What is an alcohol use disorder?

An alcohol use disorder (AUD) is drinking that causes distress and harm. It is a medical condition in which you:

• Drink alcohol compulsively
• Can't control how much you drink
• Feel anxious, irritable, and/or stressed when you are not drinking

An AUD can range from mild to severe, depending on the symptoms. Severe AUD is sometimes called alcoholism or alcohol dependence.

What are the treatments for alcohol use disorder?

Most people with an alcohol use disorder can benefit from some form of treatment. Medical treatments include medicines and behavioral therapies. For many people, using both types gives them the best results. People who are getting treatment for AUD may also find it helpful to go to a support group such as Alcoholics Anonymous (AA). If you have an AUD and a mental illness, it is important to get treatment for both.

Some people may need intensive treatment for AUD. They may go to a residential treatment center for rehabilitation (rehab). Treatment there is highly structured. It usually includes several different kinds of behavioral therapies. It may also include medicines for detox (medical treatment for alcohol withdrawal) and/or for treating the AUD.

Which medicines can treat alcohol use disorder?

Three medicines are approved to treat AUD:

• Disulfiram causes unpleasant symptoms such as nausea and skin flushing whenever you drink alcohol. Knowing that drinking will cause these unpleasant effects may help you stay away from alcohol.
• Naltrexone blocks the receptors in your brain that make you feel good when you drink alcohol. It can also reduce your craving for alcohol. This can help you cut back on your drinking.
• Acamprosate helps you avoid alcohol after you have quit drinking. It works on multiple brain systems to reduce your cravings, especially just after you have quit drinking.

Your health care provider can help you figure out if one of these medicines is right for you. They are not addictive, so you don't have to worry about trading one addiction for another. They are not a cure, but they can help you manage AUD. This is just like taking medicines to manage a chronic disease such as asthma or diabetes.

Which behavioral therapies can treat alcohol use disorder?

Another name for behavioral therapies for AUD is alcohol counseling. It involves working with a health care professional to identify and help change the behaviors that lead to your heavy drinking.:

• Cognitive-behavioral therapy (CBT) helps you identify the feelings and situations that can lead to heavy drinking. It teaches you coping skills, including how to manage stress and how to change the thoughts that cause you to want to drink. You may get CBT one-on-one with a therapist or in small groups.
• Motivational enhancement therapy helps you build and strengthen the motivation to change your drinking behavior. It includes about four sessions over a short period of time. The therapy starts with identifying the pros and cons of seeking treatment. Then you and your therapist work on forming a plan for making changes in your drinking. The next sessions focus on building up your confidence and developing the skills you need to be able to stick to the plan.
• Marital and family counseling includes spouses and other family members. It can help to repair and improve your family relationships. Studies show that strong family support through family therapy may help you to stay away from drinking.
• Brief interventions are short, one-on-one or small-group counseling sessions. It includes one to four sessions. The counselor gives you information about your drinking pattern and potential risks. The counselor works with you to set goals and provide ideas that may help you make a change.

Is treatment for alcohol use disorder effective?

For most people, treatment for an AUD is helpful. But overcoming an alcohol use disorder is an ongoing process, and you may relapse (start drinking again). You should look at relapse as a temporary setback, and keep trying. Many people repeatedly try to cut back or quit drinking, have a setback, then try to quit again. Having a relapse does not mean that you cannot recover. If you do relapse, it is important to return to treatment right away, so you can learn more about your relapse triggers and improve your coping skills. This may help you be more successful the next time.

People often think there are only two places to get help for alcohol problems—Alcoholics Anonymous (AA) or residential rehab. But today there are more choices than you might expect.

Healthcare professionals now provide up-to-date treatments backed by science. Care is offered at different levels of intensity in a variety of settings. Many outpatient options allow people to maintain their regular routines and their privacy, too, if desired.

Two main components of professionally led treatment

Health care professionals provide two types of treatment for alcohol use disorder:

• Talk therapy. A licensed therapist can help people build coping strategies and skills to stop or reduce drinking. Treatment can include one-on-one, family, or group sessions.
• Medications. A primary care clinician or a board-certified addiction doctor can prescribe non-addicting medications. These can help people stop drinking and avoid relapse.

These two options can be used in combination and tailored to individual needs.

