Zaburzenie używania alkoholu

Zaburzenie używania alkoholu
Leczenie

Zaburzenie używania alkoholu (ZUA) to przewlekły stan charakteryzujący się niezdolnością do kontrolowania spożycia alkoholu pomimo negatywnych konsekwencji zdrowotnych i społecznych. W USA dotyka około 29,5 miliona osób powyżej 12 roku życia, jednak mniej niż 10% z nich otrzymuje odpowiednie leczenie. Leczenie ZUA jest wieloaspektowe i obejmuje detoksykację trwającą zazwyczaj 2-7 dni, terapię behawioralną (m.in. CBT, DBT, terapię motywacyjną), farmakoterapię oraz wsparcie społeczne, w tym grupy samopomocy takie jak Anonimowi Alkoholicy. Farmakoterapia zatwierdzona przez FDA obejmuje naltrekson (doustny Revia, iniekcyjny Vivitrol), akamprozat (Campral) oraz disulfiram (Antabuse), które różnią się mechanizmem działania i wskazaniami: naltrekson zmniejsza intensywne picie i jest skuteczny u osób utrzymujących abstynencję, akamprozat wspomaga utrzymanie abstynencji i jest preferowany u pacjentów z marskością wątroby klasy C (przeciwwskazany przy klirensie kreatyniny ≤30 ml/min), a disulfiram wywołuje reakcję awersyjną po spożyciu alkoholu i wymaga nadzoru przy podawaniu. Ponadto stosuje się leki off-label, takie jak topiramat, gabapentyna i baklofen, które wspomagają redukcję spożycia alkoholu.

Wstęp do leczenia zaburzenia używania alkoholu

Zaburzenie używania alkoholu (ZUA) to stan medyczny charakteryzujący się upośledzoną zdolnością do zaprzestania lub kontrolowania spożycia alkoholu pomimo negatywnych konsekwencji społecznych, zawodowych lub zdrowotnych.¹ Jest to powszechny problem zdrowotny, dotykający miliony dorosłych na całym świecie – w samych Stanach Zjednoczonych około 29,5 miliona osób w wieku 12 lat i starszych cierpiało na zaburzenie używania alkoholu w ciągu ostatniego roku.¹ Mimo powszechności tego zaburzenia, szacuje się, że mniej niż 10% osób potrzebujących pomocy faktycznie otrzymuje leczenie.²

Dobra wiadomość jest taka, że bez względu na to, jak poważny wydaje się problem, większość osób z ZUA może odnieść korzyści z pewnej formy leczenia. Wielu pacjentów znacząco ogranicza spożycie alkoholu i zgłasza mniej problemów związanych z alkoholem.¹ Dowody naukowe potwierdzają, że leczenie ZUA jest dostępne, zmiana jest możliwa, a większość osób z ZUA wraca do zdrowia lub znacząco poprawia swój stan.¹

Leczenie zaburzenia używania alkoholu może obejmować wiele różnych metod, w zależności od indywidualnych potrzeb pacjenta. Może to być krótka interwencja, indywidualne lub grupowe poradnictwo, program ambulatoryjny lub pobyt w ośrodku stacjonarnym.¹ Ostatecznie nie istnieje jedno uniwersalne rozwiązanie, a to, co może działać dla jednej osoby, może nie być odpowiednie dla kogoś innego.² Samo zrozumienie różnych opcji może być ważnym pierwszym krokiem w kierunku zdrowienia.

Cele leczenia ZUA

Głównym celem leczenia zaburzenia używania alkoholu jest poprawa jakości życia poprzez zaprzestanie lub ograniczenie spożycia alkoholu.¹ Cele mogą różnić się w zależności od indywidualnych potrzeb i preferencji pacjenta i powinny być ustalane wspólnie przez pacjenta i lekarza.¹²

W Stanach Zjednoczonych celem leczenia jest zazwyczaj abstynencja, opierająca się na przekonaniu, że osoby z ZUA prawdopodobnie nie będą w stanie powrócić do kontrolowanego, zdrowego spożywania alkoholu. Jednak w niektórych częściach Europy kontrolowane picie i redukcja szkód są często celami leczenia.¹

Ogólnie rzecz biorąc, cele leczenia ZUA można postrzegać jako przywrócenie dobrostanu medycznego i społecznego poprzez kontrolę picia i jego konsekwencji.¹ W ciągu ostatnich 15-20 lat wzrosła świadomość, że leczenie może być korzystne nawet jeśli nie osiąga się całkowitej abstynencji. W rezultacie, do pomiaru skuteczności leczenia stosuje się inne wyniki, które można ująć w koncepcji redukcji szkód.¹

Detoksykacja i leczenie odstawienne

Dla wielu osób z ciężkim ZUA pierwszym krokiem w leczeniu jest detoksykacja, czyli proces medycznie zarządzanego odstawienia alkoholu. Jest to kluczowy etap, ponieważ nagłe przerwanie spożywania alkoholu przez osobę uzależnioną może prowadzić do poważnych, a nawet zagrażających życiu objawów odstawiennych.¹²

Detoksykacja trwa zazwyczaj od 2 do 7 dni i może wymagać podawania leków sedatywnych w celu zapobiegania objawom odstawiennym. Proces ten najczęściej odbywa się w stacjonarnym ośrodku leczenia lub szpitalu, gdzie pacjent może być monitorowany przez personel medyczny.¹

Celem medycznie wspomaganego leczenia odstawiennego alkoholu jest złagodzenie objawów odstawiennych w bezpiecznym środowisku, w którym osoba będzie nadzorowana przez całą dobę przez personel medyczny.¹ W zależności od nasilenia objawów, lekarze mogą przepisać benzodiazepiny do opanowania objawów odstawiennych.¹

Ważne jest jednak, aby pamiętać, że detoksykacja nie jest leczeniem samym w sobie, a jedynie pierwszym krokiem w procesie leczenia.¹ Po bezpiecznym przejściu przez fazę odstawienia, pacjent powinien kontynuować dalsze leczenie, aby zapobiec nawrotom.

Programy stacjonarne i intensywna opieka

W przypadku osób z ciężkim ZUA, konieczne może być leczenie w warunkach stacjonarnych. Programy stacjonarne zapewniają 24-godzinne, wolne od substancji środowisko.¹ Leczenie stacjonarne może być również zalecane, jeśli pacjent ma słabe wsparcie społeczne, znaczące problemy psychiatryczne lub historię nawrotów po leczeniu.¹

Większość programów leczenia stacjonarnego obejmuje terapię indywidualną i grupową, grupy wsparcia, wykłady edukacyjne, zaangażowanie rodziny i terapię zajęciową.¹ Programy te są wysoce ustrukturyzowane i zazwyczaj obejmują kilka różnych rodzajów terapii behawioralnych. Mogą również obejmować leki do detoksykacji i/lub leczenia ZUA.¹

W innych przypadkach, programy intensywnej opieki ambulatoryjnej zapewniają całodniową terapię grupową, zajęcia i aktywności, pomagając osobom zrozumieć proces uzależnienia i wpływ współwystępujących zaburzeń psychicznych.¹ Programy te umożliwiają pacjentom codzienne powroty do domu, zachowując jednocześnie intensywność leczenia stacjonarnego.

Farmakoterapia zaburzenia używania alkoholu

Farmakoterapia stanowi ważny element w leczeniu zaburzenia używania alkoholu, szczególnie w przypadkach umiarkowanego i ciężkiego nasilenia. Obecnie w Stanach Zjednoczonych dostępne są trzy leki zatwierdzone przez FDA (amerykańską Agencję Żywności i Leków) do leczenia ZUA: akamprozat, disulfiram i naltrekson.¹² Leki te mogą być stosowane samodzielnie lub w połączeniu z interwencjami psychospołecznymi.

Panel Konsensusu Służby ds. Nadużywania Substancji i Zdrowia Psychicznego/Narodowego Instytutu ds. Nadużywania Alkoholu i Alkoholizmu zaleca farmakoterapię wraz z interwencjami behawioralnymi w leczeniu ZUA.¹ Wybór konkretnego leku zależy od wielu czynników, w tym od celu leczenia, współistniejących schorzeń i preferencji pacjenta.¹

Naltrekson

Naltrekson (Revia, Vivitrol) to antagonista receptorów opioidowych, który zmniejsza spożycie alkoholu u pacjentów z ZUA i jest bardziej skuteczny u osób, które zachowują abstynencję przed rozpoczęciem leczenia.¹ Naltrekson działa poprzez zmniejszenie uwalniania dopaminy w odpowiedzi na alkohol, blokując niektóre przyjemne efekty picia.¹ Jest dostępny w formie doustnej (Revia) lub jako długo działający preparat do wstrzykiwań (Vivitrol).¹

Przegląd Cochrane obejmujący 50 randomizowanych badań z udziałem 7793 pacjentów wykazał, że doustny naltrekson zmniejszał intensywne picie i nieznacznie zmniejszał codzienne picie.¹ Naltrekson jest preferowany u osób z współistniejącym zaburzeniem używania opioidów, jednak nie może być stosowany u osób, które niedawno przyjmowały opioidy lub są leczone agonistami opioidów z powodu zaburzenia używania opioidów.¹

Akamprozat

Akamprozat (Campral) to lek, który pomaga przywrócić równowagę chemiczną w mózgu, która mogła zostać zaburzona przez długotrwałe picie alkoholu.¹ Jest skuteczny w utrzymywaniu abstynencji, ale ma mniejszy wpływ na nawrót intensywnego picia po wznowieniu spożycia alkoholu.¹

Akamprozat jest zalecany do osiągnięcia i utrzymania całkowitej abstynencji, a nie do redukcji picia lub zapobiegania nawrotom w przypadku picia.¹ Chociaż akamprozat może być rozpoczęty i przyjmowany w czasie, gdy ktoś pije alkohol, badania wykazały, że jest bardziej skuteczny, gdy zaczyna się go stosować po zaprzestaniu picia przez pacjenta.¹

Warto zaznaczyć, że akamprozat jest metabolizowany głównie przez nerki, co czyni go preferowanym wyborem u pacjentów z zaawansowaną chorobą wątroby (marskość wątroby klasy C według Child-Pugh).¹ Jednakże, należy zachować ostrożność przy przepisywaniu akamprozatu osobom z dysfunkcją nerek – jest on przeciwwskazany u osób z klirensem kreatyniny ≤30 ml/min.²

Disulfiram

Disulfiram (Antabuse) to najstarszy lek zatwierdzony przez FDA do leczenia ZUA w 1948 roku.¹ Jest to lek awersyjny, który nie wpływa bezpośrednio na motywację do picia, ale zniechęca do picia poprzez groźbę „reakcji disulfiramowej”.¹

Disulfiram blokuje enzym wątrobowy niezbędny do rozkładu aldehydu octowego, produktu ubocznego alkoholu.¹ Jeśli pacjent przyjmujący disulfiram spożyje alkohol, doświadczy nieprzyjemnych efektów, takich jak nudności, wymioty, ból głowy, zaczerwienienie (twarzy, szyi lub klatki piersiowej), pocenie się i ból w klatce piersiowej.¹

Disulfiram jest zalecany tylko do utrzymania abstynencji; stosowanie tego leku w celu ograniczenia picia nie jest zalecane.¹ Jest on skuteczny w osiąganiu abstynencji, jeśli jest przyjmowany pod nadzorem, na przykład farmaceuty, partnera lub sponsora grupy wzajemnej pomocy (np. AA).¹

Inne leki i nowe kierunki w farmakoterapii

Oprócz trzech leków zatwierdzonych przez FDA, kilka innych środków jest stosowanych poza wskazaniami (off-label) do leczenia umiarkowanego lub ciężkiego ZUA. Należą do nich topiramat, baklofen i gabapentyna.¹

Topiramat (Topamax, Trokendi XR, Qudexy XR) to lek przeciwdrgawkowy o właściwościach farmakologicznych obejmujących blokowanie zależnych od napięcia kanałów sodowych, potencjalizację transmisji za pośrednictwem kwasu gamma-aminomasłowego i antagonizm receptorów glutaminowych.¹ Wykazano, że zmniejsza on spożycie alkoholu u osób z ZUA i jest preferowanym wyborem u pacjentów ze współistniejącymi zaburzeniami drgawkowymi.¹

Trwają badania nad nowymi lekami i podejściami do farmakoterapii ZUA. Badacze z UC San Francisco opracowali terapię dwulekową dla ZUA, wykorzystującą dwie nowe cząsteczki, jedna z których jest obecnie w badaniach klinicznych onkologicznych.¹ Z kolei naukowcy z NYU Langone Health wykazali, że dwie dawki psylocybiny, związku znajdującego się w grzybach psychodelicznych, zmniejszają intensywne picie średnio o 83% wśród osób pijących intensywnie, gdy są łączone z psychoterapią.¹

Ważnym ostatnio kierunkiem badań nad lekami na ZUA, finansowanym przez Narodowy Instytut ds. Nadużywania Alkoholu i Alkoholizmu, jest zastosowanie podejścia medycyny precyzyjnej w celu identyfikacji pacjentów, dla których określony lek może mieć większy efekt.¹

Terapie behawioralne w leczeniu ZUA

Leczenie behawioralne, znane również jako poradnictwo alkoholowe, polega na współpracy z profesjonalistą opieki zdrowotnej w celu identyfikacji i pomocy w zmianie zachowań, które prowadzą do intensywnego picia.¹ Terapie behawioralne są jednym z najczęściej stosowanych i empirycznie potwierdzonych podejść w leczeniu ZUA.

