Alcohol Addiction Treatment: From Diagnosis to Sustainable Sobriety

According to the 2019 National Survey on Drug Use and Health (NSDUH), almost 15 million Americans over the age of 12 live with alcohol addiction. The 2019 NSDUH also reported that only 7.2% of Americans with alcohol addiction received any form of treatment in the past 12 months.1 While there are barriers to alcohol addiction treatment, many services exist to help those who struggle with alcohol misuse, dependence, and addiction find recovery.

How to Know if You Have Alcohol Addiction

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), identifies three levels of severity related to substance use: mild, moderate, and severe.2 These levels of severity help determine the right level of alcohol addiction care. Mental health professionals generally consider a person to have an addiction when diagnosed with severe substance use disorder (SUD).3

A significant body of research indicates the benefits of beginning treatment in the disorder’s early stages.4 If you have a mild or moderate SUD, you are at risk of developing a severe SUD without intervention.

There are 11 criteria to determine the severity of an SUD. These 11 criteria encompass 4 categories affected by substance misuse:2

  1. Impaired control
  2. Social problems
  3. Risky use
  4. Physical dependence

If you meet 2 of the 11 criteria for a substance use disorder, you have a mild SUD. If you meet 4-5 criteria, you have a moderate SUD. If you meet 6 or more criteria, you have a severe SUD.Your mental health provider evaluates the following criteria with you to determine the severity of your SUD:

  1. More use than intended—You have lost control of your intentions and use more of the substance, in quantity or duration of time, than you had planned.
  2. Attempts to stop use—You have been unsuccessful when you have tried to stop using the substance despite genuine desire to quit.
  3. Time involvement— You spend more time than you would like in activities that involve acquiring, using, or recovering from the substance.
  4. Negative impact on responsibilities— You are unable to fulfill your responsibilities at home, school, or work due to your substance use, and this has negatively impacted relationships and positions in these settings.
  5. Social and relationship problems—You have repeated problems in relationships caused by your use or due to the effect of the substance.
  6. Reduced activities—You have either significantly reduced or stopped enjoyable recreational, social (e.g., outings with friends, physical intimacy, etc.), and occupational activities you once enjoyed due to your use of the substance.
  7. High-risk behavior—You engage in behaviors that risk your safety or the safety of others related to your use. These behaviors can include driving under the influence, unprotected sex, and using alcohol to the point of blacking out.
  8. Continued use despite harm—You are aware that the substance is causing physical and psychological harm—for example, liver problems, damage to your organs, depression, or anxiety—yet you continue the use of the substance nonetheless.
  9. Craving—You crave the substance physically or psychologically.
  10. Tolerance—You must use an increasing amount of the substance to achieve the same effect.
  11. Withdrawal—You experience uncomfortable and painful withdrawal symptoms when you do not use the substance, and you take the substance to relieve these withdrawal symptoms.

Levels of Care of Alcohol Addiction Treatment

When you enter addiction treatment, a specialist assesses the appropriate level of care. Specialists make this determination through statistically validated assessments that identify the impact addiction currently has in your life.5 The more serious your health consequences and the more significant the risks in your life related to addiction, the higher level of care you need.

Additionally, the withdrawal symptoms associated with certain substances can be medically significant and even potentially life-threatening. Controlled medical care may be required to monitor vital signs and reduce your risk of relapsing. The American Society of Addiction Medicine has established five levels of care on a continuum.6

Level 4: Medically Managed Intensive Inpatient Care

Level 4 is the most intensive level of care, with medical and mental health staff available 24 hours a day. This level of care is right for you if you need medical detoxification with regular monitoring to ensure your medical stability.7

This level of care also serves people who are experiencing severe emotional and mental instability. Level 4 is often in a locked, controlled facility to support the person with addiction from leaving to use the substance to stop the withdrawal symptoms or from harming themselves or others.

The goal at this level of care is to keep you safe, support your medical and psychological stability, and encourage your transition to a lower level of care. Then the length of your stay at this level of care is dependent on medical factors involved in your detox, as well as your psychological stability.

Level 3: Clinically Managed Residential Services

The services at Level 3 can range in intensity. However, all of these services take place in an inpatient or residential setting with 24-hour support available. You live at the treatment site and participate in a daily regimented program. Activities of the program include group and individual therapy, lectures and classes on substance use and recovery, alternative addiction treatments such as yoga and tai chi, attending 12-step groups, and on-site recreational activities. You have minimal free time at this level of care, and receive regular medical and psychological support.

A physician may recommend this level of care if you have attempted outpatient treatment yet continue to deal with AUD.8  The goal in this treatment is to provide a controlled environment to focus on recovery. In addition, you learn tools to cope with triggers and prevent relapse and how to find sober activities and social networks. These tools support a step down into a lower level of care. The length of stay here is program-specific, but tends to range between 30 days and 90 days.

Level 2: Partial Hospitalization and Intensive Outpatient Services

Both partial hospitalization programs (PHP) and intensive outpatient programs (IOP) occur at a hospital, day treatment center, or behavioral health center. Like residential treatment programs, PHP and IOP services offer structured and regimented support through both group and individual counseling, activities, alternative addiction therapies, and lectures..

