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Preventing Relapse: The Role of Medical Treatment in Alcohol Dependence

Authors: Raymond F. Anton, MDFaculty and Disclosures



Alcohol use disorders cover a spectrum of drinking patterns that range from heavy drinking to alcohol dependence. In general, heavy drinking is considered to be more than 14 drinks a week for men and 7 drinks a week for women (with no more than 4 drinks in a day for men or 3 for women)[1,2] and is thought to lead to chronic health consequences, such as hypertension and increased risk for cardiovascular disease and stroke. When individuals increase their alcohol intake markedly above these limits, and regularly drink more than 4-5 standard drinks (a standard drink being 1.5 ounce of liquor, 12 ounces of beer, or 5 ounces of wine) on several occasions per week, health consequences increase and social and psychological consequences may start to appear.[3] Alcohol abuse is diagnosed when drinking "binges" lead to intermittent medical, legal, or social problems. People who abuse alcohol have significant intermittent drinking binges (6-20 standard drinks) that can lead to adverse consequences. They generally have not "lost control" of their daily alcohol use and can stop for periods of time, but when they drink, it's often in excess. On the other hand, people with alcohol dependence who are characterized by "loss of control" over alcohol consumption, are repeatedly unsuccessful in their efforts to cut down or quit, and continue to drink heavily, despite apparent medical or social consequences.[4] Alcohol withdrawal and alcohol-induced liver disease become more likely as the illnesses become more severe.

For heavy or harmful drinkers, it has been shown that advice by healthcare professionals to "cut down" or "stop" leads to reduction in a large number of cases.[5,6] For those with alcohol abuse, some form of intervention (family, friends, employer) and/or external pressure (threats of job loss, divorce, legal penalties) may be effective, at least in the short run. For those individuals with alcohol abuse who don't respond to these interventions, and for those with alcohol dependence, some form of addiction counseling and/or medication is likely to be necessary.[7]

For many years, the mainstay of treatment for alcohol abuse and dependence (alcoholism) has been counseling and self-help groups (such as Alcoholics Anonymous). It has become a popular belief that "going in for rehab" is the treatment of choice. In fact, while inpatient or residential treatment was one of the main, and most expensive, forms of alcoholism treatment during the 1980s and 1990s, for most individuals this is both not necessary and not affordable. Studies such as Project MATCH, funded by the National Institutes of Health,[8] and other studies[9] found minimal long-term difference between inpatient/residential treatment and outpatient counseling approaches for moderately severe alcoholics. However, individuals with co-occurring drug abuse and/or psychiatric disorders might need more intensive and prolonged treatment away from the stresses of everyday life and away from their social circle of substance abuse.

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