Przez ostatnie 30 lat liczne metaanalizy i systematyczne przeglądy wykazały, że terapia poznawczo-behawioralna (CBT) jest skutecznym leczeniem ZUA.¹ Interwencje CBT są zwykle projektowane jako krótkoterminowe, wysoce ukierunkowane terapie, które mogą być wdrażane w różnych warunkach klinicznych. Te interwencje są elastyczne i mogą być stosowane w indywidualnym lub grupowym formacie terapii.¹

Najczęściej stosowane terapie behawioralne

Terapia poznawczo-behawioralna (CBT) to ustrukturyzowana, ukierunkowana na cel forma psychoterapii, w której pacjenci uczą się, jak ich procesy myślowe przyczyniają się do ich zachowania.¹ CBT pomaga osobom z ZUA identyfikować i zmieniać negatywne myśli i zachowania związane z piciem. Terapia ta może obejmować indywidualne lub grupowe sesje terapeutyczne i może być dostosowana do indywidualnych potrzeb.¹

Zapobieganie nawrotom to jedna z dominujących, empirycznie potwierdzonych terapii CBT stosowanych w ZUA przez ostatnie 30 lat. Jest to interwencja zaprojektowana, aby pomóc osobom z ZUA identyfikować sytuacje wysokiego ryzyka nawrotu i rozwijać skuteczne strategie radzenia sobie.¹ Zarówno CBT, jak i DBT (terapia dialektyczno-behawioralna) uznają znaczenie zapobiegania nawrotom. Celem zapobiegania nawrotom jest identyfikacja i rozwiązanie sytuacji wysokiego ryzyka dla klienta oraz pomoc w rozwoju mechanizmów radzenia sobie w celu utrzymania trzeźwości.¹

Terapia dialektyczno-behawioralna (DBT) została początkowo opracowana do leczenia osób z długotrwałymi zachowaniami samobójczymi, ale stała się najbardziej znana z leczenia zaburzenia osobowości typu borderline, problemu zdrowia psychicznego często związanego z współwystępującym nadużywaniem substancji. Technika ta została skutecznie zastosowana do leczenia samego nadużywania substancji. DBT ma na celu pomóc pacjentom poprawić ich życie poprzez znalezienie równowagi między chęcią uniknięcia bolesnych doświadczeń a potrzebą zaakceptowania niektórych nieuniknionych bólów związanych z życiem. Technika DBT działa poprzez promowanie dwóch przeciwstawnych celów: zmiany i akceptacji.¹

Wywiad motywacyjny to oparta na dowodach technika poradnictwa mająca na celu wywołanie zmiany zachowania poprzez pomoc pacjentowi w zbadaniu i rozwiązaniu ambiwalencji dotyczącej zmiany.¹ Został opracowany w celu zwiększenia zaangażowania osoby w wysiłki na rzecz zdrowienia i jest skuteczny w ograniczaniu używania substancji. Bazuje na etapach zmiany, pomagając ludziom przejść od myślenia o dokonaniu zmiany do aktywnego dążenia do niej. Ta forma terapii zaburzeń związanych z alkoholem może być stosowana samodzielnie lub w połączeniu z innymi praktykami terapeutycznymi. Jest to krótkoterminowa terapia, która może być oferowana w indywidualnych i grupowych warunkach.²

Terapia dla par i rodzin

Terapia par i rodzin stanowi ważny element leczenia ZUA, ponieważ zaangażowanie rodziny może być istotnym czynnikiem w procesie zdrowienia.¹ Alkoholowa terapia behawioralna par i terapia behawioralna par w alkoholizmie i nadużywaniu narkotyków to terapie oparte na podręcznikach dla ZUA, które angażują znaczącego innego lub partnera romantycznego w sesje terapii par.¹

Terapia rodzinna zapewnia członkom rodziny możliwość poznania natury uzależnienia od alkoholu i wsparcia członka rodziny, który stara się powstrzymać od alkoholu.¹ Ponieważ uzależnienie wpływa na każdego członka rodziny, terapia behawioralna rodziny okazała się skuteczna w leczeniu uzależnienia. Technika terapii rodzinnej zajmuje się zarówno uzależnieniem, jak i relacjami w rodzinie, zatrudnieniem, problemami rodzicielskimi i problemami behawioralnymi.¹

Terapia rodzinna to świetny sposób na rozwiązanie nie tylko problemów osoby zmagającej się z alkoholizmem, ale także tego, jak jej choroba wpływa na cały system rodzinny. Ma ona na celu umożliwienie każdemu członkowi rodziny wyrażenia swoich uczuć, doświadczeń, myśli i obaw dotyczących obecnej sytuacji i ich drogi naprzód.¹ Chociaż terapia rodzinna nie zastępuje tradycyjnych programów leczenia uzależnień, jest ona potężnym narzędziem uzupełniającym, szczególnie w rodzinach z historią alkoholizmu.¹

Podejście wzmocnienia społeczności i zarządzanie nieprzewidywalnymi sytuacjami

Podejście wzmocnienia społeczności (community reinforcement approach) to CBT zaprojektowana w celu wzmocnienia umiejętności społecznych, rekreacyjnych i zawodowych.¹ Celem tego podejścia jest pomoc osobom z ZUA w rozwijaniu zdrowych relacji i umiejętności, które mogą zastąpić zachowania związane z piciem.

Zarządzanie nieprzewidywalnymi sytuacjami (contingency management) to interwencje behawioralne dla zaburzeń używania substancji, które oferują zachęty do promowania abstynencji lub zniechęcają do używania substancji.¹ Wykorzystuje podstawowe zasady behawioralne pozytywnego i negatywnego wzmocnienia w celu promowania inicjacji i utrzymania abstynencji lub innych pozytywnych zmian zachowania.¹ Małe nagrody lub vouchery na przedmioty są oferowane w zamian za pozytywne zachowania, takie jak negatywne wyniki testów na narkotyki lub badań alkomatem. Wartości nagród mogą pozostać takie same lub wzrosnąć przy utrzymującej się abstynencji. Nagrody ustają w przypadku negatywnego zachowania, takiego jak nawrót.¹

Grupy wsparcia i programy 12 kroków

Grupy wsparcia stanowią kluczowy element leczenia ZUA dla wielu osób. Grupy te składają się z rówieśników (tj. innych osób zmagających się z alkoholem lub narkotykami), którzy oferują sobie nawzajem wsparcie w zdrowieniu lub utrzymaniu zdrowienia z uzależnienia od alkoholu lub innych narkotyków.¹

Wiele osób z problemami alkoholowymi i członkowie ich rodzin uważają, że udział w grupach wsparcia jest niezbędnym elementem radzenia sobie z chorobą, zapobiegania nawrotom lub radzenia sobie z nimi oraz utrzymania trzeźwości.¹ Te grupy są często wymieniane w internecie, a Twój lekarz lub doradca może zasugerować grupę wsparcia.¹

Anonimowi Alkoholicy i inne grupy wsparcia

Anonimowi Alkoholicy (AA) to grupa samopomocy dla osób wychodzących z alkoholizmu. AA oferuje trzeźwą grupę rówieśniczą i jest zbudowana wokół 12 kroków jako skutecznego modelu osiągania całkowitej abstynencji.¹ Jest to międzynarodowa wspólnota ludzi, którzy zmierzyli się z problemami z alkoholem. Jest to organizacja nieprofesjonalna, samowystarczalna, wielorasowa, apolityczna i dostępna prawie wszędzie. Członkostwo jest otwarte dla każdego, kto chce przestać pić.¹

Nowa osoba w AA jest przydzielana do sponsora AA (osoby wracającej do zdrowia z alkoholizmu, która nadzoruje i wspiera zdrowienie nowego członka).¹ Podejście 12 kroków AA wykorzystuje techniki psychospołeczne stosowane w zmianie zachowania (np. nagrody, sieci wsparcia społecznego, wzorce ról).¹

Oprócz AA, dostępne są również inne grupy wsparcia, takie jak SMART Recovery, które pomagają młodzieży i dorosłym z uzależnieniem od alkoholu lub innymi uzależnieniami poprzez terapię grupową.¹

Ułatwienie w programach 12 kroków

Ułatwienie w programach 12 kroków (Twelve-step facilitation therapy) to terapia oparta na podręczniku, która angażuje grupy samopomocy 12 kroków, takie jak Anonimowi Alkoholicy. Jako podejście terapeutyczne, ułatwienie w programach 12 kroków zachęca do uczestnictwa i aktywnego udziału w spotkaniach 12 kroków jako celu promowania abstynencji. Większość sesji jest indywidualna, chociaż niektóre mogą obejmować członków rodziny, jeśli jest to pożądane.¹

Lekarze powinni zachęcać hospitalizowanych pacjentów do dzwonienia do AA ze szpitala. AA wyśle kogoś do rozmowy z nimi, jeśli pacjent nawiąże kontakt. Pacjenci muszą regularnie uczestniczyć w spotkaniach (początkowo codziennie) i przez wystarczająco długi czas (zwykle 2 lata lub więcej), ponieważ zdrowienie jest trudnym i długotrwałym procesem.¹

Pacjenci, którzy próbowali AA, mogli mieć złe doświadczenia w przeszłości. Pacjenci powinni spróbować co najmniej 5-10 różnych spotkań, zanim zrezygnują z podejścia AA, ponieważ każde spotkanie jest inne.¹

Leczenie zintegrowane i współwystępujące zaburzenia psychiczne

Zaburzenie używania alkoholu często współwystępuje z innymi zaburzeniami zdrowia psychicznego. Jeśli cierpisz na depresję, lęk lub inny stan zdrowia psychicznego, możesz potrzebować terapii rozmownej (psychoterapii), leków lub innego leczenia.¹

Około 8 milionów Amerykanów żyjących z zaburzeniem używania substancji ma jedno lub więcej współistniejących chorób psychicznych, takich jak depresja lub lęk.¹ Przy leczeniu zaburzeń związanych z alkoholem, ważne jest również zajęcie się wszelkimi współistniejącymi problemami zdrowia psychicznego.¹

