Alcohol addiction treatment

Alcohol use disorder (AUD) is defined as a maladaptive pattern of alcohol consumption resulting in clinically significant impairment or distress. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a diagnosis requires the presence of at least two of the following criteria within a 12-month period. Severity is classified as:

• Mild. Two to three criteria present
• Moderate. Four to five criteria present
• Severe. Six or more criteria present

In the past year, an individual may meet diagnostic criteria if they have experienced:

• Recurrent episodes of consuming alcohol in larger amounts or over a longer duration than initially intended.
• Persistent desire or unsuccessful efforts to reduce or discontinue alcohol use.
• Significant time spent obtaining, consuming, or recovering from the effects of alcohol.
• Strong cravings or urges to consume alcohol.
• Recurrent alcohol use resulting in failure to fulfill major obligations at work, school, or home.
• Continued alcohol consumption despite persistent or recurrent social or interpersonal problems caused or exacerbated by drinking.
• Reduction or cessation of important social, occupational, or recreational activities in favor of alcohol use.
• Recurrent alcohol use in situations where it is physically hazardous, such as driving or operating machinery.
• Continued alcohol use despite knowledge of a persistent or recurrent physical or psychological problem likely caused or worsened by alcohol.
• Development of tolerance, defined by a need for markedly increased amounts of alcohol to achieve intoxication or desired effect, or a markedly diminished effect with continued use of the same amount.
• Presentation of withdrawal symptoms, such as insomnia, tremors, restlessness, nausea, diaphoresis, tachycardia, dysphoria, malaise, depressive symptoms, seizures, or perceptual disturbances, or use of alcohol to relieve or avoid withdrawal symptoms.

The presence of multiple criteria increases the likelihood of significant alcohol-related morbidity. Health care providers conduct a comprehensive assessment to determine the number, pattern, and severity of symptoms, and to guide the selection of appropriate evidence based treatments.

The diagnosis of alcohol use disorder (AUD) is based on established criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), in conjunction with a comprehensive clinical assessment performed by a qualified health care provider. This process evaluates the pattern, frequency, and consequences of alcohol consumption, as well as the presence of co occurring medical or psychiatric conditions.

A diagnostic evaluation typically includes:

• Detailed medical history and physical examination to identify alcohol-related problems, such as hepatic disease, cardiovascular complications, neuropathy, or other systemic effects.
• Laboratory testing to detect biochemical markers suggestive of chronic alcohol misuse, including elevated liver enzymes (AST, ALT, GGT), macrocytosis (MCV), or other metabolic abnormalities.
• Imaging studies when indicated to assess organ function or detect alcohol-related pathology, such as hepatic steatosis or cardiomyopathy.
• Mental health screening to evaluate for comorbid psychiatric disorders, such as depression, anxiety disorders, or trauma-related conditions, which may complicate alcohol treatment.
• Structured discussion of drinking habits including onset of alcohol use, quantity and frequency of consumption, high risk drinking behaviors, and any episodes of alcohol withdrawal.
• Collateral history from family members, when appropriate and with patient consent, to provide additional insight into drinking behavior and associated functional impairment.

Following assessment, the provider determines whether diagnostic criteria for AUD are met and assigns a severity level (mild, moderate, or severe). This classification informs the selection of evidence based treatments, which may include behavioral treatments, pharmacotherapy, or integrated care for co occurring disorders.

Management of alcohol use disorder (AUD) is individualized and informed by the severity of symptoms, the presence of co occurring medical or psychiatric conditions, and patient treatment preferences. The primary goals are to stop drinking or reduce alcohol use to safer levels, prevent relapse, and address alcohol-related health consequences. Evidence based treatments may be delivered across a continuum of care, ranging from outpatient services to medically supervised residential programs.

