Alcohol Abuse and Dependence

Treatment for alcohol abuse and dependence usually includes group therapy, one or more types of counseling, and alcohol education. You also may need medicine. A 12-step program often is part of treatment and continues after treatment ends.

Treatment doesn't just deal with alcohol. It will help you manage problems in your daily life so you don't have to depend on alcohol. You'll learn good reasons to quit drinking.

Treatment helps you overcome dependence, but it doesn't happen all at once. Recovery from alcohol abuse or dependence—staying sober—is a lifelong process that takes commitment and effort. You may be in group therapy or counseling for a year or more.

Recovery helps you stay sober and adjust to life without alcohol. It helps you avoid a relapse, which happens when you slip up and drink again. Most people relapse, so it's best to accept it and move on.

Your family and friends are affected by your treatment. They can benefit from education, family therapy, and Al-Anon or other self-help support groups.

Can you quit on your own?

If you are abusing alcohol and not dependent on it, you may be able to cut back or quit on your own. But most people need help when they quit drinking.

If you want to quit, talk to your doctor. If your doctor thinks you can quit on your own, he or she can help you find support and give you medicine that will help you safely withdraw from alcohol. Your doctor also may prescribe medicines to help you stay sober. When you get a doctor's help, treatment for alcohol abuse or dependence is safer, less painful, and quicker.

Alcohol problems: How to stop drinking

If you can't stop drinking alcohol on your own, a treatment program can help you get through the first cravings for alcohol and learn how to stay sober.

Getting started

You might start treatment with your family doctor, or your doctor may recommend that you enter a treatment facility. A friend may bring you to a self-help group, such as Alcoholics Anonymous, or you might go to a clinic that deals with alcohol abuse. You may just decide you drink too much and want to cut back or quit on your own.

You may have a treatment team to help you. This team may include a psychologist or psychiatrist, counselors, doctors, social workers, nurses, and a case manager. A case manager helps plan and manage your treatment.

When you first seek treatment, you may be asked questions about your drinking, health problems, work, and living situation. Be open and honest to get the best treatment possible. Your treatment team may write a treatment plan, which includes your treatment goals and ways to reach those goals. This helps you stay on track.

Do you need detox?

Detoxification, or detox, flushes alcohol out of your body. You may need detox before you start treatment if you are physically addicted to alcohol. This means that when you stop drinking, you have physical withdrawal symptoms, such as feeling sick to your stomach or intense anxiety.

Detox helps get you ready for treatment. It doesn't help you with the mental, social, and behavior changes you have to make to get and stay sober.

Whether you need detox and whether you can go through it at home or need to go to a clinic or other facility depends on how severe your withdrawal symptoms are. Most people don't need to stay at a clinic but do need to check in with a doctor or other health professional. Whether you need to spend time in a clinic (called inpatient care) also depends on other problems you may have, such as a mental health problem.

You doctor may give you medicines to help reduce withdrawal symptoms. These include:

• Antianxiety medicines (such as diazepam), which treat withdrawal symptoms such as delirium tremens (DTs).
• Seizure medicines, which are used to reduce or stop severe withdrawal symptoms during detox.

What's the best treatment program for you?

Treatment programs can be outpatient, inpatient, or residential. They offer similar therapies, but how long they last and your level of medical care may vary. Your doctor can help you decide which type of program is best for you.

• In outpatient treatment, you regularly go to a mental health clinic, counselor's office, hospital clinic, or local health department for treatment.
• In inpatient treatment, you stay at a facility and have therapies during the day or evening. This usually lasts 1 to 6 weeks. You most likely will then go to outpatient therapy.
• Residential treatment provides a place for you to live while you recover. This may be a good option if you have a long history of alcohol or drug use, have a bad home situation, or don't have social support. These programs may last for months.

If you are thinking about going into a treatment program, here are some questions to ask.

What does a treatment program include?

Treatment programs usually include counseling, such as:

• Individual and group therapy, where you talk about your recovery with a counselor or with other people who are trying to quit. You can get support from others who have struggled with alcohol.
• Cognitive-behavioral therapy (CBT), where you learn to change thoughts and actions that make you more likely to use alcohol. A counselor teaches you ways to deal with cravings and avoid going back to alcohol.
• Motivational interviewing (MI), where you resolve mixed feelings about quitting and getting treatment. A counselor helps you find personal motivation to change.
• Motivational enhancement therapy (MET), which uses motivational interviewing to help you find motivation to quit. It usually lasts for two to four sessions.
• Brief intervention therapy, which provides feedback, advice, and goal-setting.
• Couples and family therapy, which can help you become and stay sober and keep good relationships within your family.

A treatment program may include medicines that can help keep you sober during recovery. These include:

• Disulfiram (Antabuse), which makes you sick to your stomach when you drink.
• Naltrexone (ReVia, Vivitrol), which interferes with the pleasure you get from drinking. ReVia is a pill you take every day. Vivitrol is a once-a-month injection used to treat alcohol dependence.
• Acamprosate (Campral), which may reduce your craving for alcohol.
• Topiramate (Topamax), which is a medicine used to treat seizures. One recent study shows that it might also help treat alcohol problems.⁶ Experts are studying how this medicine, and medicines like it, might help with recovery from alcohol abuse and addiction.

Most programs provide education about alcohol abuse and dependence. Understanding alcohol problems can help you and your family know how to overcome them. Some programs also offer job or career training.

Treatment programs often include going to a support group, such as Alcoholics Anonymous (AA). Your family members also might want to attend a support group such as Al-Anon or Alateen.

What to think about

Alcohol abuse can cause your body to become low in certain vitamins and minerals, especially thiamine (vitamin B1). You might need to take thiamine supplements to improve your nutrition during recovery. Thiamine helps prevent Wernicke-Korsakoff syndrome, which causes brain damage.⁷

You also might need supplements to help replace fluids and electrolytes.

Acupuncture has been used to treat some people with alcohol problems. Although acupuncture might be helpful for some people, there is no scientific proof that it is effective for alcohol problems.

People with alcohol problems often have other special considerations:

• If you have an alcohol problem and a mental health problem, such as depression, you will need treatment for both problems. Doctors call this a dual diagnosis.
• Older adults may have alcohol problems, and alcohol generally affects them more strongly than younger adults.
• Alcohol abuse in the military can interfere with military readiness.
• Some people are sent to alcohol treatment because of a court decision. This may happen if you have an alcohol problem and you commit a crime. A court may require treatment and keep track of your progress. Treatment often is available in prison.