Recovering from Alcohol Addiction Without Medication

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Alcohol use disorder (AUD) is a chronic condition, and alcoholism treatment recommendations vary due to the complexity and co-morbid factors. However, alcoholism treatment typically includes a combination of interventions like individual therapy, group counseling, and family therapy.¹ Additionally, medication-assisted treatment (MAT) may be recommended depending on the severity of misuse, length of misuse, and any co-occurring disorders.²

In this article:

• What is Medication-Assisted Treatment?
• When Medication-Assisted Treatment is Recommended?
• When Medication-Assisted Treatment May Not Be Used
• Questions to Ask Your Provider About Alcoholism Treatment

What is Medication-Assisted Treatment?

Medication-assisted treatment (MAT) involves a combination of therapy and alcohol addiction treatment medications, helping you recover from alcohol use disorder by reducing cravings and protracted withdrawal as well as preventing relapse. Always speak to your doctor or treatment team to see if medication-assisted treatment is right for you and your recovery.

Medication-assisted treatment is a good option for many people looking to maintain long-term abstinence, though it may be best if you have moderate to severe alcohol use disorder, have distressing protracted withdrawal symptoms, or have a high risk of relapse.

Signs and symptoms of alcohol use disorder include:³

• Failing to reduce or control alcohol use
• Cravings for alcohol
• Drinking more or more often than intended
• Giving up or reducing important life activities due to alcohol use
• Experiencing interpersonal problems caused by alcohol use
• Developing a high tolerance to alcohol
• Experiencing withdrawal symptoms when abstaining from alcohol use
• Consuming alcohol despite physical or psychological problems caused by use
• Drinking alcohol in dangerous situations, such as while driving

Medications for Alcohol Use Disorder

Several medications have been approved by the Food and Drug Administration (FDA) for alcoholism treatment. Alcohol use disorder medications include acamprosate, disulfiram, and oral and extended-release injectable naltrexone.^2,4 While all these medications can be used for treatment for AUD, each one has a different function and may help an individual in various stages of recovery.⁵ These medications include:⁵

• Acamprosate: Acamprosate can be prescribed when you are dependent on alcohol but have abstained from alcohol use at the time of beginning treatment. It helps with the maintenance of sobriety by reducing protracted withdrawal symptoms like anxiety and depression.
• Disulfiram: Disulfiram is used if you are dependent on alcohol and are supervised by family members or in a treatment facility. This drug is meant to act as a deterrent to drinking and causes serious physical reactions when combined with alcohol.
• Oral naltrexone: Oral naltrexone is recommended for the treatment of alcohol addiction and dependence. This medication blocks the reward receptors in the brain for drinking and craving alcohol.
• Extended-release injectable naltrexone: Like oral naltrexone, the extended-release injectable naltrexone also blocks the reward receptors for alcohol. This medication is best used in an outpatient setting if you have been able to abstain from alcohol but are having a difficult time complying with medication.

Screening for medication-assisted treatment is crucial to help providers choose the appropriate medication for your stage of recovery and medical and psychological history.

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When Medication-Assisted Treatment is Recommended?

Research shows MAT is being underutilized for alcoholism treatment.⁵ The National Institute on Alcohol Use and Alcoholism reported that less than 4% of individuals eligible for medication-assisted treatment were actually prescribed.⁶

Utilizing medication-assisted treatment is generally recommended if you have stopped drinking and are having difficulties with intense cravings, protracted withdrawal symptoms, and previous relapses.

Also, further assessment for MAT is recommended if you have tried mental health treatment alone and not seen improvement in your alcohol use disorder, you have physical symptoms from excessive alcohol use (such as cirrhosis or vitamin deficiencies), you have reported one or more heavy drinking days in the past year, or if you have an AUDIT score of more than 8.<sup.5

When Medication-Assisted Treatment May Not Be Used

While the research shows that medication-assisted treatment can help in your alcoholism treatment, you may not require MAT or meet the qualifications for MAT. It might not be right for you if you:^5,7

• Are on opioid analgesics or sedative-hypnotics
• Have severe medical or psychiatric problems
• Have mild AUD symptoms
• Do not have co-occurring disorders
• Are medically stable
• Are breast-feeding or pregnant

Medication-assisted treatments may not be necessary where psychotherapies and/or support groups are working. Twelve-Step programs for recovery like Alcoholics Anonymous (AA) are one of the most widely used and available approaches to recovery. AA is not professional treatment, but it provides structure, guidelines, and significant social peer support, which has been shown to be beneficial in recovery. Additionally, no costs are associated with AA, and it is easily accessible with the opportunity for online meetings and availability many hours of the day, every day.¹

Evidence-based therapies may also benefit an individual seeking recovery. These include:¹

• Cognitive Behavioral Therapy (CBT): CBT helps a person with an addiction to figure out where their addictive behavior stems from and offers strategies for changing behaviors.
• Motivational Interviewing (MI) and Motivation Enhancement Therapy (MET): MI and MET focus on improving an individual’s motivation to change.
• Family-based approaches: These include Community Reinforcement Approach (CRA) and Community Reinforcement and Family Therapy (CRAFT), which focuses on social change in the environment.

Questions to Ask Your Provider About Alcoholism Treatment

Always discuss how medication-assisted treatment may or may not help you in your recovery. Your alcohol treatment team, which can consist of a primary care doctor, psychiatrist, and licensed mental health therapist, can help determine the best approach for your situation.

Questions you can ask your provider if medication-assisted treatment is right for you may include:⁵

• How does medication help treat alcohol use disorder?
• What can I expect from medication-assisted treatment?
• Which medication is best for me and my situation?
• How long it will take for the medication to begin working?
• What are the risks and benefits of the medication?
• How long can I expect to be on medication?
• What are potential contraindications with medications I’m already taking?
• Which side effects are common with the medication?
• What do I do if I use alcohol while taking medication?
• What side effects are dangerous?
• What are the plans for follow-up care?

Your treatment team may need to reassess whether medication for your alcohol use disorder is needed or if your medication needs to be adjusted. This may depend on your ability to maintain or abstain from alcohol, whether your symptoms or diagnoses change, or if any side effects occur.

Additionally, medication-assisted treatment may be recommended if you have been utilizing a combination of psychotherapy and support groups that is not sufficient in helping you maintain your sobriety.

Talk to a treatment support specialist at 800-948-8417 Who Answers? to discuss your alcoholism treatment options.

Resources

1. Mendola, A., & Gibson, R. L. (2016). Addiction, 12-step programs, and evidentiary standards for ethically and clinically sound treatment recommendations: What should clinicians do? AMA Journal of Ethics, 18(6), 646-655.
2. Substance Abuse and Mental Health Services Administration. Mat medications, counseling, and related conditions.
3. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association Publishing.
4. Substance Abuse and Mental Health Services Administration. (2021). Prescribing Pharmacotherapies for Patients With Alcohol Use Disorder. Advisory.
5. Substance Abuse and Mental Health Services Administration and National Institute on Alcohol Abuse and Alcoholism. Medication for the Treatment of Alcohol Use Disorder: A Brief Guide. HHS Publication No. (SMA) 15-4907. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2015.
6. National Institute on Alcohol Abuse and Alcoholism. (2021). Alcohol Facts and Statistics.
7. Lee, J., Kresina, T. F., Campopiano, M., Lubran, R., & Clark, H. W. (2015). Use of pharmacotherapies in the treatment of alcohol use disorders and opioid dependence in primary care. BioMed research international, 2015, 137020.