Alcohol Addiction Treatment
Alcohol consumption has a long tradition in the U.S. with alcohol being consumed on numerous social occasions, business transactions, and personal activities. As alcoholic beverages are marketed aggressively in many different forms and are legal for individuals over the age of 21, the use and availability of alcohol remain quite extensive despite numerous dangers associated with its use and abuse.
The term alcohol use disorder(AUD), as coined by the American Psychiatric Association (APA), is used to describe the entire spectrum of alcohol abuse.1 An individual with an alcohol use disorder is experiencing problems associated with their use of alcohol which can range from mild issues (previously referred to as alcohol abuse) to significant problems with alcohol addiction (often referred to as alcoholism or alcohol dependence).
Only a trained mental health clinician can formally diagnose an SUD, and only such a clinician is able to reliably ascertain the potential seriousness of one’s issues regarding their use of alcohol. In many cases, people suffering from AUD need professional help, i.e. alcohol treatment programs that can help them overcome addiction.
The Prevalence of Alcohol Use and Abuse in the U.S.
Alcohol use and AUD are relatively common in the U.S. The National Survey on Drug Use and Health conducted by Substance Abuse and Mental Health Service Administration (SAMHSA) established the following:2
- Well over 85% of individuals over the age of 18 report using alcohol at least once in their lifetime. In 2017, 140.6 million individuals aged 12 or older admitted to using alcohol within the month prior to the survey.
- Approximately 66.6 million individuals reported engaging in binge drinking (five or more alcoholic drinks on a single occasion for men and four or more for women) within the past month, whereas 16.7 million reported being heavy alcohol users (binge drinking five or more times within a period of a month).
- Approximately 14.5 million individuals qualify for a diagnosis of AUD, according to SAMHSA’s diagnostic criteria.
- Adolescents are not immune to alcohol abuse issues either. In 2017, approximately 2.5 million people aged 12 to 17 admitted to drinking in the prior month, about 1.3 million admitted to binge drinking, approximately 174,000 adolescents admitted to heavy alcohol use, and about 434,000 met the criteria for AUD.
According to the official data published by the Centers of DIsease Control and Prevention, around 95,000 people in the U.S. die every year as a result of alcohol abuse.3 Therefore, it is essential that individuals learn more about alcohol abuse treatment and seek professional help for themselves or their loved ones.
The Effects of Alcohol
Alcohol is classified as a central nervous system depressant, meaning that its primary mechanism of action is to slow down and even inhibit the firing of the neurons in the brain and spinal cord. This does not mean that drinking alcohol makes one emotionally depressed, although in certain instances that can occur.4
Drinking alcohol affects numerous neurotransmitters in the brain and spinal cord by:4
- Increasing levels of the major inhibitory neurotransmitter in the brain, GABA (gamma-aminobutyric acid).
- Affecting levels of dopamine in the brain, which can lead to feelings of reinforcement and a tendency to repeat behavior.
- Inhibiting excitatory neurotransmitters, including NDMA (a form of glutamate-N-methyl-D-aspirate).
The initial effects of drinking alcohol will result in the feelings of wellbeing, euphoria, enhanced mood, relaxation, loss of inhibitions, and decreased reflex actions and motor coordination. The effects of alcohol are dose-dependent. Many individuals experience mild stimulation with very small doses of alcohol, whereas the central nervous system depressant effects begin to occur at moderate to high doses.5
Risk Factors for Developing AUD
The path that individuals transverse from social alcohol use to the development of AUD is not uniform. Typically, individuals begin drinking alcohol socially and may increase their use in order to deal with stress, socialize, or even resort to alcohol as a substitution for companionship. Since repeated use of alcohol is reinforcing for some individuals, a significant number of people may be at risk of developing alcohol use disorders.
