According to the latest available data from the Substance Abuse and Mental Health Services Administration (SAMHSA):
- In 2015, it was estimated that 21.7 million people over the age of 12 (8.1 percent of the population) needed treatment for some substance use disorder.
- About 11 percent of the people who needed treatment for a substance use disorder (about 2.3 million people) received treatment at a specialty facility within the year prior to the survey.
- This leaves about 19.3 million people who were classified as needing treatment for a substance use disorder at a specialty facility not receiving it.
- Of the 19.3 million people not getting substance use disorder treatment, over 95 percent did not think they needed treatment for their substance abuse.
If an individual is diagnosed with a mental health disorder, such as a substance use disorder, or meets the diagnostic criteria for a substance use disorder, then by definition, the individual requires some form of intervention. These disorders do not go into remission on their own, and individuals who meet the diagnostic criteria for any type of substance use disorder, such as an alcohol use disorder, are experiencing significant issues in life that include issues with stress, functioning normally, and controlling their use of alcohol or other drugs.
According to numerous resources, including professional texts like Kaplan and Sadock’s Synopsis of Psychiatry, the vast majority of individuals diagnosed with these disorders by meeting the formal diagnostic criteria for them require some level of intervention. Interestingly, one of the paradoxes often observed in individuals with substance use disorders is their consistent cavalier attitude regarding the effects that their substance abuse has on them and others in their lives. Once these individuals actually get into treatment and reflect upon their behaviors, it becomes clear to them how their behavior was both dysfunctional and damaging to themselves and others.
Perhaps part of the problem regarding individuals not seeking treatment is their stereotypic notion of what an “alcoholic” is and a general misconception of what treatment can accomplish. There are numerous available treatments that can be tailored to meet the needs of the individual.
Interventions for Alcohol Use Disorders
There are numerous interventions that can be used to address an individual who has an alcohol use disorder. The type of the intervention that individual chooses will depend on several different factors that include:
- Withdrawal: whether or not the individual experiences withdrawal from alcohol once they discontinue drinking
- Severity: the severity of the individual’s alcohol use disorder
- Co-occurring disorders: the presence of any other co-occurring psychological disorders (very common in individuals with alcohol use disorders)
- Other variables: personality characteristics of the individual, such as if the individual is primarily outgoing or more introverted, if they function well in groups, how willing they are to disclose issues, if they enjoy physical activities, etc.
Listing all the available interventions to address alcohol abuse is beyond the scope of this article. According to SAMHSA and the American Society of Addiction Medicine (ASAM), some of the major approaches based on the above considerations include:
- Withdrawal management: Physician-assisted withdrawal management programs (often referred to as detox or medical detox) are a treatment intervention that is a must for individuals who experience withdrawal symptoms once they discontinue alcohol. The treatment typically consists of a physician using a medication that controls the withdrawal syndrome (most often a benzodiazepine) and then tapering down the dosage of the drug at specific intervals to wean the individual off the drug while at the same time controlling withdrawal symptoms.
According to the American Psychiatric Association (APA), about half of high-functioning individuals with alcohol use disorders never experience full alcohol withdrawal syndromes, but the rate is much higher in individuals who are hospitalized due to severe abuse or who are homeless. While there is no sure way to predict whether anyone will experience withdrawal symptoms, the severity of the individual’s alcohol use disorder, as determined by the number of symptoms they express, is often one of the best predictors.
Withdrawal from alcohol can be potentially fatal due to the potential for developing delirium tremens and withdrawal seizures; however, APA reports that less than 10 percent of individuals who undergo withdrawal from alcohol experience these issues.
- Inpatient treatment: This level of care typically occurs in a hospital or medical clinic, and is reserved for individuals who have been deemed to have a medical necessity for 24-hour medical supervision or care. This may include an individual who is undergoing a withdrawal management program, someone who has a serious co-occurring medical condition or mental health disorder, someone who is suicidal, or someone who has any other number of conditions that physicians and insurance companies deem as requiring inpatient treatment. The majority of individuals in treatment for alcohol abuse will not require inpatient treatment, but those who do have serious needs.
- Residential treatment: Residential treatment occurs when individuals need to be isolated from their environment and have close supervision, but do not need 24-hour medical monitoring or care. These individuals live in a residential facility and typically attend treatment at the facility or clinic. Individuals who have been recently released from an inpatient treatment center, who have toxic environments, who have made multiple unsuccessful attempts to stop drinking, or who have other special needs are often suited for residential treatment.
