Alcohol Use Disorder (commonly known as “alcoholism”) is one of the most common health conditions in the United States, affecting nearly 7% of men and 4% of women. AUD is the third leading cause of preventable death in the United States. Globally, more than 5% of deaths can be attributed to alcohol consumption.
While the stigma around addiction is improving, treatment for and research about alcoholism still lags other major public health concerns like heart disease and diabetes. As a result, two of the treatment options described in this article were created as a response to the lack of formal medical treatment options for AUD.
While there is still a long way to go when it comes to treatment options for AUD, there is help out there. Read on for four ways to address your drinking in an outpatient setting.
For nearly a century, AA has been an option for people struggling with alcoholism. Founded in 1935 in Akron, Ohio, AA’s premise is based on the idea that alcoholism is a malady of the mind, body, and spirit. While we take many of these ideas for granted now, in 1935, the idea that excessive alcohol use is a “disease” was groundbreaking.
The 12 steps of AA recommend that followers surrender their egos, engage in deep reflection, make amends to those they have harmed during their time drinking, and connect with a “higher power”. AA members work the steps with the help of a “sponsor”—an AA member who has completed all 12 steps and maintained sobriety for at least one year. It is believed that done correctly, these steps can lead to life-long sobriety. While the program has been helpful to many people over the years, its actual success rate is not known.
Advantages of AA
- Convenience: AA chapters exist in nearly every city and town in the United States and the program has even expanded across the globe. Meetings are held at all times of the day and night.
- Cost: Alcoholics Anonymous meetings are free to attend, with optional donations requested.
- Access: All are welcome at AA, the only requirement being a desire to quit drinking. There is no application form or interview. All you have to do is show up.
- Inclusivity: AA prioritizes “principles over personalities”, meaning that discussion of politics, religion, and other controversial topics is discouraged among members.
- Privacy: Anonymity is taken very seriously in AA. Members are encouraged to protect the identities of their fellow members, and it is common for only first names to be used at meetings. Meeting attendance and member records are not kept.
- Mutual Support: Community is the cornerstone of Alcoholics Anonymous. Connecting with others is known to be a powerful antidote for addiction.
Disadvantages of AA
- Layperson-Run: AA runs on the volunteer work of its members. Meeting facilitators are fellow alcoholics in recovery. They are not medical or mental health professionals.
- Unknown Efficacy: While adherents to AA’s philosophy offer anecdotal evidence of the program’s effectiveness, there is not sufficient data to demonstrate how effective it actually is. It is notoriously difficult to perform research studies on AA because its members typically remain anonymous.
- One-Size-Fits-All Approach: Some have argued that the philosophical underpinnings of AA’s approach may not be right for everyone. Gabrielle Glaser, an author who has written extensively about women and alcoholism, argues that the imperative to declare “powerlessness” and shed one’s ego could be counterproductive for women. It follows that anyone who has experienced a sense of powerlessness because of their gender, race, sexuality, or other minority status, could be affected negatively by this idea.
Self-Management And Recovery Training (SMART) Recovery, like Alcoholics Anonymous, is a free mutual support group for people who want to quit drinking or stop using other addictive substances. SMART Recovery was founded in 1994 and there are now more than 2,000 established meetings around the United States and the World.
SMART Recovery’s approach is based on a four point system that is designed to help members change self-destructive habits:
- Building and maintaining the motivation to change
- Coping with urges to use
- Managing thoughts, feelings, and behaviors in an effective way without addictive behaviors
- Living a balanced, positive, and healthy life
SMART Recovery focuses on the present and future, encouraging members not to excavate the past. Their methods are scientifically validated, and their group facilitators are trained to run meetings in a straightforward and organized way.
Advantages of SMART Recovery
- Science-Based: SMART Recovery’s approach is rooted in scientific and psychological principles.
- Program Standardization: SMART Recovery’s program is held to an established standard and is administered by trained facilitators.
- Cost: Attendance at SMART Recovery meetings is free. Donations are requested at the end of each meeting, but are not required.
- Access: There is no application form or interview. All you have to do is show up.
- Flexible Program: SMART Recovery Programs can be personalized to your individual needs.
- Mutual Support: Mutual support is an important part of SMART Recovery’s program. Connecting with others is known to be a powerful antidote for addiction.