Four basic levels of care

There are four basic levels of care or intensity for alcohol treatment. These levels, as defined by the American Society of Addiction Medicine, include:

• Outpatient. Regular office visits for counseling, medication support, or both. See below for some "lower intensity" alternatives for outpatient care.
• Intensive outpatient or partial hospitalization. Coordinated outpatient care for complex needs.
• Residential. Low or high intensity programs in 24-hour treatment settings.
• Intensive inpatient. Medically-directed 24-hour services; may manage withdrawal.

How do you know which level is right for someone? A complete assessment of a person’s alcohol problems and complications provides guidance. See Why do different people need different options?

Three modern alternatives for "lower intensity" outpatient care

If a full assessment shows that lower intensity outpatient care is appropriate, you have several options. You can use the Navigator to find a high-quality, traditional outpatient program. And you can consider some new alternatives such as these, which can help maintain privacy and regular routines:

Do-it-yourself – build a custom care team.

If you have insurance coverage or other means to cover the costs, you can build your own care team. The Navigator can help you find therapists and doctors with addiction specialties to team with your primary care provider.

This combination can mirror the "active ingredients" of the best specialty programs. At the same time, it's a way to get higher quality, one-on-one care that maintains privacy. A mutual help group can be added if desired.

Telehealth—phone or video sessions.

In many states, insurance companies and Medicaid now cover “telehealth” services. These are phone or video sessions for talk therapy or medical care. They can be particularly useful in locations with few addiction health professionals. There are even accredited, all-telehealth alcohol treatment programs. Check with your insurance company about coverage.

The Navigator can help you find alcohol telehealth services:

• Find treatment programs here and filter for “telemedicine/telehealth.” Note: Since the pandemic, many programs have added telehealth services. If needed, search without the filter and call to check availability of telehealth services.
• Find therapists with addiction specialties here. Note: You’ll see a filter for “online/phone counseling” but it’s not necessary to use it. Most therapists listed are shifting to telehealth services. Contact therapists of interest to confirm.
• Find doctors with addiction specialties here and ask office staff whether they offer telehealth services.

eHealth options—online or mobile.

They include:

• A computer-based cognitive-behavioral therapy program, which any physician or licensed therapist can prescribe
• A digital self-help program
• A mobile tool to prevent relapse, used by some specialty treatment programs

Regardless of where or how you seek treatment, it's important to look for approaches that are “evidence-based.” This means the treatments are backed by large, well-designed studies.

In addition to professionally led treatment, many people benefit from mutual support groups. Here, too, are more options than people might expect. Groups can vary widely, so it's important to try different ones to find a good fit.

When it comes to alcohol treatment, there is no one-size-fits-all solution. What may work for one person with alcohol use disorder (AUD) may not be a good fit for someone else.

Individual routes to recovery

Depending on their situations, different people will have different routes to recovery.

How do you know what route is best? A complete assessment of a person's condition will suggest what specific type of treatment would be best for that individual.

The importance of a complete assessment by a health professional

A person with a drinking problem should be evaluated by a health professional—a therapist or medical doctor who has formal training in addiction treatment.

When doing an assessment, a health professional will usually ask about the areas listed below. All are important when deciding which types of treatment will provide the best support.

Individual factors for health professionals to assess

Alcohol and other drug use and previous treatment

• Drinking patterns or behaviors.
• Other substance use issues.
• Severity of alcohol or other drug problems.
• Prior treatment (if any) and how it went.

Other health issues

• Other medical or mental health conditions, such as diabetes or depression, that will need attention during treatment.

Living and social situation

• Amount of support from family and social network.
• Stability of living situation.
• Access to transportation.

Legal system issues

• Any drinking-related arrests, probation, or other legal issues that require coordination with the justice system or social services.

Other specialized needs

• Common examples include pregnant women, people for whom English is not their primary language, and people in safety-sensitive occupations, such as airline pilots, physicians, or law enforcement.

From assessment to treatment plan

Here's how a comprehensive assessment can help set a course of action:

• If the assessment finds that the person entering treatment has a less severe AUD, a stable living environment, supportive friends and family, access to transportation, and relatively good health, then outpatient treatment with one-on-one or group therapy may be a good option. Outpatient counseling allows a person to maintain much of his or her regular daily routine.
• If the assessment finds that the person has a more severe AUD, or unstable housing, or limited transportation, or few nondrinking peers, or has other health issues in addition to AUD, then he or she may benefit from extended time in a residential treatment program. Residential programs are also good for anyone who needs a more structured living environment with a predictable daily schedule. A person with significant health issues should consult his or her primary care doctor and might consider a hospital-based inpatient program where medical staff are available.