APA and the National Institute on Drug Abuse (NIDA) have listed the risk factors that can increase the potential that an individual will develop an AUD. Although the presence of any of these risk factors does not guarantee that an individual will develop any specific condition, some risk factors are associated with a more salient probability of developing a specific type of disorder. Having more than one of the following risk factors can substantially increase the risk of developing a specific disorder:6
- Having a family history of alcohol abuse or some other substance abuse issue. Having a first-degree relative with an SUD history substantially increases the risk that one will develop an SUD. Having any family member with an SUD also increases this risk as this is associated with learning these types of behaviors. It is also well accepted that there are genetic factors that significantly increase the risk for developing any form of substance abuse issue, but specific genetic factors that could aid in the diagnosis of an SUD have not been identified.
- Gender. Males are at greater risk to develop alcohol abuse issues than females, although the gap between the prevalence of AUDs in males and females has narrowed in recent years.
- Having a co-occurring mental health issue. The co-occurrence of SUDs and other psychological disorders (e.g., depression, personality disorders, trauma- or stressor-related disorders, anxiety disorder, etc.) is so prevalent that when individuals are assessed for a substance abuse issue, they should automatically also be assessed for the presence of any other formal psychiatric diagnosis.
While the exact reason for this relationship has not been determined, it is most often believed that the biological and environmental factors that make a person susceptible to any type of mental health disorder also result in being more susceptible to developing a substance abuse issue.
- Peer influence. Individuals with friends who drink heavily are more likely to drink heavily themselves, which increases the risk for the development of AUD. This risk factor is influential over all ages, but particularly salient in younger individuals.
- Lack of perceived social support. People who do not believe they have strong family ties or productive peer relations often become isolated, which makes them more vulnerable to the development of SUDs.
- Experiencing stress or trauma. Individuals who perceive they are under extreme stress or have experienced traumatic events are more vulnerable to the development of SUDs. While this risk factor is salient across all age groups, it is particularly influential in younger individuals and children.
- Other personal variables. There are numerous personal factors that can increase the risk that an individual might develop issues with alcohol abuse. These can include having a history of delinquent behavior, beginning to use alcohol at an early age, having a natural higher tolerance to the effects of alcohol, living in areas where there are high rates of drug abuse or high rates of crime, etc.
Negative Consequences of AUD
The negative effects of chronic alcohol abuse have been well documented in literature. These include:7
- Significant and often irreparable damage to professional and/or personal relationships.
- Significant losses of productivity or failure to meet goals.
- Increased financial burdens to the individual, the individual’s family, and society as a result of lost productivity and increased need for medical and psychological services.
- Increased risk of having accidents that can lead to serious and even permanent physical injuries.
- Increased risk of developing serious diseases or disorders of numerous organ systems that can include increased risk of cardiovascular disease, cancer, fetal alcohol syndrome in the children of pregnant mothers suffering from AUD, liver damage, etc.
- Increased potential to be a victim of crime, to be a perpetrator of the crime, or to engage in acts of self-harm.
- Increased potential to develop serious neurological issues, such as dementia.
- Increased potential to develop other mental health disorders, including depression, anxiety disorders, trauma- and stressor-related disorders, bipolar disorder, etc.
- The development of physical dependence on alcohol.
Considering both short-term and long-term consequences of alcohol use disorder, individuals who are struggling with alcohol abuse should consider undergoing alcohol rehab at a dedicated treatment facility.
Chronic use of alcohol is associated with the development of physical alcohol dependence. Physical dependence is characterized by the syndromes of tolerance and withdrawal. As individuals continue to drink alcohol on a regular basis, they will often find that they need to drink more alcohol to achieve the effects that they once achieved with lower amounts (tolerance).8
After the development of tolerance, some individuals will begin to experience negative effects that can consist of physical and psychological/emotional issues once they have not consumed alcohol. This is the beginning of the withdrawal syndrome.9 When an individual expresses both tolerance and withdrawal symptoms, they have developed physical dependence on alcohol.8
Research suggests that the actual withdrawal syndrome an individual experiences is dependent on numerous factors, including:9
- Individual’s genetic makeup.
- The amount of alcohol typically consumed.
- Metabolic differences in individuals.
