Alcohol Abuse and Addiction:

Finding the road to recovery

How do I get started?

Feeling overwhelmed at this early stage in the game is very common. Once you’ve made the decision to make a change in your life you can attend a support group like Alcoholics Anonymous (AA), but when you’re ready to stop drinking, regardless of how much you drink, you need to consider your medical condition.

How do I determine how serious my problem with alcohol is?

Alcohol abusers, or problem drinkers, are people who clearly drink too much on a regular basis. Their alcohol use is self-destructive or can present a danger to others, but they are able to set limits and establish some measure of control over their drinking.

When alcohol abuse progresses to alcoholism, also called alcohol addiction and alcohol dependence, the drinker loses control of the amount they drink, and they cannot stop using alcohol despite the severe physical and psychological consequences of excessive drinking.

See Screening and testing for alcohol abuse for simple questions to determine your level of addiction.

 Alcoholism usually requires medical help

If you’ve never tried to quit drinking alcohol before, or you’ve tried to quit and have suffered from one or more withdrawal symptoms, then it’s recommended that you see a doctor. Withdrawal symptoms can include sweats, shakes, cravings, headache, nausea, vomiting, rapid heart rate, elevated blood pressure, seizures and delirium tremens which can be life threatening. It’s important to remember that trying to stop drinking alcohol on your own, without appropriate medical attention, can be dangerous.

A medical provider at an emergency room, free clinic, or detox facility can talk with you about your symptoms and drinking history to determine whether your problem with alcohol is abuse or dependence, and can determine whether you will need to be medically monitored during detoxification (detox). In some cases, if medically appropriate, detox can be done on an outpatient basis.

Group support programs for alcohol abuse

Alcoholics Anonymous

AA estimates that it serves more than 2,000,000 people worldwide in more than 114,000 groups. AA meetings are always free and are facilitated by fellow addicts, not health professionals or social workers. These participants have walked in your shoes and provide empathy and support to one another by sharing their stories and knowledge in applying the program principles. The only requirement for membership is a desire to stop drinking.

A list of the 12-steps is provided by 12-step.org. This approach helps you examine what effect your behavior has had on your life. Skipping ahead to Step 9, you’re asked to be willing to make amends to all persons you have harmed by your words or actions. When you get to this place in the process, remember to think about forgiving yourself which is an important part of your healing as well. 

The 12-step approach has a strong spiritual component in that the treatment recovery steps include admitting powerlessness over the addiction and surrendering to a “higher power,” which you can interpret according to your own beliefs.

It’s a program that promotes total abstinence which is achieved one day at a time.

Other group support programs

Group support programs call upon the alcoholic to take responsibility for their own life, while fostering self-acceptance and self-esteem. Each type of program encourages the individual to understand the dangers involved in prolonged drinking and provides the support needed during the recovery process to maintain sobriety and prevent relapse. There are many different types of alcohol support groups available. Check the internet for groups in your area. Here are examples of what you will find:

SMART Recovery®

Offers free online 90 minute meetings. Based on a four-point method that teaches self-empowering skills designed to help you become and stay motivated; cope with cravings; problem solve; and prevent relapse by achieving a balanced lifestyle

Secular Organizations for Sobriety/Save Our Selves (SOS)

SOS provides an alternative path for those who are uncomfortable with the spirituality of the 12-step programs. Check out their sobriety toolkit which includes: self-empowerment; achieving and maintaining sobriety through abstinence; avoiding people, places or things that are a danger to your sobriety; interrupting negative thoughts; taking action no matter how small it seems; and real time online chat meetings

Alcohol treatment programs

Types of treatment programs for alcohol addiction

Inpatient treatment
Medical detoxification	Admission to this level of treatment requires an assessment. Usually an appointment is necessary and there are many centers available 24 hours a day. If you have a serious problem you can also go directly to an emergency room   Usually involves a 3-5 day stay in a medically supervised detox treatment center. The program includes counseling, medications, and group sessions
Long-term residential programs	Usually involves a stay for a few months but it can last 12 months. These therapeutic communities are geared toward addicts with more severe problems who have had more than one relapse. There is an emphasis on group affiliation and counseling to prevent relapse

Outpatient programs
Partial hospitalization	This relapse prevention treatment program usually meets 3-5 days a week, 4-6 hours/day and is for people who require medical monitoring on an outpatient basis
Intensive Outpatient Program (IOP)	Usually meets 3 days a week, 2-4 hours/day. Insurance companies encourage attendance at IOPs. These relapse prevention treatment programs are scheduled around your work or school schedule
Counseling (Individual, Group, Couple or Family Therapy)	Talk therapy offers an opportunity for emotional healing through exploration and education. Looking at your issues from a different perspective can help to identify the root causes of your drinking, and can be beneficial in helping you  learn how to make more constructive choices in your life. Treatment is most effective when it occurs once a week. Sessions usually last 50 minutes There are many types of therapy and each therapist is different. The therapeutic relationship is important. If you don’t feel comfortable with one therapist, try another until you find the right connection

Role of medications to prevent relapse 

The following medications can help you stop drinking:

