Alcoholism Treatments

Rationing

Some programs attempt to help problem drinkers before they become dependents. These programs focus on harm-reduction and reducing alcohol intake as opposed to cold-turkey approaches. Since one of the effects of alcohol is to reduce a person's judgment faculties, each drink makes it more difficult to decide that the next drink is a bad idea. As a result, rationing or other attempts to control use are increasingly ineffective as pathological attachment to the drug develops. Use may continue despite serious adverse health, personal, legal, work-related, and financial consequences.

Nonetheless, this form of treatment is effective for some people, and it avoids the physical, financial, and social costs that other treatments result in. Professional help can be sought for this form of treatment from programs such as Moderation Management.

Detoxification

Treatments for alcohol dependence include detoxification programs run by medical institutions. These may involve stays for three or more weeks in specialized hospital wards; often, however, patients are hospitalized for only a few days. Some insurance providers limit detox stays to 5-6 days or less. Drugs may be used to avoid withdrawal symptoms, which in severe cases may lead to death. To that point, even a simple detox can involve seizures, if not properly monitored. In many cases, the physical effects of rapid detox can result in neurological damage.

Most other forms of treatment require detoxification before they can be effective because they rely upon the maintenance of abstinence. For these treatments, the elimination of the physical dependence is an important first step that allows the treatment of the underlying psychological or neurochemical addictions. With the exception of pharmacological extinction, any treatment that doesn't rely on detox has questionable effectiveness because it allows the patient continued access to the substance to which they are addicted.

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 dependence, and also to provide the recovering addict with relapse prevention skills. Aversion therapies may be supported by drugs like Disulfiram, which causes a strong and prompt sensitivity reaction whenever alcohol is consumed. Naltrexone or Acamprosate may improve compliance with abstinence planning by treating the physical aspects of cravings to drink. The standard pharmacopoeia of antidepressants, anxiolytics, and other psychotropic drugs treat underlying mood disorders, neuroses, and psychoses associated with alcoholic symptoms.

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 this movement. Other groups that provide similar treatment without AA's religious bias include LifeRing Secular Recovery and SMART Recovery.

Medications

The classical use of medications for alcoholism is to supplement a person's willpower and encourage abstinence. Antabuse (a.k.a. disulfiram), for instance, prevents the elimination of chemicals which cause severe discomfort when alcohol is ingested, effectively preventing the alcoholic from drinking in significant amounts while they take the medicine. Heavy drinking while on ant abuse 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 of these, however, have been demonstrated to cause a rebound effect when the user stops taking them. These do allow a person to resist psychological addictions to alcohol, but they do not treat the neurochemical addiction.

Pharmacological Extinction

In more recent studies it has been demonstrated that the use of endorphin antagonists [e.g. naltrexone] while the alcoholic continues to drink can result in extinction of the neurochemical addiction. Over a period of roughly three months the patient, while continuing to drink, looses interest in drinking alcohol and can eventually just give it up as being sensibly unbeneficial. This technique is used to good effect inFinland, Florida, and Pennsylvania.

There is a lot of professional bias against this treatment for two reasons. The first is the long-standing bias against any treatment that doesn't involve detoxification and abstinence. The second is due to a large body of research which has been done using naltrexone to encourage abstience, for which it is poorly suited. Naltrexone use during abstinence fails to treat the neurochemical addiction, and can result in a rebound effect when the patient stops taking it, and these results have been falsely assumed to reflect its effectiveness as a treatment when coupled with continued drinking. This particular form of treatment is sometimes referred to as the Sinclair Method.

Nutritional therapy

Another treatment program is based on nutritional therapy. 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, side-effects often seen among alcohol dependents in treatment. The metabolic aspects of such dependence are often overlooked, resulting in poor treatment outcomes.

Return to normal drinking

Although it has long been argued that alcoholic dependents cannot learn to drink in moderation, research by the U.S. National Institute on Alcohol Abuse and Alcoholism (NIAAA) indicates that about 18% of such individuals in the US whose dependence began more than one year earlier are now drinking in moderation. In contrast, roughly 78% of those who undergo pharmacological extinction are capable of normal drinking habits, although this does involve the use of naltrexone an hour before any drinking occurs in order to maintain this.