Why is alcohol addictive? The physical and psychological factors and treatments
Table of content
- What makes alcohol addictive?
- What are the physical factors that make alcohol addictive?
- What are the psychological factors that make alcohol addictive?
- What are the health risks attributed to alcohol addiction?
- What are the different ways to treat alcohol addiction?
Alcohol is addictive because it acts directly on chemicals in the brain and changes how the brain works. The reward center in the brain, which is regulated by dopamine plays a major role in alcohol addiction. Alcohol produces pleasurable effects that make a person want more, which can lead to tolerance, dependence, and addiction.
The physical factors that make people addicted to alcohol include withdrawal symptoms, tolerance, cravings, dopamine release, and neurological changes. Psychological factors include stress, depression, anxiety, childhood trauma, and mental illnesses such as schizophrenia.
What makes alcohol addictive?
The influence on the brain’s communication pathways and neurotransmitters makes alcohol addictive. Alcohol consumption can affect the way the brain works, and it releases endorphins connected to reward processing. As a result, a person who drinks alcohol feels good and wants to keep drinking.
But, what is in alcohol that makes it addictive? Alcoholic beverages contain ethanol (alcohol) and water mostly. However, the liver metabolizes alcohol to a chemical called acetaldehyde. This chemical also occurs naturally in drinks such as beer, wine, and spirits. The National Institute on Alcohol Abuse and Alcoholism reported that acetaldehyde contributes to many behavioral effects of alcohol, particularly its stimulating properties. In their paper from the February 2017 issue of Frontiers in Behavioral Neuroscience, A. Brancato et al. confirms that acetaldehyde contributes to the psychoactive effects of alcohol through its own rewarding properties. This chemical mirrors the effects of alcohol on the brain, which is why it may contribute to the onset of alcohol addiction. The important role of acetaldehyde in the development of alcohol addiction was also reported in a paper that C.Y. Hahn et al. published in the July 2006 issue of JAMA Psychiatry.
While the answer to “is alcohol an addictive substance” is affirmative, not every person who drinks becomes addicted to it. The development of alcohol addiction involves a wide spectrum of factors that can be physical and psychological. These factors will be discussed in detail further in this post.
The development of alcohol addiction occurs in several stages, but the first stage is occasional abuse and binge drinking. According to the CDC, binge drinking is the most common and costly pattern of excessive alcohol use in the U.S. and it is defined as consuming five or more drinks on an occasion for men and four or more drinks on an occasion for women. It is not the same as heavy drinking, which refers to drinking 15 or more drinks a week for men and eight or more drinks a week for women. The second stage in the development of alcohol addiction is increased drinking i.e. when consumption of alcoholic beverages goes past the experimental stage and becomes more frequent. The third stage is problem drinking and it refers to frequent, uncontrolled alcohol abuse when a person starts experiencing the impacts of their habit. The fourth stage is alcohol dependence. At this point, a person is dependent on alcohol, but not addicted. In alcohol dependence, a person has developed a tolerance to alcohol and experiences withdrawal when not drinking.
The fifth stage is the actual addiction to alcohol, when a person no longer drinks for pleasure only, they have a physical and psychological need to drink. A person with alcohol addiction physically craves alcohol, which is why they drink when and wherever they want. Alcohol addiction also includes strong withdrawal symptoms.
What are the physical factors that make alcohol addictive?
Physical factors that make alcohol addictive are the effects of alcohol on the brain and body that contribute to a stronger urge to drink. Alcohol influences processes in the brain thereby changing how it works and contributing to a person’s need to keep consuming it. Physical factors that make alcohol addictive are listed below:
- Withdrawal symptoms
- Dopamine release
- Neurological changes
1. Withdrawal symptoms
Withdrawal symptoms are the physical and mental symptoms resulting from abrupt or sudden cessation of the use of an addictive substance such as alcohol or drugs. The symptoms are grouped into alcohol withdrawal syndrome. With alcohol withdrawal, a person with alcohol addiction may experience a combination of physical and emotional symptoms that range from mild to severe. Healthline explains that in its most extreme form, alcohol withdrawal can be life-threatening.
