Alcohol Use Disorder

Some people are aware from the very first sip that they have a different response to and relationship with alcohol than others. For others, issues with alcohol use evolve slowly over time. It can sometimes be difficult for people to determine where normal recreational use of alcohol ends and a problem begins.

For many, they notice that a behavior that initially was meant to relax and have fun, or in some cases to dampen other issues like anxiety, gradually escalates and becomes a habit. They may find that they need to drink more than they used to in order to achieve the same effect. They can spend significant amounts of time using and recovering from alcohol, and may notice that it starts to have some negative impact on their relationships, health, or work life. Over time issues like blackouts, regrettable intoxicated behaviors, or cravings and urges may emerge. For some daily drinkers, physical dependence develops with telltale withdrawal symptoms when the drinking stops: nausea, shaking, sweating, intense anxiety, headaches, and in the more severe cases hallucinations, confusion, or seizures. In some cases, the individual makes a sincere effort to quit but finds they have severe difficulty doing so.

If you suspect alcohol may be playing a problematic role in your life we would begin by assessing your pattern of use, understanding the role alcohol plays in your life, and understanding the problems that have come up around using it. I work collaboratively with patients to set goals for themselves and achieve them, whether those goals involve harm reduction (decreasing alcohol intake to avoid some of the most negative effects) or full abstinence.

Many strategies have proven helpful for individuals with alcohol use disorder. First, those who choose to quit drinking may require help addressing withdrawal in the initial "detox" phase. For many, medications can be safely prescribed in the outpatient setting to help treat withdrawal and increase the likelihood of a successful quit. In some cases, medically monitored withdrawal treatment may be needed. I discuss with patients the risks and benefits of different approaches, working closely to bring them safely to abstinence (if that is their goal).

In individual sessions, I review strategies to help maintain abstinence or reductions in drinking levels. I also know that recovery can be a team effort! When appropriate, I review resources such as Alcoholics Anonymous, SMART Recovery, or often-overlooked supports such as friends, family, and partners to determine how you can incorporate additional support into your plan for recovery.

In addition to these psychological and social interventions, a number of medications have proven effective for helping people to stop drinking and avoid relapse. These include naltrexone, acamprosate, topiramate, or disulfiram. I review in depth the risks and benefits of these options. For those who choose to proceed, medications can sometimes be a helpful tool in achieving and maintaining recovery.

For many patients, issues with mood, anxiety, and other problems may improve significantly with time spent sober as your body recovers from the effects of prolonged alcohol use. For others, issues that may have been present all along (such as a depressive disorder or an anxiety disorder) may be evident after stopping alcohol use. As both a psychiatrist and Addiction Medicine specialist I know the importance of properly addressing any co-occuring mental health issues, not only as a way of increasing quality of life but as a way to improve the odds of achieving and maintaining your alcohol-related goals.

Seeking help for alcohol use is a big first step toward a happier and healthier life! I encourage you to consider the options that are most comfortable to you, whether that involves first talking with your primary care doctor or other trusted members of your healthcare team, seeking out groups such as AA / NA, or seeking individual psychiatric consultation. I welcome you to reach out with me for an initial evaluation and a discussion of strategies that can help you reach your goals.