Podejście do leczenia zintegrowanego

Leczenie behawioralne współwystępującego ZUA i PTSD (zespół stresu pourazowego) często było prowadzone sekwencyjnie, przy czym leczenie najpierw alkoholu było bardziej powszechne niż leczenie najpierw PTSD. Jednak osoby z współwystępującym ZUA i PTSD często proszą o zintegrowane leczenie lub nie chcą przestać pić alkoholu.¹

Mimo obaw pracowników służby zdrowia dotyczących wdrażania zintegrowanych terapii behawioralnych dla współwystępującego ZUA i PTSD, rosnąca baza dowodów wskazuje, że zintegrowane leczenie jest bezpieczne, wykonalne, dobrze tolerowane i skuteczne.¹ W niedawnym przeglądzie Simpson i współpracownicy ocenili 24 randomizowane badania kliniczne z badań nad behawioralnym leczeniem współwystępującego PTSD i zaburzenia używania substancji. Ogólnie rzecz biorąc, dane wskazują, że terapie skoncentrowane na traumie są skutecznym podejściem do zmniejszenia nasilenia PTSD. W związku z tym, zintegrowane leczenie skoncentrowane na traumie jest zalecane dla osób z współwystępującym ZUA i PTSD.¹

W przypadku pacjentów z ZUA i współwystępującym zaburzeniem używania opioidów, preferowane jest leczenie obu zaburzeń naltreksonem. Jednak naltrekson można rozpocząć dopiero po upływie wystarczającego czasu od ostatniego narażenia na opioidy i nie może być stosowany u osób leczonych agonistą opioidów z powodu zaburzenia używania opioidów.¹

Leki przeciwdepresyjne i inne terapie dla współwystępujących zaburzeń

Leki przeciwdepresyjne nie zmniejszają spożycia alkoholu u pacjentów bez zaburzeń nastroju, ale sertralina i fluoksetyna mogą pomóc pacjentom z depresją zmniejszyć spożycie alkoholu.¹ W niektórych przypadkach zespoły opieki przepisują leki w celu leczenia współistniejących chorób psychicznych, takich jak depresja lub lęk.¹

Psychoterapia indywidualna i grupowa może pomóc w lepszym zrozumieniu problemu z alkoholem i wspierać zdrowienie z psychologicznych aspektów używania alkoholu.¹ Terapeuci mogą również pomóc klientom w identyfikacji i rozwiązywaniu problemów ze zdrowiem psychicznym, które mogą przyczyniać się do ich używania alkoholu.¹

Leki zazwyczaj są stosowane w połączeniu z innymi podejściami leczniczymi, takimi jak terapia i samoopieka.¹ Ogólnie rzecz biorąc, najbardziej skuteczne plany leczenia są dostosowane do potrzeb jednostki i często obejmują kombinację podejść.¹

Dalsze wsparcie i zapobieganie nawrotom

Programy wsparcia i opieki po zakończeniu leczenia pomagają osobom wychodzącym z zaburzenia używania alkoholu w zaprzestaniu picia, zarządzaniu nawrotami i radzeniu sobie z koniecznymi zmianami w stylu życia.¹ Może to obejmować opiekę medyczną lub psychologiczną, lub uczestnictwo w grupie wsparcia.

Ciągła opieka to model leczenia, który podkreśla modyfikacje w intensywności leczenia i monitorowania, w miarę jak choroba nasila się i słabnie w czasie.¹ Ze względu na to, że ZUA jest chorobą przewlekłą, potrzeby pacjenta mogą zmieniać się w czasie, a jego plan leczenia powinien odzwierciedlać te zmiany.

Zapobieganie nawrotom i strategie radzenia sobie

Kluczowym krokiem dla pacjenta jest zrozumienie, że leczenie nie kończy się na trzeźwości. Zdrowienie oznacza, że pacjenci mogą radzić sobie ze stresami codziennego życia bez alkoholu. Dlatego pacjent musi rozwinąć i przećwiczyć strategie radzenia sobie z sytuacjami wysokiego ryzyka.¹

Udane zdrowienie wymaga od pacjenta umiejętności:¹

Nauczenia się mówienia „nie” dla picia w sytuacjach towarzyskich
Radzenia sobie z przyjaciółmi pijącymi intensywnie, którzy będą próbowali podważyć trzeźwość pacjenta
Radzenia sobie ze stresem (Pacjenci nie powinni ignorować objawów lęku)
Unikania nudy (Przed zdrowieniem pacjenci spędzali dużo czasu na piciu lub dochodzeniu do siebie po piciu. Po abstynencji pacjenci będą mieli więcej wolnego czasu)
Nauczenia się ponownego dogadywania się z rodziną i bliskimi przyjaciółmi (Problemy rodzinne często nasilają się, gdy picie ustaje)
Identyfikacji innych sytuacji, które mogą prowadzić do picia, i opracowania sposobów radzenia sobie z nimi

Gdy pacjenci mają chęć do picia, istnieje kilka technik, które można zastosować w danej sytuacji, w tym:¹

Samoodwracanie uwagi (tj. zaangażowanie się w alternatywną aktywność, którą lubią)
Zatrzymywanie myśli (tj. pacjenci nie powinni zastanawiać się nad myślami o piciu, ale powinni zatrzymać te myśli)
Przeprogramowanie (tj. pacjenci powinni unikać czynności, które przypominają im o piciu)
Korzystanie ze struktury wsparcia społecznego

Najczęstszą przyczyną nawrotu jest brak stosowania strategii radzenia sobie. Jeśli pacjent ma nawrót, należy dowiedzieć się, co się stało (postawić diagnozę), aby sformułować nowy plan leczenia.¹

Programy wsparcia i opieki następczej

Programy opieki następczej i grupy wsparcia pomagają osobom wychodzącym z zaburzenia używania alkoholu w zaprzestaniu picia, zarządzaniu nawrotami i radzeniu sobie z koniecznymi zmianami w stylu życia.¹ Dla większości osób kombinacja leków i terapii indywidualnej lub grupowej jest najbardziej skuteczna.¹

Opieka następcza w leczeniu zaburzeń używania substancji obejmuje:¹

Edukację na temat narzędzi zdrowienia i zapobiegania nawrotom
Wprowadzenie do dodatkowych zasobów społeczności
Dostęp do spotkań grupowych, gdzie otrzymuje się wsparcie od innych na tej samej drodze
Instrukcje dla rodziny w procesie zdrowienia, ponieważ zaburzenie używania substancji wpływa na całą rodzinę

Zdrowienie może być długotrwałym procesem i może wiązać się z okresami remisji i nawrotów.¹ Nie należy traktować nawrotu jako porażki, ale jako tymczasowy krok wstecz, i nadal próbować. Wiele osób wielokrotnie próbuje ograniczyć lub rzucić picie, ma nawrót, a następnie próbuje ponownie rzucić. Jeśli dojdzie do nawrotu, ważne jest, aby natychmiast wrócić do leczenia, abyś mógł dowiedzieć się więcej o swoich wyzwalaczach nawrotu i poprawić swoje umiejętności radzenia sobie. Może to pomóc odnieść większy sukces następnym razem.¹

Konkluzje i perspektywy leczenia ZUA

Zaburzenie używania alkoholu jest wysokoprewaletnym i powodującym niepełnosprawność stanem. Wiąże się z wysokim wskaźnikiem współchorobowości medycznej i psychiatrycznej, a także wczesną śmiertelnością.¹ Jednak istnieją skuteczne metody leczenia, które mogą pomóc osobom z ZUA w zmianie ich relacji z alkoholem i poprawie jakości życia.

Najnowsze badania wskazują na obiecujące nowe kierunki w leczeniu ZUA, w tym nowe leki, terapie psychedeliczne i podejścia oparte na medycynie precyzyjnej. Trwające badania mogą prowadzić do lepszych opcji leczenia w przyszłości.¹²

Należy jednak zauważyć, że pomimo ciągłego rozwoju i postępów w podejściach do leczenia, zaburzenie używania alkoholu pozostaje jednym z najbardziej niedoleczonych zaburzeń w systemie opieki zdrowotnej; szacuje się, że tylko 1 na 4 osoby z uzależnieniem od alkoholu otrzymuje leczenie.¹

Stosowanie leków w leczeniu uzależnienia od alkoholu bardzo powoli wchodzi do praktyki klinicznej, w tym do praktyk podstawowej opieki zdrowotnej.² Leczenie ZUA często wiąże się z niepewnością i różnicami między dostawcami i placówkami. Wielu klinicystów i programów leczenia nie stosuje leków na uzależnienie od alkoholu pomimo dowodów na ich skuteczność, niewielkich dowodów na szkody i zatwierdzenia przez FDA.¹

Istnieje pilna potrzeba zwiększenia dostępu do leczenia, zwiększenia menu zatwierdzonych leczenia farmakologicznych oraz destygmatyzacji i zwiększenia poszukiwania leczenia ZUA.¹ Choć wyzwań związanych z leczeniem ZUA jest wiele, dostępność skutecznych metod leczenia i prężnie rozwijające się badania nad nowymi podejściami dają nadzieję na przyszłość.

Lek	Nazwa handlowa	Mechanizm działania	Cel leczenia	Główne zastosowanie
Naltrekson	Revia (doustny) Vivitrol (iniekcja)	Antagonista receptorów opioidowych; zmniejsza uwalnianie dopaminy wywołane alkoholem	Zmniejsza intensywne picie i nawroty	Redukcja spożycia; może być stosowany u osób, które nadal piją
Akamprozat	Campral	Przywraca równowagę neuroprzekaźników GABA i glutaminianu w mózgu	Wspomaga utrzymanie abstynencji	Utrzymanie abstynencji; bardziej skuteczny po zaprzestaniu picia
Disulfiram	Antabuse	Blokuje enzym wątrobowy rozkładający aldehyd octowy, powodując reakcję awersyjną po spożyciu alkoholu	Zniechęca do picia poprzez wywołanie nieprzyjemnych objawów	Utrzymanie abstynencji; wymaga nadzoru przy przyjmowaniu
Topiramat	Topamax, Trokendi XR, Qudexy XR	Blokowanie kanałów sodowych, potencjalizacja GABA, antagonizm receptorów glutaminowych	Zmniejsza spożycie alkoholu	Redukcja spożycia; także w leczeniu padaczki
Gabapentyna	Neurontin	Modulacja przekaźnictwa GABA	Zmniejsza pragnienie alkoholu	Redukcja spożycia; stosowany poza wskazaniami
Baklofen	Lioresal	Agonista receptorów GABA-B	Zmniejsza pragnienie alkoholu	Redukcja spożycia; stosowany poza wskazaniami

Kolejne rozdziały

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Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