The importance of withdrawal symptoms is that they represent how severe alcohol addiction is and showcase the body’s attempt to cope without alcohol use. S. Jesse et al. explain in their paper from the September 2016 issue of Acta Neurologica Scandinavica that prolonged intake of alcohol results in tolerance and dependence, which may lead to compensatory functional changes through the downregulation of GABA (gamma-aminobutyric acid, a major inhibitory neurotransmitter) receptors and increased expression of NMDA (receptor of glutamate) with increased production of glutamate (excitatory neurotransmitter) to maintain homeostasis of neurotransmitters in the central nervous system. Sudden cessation of alcohol use unmasks these changes with a glutamate-mediated excitation of the central nervous system, which leads to autonomic reactivity and neuropsychiatric complications such as seizures and delirium. Neurotransmitter dopamine is also involved in withdrawal symptoms, which further shows the deep impact of alcohol on brain structure and function.
Withdrawal symptoms are a physical factor for alcohol addiction because, upon chronic and excessive intake, the central nervous system can no longer easily adapt to the absence of alcohol. When a person with alcohol addiction suddenly stops drinking or significantly reduces the amount of alcohol they drink, they are likely to experience withdrawal symptoms.
Signs and symptoms of alcohol withdrawal tend to appear anywhere from six hours to a few days after the last drink. The withdrawal symptoms generally include at least two of the following: anxiety, tremors, nausea and/or vomiting, headache, an increased heart rate, irritability, sweating, insomnia, confusion, high blood pressure, and nightmares. The withdrawal symptoms tend to be most intense two to three days after the last drink, but milder symptoms may persist for up to a few weeks.
The most severe form of alcohol withdrawal syndrome is delirium tremens, which is considered a medical emergency and includes symptoms such as extreme confusion, extreme agitation, fever, seizures, hallucinations, excessive sweating, fast respiration, increased heart rate, and high blood pressure.
Tolerance is when a person needs to increase alcohol intake because the current consumption doesn’t produce desired effects. Alcohol tolerance occurs with continued, regular drinking. A person with alcohol tolerance, the University of Toledo explains, requires a higher BAC than a non-tolerant individual to experience the pleasurable effects of alcohol. Here, BAC stands for blood alcohol concentration i.e. the percent of alcohol in the bloodstream. For that reason, a BAC of .10% indicates the blood supply contains one part of alcohol for every 1000 parts of blood. People tend to experience the effects of alcohol such as relaxation at BAC of .04% to .06%, as per Stanford University.
Tolerance is an important physical factor because it may facilitate the consumption of increasing amounts of alcohol. Alcohol tolerance is how the body responds to alcohol and its effects. As the body adapts, a person doesn’t feel the same way they hoped they would. When that happens, they may decide to drink more and more. It is a sign of problematic alcohol use and paves the way to alcohol dependence and addiction. Alcohol stimulates the activity of GABA while inhibiting glutamate thereby creating an imbalance between the two chemicals. However, the human brain needs stability and proceeds to raise glutamate activity internally. As the activity of these neurotransmitters is back in balance, the body decreases the effects of alcohol. With chronic and repeated use, which constantly generates an imbalance between glutamate and GABA, the more efficiently the brain restores the balance. In time, it takes more and more alcohol to maintain the same effect a person had when first started drinking.
Tolerance is a physical factor for alcohol addiction because it sends a message that a person has been drinking a certain amount of alcohol long enough so the body and brain stopped responding to it in an expected manner. According to Alcohol Alert by National Institute on Alcohol Abuse and Alcoholism, tolerance influences both drinking behavior and consequences through multiple mechanisms. These include functional and metabolic tolerance.
Functional tolerance refers to developing alcohol tolerance when the brain functions adapt to compensate for the alcohol-induced disruption in behavior and bodily functions. For example, chronic heavy drinkers exhibit functional tolerance when they experience evident signs of intoxication at BAC levels which in others would be incapacitating or fatal. Metabolic tolerance occurs when a person develops tolerance from a more rapid elimination of alcohol. This type of alcohol tolerance is linked to specific liver enzymes that metabolize alcohol and are activated by chronic alcohol use.
Cravings are an experience marked by a strong desire to drink alcohol. They are also referred to as urges and can be intense and powerful. In his paper “What is Craving” from the March 1999 issue of Alcohol Research and Health, Raymond F. Anton M.D. from the Medical University of South Carolina explained that many alcoholics, including those trying to achieve abstinence, experience alcohol cravings. These cravings may persist for an extended period of time. The same paper reported that alcohol cravings were first recognized as an integral component of alcohol dependence syndrome in 1955.
