It's difficult getting alcoholics into treatment, but for many, psychological and medical treatments for alcoholism produce positive results.

Alcoholism clinicians have access today to a wide range of treatment options for their patients. Some of these treatments, such as 12-step self-help programs, have been around a long time. Others-including brief intervention and various therapies borrowed from other fields, such as motivational enhancement therapy and couples therapy-are relatively new concepts that have been shown to be effective in reducing the risk for alcohol-related problems.

The key change in the treatment of alcoholism that has occurred is the advent of alcoholism clinical research, which over the past 15 years or so has made significant progress toward rigorous evaluation of both existing therapies and newly developed therapies for use in treating alcohol-related problems. In addition, continued research on alcohol's effects in the brain and on the links between brain and behavior, which has already led to the development of medications to reduce craving for alcohol, is likely to provide clinicians with a range of highly specific medications that will, when used in conjunction with behavioral therapies, improve the chance for recovery-and the lives-of those who suffer from alcohol abuse and dependence.

What is available for treatment of alcoholism?

The goal of treatment of alcohol dependence is usually to stop drinking alcohol completely. When considering the type of alcoholism treatment, doctors and therapists look at the severity of an individual's alcoholism and the resources that are available in his or her community. Treatment may include:

• detoxification (the process of safely getting alcohol out of one's system)
• taking prescription medications, such as disulfiram (Antabuse®), naltrexone (ReVia™) or acamprosate (Campral®) to help prevent a return to drinking once drinking has stopped
• individual and/or group counseling
• attending support groups like Alcoholics Anonymous

Counseling and outside services are important components of an alcoholism treatment program

There are promising types of counseling that teach recovering alcoholics to identify situations and feelings that trigger the urge to drink and to find new ways to cope that do not include alcohol use. Any of these treatments may be provided in a hospital or residential treatment setting or on an outpatient basis.

Because the involvement of family members is important to the recovery process, many programs also offer brief marital counseling and family therapy as part of the treatment process. Some programs also link up individuals with vital community resources, such as legal assistance, job training, child care, and parenting classes.

Getting alcoholics into treatment is not easy

Most alcoholics and alcohol abusers enter treatment reluctantly because they deny that they have a problem. Health or legal problems may prompt treatment. Intervention helps some alcoholics recognize and accept the need for treatment. If you're concerned about a friend or family member, discuss intervention with a professional. A wide range of treatments is available to help people with alcohol problems. Treatment is tailored to the individual. It may involve an evaluation, a brief intervention, an outpatient program or counseling, or a residential inpatient stay.

How do these various alcoholism treatments work?

Treatments for alcoholism include detoxification programs run by medical institutions. These may involve stays of a number of weeks in specialized hospital wards where drugs may be used to avoid withdrawal symptoms. After detoxification, various forms of group therapy or psychotherapy can be used to deal with underlying psychological issues leading to alcohol dependence. Aversion therapies may be supported by drugs like Disulfiram, which causes a strong and prompt hangover whenever alcohol is consumed. Naltrexone may improve compliance with abstinance planning. Antidepressants, antipsychotics and other psychotropic drugs treat underlying mood disorders, neuroses and psychoses associated with alcoholic symptoms.

Another treatment program is based on nutritional therapy. Many alcoholics 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 alcoholics in treatment. The metabolic aspects of alcoholism are often overlooked, resulting in poor treatment outcomes.

In the 1900s, the self-help group-counseling approach to treatment became increasingly successful and remains so today, with Alcoholics Anonymous possibly being the best-known example of this movement.

Does alcoholism treatment work?

Alcoholism treatment works for many people. But like other chronic illnesses, such as diabetes, high blood pressure, and asthma, there are varying levels of success when it comes to treatment. Some people stop drinking and remain sober. Others have long periods of sobriety with bouts of relapse. And still others cannot stop drinking for any length of time. With treatment, one thing is clear, however: the longer a person abstains from alcohol, the more likely he or she will be able to stay sober.

What is the prognosis for recovery from alcoholism

About 20% of alcoholics are able to abstain from alcohol permanently without the help of formal treatment or self-help programs such as AA. Of those patients who attend AA, 44% who remain abstinent for one year probably will remain abstinent for another year. This figure increases to 91% for those who have remained abstinent and attended AA for five years or more.

On average, an alcoholic who doesn't stop drinking can expect to decrease his or her life expectancy by at least 15 years.

Sources:

• Substance Abuse and Mental Health Services Administration
• National Institute on Alcohol Abuse and Alcoholism, Alcohol Alert, No. 49, October 2000.

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