How to Treat Alcoholism

 

Excessive alcohol consumption is a universal problem of devastating socioeconomic impact, particularly in the United States. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), over seven percent of Americans age 18 or older suffer from an alcohol use disorder (AUD) according to official diagnostic criteria— an unprecedented 17 million.  Tragically, less than 25 percent seek professional help.

SIGNS AND STAGES OF ALCOHOLISM

In almost every culture, from industrialized first-world nations to primitive societies, alcohol is readily available. This global prevalence and social popularity can make it difficult to determine exactly what constitutes abuse. Even in the United States, where alcohol is ubiquitous, what some subcultures and social circles consider “normal” use is actually excessive and dangerous.

Binge drinking is a universal indicator of behavior that leads to alcohol abuse. According to the Centers for Disease Control and Prevention (CDC), binge drinking is defined as:

• Consuming alcoholic beverages with the intention of getting intoxicated
• Consuming five or more alcoholic beverages within a two hour time span (for men)
• Consuming four or more beverages within a two hour time span (for women)

Although binge drinking is undoubtedly the most common form of alcohol abuse, a variety of excessive drinking patterns exist. For some people, immoderate alcohol consumption and associated behavior appear as:

• Drinking alcohol in smaller quantities continuously throughout the day
• Consuming alcoholic beverages prior to, or while driving
• Irresponsible drinking observed only in social settings
• Regular alcohol consumption to the point of “feeling a buzz,” but stopping short of full-blown intoxication

Regardless of the specific type of drinking pattern one engages in, excessive alcohol consumption activates electrical and neurological changes in the brain— all of which are problematic. Once brain function has been negatively impacted by these changes, people generally exhibit even less control over their alcoholic behaviors. At this point, drinking is not just a habit, but a crippling compulsion, a debilitating psychiatric and medical condition requiring aggressive intervention. According to the National Council on Alcoholism and Drug Dependence (NCADD), common indicators of alcoholism may include:

• Noticeable withdrawal symptoms in between binge drinking sessions
• Increasing tolerance for alcohol and greater quantities required to produce the desired effect
• A genuine desire to stop drinking accompanied by the failure or inability to do so
• An all-consuming interest and prioritization of alcohol above other commitments and responsibilities in one’s life
• Continued alcohol consumption despite major problems caused by drinking, for example, DUI’s, reckless driving or other impairment-related driving charges, car crashes, strained or broken relationships (friendships, business partnerships, marriages, etc.), personal and professional failures

Just as there is a wide range of behavioral signs and symptoms that outwardly define alcoholism, there are also numerous subtypes of alcoholics. As with other forms of addiction, alcoholism has a strong genetic component in certain people. However, genetics alone is insufficient when determining the exact cause. The following five subtypes are widely recognized by NIAAA and used for clinical and diagnostic purposes:

• Young adult subtype – This category is comprised of young alcoholics who exhibit low rates of family alcoholism, co-occurring mental illness and seldom seek help for their addiction. The “young adult subtype” accounts for approximately 32 percent of alcoholics in the United States, making it the most commonly occurring subtype.
• Young antisocial subtype – This category is comprised of alcoholics in their mid-twenties who display early-onset drinking and alcohol problems. Within this subtype, which accounts for 21 percent of US alcoholics, over half come from families with a known history of alcoholism, and approximately half are believed to suffer from an antisocial personality disorder (APD). Other presenting mental health issues that commonly appear in this subtype are general anxiety and depression-related disorders, including bipolar disorder, and an unusually high prevalence of co-occurring substance abuse disorders (SUDs). Approximately one-third of “anti-socials” seek treatment for their alcoholism.
• Functional subtype – This category is comprised primarily of middle-aged, well-educated alcoholics with families and jobs/careers. Within the “functional subtype,” approximately one-third suffer from family histories of multi-generational alcoholism, approximately one-quarter suffer from co-occurring anxiety and depression-related disorders, and approximately one-half are smokers. This subtype accounts for approximately 21 percent of alcoholics in the United States.  
• Immediate family subtype – This category is comprised primarily of middle-aged alcoholics, approximately 50 percent of whom come from families plagued by multigenerational alcoholism. Approximately half of these individuals suffer from clinically significant depression, and 20 percent suffer from bipolar disorder. Within this subtype, the majority of individuals smoke cigarettes and approximately 20 percent suffer from co-occurring SUDs. The “immediate family subtype” accounts for approximately 20 percent of alcoholics in the United States.
• Chronic severe subtype – This minor category, representing only nine percent of alcoholics in the United States, is comprised of middle-aged individuals suffering from high rates of early-onset alcoholism in addition to a strong family history of multigenerational alcoholism (80 percent). High rates of co-occurring mental health disorders, including APD and criminality, are also defining factors. Due to the severity of their alcoholism, and the resulting consequences, approximately two-thirds of “chronic severe subtype” alcoholics seek professional treatment.

