Though there have been some medical advances over time, detoxification, inpatient and residential treatment, individual and group counseling, community-based recovery groups, sponsorship and other peer support have been the mainstay of treatment for patients struggling with alcohol use disorder for over 80 years now.
It has only been since the early 2000’s that more effective medical interventions have become available. Out of the services listed, Sunrise can provide detoxification on a case-by-case basis, individual and intensive outpatient group counseling, and medication-assisted treatment (MAT) where indicated and desired.
Naltrexone was first approved for the treatment of alcohol dependence in 1995. At that time, it was available in an oral tablet formulation and marketed as ReVia. Unfortunately, the dosing for ReVia is challenging for patients and it comes along with a number of side effects, too. In 2006, Naltrexone was re-released as an intramuscular injection formulation called Vivitrol. Vivitrol is indicated for the treatment of alcohol dependence in patients who are able to abstain from alcohol in an outpatient setting prior to the initiation of treatment. It has been shown to have a modest benefit in its ability to help patients to decrease the amount and frequency of alcohol consumption, though it does not appear to change the percentage of people consuming alcohol while being treated. Sunrise is able to initiate treatment with Vivitrol on an outpatient basis for qualifying patients struggling with alcohol use disorder, though it sometimes works better for patients to receive their initial injection prior to being discharged from an inpatient detoxification or residential treatment program. Vivitrol is very expensive, so getting the medication approved by insurance is critical.
Campral contains a chemical called Acamprosate and first became available in 2004. It is indicated for the maintenance of abstinence from alcohol in patients with alcohol dependence who are abstinent at treatment initiation. Campral may work better than naltrexone for eliminating drinking, while naltrexone may decrease the desire for alcohol to a greater extent. Campral comes as an oral tablet that has to be taken multiple times a day, which can be challenging. It also has a few side effects that patients sometimes find intolerable and unacceptable. The mechanism of action isn’t completely understood.
The detoxification process from any substance can be challenging, but some of them are potentially lethal. Withdrawing from alcohol can be serious, debilitating and sometimes fatal. For those who have a long history of heavy alcohol use and dependence, Sunrise will require inpatient detoxification prior to enrollment in our outpatient program. If the patient’s history of alcohol use is shorter and to a lesser degree without any history of severe withdrawal episodes or noticeable withdrawal symptoms during a week-long period of abstinence, then recovery from alcohol use disorder could begin in an outpatient program. Medications would be utilized on a case by case basis to manage any associated minor withdrawal symptoms.
Patients desiring counseling-only may admit to our program directly or as a step-down for ongoing care after completing an inpatient or residential program. As with all substance use disorders, relapse rates are high for this approach, so additional therapeutic activities are encouraged. Some folks will do well with just individual counseling at Sunrise and frequent attendance at community-based recovery groups where they’ll also have access to sponsors and other peer supports. As an alternative or even in addition to that approach, some patients will be best served by participating in our intensive outpatient group counseling program, which would still have the individual counseling component.
There are other medications that have been tried in the past for alcohol use disorder with limited success (e.g. Antabuse). There are other medications that medical professionals have tried to use off-label (i.e. not officially approved by the FDA for the intended use) to help patients with alcohol use disorder, which also have had limited success. Any such interventions would be attempted on a case by case basis after careful consideration by the Sunrise medical staff.
The National Survey on Drug Use & Health reports extensively on the substance use issues in America. Not only do they study those with any use of substances year over year, but also the number of people newly exposed to substances each year. The results are staggering. Perhaps the most troubling are their statistics for how many people in our country meet criteria for an actual substance use disorder (i.e. not just illicit use, abuse or misuse).
From their report, there are 20.3 million people in America 12 and older who met criteria for substance use disorder in 2018. Alcohol remains the leading substance use disorder with 14.8 million people affected. Of those, 12.2 million “just” have an alcohol problem with the other 2.7 million also meeting criteria for an illicit drug use disorder. There are 5.4 million people, then, who “just” have an illicit drug use disorder.
Though there are some medication-assisted treatment options to directly impact alcohol use disorder, they are not as effective as the options currently available for opioid use disorder. For any of these other illicit drug use disorders, researchers have yet to develop any FDA-approved medication-assisted interventions, so providers are relegated to using other medications off-label to help.
Absent such modalities, many people have been and can be helped with these substance use disorders on an outpatient basis with a combination of therapeutic individual counseling, group activities, case management, crisis intervention and peer support. There are some medications that can be used for minor detoxification and withdrawal management, but that would be on a case-by-case basis.
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