Cravings are an important physical factor in alcohol addiction because they contribute to substance-seeking and substance-using behaviors. When a person starts experiencing cravings for alcohol, it means their brain and body got used to the substance and can’t easily cope without it. Cravings are a sign of alcohol dependence and addiction. They are part of a vicious cycle where a person with alcohol addiction wants to stop drinking but is unable to resist cravings and starts drinking again.
Cravings are a physical factor for alcohol addiction due to several reasons and one of them is altered brain chemistry. Alcohol use affects neurotransmitters in the brain, which can lead to tolerance. However, these changes can also leave a person more sensitive to the effects of alcohol and increase the risk of withdrawal symptoms. Cravings are a major component of alcohol withdrawal. More precisely, the central feature in the development of alcohol dependence is the gradual, and potentially permanent, adaptation of brain function to the presence of alcohol. Long-term alcohol consumption interferes with brain functions. That happens because the body, especially the brain, strives for homeostasis (a balanced state), which is why nerve cells start adapting their activities in response to a long-term alcohol intake. The neuroadaptation causes specific characteristics of alcohol dependence or addiction such as tolerance and withdrawal. The brain’s reward system and neurotransmitters such as GABA and glutamate are also involved in the development of addiction and withdrawal symptoms including cravings.
4. Dopamine release
Dopamine release is an increased production and release of dopamine in response to a pleasurable activity. Dopamine is a neurotransmitter made in the brain and it is one of the feel-good chemicals that produces the sense of pleasure. Dopamine gives a person motivation to repeat activities that make them feel good. This neurotransmitter is in charge of the brain’s reward system, which is why it plays a major role in the development of addiction.
Dopamine release is important in alcohol addiction development because it regulates the reward system. At the same time, a person who drinks alcohol experiences pleasurable effects that they want to experience again. The desire to achieve the same effect leads to increased consumption of alcohol thereby paving the way to dependence and addiction.
Dopamine release is a physical factor in the development of alcohol addiction because chronic and heavy drinking influences this neurotransmitter directly. Changes in the dopamine system influence a person’s behavior. The paper “The Dopamine System and Alcohol Dependence” in the April 2014 issue of Shanghai Archives of Psychiatry explained that alcohol’s effects on dopamine release are dose-dependent. Alcohol withdrawal can also reinforce the model of alcohol-related changes in dopamine. The negative mood observed in alcohol withdrawal is associated with a decreased release of dopamine. This further confirms the major impact of alcohol on dopamine and how long-term drinking can affect this important neurotransmitter. Alcohol-induced increases in extracellular dopamine in the central nervous system and the amygdala play a role in alcohol preference.
Not only does alcohol affect dopamine release, but it also affects the functioning of dopamine receptors, particularly D2 and D1 receptors. The latter binds with excitatory proteins whereas D2 binds with inhibitory protein. In people with alcohol dependence, the density of D2 receptors is reduced. Lower density or sensitivity of dopamine receptors indicates a person needs to increase the use of a specific substance, in this case, alcohol, to experience desired effects.
5. Neurological changes
Neurological changes are changes in the structure and function of the brain, including specific regions in the brain or levels of chemicals such as neurotransmitters. Several factors can cause neurological changes. Good examples are injuries, health conditions such as Alzheimer’s disease, and mental illnesses such as depression, but they can also occur due to alcohol intake. This is particularly the case with long-term, heavy drinking.
Neurological changes are an important physical factor because they show how powerful alcohol can be. This substance can change how the brain works. These changes may further facilitate alcohol-seeking behavior and contribute to a vicious cycle of addiction.
Neurological changes are a physical factor for alcohol addiction because the consumption of alcohol generates a chain of complex reactions. A study by R. Daviet et al. in the March 2022 issue of Nature Communications revealed that alcohol consumption is negatively associated with global brain volume measures, regional gray matter volume, and white matter microstructure. Chronic alcohol use is particularly linked to changes in brain structure and connectivity. These changes mainly affect frontal, diencephalic, hippocampal, and cerebral structures. For that reason, people with alcohol addiction tend to have a lower gray matter volume than their counterparts who don’t drink. In their paper from the June 2017 issue of BMJ, A. Topiwala et al. reported that even moderate alcohol intake is linked to adverse brain outcomes, including brain shrinkage.
The effects of alcohol on the brain begin at the cellular level. Alcohol directly affects brain function in several ways, mainly by disrupting the activity of neurotransmitters such as GABA and glutamate. Neurological changes may also result from liver disease and vitamin deficiency, health problems that are common in people with alcohol addiction, according to a review by M. Oscar-Berman et al. in the January 1997 issue of Alcohol Health and Research World.
