According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), approximately 17 million American adults have an alcohol use disorder (AUD).20 But the good news is, no matter how severe the problem may seem, recovery is possible.
To treat this chronic condition, there are several therapeutic approaches that can be used within formal recovery treatment. Comprehensive recovery efforts commonly include a combination of medications, behavioral therapies, and mutual-support group participation.1 While there is no one-size-fits-all solution to recovery, as a part of a comprehensive treatment plan, a combination of these three approaches has helped many individuals maintain sobriety long-term.1
Behavioral therapies help people modify their problematic behaviors and alcohol drinking patterns.1 These therapies are based on scientific evidence and are led by mental health professionals via counseling sessions within recovery programming.1 Common behavioral therapies used to treat alcohol use disorders include:1
- Cognitive-behavioral therapy (CBT):2 CBT focuses on identifying and changing maladaptive behavioral patterns that result in substance abuse and teaches individuals to detect and correct the behaviors associated with drinking. It may also address additional co-occurring disorders, such as problems with anxiety or depression. Essentially, CBT helps a person to change the way they think, positioning them to effectively control their emotions and select healthy behaviors allowing them to make better, healthier, choices around drinking.
- Motivational enhancement:3 This treatment approach uses motivational interviewing techniques to help people overcome their ambivalence about or resistance to treatment and stopping substance use. After a thorough assessment, the therapist typically works with the individual in private sessions.
- Contingency management:4 This approach is centered around providing incentives for behavioral changes related to drinking. When a person reaches a certain milestone in treatment, such as having a negative alcohol test, they receive a voucher for activities they enjoy like free movie tickets. Or, for example, people who attend a certain number of 12-step programs may be entered into a drawing with others in treatment for a chance to win prizes.
- 12-step facilitation:5 Often used in treatment programs, 12-step facilitation incorporates the principles of 12-step groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) into the treatment program. These programs are designed to help people see that life has become unmanageable because of the addiction and focuses on surrendering the self over to a higher power. Furthermore, 12-step facilitation is designed for those in treatment to become familiar with going to 12-step meetings and using a 12-step program to help them maintain recovery following formal treatment.
- Family behavior therapy (FBT):6 This behavior-based therapy is primarily geared toward adolescents and their families. FBT addresses various types of behavioral problems and family conflict. It uses contingency management and contracting for certain behavioral expectations. FBT can also be used with adults, provided that at least one family member participates in the sessions with the person receiving treatment.
Along with behavioral therapies used to treat alcoholism, three FDA-approved medications are also available to treat alcohol dependence. They include:1
- Acamprosate is administered to help curb drinking in patients who are not currently drinking alcohol. Unlike some other alcohol dependency medications, acamprosate can be given to people who have liver diseases or hepatitis.7 It has been found to increase periods of abstinence from alcohol and lessen the risk of using alcohol after a period of abstinence.7 However, in people who take the medication and continue to drink, it does not reduce the number of days in which they consume large amounts of alcohol.7 It is worth noting, though, that acamprosate is safe, has relatively few side effects, and has been extensively studied in clinically valid studies for years.7
- Disulfiram, also known as Antabuse, is used to discourage a person from using alcohol.8 People who consume alcohol while taking disulfiram will develop highly unpleasant side effects within about 10 minutes.8 These side effects may include flushing, nausea, chest pain, blurred vision, and anxiety.8 There are limited trials to support its effectiveness as it does not reduce cravings for alcohol but may act as a deterrent to drinking as long as the medication is taken.17
- Naltrexone is an oral or injectable medication that reduces the pleasurable effects of alcohol and reduces cravings. Naltrexone blocks the endogenous opioids released when alcohol is consumed from attaching to the body’s opioid receptors, interrupting the body’s ability to mediate the pleasurable effects of alcohol.7 Naltrexone can reduce a person’s desire to drink and lessens the effect of alcohol when ingested.9 While it helps people stay abstinent, there are some downsides: a person must not consume any alcohol for 7 days before starting to use it, and those who need opioids for pain relief cannot use naltrexone because it stops the opioids from working.9 People with acute hepatitis or severe liver failure also cannot use naltrexone.9 On the plus side, naltrexone is not habit-forming, and few people experience side effects after taking it.
How Do I Start Treatment?
Mutual Support Groups
Behavioral therapies and medications are two valuable treatment tools for alcohol use disorders. As part of a comprehensive treatment program, mutual support groups add another layer of support and can increase the effectiveness of treatment.
Sometimes called peer support groups, these groups consist of people in recovery from substance use disorders such as alcohol. Mutual help groups are typically not run by professionals and are often a valuable adjunct to treatment or a valuable form of aftercare to support a person following completion of formal treatment. They offer support and a sober peer group that someone in recovery can rely on as each helps one another along their recovery journey.10
Alcoholics Anonymous and similar 12-step programs are the most well-known mutual support groups for people with alcohol or other substance use disorders. Despite being in existence for more than 80 years, research, on the effectiveness is controversial and subject to widely divergent interpretations. Some studies show greater periods of abstinence while others show no differences in substance use between those who participated in mutual support groups as a part of treatment and those who did not.11,18
However, other research has found AA to promote better outcomes than people who did not participate in AA.11 In general, participation in mutual support groups are generally encouraged by physicians specializing in addiction medicine as the only requirement to attend is the desire to be free from alcohol or drugs and the only cost is the person’s time.19 Participation in mutual help groups may also begin while in formal treatment and they may also be a part of a person’s aftercare plan following formal treatment.19
Some mutual support groups do not use the 12-step model. These include SMART recovery, which utilizes research-based practices to overcome AUDs. Unlike AA, this group views an alcohol use disorder as a treatable condition rather than a life-long disorder that requires continual participation in a 12-step group.12 SMART recovery also does not use the concept of a higher power, nor does it expect the person to be powerless to manage their alcohol use disorder.12
Although the use of alternative treatments for alcohol use disorders has increased, the research on their effectiveness is limited. Alternative and holistic therapies may, however, be included as part of a person’s overall treatment program.
