Alcohol Use Disorder (AUD) is the clinical term used to describe what some may refer to as alcoholism. AUD is considered a medical condition as well as a brain disorder and can be classified as mild, moderate, or severe. “According to the 2021 National Survey on Drug Use and Health, 28.6 million (American) adults ages 18 and older had AUD in 2021.”
Recovery from alcohol use disorder is possible. In this article, we will discuss how AUD is diagnosed, available treatment options, when to seek treatment, and how to find the right support for your needs. If you or someone you love is considering getting help for AUD, read on to learn about effective treatment options you can access quickly.
How is AUD diagnosed?
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, classifies AUD by meeting two of the following eleven criteria, during the same year.
- Had times when you ended up drinking more, or longer than you intended?
- More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
- Spent a lot of time drinking? Or being sick or getting over after-effects?
- Wanted a drink so badly you couldn’t think of anything else?
- Found that drinking – or being sick from drinking – often interfered with taking care of your home or family? Or cause job troubles? Or school problems?
- Continued to drink even though it was causing trouble with your family or friends?
- Given up or cut back on activities that were important or interesting to you, or gave you pleasure in order to drink?
- More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
- Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or having had a memory blackout?
- Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
- Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure? Or sensed things that were not there? (Association, 2022)
The severity of AUD is determined by the number of symptoms that are present. Mild AUD requires 2-3 symptoms, moderate AUD requires 4-5 symptoms, and severe AUD requires 6 or more symptoms.
What are the available treatment options?
Treating Alcohol Use Disorder is not a one-size fits all treatment plan. Though some forms of treatment have been well-researched and considered effective, not all treatment options are created equal. While one form of treatment might be considered successful for one person, the same treatment might not be effective for another.
Various talk therapies, such as cognitive behavioral therapy, dialectical behavior therapy, motivational interviewing, and twelve-step facilitation therapy, are all researched based modalities proven to be successful at treating AUD. Alcoholics Anonymous, medication, and in-patient treatment centers, have also been considered effective forms of treatment for helping people abstain from alcohol.
It is important to note, relapse is considered part of the recovery process. Relapse viewed this way, encourages clients to keep working on their sobriety and refrain from giving up. No matter which treatment is chosen, relapse is likely to occur and should not be considered a failure of treatment.
Treating AUD with Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy is considered a successful form of talk therapy for those struggling with substance use disorders. CBT is based on the theory that our thoughts, and beliefs affect our emotions and behavior. Therefore, if we can alter our thoughts and beliefs to better serve us, our behavior and our emotions will improve.
For those who have been diagnosed with AUD, cognitive behavioral therapy can help by first identifying maladaptive thoughts and beliefs which may be contributing to their alcohol abuse. For example, a client may believe their problems are insurmountable and think the only way they can cope is to numb themselves with alcohol. The therapist would help the client examine these beliefs and thoughts by collaboratively assessing how realistic these views are.
They might ask such questions like:
- Have there been times in your life when you have felt your problems couldn’t be solved?
- If so, what happened? Did the problems go away? Did someone else help you solve them?
- How have you successfully solved problems in the past?
- Has drinking helped you solve your problems?
- What are the benefits of drinking? What are the consequences?
This line of questioning helps the client deeply evaluate their beliefs and thoughts to determine if these views have served them positively or negatively. After identifying these thoughts and beliefs, the next step is to understand how these thoughts and beliefs contributed to their emotional state and behavior.
As the client and therapist develop a deeper understanding of the issues, together they would work on replacing maladaptive thoughts and beliefs with more realistic and positive thoughts and beliefs. Such thoughts and beliefs might include:
- I have been successful at solving problems in the past, and I can be successful at solving problems now.
- Though I may feel helpless at times, I know this isn’t always true. I can often help myself and resolve my problems.
- Drinking has contributed to more problems and has not helped me to feel better. Drinking has not solved my problems in the past, nor is it likely it will solve my problems presently, or in the future.
Having adopted new realistic beliefs and thoughts, the client feels less helpless and therefore has a better chance of altering his behavior and discontinuing drinking. Though CBT focuses on the here and now, it would be helpful to examine how some of the clients’ thoughts and beliefs developed. Most therapists using CBT as their primary modality, still employ other treatment interventions to meet the needs of their clients – including examining the the origin of beliefs.