Alcohol acts on dopamine and the brain’s reward system, a relationship that is well-established in this post. However, these effects are more serious than most people assume. The June 2018 issue of Molecular Psychiatry published a study by S. Turton et al, which showed that the crucial part of the brain’s reward system is “blunted” in alcohol addiction, even after long periods of abstinence. That means in people with alcohol use disorder, fewer endorphins (feel-good chemicals) are released in the brain.
The negative effects of alcohol on brain functions involve problems with memory, speech, judgment, decision-making, problem-solving, and balance.
The December 2017 issue of the Spanish journal Gastroenterologia y Hepatologia published a paper by A. Planas-Ballve et al. who explained that the most serious neurological changes in alcohol addiction include the development of Wernicke’s encephalopathy and Korsakoff syndrome. Wernicke’s encephalopathy is an acute phase of Korsakoff amnesic syndrome indicated by problems acquiring new information or establishing new memories or retrieving previous memories. These neurological changes occur due to vitamin B1 deficiency, a major problem with long-term, heavy alcohol use.
What are the psychological factors that make alcohol addictive?
Psychological factors that make alcohol addictive are listed below:
- Depression: people with depression are two to three times more likely to develop alcohol use disorder, as reported by P. Yang et al. who published their paper in the May 2018 issue of Frontiers in Neuroscience. Individuals with depression tend to drink alcohol to cope with the depressive symptoms they experience. Alcohol addiction and depression have a bidirectional relationship, meaning one problem can increase the risk of developing the other.
- Stress: it becomes a psychological factor that makes alcohol addictive because alcohol use is a common coping strategy to reduce stress. A randomized controlled trial by E. McGrath et al. in the April 2016 issue of Psychopharmacology confirmed that stress increases alcohol consumption in heavy drinkers. Stress is involved in all levels of alcohol intake starting with facilitation of initial use to regular and excessive use. The use of alcohol may become a habitual response to stressful situations, which can further increase the risk of alcohol addiction.
- Anxiety: individuals with anxiety and other mental illnesses such as depression are more susceptible to developing alcohol addiction, reported S. Obeid et al. in their study from the February 2020 issue of BMC Public Health. Anxiety is a risk factor that makes alcohol addictive because people with these disorders could drink alcohol to cope with their symptoms. A good example is a social anxiety disorder. A person with this disorder may start drinking more to cope with the stress that comes with social interactions.
- Schizophrenia: people with schizophrenia are three times more likely to drink alcohol, WebMD reported. Alcohol serves as a way to cope with symptoms of psychosis or side effects of medications that patients with schizophrenia are using.
- Childhood trauma: people with a history of childhood trauma, such as those in war-exposed regions for over 30 days, are 5.3 times more likely to develop alcohol addiction, according to a paper that L. Wang et al. published in the January 2020 issue of BMC Psychiatry. Experiencing trauma in childhood may lead to emotion regulation difficulties, which play a major role in the development of alcohol addiction. In addition to childhood trauma, it is worth noting that trauma of any kind can contribute to post-traumatic stress disorder (PTSD) and increase the risk of alcohol addiction.
How do stress and anxiety contribute to the development of alcohol addiction?
Stress and anxiety contribute to the development of alcohol addiction because drinking becomes a coping mechanism. For people with anxiety disorders or major life stress, alcohol serves as a tool to deal with symptoms or emotions they experience.
Stress and anxiety may contribute to the development of alcohol addiction on a physiological level too. A good example is a higher level of stress hormone cortisol, which is also increased in patients with anxiety. Cortisol interacts with the brain’s reward system. As a result, this particular hormone contributes to reinforcing the effects of alcohol and motivates a person to keep drinking, according to the National Institute on Alcohol Abuse and Alcoholism. Additionally, stress increases the adrenal hormone glucocorticoid, which may increase drinking, as per a paper “Effects of Stress on Alcohol Consumption” from the April 2012 issue of Alcohol Research: Current Reviews.
The same issue of this journal also published a paper called “Anxiety and Alcohol Use Disorders” which showed that people with anxiety are more susceptible to alcohol dependence because they use it to self-medicate. More precisely individuals with anxiety attempt to relieve the negative consequences of these disorders by drinking alcohol to cope with symptoms. The same paper shows anxiety may contribute to alcohol addiction through a common-factor model are genetic factors and personality traits such as anxiety sensitivity.
