We recently sat down with Nurse Practitioner Roz Vara-Good of our Addiction Medicine team at Gifford to get answers to frequently asked questions about alcohol addiction. If you or a loved one have additional questions, or would like to speak with a member of our team who can provide help, please call 802-728-7744.
1. How do I know it is time to seek treatment for alcohol addiction?
People seek treatment for alcohol addiction for many different reasons. There is new research that shows that there is no safe level of alcohol to consume, that even small amounts can lead to worse health outcomes. However, men who drink more than four drinks per day or more than 14 drinks per week, and women who drink more than three drinks per day or more than seven per week, are at much higher risk for developing health problems. Sometimes, folks come to us after developing health problems that are the result of alcohol use.
Other reasons to seek care for alcohol use include:
- An increased tolerance to alcohol—meaning you are drinking more to achieve the desired effect or to prevent withdrawal symptoms.
- Withdrawal symptoms when you aren’t drinking, such as feeling shaky, nauseous, sweaty, anxious, or having a headache.
- When alcohol impacts your responsibilities at home, work, or school.
- When alcohol impacts your relationships.
- You develop legal issues related to your drinking, like a DUI.
- You develop financial difficulties related to your drinking.
- You have tried to quit or cut back on your own and have been unable.
2. What are my options for treatment?
The first thing we do when you come to Gifford’s Addiction Medicine Clinic is to figure out what your goals are. Some patients come to us wanting to stop drinking entirely, while others want to cut back on their drinking. Either way, we can work together to help you achieve your goals.
For folks who want to stop drinking entirely, we first have to come up with a safe plan to help you stop. Alcohol withdrawal can be very serious and life-threatening. Some people require a short hospitalization to safely manage withdrawal, while others can do it at home with medication.
Once a patient has gone through withdrawal, we recommend a combination of medication and counseling. However, there are no counseling requirements at our clinic. If a patient is interested in medication only, we are happy to do that.
There are three FDA-approved medications used to treat alcohol-use disorder. There are also a number of medications used “off-label” for treatment. These medications are all taken daily.
In addition to medication we strongly encourage patients to work with a licensed drug and alcohol counselor. We also recommend that patients engage in the recovery community, either by attending groups or working with a recovery coach, or both.
3. What medications are available to treat alcohol addiction? How do I know what’s right for me?
There are three FDA-approved medications to treat alcohol-use disorder: Naltrexone, Acamprosate, and Disulfiram. Together we will review your medical history, current medications, and preferences to determine the right treatment plan for you. For most people, I recommend starting with Naltrexone, a once-daily medication, as it has been shown to be the most effective of the three. However, it is not an option for all patients.
4. What are the side effects of various medications?
Naltrexone is generally very well tolerated. The most common side effects are nausea, vomiting, diarrhea, and headache. Generally, we can alleviate these effects by having you take the medication with a full glass of water and a meal. Additionally, we start at a low dose for a few days before increasing to the full dose.
Acamprosate’s main side effect is also diarrhea. The biggest challenge with this medication is that it needs to be taken three times per day.
Disulfiram is the medication that most people are familiar with as “the one that makes you really sick if you drink while you’re taking it.” Folks who opt to take Disulfiram cannot drink any alcohol—even small amounts such as in baked goods, shaving cream, and kombucha can cause a “disulfiram reaction,” with sweating, headache, flushing, palpitations, nausea, vomiting, and lowered blood pressure. It is also not safe for patients with severe heart problems, and there are numerous drug interactions. Disulfiram is reserved for patients who are totally committed to abstinence and have good social support at home.
5. What is the first step in getting treatment?
Call us and set up an appointment! At our first meeting, we will review your relationship with alcohol, your past medical history, and current medications. Together we will develop a plan that you are comfortable with.
6. How long does treatment take? Will I need treatment my whole life or can I eventually manage on my own?
Alcohol-use disorder is a chronic health condition, just like diabetes or high blood pressure. As such it does require ongoing treatment, but how that treatment looks depends on the individual. Most patients who opt to start medication for alcohol-use disorder concurrently want to know when they can stop the medication. The truth is, there are no clear guidelines for how long folks should be on medication. Generally, if the medication is helpful and not causing bothersome side effects, I encourage folks to continue to take them. Studies show that these medications are safe to take long-term. We do monitor kidney and liver function periodically.
7. Is counseling part of the treatment process?
While counseling is not required, it is highly encouraged. Patients who engage in counseling are more likely to achieve their goals. We also recommend getting involved in groups like Alcoholics Anonymous (AA) or SMART Recovery. There are also numerous phone apps that can provide additional support.
8. Should I go to individual or group therapy?
This depends on your individual needs but we recommend doing both.
9. How else can you support me?
Some folks desire or need inpatient treatment, and we can help arrange this. We also can help you get established with primary care providers and case management, as well as Medicaid for those who qualify. We have a licensed drug and alcohol counselor on staff.
10. I feel alone and ashamed. Should I tell other people I am getting treatment?
Unfortunately, there is still a great deal of stigma associated with addiction treatment. However, alcohol-use disorder is extremely common. More than 18 million Americans meet criteria for alcohol-use disorder, but only 10 percent receive any kind of treatment. Reaching out for help is not easy but we will be there to support you every step of the way.
Addiction is not a choice or a moral failing. It is a chronic health condition that requires treatment just like other chronic health conditions like asthma, high blood pressure, or diabetes. If you are comfortable, we certainly encourage you to be open about your treatment with your friends or family. Our counselor can provide you with additional support around having these kinds of conversations.
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