In the U.S., approximately 14.8 million people aged 12 or older had an alcohol use disorder (AUD) in 2018.1 This accounts for about 1 in 19 people, or 5.4% of the population.1 Thankfully, even at its most severe, this disease may be effectively managed with professional treatment and ongoing recovery efforts.2 Research has shown that about 1/3 of people who do complete alcohol addiction treatment have no further symptoms 1 year later.2

If you’ve never been to a rehab facility before—or have only seen treatment portrayed through television shows or movies—you may not know what to expect or may have a false sense of what it will be like. While some people may enter treatment for solely drug- or alcohol-related addictions, recovery programming for both types of substance use disorders is often pretty similar.

However, there are a few ways in which alcohol addiction treatment can be unique in its offerings, such as during the initial medical detox phase and in terms of relapse prevention education. The former is an important step in the early recovery process due to alcohol’s uncomfortable and more serious withdrawal symptoms. The latter may focus on how to successfully reintegrate into society where drinking is more common or widely-accepted than the use of drugs; therefore placing you at a higher risk of having to encounter it within your social circles.

Medical Detox for Alcohol Withdrawal

While those abusing some types of illegal and/or prescription drugs might benefit from a medical detox (especially when it comes to opioids), this is one area in which alcohol addiction treatment will frequently start out differently than other types of substance abuse treatments. While medical detoxification may be helpful in a number of recovery situations, in cases of significant alcohol dependence, it may be a medical necessity, so as to keep people safe from potential withdrawal complications or to protect against severely unpleasant withdrawal symptoms.

The acute alcohol withdrawal syndrome may include symptoms such as:3,4

  • Irritability.
  • Anxiety.
  • Transient hallucinations (visual, hearing, tactile).
  • Hand tremor.
  • Fever.
  • Sweating.
  • Increased heart rate.
  • High blood pressure.
  • Seizures.
  • Delirium tremens (rare).

The type of detox program or level of intensity needed for effective alcohol withdrawal management will depend on the magnitude of alcohol dependence, the severity of the addiction, and the risk of experiencing a complicated withdrawal. AAC offers medical detox services at all of its facilities. During this process, a doctor or other treatment professional may evaluate for those factors prior to making a recommendation on your needed level of detox care.

Who is At Risk for Delirium Tremens?

In some cases, a person may develop what is known as delirium tremens (DTs), typically in instances of pronounced alcohol dependence and severe accompanying withdrawal. DTs are most commonly seen in those who have a history of alcohol withdrawal, have experienced prior seizures, have additionally significant medical disorders, have abused alcohol for more than 10 years, or drink daily, for months on end.4 DTs typically only develop in about 5% of patients experiencing withdrawal.5

Signs and symptoms of delirium tremens may include:4

  • Profoundly altered mental status.
  • Severe confusion or disorientation.
  • Hallucinations.
  • Agitation.
  • Racing heart rate.
  • Body tremors.
  • Fever.
  • Sweating.
  • Seizures.

If you suspect you or someone you know is experiencing delirium tremens or severe alcohol withdrawal, seek medical attention immediately.

Although medical detoxification helps to safely manage the acute symptoms of withdrawal, it may ultimately do little to help individuals abstain from alcohol use long-term.

What Does Effective Alcoholism Treatment Look Like?

When it comes to effective treatment for alcoholism, there are a number of key principles that may form the basis of any successful recovery programming.6 Treatment may involve medications to ease alcohol withdrawal symptoms, therapy to better understand potential contributors to addiction and change certain behaviors, and long-term aftercare programming (e.g., support groups/mutual help meetings, sober living arrangements, continued counseling/therapy) to help maintain sobriety and avoid relapse.6

Because no single treatment plan is appropriate for everyone, AAC customizes each plan based on your unique, individual needs and regularly reviews and modifies them based on your recovery progress and any changing treatment requirements. Effective treatment will also integrate therapeutic interventions for any co-occurring mental health disorders in conjunction with a person’s alcohol abuse.6 

During your time in treatment, you may experience any of the below within your recovery programming: 

  • Group, private and family counseling.
  • Behavioral therapies (e.g., Cognitive-Behavioral Therapy, Contingency Management).
  • Complementary or alternative therapies (e.g., equine therapy, yoga, meditation).
  • Relapse prevention techniques.