What is the role of peer pressure in the development of alcohol addiction?
The role of peer pressure in the development of alcohol addiction is in the encouragement of alcohol-seeking behavior because drinking is socially acceptable. Peer pressure also contributes to early life use of alcohol i.e. drinking among adolescents.
V. Ivaniushina et al. published a study in the April 2021 issue of PLoS One and confirmed the influence of peer pressure on adolescent drinking behavior. The same paper showed adolescents adjust their drinking behavior to match the behavior of their friends. In fact, the chances of a teenager moving one unit closer to the mean level of alcoholic behavior of their friends are 76% higher than the chances they will not change their behavior.
Peer pressure isn’t present among adolescents only but among adults too. A good example is a study that H. Morris et al. published in the July 2020 issue of BMC Public Health. The study showed peer pressure to drink alcohol affects people across the lifespan and can be experienced as overt and aggressive or subtle and friendly. People who consume little to no alcohol are more likely to feel overt or aggressive forms of peer pressure. Peer pressure may lead to social isolation or a person gives in and starts drinking alcohol against their wishes. The same paper explains that social norms influence drinking behavior. For instance, in social groups, people may be required to keep up in order to fit in. As a result, they drink more than they would have liked to. Specific social situations can make it particularly difficult to resist peer pressure. Good examples are student initiation ceremonies and being a part of buying rounds in the pub or bar.
A mediation analysis of drinking motives by J. Studer et al. in the July 2014 issue of the International Journal of Drug Policy showed that peer pressure to misconduct was linked to increased alcohol use. The relationship between drinking outcomes and peer pressure was partially mediated by enhancement and coping motives. Peer pressure is associated with drinking motives which further leads to alcohol use.
How does a family history of alcoholism affect the likelihood of alcohol addiction?
A family history of alcoholism affects the likelihood of alcohol addiction because drinking can be a learned behavior and a person may have a genetic predisposition to develop alcoholism. Learned behavior refers to adopting alcohol drinking habits from family or people in social circles. A person who grew up in a household where alcohol consumption was common and accepted may also start drinking and develop an alcohol addiction. They may start drinking at an earlier age e.g. in adolescence. Children of individuals with alcoholism may have a difficult temperament and experience poor parenting. For that reason, they are at a higher risk of emotional distress and poorer academic performance, which increases the risk of affiliation with a deviant peer group and alcohol use, according to Chapter 3: Genetic and Psychosocial Influences in “Psychosocial Factors in Alcohol Use and Alcoholism” published in 2000.
As mentioned above, family history affects the risk of alcohol addiction through genetic predisposition. Indeed, alcohol addiction is a complex genetic disease and variations in a large number of genes contribute to the risk, according to a paper “Genetics and Alcoholism” from the August 2013 issue of Nature Reviews: Gastroenterology and Hepatology. Genes associated with susceptibility to alcohol addiction include ADH1B, ALDH2, GABRA2, CHRM2, KCNJ6, and AUTS2. The same paper reported that 45% to 65% of liability in alcohol addiction is due to genetic factors. It is important to mention here that genetics is an important risk factor for alcohol addiction, but not the only cause. People who carry variations in the abovementioned genes won’t automatically become addicted to alcohol. A combination of genetics and other factors (e.g. environmental influences) can increase one’s likelihood of developing alcohol addiction.
People with a family history of alcohol addiction may have differences in their brain structure compared to individuals without a family history of alcoholism, but this subject requires further research. According to a paper “Neurological Phenotypes Associated with a Family History of Alcoholism” from the January 2016 issue of Drug and Alcohol Dependence, people with a family history of alcohol addiction differ in amygdalar, hippocampal, basal ganglia, and cerebral volume. They also have both increased and decreased white matter integrity compared to their counterparts. The author of the paper, Anita Cservenka from the University of California, Los Angeles, reported that MRI studies have found altered inhibitory control and working memory-related brain response in youth with a family history of alcohol addiction. These findings suggest the neural markers of executive functioning could be linked to increased vulnerability to developing alcohol use disorder in people with a family history of alcoholism. Individuals with a family history of alcohol addiction also have brain activity differences in areas that participate in reward and emotional processing such as the nucleus accumbens and amygdala.
What are the health risks attributed to alcohol addiction?