Materiały źródłowe

#1 Evidence-Based Treatments for Alcohol Use Disorder
https://dhhr.wv.gov/office-of-drug-control-policy/newsletters/Pages/Evidence-Based-Treatments-for-Alcohol-Use-Disorder.aspx
Alcohol use disorder (AUD) is a medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. […] All individuals suffering from AUD deserve treatment and can recover, no matter the severity of the disorder. In general, treatment goals of AUD are to reduce and manage symptoms and improve health and functioning. […] There are multiple effective and evidence-based treatment approaches for AUD including medications, behavioral treatments, and mutual support groups. […] Medications: Three medications are currently approved by the FDA to help people stop or reduce their drinking and prevent relapse. […] Behavioral treatments: Another name for behavioral treatment for AUD is alcohol counseling, which involves working with a healthcare professional to identify and help change behaviors that are contributing to distressing aspects of drinking.
#1
https://elearning.asam.org/products/treatment-of-alcohol-use-disorder-course
According to the 2021 National Survey of Drug Use and Health, 29.5 million people ages 12 and older had Alcohol Use Disorder in the past year. Alcohol Use Disorder is a chronic and complex disease that affects thousands of patients every year. There are evidence-based approaches to treatment, including non-pharmacological interventions and medications. Understanding these options and misconceptions about treatment alternatives can help improve outcomes for patients. […] This 4-hour introductory course provides an overview of the diagnosis and management of Alcohol Use Disorder, with a focus on treatment in both the inpatient and outpatient settings. This case-based, interactive, asynchronous course highlights the triage and management of patients with alcohol withdrawal syndromes and the successful transition to evidence-based pharmacotherapy. Adjunct behavioral therapies will also be discussed. […] Discuss evidence-based methods of treatment for alcohol use disorder, including pharmacotherapy and behavioral treatments.
#1 Treatment for Alcohol Problems: Finding and Getting Help | National Institute on Alcohol Abuse and Alcoholism (NIAAA)
https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/treatment-alcohol-problems-finding-and-getting-help
Millions of adults in the United States have alcohol use disorder (AUD), and approximately 1 in 10 children live in a home with a parent who has AUD. […] The good news is that no matter how severe the problem may seem, most people with AUD can benefit from some form of treatment. Many others substantially reduce their drinking and report fewer alcohol-related problems. […] Evidence-based AUD treatment is available, change is possible, and most people who have AUD recover or markedly improve. […] When asked how alcohol problems are treated, people commonly think of 12-step programs or 28-day inpatient treatment centers but may have difficulty naming other options. In fact, there are many treatment options available thanks to significant advances in medical and behavioral research over the past decades.
#1 Alcohol use disorder – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/diagnosis-treatment/drc-20369250
You’re likely to start by seeing your primary health care provider. If your provider suspects that you have a problem with alcohol, you may be referred to a mental health provider. […] Treatment for alcohol use disorder can vary, depending on your needs. Treatment may involve a brief intervention, individual or group counseling, an outpatient program, or a residential inpatient stay. Working to stop alcohol use to improve quality of life is the main treatment goal. […] Treatment for alcohol use disorder may include: Detox and withdrawal. Treatment may begin with a program of detoxification withdrawal that’s medically managed. Sometimes called detox, this generally takes 2 to 7 days. You may need to take sedating medications to prevent withdrawal symptoms. Detox is usually done at an inpatient treatment center or a hospital.
#1 Alcohol use disorder: Pharmacologic management – UpToDate
https://www.uptodate.com/contents/alcohol-use-disorder-pharmacologic-management
Alcohol use disorder: Pharmacologic management […] Pharmacologic treatment of alcohol use disorder has focused on altering the reinforcing effects of alcohol use. Several medications can be used to treat alcohol use disorder, leading to reduced heavy drinking and increased days of abstinence. This topic reviews the pharmacotherapy for treatment of alcohol use disorder. Pharmacotherapy is a component of the treatment of alcohol use disorder that is often combined with psychosocial interventions. The decision to treat alcohol use disorder with medication management is based on the severity of the disorder; however, patient preference is an important factor as all treatment decisions are made by shared decision making. In general, we include medications, along with psychosocial intervention as part of the treatment approach in patients with moderate to severe alcohol use disorder, or in those with mild disorder who request it. Several agents are effective in the treatment of alcohol use disorder. However, minimal direct evidence supports one treatment as compared with another, therefore our choice is based on other factors such as prior history, presence of co-occurring conditions, treatment goal, and patient preference.
#1 Pharmacotherapy for Adults With Alcohol-Use Disorders in Outpatient Settings | Effective Health Care (EHC) Program
https://effectivehealthcare.ahrq.gov/products/alcohol-misuse-drug-therapy/research-protocol
Alcohol-use disorders (AUDs) include harmful use, alcohol abuse, and alcohol dependence; they are relatively common in developed countries. AUDs cause substantial morbidity and mortality that is, threefold to fourfold increased rates of early mortality. […] Some studies indicate that less than 10 percent of those with AUDs are able to achieve long periods of nonproblematic drinking. Thus, the goal of treatment in the United States is typically abstinence, because of the belief that it is unlikely that those with AUDs can return to controlled, healthy alcohol use. However, controlled drinking and harm reduction are often goals of treatment in parts of Europe. […] Treatments for AUDs continue to evolve as research on the effectiveness of various treatments is published, and new treatments, including pharmacotherapy, are introduced and used more frequently. No single best approach has yet proven superior among the variety of available treatment options. Some common treatments for AUDs include cognitive behavioral therapy, motivational enhancement therapy, 12-step programs (e.g., Alcoholics Anonymous), and pharmacotherapy (disulfiram, naltrexone, acamprosate). Treatment may be delivered via intensive outpatient programs using group or individual counseling, alcoholism treatment centers, or other approaches.
#1 Alcohol use disorder: Psychosocial management – UpToDate
https://www.uptodate.com/contents/alcohol-use-disorder-psychosocial-management
Alcohol use disorder is a highly prevalent and disabling condition. It is associated with high rates of medical and psychiatric comorbidity as well as early mortality. Psychosocial treatments can reduce alcohol consumption and increase abstinence, either alone or in conjunction with pharmacologic treatment. […] The goal of treatment for alcohol use disorder can be broadly seen as restoration of medical and social well-being by control of drinking and its consequences. […] Motivational interviewing is an evidence-based counseling technique for eliciting behavior change by helping the patient explore and resolve ambivalence about change. […] Cognitive-behavioral therapy (CBT) is a structured goal-directed form of psychotherapy in which patients learn how their thought processes contribute to their behavior.
#1 Pharmacotherapy for Adults With Alcohol-Use Disorders in Outpatient Settings | Effective Health Care (EHC) Program
https://effectivehealthcare.ahrq.gov/products/alcohol-misuse-drug-therapy/research-protocol
Over the past 15 to 20 years, awareness has grown that treatment may still be beneficial even if complete abstinence is not achieved. As a result, research has used other outcomes to measure the effectiveness of treatment, which can be subsumed under the concept of harm reduction. […] In clinical trials the FDA-approved medications have shown evidence for efficacy in enhancing abstinence, reducing relapse to heavy drinking, and reducing overall drinking behavior. […] Despite ongoing developments and advancements in treatment approaches, alcohol dependence represents one of the most undertreated disorders in the U.S. health care system; it is estimated that only 1 in 4 individuals with alcohol dependence receives treatment. […] The use of medications for alcohol dependence has had a very slow uptake into clinical practice, including primary care practices.
#1 What is Medication-Assisted Treatment for Alcoholism? – CWC Recovery
https://www.cwcrecovery.com/blog/medication-assisted-treatment-mat-for-alcoholism/
Seeking professional treatment for alcoholism is a vital component to recovery as attempting to quit alcohol without medical intervention can lead to severe withdrawal complications and even death. […] The goal of medically assisted alcohol treatment is to ease the withdrawal symptoms in a safe environment in which the individual will be supervised around the clock by medical professionals. […] Individual and group therapy are key components of medication-assisted treatment programs for alcohol addiction. […] Effective MAT for alcohol use disorder and dependence include FDA approved medications such as Naltrexone, Vivitrol, Disulfiram, Benzodiazepines, and Acamprosate. […] This specific type of treatment addresses many of the obstacles that often lead to relapse while allowing clients to focus on the internal work required for recovery.
#1 Alcohol Use Disorder > Fact Sheets > Yale Medicine
https://www.yalemedicine.org/conditions/alcohol-use-disorder
Medications, such as benzodiazepines, are given to help control withdrawal symptoms. […] The Food and Drug Administration (FDA) has approved three medications for the treatment of alcohol use disorder. In general, these medications aim to reduce cravings and consumption of alcohol. […] Family counseling. For people with alcohol use disorder and their families, this form of therapy helps all involved to identify and face consequences of alcohol use in order to support reduction in or abstinence from alcohol consumption. […] Counseling and behavioral therapy. […] Alcohol use disorder is a chronic brain disease, and people who have the disorder and stop drinking are prone to relapse. AUD is associated with a range of health problems, from liver disease to heart disease to certain types of cancer to depression, to name a few.
#1 Treatment of Alcohol Abuse & Alcoholism: How To Stop Drinking
https://www.webmd.com/mental-health/addiction/alcohol-use-disorder-treatments
Alcohol use disorder is what doctors call it when you cant control how much you drink and have trouble with your emotions when youre not drinking. […] An important first step is to learn more about alcohol use disorder and your treatment options. […] Together, you can start to make a treatment plan. […] The one thats right for you depends on your situation and your goals. Many people find that a combination of treatments works best, and you can get them together through a program. […] This is a key step if your drinking problem is severe. Detox isnt a treatment by itself. […] Doctors and other experts can keep an eye on you and give you medicine to help with your symptoms. […] During or after your alcohol rehabilitation, seeing a therapist can help you learn new skills and strategies to help you stay sober for the long term.
#1 Alcohol use disorder: Psychosocial management – UpToDate
https://www.uptodate.com/contents/alcohol-use-disorder-psychosocial-management
Behavioral couples therapy is a manualized psychotherapy that involves the spouse or intimate partner of the patient with alcohol use disorder in conjoint couple’s sessions with the intent of helping the partner to engage in behaviors that reinforce alcohol abstinence and overall improve the coupleâs relationship. […] Residential programs provide a 24-hour, substance-free environment. […] Mutual help groups, including 12-step programs and other models, are a common component of treatment for alcohol use disorder. […] Contingency management interventions for substance use disorders offer incentives to encourage abstinence or discourage substance use. […] Medical management is a manual-based therapy that is designed to mimic the management of medical conditions and is effective in the treatment of alcohol use disorder.
#1 Alcoholism Treatment & Management: Approach Considerations, Medical Care, Consultations
https://emedicine.medscape.com/article/285913-treatment
Strongly recommend AA. […] Complete abstinence is the only treatment for alcohol dependence. Emphasize that the most common error is underestimating the amount of help that will be needed to stop drinking. […] Hospitalize patients if they have a history of delirium tremens or if they have significant comorbidity. Consider inpatient treatment if the patient has poor social support, significant psychiatric problems, or a history of relapse after treatment. […] Encourage hospitalized patients to call AA from the hospital. AA will send someone to talk to them if the patient makes the contact. Patients need to attend meetings regularly (daily at first) and for a sufficient length of time (usually 2 y or more) because recovery is a difficult and lengthy process. […] Patients who have tried AA may have had a bad past experience. Patients should try at least 5-10 different meetings before giving up on the AA approach because each meeting is different.
#1 Alcohol use disorder – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/diagnosis-treatment/drc-20369250