• Aversive drugs, most notably Disulfiram (Antabuse) is the oldest medication for fighting alcohol abuse. Disulfiram is a pill that is taken daily which makes you feel sick if you drink alcohol. It doesn’t reduce cravings or treat withdrawal symptoms.
• Anti-craving medications block the brain’s receptors for feeling pleasure. Naltrexone (Revia and Depade) is for people who have already stopped drinking. It is a pill taken once a day that helps maintain abstinence by reducing cravings.
• Acamprosate (Campral) is the newest medication on the market for people who have already stopped drinking. It is taken three times a day and reduces the physical and emotional discomforts people feel when they’re trying to stay sober. It helps restore a chemical balance in the brain and has been found to improve sleep difficulties. It doesn’t help with withdrawal symptoms.
• Short-term use of drugs that treat co-existing mood disorders such as depression or anxiety are sometimes also used.

Choosing an alcohol treatment program

Questions to ask

Obviously, the quality of care and the credentials of the caregivers who assist in recovery from alcohol addiction are of utmost importance. Questions to ask include:

• What type of accreditation or licensing does the program have? Several national accreditation agencies evaluate detox and aftercare facilities, checking whether they offer effective elements of treatment and a well-documented patient complaint process.
• Have there been studies to measure the effectiveness of the program's treatment methods? Treatment effectiveness is a new field of study, but treatment centers should at least have some statistics on their success rates, preferably from an objective external agency.
• What sort of aftercare program does the facility offer to prevent relapse? Intensive treatment requires follow-up, therefore, programs should offer a well-run aftercare program, with referrals to appropriate self-help groups. It’s important that a staff member collaborate with you to create a discharge plan before you leave detox.

How insurance companies can help

If you have insurance, call the number on the back of your medical I.D. card to access your mental health and substance abuse benefits, and obtain pre-authorization for services. Most insurance companies employ after-hours personnel to provide service 24 hours a day, seven days a week.  You can request to speak to a licensed care manager who will review your insurance benefits and provide you with information about your treatment options. They can also provide referrals to in-network facilities and mental health providers and tell you what your out-of-pocket costs will be including deductible and co-payment amounts.

I’m clean, is it over?

After detox a discharge planner will discuss your aftercare plans. Usually an Intensive Outpatient Program is recommended. They will locate a facility for you, confirm availability, and schedule your first appointment. Plan on attending a 12-step meeting or another type of support group the day after your discharge from detox. If you have any questions, this is the time to ask.   

Sample discharge plan

• Attend IOP three days a week for several weeks
• Go to 90 12-step meetings in 90 days and obtain a sponsor
• Surround yourself with people who can support your sobriety
• Keep a journal to identify triggers
• Exercise
• Eat nutritional meals and snacks
• Take medications as prescribed
• Pat yourself on the back for having the courage to face this challenge and implement change in your life

Life without alcohol

The road to recovery is not easy and it can sometimes feel overwhelming. From a medical standpoint drinking alcohol affects your brain chemistry. Once the alcohol has been cleansed from your system, it takes time for your body to readjust. Feelings that were masked by the alcohol will resurface, and when they do, you will need to do something different because you won’t have the alcohol to fall back on. Relapse prevention includes identifying triggers to drinking, learning more adaptive coping skills, and making better decisions when dealing with life’s challenges.

Your chances of staying clean improve if you are participating in a social support group like Alcoholics Anonymous, have a sponsor, and are involved in an Intensive Outpatient Program or individual therapy.  If you choose not to seek help from a treatment support group, chances are you’ll revert back to your old habits and relapse becomes more likely. An important thing to think about during the treatment process is how you perceive a relapse. If relapse occurs, it is more helpful to look at it as a normal part of the process, rather than a personal failure.

Related links for group support and treatment programs

Alcoholism group support programs

Support Groups and Meetings – Provides support group options ranging from Alcoholics Anonymous to non-12-step programs, with links to online directories of meetings. (American Council on Alcoholism)

Welcome to Alcoholics Anonymous – Homepage with information about the program and access to publications regarding alcohol addiction (Alcoholics Anonymous)

Welcome to SOS/Save Our Selves – Homepage with access to articles and meeting links for organization which is an alternate approach to sobriety without religious or supernatural beliefs (Secular Organizations for Sobriety)

SMART Recovery – Self-Management and Recovery Training (SMART) is a program that aims at abstinence from alcohol through self-empowerment and self-directed change. (SMART Recovery)

Alcohol treatment programs

Some Questions to Ask When Choosing an Addiction Treatment Program – Detailed list of points to consider when choosing a treatment program (pbs.org)

Substance Abuse Treatment Facility Locator – Searchable database for finding private and public alcohol and drug treatment facilities by location (U.S. Department of Health and Human Services)

Find Help Now – A database of more than 11,000 facilities nationwide that offer treatment for alcohol abuse, plus listings of AA and other support meetings (American Council on Alcoholism)

Deborah Cutter, Psy.D. and Jeanne Segal, Ph.D., contributed to this article. Last modified on: 1/24/08.