Finding an option that best fits your situation is what’s important.

Before you start searching, it's important to understand how treatment providers will charge for their services, what health insurance may cover, and other ways to pay.

How can I estimate treatment costs?

The cost of treatment can vary widely—it depends on the provider, the setting, the services offered, and your specific needs. Treatment providers should be able to help you understand:

• Costs for a typical course of treatment—and how long it might last.
• Accepted health insurance plans.
• Services usually covered by insurance versus those billed separately.
• Other ways to pay (cash or credit cards).
• Payment plans, if available.

When evaluating costs of different options, compare them "apples to apples":

• Individual providers—medical doctors and therapists—charge by the hour or for each office visit or therapy session.
• Addiction treatment programs—hospital inpatient, residential rehab, and outpatient programs—may charge by the day, week, or month, depending on the type of services received.

Keep in mind that the most expensive option is not always the best—but neither is the cheapest. Look for a balance between cost and quality when weighing your options.

What about health insurance?

Most health insurance covers some alcohol or drug treatment. Insurers may call this "behavioral health" coverage. You can contact the insurance company (call the number on the insurance card) or review the schedule of benefits to learn:

• What is covered:
  • Number of inpatient days and outpatient sessions.
  • Which medications, if any.
  • Any additional services.
• What the copayments (if any) will be.
• Whether the treatment options are limited to in-network providers, and who they are.

A note on health insurance for veterans: If the person needing treatment is a veteran or is covered by health benefits for veterans, the U.S. Department of Veterans Affairs (VA) can help you find VA services near you. Visit the VA Substance Use Disorder Program Locator to do your search.

Are there other options for people with limited financial resources?

For people with limited financial resources to pay for alcohol treatment, here are a few suggestions:

• Look into eligibility for Medicaid, which provides health insurance for people who do not have other resources. In most states, Medicaid will cover some form of addiction treatment.
• Contact your local or State health departments to inquire about treatment services. Start with this Directory of Local Health Departments. If you need additional options, try contacting your State agency for substance abuse services.
• Look for therapists or programs that offer payment assistance or a sliding fee—these terms mean that the cost of treatment can be adjusted to meet the person's ability to pay. This makes the same treatment available at a reduced cost.
• Consider paying for one session with a health professional who can conduct an assessment and recommend next steps. This may cost up to a few hundred dollars.
• Ask therapists whether they offer a free brief consultation for new clients. While this isn't treatment, it could be a good opportunity to learn what a course of treatment might involve, and then you could better estimate what it might cost.

When Is It Time for Treatment?

Alcohol-related problems—which result from drinking too much, too fast, or too often—are among the most significant public health issues in the United States.

Many people struggle with controlling their drinking at some time in their lives. More than 14 million adults ages 18 and older have alcohol use disorder (AUD), and 1 in 10 children live in a home with a parent who has a drinking problem.

Does Treatment Work?

The good news is that no matter how severe the problem may seem, most people with AUD can benefit from some form of treatment.

Research shows that about one-third of people who are treated for alcohol problems have no further symptoms 1 year later. Many others substantially reduce their drinking and report fewer alcohol-related problems.

Signs of an Alcohol Problem

Alcohol use disorder (AUD) is a medical condition that doctors diagnose when a patient’s drinking causes distress or harm. The condition can range from mild to severe and is diagnosed when a patient answers “yes” to two or more of the following questions.

In the past year, have you:

• Had times when you ended up drinking more, or longer than you intended?

• More than once wanted to cut down or stop drinking, or tried to, but couldn’t?

• Spent a lot of time drinking? Or being sick or getting over the aftereffects?

• Experienced craving—a strong need, or urge, to drink?

• Found that drinking—or being sick from drinking—often interfered with taking care of your home or family? Or caused job troubles? Or school problems?

• Continued to drink even though it was causing trouble with your family or friends?

• Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?

• More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?

• Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?

• Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?

• Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating? Or sensed things that were not there?

If you have any of these symptoms, your drinking may already be a cause for concern. The more symptoms you have, the more urgent the need for change. A health professional can conduct a formal assessment of your symptoms to see if AUD is present.