- Using alcohol in conjunction with other drugs.
Symptoms of Alcohol Withdrawal
- A minor alcohol withdrawal syndrome occurs when individuals experience discomfort and stress but do not experience potentially severe consequences. This syndrome is far more common than the more severe presentation.
- A severe alcohol withdrawal syndrome is associated with a far more chronic and severe level of an alcohol use disorder. This syndrome has potentially serious complications associated with it.
Minor Alcohol Withdrawal Syndrome
The symptoms of the minor withdrawal alcohol syndrome are typically the following:11
- Symptoms begin appearing within roughly six hours after the person has stopped using alcohol.
- The withdrawal syndrome will typically last 24–72 hours, with most individuals experiencing withdrawal symptoms for 24–48 hours.
- Withdrawal symptoms mostly peak 12–24 hours after discontinuation of alcohol.
- Major symptoms associated with minor alcohol withdrawal include: nausea, stomach cramps, vomiting, sweating, increased heart rate, loss of appetite, shakiness, mild tremors, sleep difficulties, headache, dehydration, anxiety, and mild depression.
Most individuals who experience withdrawal at this level are moderate users of alcohol and may or may not need to seek alcohol rehab treatment.
Severe Alcohol Withdrawal Syndrome
For some individuals who have chronic and more severe alcohol abuse histories, withdrawal symptoms will be as follows:11
- Though symptoms may appear only a few hours after discontinuation of alcohol, it may take up to 48 hours for them to appear for some people. Some individuals may experience withdrawal symptoms while they are still intoxicated as they have extremely high tolerance and normally have high levels of alcohol in their blood. When the individual’s blood alcohol level begins to fall, the withdrawal syndrome is elicited.
- Withdrawal symptoms can last for a week or longer.
- Individuals with severe alcohol withdrawal are at a risk of experiencing seizures. Seizures can develop rapidly after discontinuation (within six hours), and the potential to develop seizures typically peaks within 12–18 hours after the individual has discontinued alcohol use. Nonetheless, individuals with severe AUD may be at risk to develop seizures for several days or weeks following discontinuation. Seizures occurring as a result of alcohol withdrawal can be potentially fatal, and individuals who experience them require medical alcohol treatment immediately.
- Some individuals may develop hallucinations (most often, visual hallucinations or auditory hallucinations) within 18 hours after discontinuation. Hallucinations may continue to occur for a week or more.
- Individuals may have severe issues with depression, hopelessness, and anxiety, and may be at risk of self-harm.
- There is a risk to develop delirium tremens (DTs). This occurs when there is a sudden drop in an individual’s blood alcohol level. The syndrome consists of severe disorientation, confusion, psychosis (hallucinations, delusions, and a loss of reality), potential seizures, and other typical withdrawal symptoms, such as chills, sweating, nausea, vomiting, etc.
Individuals with severe alcohol use disorders are at risk of DTs within 48–72 hours after discontinuation. The risk may last for days or even weeks, depending on the individual and the serious nature of their alcohol abuse. As individuals can become extremely dehydrated, develop seizures, and become psychotic, DTs can be potentially fatal.
Medical Alcohol Treatment
The majority of individuals with alcohol use disorders will not experience severe complications, such as seizures or delirium tremens. Nevertheless, the American Society of Addiction Medicine (ASAM), the largest organization of physicians specializing in addiction medicine in the country, recommends that anyone with AUD should undergo a physician-assisted withdrawal management program (medical alcohol treatment) when they discontinue alcohol for several reasons:12
- There is no standard protocol that can predict what symptoms an individual undergoing withdrawal from alcohol will experience.
- Other issues besides seizures and delirium tremens can be potentially serious, such as dementia, dehydration, etc.
- Significant relief of withdrawal symptoms is associated with greater success and lower instances of relapse in the early days of recovery.
- The use of medications in a physician-assisted withdrawal management treatment program results in the easiest and safest approach to manage alcohol withdrawal.