Once alcohol abuse progresses into full-blown alcoholism, professional treatment is mandatory in order to achieve optimal recovery outcomes. For those who ignore the necessity of professional treatment against medical advice, a more difficult and painful recovery process can be expected. Even with professional intervention, alcoholism is an insidious disease known for its 40-60 percent relapse rate. Those who are serious about their health and longevity simply cannot afford to avoid undergoing medically managed treatment.    

PROFESSIONAL TREATMENT OPTIONS

The very first step involved in properly treating alcoholism is detox— a process designed to help the body expel the toxic accumulation of alcohol from the system and stabilize emotional and psychological processes. Initial alcohol detox is usually a short-term process, with mild alcohol withdrawal symptoms appearing as early as two hours following the last drink and peaking within two days. For many clients, early withdrawal symptoms may include:

• Anxiety
• Agitation
• Difficulty concentrating
• Fatigue
• Depression
• Environmental sensitivity
• Disorientation
• Mood swings
• Vomiting
• Tremors
• Gastrointestinal distress
• Nightmares
• Disorientation
• Psychosis

The initial intensity of the first 24-48 hours is followed by an extended withdrawal process of less acute symptoms that usually lasts for one to two weeks. Following this transitory period, a third and final withdrawal phase known as post-acute withdrawal syndrome (PAWS) kicks in. Although generally characterized by milder symptoms, PAWS may linger for months, or even years in certain clients.  Although all cases of alcoholism require professional medical management and official diagnosis, extreme cases may require additional measures including 24/7 monitoring of blood pressure and vital signs, intravenous injections of special medication, and a host of other precautions on an as-needed basis.

Once a client successfully stabilizes following initial detox and demonstrates readiness to move on to the next phase of treatment, intensive inpatient treatment is generally considered the industry gold standard. This popular treatment method—which usually lasts for one month but may last as long as three—involves clients living at a designated residential facility while receiving ongoing medication management and individual and/or group psychotherapy. Many inpatient treatment facilities also feature ancillary benefits and services beyond the 24/7 staff monitoring and premium level of clinical care they provide. These benefits and services include alumni networking, comprehensive aftercare planning, alternative healing modalities, state-of-the-art technology, and on-site social and recreational amenities.

Although intensive outpatient treatment (IOP), outpatient treatment (OP), and government- subsidized programs represent additional treatment options, they are usually more casual and less effective than inpatient treatment and, therefore, inappropriate for those suffering from alcoholism. In most cases, they are better utilized as transitional methods of care following successful completion of detox and a reputable inpatient program.    

MEDICATION-ASSISTED TREATMENT (MAT)

MAT describes the use of Food and Drug Administration (FDA) approved pharmacological interventions in tandem with psychotherapy. The following evidence-based therapies are frequently included in the scope of AUD treatment:

• Cognitive behavioral therapy (CBT)
• Dialectical behavioral therapy (DBT)
• Motivational interviewing (MI)
• Trauma-informed therapy

Depending upon a client’s presenting issues and overall case history, family therapy or other creative and expressive therapies may be incorporated into the treatment regimen. The following medications are currently considered the staple of AUD treatment:

• Acamprosate
• Disulfiram
• Naltrexone
• Beta-blockers
• Anti-anxiety
• Anti-seizure
• Benzodiazepines

Additional medications may be required to treat co-occurring substance abuse or mental health disorders— both of which play a significant role in the development of alcoholism.

RELAPSE PREVENTION

Effectively treating alcoholism requires an intense, long-term commitment that lasts well beyond the initial detox and medically managed treatment phase. Aside from continuing one-on-one (or group) therapy and taking follow-up medications exactly as prescribed, many clients benefit from an empirically proven relapse prevention strategy that encompasses:  

• AA involvement
• Sponsorship
• Life and jobs skills coaching
• Random drug testing
• Sober peer support
• Healthy dietary and lifestyle decisions
• Abstinence from social/environmental triggers
• Developing a strong sense of spirituality

A STEP IN THE RIGHT DIRECTION

If you or someone you love is suffering from alcoholism, contact a substance abuse professional today. The first step to building a better tomorrow is admitting that you have a problem today. Never be ashamed of the fact that you need help; instead, use your courage as a motivating factor. 

For more about alcoholism and recovery, check out these related articles:

1. “How Long Does Alcohol Withdrawal Take?”
2. “How Long Does Alcohol Stay in Your System?”
3. ”How Untreated Drug or Alcohol Addiction Affects other Health Issues”
4. “5 Signs Your Loved One is Masking a Drinking Problem”

Sources:

Journal of the American Medical Association (JAMA). Alcohol Abuse and Alcoholism. May, 2006.

OJM-International Journal of Medicine. Depression and Alcoholism. April, 2004.

The Lancet. No Level of alcohol consumption improves health. August, 2018.

PLOS ONE. Disulfiram Efficacy in the Treatment of Alcohol Dependence: A Meta-Analysis. Feb, 2014.