Treatment for psychological problems. Alcohol use disorder commonly occurs along with other mental health disorders. If you have depression, anxiety or another mental health condition, you may need talk therapy (psychotherapy), medications or other treatment. […] For serious alcohol use disorder, you may need a stay at a residential treatment facility. Most residential treatment programs include individual and group therapy, support groups, educational lectures, family involvement, and activity therapy. […] Many people with alcohol problems and their family members find that participating in support groups is an essential part of coping with the disease, preventing or dealing with relapses, and staying sober. Your health care provider or counselor can suggest a support group. These groups are also often listed on the web. […] Alcoholics Anonymous (AA) is a self-help group for people recovering from alcoholism. AA offers a sober peer group and is built around 12 steps as an effective model for achieving total abstinence.
#1 Alcohol Use Disorder (AUD) Treatment: MedlinePlus
https://medlineplus.gov/alcoholusedisorderaudtreatment.html
An alcohol use disorder (AUD) is drinking that causes distress and harm. It is a medical condition in which you: […] Most people with an alcohol use disorder can benefit from some form of treatment. Medical treatments include medicines and behavioral therapies. For many people, using both types gives them the best results. […] Some people may need intensive treatment for AUD. They may go to a residential treatment center for rehabilitation (rehab). Treatment there is highly structured. It usually includes several different kinds of behavioral therapies. It may also include medicines for detox (medical treatment for alcohol withdrawal) and/or for treating the AUD. […] Three medicines are approved to treat AUD: […] Your health care provider can help you figure out if one of these medicines is right for you. They are not addictive, so you don’t have to worry about trading one addiction for another. They are not a cure, but they can help you manage AUD. This is just like taking medicines to manage a chronic disease such as asthma or diabetes.
#1 Alcohol and Drug Abuse Treatment Centers | NCDHHS
https://www.ncdhhs.gov/divisions/state-operated-healthcare-facilities/facilities/alcohol-and-drug-abuse-treatment-centers
Both ADATCs permit pregnant patients with substance use disorders or co-occurring substance use and mental health disorders to receive treatment throughout their pregnancy. […] The ACU is staffed with an interdisciplinary team that provides medically monitored detoxification services for substance use patients and psychiatric stabilization for substance use patients with co-occurring mental health disorders. […] Acute rehabilitation services consist of a full day of therapy groups, classes, and activities to help individuals understand the addiction process and the impact of co-occurring mental health disorders. […] WBJ ADATC’s Outpatient Opioid Treatment Program Clinic provides treatment to adults by using Medications for Opioid Use Disorder, methadone and buprenorphine. […] Daily dosing of methadone or buprenorphine assists with reducing opioid withdrawal symptoms and cravings, which increases an individual’s ability to focus energy on their day-to-day life in recovery.
#1 Medications for Alcohol Use Disorder | AAFP
https://www.aafp.org/pubs/afp/issues/2016/0315/p457.html
A more recent article on medications for alcohol use disorder is available. […] The U.S. Preventive Services Task Force recommends that clinicians screen adults for alcohol misuse and provide persons engaged in risky or hazardous drinking behaviors with brief behavioral counseling to reduce alcohol misuse. […] Three medications are approved by the U.S. Food and Drug Administration to treat alcohol use disorder: acamprosate, disulfiram, and naltrexone. […] Acamprosate and naltrexone reduce alcohol consumption and increase abstinence rates, although the effects appear to be modest. […] Disulfiram has been used for years, but evidence supporting its effectiveness is inconsistent. […] Other medications may be beneficial to reduce heavy alcohol use. […] Antidepressants do not decrease alcohol use in patients without mood disorders, but sertraline and fluoxetine may help depressed patients decrease alcohol ingestion.
#1 Medications for Alcohol Use Disorder | AAFP
https://www.aafp.org/pubs/afp/issues/2016/0315/p457.html
Further study is needed for genetically targeted or as-needed medications to reduce alcohol use. […] The U.S. Preventive Services Task Force (USPSTF) recommends screening adults for alcohol misuse and providing persons engaged in risky or hazardous drinking behaviors with brief behavioral counseling to reduce alcohol misuse. […] Individuals who engage in high-risk drinking should be counseled to decrease their alcohol use, and patients diagnosed with AUD should be offered treatment, such as brief behavioral interventions, support programs such as Alcoholics Anonymous, individual and group therapy, and medications. […] A Substance Abuse and Mental Health Services Administration/National Institute on Alcohol Abuse and Alcoholism Consensus Panel recommends pharmacotherapy along with behavioral interventions for AUD.
#1 Alcohol use disorder: Pharmacologic management – UpToDate
https://www.uptodate.com/contents/alcohol-use-disorder-pharmacologic-management
For individuals without co-occurring disorders the choice of agent is guided by treatment goal and patient preferences: Treatment goal is complete abstinence â In individuals whose goal of treatment is complete abstinence, we typically use disulfiram. Treatment goal is reduction of use â In individuals whose goal is reduction of use we choose from among naltrexone, acamprosate, and topiramate. The presence of specific co-occurring disorders is a prominent factor in our choice of initial pharmacologic management of alcohol use disorder. […] For patients with alcohol use disorder and co-occurring opioid use disorder, we prefer to treat both disorders with naltrexone. However, naltrexone can only be started after a sufficient time has elapsed since last opioid exposure and cannot be used in individuals treated with opioid agonist for opioid use disorder.
#1 Medications for Alcohol Use Disorder | AAFP
https://www.aafp.org/pubs/afp/issues/2016/0315/p457.html
The Department of Veterans Affairs recommends the consideration of naltrexone (Revia, Vivitrol) and/or acamprosate (Campral) for AUD treatment, along with counseling. […] The Substance Abuse and Mental Health Services Administration/National Institute on Alcohol Abuse and Alcoholism Consensus Panel provides a guide for the use of acamprosate, disulfiram, and naltrexone. […] An Agency for Healthcare Research and Quality (AHRQ) review that included 135 studies of pharmacologic treatment of AUD in outpatient settings found moderate evidence to support the use of naltrexone and acamprosate, and insufficient evidence to support the use of disulfiram. […] Naltrexone, an opioid antagonist, reduces alcohol consumption in patients with AUD, and is more successful in those who are abstinent before starting the medication.
#1 Alcohol Use Disorder Can Be Treated With an Array of Medications â But Few People Have Heard of Them
https://news.cuanschutz.edu/news-stories/alcohol-use-disorder-can-be-treated-with-an-array-of-medications-but-few-people-have-heard-of-them
Many effective treatments exist for alcohol use disorder, including psychotherapy, peer support groups such as Alcoholics Anonymous and SMART Recovery, and medications. […] As of May 2024, three medications have been approved by the Food and Drug Administration for treatment of alcohol use disorder. […] Disulfiram is effective for reducing drinking but must be taken daily by mouth, which limits its utility if patients do not take it on this schedule. […] A more recently FDA-approved and more effective medication for alcohol use disorder is the opioid receptor antagonist naltrexone. […] Naltrexone reduces dopamine release from alcohol, blocking some of the pleasurable effects of drinking. […] The third FDA-approved medication, acamprosate, also reduces alcohol cravings, but its molecular effects are less well understood.
#1 Medications for the Treatment of Alcohol Use Disorder | Office of Addiction Services and Supports
https://oasas.ny.gov/providers/medications-treatment-alcohol-use-disorder
Medications for the Treatment of Alcohol Use Disorder […] Acamprosate (Campral) is a prescription medication that may prevent individuals who already have stopped drinking from returning to alcohol use. The precise way acamprosate works is not understood fully but it likely helps restore the proper balance of certain neurotransmitters GABA and glutamate in the brain that becomes disrupted with chronic alcohol use. Acamprosate also may reduce cravings for alcohol. […] Although acamprosate can be started and taken while someone is drinking alcohol, studies have shown that it is more effective when started after someone has stopped drinking. […] The prescribing healthcare professional can answer questions and provide guidance about the use of acamprosate for alcohol use disorder. […] Naltrexone, an antagonist of opioid receptors in the brain, is a prescription medication that is available in oral (Revia) and long-acting injectable (Vivitrol) formulations. Both formulations are indicated for the treatment of alcohol use disorder, but only the long-acting injectable formulation is indicated for the treatment of opioid use disorder. […] For alcohol use disorder, naltrexone has been shown to reduce heavy alcohol use during an episode of drinking and, if someone has decreased or stopped drinking, prevent a return to heavy alcohol use if drinking does occur. […] The prescribing healthcare professional can answer questions and provide information about the use of naltrexone for alcohol use disorder.
#1 Medications for Alcohol Use Disorder | AAFP
https://www.aafp.org/pubs/afp/issues/2016/0315/p457.html
A Cochrane review that included 50 randomized trials and 7,793 patients found that oral naltrexone decreased heavy drinking and slightly decreased daily drinking. […] Ondansetron may decrease alcohol consumption in patients with AUD. […] The combination of ondansetron and naltrexone may be effective in treating early AUD. […] There is inconclusive evidence to support baclofen and various supplements for AUD.
#1 Medicines To Treat Alcohol Use Disorder | Effective Health Care (EHC) Program
https://effectivehealthcare.ahrq.gov/products/alcohol-misuse-drug-therapy/consumer
Medicines are usually used with talk therapy (also called „psychotherapy”) and support groups to treat alcohol use disorder. This summary only reviews research on medicines to treat alcohol use disorder. […] Treatment for alcohol use disorder may include talk therapy (also called psychotherapy), support groups, medicines, or a combination of treatments. Alcohol use disorder can be a long-term condition, like high blood pressure or asthma. You may need treatment over a long period of time. […] Your doctor may suggest a medicine to help treat your alcohol use disorder. Medicines are usually used together with talk therapy and support groups. […] Acamprosate (Campral): This medicine was approved by the U.S. Food and Drug Administration (FDA) to treat alcohol dependence*. It helps rebalance chemicals in the brain that may be changed by drinking too much.
#1 Medications for alcohol dependence: When to prescribe | SA Health
https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+programs+and+practice+guidelines/substance+misuse+and+dependence/medications+for+alcohol+dependence+when+to+prescribe
If a patient is alcohol dependent and they want to reduce or stop drinking, the use of medications as part of an overall treatment strategy enhances the likelihood of success. […] Three medications are available in Australia for assisting abstinence from alcohol: […] Acamprosate is effective at maintaining abstinence, but has less impact on relapse to heavy drinking once alcohol consumption is recommenced, whereas naltrexone is effective in preventing relapse to heavy drinking and is less effective at maintaining abstinence. […] Disulfiram has been less well researched, but is well known by patients and their families. […] Information about medication assisted treatment for people with alcohol dependence and finding the right treatment for you.
#1
https://link.springer.com/article/10.1007/s40265-021-01670-3
Therefore, there is a pressing need for the development of novel, diverse, and effective pharmacological treatment options for AUD with the hopes of increasing utilization and improving care. […] The focus of the current review is to summarize pharmacotherapies for AUD with a clinical perspective. […] This section briefly describes medications currently approved by agencies in many countries including the US FDA and EMA for the treatment of AUD: disulfiram, acamprosate, and naltrexone (oral and extended-release), as well as nalmefene, which is EMA-approved. […] Disulfiram is only recommended in the maintenance of abstinence; using this medication to reduce drinking is not advised. […] Acamprosate is recommended for the achievement and maintenance of complete abstinence, rather than for the reduction of drinking or prevention of relapse in the event of drinking.
#1 Alcohol use disorder: Pharmacologic management – UpToDate
https://www.uptodate.com/contents/alcohol-use-disorder-pharmacologic-management
The presence of advanced liver disease affects our choice of medication for alcohol use disorder: For Child-Pugh Class C (decompensated cirrhosis), we typically choose acamprosate as it is metabolized primarily through the kidneys. If acamprosate is ineffective or unavailable, topiramate or naltrexone may be used with extreme caution. Disulfiram is avoided. […] Topiramate is our preferred choice of medications in patients who have a co-occurring seizure disorder that would appropriately be treated with this agent. […] We are cautious when prescribing acamprosate to individuals with kidney dysfunction. Acamprosate is contraindicated in individuals with creatinine clearance â¤30 mL/min. […] We prefer psychosocial treatments, rather than medication management for pregnant individuals. There is a paucity of data on the safety of pharmacologic therapies for alcohol use disorder in pregnant individuals.
#1 Managing Alcohol Use Disorder
https://www.uspharmacist.com/article/managing-alcohol-use-disorder
The American Psychiatric Association recommends using naltrexone or acamprosate in patients with moderate-to-severe AUD as first-line therapies. […] Disulfiram became the first FDA-approved drug for the treatment of AUD in 1948. […] Pharmacists have the opportunity to provide evidence-based pharmacotherapy recommendations and psychosocial interventions as a member of a multidisciplinary team to treat individuals with AUD. […] Patient-centered treatment plans should include support groups and pharmacologic agents as appropriate.
#1 Alcohol use disorder: Pharmacologic management – UpToDate
