Alcohol & Drug Addiction

Alcohol use disorder (AUD) involves frequent or heavy alcohol drinking that becomes difficult to control and leads to problems such as in relationships, work, school, family, or other areas.

AUD is common and often goes untreated. There are treatments that work, including medication, therapies, and support/self-help groups.

People can seek treatment and make changes at any point in their journey — they don’t have to wait until alcohol has completely changed their life. They can also work toward a range of goals, from reducing drinking to complete abstinence.

Prevalence

• Alcohol use is common, 84% of adults ages 18 and older report drinking alcohol at some point in their lives. 1
• Among adults aged 18 and over, approximately 11% had AUD in the past year.1
• Among adults aged 18-25, approximately 15% had AUD in the past year; including 14% of full-time college students.2
• An estimated 3% of youth aged 12 to 17 had AUD in the past year.1
• One in 10 children live with a parent with AUD.3
• The rate of AUD is three to four times higher in close relatives of individuals with AUD.
• While most people who drink alcohol occasionally feel “drunk,” only a minority (less than 20%) ever develop alcohol use disorder.

Symptoms and Diagnosis

Alcohol use disorder involves a problematic pattern of alcohol use that leads to significant distress or problems functioning. Symptoms of AUD include:

• Drinking more alcohol or over a longer period than originally intended.
• Unsuccessfully trying to cut down or control alcohol use.
• Craving, or a strong desire or urge to use alcohol. (Wanting a drink so much it’s difficult to think of anything else)
• Drinking that interferes with responsibilities at home, at work, or at school.
• Continuing to use alcohol even when it causes problems with family and friends.
• Giving up important social, occupational, or recreational activities because of alcohol use.
• Repeatedly using alcohol in physically hazardous situations.
• Developing a tolerance to alcohol (needing more alcohol to get the same effect).
• Experiencing withdrawal symptoms such as shakiness, restlessness, nausea, or sweating after stopping or reducing drinking.

Having two or more of these symptoms in the last year could signal an alcohol use disorder.

Drinking, even small amounts daily and occasional intoxication do not by themselves make a diagnosis of alcohol use disorder.

Health impacts and consequences of alcohol use

• AUD is the 4th leading preventable cause of death in the U.S.4
• Repeatedly consuming large amounts of alcohol can affect nearly every organ system, especially the digestive system, cardiovascular system, and central and peripheral nervous systems.
• Gastrointestinal effects include “acid reflux/heartburn,” gastritis, and stomach ulcers. In about 15% of individuals who drink alcohol heavily, this can lead to liver cirrhosis and/or pancreatitis.
• AUD is associated with a significant increase in the risk of accidents and violence.5
• AUD is a contributor to suicide risk.
• Heavy drinking can also impact a person’s mood and may make depression harder to treat.

It is estimated that 40% of individuals in the United States experience an alcohol-related adverse event at some time in their lives. Alcohol accounts for up to 55% of fatal driving events.6

Binge drinking can also be problematic. Though definitions vary somewhat, binge drinking typically refers to when women have four or more drinks and men have five or more drinks within a couple of hours. (See more in NIAAA Glossary). Binge drinking is highest among young adults — about 29% of individuals ages 18 to 25 reported binge drinking in the past month.2

Treatment and Recovery

Less than 5% of individuals in the U.S. with a diagnosis of alcohol use disorder receive any treatment.1

Evidence-based treatments including behavioral treatments (therapy/counseling), medication, and mutual support programs can play a major role in treating AUD.

Talking with a primary care doctor or other health care clinician can be a great place to start.

• Recovery is unique to every individual. Some may choose to stop drinking altogether, while others may focus on reducing their drinking or limiting it in certain situations.
• Recovery is a process and may involve periods of remission and relapse.
• Support from family and friends is crucial for a person beginning a recovery journey.
• Forming a treatment plan with your doctor and tracking progress on that plan can greatly increase your chances of successfully recovering.

Medication

Medications are often used to treat AUD. There are three FDA-approved medications for AUD.

• Naltrexone - helps people reduce heavy drinking.

    More on naltrexone

What is Naltrexone?

Naltrexone is an FDA-approved medication that can help treat alcohol use disorder. It can help reduce alcohol cravings and support recovery. Below is an overview of how naltrexone works, who it can help, and what to consider when starting this treatment.

What is naltrexone and how do I take it? Naltrexone is one of three medications approved by the U.S. Food and Drug Administration for treatment of alcohol use disorder in adults. Naltrexone is not approved for use in children. Naltrexone comes as a once-daily pill (50mg) taken by mouth. (Brand name ReVia) It also comes as an extended-release intramuscular injection (380mg) that lasts 28 days. (Brand name Vivitrol) The extended-release injectable form of naltrexone is also approved for treatment of opioid use disorder. With the injection, patients only need to receive one injection every 28 days and do not have to take any naltrexone pills because the injected medicine will be released slowly over a month.

What is naltrexone used for?  Naltrexone has been shown to help patients reduce heavy drinking days and promote recovery. For patients whose goal is abstinence, naltrexone can help support them with this goal too. For some people who have strong cravings for alcohol or think about it all the time, naltrexone can help reduce the intensity of the cravings and thoughts.

