Alcoholism Treatment and Recovery
Alcohol dependency creates havoc in the lives of everyone it impacts. People who develop an addiction to alcohol will experience significant personal, financial, legal and health-related hardships because of their drinking, while spouses, children, parents, siblings and close friends will have to deal with the fallout.
It can take just weeks for alcohol dependency to develop, but recovery will be a lifetime affair. Men and women with alcohol use disorders can change their fortunes through alcoholism treatment, if their motivation is strong and their efforts to change sincere and consistent.
Outline of an Alcohol Treatment Program
There are four stages involved in treatment for alcohol abuse, all of which are essential to any comprehensive recovery plan[1]:
Evaluation and diagnosis
Someone suspected of having a drinking problem must be evaluated by an addiction specialist with the skills and training to diagnose an alcohol use disorder. Physicians and mental health professionals may be involved in the evaluation as well, to uncover any physical maladies or co-occurring mental health conditions that will need to be addressed.
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Medically-assisted detox
When a person first stops drinking, they may experience serious withdrawal symptoms that can put their sobriety and their health at risk. Medically-assisted detox is designed to manage these symptoms and monitor the health conditions of the newly sober person.
Therapy and other forms of treatment
Once their condition is stabilized and withdrawal symptoms are under control, a person in recovery for alcohol addiction will begin receiving treatment at a residential drug and alcohol treatment center. Inpatient programs that last from 30-90 days are standard, but clients with outside responsibilities that prevent them from staying onsite may enroll in intensive outpatient programs as an alternative.
Aftercare or continuing care
Once formal treatment is complete, people in recovery will return to their homes, or possibly (for a few months) to sober living facilities that can smooth their transition to an alcohol-free lifestyle. Aftercare programs will usually include some combination of individual and family therapy, medication and regular attendance at AA meetings (or other 12-step alternatives), and may continue for months or years after the cessation of formal treatment. Relapse prevention is a primary focus during aftercare, since people who are new to recovery frequently relapse at least once following their initial trip to rehab.
The Use of Therapy in Alcohol Treatment
Therapy for alcohol use disorders has two primary functions: to help uncover the underlying factors responsible for the alcohol abuse and to help the client develop practical strategies to reduce the risk of future relapse.
During individual therapy sessions, addiction counselors will lead clients through an extensive and detailed life review. The purpose is to gain greater insight into how past experiences may have shaped the person’s behavior and attitudes, making them vulnerable to the lure of alcohol. Addiction often develops from an urge to escape the most unbearable sorrows, disappointments and traumas, and once those experiences and exposures are openly acknowledged they will lose some of their capacity to determine a person’s actions.
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To help men and women suffering the ill effects of substance abuse, therapists often instruct them in the techniques of cognitive-behavioral therapy (CBT), an evidence-based treatment method with a well-established track record of success[2].
Through careful reflection and attention to detail, in CBT clients in recovery learn to identify and demystify destructive patterns of thinking and behavior, which tend to trigger bouts of drinking or undermine attempts to embrace sobriety. The next step is to reprogram their minds to respond in a more controlled and reflective manner to stressful stimuli, breaking the connection between life distress and alcohol consumption.
Cultivating such a capacity can be vitally important for people recovering from alcohol use disorders, since temptation will always be around once they leave treatment and return to their regular lives.
Medication-Assisted Treatment for Alcohol Use Disorders
Research indicates that certain medications can be useful in the treatment of alcohol dependency. These medications can counteract the normal effects of alcohol on the brain and body, and when used in conjunction with therapy they can help preserve and protect a person’s commitment to sobriety.
The two medications most often prescribed for the treatment of alcohol use disorders are naltrexone and acamprosate[3].
Naltrexone helps negate the euphoric impact of alcohol consumption by binding with opioid receptors in the brain. The relationship between opioid receptors and alcohol consumption is not entirely clear, but naltrexone has been used to treat problem drinking for many years and has produced impressive results in many instances.