- Partial hospital programs: Partial hospital programs combine the aspects of an inpatient treatment program and a residential treatment program. Individuals receive treatment at a hospital or medical clinic and then return to a residential living facility that is either attached to the clinic, but not part of it, or on the same campus as the hospital.
- Intensive outpatient treatment and outpatient treatment: Outpatient treatment occurs in a specialized clinic or other facility, and after treatment, the individual returns to their own home or living area, and continues to participate in the daily aspects of their life. Intensive outpatient treatment provides intensive treatment, similar to what will occur in an inpatient unit or residential treatment program. It is often lengthier than normal outpatient treatment.
Within each of these basic treatment divisions, there are specialized forms of treatment that individuals may receive. According to APA, ASAM, and SAMHSA, some of these interventions include:
- Medically assisted treatments: These treatments include the use of medications and other medical procedures.
- Psychotherapy or counseling: Therapy or counseling is the cornerstone of any treatment program for a substance use disorder, such as an alcohol use disorder. Medically assisted treatments can help to relieve certain symptoms or reduce their severity, but these treatments alone cannot help an individual recover from an alcohol use disorder. Therapy gets to the root of the individual’s problem, teaches them coping skills, helps them develop a program of relapse prevention, and also addresses the issues that drove their substance of use.
Most often, some form of Cognitive Behavioral Therapy is used in the treatment of substance use disorders. Therapy can be delivered on a one-on-one basis (individual therapy), a group basis (group therapy), or in a combination of both individual and group therapy sessions.
- Support group participation: Social support group, such as Alcoholics Anonymous and many other similar groups, are not technically forms of psychotherapy or counseling because they do not employ the use of a trained or licensed therapist. Instead, these are peer support groups, and, they can be very useful.
- Alternative treatments: Often referred to as complementary and alternative treatments, these various forms of treatment are used in addition to the three major forms of intervention listed above. Alternative treatments can consist of numerous interventions, including exercise programs, meditation, music therapy, art therapy, wilderness therapy, martial arts, etc. These interventions are typically not standalone treatments for alcohol use disorders or other substance use disorders, but they can add to the effectiveness of standard treatments and add variety in an individual’s treatment program.
Treatment for a substance use disorder, such as an alcohol use disorder, is readily available throughout the United States. For instance, in 2012, the National Institute on Drug Abuse (NIDA) reported that there were over 14,500 specialty substance abuse treatment programs in the US. When one factors in the number of 12-Step meetings that occur throughout the country, online meetings, alternative treatments, and interventions in community health centers and other public facilities, this number is greatly increased.
While there are many private treatment centers available, treatment in these facilities is often costly. In addition, there are various levels of care offered by different private treatment facilities. For instance, some facilities may not offer withdrawal management and only offer therapy; other facilities may only offer inpatient or residential treatment but not outpatient care.
Making an Informed Decision about Treatment
Once an individual has decided they need treatment for their alcohol use disorder, the next question they should consider is: “What level of treatment or care is appropriate for me?”
Although there are many personal considerations that go into making a decision on what type of treatment one should seek, there are some general guidelines one should consider when seeking treatment for an alcohol use disorder.
- Get your physician involved. There are several important reasons that an individual should get their physician involved in seeking out a treatment program for alcohol abuse. If one does not have a personal physician, one should get one.
First, having a physician monitor the early stages of the individual’s recovery can determine the need for a formal withdrawal management program. Because alcohol withdrawal can be dangerous and is also a major cause of early relapse, this needs to be potentially addressed if the individual experiences significant alcohol withdrawal symptoms.
Second, physicians and only physicians can make the case for medical necessity for specific types of treatments that the individual may need. Basically, medical necessity refers to the notion that a specific treatment intervention is necessary from a medical point of view in order for the treatment program to be successful. Often, insurance companies require this for certain types of treatment, such as inpatient treatment, residential treatment, the use certain medications, etc.
Third, treatment providers listen to physicians. Intake personnel, therapists, and other treatment providers pay special attention to referrals and other information, such as requests for specific interventions, when they are given by a physician. Physicians have far more weight than family members, social workers, therapists, etc., when it comes to getting things done in the medical field.
- Make sure one can participate in the treatment. Make sure that the treatment program is actually available and accessible. Choosing a residential program in Montana when one lives in Florida is not the best choice, no matter how good the residential program is, if one is unable to remain in the program for the duration of treatment. Make sure to understand exactly what is required in treatment and that treatment can be completed. Making special demands that inconvenience treatment providers or asking for significant exceptions to an established treatment program is not a productive way to approach treatment.