Health risks attributed to alcohol addiction are listed below:
- Liver damage: liver metabolizes alcohol and flushes it out of the body, but it can’t keep up with excessive and heavy drinking. Every time the liver filters alcohol, a certain number of liver cells die. Although the liver has the potential to regenerate and produce new cells, heavy alcohol use impairs this ability and causes permanent liver damage. A person with alcohol addiction is at risk of developing alcohol-related liver disease, which develops in several stages. The first stage is alcoholic fatty liver disease i.e. accumulation of fats in the liver, which is a reversible condition if a person stops drinking alcohol. The second stage is alcoholic hepatitis, a potentially serious condition, indicated by inflammation of the liver. Inflammation occurs due to long-term alcohol intake. The third stage of alcohol-related liver disease is cirrhosis or scarring of the liver. This condition isn’t reversible, the UK’s NHS explained.
- Cardiovascular problems: long-term, heavy alcohol intake causes high blood pressure and increases the risk of heart failure and stroke. Johns Hopkins Medicine reports that excessive drinking can contribute to cardiomyopathy, a disease that makes it harder for the heart to pump blood to the rest of the body. People with alcohol addiction are also more susceptible to arrhythmia or irregular heartbeat.
- Weight gain: heavy alcohol intake is associated with excess body weight and higher body fat percentage, as per a paper by G. Traversy and Jean-Philippe Chaput in the January 2015 issue of Current Obesity Reports.
- Pancreatic damage: alcohol encourages the production of toxic substances in the pancreas, which eventually results in acute pancreatitis, inflammation, and swelling of blood vessels in the pancreas. Repeated episodes of acute pancreatitis lead to chronic pancreatitis. This happens because heavy alcohol use increases viscous secretions that block small pancreatic ducts and it contributes to premature activation of digestive and lysosomal enzymes within acinar cells (pancreatic cells), as per a post “Alcoholic Pancreatitis” by A. Klochkov et al. on the website of the National Library of Medicine, last updated in May 2023. Alcohol abuse increases the risk of pancreatic cancer as well, according to a study that Y.T. Wang et al. published in the March 2016 issue of BMC Cancer.
- Kidney damage: regular heavy drinking doubles the risk of chronic kidney disease, especially among people who smoke cigarettes too. According to the National Kidney Foundation, alcohol induces changes in function of the kidneys thereby impairing their ability to filter the blood. Additionally, alcohol impairs the ability of kidneys to regulate fluid and electrolytes in the body and contributes to dehydration, which also affects the kidneys.
- Digestive problems: alcohol use can inflame the lining of the stomach and cause nausea and heartburn. Heavy, long-term alcohol intake leads to even bigger problems such as ulcers and chronic inflammation in the stomach, esophagus, and gut. Other problems like difficulty digesting nutrients such as thiamine and vitamin B12 may also occur.
- Weakened immune system: alcohol intake makes it difficult for the immune system to defend the body against viruses and pathogens. In the lungs, alcohol causes damage to the immune cells and fine hairs whose main function is to clear pathogens out of the airway. Damage to those fine hairs and immune cells impairs the defense mechanism in the immune system and makes a person more susceptible to infections and diseases, including flu or the common cold.
What are the different ways to treat alcohol addiction?
Different ways to treat alcohol addiction are based on the severity of addiction and a patient’s individual needs. There is no “one size fits all” solution in the treatment of alcohol addiction. The most important step is to learn and understand different solutions and options. Different ways to treat alcohol addiction are listed below:
- Support groups
- Outpatient treatment
- Residential treatment
Medications are a form of pharmacotherapy, prescription drugs, that help treat alcohol use disorder. They are never the only treatment approach. Instead, they are used in combination with other strategies such as talk therapy and support groups, according to the Agency for Healthcare Research and Quality’s Effective Health Care Program. Medications used in the treatment of alcohol addiction include acamprosate (Campral), disulfiram (Antabuse), naltrexone (Revia, Vivitrol), and topiramate (Topamax, Trokendi XR, Qudexy XR).
Medications for the treatment of alcohol addiction work to rebalance chemicals in the brain that may be changed by long-term drinking, in the case of acamprosate and topiramate. They may also reduce cravings for alcohol (naltrexone mechanism of action) and cause unpleasant side effects when a person starts drinking alcohol (disulfiram mechanism of action).