https://www.uptodate.com/contents/alcohol-use-disorder-pharmacologic-management
Medication for alcohol is underused, despite the morbidity and mortality associated with alcohol use disorder, the known efficacy of medications for alcohol use disorder, and the guideline recommendations. […] Naltrexone is an effective treatment in the management of alcohol use disorder. The preferable dosing schedule, its ability to be used in individuals who are still drinking, and its efficacy in individuals with co-occurring opioid use disorder make it an attractive agent for many. […] Acamprosate is effective in maintaining abstinence in individuals with alcohol use disorder who were recently withdrawn from alcohol use. […] Disulfiram is an aversive agent that does not directly influence motivation to drink but discourages drinking via the threat of the âdisulfiram reaction.â
#1 Medications for the Treatment of Alcohol Use Disorder | Office of Addiction Services and Supports
https://oasas.ny.gov/providers/medications-treatment-alcohol-use-disorder
Disulfiram (Antabuse) is a prescription medication that can help prevent a return to alcohol use after an individual has stopped drinking completely. Disulfiram blocks a liver enzyme that is necessary for breaking down an alcohol byproduct called acetaldehyde. […] Those who choose to take disulfiram should be informed fully about the physical effects that can occur if they drink alcohol. […] The prescribing healthcare professional can answer questions and provide information about the use of disulfiram for alcohol use disorder.
#1 Medicines To Treat Alcohol Use Disorder | Effective Health Care (EHC) Program
https://effectivehealthcare.ahrq.gov/products/alcohol-misuse-drug-therapy/consumer
Disulfiram (Antabuse): This medicine was approved by the FDA to treat alcohol dependence*. If you drink alcohol, this medicine causes unpleasant effects, such as nausea, vomiting, headache, flushing (reddening of the face, neck, or chest), sweating, and chest pain. […] Naltrexone (Revia, Vivitrol): This medicine was approved by the FDA to treat alcohol dependence*. It works by decreasing the craving for alcohol. […] Topiramate (Topamax, Trokendi XR, Qudexy XR): This medicine was approved by the FDA to treat seizures and prevent migraine headaches. Some doctors also use it to treat alcohol use disorder. It helps rebalance chemicals in the brain and helps correct the electrical activity of brain cells. […] The FDA lists the following possible side effects for medicines to treat alcohol dependence and alcohol use disorder.
#1 Alcohol Use: Medications for alcohol use disorders | CAMH
https://www.camh.ca/en/professionals/treating-conditions-and-disorders/alcohol-use/alcohol-use—treatment/treatment—medications-for-alcohol-use-disorders
Disulfiram is effective in achieving abstinence if it is taken under supervision, for example by a pharmacist, partner or mutual aid (e.g., AA) sponsor. […] Several medications are used off-label to treat moderate or severe alcohol use disorder. These include topiramate, baclofen, and gabapentin. […] Prescribing thiamine is important because heavy alcohol consumption can result in thiamine deficiency, which can lead to alcohol-induced brain damage. […] Emphasize that medication is an essential component of recovery for many patients.
#1 Alcohol use disorder: Pharmacologic management – UpToDate
https://www.uptodate.com/contents/alcohol-use-disorder-pharmacologic-management
Topiramate, an anticonvulsant medication with pharmacologic properties including blocking of voltage-dependent sodium channels, potentiation of gamma-aminobutyric acid mediated transmission and antagonism of glutamate receptors, has been found to decrease alcohol use in individuals with alcohol use disorder. […] For individuals with a good response to treatment (met treatment goals) with pharmacologic management, we continue treatment for at least one year. For inadequate response to initial agent, we choose each of the other initial pharmacotherapy agents that are clinically acceptable in succession. […] While ketamine, glucagon-like peptide 1 agonists, nalmefene, and others have shown limited data supporting their use, we do not recommend these agents until further studies support their efficacy.
#1 Dual-Drug Therapy Shows Promise for Treating Alcohol Use Disorder | UC San Francisco
https://www.ucsf.edu/news/2021/07/421146/dual-drug-therapy-shows-promise-treating-alcohol-use-disorder
UC San Francisco researchers have leveraged two new molecules, one of which is currently in clinical oncology trials, to devise a dual-drug therapy for alcohol use disorder (AUD), without the side effects or complications associated with current treatment regimens. […] Current pharmaceutical options for AUD attempt to change behavior by making alcohol consumption an unpleasant experience and some require patients to abstain for several days before beginning treatment. […] Ron believes that tackling addiction from this neurological perspective has potential for broad applications. […] If thats true, Ron said, It suggests that this approach can be applied to other drugs of abuse as well, essentially solving the problem of addiction.
#1 Psychedelic Drug Therapy May Help Treat Alcohol Addiction | NYU Langone News
https://nyulangone.org/news/psychedelic-drug-therapy-may-help-treat-alcohol-addiction
Two doses of psilocybin, a compound found in psychedelic mushrooms, reduces heavy drinking by 83 percent on average among heavy drinkers when combined with psychotherapy, a new study shows. […] Our findings strongly suggest that psilocybin therapy is a promising means of treating alcohol use disorder, a complex disease that has proven notoriously difficult to manage, says study senior author and psychiatrist Michael P. Bogenschutz, MD, director of NYU Langones Center for Psychedelic Medicine. […] According to study investigators, previous research had already identified psilocybin treatment as an effective means of alleviating anxiety and depression in people with the most severe forms of cancer. And earlier research by Dr. Bogenschutz and others suggested that psilocybin could serve as a potential therapy for alcohol use disorder and other addictions.
#1 Alcohol Use Disorder Can Be Treated With an Array of Medications â But Few People Have Heard of Them
https://news.cuanschutz.edu/news-stories/alcohol-use-disorder-can-be-treated-with-an-array-of-medications-but-few-people-have-heard-of-them
Several medications have demonstrated encouraging effects on drinking in randomized controlled trials but are not yet FDA-approved for alcohol use disorder. […] An important recent focus of research, funded by the National Institute on Alcohol Abuse and Alcoholism, on alcohol use disorder medications has been the application of a precision medicine approach to identify patients for whom a particular medication is more likely to have a large effect. […] The search for robustly effective medications to treat alcohol use disorder is a significant area of current research. […] Alcohol use disorder is a devastating condition for which better treatments are desperately needed. Approved and off-label medications are currently available.
#1 Alcohol Use Disorder (AUD) Treatment: MedlinePlus
https://medlineplus.gov/alcoholusedisorderaudtreatment.html
Another name for behavioral therapies for AUD is alcohol counseling. It involves working with a health care professional to identify and help change the behaviors that lead to your heavy drinking. […] For most people, treatment for an AUD is helpful. But overcoming an alcohol use disorder is an ongoing process, and you may relapse (start drinking again). You should look at relapse as a temporary setback, and keep trying. Many people repeatedly try to cut back or quit drinking, have a setback, then try to quit again. Having a relapse does not mean that you cannot recover. If you do relapse, it is important to return to treatment right away, so you can learn more about your relapse triggers and improve your coping skills. This may help you be more successful the next time.
#1 Behavioral Treatments for Alcohol Use Disorder and Post-Traumatic Stress Disorder
https://pmc.ncbi.nlm.nih.gov/articles/PMC6561400/
Alcohol use disorder (AUD) and post-traumatic stress disorder (PTSD) are highly prevalent and debilitating psychiatric conditions that commonly co-occur. This review describes evidence-supported behavioral interventions for treating AUD alone, PTSD alone, and comorbid AUD and PTSD. Evidence-based behavioral interventions for AUD include relapse prevention, contingency management, motivational enhancement, couples therapy, 12-step facilitation, community reinforcement, and mindfulness. Behavioral interventions are a primary component of the treatment of AUD and can be used as freestanding treatments or as part of a more comprehensive treatment plan that includes pharmacotherapies. Cognitive behavioral therapies (CBTs) are some of the most commonly used and empirically supported behavioral treatments for AUD. Over the past 30 years, numerous meta-analyses and systematic reviews have demonstrated that CBT is an effective treatment for AUD. CBT interventions typically are designed as short-term, highly focused treatments that can be implemented in a wide range of clinical settings. These interventions are flexible and can be applied in individual or group therapy formats. Behavioral treatments for people with AUD also target motivation for change and improvement of specific skills to reduce the risk for relapse. For the past 30 years, relapse prevention has been one of the prevailing empirically supported CBTs for AUD. Relapse prevention is designed to help people with AUD identify high-risk situations for relapse and develop effective coping strategies. Contingency management is a behavioral therapy that employs the basic behavioral principles of positive and negative reinforcement to promote the initiation and maintenance of abstinence or other positive behavior changes. Motivational enhancement therapy is an intervention designed to enhance internal motivation for change and engagement in the change process. Alcohol behavioral couple therapy and behavioral couples therapy for alcoholism and drug abuse are manual-guided treatments for AUD that incorporate participation of a significant other or romantic partner. Twelve-step facilitation is a manual-guided intervention for AUD that is based on the 12 steps of Alcoholics Anonymous. The community reinforcement approach is a CBT designed to enhance social, recreational, and vocational skills. More recently, several mindfulness-based interventions have been developed for the treatment of substance use disorders. Behavioral intervention is considered a first-line approach in the treatment of PTSD. Several empirically supported behavioral interventions have been disseminated across populations and treatment settings. As with treatments for AUD, various treatment modalities for PTSD have been studied. Comprehensive analysis of the literature on this topic is challenging because of the diversity of inclusion and exclusion criteria of participants, the heterogeneous nature of PTSD symptoms, high treatment dropout rates, and symptoms that persist after treatment. Behavioral treatments for comorbid AUD and PTSD often have been conducted sequentially, with alcohol-first treatments being more prevalent than PTSD-first treatments. However, individuals with comorbid AUD and PTSD often request integrated treatment or are unwilling to stop drinking alcohol. Despite health care provider concerns about implementing integrated behavioral treatments for comorbid AUD and PTSD, a growing evidence base indicates that integrated treatments are safe, feasible, well-tolerated, and effective. In a recent review, Simpson and colleagues evaluated 24 randomized clinical trials from studies of behavioral treatments for comorbid PTSD and substance use disorder. Overall, the data indicate that trauma-focused treatments are an effective approach for reducing PTSD severity. Thus, integrated trauma-focused treatments are recommended for individuals with comorbid AUD and PTSD.
#1 Comprehensive Treatment Options For Alcoholism – The Ridge Ohio
https://theridgeohio.com/alcohol-abuse/comprehensive-treatment-options-for-alcoholism/
Comprehensive treatment options for alcoholism involve a combination of therapy, medication, and support groups. These options may include cognitive-behavioral therapy, medication-assisted treatment, and participation in groups like Alcoholics Anonymous. […] Cognitive-behavioral therapy is a common treatment option for alcoholism, as it can help individuals identify and change negative thoughts and behaviors related to drinking. This therapy may include individual or group therapy sessions, and may be customized to meet individual needs. […] Medication-assisted treatment involves the use of medications to help manage cravings and withdrawal symptoms associated with alcoholism. These medications may include acamprosate, naltrexone, and disulfiram, and are usually used in combination with therapy and support groups.
#1 Alcohol Addiction Therapy: Types of Psychotherapy
https://www.therecoveryvillage.com/alcohol-abuse/treatment-rehab/psychotherapy/
The best form of psychotherapy depends on the patients situation, the extent and nature of their alcohol abuse and their therapists professional opinion. […] There are many forms of psychotherapy that a therapist might use to help clients in alcohol addiction recovery. Two of the most commonly used types include cognitive behavioral therapy and dialectical behavior therapy. […] Both CBT and DBT recognize the importance of relapse prevention. The goal of relapse prevention is to identify and address high-risk situations for the client and help them develop coping mechanisms to maintain sobriety. […] Finding the right type of treatment is important, and The Recovery Village is here to help. We offer a full continuum of care that addresses drug and alcohol addiction as well as any co-occurring mental health disorders.
#1 Therapy for Alcoholism | Alcohol.org
https://alcohol.org/therapy/