For example, yoga was found to be helpful in the short term to help with cravings for substances such as alcohol.13 However, the long-term impact of yoga on recovery from alcohol or other substance use disorders remains to be seen.13 Other holistic treatments include equine, or horse-assisted, therapy. While this treatment is gaining in popularity, a good deal of the research is exploratory and there has yet to be a study designed to measure its clinical effectiveness.13
A recent study did indicate that young adults who participated in a substance use treatment program that included equine therapy were more likely to stay in treatment than those who had the same treatment program but did not participate in equine therapy.14
Treatment programs may also incorporate creative arts into AUD treatment such as art therapy and music therapy. One recent analysis of music therapy found that it increased motivation and readiness for treatment among people who had substance use disorders.15 It was not possible to determine if these effects were lasting, but it is a promising study encouraging exploration into the role of music therapy in substance use disorder treatment.15
Exploratory research of art therapy also supports conducting further research to determine its effectiveness as an adjunct to treatment of substance use disorders.16 Art therapy may allow people to get in touch with suppressed feelings in a way that is less threatening to them than talk therapy.16
Get Help for Alcoholism
If you or someone you care about is struggling with alcoholism and would like to learn more about treatment, American Addiction Centers (AAC) can help. Alcohol.org is a subsidiary of AAC, a nationwide provider of addiction treatment facilities.
We provide personalized addiction services to those struggling with drugs and alcohol and are dedicated to making treatment accessible to everyone in need. Everyone deserves the highest quality of treatment, marked by clinical excellence, and our approach to treatment allows individuals to work toward recovery in a safe, supportive and welcoming community.
AAC offers a range of treatment centers across the U.S. so that you can work toward recovery in a setting that best fits your needs. We are also equipped to treat co-occurring disorders throughout our network of facilities via an integrated approach to treatment.
Call our hotline today to learn more about your treatment options. Our admissions navigators are available 24/7 to speak with you and there is no obligation to make any decisions right away. We’re here for you and are excited to be on this journey with you.
. National Institute on Alcohol Abuse and Addiction. (n.d.). Treatment for alcohol problems: Finding and getting help.
. National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: Cognitive-behavioral therapy.
. National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: Motivational enhancement.
. National Institute on Drug Abuse. (2018). Contingency Management Interventions/Motivational Incentives (Alcohol, Stimulants, Opioids, Marijuana, Nicotine).
. National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: 12-step facilitation therapy.
. National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: Family behavior therapy.
. Witkiewitz, K., Saville, K., & Hamreus, K. (2012). Acamprosate for treatment of alcohol dependence: mechanisms, efficacy, and clinical utility. Therapeutics and Clinical Risk Management, 8, 45.
. U.S. National Library of Medicine. (2017). Disulfiram.
. National Institute on Alcohol Abuse and Addiction. (n.d). Naltrexone.
. Tracy, K., & Wallace, S. P. (2016). Benefits of peer support groups in the treatment of addiction. Substance Abuse and Rehabilitation, 7, 143–154.
. Kelly, J. F., & Yeterian, J. D. (2011). The role of mutual-help groups in extending the framework of treatment. Alcohol Research & Health, 33(4), 350–355.
. SMART Recovery. (2020). About SMART recovery.
. Kuppili, P. P., Parmar, A., Gupta, A., & Balhara, Y. (2018). Role of yoga in management of substance-use disorders: A narrative review. Journal of Neurosciences in Rural Practice, 9(1), 117–122.
. Kern-Godal, A., Arnevik, E. A., Walderhaug, E., & Ravndal, E. (2015). Substance use disorder treatment retention and completion: a prospective study of horse-assisted therapy (HAT) for young adults. Addiction Science & Clinical Practice, 10, 21.
. Megranahan, K., & Lynskey, M. T. (2018). Do creative arts therapies reduce substance misuse? A systematic review. The Arts in Psychotherapy, 57, 50-58.
. Adams, C., & Stickley, T. (2019). Group art activities and arts therapies for people using substances: A rapid review of the literature. Nordic Journal of Arts, Culture and Health, 1(01), 47-59.
. American Family Physician. (2016). Medications for Alcohol Use Disorder.
. Kelly JF, Humphreys K, Ferri M. (2020). Alcoholics Anonymous and other 12‐step programs for alcohol use disorder. Cochrane Database of Systematic Reviews 2020, Issue 3. Art. No.: CD012880.
. Miller, Shannon C.; Fiellin, David A.; Rosenthal, Richard N. (2018). The ASAM Principles of Addiction Medicine.
. SAMHSA, Center for Behavioral Health Statistics and Quality. (2019). National Survey on Drug Use and Health.