The treatment options available for alcohol misuse depend on whether your drinking is hazardous, harmful or dependent, and whether you are trying to drink less or give up drinking completely.
Hazardous drinking
If you are drinking hazardous amounts of alcohol, it is likely that you will 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 around 10 to 15 minutes and covers the risks associated with your pattern of drinking, advice on reducing the amount of alcohol you drink, alcohol support networks available to you and any emotional issues around your drinking.
You may be advised to keep a "drinking diary" so that you can record how many units of alcohol you drink a week. You may also be given tips on social drinking, such as alternating soft drinks with alcoholic drinks when you're out with friends.
Harmful drinking
If you are drinking harmful amounts of alcohol, you will first have to make the decision about whether you want to reduce your alcohol intake (moderation) or give up drinking alcohol altogether (abstinence).
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, although there are circumstances where abstinence is strongly recommended. These include:
- if you have liver damage, such as liver disease or cirrhosis
- if you have other medical problems that can be made worse by drinking, such as heart disease
- if you are taking medication that can react badly with alcohol, such as antipsychotics
- if you are pregnant or are planning to become pregnant
Abstinence may also be recommended if you have previously tried to achieve moderation and been unsuccessful.
If you choose moderation, you will probably be asked to attend further counselling sessions so that your progress can be monitored 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
As with harmful drinking, you will need to choose between moderation and abstinence. Abstinence will usually be recommended for people with moderate to severe dependency.
Whatever your level of alcohol dependency, it is recommended that you spend a period of time free from alcohol so that your body can 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 have 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 you have severe dependency, you may go to a hospital or clinic to detox as 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 between three and seven days from the time of your last drink.
You will also find that your sleep is disturbed. You may wake often 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, you should drink plenty of fluids – about three litres a day. However, avoid drinking a large number of caffeinated drinks, including tea or coffee, because they can make your sleep problems worse and cause feelings of anxiety. Water or fruit juice is a better choice.
Try to eat regular meals even if you are not feeling hungry. Your appetite will return gradually.
If you are taking medication to help ease your withdrawal symptoms, you should not drive or operate heavy machinery because the medication will probably make you feel drowsy. Only take your medication as directed.
Detox can be a stressful time. Ways that you can try to relieve stress include listening to music, going for a walk or taking a bath. Read more about stress management.
If you are detoxing at home you will regularly see a nurse or other health professional. This might be at home, your GP practice or at a specialist NHS service. You will 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 problems with alcohol. However, withdrawal is not an effective treatment by itself. You will be advised to undergo 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 certain treatment is not working for you, you can discuss alternatives with your care team or your GP.
Medication
There are several medications recommended by NICE to treat alcohol misuse:
Before being prescribed medication you will have a full medical assessment, including blood tests. 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 is 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 partially responsible for inducing a craving for alcohol.
If you are prescribed acamprosate, the course of medication will usually start as soon as you begin withdrawal from alcohol and can last for up to six months initially.
Naltrexone
Naltrexone is also used to prevent a relapse or limit the amount of alcohol someone drinks. It is usually used in combination with other medicine or counselling. It works by blocking the opioid receptors in the body, stopping the effects of alcohol.
If naltrexone is recommended for you, you should be informed that naltrexone will 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 for up to six months although it may sometimes be longer.
Disulfiram
Disulfiram (brand name Antabuse) is a medication that can be used if you are trying to achieve abstinence but are concerned that you may relapse, or if you've had previous relapses.
Disulfiram works by causing a series of very unpleasant physical reactions if you drink any alcohol to help deter you from drinking. This can include:
- nausea
- chest pain
- vomiting
- dizziness
As well as alcoholic drinks, it is 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
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 is important to maintain your abstinence during this time.
When taking disulfiram you will 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.
Counselling
Self-help groups
Many people with a dependence on alcohol find it useful to attend self-help groups, such as Alcoholics Anonymous.
Alcoholics Anonymous believes that alcoholic dependence is a long-term and progressive, incurable condition and that total abstinence is the only solution.
The treatment plan promoted by Alcoholics Anonymous is based on a 12-step programme that is designed to help you overcome addiction. It includes the following steps:
- You admit that you are powerless over alcohol and your life has become unmanageable.
- You recognise that you need a power greater than yourself to restore your strength
- You examine past errors in your life with the help of a sponsor (an experienced member of the group).
- You make amends for those errors
- You learn to live a new life with a new code of behaviour.
- You help others who have an alcohol dependence.
Read more about alcohol support.
Twelve-step facilitation therapy
Twelve-step facilitation therapy is based on the programme devised by Alcoholics Anonymous. The difference is that you work through the stages on a one-to-one basis with a counsellor, rather than as 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 emphasises 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 will be asked 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 a pub, club or restaurant
The therapist will teach you how to avoid certain triggers and how to cope effectively with those that are unavoidable.
Family therapy
Alcohol dependence doesn't just impact on an individual – it can also affect a whole family. Family therapy provides the opportunity for family members to:
- learn about the nature of alcohol dependence
- support the family member who is trying to abstain from alcohol
Help is also available for family members in their own right. It can be stressful living with someone who misuses alcohol and it can be helpful to receive support. Some specialist alcohol services provide support to family members as does AlAnon, an organisation affiliated to Alcoholics Anonymous.
Read more about the different types of talking therapies.
