Treatment of Alcohol Use Disorder | Psychiatry and Behavioral Health | JAMA | JAMA Network
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JAMA Patient Page
February 9, 2021

Treatment of Alcohol Use Disorder

Author Affiliations
  • 1University of Mississippi Medical Center, Jackson
  • 2University of Nebraska Medical Center, Omaha
JAMA. 2021;325(6):596. doi:10.1001/jama.2020.2012

Alcohol use disorder (AUD) is a disease that occurs when alcohol significantly impairs an individual’s health and functioning.

The severity of AUD ranges from mild to severe, and symptoms have the potential for recurrence and remission. No matter how severe the disorder is, individuals can benefit from treatment.

Diagnosis

To diagnose AUD, a doctor performs a face-to-face evaluation, assessment of symptoms, and review of medical history, and obtains information from family members if applicable. The doctor conducts a diagnostic evaluation for any co-occurring mental health conditions. People with AUD have a higher rate of anxiety and depressive disorders than those without AUD.

Treatment Planning

Treatment for AUD can vary depending on individual goals. In general, the goals of AUD treatment are to reduce and manage symptoms and improve health and functioning.

People commonly think of “rehab,” a 28-day residential program, for AUD treatment. However, most people do not need or benefit from 28-day residential treatment. Advances have led to evidence-based treatments that are less intensive and can be accessed through a primary care physician or mental health clinic. Components of effective treatment include medications and behavioral treatments, ideally in combination. Community mutual-aid groups such as Alcoholics Anonymous (AA) can also help support a person’s goals, but peer support groups are not meant to replace formal medical treatment.

Medication Treatment

Three medications have been approved by the US Food and Drug Administration for AUD. These medications are nonaddictive and are designed to help manage disease. Medication may not be effective or necessary for everyone with AUD, but as part of a personalized treatment plan, they can help an individual meet their goals.

  • Naltrexone has been proven to reduce heavy drinking days and help promote abstinence. It can also help manage cravings to drink for some people. It is a once-daily pill or once-monthly injection.

  • Acamprosate has been proven to reduce heavy drinking and maintain abstinence once someone is already sober. It can also help manage cravings in some people.

  • Disulfiram blocks the breakdown of alcohol in the body and causes unpleasant symptoms such as nausea if alcohol is consumed. These symptoms can help some people not to drink alcohol.

Nonmedication Treatments

Several evidence-based psychotherapy options exist for AUD. One is cognitive behavior therapy (CBT), which focuses on the relationships among thoughts, feelings, and behaviors to help manage urges and triggers. This therapy can also address co-occurring mental health conditions such as anxiety or depression.

There is no one-size-fits-all treatment that works for everyone. What is effective for one person may not be a good fit for someone else. The decision to get treatment is often more important than the type of treatment used.

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Article Information

Conflict of Interest Disclosures: None reported.

Sources: Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Dept of Health and Human Services; 2016.

National Institute on Alcohol Abuse and Alcoholism. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/treatment-alcohol-problems-finding-and-getting-help

Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). American Psychiatric Association; 2013.

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