---

Alcohol Abuse and Alcoholism:

Self-Help, Prevention, and Treatment Options

What are the different treatment options for alcohol abuse or alcoholism?

There is no "one size fits all" treatment for alcoholism. Instead, there are many different treatments available that depend on the needs of the individual and the severity of the abuse. Treatments might include:

• Therapy to help understand their behavior and motivation and improve coping skills
• Medication to relieve withdrawal symptoms and control cravings
• Self-help and support groups.

Treatment can be provided in a variety of settings:

• Medical facility
• Residential setting (round-the-clock or half-way "sober living"house)
• Outpatient

Therapy

The three most commonly used behavioral treatments for alcoholism are:

• Motivation enhancement therapy
• Cognitive-behavioral therapy, and
• 12-step facilitation therapy

These treatment options have proven to be effective in reducing alcohol problems and fostering abstinence. One large-scale study found that each of these treatment modalities significantly reduced drinking in the year following treatment. The study also found that about one-third of the study participants who were followed up either were still abstinent or were drinking without serious problems three years after the study ended.

What are the differences between outpatient treatment and inpatient treatment programs for alcoholism?

Outpatient treatment

Outpatient treatment refers to treatment that does not require overnight stays in a facility. Treatment can include drug education, individual and group counseling, education groups for caregivers, and case management services. Outpatient treatment varies in the types and intensity of services offered. For example:

Night classes

• Allows a person to maintain a job
• Requires more personal self-management

Intensive outpatient day programs in hospitals

• For adults who requires continuity of treatment
• Becoming a common treatment option
• Typically 8-hour treatment sessions, including group therapy with emphasis on preventing relapse, managing stress, and communicating with family.

Inpatient treatment programs

Inpatient treatment programs involve a stay for detoxification, short-term (a few days to a few weeks), or longer term treatment (a few months to a year or more). They are the choice of treatment for those who:

• Lack healthy social networks
• Have not succeeded in outpatient programs
• Suffer from serious medical or psychological conditions

Inpatient facilities provide a structured environment, often based on the 12-step approach, and include alcohol education and different types of therapy (group, individual, and sometimes family or couples therapy). Inpatient treatment is generally in one of two settings:

• Residential sober-living treatment program
• Medical facility for alcoholics (especially when medications must be administered and closely monitored)

Inpatient and outpatient facilities have comparable success rates. The choice of institutional treatment program can be dictated by any of a number of factors, such as:

• Severity of dependence
• Availability of facilities
• Insurance coverage or financial aid
• Need for detoxification, methadone, or long-term treatment
• Factors such as age, pregnancy, young children, or need for other medical treatment
• Need for treatment in language other than English

One randomized study of patients entering employee assistance programs compared inpatient treatment combined with AA with referral to AA alone. This study found that inpatient treatment (a combination of professional treatment and AA) achieved better results for more people than AA alone. Inpatient programs are usually followed up with additional outpatient therapy and participation in AA, or other self-help group.

How do I find an appropriate alcohol treatment program?

The Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (CSAT) provides a toll-free, 24-hour treatment referral service to help you locate treatment options near you. For a referral to a treatment center or support group in your area, call: 1-800-487-4889 (TDD) • 1-877-767-8432 (Spanish).

The American Council on Alcoholism is a referal service for individuals seeking alcoholism treatment and recovery from their disease. They offer  treatment programs and support groups and a HelpLine (800) 527-5344.

The National Drug and Alcohol Treatment Referral Routing Service provides a toll-free telephone number, 1-800-662-HELP (4357), offering various resource information.

What are some questions to ask in choosing an alcohol treatment program?

1. Does the program accept your insurance? If not, will they work with you on a payment plan or find other means of support for you?
2. Is the program run by state-accredited, licensed and/or trained professionals?
3. Is the facility clean, organized and well-run?
4. Does the program encompass the full range of needs of the individual (medical: including infectious diseases; psychological: including co-occurring mental illness; social; vocational; legal; etc.)?
5. Does the treatment program also address sexual orientation and physical disabilities as well as provide age, gender and culturally appropriate treatment services?
6. Is long-term aftercare support and/or guidance encouraged, provided and maintained?
7. Is there ongoing assessment of an individual's treatment plan to ensure it meets changing needs?
8. Does the program employ strategies to engage and keep individuals in longer-term treatment, increasing the likelihood of success?
9. Does the program offer counseling (individual or group) and other behavioral therapies to enhance the individual's ability to function in the family/community?
10. Does the program offer medication as part of the treatment regimen, if appropriate?
11. Is there ongoing monitoring of possible relapse to help guide patients back to abstinence?
12. Are services or referrals offered to family members to ensure they understand addiction and the recovery process to help them support the recovering individual?

What kind of self help programs are available for overcoming alcohol addiction?

There are a number of self-help programs that help the alcoholic deal with addiction.

Alcoholics Anonymous

Founded by alcoholics Group meetings facilitated by members Meetings take place on a regular basis daily, at various times, and in many different locations around the world Attendance is voluntary, and membership is free Members are free to attend any of the many meetings held each week Includes support from fellow members who either are struggling or have struggled with the same problem Uses a buddy system ("sponsor") and group intervention to help members when they are tempted to relapse or do relapse Uses the 12-Step Program as guiding principles (developed by the earliest members of Alcoholics Anonymous; adopted and adapted to many other self-help programs) Abstinence-based personal recovery program from the substance or addictive behavior Person admits his or her powerlessness over the substance or behavior Turns his or her fate over to a higher power "as you understand it" Follows steps to examine the effects the behavior has had on his or her life, to accept responsibility for damage caused to others, and to make amends.