Dialectical behavioral therapy (DBT) was initially developed to treat people with long-term suicidal behaviors, but it has become most well-known for treating borderline personality disorder, a mental health issue commonly associated with concurrent substance abuse. The technique has since been effectively applied to treating substance abuse itself. DBT ultimately aims to help patients improve their lives by synthesizing a balance between the urge to avoid painful experiences and the need to accept some of the unavoidable pain associated with life. DBT technique works through the promotion of two opposing goals change and acceptance. […] Motivational interviewing was developed to increase an individuals engagement with recovery efforts and is effective at reducing substance use. It builds on the stages of change, helping people move from thinking about making a change to actively working toward it. This form of therapy for alcohol abuse can be used alone or in conjunction with other therapeutic practices. Motivational interviewing is a short-term therapy that can be offered in individual and group settings.
#1 Alcohol use disorder – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/diagnosis-treatment/drc-20369250
Learning new skills and making a treatment plan. This process usually involves alcohol treatment specialists. It may include goal setting, behavior change techniques, use of self-help manuals, counseling and follow-up care at a treatment center. […] Psychological counseling. Counseling and therapy for groups and individuals help you better understand your problem with alcohol and support recovery from the psychological aspects of alcohol use. You may benefit from couples or family therapy family support can be an important part of the recovery process. […] Continuing support. Aftercare programs and support groups help people recovering from alcohol use disorder to stop drinking, manage relapses and cope with necessary lifestyle changes. This may include medical or psychological care or attending a support group.
#1
https://www.nhs.uk/conditions/alcohol-misuse/treatment/
Cognitive behavioural therapy (CBT) is a talking therapy that uses a problem-solving approach to alcohol dependence. […] Family therapy provides family members with the opportunity to learn about the nature of alcohol dependence and support the member of the family who is trying to abstain from alcohol.
#1 Therapy for Alcoholism | Alcohol.org
https://alcohol.org/therapy/
Contingency management (CM) uses rewards to reinforce behavioral changes. Small prizes or vouchers for items are offered in return for positive behaviors such as negative drug or breathalyzer results. Reward values may stay the same or increase with ongoing abstinence. The rewards stop in the event of negative behavior, such as relapse. […] Twelve-step facilitation therapy involves 12-step help groups such as Alcoholics Anonymous. As therapeutic approach, 12-step facilitation encourages attendance and active participation in 12-step meetings as a goal of promoting abstinence. Most sessions are individual, although some may include family members if desired. […] Addiction affects everyone within a family, and family behavior therapy has been shown to be effective in treating addiction. Family therapy technique addresses the addiction as well as the relationships within the family, employment, parenting issues, and behavioral concerns.
#1 Family Therapy In Alcohol Addiction Treatment – Alcohol Help
https://www.alcoholhelp.com/treatment/family-therapy/
Family therapy can help restore a family with a member suffering from an alcohol use disorder. […] An alcohol use disorder (AUD) is a disease in which the chronic consumption of alcohol is used regardless of negative consequences. […] Treatment for alcoholism and other substance use disorders typically includes a detox plan, prescribed medications, individual therapy, and group therapy. […] Once a treatment plan is put together by a rehab facility’s professional team, the individual’s counselor may suggest family therapy. […] Family therapy is a great way to not only address the issues of the individual struggling with alcoholism, but also how their illness affects the family system as a whole. […] Family therapy is intended to allow every member of the family an opportunity to share their feelings, experiences, thoughts, and concerns about the current situation and their path moving forward.
#1 Family Therapy In Alcohol Addiction Treatment – Alcohol Help
https://www.alcoholhelp.com/treatment/family-therapy/
While family therapy is not a replacement for traditional addiction treatment programs, it is a powerful tool to supplement, especially in families with a history of alcoholism. […] Family therapy influences many powerful changes for both the individuals struggling as well as the entire family unit including: Improved outcomes of recovery and abstinence from drinking. […] Supportive family involvement can help both the individual and the people in their life. […] Some families choose online therapy as a virtual option for family therapy, to avoid the complications of commuting and scheduling.
#1 Evidence-Based Treatments for Alcohol Use Disorder
https://dhhr.wv.gov/office-of-drug-control-policy/newsletters/Pages/Evidence-Based-Treatments-for-Alcohol-Use-Disorder.aspx
Mutual support groups: These groups are comprised of peers (i.e., other individuals struggling with alcohol or drugs) that offer support to each other in recovering or maintaining recovery from alcohol or other drug dependence or problems. […] The good news is that no matter how severe the problem may seem, evidence-based treatment with medications, behavioral therapies, and mutual-support groups can help people with AUD achieve and maintain recovery.
#1 What is alcohol use disorder? How to treat alcoholism
https://www.medicalnewstoday.com/articles/157163
Alcoholics Anonymous: Alcoholics Anonymous is an international fellowship of people who have faced problems with alcohol. It is nonprofessional, self-supporting, multiracial, apolitical, and available almost everywhere. Membership is open to anyone who wants to stop drinking. […] Treatment for AUD may be lifelong and include counseling, support groups, residential programs, and medications.
#1 Alcoholism Treatment & Management: Approach Considerations, Medical Care, Consultations
https://emedicine.medscape.com/article/285913-treatment
The AA 12-step approach involves psychosocial techniques used in changing behavior (eg, rewards, social support networks, role models). Each new person is assigned an AA sponsor (a person recovering from alcoholism who supervises and supports the recovery of the new member). […] The physician should have AA literature in the office (dates and places of meetings), have the AA phone number available, and know about other treatment services in the community, including referrals for medical consultants or specialists in chemical dependency. […] Treatment of alcoholism involves the following: Brief physician advice makes a difference. […] Strongly encourage family members of patients with alcoholism to contact Al-Anon and Alateen via its Web site (Al-Anon/Alateen) or mailing address (Al-Anon Family Group Headquarters; PO Box 182; Madison Square Garden Station; New York, NY 10159-0182).
#1 Find help for substance abuse | USAGov
https://www.usa.gov/substance-abuse
The Alcohol Treatment Navigator explains how to choose among different treatment programs. And it offers advice on getting support for yourself or a loved one through the recovery process. […] Find medication-assisted treatment (MAT). This combines medications with counseling and behavioral therapies to treat substance use disorders. […] SMART Recovery assists young people and adults with alcohol or other addictions through group therapy.
#1 Addiction & Substance Use Rehab – Psychiatry | NewYork-Presbyterian
https://www.nyp.org/psychiatry/addiction-substance-use
At NewYork-Presbyterian, we provide personalized treatment that focuses on long-term strategies for reducing relapse and improving your quality of life. […] Our team performs a comprehensive evaluation, which includes a physical, psychiatric, psychosocial, spiritual, and vocational assessment. Based on the information gathered during the assessment, we create a unique treatment plan, which may include: Individual, group, and family counseling, Cognitive behavioral therapy, Motivational (reward-based) therapy, Medication. […] About 8 million Americans living with substance use disorder has one or more co-existing psychiatric diseases, such as depression or anxiety. […] At NewYork-Presbyterian, our geriatric psychiatrists and other mental health care professionals with expertise caring for older patients offer experience and compassion. Using cognitive-based therapy, reward-based therapies, and other techniques, they target substance use along with any co-existing disorders to help our older patients achieve abstinence and recovery. […] Patients who come to The Haven for substance use treatment benefit from a comprehensive consultation, expert assessment, and discreet, compassionate care delivered by nationally recognized psychiatric specialists.
#1 Treatment for Alcohol Problems: Finding and Getting Help | National Institute on Alcohol Abuse and Alcoholism (NIAAA)
https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/treatment-alcohol-problems-finding-and-getting-help
Currently, there are three medications approved for AUD in the United States, and they are an effective and important aid in the treatment of people with this condition. […] Just like any other medical condition, people with substance use disorders deserve to have a range of treatment options available to them. […] Because AUD is a chronic, relapsing disorder, persistence is key. It is rare that someone would go to treatment once and then never drink again. […] Seeking professional help can prevent a return to drinkingâbehavioral therapies can help people develop skills to avoid and overcome triggers, such as stress, that might lead to drinking. […] When addressing drinking problems, it’s important to also seek treatment for any accompanying medical and mental health issues. […] Based on clinical experience, many health care providers believe that support from friends and family members is important in overcoming alcohol problems. […] Overcoming this disorder is not easy or quick.
#1 Treatment for Substance Use Disorder | Kaiser Permanente
https://healthy.kaiserpermanente.org/health-wellness/addiction-and-recovery/drug-and-alcohol-treatment
In some cases, our care teams prescribe medication to treat an underlying mental health condition, like depression or anxiety. […] Medication is typically used in combination with other treatment approaches, like therapy and self-care. […] The ultimate goal of treatment is recovery. […] Your care team can help you access recovery resources, including: […] 12-step programs like Alcoholics Anonymous and Narcotics Anonymous, as well as non-12-step support like SMART Recovery. […] Addiction medicine physicians are specifically trained in a wide range of prevention, evaluation, and treatment methods for helping people with SUD and addiction. […] Kaiser Permanente primary care physicians are trained to screen for possible alcohol misuse at every appointment and connect members who need support to addiction medicine specialists.
#1 Types Of Therapy For Alcoholism – Alcohol Help
https://www.alcoholhelp.com/treatment/types-therapy-alcoholism/
There are many effective, evidence-based treatment therapy options for alcoholism. Most rehab facilities will utilize some or all of following treatment methods. […] An inpatient or outpatient rehab program for alcoholism will offer a variety of treatment therapy options. […] Psychotherapy is the classic approach of having a conversation. […] In cases of psychotherapy for alcoholism, a psychologist might help a patient better understand and manage their cravings and stay motivated to achieve their sobriety goals. […] Psychotherapy acts as a roadmap for clinicians. […] Cognitive Behavioral Therapy (CBT) is a proven method for alleviating the burdens of alcoholism. […] Dialectical Behavioral Therapy (DBT) is another type of evidence-based talk therapy. […] Research has shown that DBT is effective for people who struggle with alcoholism and other substance abuse disorders.
#1 Comprehensive Treatment Options For Alcoholism – The Ridge Ohio
https://theridgeohio.com/alcohol-abuse/comprehensive-treatment-options-for-alcoholism/
The success rate of comprehensive treatment for alcoholism varies depending on a number of factors, including the severity of the addiction, the patients willingness to change, and the quality of the treatment program. However, studies have shown that comprehensive treatment can greatly improve the chances of long-term sobriety.
#1 Alcohol use disorder: Psychosocial management – UpToDate
https://www.uptodate.com/contents/alcohol-use-disorder-psychosocial-management
Brief intervention has been shown to be efficacious for unhealthy mild alcohol use disorder. […] Internet- or videoconference-delivered therapy has limited data supporting its efficacy for alcohol use disorder. […] Continuing care is a treatment model that emphasizes modifications in the intensiveness of treatment and monitoring as the illness waxes and wanes over time.
#1 Alcoholism Treatment & Management: Approach Considerations, Medical Care, Consultations
https://emedicine.medscape.com/article/285913-treatment
Frequent follow-up is essential to support the patient in recovery. The most common mistake physicians make is assuming too soon that the patient is stable. Ask patients about attendance at AA meetings and about their relationships with their sponsors. Less than 20% of patients remain abstinent for a full year. Among patients who have been sober for 2 years, the relapse rate is 40%. Patients who have been sober for 5 years are likely to remain sober, but they are still at risk for relapse. […] The key step for the patient is to realize that treatment does not end with sobriety. Recovery means that patients can handle the stresses of everyday life without alcohol. Therefore, the patient must develop and rehearse strategies to cope with high-risk situations. […] Successful recovery requires the patient to be able to do the following: Learn to say no to drinking in social situations. Handle heavy-drinking friends who will try to undermine the patient’s sobriety. Handle stress. (Patients should not ignore symptoms of anxiety.) Avoid boredom. (Prior to recovery, patients spent a great deal of time drinking or recovering from drinking. Upon abstinence, patients will have more free time.) Learn to get along again with family and close friends. (Family problems often increase when drinking stops.) Identify other situations that can lead to drinking and develop ways to cope with them.
#1 Alcoholism Treatment & Management: Approach Considerations, Medical Care, Consultations
https://emedicine.medscape.com/article/285913-treatment
