Alcohol use disorder is a medical condition that affects millions of people worldwide, making it difficult or impossible to stop drinking despite serious consequences. The good news is that various treatment approaches exist, ranging from established medications and behavioral therapies to innovative research studies exploring new ways to help people recover.

How Treatment Helps People Regain Control

When someone develops alcohol use disorder, which is a medical term for what many people call alcoholism, their brain undergoes lasting changes that make it extremely difficult to control drinking. Treatment aims to help people either stop drinking completely or significantly reduce their alcohol consumption to improve their overall quality of life. The approach taken depends on several factors, including how severe the drinking problem has become, whether the person has other health conditions, and their personal goals for recovery.^[1]

Evidence shows that treatment works for most people. No matter how severe the problem may seem, research demonstrates that people with alcohol use disorder can benefit from various forms of treatment. Many individuals substantially reduce their drinking and report fewer alcohol-related problems after receiving appropriate care. Some people achieve complete abstinence, while others learn to drink in moderation, though abstinence typically provides greater health benefits and is often the recommended goal.^[10]

The choice between complete abstinence and moderate drinking depends on individual circumstances. Abstinence is strongly recommended for people who have liver damage such as cirrhosis (severe scarring of the liver), other medical problems that worsen with drinking, or who take medications that interact badly with alcohol. It’s also essential for pregnant women or those planning pregnancy. Additionally, if previous attempts at moderate drinking have failed, complete abstinence may be the safer path forward.^[12]

Studies indicate that less than twenty percent of patients remain abstinent for a full year after initial treatment, and among those who have been sober for two years, the relapse rate is forty percent. However, patients who maintain sobriety for five years are much more likely to remain sober long-term, though some risk of relapse always exists. This highlights that recovery is an ongoing process requiring continued support and commitment.^[13]

Standard Treatment Options

Detoxification and Withdrawal Management

For people who are physically dependent on alcohol, the first step in treatment often involves detoxification, which means safely removing alcohol from the body. When someone who has been drinking heavily for an extended period suddenly stops, they can experience withdrawal symptoms, which may include headache, nausea, vomiting, anxiety, fatigue, muscle shaking, and disturbed sleep. These symptoms are typically most severe during the first forty-eight hours and should gradually improve as the body adjusts to functioning without alcohol, usually taking three to seven days from the last drink.^[12]

The location and method of detoxification depend on the severity of alcohol dependency. People with mild dependency may be able to detox at home without medication, as their withdrawal symptoms will also be mild. Those who consume high amounts of alcohol or have previously experienced withdrawal symptoms may detox at home with medication to ease symptoms. A tranquilizer called chlordiazepoxide is commonly prescribed for this purpose. However, people with severe dependency typically need to go to a hospital or specialized clinic for detox, where withdrawal symptoms can be monitored and treated by healthcare professionals.^[12]

Medications for Alcohol Use Disorder

Several medications have been approved to help people with alcohol use disorder achieve and maintain recovery. These medications work through different mechanisms in the brain to reduce cravings, create unpleasant reactions to alcohol, or block the rewarding effects of drinking.^[9]

Disulfiram is one medication that creates an unpleasant physical reaction when someone drinks alcohol while taking it. This medication acts as an aldehyde dehydrogenase inhibitor, meaning it blocks an enzyme that helps break down alcohol in the body. If a person drinks while taking disulfiram, they experience uncomfortable symptoms like nausea, flushing, and rapid heartbeat, which discourages further drinking.^[13]

Naltrexone is an opiate antagonist that works by blocking certain receptors in the brain involved in the rewarding and pleasurable effects of alcohol. By reducing these pleasurable sensations, naltrexone helps decrease cravings and the urge to drink. This medication can be particularly helpful for people trying to maintain abstinence or reduce their alcohol consumption.^[13]

Acamprosate is another medication used to support recovery. It works as a glutamate receptor blocker, helping to restore the balance of brain chemicals that become disrupted during long-term alcohol use. This medication can help reduce cravings and support continued abstinence, particularly after someone has already stopped drinking.^[9]

Behavioral Therapies and Counseling

Psychological treatments form a crucial component of comprehensive care for alcohol use disorder. Brief interventions are short counseling sessions, lasting about five to ten minutes, offered to people who may be drinking harmfully but haven’t yet developed severe dependency. These sessions cover the risks associated with current drinking patterns, advice about reducing consumption, available support networks, and emotional issues related to drinking. Patients may be encouraged to keep a drinking diary to record how many units of alcohol they consume each week.^[12]

Cognitive behavioral therapy, often abbreviated as CBT, is a more intensive form of psychological treatment. This approach helps people identify situations that trigger their desire to drink, develop healthier coping strategies, and change thought patterns that contribute to problem drinking. Patients learn to handle stress without alcohol, manage relationships better, and develop specific responses to high-risk situations.^[12]

