The term “alcoholic” is no longer used as a medical diagnosis. Neither are the categories “alcohol dependence” or “alcohol abuse”. The medical term used for drinking problems according to the newest version of the Diagnostic and Statistical Manual is “Alcohol Use Disorder”.
I think this term is more intuitive and self-explanatory. By this definition, alcohol use itself is not a disease, but rather becomes one when it causes problems. Issues arising from alcohol use include health problems or risks thereof, financial issues, work and family related disorders, legal troubles, and more.
Heavy drinking is, without a doubt, linked to several serious health issues. Stomach ulcers, cognitive and coordination issues, liver disease, and certain cancers are just a few of the many. The Center for Disease Control lists the following guidelines for healthy alcohol use:
“Adults of legal drinking age can choose not to drink, or to drink in moderation by limiting intake to 2 drinks or less in a day for men or 1 drink or less in a day for women, on days when alcohol is consumed. The guidelines also do not recommend that individuals who do not drink alcohol start drinking for any reason and that if adults of legal drinking age choose to drink alcoholic beverages, drinking less is better for health than drinking more.”
How does one know if alcohol is a problem? If alcohol is causing issues in your life, or if you’re consuming larger quantities than are thought to be healthy, it is likely a disorder. This does not always mean you need to become completely sober. Many patients are able to moderate their drinking and go on to live healthier lives.
Recovery, defined as the resolution of disordered alcohol use, can take many forms. For some, complete sobriety is the answer but for many simple moderation works just as well. As mentioned above, there is little to no evidence that alcohol use has any benefit.
Some individuals are able to moderate their alcohol intake or even quit drinking on their own. This can be done by setting an intention and/or setting limits and sticking to them. Family or peer support is also highly useful in general. One study suggested up to one third of individuals have success this way. Usually, however, this method is most efficacious in individuals who have only mild alcohol use disorder.
Therapy is always a good option. A good therapist can do wonders for one’s health, regardless of alcohol intake. At some point in most people’s lives a therapist can be necessary. Especially in the early phase of alcohol related treatment, Cognitive Behavioral Therapy can help a person create new habits and stick to them. Therapy is also highly beneficial for patients with alcohol use disorder who are feeling angry. We do offer therapy at Hashemi Healthcare, and I think we’re pretty good at it.
12 step support groups, such as Alcoholics Anonymous, are another modality which has shown benefit for individuals suffering from alcohol use disorder. These meetings occur frequently and are essentially a form of peer support. Generally, alcoholics anonymous is used to achieve complete abstinence from alcohol. That said, a few meetings early on can help patients educate themselves on the symptoms of disordered drinking and philosophies for improvement, even if they do not plan on complete sobriety. 12 step meetings are beneficial for more severe forms of Alcohol Use Disorder, especially when one has a lack of support in their personal lives.
There are also medications for Alcohol Use Disorder. The COMBINE Study is a peer reviewed publication showing research comparing different modalities of these therapies. It provided a head to head comparison of the most common drugs used to treat this disorder. These medications studied included Disulfiram (or Antabuse), Acamprosate (or Campral), and daily oral Naltrexone (or Revia).
Disulfiram is a medication which blocks an enzyme in the processing pathway of alcohol. The result is violent illness if a patient drinks. The medication must be taken once every day, and stops working if approximately 2 doses are missed. The drug does little for alcohol cravings. Although many patients do succeed with this approach, the COMBINE study did not show superiority over the other two modalities. Benefit is greatest if patients are observed daily taking this drug by a family member or peer. There is also the issue of becoming violently ill if an patient does drink, which can be dangerous.
Acamprosate is a medication specifically used for the reduction of alcohol cravings. The COMBINE study showed a mild to moderate improvement in drinking severity, again not superior to the other two modalities. Acamprosate has very few side effects and does not make patients sick if they drink. One drawback is it’s dosing, which is three times a day.
Daily Oral Naltrexone was found to be the drug of choice in Alcohol Use Disorder according to the study. Naltrexone plus medical therapy (regular followup with a physician) showed the greatest improvement in drinking patterns. Interestingly, many patients were able to return to drinking but drank much less, returning their intake to the recommended levels. Naltrexone acts on the brain’s reward pathway and is thought to be the best drug for alcohol cravings. It has limited side effects and does not make patients sick if they drink. Naltrexone is conveniently dosed only once day. It is also available in a once monthly depot intramuscular injection. The injected form of Naltrexone is marketed under the brand name Vivitrol.
We offer all three of these medications for alcohol use disorder as well as cognitive and medical therapy at Hashemi Healthcare. We believe the end goal of treatment for disordered drinking should be tailored to the individual. We do not preach complete sobriety if a patient wishes to attempt to return to responsible drinking patterns. We custom tailor treatment to individual patient needs and offer a supportive environment. We believe this approach works best, and our results support this conclusion.
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