cannot control how much you drink, or drink compulsively even if you intend not to drink, you may have AUD. It is important to get a diagnosis from a medical professional and then decide on your treatment options. 

WHAT IS THE BEST APPROACH TO TREATMENT?

The basic course of treating chronic alcoholism is similar to approaches for other forms of addiction: medically supervised detox, a rehabilitation program that provides therapy to change behaviors, and an aftercare plan. Behavioral counseling is the foundation of all addiction treatment. Since the hallmark of addiction is compulsive behaviors, therapy helps you understand these behaviors, so you can manage problems like emotional stress that might trigger them and spot the beginning of these problems before they lead to relapse.

Although detox and rehabilitation—along with mutual support groups and other approaches to aftercare—focus on avoiding relapse back into drinking or other drug abuse, it is important to know that relapse is often part of the recovery process. The National Institute on Drug Abuse (NIDA) compares addiction relapse rates to other chronic health conditions like hypertension, asthma, and diabetes, and notes that they are very similar. Type 1 diabetes, for example, has symptom relapse rates between 30 percent and 50 percent, and asthma relapse rates are 50 percent to 70 percent. Addiction relapse rates are between 40 percent and 60 percent.

Like other chronic illnesses, the concept of relapse with addiction simply means a return of symptoms after being stabilized by medical treatment. For diabetes, this means higher blood sugar and some physical symptoms. With addiction, this means a return of compulsive consumption of drugs or alcohol.

If the criteria listed in the DSM-5 have given you cause for concern, it is important to first find a doctor or addiction specialist who understands alcohol addiction and can appropriately diagnose this condition. When you make an appointment for a diagnosis, your doctor will screen you with:

• A list of questions regarding your drinking habits.
• A physical exam.
• Lab tests and imaging to determine if alcohol has caused any physical damage.
• A psychological evaluation to understand if you have associated mental health conditions that need simultaneous treatment.

Once you have received a medical diagnosis, including a determination of what level your AUD is, you should find an appropriate detox center. If you have co-occurring mental health problems, diseases caused by abusing alcohol, or have abused alcohol for a long time, you may need special medical treatment. Your physician can help you find and manage these resources.

ALCOHOL WITHDRAWAL AND DELIRIUM TREMENS: SIGNIFICANT RISKS TO SAFETY

Regardless of whether AUD is diagnosed as mild, moderate, or severe, supervised detox is crucial. Unlike detoxing from some other substances like cocaine, withdrawal from alcohol can be life-threatening.

Medically supervised detox involves monitoring withdrawal symptoms and prescribing medication as necessary to treat symptoms. Withdrawal symptoms associated with alcohol detox include: 

•  Anxiety
•  Nervousness or restlessness
•  Depression
•  Fatigue
•  Mood swings
•  Sleep disturbances, including insomnia or nightmares
•  Foggy thinking
•  Clammy skin
•  Sweating
•  Dilated pupils
•  Headaches
•  Loss of appetite
•  Nausea, vomiting, or stomach problems
•  Rapid heartbeat
•  Tremors in the hands and feet

Although these symptoms are uncomfortable, none of them are life-threatening. However, people who consumed a substantial amount of alcohol for a long period of time are at risk for alcohol withdrawal syndrome, which can include a condition called delirium tremens (DTs). DTs is a potentially deadly syndrome. Signs of DTs include:

•  Sudden, severe confusion called delirium
•  Body tremors
•  Changes in mental function and memory
•  Extreme agitation
•  Sleeping deeply for a day or more
•  Intense fear or excitability
•  Quick mood changes
•  Surges of energy
•  Sensitivity to stimuli, such as light, touch, or sound
•  Stupor, fatigue, or sleepiness
•  Hallucinations
•  Chest and stomach pain
•  Fever
•  Seizures

While the first alcohol withdrawal symptoms appear a few hours after the last drink, symptoms of delirium tremens begin between 12 and 48 hours after the final drink. Heart problems and seizures can be deadly, so it is important for addiction specialists to monitor the process of alcohol withdrawal, treat people who are at risk of DTs with medication, and begin treating those who show signs of DTs as soon as possible. 

DETOXING SAFELY AND GETTING REHABILITATION

Most people who go through alcohol detox do not require hospitalization or medication, but there are medications available to ease withdrawal symptoms as needed. Some forms of medication-assisted treatment (MAT) aim to taper the body off dependence on alcohol. Here are some of the common medications that are sometimes used for alcohol withdrawal:

BENZODIAZEPINES

This class of drugs was originally designed to treat anxiety disorders and panic attacks, and several medications in this group also treat insomnia and seizure disorders like epilepsy.

When someone abuses alcohol for a long time, the GABA receptors get used that substance managing the flow of GABA neurotransmitters.

Prescribing a small dose of benzodiazepines, and managing a taper off of these drugs, can be helpful for some people who have developed DTs and need hospitalization to manage the symptoms. 

DISULFIRAM

One of the first drugs used to help people detox from alcohol abuse, this medication is taken once per day. It can cause intense nausea, headaches, face flushing, chest pain, physical weakness, sweating, breathing problems, and anxiety when there is any alcohol present in the body. While the experience of these symptoms is supposed to quickly associate illness with drinking instead of pleasant effects, disulfiram’s side effects can be dangerous to people who have chronic illnesses, heart disease, or liver problems.

ACAMPROSATE

This medication is prescribed to people who have safely detoxed from alcohol and want to avoid drinking again. It is taken alongside therapy in rehabilitation. Acamprosate is taken once per day, preferably with a meal, and it reduces cravings for alcohol. There are some studies that indicate acamprosate helps the brain to function normally while recovering from alcohol use disorder.

NALTREXONE

Like acamprosate, this medication is prescribed after you have detoxed from alcohol, and it helps to reduce cravings. Naltrexone stops addictive chemicals like opioids and alcohol from binding to receptor cells in the brain and triggering the reward system, so any pleasant effects do not occur. Unlike disulfiram, however, naltrexone does not cause negative side effects—it just stops euphoria from occurring.

After a clinician has determined whether or not you need medication to help you ease off alcohol addiction or to prevent relapse, you will enter a rehabilitation program for therapy. Rehabilitation is based in group therapy, so most programs offer this approach. Some outpatient programs stop at group therapy and provide no other services while others offer individual therapy, different types of group therapy, complementary treatments like exercise or art therapy, and residential options that include food and lodging.

There are various approaches to therapy.

•  Cognitive behavioral therapy
•  Dialectical behavior therapy
•  Contingency management
•  Motivational enhancement therapy
•  12-step facilitation 
• Family therapy

When you complete a rehabilitation program, creating an aftercare plan is important. This plan should include mutual support groups, a list of people to contact in the event of a relapse, approaches to saying “no” to alcohol, physicians’ appointments, prescription medications, and ways to de-stress.

Sources

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(September 2017) Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. Retrieved August 2018 from https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.pdf

(January 2018) Alcohol and Public Health: Fact Sheets – Alcohol Use and Your Health. Centers for Disease Control and Prevention. Retrieved August 2018 from https://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm

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