Treatment for Alcohol Use Disorder: What Works?
“Be open and honest about it. Talk about it with your healthcare providers.”
“There are a lot of negative consequences of ongoing alcohol use,” says Jonathan Avery, MD, director of Addiction Psychiatry at Weill Cornell Medicine and NewYork-Presbyterian Hospital. Not only can it mess with your life and potentially ruin relationships and jobs, but it can also deteriorate your physical health, including liver damage, brain damage, and an increased risk of certain types of cancer.
If you fear you may be drinking more than you should be, but you’re having trouble cutting back, don’t be afraid to reach out for help, even if the situation isn’t dire yet. “Talk about it with your healthcare providers,” says Dr. Avery. “Don't let things get to the point where things are so severe that you're forced to treatment.”
Treating any type of substance use disorder can be challenging. Your brain has essentially been rewired to depend on the substance, so it’s not as simple as just having “discipline.”
“I argue that the first step when you have an alcohol use disorder is to, one, make sure everyone in your life knows, and then let a healthcare provider know [who] can give you some good advice,” says Dr. Avery.
Treatment Programs for Alcohol Use Disorder
“Treatment for alcohol use disorder … can involve self-help groups like Alcoholics Anonymous, or alternatives to AA like SMART Recovery, which are basically both free, peer-based groups that you can work the Steps, get the sponsor, and have the sober community that can usher you into recovery,” says Dr. Avery.
The “steps” Dr. Avery refers to are the 12 Steps of recovery. It’s a formalized program to eliminate alcohol use (but it has also been adapted to treat other addictions and substance use disorders).
Medications for AUD
“Increasingly, we're also recommending medications to help with alcohol use disorder,” says Dr. Avery, “and we feel sometimes that that combination of psychosocial support and medications can help people achieve sobriety.”
The main type of medication used to treat alcohol use disorder works by suppressing cravings for alcohol “so you feel less compelled to use,” says Dr. Avery. “They help with the neurocircuitry that's been rewired in your brain.”
Another treatment for alcohol use disorder works by causing very unpleasant side effects if you drink while taking them, thus discouraging drinking. Within minutes of consuming alcohol, you might experience headache, vomiting, sweating, and impaired vision. This was actually one of the first drugs created for alcohol dependency, approved by the Food and Drug Administration in 1951.
“It can be hard to get treatment for alcohol use disorder because it's such a part of our lives and culture, [but it’s] important to intervene early so you can learn to live life without it,” says Dr. Avery.
Dr. Avery is the director of Addiction Psychiatry at Weill Cornell Medicine and NewYork-Presbyterian Hospital.
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There are a lot of negative consequences
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of ongoing alcohol use.
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If you're in the at-risk category, you're maybe drinking
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a little too much, maybe using a little more substances
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than you would like, you might just need to sort of step back
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and be aware and to see if you can regulate,
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maybe experiment with going to a self-help group.
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For the at-risk group, though, the big thing is,
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be open and honest about it.
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Talk about it. Talk about it with your healthcare providers.
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Don't let things get to the point where things are so severe
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that you're forced to treatment, forced to go to rehab,
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forced to lose your job or those other things,
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and so, you do want to talk about it early,
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and you do want to intervene early if possible.
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I argue that the first step when you have an alcohol use disorder
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is to, one, make sure everyone in your life knows,
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and then let a healthcare provider know
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or someone that you trust in the medical field
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that can give you some good advice.
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And treatment for alcohol use disorder often involves a combination
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of things, so it can involve self-help groups like Alcoholics Anonymous
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or alternatives to AA like SMART Recovery,
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which are basically both free, peer-based groups
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that you can work the Steps, get a sponsor,
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and have the sober community that can usher you into recovery.
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Increasingly, we're also recommending medications
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to help with alcohol use disorder, and we feel sometimes that
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that combination of psychosocial support and medications
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can help people achieve sobriety.
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And there are medications for alcohol use disorder
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that you can take every day
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and they result in decreases in craving,
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so you feel less compelled to use.
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They help with the neurocircuitry that's been rewired in your brain.
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And there are also medications you can take every day
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that if you drink on them, you become toxically ill,
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and so you basically create this barrier where you're saying,
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"Hey, I can't drink because I have this medication in my system."
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Ideal treatment involves both psychosocial support, family support,
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and potentially these medications.
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It can be hard to get treatment for alcohol use disorder
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because it's such a part of our lives and culture,
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and it's important to get treatment early
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because it can really hijack your lives in all these subtle ways,
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and once it becomes the answer to every question,
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you're gonna start to lose all these important things in your life.
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Lose your family members, your job, your physical health,
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and so it's important to intervene early so you don't lose those things,
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but it's also important to intervene early
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so you can learn to live life without it.
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Live life to learn to cope and to feel okay to be you,
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and to develop these sort of milestones in your life
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that you need to in order to be happy and healthy.
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(music fades)
Approach to treating alcohol use disorder. Waltham, MA: UpToDate, 2020. (Accessed on April 27, 2020 at https://www.uptodate.com/contents/approach-to-treating-alcohol-use-disorder.)
Exploring treatment options for alcohol use disorders. Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism. (Accessed on April 27, 2020 at https://pubs.niaaa.nih.gov/publications/aa81/aa81.htm.)
The 12 Steps of Alcoholics Anonymous (AA). American Addiction Centers Resource, 2020. (Accessed on April 27, 2020 at https://www.alcohol.org/alcoholics-anonymous/.)
Using disulfiram to treat alcoholism and alcohol abuse. American Addiction Centers, 2019. (Accessed on April 27, 2020 at https://americanaddictioncenters.org/addiction-medications/disulfiram.)