By Mark L. Willenbring, M.D.

Summary

If you think you are addicted to alcohol, you can get help from your family physician.

When combined with brief counseling, the prescription medication naltrexone can be highly effective in treating alcoholism.

Treatment is more successful early in alcoholism's development than when the illness has been allowed to progress for years. Early treatment can reduce alcoholism's destructive impact.

Recent medical advances in the treatment of alcohol dependence (alcoholism) suggest that effective treatment may soon become much easier to obtain. Patients now have more choice, and health professionals have more tools to help them.

The first treatments for alcoholism involved group counseling and referral to community support groups, and took place in specialized treatment centers.

Although this type of treatment is effective, and is necessary for some people, researchers have developed new behavioral treatments (talk therapy) and new medications that people can get in many locations.

The National Institutes of Health found through a recent extensive study that a medication, naltrexone, when combined with brief counseling from a doctor or nurse, was as effective as up to 20 sessions of specialized alcohol counseling.

The best news of all was that most people improved a lot, and many were able to stop drinking completely.

FIVE THINGS TO KNOW

1. Almost one in 10 people in the United States experience alcohol dependence at some time during their lives.

Alcoholism occurs in both sexes, all ethnic and racial groups, and in people from all walks of life. It develops when someone drinks too much too often.

Drinking more than three drinks a day if you are a woman or four drinks if you are a man increases health risks, including risk for alcohol dependence. If you are concerned about whether you are drinking too much, discuss it with your doctor.

2. Alcoholism usually starts in the late teens or early twenties, yet most people don't seek help until 15- 20 years later.

Earlier treatment is more successful and results in far less destruction to individuals and their families.

Seek help if you keep going over your limit, can't quit or cut down on your own, continue drinking in spite of emotional, physical or social problems caused by drinking, or if your friends or family express concern. You don't have to wait for a crisis.

3. Only about one in 10 people with alcoholism ever receives professional treatment.

Recent research suggests that newer medications are effective treatments for alcohol dependence when combined with brief counseling by a health professional.

This means that many more people can receive treatment from their family, or primary care, doctor. Specialized alcohol counseling also works well, and all approaches (12-step, cognitive and motivational) are about equally effective. Some people will need more intensive programs.

4. Whatever treatment you receive, the most important thing is to stick with it. The longer you stay in treatment, the more likely you are to succeed.

If you have a relapse, recognize that this is a chronic disease, and try to get back on track as quickly as possible. If you are taking medication for alcohol dependence, be sure to take it as prescribed.

Do not discontinue it even if you don't notice feeling any different. The medicine is working if you are not drinking, or if you are drinking much less.

5. Twelve-step and other support programs really do work! Recovering people who attend groups on a regular basis do better than those who do not.

If you are taking medication for alcohol dependence, don't worry about whether it is a "crutch." Medication can improve recovery rates by 20-40% in the first three months after stopping.

Also, it's fine to take medication and to attend support groups or alcohol counseling.
 
FIVE QUESTIONS TO ASK YOUR DOCTOR

1. First, do some homework.

If you have access to the Internet, check out Frequently Asked Questions and other research-based materials at www.niaaa.nih.gov.

For a brief test for drinking problems, see also www.alcoholscreening.org.

Or look in your local bookstore or library for books on alcoholism. It also helps if you know something about what kinds of treatments are available and what kind you might want (counseling, medications, etc.).

Take this information with you when you see your doctor.

2. Let your doctor know you are concerned about your drinking, and why.

Ask whether she or he thinks you have alcoholism. If you drink a lot nearly every day, be sure to say so, because you may need treatment for withdrawal (sweating, tremor, anxiety, insomnia); quitting suddenly without treatment for withdrawal can be dangerous.

Don't be afraid to ask for such treatment.

3. Ask your doctor if she or he prescribes medications for alcohol dependence, such as naltrexone (tablets or monthly injections) or acamprosate.

These medications act to correct abnormalities in the brain caused by alcoholism and make it easier to quit. They are not addictive, nor do they make you sick when you drink.

Download and print a copy of the National Institute on Alcohol Abuse and Alcoholism publication Helping Patients Who Drink Too Much: A Clinician's Guide, and give it to your doctor available at www.niaaa.nih.gov/guide.

It has information about diagnosis and treatment of alcohol dependence, including medications. If you would like to try one of them, tell your doctor.

4. Find out whether you have any evidence of organ damage, such as liver disease, due to heavy drinking.

Ask your doctor to order appropriate tests to find out. If you have organ damage, ask whether it will get better if you quit drinking, and what might happen if you do not.

5. Be sure to mention if you are feeling depressed, suicidal or anxious.

If you are experiencing one or more of these feelings, ask your doctor whether additional treatment would be helpful. One example might be an antidepressant medication. Many people with alcohol dependence also have depression or anxiety.

If you would like a referral to a specialist, ask for one. You are more likely to stick with a treatment that you like.

Since there are several research-proven ways to help people recover (such as different counseling approaches, medications and support groups), you can select one that has the most appeal.

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