Treatment Options For Alcohol Abuse

Treatments for alcohol abuse are quite varied in keeping with the multiple perspectives of the condition itself. Counselors approaching the condition as a medical disease will recommend different treatment processes and goals than, for instance, those approaching the condition as one of social choice. Most treatments focus on helping abusers completely discontinue their alcohol intake, as well as providing life training and/or social support to help them resist a return to alcohol use. Since alcohol abuse involves many factors which encourage a person to continue drinking (psychological/social, physical, and neurochemical), all of these factors must be addressed in order to successfully prevent a return to active alcohol use.

The most common approach to alcohol abuse treatment is detoxification followed by a combination of supportive therapy, attendance at self-help groups, and ongoing development of coping mechanisms. The treatment community for alcohol abuse typically supports an abstinence-based approach, as studies have shown that the vast majority of people who abuse alcohol cannot learn to drink in moderation.

The effectiveness of alcohol abuse treatments vary from successful to counterproductive. When considering the effectiveness of treatment options, it is important to consider the percentage of those who drop out of a program, not just those who complete it. Most programs can boast a high cure rate for those who complete it because most people only complete a program if it works for them. It is also important to consider not just the percentage of those reaching sobriety but how many of those experience relapsing.

Here are the most common treatment options for alcohol abuse:
Detoxification
Detoxification (commonly referred to as "detox") is the process of eliminating alcohol drinking and giving the drinker's bodily system time to re-adjust to the absence of alcohol. Drugs that have similar effects to alcohol are used to ease the withdrawal symptoms, which can actually be deadly in extreme cases if left untreated. The most often used drugs are sedative-hypnotics, such as diazepam or clonazepam. Less frequently, barbiturates such as phenobarbital are used. Many weeks after alcohol intake has completely stopped individuals may still suffer from milder withdrawal symptoms; sleep is generally the last function to return to normal.

Detoxification is not a treatment for alcohol abuse itself, but is simply a treatment of the physiologic effects of ongoing abuse of alcohol. It provides an initial path for an abuser to stop drinking in the first place. Detoxification treatments without supplemental help for the patient to continue abstinence have a very high rate of relapse.

Detoxification often takes place within an inpatient environment, but some programs do offer outpatient detoxification.

Group therapy and psychotherapy
After detoxification, various forms of group therapy or psychotherapy can be used to deal with underlying psychological issues leading to alcohol abuse, and also to provide the recovering abuser with relapse prevention skills.

In the mid-1930s, the mutual-help group-counseling approach to treatment began and has become very popular. Alcoholics Anonymous is the best-known example of the support group movement. Other groups that provide similar self-help and support without AA's spiritual focus include LifeRing Secular Recovery, Smart Recovery, Women For Sobriety, and Rational Recovery.

Medications
Medications for alcohol abuse are most often used to supplement a person's willpower and encourage abstinence.

Antabuse (disulfiram), for instance, prevents the elimination of the chemical acetaldehyde. This causes severe discomfort when alcohol is ingested, effectively preventing the abuser from drinking in significant amounts while they take the medication. Heavy drinking while on Antabuse can result in severe illness and death.

Naltrexone has also been used because it helps curb cravings for alcohol while the person is on it. Both Antabuse and Naltrexone are used to encourage abstinence. The have, however, been demonstrated to cause a rebound effect when the user stops taking them.

Pharmacological extinction (also called the Sinclair Method)
Pharmacological extinction is the use of opioid antagonists [e.g. naltrexone] combined with normal drinking habits in order to eliminate the craving to consume alcohol. While standard naltrexone treatment uses the drug to curb craving and enforce abstinence, pharmacological extinction targets the endorphin-based neurological conditioning. Our behaviors become conditioned when we do something and endorphin bathes our neurons, and that conditioning is reversed when we do that thing and we don't receive the endorphins. This method involves the alcohol abusers going about their normal drinking habits (limited only by safety concerns). Naltrexone is used to prevent the endorphins from being released by the alcohol, and thus rewarding the drinker's neurochemistry. As such, the desire to drink is eliminted over a period of about three months. This allows an alcohol abuser to give up drinking as being sensibly unbeneficial. The effects persist after the drug is discontinued, but the addiction can return if the person drinks without first taking the drug. This treatment is highly unusual in that it works better if the patient does not go through detoxification prior to starting it.

This technique is used with positive results in Finland, Pennsylvania, and Florida, and is sometimes referred to as the Sinclair Method.

However, there is a lot of professional bias against this treatment for two reasons.
First, most alcohol abusers cannot successfully drink in moderation. Second, some studies have also been done which claim to demonstrate naltrexone to be of questionable value in supporting abstinence. However, the evidence is inconclusive.

Nutritional therapy
Nutritional therapy is not a treatment of alcohol abuse itself, but rather a treatment of the difficulties that can arise after years of heavy alcohol abuse; many alcohol dependents have insulin resistance syndrome, a metabolic disorder where the body's difficulty in processing sugars causes an unsteady supply to the blood stream. While the disorder can be treated by a hypoglycemic diet, this can affect behavior and emotions. These side-effects are often seen among alcohol dependents in treatment. The metabolic aspects of such dependence are often overlooked, resulting in poor treatment outcomes.

There are other less popular treatments for alcohol abuse. This list is not meant to be an exhaustive compilation of every known treatment, but merely a general description of the most common treatments in use today. People are unique; what works best for one alcohol abuser may not be the same treatment that works best for another. For the greatest level of success, the treatment used must address the root causes of abuse to begin with. Only then will long-term success be achievable.