Options for Treatment

When asked how alcohol problems are treated, people commonly think of 12-step programs or 28-day inpatient rehab but may have difficulty naming other options. In fact, there are a variety of treatment methods currently available, thanks to significant advances in the field over the past 60 years.

Ultimately, there is no one-size-fits-all solution, and what may work for one person may not be a good fit for someone else. Simply understanding the different options can be an important first step.

Types of Treatment

Behavioral Treatments

Behavioral treatments are aimed at changing drinking behavior through counseling. They are led by health professionals and supported by studies showing they can be beneficial.

Medications

Three medications are currently approved in the United States to help people stop or reduce their drinking and prevent relapse. They are prescribed by a primary care physician or other health professional and may be used alone or in combination with counseling.

Mutual-Support Groups

Alcoholics Anonymous (AA) and other 12-step programs provide peer support for people quitting or cutting back on their drinking. Combined with treatment led by health professionals, mutual-support groups can offer a valuable added layer of support.

Due to the anonymous nature of mutual-support groups, it is difficult for researchers to determine their success rates compared with those led by health professionals.

Starting With a Primary Care Doctor

For anyone thinking about treatment, talking to a primary care physician is an important first step—he or she can be a good source for treatment referrals and medications. A primary care physician can also:

• Evaluate a patient’s drinking pattern

• Help craft a treatment plan

• Evaluate overall health

• Assess if medications for alcohol may be appropriate

Individuals are advised to talk to their doctors about the best form of primary treatment.

Types of Professionals Involved in Care

Treatments Led by Health Professionals

Professionally led treatments include:

Medications

Some are surprised to learn that there are medications on the market approved to treat alcohol dependence. The newer types of these medications work by offsetting changes in the brain caused by AUD.

All approved medications are non-addictive and can be used alone or in combination with other forms of treatment.

Behavioral Treatments

Also known as alcohol counseling, behavioral treatments involve working with a health professional to identify and help change the behaviors that lead to heavy drinking. Behavioral treatments share certain features, which can include:

• Developing the skills needed to stop or reduce drinking

• Helping to build a strong social support system

• Working to set reachable goals

• Coping with or avoiding the triggers that might cause relapse

Types of Behavioral Treatments

• Cognitive–Behavioral Therapy can take place one-on-one with a therapist or in small groups. This form of therapy is focused on identifying the feelings and situations (called “cues”) that lead to heavy drinking and managing stress that can lead to relapse. The goal is to change the thought processes that lead to alcohol misuse and to develop the skills necessary to cope with everyday situations that might trigger problem drinking.

• Motivational Enhancement Therapy is conducted over a short period of time to build and strengthen motivation to change drinking behavior. The therapy focuses on identifying the pros and cons of seeking treatment, forming a plan for making changes in one’s drinking, building confidence, and developing the skills needed to stick to the plan.

• Marital and Family Counseling incorporates spouses and other family members in the treatment process and can play an important role in repairing and improving family relationships. Studies show that strong family support through family therapy increases the chances of maintaining abstinence (stopping drinking), compared with patients undergoing individual counseling.

• Brief Interventions are short, one-on-one or small-group counseling sessions that are time limited. The counselor provides information about the individual’s drinking pattern and potential risks. After the client receives personalized feedback, the counselor will work with him or her to set goals and provide ideas for helping to make a change.

Ultimately, choosing to get treatment may be more important than the approach used, as long as the approach avoids heavy confrontation and incorporates empathy, motivational support, and a focus on changing drinking behavior.

What FDA-Approved Medications Are Available?

Certain medications have been shown to effectively help people stop or reduce their drinking and avoid relapse.

Current Medications

The U.S. Food and Drug Administration (FDA) has approved three medications for treating alcohol dependence, and others are being tested to determine whether they are effective.

• Naltrexone can help people reduce heavy drinking.

• Acamprosate makes it easier to maintain abstinence.

• Disulfiram blocks the breakdown (metabolism) of alcohol by the body, causing unpleasant symptoms such as nausea and flushing of the skin. Those unpleasant effects can help some people avoid drinking while taking disulfiram.

It is important to remember that not all people will respond to medications, but for a subset of individuals, they can be an important tool in overcoming alcohol dependence.

