John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
A team of professionals is often needed to treat the alcohol dependent person. The physician usually plays a key role in medical stabilization and facilitating treatment entry, but others are routinely needed beyond the initial management (for example, alcoholism counselors, social workers, psychologists, family therapists, psychologists, and pastoral counselors).
Treatment of alcoholism can be divided into three stages. Initially, the person has to be medically stabilized. Next, he or she must undergo a detoxification process, followed by long-term abstinence and rehabilitation.
Stabilization: It is the treating doctor's responsibility to treat any medical conditions related or unrelated to alcoholism. Vast arrays of medical and surgical complications are associated with alcoholism, but only stabilization of alcohol withdrawal and alcoholic ketoacidosis are discussed here.
Alcohol withdrawal is treated by oral or intravenous (IV) hydration along with medications that reverse the symptoms of alcohol withdrawal. The most common group of medications used to treat alcohol withdrawal symptoms are benzodiazepines. Commonly used medications in this class are lorazepam (Ativan), diazepam (Valium), and chlordiazepoxide (Librium). They can be given by IV, orally, or by injection. Diazepam also comes as a rectal suppository. Chlordiazepoxide generally takes longer to have an effect than diazepam or lorazepam and is therefore less commonly used in withdrawal emergencies. Pentobarbital is another medication occasionally used to treat alcohol withdrawal. It has an effect similar to benzodiazepines but is more likely to slow down breathing, making it less attractive for this use. Occasionally the agitated and confused person may have to be physically restrained until he or she becomes calm and coherent.
Alcoholic ketoacidosis is treated with IV fluids and carbohydrates. This is usually done in the form of sugar-containing fluid given by IV until the person can resume drinking fluids and eating.
Any person with alcoholism who is treated by a doctor should receive thiamine (vitamin B1). Thiamine levels are often low in alcohol dependent people, and deficiency of this important vitamin could lead to Wernicke's encephalopathy, a disorder characterized initially by the eyes looking in different directions from each other. If thiamine is given in a timely fashion, this potentially devastating disorder can be completely reversed. In the emergency setting, thiamine is customarily given as an injection. Folate (a vitamin) and magnesium are often given to individuals with alcoholism as well.
Detoxification: This stage involves stopping alcohol consumption. This is very difficult for an alcohol-dependent person, requires extreme discipline, and usually requires extensive support. It is often performed in an inpatient setting where alcohol is not available. The person is treated with the same medications discussed in the treatment of alcohol withdrawal, namely, benzodiazepines. During detoxification, the medication is measured carefully to prevent withdrawal and is then gradually tapered off until no withdrawal symptoms are evident. This usually requires a few days to a week. Recently, as physician-assisted, outpatient detoxification has become popular it
may become more difficult to obtain coverage for in-hospital detoxification.
Rehabilitation: Short- and long-term residential programs aim to help people who are more severely dependent on alcohol develop skills not to drink, to build a recovery support system, and to work on ways to keep them from drinking again (relapsing).
Short-term programs last less than four weeks. Longer programs last for a month to a year or more and are often referred to as sober-living facilities. These are structured programs that provide therapy, education, skills training, and help develop a long-term plan to prevent relapsing.
Outpatient counseling (individually, in groups, or with families) can be used as a primary treatment or as a "step-down" for people as they come out of a residential or structured day program.
Outpatient counseling can provide education on alcoholism and recovery, can help the person learn skills not to drink, and spot early signs of potential relapse.
There are several very effective individual treatments delivered by professional counselors in outpatient treatment clinics. These treatments are Twelve-Step Facilitation Therapy, Motivational Enhancement Therapy, and Cognitive-Behavioral Coping Skills. A well-known self-help program is Alcoholics Anonymous (AA). Other self-help programs (for example, Women for Sobriety, Rational Recovery, and SMART Recovery) allow alcoholics to stop drinking and remain sober on their own.