Treating AUD with Dialectical Behavior Therapy
Dialectical Behavior Therapy (DBT) is another form of talk therapy, proven to be helpful in treating alcohol use disorder. The underlying concept of DBT is, life is inherently difficult at times, and part of creating a healthy mindset and lifestyle, is embracing this truth. In addition, learning to change what one can to improve their life, in conjunction with accepting things that can not be changed, leads to a healthier mindset.
Dialectical behavior therapy utilizes education to help clients build skills and coping mechanisms. It is similar to CBT in that it helps clients challenge distorted, maladaptive, unrealistic, and negative thinking patterns. DBT strives to help clients improve four foundational areas in their lives.
- Mindfulness – helps patients stay present. Increasing the ability to be mindful means decreasing worry and stress. When one is able to remain present, they can slow down enough to decrease their reactivity to situations.
- Distress tolerance – helps clients understand that stress is usually temporary and can be tolerated with healthy coping skills.
- Emotional regulation – helps clients develop skills to help manage intense emotions.
- Interpersonal effectiveness – helps clients learn positive social skills by developing assertiveness, maintaining appropriate boundaries, and more.
Treating AUD with Motivational Interviewing
Motivational interviewing is a type of talk therapy intended to be used in conjunction with other therapies or treatment practices. It is typically considered short-term therapy and very goal oriented. There are three main components of motivational interviewing that differentiate it from other talk therapies.
- Clients are encouraged to develop their own goals rather than the therapist suggesting or recommending goals to the client.
- Sessions are referred to as interviews, suggesting a more equitable and collaborative relationship between the client and the therapist.
- Empowering clients to become the agents of change in their own life, rather than relying on the therapist.
Learned helplessness is often a component of alcohol abuse, therefore, motivational interviewing can help instill empowerment, accountability, and the motivation necessary to quit using alcohol.
Treating AUD with 12-step Facilitation (TSF)
Like motivational interviewing, TSF is intended to be used as an adjunct therapy and is considered short-term therapy. In this case, TSF is an adjunct to Alcoholics Anonymous (which we will learn more about in the next section). A TSF therapist will work with the client to help locate Alcoholics Anonymous (AA) meetings as well as a sponsor.
A TSF therapist will encourage participation in AA meetings. The therapist will also help the client work through any hesitation about attending meetings, as well as other issues that might arise from AA. The therapist will encourage the client to read the “Big Book,” which is the AA manual, and might assist the client in working through some of the 12-steps outlined in the book.
“TSF operates under the assumption that addiction is a chronic and progressive disease that has biological, psychological, and spiritual aspects, all of which are addressed as an individual works through their 12-steps.” – Nova Recovery Center
Alcoholics Anonymous (AA) has been around for 80 years and according to a comprehensive study conducted by Stanford University School of Medicine, “is nearly always considered to be more effective than psychotherapy alone in achieving abstinence.” AA meetings are conducted anonymously and led by those in recovery. There are in-person meetings available as well as online meetings.
AA is based on community support of peers in recovery and the following 12-steps:
1. We admitted we were powerless over alcohol — that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when doing so would injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these Steps, we tried to carry this message to alcoholics and practice these principles in all our affairs.
*God is often replaced with the term, “Higher Power,” to be more inclusive of those from various religious backgrounds.
Non 12-step alcohol treatment programs
There are a variety of treatment options for those struggling with alcohol abuse. In-treatment programs are an option and do not always follow the 12-step protocol for recovery. These programs are sometimes covered by insurance (28-day treatment), while others are quite expensive. The downside to in-treatment facilities is, people return home to the same stressors and problems that contributed to their drinking, creating a greater likelihood of relapse.
Another possible treatment is medication. There are a few medications used to treat AUD, all of which are non-addictive. There is a medication called Naltrexone used to help people achieve and maintain sobriety. Those who have been sober for a while might be prescribed Naltrexone during times of high stress, like divorce, to help maintain sobriety.
There is also a medication called Disulfiram that will make people sick if they drink alcohol while on this medicine. This will lead to negative associations with drinking and hopefully help the person refrain from use. There is mixed data about the long-term effectiveness of both medications.
When is the right time for treatment?
The right time to seek treatment is when alcohol begins to negatively impact your life and you are struggling to quit. The earlier the intervention, the greater likelihood of obtaining and maintaining long-term sobriety.
Taking steps to get help when struggling with alcohol is courageous, and it begins with first acknowledging you have a problem with alcohol. AUD is considered a medical condition and should not be considered a shameful diagnosis. With millions of people struggling with AUD, take comfort in knowing you are not alone and there are several effective treatment options to help you get sober and stay sober.
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