Scientists are working to develop a larger menu of pharmaceutical treatments that could be tailored to individual needs. As more medications become available, people may be able to try multiple medications to find which they respond to best.

“Isn’t taking medications just trading one addiction for another?”

This is not an uncommon concern, but the short answer is “no.” All medications approved for treating alcohol dependence are non-addictive. These medicines are designed to help manage a chronic disease, just as someone might take drugs to keep their asthma or diabetes in check.

Looking Ahead: The Future of Treatment

Progress continues to be made as researchers seek out new and better treatments for alcohol problems. By studying the underlying causes of AUD in the brain and body, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) is working to identify key cellular or molecular structures—called “targets”—that could lead to the development of new medications.

Personalized Medicine

Ideally, health professionals would be able to identify which AUD treatment is most effective for each person. NIAAA and other organizations are conducting research to identify genes and other factors that can predict how well someone will respond to a particular treatment. These advances could optimize how treatment decisions are made in the future.

Current NIAAA Research—Leading to Future Breakthroughs

Certain medications already approved for other uses have shown promise for treating alcohol dependence and problem drinking:

• The anti-smoking drug varenicline (marketed under the name Chantix) significantly reduced alcohol consumption and craving among people with AUD.

• Gabapentin, a medication used to treat pain conditions and epilepsy, was shown to increase abstinence and reduce heavy drinking. Those taking the medication also reported fewer alcohol cravings and improved mood and sleep.

• The anti-epileptic medication topiramate was shown to help people curb problem drinking, particularly among those with a certain genetic makeup that appears to be linked to the treatment’s effectiveness.

Tips for Selecting Treatment

Professionals in the alcohol treatment field offer advice on what to consider when choosing a treatment program.

Overall, gather as much information as you can about the program or provider before making a decision on treatment. If you know someone who has first-hand knowledge of the program, it may help to ask about his or her personal experience.

Here are some questions you can ask that may help guide your choice:

• What kind of treatment does the program or provider offer?
  It is important to gauge whether the facility provides all the currently available methods or relies on one approach. You may want to learn if the program or provider offers medication and if mental health issues are addressed together with addiction treatment.

• Is treatment tailored to the individual?
  Matching the right therapy to the individual is important to its success. No single treatment will benefit everyone. It may also be helpful to determine whether treatment will be adapted to meet changing needs as they arise.

• What is expected of the patient?
  You will want to understand what will be asked of you in order to decide what treatment best suits your needs.

• Is treatment success measured?
  By assessing whether and how the program or provider measures success, you may be able to better compare your options.

• How does the program or provider handle relapse?
  Relapse is common, and you will want to know how it is addressed.

When seeking professional help, it is important that you feel respected and understood and that you have a feeling of trust that this person, group, or organization can help you. Remember, though, that relationships with doctors, therapists, and other health professionals can take time to develop.

Additional Considerations

Treatment Setting—Inpatient or Outpatient?

In addition to choosing the type of treatment that’s best for you, you’ll also have to decide if that treatment is inpatient (you would stay at a facility) or outpatient (you stay in your home during treatment). Inpatient facilities tend to be more intensive and costly. Your healthcare provider can help you evaluate the pros and cons of each.

Cost may be a factor when selecting a treatment approach. Evaluate the coverage in your health insurance plan to determine how much of the costs your insurance will cover and how much you will have to pay. Ask different programs if they offer sliding scale fees—some programs may offer lower prices or payment plans for individuals without health insurance.

An Ongoing Process

Overcoming alcohol use disorder is an ongoing process, one which can include setbacks.

The Importance of Persistence

Because AUD can be a chronic relapsing disease, persistence is key. It is rare that someone would go to treatment once and then never drink again. More often, people must repeatedly try to quit or cut back, experience recurrences, learn from them, and then keep trying. For many, continued follow up with a treatment provider is critical to overcoming problem drinking.

Relapse Is Part of the Process

Relapse is common among people who overcome alcohol problems. People with drinking problems are most likely to relapse during periods of stress or when exposed to people or places associated with past drinking.

Just as some people with diabetes or asthma may have flare-ups of their disease, a relapse to drinking can be seen as a temporary setback to full recovery and not a complete failure. Seeking professional help can prevent relapse—behavioral therapies can help people develop skills to avoid and overcome triggers, such as stress, that might lead to drinking. Most people benefit from regular checkups with a treatment provider. Medications also can deter drinking during times when individuals may be at greater risk of relapse (e.g., divorce, death of a family member).