The importance of medications for the treatment of alcohol addiction is that they provide additional support to a person who wants to achieve sobriety. Recovery is a challenging process, especially for individuals with severe addiction. Medications can help alleviate cravings and make withdrawal from alcohol more tolerable.
The process of using medications is quite simple; the most important thing is to adhere to the instructions provided by a doctor. Patients who get an acamprosate prescription need to take two pills three times a day. Disulfiram and naltrexone are taken once a day (one pill). Patients who get a topiramate prescription need to take one pill once or twice a day.
The length of medication treatment depends on specific pills. The duration of acamprosate treatment is for up to six months, but it can be longer if necessary. The length of disulfiram treatment is at least three months, but people generally need to take it for up to 12 months. The duration of topiramate treatment depends on the specific needs of each patient, it can be anywhere from six weeks to 14 weeks. Once a patient is ready to stop taking topiramate, they need to gradually reduce the dosage. The duration of treatment with oral naltrexone is three to four months.
The cost of medications depends on the strength, pharmacy, and it may vary in different locations. The cost of a one-month supply (180 tablets) of acamprosate is around $125 whereas 30 tablets are usually around $25 for 333mg. The cost of a disulfiram oral tablet of 250mg is about $46 for a supply of 30 tablets. The cost for a naltrexone oral tablet of 50mg is around $48 for 30 tablets. Finally, the price of topiramate 100mg tablet is around $18 for seven tablets or $424 for 60 tablets of 25mg.
Medications are effective in the treatment of alcohol addiction. For example, a meta-analysis by N.C. Maisel et al. in the February 2013 issue of Addiction found that acamprosate was more effective in promoting abstinence and naltrexone is more efficacious in reducing heavy drinking and craving. In a review that R. Guglielmo et al, published in the May 2015 issue of CNS Drugs, topiramate was described as a safe, well-tolerated, and effective medication for people with alcohol use disorder.
2. Support groups
Support groups are gatherings of people facing common issues to share what’s troubling them. They play an important role in recovery from substance abuse, including alcohol addiction. The most well-known support group for alcohol addiction recovery is Alcoholics Anonymous (AA), but there are many others including SMART Recovery, Women for Sobriety, LifeRing Secular Recovery, and Moderation Management.
Support groups work by allowing members to share their experiences with alcohol addiction and recovery. Members in support groups share their stories, ups, and downs, and offer support and encouragement to other members. They receive support and comfort from other members too. More precisely, support groups function by offering and receiving help. A person with alcohol addiction realizes they’re not alone, they can use someone else’s experience as a motivation to keep going and share their story so they can feel better or inspire other members.
The importance of support groups is that people feel less lonely or judged and they reduce distress, depression, and anxiety. Other benefits of support groups, according to Mayo Clinic, are improved skills to cope with challenges, a sense of empowerment, increased motivation, control, and hope.
Support groups don’t have a specific duration, people can attend the meetings for months or years after recovering from alcohol addiction. They serve as support for maintaining sobriety. The duration of meetings is about an hour.
Support groups such as AA generally have no membership fees. They may have a collection during the meeting to cover running expenses such as rent or coffee. Members are free to contribute as little or as much as they want.
Support groups are an effective strategy for the treatment of alcohol addiction treatment and could be more beneficial than cognitive behavioral therapy (CBT). Mutual help groups are effective for a broad array of people and are highly cost-effective, as per a paper by J.F. Kelly and J.D. Yeterian in the April 2011 issue of Alcohol Research and Health.
Detoxification (detox) is the process through which the body removes toxins or drugs, in this case, alcohol. It is the first step in alcohol addiction treatment and may lead to withdrawal symptoms.
Detoxification works through abrupt cessation of alcohol use. The brain and body start adjusting to the presence of alcohol in the body, which results in withdrawal syndrome. Detox is performed under medical supervision. Patients may receive medications to alleviate symptoms they experience.
The importance of detoxification is that it marks the beginning of recovery from withdrawal symptoms. Although a challenging time, detox is necessary to ensure there is no more alcohol in the system. It serves as a preparatory step for an alcohol addiction treatment program.
The process of detoxification includes a comprehensive review to understand the patient’s situation, administration of medications (if necessary), and providing medical and psychological therapies to help a patient reach a balance of mind and body.
Detoxification lasts from a few days to several weeks, depending on the severity of the addiction. Symptoms of withdrawal peak in two to three days after the last drink.
