Understanding alcohol abuse - treatment

What are the treatments for alcoholism?

The goal of treatment for alcoholism is abstinence. Among alcoholics with otherwise good health, social support and motivation, the likelihood of recovery is good. Approximately 50 to 60% remain abstinent at the end of a year's treatment and a majority of those stay dry permanently. Those with poor social support, poor motivation, or psychiatric disorders tend to relapse within a few years of treatment. For these people, success is measured by longer periods of abstinence, reduced use of alcohol, better health, and improved social functioning.

Conventional medicine for alcoholism

Treatment for alcoholism can begin only when the alcoholic accepts that the problem exists and agrees to stop drinking. He or she must understand that alcoholism is curable and must be motivated to change. Treatment has two stages: discontinuing alcohol use, which is sometimes called detoxification or detox and recovery.

Because detoxification does not stop the craving for alcohol, recovery is often difficult to maintain. For a person in an early stage of alcoholism, discontinuing alcohol use may result in some withdrawal symptoms, including anxiety and poor sleep. Withdrawal from long-term dependence may bring the uncontrollable shaking, spasms, panic and hallucinations or delirium tremens (DT). If not treated professionally, people with DT have a mortality rate of more than 10%, so detoxification from late-stage alcoholism should only be attempted under the supervision of an experienced carer and may require a brief inpatient stay at a hospital or treatment centre.

Treatment may involve one or more medications. Benzodiazepines are anti-anxiety medicines used to treat withdrawal symptoms such as anxiety and poor sleep and to prevent seizures and delirium. These are the most frequently used medications during the detox phase, after which time they are usually tapered and then discontinued. They must be used with care, since they may be addictive.

Disulfiram may be used once the detox phase is complete and the person is abstinent. It interferes with alcohol metabolism so that drinking a small amount will cause nausea, vomiting, confusion and breathing difficulty.

Acamprosate is a medicine that has been specifically developed to help people manage cravings for alcohol.  It is a type of chemical called a synthetic GABA analogue, which restores the normal activity of chemical messengers in the brain that become overexcited by the withdrawal of alcohol and lead to craving. Studies suggest that acamprosate can as much as double the chances of successfully giving up alcohol.

Naltrexone reduces the craving for alcohol and can prevent relapse. It works by blocking the opioid receptors in the body and consequently the effects of alcohol.

Because an alcoholic remains susceptible to becoming dependent again, the key to recovery is total abstinence. Recovery typically takes a broad-based approach, which may include education programmes, group therapy, family involvement, and participation in self-help groups. Alcoholics Anonymous (AA) is the most well known of the self-help groups, but other approaches have also proved successful.