Core components of treatment include:

• Medical detoxification and withdrawal management to stabilize the patient and prevent complications associated with alcohol withdrawal. This may occur in an inpatient setting or, when appropriate, as part of a closely monitored outpatient program. Clinical staff provide continuous observation, administer medications to alleviate withdrawal symptoms, and intervene promptly if complications such as seizures or delirium tremens occur.
• Behavioral treatments such as cognitive behavioral therapy (CBT), motivational enhancement therapy (MET), contingency management, and relapse prevention strategies. These interventions aim to modify drinking behavior, address maladaptive thought patterns, and strengthen coping skills.
• Pharmacotherapy using FDA-approved medications for AUD, including naltrexone (oral or long-acting injectable), acamprosate, and disulfiram. Selection depends on the patient’s clinical profile, treatment goals, and potential contraindications.
• Treatment of co occurring mental health issues such as major depression, anxiety disorders, or post-traumatic stress disorder, using integrated care models that address both substance use and psychiatric conditions simultaneously.
• Mutual support groups, including Alcoholics Anonymous (AA), SMART Recovery, and other peer-led support groups, provide long-term recovery support, peer accountability, and community connection that can help reinforce treatment gains.
• Brief interventions for individuals who engage in hazardous or harmful drinking but do not meet full diagnostic criteria for AUD. These short counseling sessions, conducted by health care professionals, focus on personalized feedback, education, and goal setting.

In addition to these core elements, patients may access different levels of structured care based on clinical needs:

• Inpatient treatment programs provide 24-hour supervision in a structured, recovery-focused environment. Patients participate in individual therapy, group sessions, psychoeducation, relapse prevention training, and, when indicated, medication management. This immersive setting is beneficial for individuals who require separation from high-risk environments to achieve stabilization.
• Partial hospitalization programs (PHPs) deliver intensive day treatment that mirrors inpatient services but allows patients to return home or to supportive housing in the evenings.
• Intensive outpatient programs (IOPs) typically involve nine or more hours of programming per week, allowing patients to maintain work, school, or family responsibilities while receiving structured therapeutic support.
• Traditional outpatient programs (OPs) provide ongoing counseling, and recovery monitoring for individuals who are stepping down from higher-intensity services or have stable symptoms that can be managed with periodic professional oversight.
• Dual diagnosis treatment integrates substance use treatment with psychiatric care for individuals with co occurring disorders, improving long-term outcomes by addressing both conditions concurrently.

Treatment plans are reviewed and updated regularly to reflect clinical progress, emerging needs, and evolving recovery goals, ensuring a patient-centered approach that maximizes the likelihood of sustained remission.

There is no single cure for alcohol dependence, but most people can stop drinking or reduce heavy drinking through medications approved for alcohol use disorder (AUD), behavioral treatments, and mutual support groups. Participation in residential treatment programs, alcohol counseling, or talk therapy can help maintain recovery, manage stress, and support efforts to stop drinking. For those who struggle with heavy drinking, healthcare professionals can provide targeted interventions to help control alcohol use and change behavior.

Preventing misuse involves keeping alcohol intake within safer limits:

• Women. No more than 4 alcoholic drinks in one day or 8 per week.
• Men. No more than 5 alcoholic drinks in one day or 15 per week.

Those who regularly drink alcohol beyond these limits should consider quitting alcohol or reducing intake. A brief intervention from a primary care provider or other healthcare professional can include personalized feedback, education, and strategies for treating alcohol misuse before it develops into alcohol use disorder.

Recovery from alcohol dependence is an ongoing process that can include behavioral treatment, alcohol counseling, and support from family members. Mutual support groups such as Alcoholics Anonymous (AA), SMART Recovery and other structured support groups provide peer connections, accountability, and ongoing encouragement for individuals working to stop drinking and sustain recovery. Involving family members in therapy can improve communication and support treatment goals. Strategies to manage stress, maintain recovery, and quit drinking may include regular physical activity, healthy coping skills, and addressing any co occurring mental health condition.

Anyone with alcohol dependence, alcohol abuse, or related medical conditions should seek evaluation by a primary care provider or addiction specialist. Immediate medical care is essential if withdrawal causes unpleasant symptoms such as seizures, hallucinations, or confusion.

Treatment options may include medications approved for AUD—such as long acting injectable naltrexone for blocking opioid receptors—behavioral treatments, or residential treatment programs. Individuals interested in advancing treatment for alcohol use disorder may participate in clinical trials that study new approaches to treating alcohol, including novel medications and behavioral treatments.