There are various medications that can be used to assist individuals through alcohol withdrawal in alcohol abuse treatment programs:13
- Benzodiazepines, such as Librium, Valium, Xanax, etc., are often the primary treatment for alcohol withdrawal. They reduce the symptoms of withdrawal, protect against seizures, guard against delirium tremens, and alleviate other issues. Benzodiazepines should only be used under the supervision of a physician.
- Beta blockers are drugs that are typically used in the treatment of hypertension, and they can be used to address issues with high blood pressure, irregular heartbeat, etc., during withdrawal from alcohol.
- Certain anticonvulsant medications may reduce the withdrawal symptoms associated with alcohol.
- The muscle relaxant baclofen has been shown to reduce cravings in individuals undergoing withdrawal from alcohol.
- Antabuse is a medication that may be given to individuals who have had relapses. It does not address the symptoms of withdrawal, but if an individual drinks alcohol while taking the medication, they become violently ill. This increases the individual’s motivation to stay abstinent from alcohol.
Physicians have access to numerous other medications for specific symptoms that can also be useful during the early and middle stages of withdrawal.
Different Alcoholic Treatment Options
Simply going through medical alcohol treatment is not sufficient for an individual to recover from AUD. Individuals should consider becoming involved in some form of comprehensive care once they have gotten through the withdrawal period. Alcohol treatment programs may involve the following elements:13
Getting involved in alcohol use disorder behavioral therapy in either a group format or in individual sessions, or both, helps the individual get the insight and develop tools needed to ensure that recovery will be successful on a long-term basis.
Peer Support Groups
Peer support groups represent potential long-term aftercare programs that people can continue to participate in for years, even after they have completed their formal alcohol treatment programs.
Becoming involved in social support groups, either those based on 12-step principles (such as Alcoholics Anonymous) or other more secular groups, can have a very positive effect on recovery.14 These groups offer a formal program of recovery, peer support, the chance to meet individuals in recovery and develop new relationships, and long-term participation in treatment-related activities. Organizations for peer support in addiction treatment usually provide opportunities for both in-person and online alcohol treatment meetings.
To maintain the positive outcomes of alcohol rehab treatment, there should be continued medical management of issues that are relevant to the individual’s personal situation. This includes the treatment of co-occurring psychological/psychiatric conditions and physical problems.
Involvement in complementary activities, such as animal-assisted therapy, psychodrama, music therapy, and others, can be beneficial. These forms of alternative therapy are not mandatory in alcohol treatment programs and should only be used if the patient enjoys them. They can add variation to an individual’s recovery program but should not be considered as standalone treatment. They are rather used in conjunction with formal treatment within inpatient facilities for alcohol abuse or outpatient treatment options for individuals struggling with alcoholism.
Frequently Asked Questions
- While the social use of alcohol is condoned by most of the US population, the abuse of alcohol is condemned and highly stigmatized. Words such as alcoholic, alcoholism, alcohol abuse, etc., often elicit stigmatized images of individuals with moral failings or of individuals who live a skid row-type of existence and have very little willpower.These terms are often used as overall catchphrases for individuals who abuse alcohol. However, there is no particular description of an individual who has an alcohol abuse problem. Moreover, the current clinical description of a substance use disorder (SUD) is a far more accurate account of issues with the use of any substance, including alcohol.Alcoholism is the colloquial term for alcohol use disorder (AUD). It is officially defined as “a chronic relapsing brain disease characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.”15
- When drinking alcohol causes distress or harm, and the person does not have control of it, these are the signs that the person is suffering from AUD. To help people identify a potential issue in themselves or their loved ones, the National Institute on Alcohol Abuse and Alcoholism has created a freely available questionnaire for self-evaluation What are symptoms of an alcohol use disorder?16
- To be diagnosed with any kind of an SUD, an individual must demonstrate significant distress or functional impairment as a result of their substance use. APA lists specific diagnostic criteria for different SUDs in its Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In general, individuals diagnosed with an SUD must meet at least two of the diagnostic criteria within a time period of one year. This is a brief summary of these criteria:17
- Major issues with control over alcohol use:
- Being unable to control the amount of alcohol one frequently drinks;
- Being unable to control the amount of time one spends drinking alcohol;
- Formally stating or attempting to cut down or stop using alcohol but not being able to do so;
- Continuing to drink alcohol in spite of experiencing negative issues at work, in personal relationships, at school, or in other important areas of life;
- Continuing to drink alcohol even though one recognizes that it is causing physical and/or psychological distress;
- Frequently drinking alcohol in situations where it is hazardous to do so.
