Alcohol misuse - treatment
Alcohol misuse, sometimes called alcohol abuse, is when a person regularly drinks more than the recommended amounts of alcohol.
Alcohol misuse types include:
- Hazardous drinking over guideline limits
- Harmful drinking over guideline limits leading to alcohol-related health problems
- Dependent drinking in which a person feels unable to function without drinking alcohol
Being dependent on alcohol is commonly called alcoholism. However, doctors now prefer to use the term alcohol dependence.
What are the treatments for alcohol dependence?
The goal of treatment for alcohol dependence 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 mental health 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 medication for alcohol dependence
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 drugs used to treat withdrawal symptoms such as anxiety and poor sleep, and to prevent seizures and delirium tremens. These are the most frequently used medications during the detox phase, after which time they are usually tapered off and then discontinued. They must be used with care, since they can 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 drug that is specifically designed 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.
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.
Nalmefene is another option for alcohol dependence. It works by blocking opiate receptors in the brain, reducing cravings in alcohol-dependent drinkers and consequently reducing alcohol consumption.