When patients have the urge to drink, there are several techniques that can be used to deal with the situation, including (1) self-distraction (i.e. getting involved with an alternate activity that they enjoy), (2) thought stopping (i.e. patients should not dwell on thoughts of drinking but should stop these thoughts), (3) reprogramming (ie, patients should avoid activities that remind them of drinking), and (4) use of social support structure. The most common cause of relapse is failure to use coping strategies. […] If the patient has a relapse, find out what happened (make a diagnosis) in order to formulate a new treatment plan. […] The first step in treatment is brief intervention. The physician states unequivocally that the patient has a problem with alcohol and emphasizes that this determination stems from the consequences of alcohol in that patient’s life, not from the quantity of alcohol consumed.
#1 Psychiatry.org – What Is a Substance Use Disorder?
https://www.psychiatry.org/patients-families/addiction-substance-use-disorders/what-is-a-substance-use-disorder
Effective treatments for substance use disorders are available. […] A medical professional should conduct a formal assessment of symptoms to identify if a substance use disorder is present. […] Because SUDs affect many aspects of a person’s life, multiple types of treatment are often required. For most, a combination of medication and individual or group therapy is most effective. […] Medications are used to control cravings, relieve symptoms of withdrawal, and to prevent relapses. Psychotherapy can help individuals with SUD better understand their behavior and motivations, develop higher self-esteem, cope with stress, and address other psychiatric problems. […] A person’s recovery plan is unique to the person’s specific needs and may include strategies outside of formal treatment.
#1
https://atriumhealth.org/medical-services/prevention-wellness/behavioral-health/substance-use-disorder-treatment
Our aftercare treatment for substance use disorders includes: Education on recovery tools and preventing relapse, Introduction to additional community resources, Access to group meetings, where you receive support from others on the same journey, Instruction for the family in recovery, as substance use disorder impacts the entire family. […] A 12-step recovery program is a structured approach to addiction recovery that highlights mutual support and spiritual principles. Participants acknowledge the powerlessness over their addiction, surrender to a higher power and engage in self-reflection. The program involves attending meetings, working through steps that include personal inventory and making amends, and providing ongoing support to others in recovery. It aims to foster spiritual growth, accountability and a lifelong commitment to sobriety.
#1 Psychiatry.org – Alcohol Use Disorder
https://www.psychiatry.org/patients-families/alcohol-use-disorder
Alcohol use disorder (AUD) is when frequent or heavy alcohol drinking becomes difficult to control and leads to problems such as in relationships, work, school, family, or other areas. AUD is common and often goes untreated. There are treatments that work, including medication, therapies, and support/self-help groups. […] There are treatments that work. […] People can seek treatment and make changes at any point in their journey. […] Recovery is a process and may involve periods of remission and relapse. […] Evidence-based treatments including behavioral treatments (therapy/counseling), medication, and mutual support programs can play a major role in treating AUD. […] Behavioral treatments, therapy or counseling, can help people understand and change behaviors that lead to heavy drinking. […] Community-based peer support groups such as Alcoholics Anonymous and other 12-step programs are helpful for many people but are not a substitute for medication and therapy. […] The NIAAA Alcohol Treatment Navigator helps adults find alcohol treatment for themselves or an adult loved one.
#1 Pharmacotherapy for Adults With Alcohol-Use Disorders in Outpatient Settings | Effective Health Care (EHC) Program
https://effectivehealthcare.ahrq.gov/products/alcohol-misuse-drug-therapy/research-protocol
The Veterans Administration (VA), National Institute on Alcohol Abuse and Alcoholism (NIAAA), and Substance Abuse and Mental Health Services Administration (SAMHSA) all have guidelines addressing the use of pharmacotherapy for alcohol dependence. […] The treatment of alcohol dependence and the use of medications in the treatment of alcohol dependence are associated with uncertainty and variation across providers and settings. Many clinicians and treatment programs do not use medications for alcohol dependence despite evidence of efficacy, little evidence of harms, and FDA approval.
#1
https://link.springer.com/article/10.1007/s40265-021-01670-3
Alcohol use disorder (AUD) is a highly prevalent but severely under-treated disorder, with only three widely-approved pharmacotherapies. […] As such, there is a need to develop new, more effective, and diverse pharmacological treatment options for AUD with the hopes of increasing utilization and improving care. […] Overall, many repurposed and novel agents discussed in this review demonstrate clinical effectiveness and promise for the future of AUD treatment. […] However, there remains a great need to improve access to treatment, increase the menu of approved pharmacological treatments, and de-stigmatize and increase treatment-seeking for AUD. […] Although AUD is an important public health concern, the disorder remains severely under treated with only 7% of adults with AUD in the USA and less than 10% in Europe receiving pharmacotherapy and/or psychotherapy treatment.
#2 Millions of Americans Have Alcohol Use Disorder, but Few Get Treatment | The Pew Charitable Trusts
https://www.pewtrusts.org/en/research-and-analysis/articles/2024/06/06/millions-of-americans-have-alcohol-use-disorder-but-few-get-treatment
Not enough. We estimate that less than 10% of people who need treatment for AUD actually get it, and that only 2% access these FDA-approved medications. […] Unfortunately, because of the stigma associated with views about overdrinking and treating patients with AUD, in most cases there’s a long lag between when problems start to emerge with alcohol and the actual diagnosis and treatment. […] Clinicians need to view alcohol consumption as the fifth vital sign and screen for alcohol misuse and AUD. […] With the NIAAA treatment navigator, anyone can put their ZIP code in and find programs, doctors, and therapists in their area.
#2 Treatment for Alcohol Problems: Finding and Getting Help | National Institute on Alcohol Abuse and Alcoholism (NIAAA)
https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/treatment-alcohol-problems-finding-and-getting-help
Ultimately, there is no one-size-fits-all solution, and what may work for one person may not be a good fit for someone else. Simply understanding the different options can be an important first step. […] Behavioral treatments are aimed at changing drinking behavior through counseling. They are led by health care providers and supported by studies showing that these treatments can be beneficial. […] Three medications are currently approved in the United States to help people stop or reduce their drinking and prevent a return to drinking. These medications are prescribed by a primary care provider or other health care provider and may be used alone or in combination with counseling. […] Alcoholics Anonymous (also known as „AA”) and other 12-step programs provide peer support for people quitting or cutting back on their drinking. Combined with treatment led by health care providers, mutual-support groups can offer a valuable added layer of support.
#2 Managing Alcohol Use Disorder
https://www.uspharmacist.com/article/managing-alcohol-use-disorder
The initial goals of treatment of AUD should be agreed upon between the patient and the clinician and may include abstinence, reduction, or moderation of alcohol use, reduction of heavy drinking, or other harm-reduction strategies. […] The American Psychiatric Association recommends that patient-centered treatment plans for AUD should include nonpharmacologic and pharmacologic treatments. […] All patients with AUD should be encouraged to participate in some type of behavioral treatment, as it can help patients identify and change behaviors associated with drinking. […] Behavioral treatments help patients develop skills needed to minimize drinking, build strong social support systems, and cope with triggers that may cause them to return to use. […] There are three pharmacologic agents that are currently FDA approved for the treatment of AUD: naltrexone, acamprosate, and disulfiram.
#2 What is Medication-Assisted Treatment for Alcoholism? – CWC Recovery
https://www.cwcrecovery.com/blog/medication-assisted-treatment-mat-for-alcoholism/
Seeking professional treatment for alcoholism is a vital component to recovery as attempting to quit alcohol without medical intervention can lead to severe withdrawal complications and even death. […] The goal of medically assisted alcohol treatment is to ease the withdrawal symptoms in a safe environment in which the individual will be supervised around the clock by medical professionals. […] Individual and group therapy are key components of medication-assisted treatment programs for alcohol addiction. […] Effective MAT for alcohol use disorder and dependence include FDA approved medications such as Naltrexone, Vivitrol, Disulfiram, Benzodiazepines, and Acamprosate. […] This specific type of treatment addresses many of the obstacles that often lead to relapse while allowing clients to focus on the internal work required for recovery.
#2
https://link.springer.com/article/10.1007/s40265-021-01670-3
Therefore, there is a pressing need for the development of novel, diverse, and effective pharmacological treatment options for AUD with the hopes of increasing utilization and improving care. […] The focus of the current review is to summarize pharmacotherapies for AUD with a clinical perspective. […] This section briefly describes medications currently approved by agencies in many countries including the US FDA and EMA for the treatment of AUD: disulfiram, acamprosate, and naltrexone (oral and extended-release), as well as nalmefene, which is EMA-approved. […] Disulfiram is only recommended in the maintenance of abstinence; using this medication to reduce drinking is not advised. […] Acamprosate is recommended for the achievement and maintenance of complete abstinence, rather than for the reduction of drinking or prevention of relapse in the event of drinking.
#2 Alcohol use disorder: Pharmacologic management – UpToDate
https://www.uptodate.com/contents/alcohol-use-disorder-pharmacologic-management
The presence of advanced liver disease affects our choice of medication for alcohol use disorder: For Child-Pugh Class C (decompensated cirrhosis), we typically choose acamprosate as it is metabolized primarily through the kidneys. If acamprosate is ineffective or unavailable, topiramate or naltrexone may be used with extreme caution. Disulfiram is avoided. […] Topiramate is our preferred choice of medications in patients who have a co-occurring seizure disorder that would appropriately be treated with this agent. […] We are cautious when prescribing acamprosate to individuals with kidney dysfunction. Acamprosate is contraindicated in individuals with creatinine clearance â¤30 mL/min. […] We prefer psychosocial treatments, rather than medication management for pregnant individuals. There is a paucity of data on the safety of pharmacologic therapies for alcohol use disorder in pregnant individuals.
#2 Therapy for Alcoholism | Alcohol.org
https://alcohol.org/therapy/
Dialectical behavioral therapy (DBT) was initially developed to treat people with long-term suicidal behaviors, but it has become most well-known for treating borderline personality disorder, a mental health issue commonly associated with concurrent substance abuse. The technique has since been effectively applied to treating substance abuse itself. DBT ultimately aims to help patients improve their lives by synthesizing a balance between the urge to avoid painful experiences and the need to accept some of the unavoidable pain associated with life. DBT technique works through the promotion of two opposing goals change and acceptance. […] Motivational interviewing was developed to increase an individuals engagement with recovery efforts and is effective at reducing substance use. It builds on the stages of change, helping people move from thinking about making a change to actively working toward it. This form of therapy for alcohol abuse can be used alone or in conjunction with other therapeutic practices. Motivational interviewing is a short-term therapy that can be offered in individual and group settings.
#2 Psychedelic Drug Therapy May Help Treat Alcohol Addiction | NYU Langone News
https://nyulangone.org/news/psychedelic-drug-therapy-may-help-treat-alcohol-addiction
As research into psychedelic treatment grows, we find more possible applications for mental health conditions, says Dr. Bogenschutz. Beyond alcohol use disorder, this approach may prove useful in treating other addictions such as cigarette smoking and abuse of cocaine and opioids. […] He cautions that more work needs to be done to document psilocybins effects and to clarify appropriate dosing before the drug is ready for widespread clinical use.
#2 Pharmacotherapy for Adults With Alcohol-Use Disorders in Outpatient Settings | Effective Health Care (EHC) Program
https://effectivehealthcare.ahrq.gov/products/alcohol-misuse-drug-therapy/research-protocol
Over the past 15 to 20 years, awareness has grown that treatment may still be beneficial even if complete abstinence is not achieved. As a result, research has used other outcomes to measure the effectiveness of treatment, which can be subsumed under the concept of harm reduction. […] In clinical trials the FDA-approved medications have shown evidence for efficacy in enhancing abstinence, reducing relapse to heavy drinking, and reducing overall drinking behavior. […] Despite ongoing developments and advancements in treatment approaches, alcohol dependence represents one of the most undertreated disorders in the U.S. health care system; it is estimated that only 1 in 4 individuals with alcohol dependence receives treatment. […] The use of medications for alcohol dependence has had a very slow uptake into clinical practice, including primary care practices.