Acamprosate works by stabilizing neurological activity in the brains of people with alcohol use disorders. Consequently, they are effective at reducing the intensity of the cravings and withdrawal symptoms that would normally be expected to accompany abstinence. Studies have shown that acamprosate is at least as effective as naltrexone at helping those in recovery avoid relapse, and its use has been increasing as a result of this accumulating evidence[4].
Medication-assisted treatment for alcoholism usually begins during formal treatment and will usually be included in aftercare programs if it appears to be working. Acamprosate may occasionally be introduced during the withdrawal process, once the most severe symptoms have declined in intensity.
Withdrawal and Detox
When a person with an alcohol use disorder first stops drinking, they may experience painful and highly stressful withdrawal symptoms, which can be dangerous when they reach full intensity.
During alcohol withdrawal chronic anxiety and agitation are accompanied by sometimes intense physical aches and pains, and the cravings experienced can be overwhelming enough to put sobriety at risk. If an alcohol dependency is especially severe, troubling hallucinations or delusions might be experienced throughout the withdrawal period, and when withdrawal reaches peak intensity some people may develop a life-threatening condition called delirium tremens, also known as the DTs.
Delirium tremens can produce extreme mental confusion, hallucinations, tremors, high blood pressure, an irregular heartbeat, high fever and seizures. The latter two symptoms in particular may prove fatal if medical intervention is withheld, and that is why medically-supervised detox is often necessary to keep those suffering from alcohol addiction safe and secure.
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Medical detox takes place in a clinical setting where a person’s physical and mental wellness can be closely monitored on a round-the-clock basis, usually for a period of five-to-seven days (but possibly for longer if complications arise). Specialized medical treatment will be offered, as needed, for specific physical or mental health conditions, and nurses and other medical professionals are always available to respond to emergencies.
To help control the anxiety and agitation associated with alcohol withdrawal, anti-anxiety medications called benzodiazepines may be prescribed during detox[5]. Benzodiazepines are potent medications, but they are also highly addictive, and that makes them appropriate for short-term use only.
The overall goal of detox is to help the client move quickly and safely through the most severe stage of their withdrawal, and once symptoms decline in intensity they will be ready to begin formal treatment.
Outpatient and Inpatient Treatment Programs for Alcohol Use Disorders
Alcoholism treatment programs are designed to facilitate significant, lasting changes in lifestyle, thinking patterns and behavior. Sustainable sobriety is the ultimate objective of rehab, and the goal of therapists during every therapy session is to move the client one step closer to a new and better way of living.
Inpatient and intensive outpatient programs differ in their time requirements and living arrangements, but each includes the same menu of treatment options. Individual, group and family therapy, medication, holistic healing practices, life and coping skills classes, specialized services like motivational enhancement therapy, confidence-building recreational activities and more are made available to clients on a daily basis, and all treatment programs will be carefully customized to meet the unique needs and preferences of each individual.
As long as the commitment to sobriety is sincere, treatment for alcoholism can and will work. Alcohol use disorders are a challenging opponent, but evidence-based treatment methods can produce profound changes in those who are ready to take control of their lives and their futures.
[1] Gold, Mark S. MD. Treatment for Alcoholism.
https://psychcentral.com/lib/treatment-of-alcoholism/
[2] Oxford Handbooks Online. A Review of CBT Treatments for Substance Use Disorders.
http://www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780199935291.001.0001/oxfordhb-9780199935291-e-57
[3] Bouza, Carmen, et al. Efficacy and Safety of Naltrexone and Acamprosate in the Treatment of Alcohol Dependence: A Systematic Review.
https://onlinelibrary.wiley.com/doi/full/10.1111/j.1360-0443.2004.00763.x
[4] Maisel, Natalya C. et al. Meta-analysis of Naltrexone and Acamprosate for Treating Alcohol Use Disorders: When are These Medications Most Helpful?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3970823/
[5] Jaffe, Adi, PhD. Treating Alcohol Withdrawal with Benzodiazepines—Safe if Mindful.
https://www.psychologytoday.com/us/blog/all-about-addiction/201205/treating-alcohol-withdrawal-benzodiazepines-safe-if-mindful