- Get family and friends involved. Support is a crucial factor that helps to determine the success of any substance use disorder treatment program. Keep family members and close friends involved in treatment. On the other hand, it might be counterproductive to force someone to get involved in a treatment program if they do not wish to do so. Most people find that their close family members and friends are more than happy to assist and be involved in an individual’s treatment; however, do not force the issue.
Questions to Ask a Potential Treatment Provider
There are several basic questions that should always be asked of any potential treatment provider.
- What type of licensing or accreditation does the program possess? There are several national accreditation programs, such as the National Committee for Quality Assurance or The Joint Commission. Look for national accreditation.
Accreditation is not the same thing as being licensed. Licensing occurs through the state, and all therapists, counselors, physicians, etc., should be licensed by the state. Look for individuals who have specific accreditation and licensing in the treatment of substance abuse.
- Does the program use empirically validated treatment methods? Empirically validated treatment programs utilize treatment interventions that have been demonstrated by research studies to be effective. Programs like rapid detox, regression therapy, nutrition for substance abuse, etc., are not empirically validated for the treatment of substance use disorders. Ask if the program uses empirically validated treatment methods and then ask for the types of methods they use.
- Is the treatment personalized? Even though there is an overall approach that is followed in the treatment of any substance use disorder, including an alcohol use disorder, not every person is the same. Experienced treatment providers understand that they must use a basic empirically validated approach that is personalized to fit the needs of the individual. Find out if the program does this and how they do it.
- Does the program have access to medically assisted treatments? Some programs, such as private therapy offices or counselors, may not have direct access to a psychiatrist, addiction medicine physician, etc. An individual’s recovery program can run much more smoothly if their counselor or therapist is also communicating regularly with their physician, and medical emergencies can be handled much more efficiently if the therapist can immediately contact a medical clinic. As a result, it is important to determine if the program has access to medically assisted treatments, including physician-assisted withdrawal management programs, psychiatrists and addiction medicine physician, inpatient units, etc.
- Does the program offer a holistic approach? Successful treatment programs address all the needs of the individual, including their medical, spiritual, social, psychological, and other needs. Opt for programs that address all these issues.
- Does the program offer family involvement? As mentioned above, support is a key factor in recovery. Recovery programs that offer opportunities for an individual’s family to get involved in their treatment should be given special consideration.
- What type of aftercare or ongoing support is there? For individuals considering inpatient or residential treatment, there should be some type of access to aftercare. Aftercare occurs after the acute phase of treatment. Typically, more competent programs have links with outpatient treatment providers, such as addiction medicine physicians, psychiatrists, therapists, etc. Therapists should have links to community support groups, 12-Step groups, etc.
- What type of insurance is accepted? Typically, this question is one of the first questions asked. Understanding how one will pay for treatment lessens overall stress.
Paying for treatment is always an issue. Fortunately, the Affordable Care Act (often referred to as Obamacare) has mandated that insurance companies must provide treatment for mental health issues, including substance use disorders, at the same level that they offer primary care treatment. Pre-existing conditions cannot be excluded.
If an individual has insurance, there is some form of coverage for substance use disorder treatment. One should refer to the customer service department of their insurance provider to find out exactly what coverage they have. In addition, many clinics, therapists, etc., can check with an individual’s insurance company to find out how much of the treatment will be covered.
If an individual does not have insurance or has high copays, there are still numerous ways to pay for treatment, including:
- Crowdfunding: A very popular option for individuals to get funding for medical treatments is to start a crowdfunding campaign. There are various sites that offer the ability to set up a crowdfunding campaign
- Payment plans: Most facilities will work with an individual and develop a payment plan for treatment.
- Credit cards or other financing: Although many individuals do not like to borrow money or use their credit cards to pay for treatment, if one does a cost-benefit analysis, they will find that the benefits of getting sober and getting started on the road to recovery are much greater than the cost.
- Social support groups: Some of the most enduring interventions for alcohol use disorders are actually relatively inexpensive. For instance, participation in Alcoholics Anonymous groups is essentially free. Most members donate $1 at each meeting. Using social support groups in conjunction with therapy and needed medically assisted treatments is a viable option for many individuals.
There are numerous resources that an individual can draw upon to assist them in getting treatment for an alcohol use disorder.
- One of the best sources is the SAMHSA Treatment Provider Locator. Individuals can input information and find providers in their area with confidence that all the information they input is anonymous.
- Alcoholics Anonymous offers a website to help individuals find meetings in their area.
- Al-Anon offers meetings and support for families of individuals with alcohol use disorders and other substance use disorders.