What should I tell my healthcare provider? Before starting naltrexone, it is important to tell your healthcare provider all of the medications you are taking. You should not take opioid pain medications while you are taking naltrexone or in the week before starting naltrexone. Naltrexone is not approved for use in pregnancy. Be sure to tell your healthcare provider if you are pregnant, breastfeeding, or planning to become pregnant, because you will need to talk about the risks and benefits of taking naltrexone in this circumstance. Your healthcare provider may do a blood draw to check your liver function tests to make sure your liver is in good condition before starting naltrexone.

What are potential side effects of naltrexone? All medications may cause side effects. However, with naltrexone most people do not experience side effects or have only minor side effects. Possible minor side effects include stomach upset, nausea, vomiting, diarrhea and constipation. Other potential minor side effects are tiredness, muscle aches, and headache. For extended-release naltrexone, it is possible to have redness and tenderness at the site of the injection. These minor side effects tend to go away after a few days. If you experience these side effects and they do not go away after a week, contact your healthcare provider. A potential serious effect is liver problems. Signs of liver problems can include yellowing of the skin or eyes, dark urine, upset stomach, light colored stools, or decreased appetite. Tell your healthcare provider right away if you experience any of these symptoms.

How long do I need to take naltrexone? The optimal length of treatment with naltrexone will vary depending on the individual person. Some people take naltrexone for less than one year and others take it for many years. Talk to your healthcare provider about how long you should take naltrexone given your unique health history and your progress in treatment.

• Acamprosate - makes it easier to maintain abstinence.

    More on acamprosate

What is Acamprosate?

Acamprosate is an FDA-approved medication for the treatment of AUD. Acamprosate is usually taken as two 333 mg oral tablets (666 mg total per dose), three times daily. It works in the brain to decrease cravings and urges to use alcohol.

• Disulfiram - helps people avoid drinking and maintain abstinence. When a person taking disulfiram drinks alcohol, they experience unpleasant physical symptoms.

    More on disulfiram

What is Disulfiram?

Disulfiram is an FDA-approved medication for the treatment of AUD that discourages drinking by blocking the breakdown of alcohol in the body and creates a buildup of toxic alcohol-related compounds. Drinking alcohol while taking the medication causes the individual to become very sick, including throbbing headache, nausea and vomiting, confusion, sweating, a fast heartbeat, and chest pain. It is important to know that alcohol from any source has the potential to cause these symptoms, not just alcoholic beverages. It can be taken in doses of 250-500 mg oral tablets daily.

These medications are not addictive and can be used alone or in combination with therapy.

Behavioral treatments

Behavioral treatments, therapy or counseling, can help people understand and change behaviors that lead to heavy drinking. Counseling can involve:

• Developing skills to help stop or reduce drinking.
• Helping to build a strong social support system.
• Working to set reachable goals.
• Learning to cope with or avoid triggers that might lead to relapse.

Behavioral treatments can include therapies such as cognitive behavioral therapy, motivational enhancement therapy, marital and family counseling, brief interventions, and others. (See more on psychotherapy.)

Mutual Support

Community-based peer support groups such as Alcoholics Anonymous and other 12-step programs are helpful for many people but are not a substitute for medication and therapy

NAMI (National Alliance on Mental Illness) offers a variety of resources, support phone lines, support groups, and more for individuals and for family members.

SMART Recovery (Self-Management and Recovery Training) helps people learn the skills needed to overcome their addictions and change their lives. It provides mutual support meetings, offered online and in-person, and has specialized meetings and resources for a variety of communities, including family/friends, veterans, and more.

Moderation Management™ provides a non-judgmental, compassionate peer-support community for anyone who concerned about their drinking and wants to make positive lifestyle change.

Finding Treatment

The NIAAA Alcohol Treatment Navigator® helps adults find alcohol treatment for themselves or an adult loved one. The Navigator can help find programs, therapists, and doctors. It offers guidance on questions to ask and how to choose quality care.

For help finding treatment for adolescents, NIAAA recommends the resources available from the Partnership for Drug-Free Kids.

Note: If someone who has been drinking heavily for a long time stops suddenly, they can experience alcohol withdrawal. This can be dangerous and even life-threatening. Doctors can help make the process safer with medications to treat withdrawal symptoms. (NIAAA)

Support for Family and Friends

• Al-Anon and Al-Ateen – Support for people who are worried about someone with a drinking problem.
• Adult Children of Alcoholics/Dysfunctional Families - A Twelve Step, Twelve Tradition program of people who grew up in dysfunctional homes.
• NAMI (National Alliance on Mental Illness) – NAMI offers a variety of resources, support phone lines, support groups, and more for individuals and for family members.
• CRAFT: Community Reinforcement and Family Training
  CRAFT teaches family and friends effective strategies for helping their loved one to change and to feel better themselves. CRAFT works to affect the loved one’s behavior by changing the way the family interacts with him or her. It is a skills-based program that impacts families in multiple areas of their lives, including self-care, pleasurable activities, problem-solving, and goal setting. At the same time, CRAFT addresses their loved one’s resistance to change. More information: Center for Motivation and Change: https://the20minuteguide.com/; National Center for PTSD: Video about CRAFT.

Many people with AUD often hesitate to get treatment because they don't recognize that they have a problem and don’t know effective treatments are available. If you're concerned about someone’s drinking, ask your primary care health care professional or a professional experienced in alcohol treatment for advice on how to approach that person.

Source :- https://www.psychiatry.org/patients-families/alcohol-use-disorder