Mental Health Issues and Alcohol Use Disorder

Depression and anxiety often go hand in hand with heavy drinking. Studies show that people who are alcohol dependent are two to three times as likely to suffer from major depression or anxiety over their lifetime. When addressing drinking problems, it’s important to also seek treatment for any accompanying medical and mental health issues.

Advice For Friends and Family Members

Caring for a person who has problems with alcohol can be very stressful. It is important that as you try to help your loved one, you find a way to take care of yourself as well. It may help to seek support from others, including friends, family, community, and support groups. If you are developing your own symptoms of depression or anxiety, think about seeking professional help for yourself. Remember that your loved one is ultimately responsible for managing his or her illness.

However, your participation can make a big difference. Based on clinical experience, many health providers believe that support from friends and family members is important in overcoming alcohol problems. But friends and family may feel unsure about how best to provide the support needed. The groups for family and friends listed below may be a good starting point.

Remember that changing deep habits is hard, takes time, and requires repeated efforts. We usually experience failures along the way, learn from them, and then keep going. AUD is no different. Try to be patient with your loved one. Overcoming this disorder is not easy or quick.

Pay attention to your loved one when he or she is doing better or simply making an effort. Too often we are so angry or discouraged that we take it for granted when things are going better. A word of appreciation or acknowledgement of a success can go a long way.

Professional help

Your doctor. Primary care and mental health practitioners can provide effective AUD treatment by combining new medications with brief counseling visits.

Specialists in AUD. For specialty addiction treatment options, contact your doctor, health insurance plan, local health department, or employee assistance program.

Also known as counseling or “talk therapy,” behavioral treatments involve working with a health professional to identify and help change the behaviors that lead to alcohol use disorder (AUD). Behavioral treatments are offered by trained health professionals in a variety of settings, and may be provided in combination with prescribed medications.

Evidence-based behavioral treatments share certain features, which can include:

• Developing the skills needed to stop or reduce drinking.

• Bolstering the ability to manage emotions and stress.

• Helping to build a strong social support system.

• Working to set reachable goals.

• Coping with or avoiding the triggers that might cause relapse.

Types of evidence-based behavioral treatment include the following:

• Cognitive-behavioral therapy (CBT) can take place one-on-one with a therapist or in small groups. This form of therapy is focused on identifying the feelings and situations (called “cues”) that lead to heavy drinking, and managing stress that can lead to relapse. The goal is to change the thought processes that lead to alcohol misuse and to develop the skills necessary to cope with everyday situations that might trigger problem drinking. Health care providers can also offer their patients web-based cognitive-behavioral training that has been shown to reduce alcohol use beyond standard care.

• Motivational enhancement therapy is conducted over a short period of time to build and strengthen motivation to change drinking behavior. The therapy focuses on helping the patient identify the pros and cons of seeking treatment, form a plan for making changes in drinking behavior, build confidence, and develop the skills needed to stick to the plan.

• Contingency management approaches incorporate tangible rewards that are given to patients who achieve specific, measurable treatment goals. This approach is used to reinforce positive behaviors such as abstinence or regular attendance.

• Behavioral couples and family counseling involve partners and other family members in the treatment process and can play an important role in repairing and improving family relationships. The approaches incorporate positive activities, communication skills training, and identifying relapse triggers. Studies show that family support strengthened through family therapy increases the chances of maintaining abstinence (stopping drinking), compared with individual counseling alone.

• Brief interventions are usually delivered in a few short, one-on-one counseling sessions. The physician or counselor provides information about the individual’s drinking pattern and potential risks, and then works with him or her to set goals and provide ideas for helping to make a change.

• 12-Step Facilitation Therapy is an engagement strategy used in counseling sessions to increase a patient’s active involvement in 12-step-based mutual help groups (such as AA), in addition to professionally-led outpatient treatment. The counselor works with the patient to encourage, review, and reinforce their participation in AA, in a structured process that may include reading assignments, journaling, and setting AA participation goals for the week.

• Mindfulness-based relapse prevention (MBRP) combines CBT skill building approaches with mindfulness practices, which promote flexible rather than “autopilot” responses to physical and emotional triggers to drink.