Disadvantages of SMART Recovery
- Fewer Meetings: While SMART Recovery hosts more than 2,000 meetings around the United States and across the globe, meetings are not nearly as ubiquitous as Alcoholics Anonymous.
- Discounting of Medical Approaches: Because SMART Recovery’s approach is largely psychological, sometimes other effective approaches like medication-assisted treatments are discounted.
- Layperson-Run: While SMART Recovery facilitators do receive some training, they are not credentialed mental health or medical professionals.
Individual & Group Therapy
Individual and group therapy can be helpful in achieving sobriety. A therapist providing individual therapy and/or group therapy can be an excellent source of support in a safe and controlled environment. However, individual and group therapy work in different ways when it comes to recovery.
Individual therapy, also known as “talk therapy” is a very effective way to get to the root of an addiction or change behaviors that are contributing to addiction.
Broadly, there are three types of individual psychotherapy:
- Cognitive Behavioral Therapy: CBT is a highly structured, time-limited, and goal-oriented type of therapy that can help clients change some behaviors in the short-term.
- Integrative Therapy: Integrative therapy pulls from various therapeutic modalities, tailoring therapy to an individual’s needs.
- Psychodynamic / Psychoanalytic Therapy: Psychodynamic therapy and psychoanalysis are therapeutic modalities that help individuals gain insight into what motivates their behavior.
In addition to working through the issues that have led to your addiction, and helping you make changes to the behaviors that support your addiction, a good therapist can help connect you with other resources and help you put your recovery plan into action.
Group therapy, like SMART Recovery and Alcoholics Anonymous, can provide a safe and structured environment to connect with others struggling with addiction under the guidance of a licensed mental health professional.
Much like individual therapy, group therapy is effective in getting to the root of problems that lead to addiction, and in correcting negative patterns that perpetuate it. Group therapy can be particularly effective in recovery because of the support and encouragement fellow group members provide.
Therapeutic groups support members with a wide range of challenges. While there are groups that are designed specifically for those in recovery from drug and alcohol addiction, other groups are tailored to address issues like depression, social anxiety, eating disorders, OCD, grief and loss, and anger management. Even groups that aren’t specifically meant to treat addiction can help to address co-occuring problems that have enabled an addiction to take hold.
Advantages of Therapy
- Evidence-Based: No matter which therapeutic modality your therapist is using, there is evidence to support its effectiveness.
- Professionally Facilitated: Therapists are highly educated professionals who have years of training in their field. In most cases, they are also required to pass rigorous exams before being licensed to practice.
Disadvantages of Therapy
- Cost: Therapy can be costly, even if you have health insurance. Some therapists do not accept health insurance because of the low reimbursement rates from insurance companies.
Medication Assisted Treatment
The evidence in favor of medication assisted treatment for Alcohol Use Disorder is quickly mounting, but it remains controversial in some circles.
There are several medications available by prescription that can be helpful in treating alcohol addiction. Here are a few examples:
Naltrexone (aka. Vivitrol or Revia): Naltrexone is a medication that can be taken either as a monthly injection or as a daily pill. Naltrexone blocks opioid receptors in the brain, therefore reducing alcohol cravings.
Acamprosate (aka. Campral): Acamprosate affects brain receptors in a way that reduces alcohol cravings.
Disulfiram (aka. Antabuse): Disulfiram prevents the breakdown of alcohol in the body. When people taking Disulfiram drink alcohol, it causes them to feel very ill, creating a negative association with alcohol.
Managing alcohol cravings with medication can be a highly effective method for helping people to remain sober. These medications and others indicated for the treatment of Alcohol Use Disorder can be prescribed by a physician, psychiatrist, or nurse practitioner.
Advantages of Medication Assisted Treatment
- Fast-Acting: Medications can act quickly and be useful in emergency situations.
- Evidence-Based: There is mounting evidence that medication can be an effective part of a recovery plan.
Disadvantages of Medication Assisted Treatment
- Cost: Like therapy, cost can be a barrier to accessing medication assisted treatment.
- Short-Term: While medication can be effective, it is not necessarily a long-term solution to the issues underlying an addiction.
Each of the options outlined above may be helpful, depending on an individual’s needs. However, people in recovery tend to have the most success when they combine treatment methods. While treatment for Alcohol Use Disorder has a long way to go, there is support available if you know where to find it.