- Frequent cravings or strong urges to drink alcohol.
- Giving up important activities as a result of their alcohol use.
- Failing to meet major role obligations as a result of their alcohol use.
- Developing significant tolerance to alcohol.
- Experiencing alcohol withdrawal symptoms when quitting drinking alcohol or significantly cutting down on the amount.
The severity of the individual’s alcohol use disorder is determined by the number of symptoms they qualify for:17
- Individuals who meet the criteria for 2 or 3 symptoms would be diagnosed with a mild AUD.
- Individuals who display 4 or 5 symptoms would be diagnosed with a moderate AUD.
- Individuals who display 6 or more symptoms would be diagnosed with a severe AUD.
- Major issues with control over alcohol use:
- There are a number of alcohol abuse treatment programs offered by various institutions and organizations. The choice of optimal treatment will highly depend on the person’s particular situation. For choosing appropriate treatment, it is of crucial importance that the assessment of the patient’s condition is done by a trained professional. The factors that are considered are:18
- Drinking patterns and severity of issues.
- Whether there is any other substance.
- Whether there has been prior treatment.
- Existence of co-occurring disorders.
- Level of family and social network support.
- Living situation and access to transportation.
- Legal issues (arrests, probation, etc.) that require working with the justice system or social services.
- Other special conditions such as pregnancy.
In addition, insurance coverage is also a factor that determines which alcoholic treatment options are accessible for a particular patient. There are alcohol treatment programs that are still available without insurance.
There are also alcohol treatment options that are gender specific, for those who feel more comfortable in women-centered alcohol treatment or men’s alcohol treatment settings.
All these factors influence whether a person will opt for inpatient or outpatient services, the level of medical supervision they will need, as well as which other forms of therapy they can benefit from most.
It can generally be said that the general Principles of Effective Treatment published by the National Institute on Drug Abuse (NIDA) also apply to alcohol treatment programs.19
- For most individuals, 90 days of treatment is the typical time period that will place them on the road to abstinence.18 However, years of participation in treatment-related activities may be required for individuals to undergo successful alcohol rehab treatment.Long-term success in recovery from AUD is an ongoing process. Many individuals in alcohol rehab treatment such as 12-step groups continue to participate on a regular basis for years following the discontinuation of alcohol.For most individuals, some form of involvement in treatment-related activities should continue for 5 to 7 years following the completion of a withdrawal management program in order to be successful in long-term recovery. This involvement can include social support group participation, participation in community groups, periodic checkups with therapists, long-term psychoanalysis for individuals interested in this type of treatment, etc.
- Most people with AUD in the U.S. unfortunately receive no treatment. A national survey established that only 10.4% of individuals with AUD had any perceived need for treatment in the past year. Among those who are aware that they need alcohol rehab treatment, 70% reported receiving some kind of treatment in the past 12 months.20Education is imperative, from informing people of the dangers of binge drinking, to helping them see the need for treatment for alcohol abuse. In addition, supporting people in acknowledging that they have an issue, looking into alcoholic treatment options, and providing support during and post-treatment can be very important for recovery.
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15. National Institute on Drug Abuse. (2020). Understanding Alcohol Use Disorder.
16. National Institute on Drug Abuse and Alcoholism. What are symptoms of an alcohol use disorder?
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18. National Institute on Drug Abuse and Alcoholism. (2021). Different People, Different Options: Alcohol Treatment Navigator.
19. National Institute on Drug Abuse. (2018).Principles of Effective Treatment.
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