There are also several non-12-Step programs available, for those who have other interests, special needs, or who object to the "higher power" or "powerlessness" basis of AA:

Secular Organizations for Sobriety

A network of independent meetings with an alternative recovery method Promotes abstinence and provides support from others struggling with the same issues Encourages self-empowerment approaches to recovery for those who are uncomfortable with the spiritual content of AA Takes the approach that sobriety is a separate issue from religion or spirituality Credits the individual for achieving and maintaining his or her own sobriety, without reliance on any Higher Power

SMART Recovery

Aims toward abstinence, with focus on self-empowerment, self-reliance, and self-directed change Based on principles of Cognitive-Behavioral Therapy (CBT) Teaches specific tools and techniques within a 4-point program Enhancing and Maintaining Motivation to Abstain Coping with Urges Problem Solving (managing thoughts, feelings and behaviors) Lifestyle Balance (balancing momentary and enduring satisfactions)

Women for Sobriety

Founded in 1976, this is the only national organization focusing specifically on the needs of alcoholic women, whose recovery in AA was found to be less successful than for men. Premises and structure are: The psychological needs are different for women than for men Weekly meetings in small groups of 6-10 women, with a structured format for confidential discussion Based on thirteen positive statements to encourage emotional and spiritual growth, with emphasis on: Positive reinforcement (approval and encouragement). Cognitive strategies (positive thinking). Letting the body help (relaxation techniques, meditation, diet and physical exercise)

What help is available for the families of individuals with alcohol abuse problems?

The biggest obstacle to treatment of alcoholism is getting the alcoholic to break through the denial that is a hallmark of this condition - to realize that help is needed. The National Institute on Alcohol Abuse and Alcoholism suggests that you ask the following questions to help your loved one determine if he or she has a drinking problem:

• Have you ever felt you should cut down on your drinking?
• Have people annoyed you by criticizing your drinking?
• Have you ever felt bad or guilty about your drinking?
• Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

More than one "yes" answer means it is highly likely that a problem exists. If you think that someone you know might have an alcohol problem, it is important for him or her to see a doctor or counselor. A doctor or counselor can help determine if a drinking problem exists and plan the best course of action.

If a friend or family member has a drinking problem but is unwilling to get help, you can't force him or her to do so. However, many alcoholism treatment specialists suggest the following steps to help convince an alcoholic to get treatment:

• Stop all cover ups and other "enabling" behaviors (don't try to protect the alcoholic from the results of his or her drinking)
• Time your intervention (the best time to talk to the drinker is shortly after an alcohol-related incident has occurred)
• Be specific (use examples like the most recent incident to show how his or her drinking has caused problems)
• Explain to the drinker what you will do if he or she doesn't seek help (do not make any threats you are not prepared to carry out)
• Gather information about local treatment options (if the alcoholic is willing to get help, call immediately for an appointment with a treatment counselor)

For additional help, resources, and support:

• Learn as much as you can about alcoholism, addiction, treatment programs and the recovery process.
• Consider joining a self-help group for families of alcoholics, such as Al-Anon or CODA .You will meet others who are experiencing similar challenges and learn ways to cope.
• Once your family member is receiving treatment, continue to show your concern and express your support. Becoming alcohol-free takes effort, time and patience for both the addict and his/her loved ones.
• Take good care of yourself and expect challenging periods. Make efforts to create a healthier lifestyle for you and your loved ones, even if the abusing family member chooses not to get help.

How can I talk to my child about alcohol?

The National Institute on Alcohol Abuse and Alcoholism gives some practical strategies for bringing up the subject of alcohol use with your child:

• Encourage conversation. Encourage your child to talk about whatever interests him or her. Listen without interruption and give your child a chance to teach you something new. Your active listening to your child’s enthusiasms paves the way for conversations about topics that concern you.
• Ask open-ended questions. Encourage your teen to tell you how he or she thinks and feels about the issue you’re discussing. Avoid questions that have a simple “yes” or “no” answer.
• Control your emotions. If you hear something you don’t like, try not to respond with anger. Instead, take a few deep breaths and acknowledge your feelings in a constructive way.
• Make every conversation a “win-win” experience. Don’t lecture or try to “score points” on your teen by showing how he or she is wrong. If you show respect for your child’s viewpoint, he or she will be more likely to listen to and respect yours.
• Draw the line. Set clear, realistic expectations for your child’s behavior. Establish appropriate consequences for breaking rules and consistently enforce them.
• Offer acceptance. Make sure your teen knows that you appreciate his or her efforts as well as accomplishments. Avoid hurtful teasing or criticism.
• Understand that your child is growing up. This doesn’t mean a hands-off attitude. But as you guide your child’s behavior, also make an effort to respect his or her growing need for independence and privacy.
• 
  Heather Larson, John Dorsey, and Jeanne Segal, Ph.D., contributed to this article.
   

  ---