Successful recovery requires patients to develop and rehearse strategies for coping with challenging situations. This includes learning to refuse drinks in social settings, handling friends who might undermine sobriety efforts, managing stress and anxiety, avoiding boredom (which can be significant since people previously spent considerable time drinking or recovering from drinking), and repairing relationships with family and friends. Patients are encouraged to make written lists of high-risk situations and practice specific responses, as during high-stress periods they may become emotionally or mentally disoriented and need clear written guidance.^[13]

Mutual-Support Groups

Alcoholics Anonymous, commonly known as AA, is a mutual-support organization that has been helping people recover from alcohol problems for more than eighty years. The program is built on the simple foundation of one person with alcohol problems helping another. AA uses a twelve-step program that provides a structured approach to recovery, emphasizing personal growth, accountability, and peer support. Members typically attend regular meetings where they share experiences and support each other in maintaining sobriety.^[8]

The effectiveness of mutual-support groups comes partly from the social support structure they provide. Having a sponsor (an experienced member who provides guidance and support) and a list of people to call during difficult times helps individuals navigate challenging moments when the urge to drink feels overwhelming. These groups also help reduce the isolation and shame that many people with alcohol use disorder experience.^[8]

Ongoing Care and Relapse Prevention

Frequent follow-up care is essential to support recovery. One common mistake healthcare providers make is assuming too soon that a patient’s condition is stable. During follow-up visits, providers ask about attendance at support group meetings, relationships with sponsors, and any warning signs of relapse such as missing appointments or attending meetings less frequently.^[13]

Patients need to understand that treatment doesn’t end with sobriety. True recovery means being able to handle everyday life stresses without turning to alcohol. When patients feel the urge to drink, several techniques can help, including self-distraction (getting involved with an enjoyable alternate activity), thought stopping (deliberately not dwelling on thoughts about drinking), reprogramming (avoiding activities that remind them of drinking), and using their social support network. The most common cause of relapse is failing to use these coping strategies when needed.^[13]

Treatment in Clinical Trials

Beyond the standard treatments approved for widespread use, researchers continue to explore new approaches to help people with alcohol use disorder. Clinical trials test promising medications and therapies to determine if they are safe and effective before they become available to the general public. These studies progress through different phases, each with specific goals.

Phase I trials primarily focus on safety, testing new treatments in small groups of people to determine appropriate dosing and identify potential side effects. Phase II trials expand to larger groups and focus on whether the treatment actually works to improve the condition. Phase III trials involve even larger populations and compare the new treatment directly with existing standard treatments to determine if it offers advantages.^[10]

Research into alcohol use disorder treatment explores various innovative approaches. Some studies investigate how brain chemistry changes during alcohol addiction and recovery, which could lead to new medications targeting specific brain pathways. The cycle of addiction involves three key brain regions: the basal ganglia (involved in reward and habit formation), the extended amygdala (involved in stress and negative emotions), and the prefrontal cortex (involved in decision-making and impulse control). Understanding these mechanisms helps researchers develop more targeted interventions.^[4]

Clinical trials examining alcohol use disorder occur in various locations, including the United States and Europe. People interested in participating in clinical research can contact research institutions or use online registries to find studies seeking participants. Eligibility for trials depends on specific criteria, which might include the severity of alcohol use disorder, presence of other health conditions, age, and other factors determined by the research protocol.

Most common treatment methods

• Detoxification
  • Managed withdrawal from alcohol, typically lasting three to seven days
  • Can be conducted at home with mild dependency, or in hospital settings for severe cases
  • Often involves medication like chlordiazepoxide to manage withdrawal symptoms
  • Requires monitoring for symptoms including headache, nausea, anxiety, and muscle shaking
• Medication therapy
  • Disulfiram creates unpleasant reactions when alcohol is consumed
  • Naltrexone blocks the rewarding effects of alcohol in the brain
  • Acamprosate helps restore brain chemical balance and reduce cravings
  • Medications may be used alone or combined with behavioral therapies
• Behavioral therapy
  • Brief interventions lasting five to ten minutes for early-stage problems
  • Cognitive behavioral therapy to identify triggers and develop coping strategies
  • Individual or group counseling sessions
  • Family therapy to address relationship issues affected by drinking
• Mutual-support groups
  • Alcoholics Anonymous using twelve-step program approach
  • Peer support through regular meetings and sponsorship
  • Shared experiences and accountability from others in recovery
  • Available in communities worldwide at no cost
• Lifestyle modifications
  • Setting clear limits on drinking days and number of drinks
  • Scheduling alcohol-free days each week
  • Managing triggers by avoiding high-risk situations, people, or places
  • Developing alternative activities and stress management techniques