We also offer multiple levels of care such as medical detox, inpatient and outpatient settings, and aftercare services for 30-, 60- or 90-day treatment options. Of note, research indicates that remaining in treatment for at least 90 days allows for better outcomes.7

Medications Used in Alcoholism Treatment

During the withdrawal process, you may be given benzodiazepines—a class of sedative medications—used to treat panic, anxiety, and to control certain types of seizures.5,8

Benzodiazepines are the agents of choice to manage some of the more problematic alcohol withdrawal symptoms.5,8 Some benzodiazepines used to manage acute alcohol withdrawal syndrome include:9

  • Chlordiazepoxide (e.g., Librium).
  • Clorazepate (e.g., Tranxene).
  • Diazepam (e.g., Valium).
  • Oxazepam (e.g., Serax).
  • Ativan (e.g., lorazepam—an unapproved, or off-label use).

Another unique attribute of alcohol addiction treatment is that alcohol is one of only two substance types (the other being opioids) that have medications with specific FDA-approval to treat such a substance use disorder. Aside from the above medications used to manage alcohol withdrawal, other meds may be used within recovery programming to treat alcoholism such as disulfiram, naltrexone, and acamprosate. Disulfiram (Antabuse) inhibits an enzyme used to metabolize alcohol and, when taken daily, will result in very unpleasant effects when alcohol is consumed, even in small amounts.10 It is used to discourage continued drinking behavior through its aversive reaction with alcohol.10,11 

Naltrexone (Vivitrol) also works to decrease drinking behavior, though by an entirely different mechanism than disulfiram. Reports from those who’ve been successfully treated with it suggest that it helps them stay abstinent, reduces their urge to drink, and interferes with their desire to continue drinking if they have even a sip of alcohol.12

Lastly, when used alongside counseling and social support, acamprosate (Campral) is thought to restore a balance in the central nervous system disrupted by chronic drinking (though it is not used to prevent symptoms of alcohol withdrawal).13,14 The drug may be less effective in those who continue to drink or abuse other substances (though treatment should be maintained in the event of a relapse).14

Learning How to Reintegrate into Society

For many people, reintegrating into society while sober can feel like an impossible feat and can be a huge barrier to treatment. In the U.S., because it is legal to consume alcohol over the age of 21, drinking tends to be much more accepted in society and everyday activities can focus heavily around it. After-work events, dinner parties, and many social gatherings where alcohol may be present may put you at risk of relapse if you aren’t sure how to cope with such situations. 

By going through our relapse prevention classes and learning how to deal with real life situations through one-on-one counseling and group therapy sessions, we’ll give you the tools needed to manage many of the stressors or triggers that you may encounter in your everyday life. Plus, you’ll benefit from a nationwide network of AAC alumni who have been where you are and can be a support system or listening ear during difficult times. 

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Sources:

[1]. Substance Abuse and Mental Health Services Administration. (2019). The 2018 National Survey on Drug Use and Health (NSDUH). 

[2]. National Institute on Alcohol Abuse and Alcoholism. (2014). Treatment for Alcohol Problems: Finding and Getting Help. 

[3]. MedlinePlus (2016). Alcohol Withdrawal. 

[4]. Rahman A, Paul M. (2018). Delirium Tremens (DT)U.S. National Library of Medicine. 

[5]. Hugh Myrick, M.D., and Raymond F. Anton, M.D. (1998). Treatment of Alcohol WithdrawalAlcohol Health & Research World 22(1): 38-43. 

[6]. National Institute on Drug Abuse. (2019). Treatment Approaches for Drug Addiction. 

[7]. National Institute on Drug Abuse. (2018). Principles of Effective TreatmentPrinciples of Drug Addiction Treatment: A Research-Based Guide (Third Edition). 

[8]. National Clinical Guideline Centre. (2010). Alcohol Use Disorders: Diagnosis and Clinical Management of Alcohol-Related Physical ComplicationsNICE Clinical Guidelines, 100(2).

[9]. Tarascon Publishing. (2019). Tarascon Pocket Pharmacopoeia, 2019 Deluxe Lab-Coat Edition.

[10]. MedlinePlus. (2017). Disulfiram. 

[11]. U.S. National Library of Medicine. (1990). Disulfiram Treatment of AlcoholismAm J Med.; 88(6): 647-55.

[12]. National Institute on Alcohol Abuse and Alcoholism. (1995). Answers to Frequently Asked Medication QuestionsGuidelines for the Use of Naltrexone in the Treatment of Alcoholism; 5(1).

[13]. U.S. National Library of Medicine. (2012). Acamprosate For Treatment of Alcohol Dependence: Mechanisms, Efficacy, and Clinical UtilityTherapeutics and clinical risk management; 8, 45-53.

[14]. MedlinePlus. (2016). Acamprosate.

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