Ultimately, choosing to get treatment may be more important than the specific approach used, as long as the approach incorporates empathy, motivational support, and a focus on changing drinking behavior, and avoids confrontation.

Three medications have been approved by the US Food and Drug Administration to help people with alcohol use disorder (AUD) stop or reduce their drinking and avoid relapse:

• Naltrexone works by blocking the receptors in the brain that are involved in craving alcohol or the rewarding effects of drinking. It comes either as a pill that is taken daily, or as an injection that can be given once per month.

• Acamprosate is prescribed to help people with AUD maintain abstinence from alcohol by alleviating some negative symptoms of prolonged abstinence. It is a pill that is taken three times per day.

• Disulfiram is a pill that causes unpleasant symptoms such as nausea and flushing of the skin when a person drinks. Wanting to avoid those unpleasant effects can help some people refrain from drinking.

All of these medications are non-addictive. They are designed to help manage a chronic disease, just as someone might take medications to keep their asthma or diabetes in check.

Not all people will respond to medications, but for some individuals, they can be an important tool in overcoming alcohol use disorder.

Scientists are working to develop a larger menu of pharmaceutical treatments that could be tailored to individual needs. As more medications become available, people may be able to try multiple medications to find which they respond to best.

Medical detoxification (or “detox”) is the process of getting alcohol or drugs out of a person’s system. When someone who has been drinking heavily for a prolonged period of time suddenly stops drinking, the body can go into a painful or even dangerous process of withdrawal. Symptoms can include nausea, rapid heart rate, seizures, or other problems. Doctors can prescribe medications to address these symptoms and make the process safer and less distressing.

Detox alone is not the same as treatment. While detox helps to stabilize a person with an alcohol problem, it does not teach important skills such as how to identify and address situations that may lead to heavy alcohol use; how to refuse alcohol in social situations; or how to cope with stress in a way that does not involve drinking. All of these are the kinds of skills people learn in treatment that is delivered by health care professionals.

Research shows that people who go through detox without additional treatment are far more likely to relapse. Detox alone is not a fast or effective way to achieve long-term recovery from alcohol use disorder.

Based on what you might see on TV or in the movies, it would seem like most treatment happens in residential rehab programs. But most people do not use—and do not need—a residential program. Here’s why.

Generally, it is recommended that people with alcohol use disorder (AUD) seek the least intensive type of care first, and then move to a more intensive level only if they need it. Most people who get treatment for AUD start with outpatient counseling, either at a treatment program or in one-on-one sessions with a therapist or doctor. Outpatient treatment gives people the flexibility to continue living at home, and even to continue going to work. It’s also much less expensive than residential or hospital treatment.

Some people will find that outpatient treatment isn’t a good fit for them. This is especially likely for someone who does not have stable or secure housing, or does not have family or friends who are supportive of recovery. Residential programs can help provide stability, support, and a structured daily routine for people who need it. Hospital inpatient programs are best for people who have other health conditions that require medical attention.

In short, residential programs can be very helpful for some people with an alcohol problem but are not necessary for most. It’s important to find options that are the best match for a person’s particular situation.

If you or a loved one needs help with an alcohol problem, you have several options beyond in-person care. You can access professional telehealth care by phone or video chat. You can take self-guided online programs to reduce or quit drinking. And you can attend online mutual-support groups. You might put together a care plan that combines some or all of these choices.

Telehealth Treatment by Health Care Professionals

Many health care professionals and programs have offered telehealth alcohol treatment for years. Now, since the pandemic, more providers are offering phone or video sessions. Medicare and other insurers have expanded coverage of telehealth services as well. Check with your insurance company about coverage.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) produced the NIAAA Alcohol Treatment Navigator^® to help you find telehealth alcohol treatment by health care providers:

• Find treatment programs. Many programs are adding telehealth services. Instead of using the “telemedicine/telehealth” filter, contact programs of interest and ask about telehealth.
• Find therapists with addiction specialties.Most therapists listed are shifting to telehealth. Instead of using the “online/phone counseling” filter, contact those of interest and ask about telehealth.
• Find doctors with addiction specialties. Contact doctors you find to ask about telehealth services.

You can create a telehealth care team by combining a therapist with an addiction doctor for medications support.

Online Self-Guided Programs

Below are samples of e-health tools developed with NIAAA funding. Both of these fee-based, self-guided programs have a research base that shows their potential to help people cut down or quit drinking.

