Alcohol Use Disorder and its treatment

Alcohol use disorder is defined as the pattern of alcohol use leading to significant impairment or distress in important aspects of functioning, manifested within a 12-month period. DSM-V criteria changed the alcohol abuse and dependence to alcohol use disorder as the studies suggested that the alcohol use which is harming our body is based on the usage and the quantity, not just the dependence factor. WHO recommends using “harmful use of alcohol” instead of alcoholism. Harmful use of alcohol means that drinking which makes your daily functioning distressful or impaired to the level that you no longer can function well. (Association, 2013)

Treatment of alcohol use disorder is not as straightforward as any other disorders. It is very difficult for the patients to recover from their addiction as initially they deny the fact they are addicted or substance abusers. The treatment is a combination of medications and the therapeutic approaches. 

Traditionally, the treatment approach was only focusing on the riddance of alcohol intake, but with new research coming in, the advanced intervention plan consist of controlled alcohol drinking as a primary goal, so that there is a slow-paced improvement in the patient’s recovery. Following are some approaches used in the treatment of alcohol use disorder:

  • Use of Medications: There are two ways to use the specific drugs in the intervention of AUD, for different goals such as to immediately stop the craving of alcohol and to ease out the withdrawal process. 

 

Medications to immediately stop the craving for alcohol – There are drugs which biologically deactivate the desire to drink alcohol especially recommended for problem drinkers.  Drugs like Disulfiram (Antabuse) is a strong medication which inhibits the desire by the action of vomiting if followed by alcohol. This treatment is immediate but the limitation is that it will stop working after the person leaves the therapy and not use Antabuse again. This enhances the likelihood of relapses in problem drinkers. Also it has uncomfortable side effects like nausea, if the person uses alcohol- based aftershave or deodorant. Other drugs used are naltrexone and Gabapentin, which have similar course of action like Antabuse. (Mason, 2018)

 

Medications to reduce the withdrawal symptoms – This course of medication is somewhat different from the above mentioned drugs. The primary goal of this kind of medication is to slowly ease out the withdrawal symptoms and prevent any medical complications due to the withdrawal. Physical symptoms like insomnia, nausea, tremulousness and intestinal dysfunction can be prevented. Drugs like Valium is used for the prevention of the complications and to reduce the symptoms like heightened motor activity, nausea and delirium. (Litten, 2016)

 

  • Psychological treatment: Psychotherapies are very important as the patients have to be more acceptable of their reality that they are an abuser and that they need psychological treatment. Although many disorders can be treated efficiently with individual psychotherapies, in the case of AUD it is the group therapy that makes the difference. 

 

Group therapy is a confrontational process where the abusers are forced perhaps, to not deny and admit that they are alcohol abuser and they need to stop drinking to have a normal functioning life. This has been found effective for many alcohol abusers and sometimes the family is also included in these therapies. After a detoxification, a person needs proper therapeutic intervention and along with this family needs family counseling. (Coco, 2019)

 

Environmental intervention is an essential part of the treatment plan of alcohol use disorder. After the recovery of any patient, they are left without any jobs or even lose their home. The reactions that they get is not as sympathetic as they would get if they had physical illness of the same magnitude. As they are not acquitted with their family and friends, their environment should be supportive and considerate. They would not go back into drinking alcohol if the environment isn’t hostile and unwelcoming. That is why halfway homes are an important measure in the intervention plan. (Chartier, 2017)

 

Behavioral and cognitive behavior therapy are the most effective therapies for substance use disorders. It has been found that Cue exposure therapy, which is a behavior therapy, helps in reducing the cravings by exposing patients to the sight and smell of the alcohol but do not allow them to consume it. This will weaken the link between the CUE (sight and smell of alcohol) and the action (Consumption of alcohol). (Mellentin, 2017)

 

Cognitive behavior therapy is commonly used for alcohol-related disorders and is somewhat effective as it focuses on changing the rigid thinking about consuming alcohol whenever made available to them. It involves use of strategic intervention which is gradual yet very effective. (Epstein, 2018)

 

Alcohol is not a stimulant which can be consumed in the name of medication, it is a harmful substance and can do damage in the long-run. The journey towards a healthier life is very hard for AUD patients but if given proper intervention and support, it will be much easier. 

 

References: 

  1. Litten, R. Z., Wilford, B. B., Falk, D. E., Ryan, M. L., & Fertig, J. B. (2016). Potential medications for the treatment of alcohol use disorder: an evaluation of clinical efficacy and safety. Substance abuse, 37(2), 286-298. https://doi.org/10.1080/08897077.2015.1133472 
  2. Mason, B. J., Quello, S., & Shadan, F. (2018). Gabapentin for the treatment of alcohol use disorder. Expert opinion on investigational drugs27(1), 113-124. https://doi.org/10.1080/13543784.2018.1417383 
  3. Coco, G. L., Melchiori, F., Oieni, V., Infurna, M. R., Strauss, B., Schwartze, D., … & Gullo, S. (2019). Group treatment for substance use disorder in adults: A systematic review and meta-analysis of randomized-controlled trials. Journal of substance abuse treatment99, 104-116. https://doi.org/10.1016/j.jsat.2019.01.016 
  4. Chartier, K. G., Karriker‐Jaffe, K. J., Cummings, C. R., & Kendler, K. S. (2017). Environmental influences on alcohol use: Informing research on the joint effects of genes and the environment in diverse US populations. The American journal on addictions26(5), 446-460. https://doi.org/10.1111/ajad.12478 
  5. Mellentin, A. I., Skøt, L., Nielsen, B., Schippers, G. M., Nielsen, A. S., Stenager, E., & Juhl, C. (2017). Cue exposure therapy for the treatment of alcohol use disorders: a meta-analytic review. Clinical psychology review57, 195-207. https://doi.org/10.1016/j.cpr.2017.07.006 
  6. Epstein, E. E., McCrady, B. S., Hallgren, K. A., Cook, S., Jensen, N. K., & Hildebrandt, T. (2018). A randomized trial of female-specific cognitive behavior therapy for alcohol dependent women. Psychology of Addictive Behaviors32(1), 1. https://psycnet.apa.org/doi/10.1037/adb0000330 
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