People with an alcohol problem who are not dependent on alcohol can often control their problem just with support from a health care provider and family or friends. They also may choose to attend meetings of Alcoholics Anonymous or another support group.
You may choose to cut down on your drinking or quit. Either way you need to look at:
- your drinking patterns;
- the situations that trigger your drinking;
- the resulting problems; and
- the pros and cons of cutting down and of quitting.
Next, decide on a drinking goal (whether it is cutting down or quitting) and ways to handle your trigger situations and other difficulties of maintaining your goal.
Treating alcoholism is a much more involved process because alcoholics need to break their dependence on alcohol and deal with a large array of problems caused by their drinking. Alcoholism can be successfully treated and managed but not cured. Abstinence is usually the goal since most alcoholics are not able to control their drinking through just cutting down.
The first step in quitting drinking for a person with alcoholism is to deal with the withdrawal symptoms. Long-term treatment can involve cognitive-behavioral therapy, support groups, and/or medication to regain health, deal with other problems caused by drinking, and maintain abstinence. Treatment needs to be tailored to the individual’s specific needs.
About 95 percent of people who experience withdrawal symptoms have mild or moderate ones, such as trembling, agitation, sleep problems, and lack of appetite. Most people with mild symptoms do not seek treatment for them. About 15 to 20 percent of people with moderate symptoms have brief seizures and hallucinations but can usually be treated with medication as outpatients.
People with severe symptoms are usually treated as inpatients in a hospital or alcohol treatment center. They often have full-blown seizures or delirium tremens. Treatment with medication and monitoring of their condition are needed. The program they participate in is often referred to as "detoxification," or "detox" for short. Detoxification is the process of getting alcohol out of the body.
Cognitive-behavioral therapy is a type of psychotherapy that focuses on 1) changing unproductive thought patterns to help change how you feel and 2) changing and gaining control over unwanted behaviors. In the treatment of alcoholism it is used to help people:
- change the way they think about and use alcohol;
- identify and avoid things that trigger their drinking;
- develop strategies to cope with cravings for alcohol; and
- make changes in lifestyle that increase involvement in activities not related to alcohol use and reduce contact with drinkers.
Support groups provide an opportunity for people with alcohol problems to share experiences and support and learn from each other. Attending support group meetings reinforces the person’s commitment to recovery and can be a major help in staying sober over the long term. They also provide a chance to get to know other people in an alcohol-free environment who are trying not to drink.
There are several national self-help organizations that focus on abstinence and provide support groups throughout the United States. Each one has a different approach. Alcoholics Anonymous (AA) is the largest, oldest, and most well known of these organizations. It is based on a 12-step program for recovery. Two other groups are Secular Organizations for Sobriety (SOS) and Women for Sobriety (WFS).
Al-Anon provides support groups for family and friends of people with alcohol problems. It is associated with Alcoholics Anonymous and also based on a 12-step approach.
Two medications are currently approved by the U.S. Food and Drug Administration (FDA) to treat alcoholism over the long term. They are used in conjunction with other forms of treatment.
Disulfiram (Antabuse) discourages alcohol use by causing unpleasant symptoms when a person drinks alcohol while taking it. The symptoms include flushing, nausea, and vomiting. Disulfiram has not been shown to increase the rate of abstinence, but it helps some people who relapse to drink less. The potential for dangerous reactions limits its use.
Naltrexone (ReVia) decreases alcohol use by reducing the pleasurable effects of alcohol and cravings. It can be very effective, especially when used with counseling or support groups. The most common side effect is short-term nausea. High doses can cause liver damage.
Acamprosate (Campral) decreases alcohol use by reducing cravings. It may sometimes cause diarrhea. Acamprosate is currently being sold in Europe and is under review by the FDA for use in the United States.
Other medications, including antidepressants and anti-anxiety medications, are sometimes used to prevent relapse. Research is ongoing to develop new medications and refine the roles of existing ones.