Alcohol misuse - Treatment 

Treating alcohol misuse 

Alcohol risks for over-60s

An expert explains alcohol's effects on the body and the risks of high alcohol consumption for older people.

Media last reviewed: 06/09/2013

Next review due: 06/09/2015

Drinking diary

If you're aiming to moderate your drinking, you may be asked to keep a 'drinking diary'.

On a daily basis, make a note of:

  • all alcoholic drinks you have had
  • what time you had them
  • where you were
  • how many units you drank (if unsure you can use the NHS unit calculator)

This will give you a good idea about how much alcohol you're drinking,  situations in which you drink and how you could start to cut down.

'My drinks diary shock'

When Patrick Greene kept a drinks diary for a week he was shocked to realise how much he was really drinking

The treatment options for alcohol misuse depend on whether your drinking is hazardous, harmful or dependent, and whether you're trying to drink less or give up drinking completely.

Increased-risk (hazardous) drinking

If you're drinking hazardous amounts of alcohol, it's likely you'll be referred to a short counselling session, known as a brief intervention. This may be following an alcohol-related accident or injury.  

A brief intervention lasts about 10-15 minutes and covers risks associated with your pattern of drinking, advice about reducing the amount you drink, alcohol support networks available to you and any emotional issues around your drinking.

Keeping a 'drinking diary' may also be recommended so you can record how many units of alcohol you drink a week. You may also be given tips about social drinking, such as alternating soft drinks with alcoholic drinks, when you're out with friends.

Higher-risk (harmful) drinking

If you're drinking harmful amounts of alcohol, you will first need to decide whether you want to reduce your alcohol intake (moderation) or give up drinking alcohol altogether (abstinence).

Harmful drinking is drinking more than the recommended weekly amount of alcohol (21 units for men and 14 units for women) and experiencing health problems directly related to alcohol.

Abstinence will obviously have a greater health benefit, although moderation is often a more realistic goal, or at least a first step on the way to abstinence.

Ultimately, the choice is yours but there are circumstances where abstinence is strongly recommended, including if you:

  • have liver damage, such as liver disease or cirrhosis
  • have other medical problems, such as heart disease, that can be made worse by drinking
  • are taking medication that can react badly with alcohol, such as antipsychotics
  • are pregnant or planning to become pregnant

Abstinence may also be recommended if you have previously tried to achieve moderation and have been unsuccessful.

If you choose moderation, you will probably be asked to attend further counselling sessions so your progress can be assessed and further treatment and advice provided if necessary.

You may also have regular blood tests so the health of your liver can be carefully monitored.

Dependent drinking

If you're dependent on alcohol (you feel unable to function without it), you will also need to choose between moderation and abstinence. Abstinence is usually recommended for people with moderate to severe dependency.

Whatever your level of alcohol dependency, it's recommended you spend time free from alcohol to allow your body to recover from its effects.

Detoxification

How and where you attempt detoxification will be determined by your level of alcohol dependency. In mild cases you should be able to detox at home without the use of medication because your withdrawal symptoms should also be mild.

If your consumption of alcohol is high (over 20 units a day) or you've previously experienced withdrawal symptoms, you may also be able to detox at home with medication to help ease withdrawal symptoms. A tranquiliser called chlordiazepoxide is usually used for this purpose.

If your dependency is severe, you may need to go to a hospital or clinic to detox. This is because the withdrawal symptoms will also be severe and are likely to need specialist treatment.  

Withdrawal symptoms

Your withdrawal symptoms will be at their worst for the first 48 hours. They should gradually start to improve as your body begins to adjust to being without alcohol. This usually takes 3-7 days from the time of your last drink.

You will also find your sleep is disturbed. You may wake up several times during the night or have problems getting to sleep. This is to be expected and your sleep patterns should return to normal within a month.

During detox, make sure you drink plenty of fluids (about three litres a day). However, avoid drinking large amounts of caffeinated drinks, including tea and coffee, because they can make your sleep problems worse and cause feelings of anxiety. Water, squash or fruit juice are better choices.

Try to eat regular meals even if you're not feeling hungry. Your appetite will return gradually.

Avoid driving or operating heavy machinery if you're taking medication to help ease your withdrawal symptoms. This is because it's likely the medication will make you feel drowsy. Make sure you only take your medication as directed.

Detox can be a stressful time. Ways you can try to relieve stress include reading, listening to music, going for a walk and taking a bath. Read more about stress management.

If you're detoxing at home you will regularly see a nurse or another healthcare professional. This might be at home, at your GP practice, or at a specialist NHS service. You'll also be given the relevant contact details for other support services, should you need additional support.

Withdrawal from alcohol is an important first step to overcoming your alcohol-related problems. However, withdrawal is not an effective treatment by itself. You'll need to further treatment and support to help you in the long-term.

Abstinence

Several treatment options are available for abstinence. These often differ in effectiveness depending on the individual, so if you feel that a particular treatment isn't working for you, you can discuss alternatives with your GP or care team.

Medication

A number of medications are recommended by the National Institute for Health and Care Excellence (NICE) to treat alcohol misuse. The three main ones are:

These medications are discussed in more detail below.

Acamprosate

Acamprosate (brand name Campral) is used to help prevent a relapse in people who have successfully achieved abstinence from alcohol. It's usually used in combination with counselling.

Acamprosate works by affecting levels of a chemical in the brain called gamma-amino-butyric acid (GABA). GABA is thought to be partly responsible for inducing a craving for alcohol.

If you're prescribed acamprosate, the course will usually start as soon as you begin withdrawal from alcohol and can last for up to six months.