The cost of detoxification depends on a patient’s insurance coverage and the type of treatment program i.e. whether they are undergoing an outpatient or residential program. Outpatient programs are more affordable. Outpatient detox costs $1000 to $1500.
Detoxification is an effective strategy for achieving long-term abstinence, according to a paper that D. Quelch et al. published in the June 2019 issue of Future Healthcare Journal. More research is necessary to elucidate the full benefits of detox in alcohol addiction recovery.
4. Outpatient treatment
Outpatient treatment is a type of treatment for alcohol addiction that doesn’t require a patient to live in a rehab facility for a specific timeframe. It is most suitable for people with milder forms of addiction or patients who have completed an inpatient (residential) program and need more support to maintain sobriety.
Outpatient treatment works by providing patients therapy and support during addiction treatment while allowing them to retain employment or live in their own homes. These programs work by enabling patients to modify their lifestyles and incorporate treatment into daily life in order to recover successfully.
The importance of outpatient treatment is that it gives patients more flexibility and allows them to keep recovering from alcohol addiction in a real-world setting. Treatment is patient-centric and responds to the specific needs of each patient.
The process of outpatient treatment includes attending therapy sessions, which can be individual or in group settings. Outpatient treatment may also involve support groups and 12-step programs. Patients also receive stress management classes, relapse prevention classes, and alcohol refusal training.
Outpatient treatment lasts three to six months, depending on the severity of addiction. The intensive outpatient program includes attending services for three hours about three to five days a week. A partial hospitalization program generally takes five to six hours for five or six days a week.
The cost of outpatient treatment varies from one facility to another; it can go from $5000 for a three-month program to over $10,000.
Outpatient treatment is effective in treating alcohol addiction and studies such as the paper by M. Bottlender and M. Soyka in the March 2005 issue of European Addiction Research confirms this. The paper confirmed that outpatient programs yield a favorable outcome in people with alcohol addiction.
5. Residential treatment
Residential treatment is a live-in program for alcohol addiction and substance use disorders in a licensed treatment facility. It is also called inpatient treatment.
Residential treatment works by providing 24-hour supervision and monitoring in a non-hospital setting. Patients live in a rehab facility. Many of these facilities are located in peaceful locations such as near mountains or the seaside to provide a calming and stress-free environment to patients.
The importance of residential treatment is that it provides more structure and support to people with moderate to severe alcohol addiction. The residential treatment gives patients time to focus on themselves and get away from negative influences. Patients live in an alcohol-free environment where they are around people who are going through the same thing.
The process of residential treatment starts with detox. After detox, patients attend therapy sessions (individual or group therapy) and they learn skills necessary for successful recovery and sobriety. They also have chores and responsibilities that also assist their recovery process.
Residential treatment lasts for 30, 60, or 90 days depending on the patient’s needs or the severity of their addiction.
The cost of residential treatment depends on the rehab facility or location and a patient’s insurance coverage. The prices may go from $6000 up to $20,000 for a 30-day program. The cost for a 60- or 90-day program ranges from $12,000 to $60,000.
Residential treatment for alcohol addiction is effective, especially when it is long-term, according to a comparative study by L. Greenfield et al. in the August 2004 issue of The American Journal of Drug and Alcohol Abuse. The length of stay is a major determinant of effectiveness, the study showed.
How can behavioral therapies help individuals recover from alcohol addiction?
Behavioral therapies help individuals recover from alcohol addiction because they help them identify thought patterns and behaviors that lead to drinking. Once they identify negative patterns in thinking and behavior, patients work to change them with the therapist’s assistance. Behavioral treatments help patients with alcohol addiction develop the skills necessary to stop drinking, help build a strong social support system, set reasonable goals, and cope with or avoid triggers that may cause relapse, according to the National Institute on Alcohol Abuse and Alcoholism.
What role do holistic therapies play in treating alcoholism?
Holistic therapies play an important role in treating alcoholism because they treat a patient’s emotional, spiritual, and physical well-being at the same time. The main goal of holistic therapies is to bring spirit, body, and mind to alignment during the journey toward recovery. Holistic therapies include yoga, Tai Chi, guided meditation, massage therapy, acupuncture, art therapy, mindfulness-based therapies, animal-assisted therapy, and life skills development. Although more research on this subject is necessary, mindfulness-based treatment could reduce cravings and substance misuse, according to a paper that E.L. Garland and M.O. Howard published in the April 2018 issue of Addiction Science and Clinical Practice.