However, while attending a PHP or IOP, you live off-site. This level of care is the right fit for you if you have complex or co-occurring disorders but do not require medical detoxification or the 24-hour support available at higher levels of care.6 Additionally, PHP and IOP may be a step-down for those transitioning from inpatient care. You may live in a sober living environment while in an outpatient program.

Similar to Level 3, the goals at this level of care are to support and maintain sobriety, practice healthy lifestyle changes, encourage community involvement in recovery programs such as 12-step or SMART Recovery groups, teach life skills, develop a positive support network, and practice coping skills. In PHP, you spend 20 or more hours per week in the program. In IOP, you spend between 9 and 20 hours per week in the program.6

Level 1: Outpatient Care

Outpatient treatment is a good option for you if you have less severe symptoms of a SUD or are stepping down from a more intensive level of care. Outpatient care takes place nine or fewer hours per week and  allows you to continue with work, school, or other responsibilities.

You live off-site while receiving outpatient care. This level of care provides a connection to your support team to encourage accountability, fellowship, and practice of the skills you are learning. The goals at this level of care depend on what brought you into treatment. They typically include sobriety, life-skills training, anger management, assessments, and tending to the life challenges which led to substance use.6

Level 0.5: Early Intervention Services

In early intervention, you receive psychoeducation and assessment. Early intervention is appropriate for you if you are at risk of developing substance-related problems. Early intervention services might be right for you if you do not meet the  criterion for a substance use disorder diagnosis, or if you meet the criteria for a mild SUD. Risk factors that would indicate a need for early intervention include binge drinking or receiving a DUI.4

Additional Treatment Supports and Processes

While the five levels of care are one way of pursuing treatment for alcohol addiction, they are not the only way. Additional services are also available, often as supports for those transitioning out of intensive alcohol rehabilitation treatment.

Sober Living Homes

Sober living homes are a bridge between inpatient or residential treatment and returning to your day-to-day life. They offer structure and accountability in a sober environment.

In a sober living home, you have more freedom to practice the skills learned in inpatient treatment. You might decide to live in a sober living home while you’re attending PHP, IOP, or outpatient services. Some residents in a sober living home have a job while in treatment, while others focus solely on their treatment. Sober living homes are comprised of housemates in recovery, which can create comradery.9

Coordination of Care

Ideally, your care team coordinates with one another at each level of care. For example, your team discusses your diagnosis and the treatment methods that appeared to be beneficial for you at previous programs.

Additionally, your mental health providers may coordinate care with your medical team and vice versa. This coordination of care allows for a creation of a holistic treatment plan that is informed by your treatment, medications, diagnoses, and vulnerabilities to best support your sobriety.10

The Substance Abuse and Mental Health Service Administration (SAMHSA) defines recovery as:

“A process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential.”11

When you enter addiction treatment, you not only support your sobriety, but you tend to the challenges that led to your addiction in the first place. The right treatment can not only support sobriety but can increase the quality of your life overall.

To begin your path of recovery, call 800-839-1686Who Answers? 24/7 to find an alcohol addiction treatment program.

Resources

  1. National Institute on Alcohol Abuse and Alcoholism. (2021). Alcohol Facts and Statistics.
  2. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association Publishing.
  3. Hasin, D. S., O’Brien, C. P., Auriacombe, M., Borges, G., Bucholz, K., Budney, A., Compton, W. M., Crowley, T., Ling, W., Petry, N. M., Schuckit, M., & Grant, B. F. (2013). DSM-5 criteria for substance use disorders: recommendations and rationale. The American journal of psychiatry, 170(8), 834-851.
  4. Substance Abuse and Mental Health Services Administration (US); Office of the Surgeon General (2016). CHAPTER 4, EARLY INTERVENTION, TREATMENT, AND MANAGEMENT OF SUBSTANCE USE DISORDERS. Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health.
  5. Substance Abuse and Mental Health Service Administration. Appendix D Examples of Screening and Assessment Tools for Substance Use Disorders.
  6. Center for Substance Abuse Treatment. (2006). Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. Treatment Improvement Protocol (TIP) Series, No. 47. Rockville (MD): Substance Abuse and Mental Health Services Administration (US).
  7. Hays, L.R. (2006). A Review of: “Addiction Treatment Matching: Research Foundations of the American Society of Addiction Medicine (ASAM) Criteria. American Journal of Addictions, (15)3, 260.
  8. Mee-Lee, D. (Ed.). (2013). The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions. American Society of Addiction Medicine.
  9. Heslin K.C., Hamilton A.B., Singzon T.K., Smith J.L., & Anderson N.L.R. (2011). Alternative Families in Recovery: Fictive Kin Relationships Among Residents of Sober Living Homes. Qualitative Health Research, (21)4, 477-488.
  10. Institute of Medicine (US) Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders. (2006). Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series. National Academies Press.
  11. Substance Abuse and Mental Health Services Administration. (2020, April 23). Recovery and Recovery Support

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