Disulfiram

Disulfiram (brand name Antabuse) can be used if you're trying to achieve abstinence but are concerned that you may relapse, or if you've had previous relapses.

Disulfiram works by deterring you from drinking by causing unpleasant physical reactions if you drink alcohol. These can include:

  • nausea
  • chest pain
  • vomiting
  • dizziness

As well as alcoholic drinks, it's important to avoid all sources of alcohol because they could also induce an unpleasant reaction. Products that may contain alcohol include:

  • aftershave
  • mouthwash
  • some types of vinegar
  • perfume

You should also try to avoid substances that give off alcoholic fumes, such as paint thinners and solvents.

You will continue to experience unpleasant reactions if you come into contact with alcohol for a week after you finish taking disulfiram, so it's important to maintain your abstinence during this time.

When taking disulfiram you'll be seen by your healthcare team about once every two weeks for the first two months, and then every month for the following four months.

Naltrexone

Like acamprosate, naltrexone can also be used to prevent a relapse or to limit the amount of alcohol someone drinks. It works by blocking the opioid receptors in the body, stopping the effects of alcohol. It's usually used in combination with other medicine or counselling.

If naltrexone is recommended, you should be made aware that it will also stop painkillers that contain opioids, such as morphine and codeine, from working.

If you feel unwell while taking naltrexone, stop the medication immediately and seek advice from your GP or care team.

A course of naltrexone can last up to six months although it may sometimes be longer.

Before being prescribed any type of medication to help treat alcohol misuse you'll have a full medical assessment which will include blood tests.

Counselling

Self-help groups

Many people who have alcohol dependency problems find it useful to attend self-help groups, such as Alcoholics Anonymous (AA).

One of the main beliefs behind AA is that alcoholic dependence is a long-term and progressive condition and that total abstinence is the only solution.

The treatment plan promoted by AA is based on a 12-step programme designed to help you overcome your addiction. It includes the steps listed below.

  • Admitting you're powerless over alcohol and your life has become unmanageable.
  • Recognising you need a power greater than yourself to restore your strength.
  • Examining past errors in your life with the help of a sponsor (an experienced member of the group).
  • Making amends for those errors.
  • Learning to live a new life with a new code of behaviour.
  • Helping others who are also dependent on alcohol.

Read more about alcohol support.

Twelve-step facilitation therapy

Twelve-step facilitation therapy is based on the programme devised by AA (see above). The difference is that you work through the stages on a one-to-one basis with a counsellor rather than in a group.

Twelve-step facilitation therapy may be your preferred treatment option if you feel uneasy or unwilling to discuss your problems in a group setting.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is a talking therapy that uses a problem-solving approach to alcohol dependence.

CBT’s approach to alcohol dependence is to identify unhelpful and unrealistic thoughts and beliefs that may be contributing towards your alcohol dependence such as:

  • "I can't relax without alcohol."
  • "My friends would find me boring if I was sober."
  • "Just drinking one pint can’t hurt."

Once such thoughts and beliefs are identified, you'll be encouraged to base your behaviour on more realistic and helpful thoughts such as:

  • "Lots of people have a good time without alcohol and I can be one of them."
  • "My friends like me for my personality, not for my drinking." 
  • "I know I can't stop drinking once I start."

CBT also helps you to identify triggers that can cause you to drink such as:

  • stress
  • social anxiety
  • being in 'high-risk' environments, such pubs, clubs and restaurants

Your CBT therapist will teach you how to avoid certain triggers and how to cope effectively with those that are unavoidable.

Extended brief intervention

Extended brief intervention (EBI) is a one-to-one session with a healthcare professional, usually a doctor, nurse or counsellor. It takes the form of a motivational interviewing technique. The aim is to motivate people to change their behaviour by exploring with them why they drink in the way they do, and help them identify positive reasons for changing.

FRAMES is an acronym that’s often used to describe the components of a brief intervention. It stands for:

  • Feedback - on your risk of having alcohol problems
  • Responsibility - helping you take responsibility for change
  • Advice - providing clear advice when requested
  • Menu - explaining the options for change
  • Empathy - an approach that’s warm, reflective and understanding
  • Self-efficacy - helping you believe in your ability to change

Family therapy

Alcohol dependence doesn't just impact on an individual, it can also affect a whole family. Family therapy provides family members with the opportunity to:

  • learn about the nature of alcohol dependence
  • support the member of the family who is trying to abstain from alcohol

Support is also available for family members in their own right. Living with someone who misuses alcohol can be stressful, so receiving support can often be very helpful.

There are a number of specialist alcohol services that provide help and support for the relatives and friends of people with a dependence on alcohol.

For example, AlAnon is an organisation affiliated to AA and provides relatives and friends with help and support. Their confidential helpline number is 020 7403 0888 (10am-10pm, 365 days a year).

Read more about the different types of talking therapies.

For further information, see the latest NICE guidance about the diagnosis, assessment and management of harmful drinking and alcohol dependence (PDF, 2.72MB).

Page last reviewed: 17/10/2013

Next review due: 17/10/2015

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The 2 comments posted are personal views. Any information they give has not been checked and may not be accurate.

powellct said on 06 December 2013

While AA and 12-step programmes may be beneficial, the spiritual element does not suit many problem drinkers. Could you include a reference to SMART Recovery, please, as this is recognised by NICE as an alternative to AA/12-step.
Thanks.

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User764586 said on 25 October 2013

I went to rehab in Bournemouth over 12 years ago and am still sober now. The Providence Projects absolutely changed my life and I would recommend it to anyone.

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