• CBT4CBTis an effective, interactive cognitive-behavioral program. It uses videos and exercises to teach seven skills to help people cut down or quit drinking. Any doctor or licensed therapist can prescribe it for you and monitor your progress.
• CheckUp & Choicesis a digital self-help program. It can help people to build the motivation and skills needed to change their drinking. This program includes an alcohol screener, feedback, options for making a change, and skills training for moderating drinking or abstaining.

Self-guided programs such as these can be added to an overall treatment plan led by a health care professional.

Online Mutual-Support Groups and Other Resources

Mutual-support groups can be particularly helpful during this challenging time. A growing number of groups have online communities. These groups can vary widely, so it's important to try different ones to find a good fit.

The Navigator can help you find some mutual-support groups to consider. You can find more recovery support options from the American Society of Addiction Medicine’s list of online support groups, apps, and podcasts. See also the tips and tools on NIAAA’s Rethinking Drinking website.

Online groups and apps can provide much-needed support, but some issues need the help of a professional. In these cases, see above to find telehealth options for professional care.

Don’t be discouraged if progress seems slow. Remember that the total length of treatment is likely to be measured in months, not weeks or days. And, there may be some bumps along the way.

It might take one or more tries to find a treatment provider that “fits.” Therapists each have their own personal style, and treatment programs each have a different environment. It’s okay if the first one doesn’t “click.” Just use that experience—along with the resources in the Navigator—to search for another option.

If you’re the helper, there are some things you can do during treatment to provide support:

• Ask your loved one how you can be most helpful. It’s important for there to be a solid support network they can count on.
• Get involved if you’re comfortable and if it’s appropriate, such as when the treatment provider offers family therapy or a family program.

A “relapse” is when someone returns to drinking after having stopped for a period of time. Here are some points to help you understand relapse:

• Relapse is common as people work to overcome alcohol problems. Relapse is most likely to happen during periods of stress, or when someone is exposed to people or places that are associated with past drinking.
• Just as some people with diabetes or asthma may have flare-ups of their disease, a relapse to drinking can be seen as a temporary set-back to full recovery and not a complete failure.
• Professional treatments work to prevent relapse. Behavioral treatments (talk therapy) can help people develop skills to avoid and overcome triggers, such as stress, that might lead to drinking. Medications also can also be helpful for some people to deter drinking during times when they may be at greater risk of relapse.
• When a patient experiences a relapse, their counselor should adjust their treatment plan accordingly. For some people, relapse is a powerful learning experience and helps to clarify the situations that they may not be ready to handle yet. For others, relapse signals a need for a different kind of treatment or more frequent treatment sessions. Treatment providers can help make these adjustments.

For someone who has been involved in treatment, it can be challenging to establish a routine that is free from alcohol or other substance use and away from the situations and social networks that used to support their drinking.

Participating in a mutual support group can reinforce and extend the benefits of professional treatment and provide much-needed social support over the long term.

There are several groups to consider:

• Alcoholics Anonymous (AA)—the most common mutual help group, with meetings in most communities and online. Meetings involve participants sharing their personal histories with drinking and recovery, and encourage progress along “12 steps” that have a strong spiritual component. Because group dynamics can vary from meeting to meeting, people often visit several meetings before they find one where they feel comfortable. Visit Alcoholics Anonymous to learn more and find a meeting nearby.
• LifeRing—a secular (nonreligious) peer support network supporting abstinence from alcohol and other drugs. Visit LifeRing to learn more and to find an in-person or online meeting.
• Secular Organizations for Sobriety—an alternative to spiritual support groups, this is a network of local and online groups dedicated to helping people achieve and maintain sobriety. Visit Secular Organizations for Sobriety to learn more.
• SMART Recovery—a research-based support program that focuses on empowering members to build four sets of skills: motivation to abstain, coping with urges, problem solving, and lifestyle balance. Visit SMART Recovery to learn more and find an in-person or online meeting.
• Women for Sobriety—a self-help program designed by and for women, focusing on emotional and spiritual growth. Visit Women for Sobriety to learn more and find a meeting or online message board.

In addition to support groups, people in recovery should also maintain a connection with their treatment counselor. While mutual help groups are an excellent source of support and encouragement, they are usually not run by professional clinicians. Some issues may require the help of a trained health professional.