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The Healthcare Professional's

Core Resource on Alcohol

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Recommend Evidence-Based Treatment: Know the Options

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    Takeaways

    • You can maximize patient choice and outcomes by offering a full menu of evidence-based treatment options. Approaches for treating alcohol use disorder (AUD) include behavioral health treatments, FDA-approved AUD medications, and mutual support groups, or a combination of any of these.
    • Behavioral health treatments for AUD can bring lasting positive change. Steer patients in need of referral for behavioral health treatment to licensed therapists who provide evidence-based modalities.
    • Three FDA-approved medications for AUD can help prevent a return to heavy drinking and promote abstinence. The medications are neither addicting nor complicated to prescribe. Seek a prescribing specialist for assistance if needed.
    • One size does not fit all. If one treatment approach does not work for a particular patient, try another.
    • The NIAAA Alcohol Treatment Navigator can help you and your patients recognize the signs of evidence-based care for AUD and locate healthcare professionals who provide quality treatment.

    As with many other medical conditions, treatment for alcohol use disorder (AUD) is not “one size fits all.” Different patients need different options. Fortunately, there are more AUD treatment choices than many people may expect. Evidence-based, quality treatment is offered at different levels of intensity and in a variety of settings to meet individual needs. Treatment can help patients achieve a goal of quitting drinking or of cutting down significantly, either of which can markedly improve their health status as well as how they feel and function.1

    Two types of evidence-based treatment for AUD are offered by healthcare professionals: behavioral healthcare and medications. They have been shown to be about equally effective2 and can be combined and tailored to improve outcomes for each patient. Many patients also benefit from active participation in mutual support groups such as Alcoholics Anonymous (AA) or a number of secular alternatives such as SMART Recovery (see Resources), either on their own or as a complement to professionally led treatment. 2

    Treatment for AUD is offered in more settings than just specialty addiction programs. Primary care professionals can offer medications for AUD along with brief counseling. (See Core article on brief intervention.) Addiction physicians, clinical psychologists, and other licensed therapists also provide outpatient care in private practices and community clinics. (See Core article on referral.) These and other flexible, convenient options such as telehealth professional services and online or in-person mutual support groups may reduce stigma and other barriers to recovery. Here, we briefly describe options available to help patients with AUD.

    A note on a drinking level term used in this Core article: Heavy drinking has been defined for women as 4 or more drinks on any day or 8 or more per week, and for men as 5 or more drinks on any day or 15 or more per week.

    What professionally led behavioral health treatments have been shown to be effective in treating AUD?

    Patients with less severe AUD may be able to receive treatment in primary care via brief interventions (see Core article on brief intervention) and FDA-approved AUD medications. For people with more severe AUD or with mental health comorbidities, it is wise to seek evidence-based behavioral health treatment with a licensed professional therapist to set the stage for lasting change. (See Core article on mental health issues.)

    Broadly, AUD-focused behavioral health treatments aim to help patients set goals, identify triggers that could prompt drinking, develop skills to stop or reduce drinking, manage emotions and stress, and build relationships that will support treatment goals. Specific evidence-backed approaches, which are about equally effective, 2 include the following:

    • Cognitive-behavioral therapy (CBT) focuses on identifying and managing the thoughts, feelings, situations, behaviors, and stressors (called “triggers” or “cues”) that lead to heavy drinking. The goal is to change unhelpful thought processes and behaviors and develop skills to cope with situations and triggers that might result in an urge to drink.
    • Motivational enhancement therapy is conducted over a short period of time to help people build their own motivation for changing their drinking, form a specific plan for changing drinking behavior, and develop the skills and confidence needed to stick to the plan.
    • Acceptance- and mindfulness-based interventions increase awareness and acceptance of present-moment experiences. Mindfulness-based relapse prevention incorporates CBT skill-building strategies to promote flexible rather than “autopilot” responses to triggers that can prompt drinking.
    • Contingency management approaches incorporate tangible rewards for achieving specific, measurable treatment goals. These approaches reinforce positive behaviors such as abstaining from drinking or regularly attending treatment sessions.
    • Couples counseling and family counseling focus on promoting positive interactions and activities and improving communication skills. Evidence-based approaches based on cognitive behavioral and family systems theories improve patient support and increase the likelihood of improving drinking outcomes compared with individual counseling alone. 3,4
    • Twelve-step facilitation therapy is a clinical intervention developed to increase a patient’s active involvement in a 12-step group such as AA. 5 Increased attendance at group meetings can, in turn, facilitate decreases in alcohol consumption.6 Similarly, a clinical intervention called Mutual Support Group Facilitation encourages patients with AUD to sample mutual help groups broadly, including secular options.7 (See the section below on mutual support groups.)

    Therapists who specialize in addiction can offer individual, couples, family, or group sessions. These specialists can be found in addiction specialty treatment programs, independent private practice, and other clinical settings. NIAAA’s Alcohol Treatment Navigator can guide you to providers who offer evidence-based behavioral health treatment near you, as well as telehealth and online options.

    If you are a licensed therapist, see the Resources, below, for therapy manuals from NIAAA-sponsored clinical trials. The manuals contain modules for alcohol-focused CBT, motivational enhancement, mutual support group facilitation, and other evidence-based approaches that can help you treat clients who have AUD.

    What evidence-based medications are available to treat AUD?

    Three medications are approved by the FDA to treat AUD.8,9 You don’t need specialized training or licensing to prescribe these non-addicting medications, so they are no more complicated to prescribe than those for other common medical conditions. As with treatment for other mental health conditions, such as depression, if a patient does not respond well to one medication, it is often helpful to try another.

    • Naltrexone (available in either oral or injectable extended-release forms) works by blocking the opioid receptors in the brain that are involved in the rewarding effects of drinking alcohol (see Core article on neuroscience). The pill is taken once per day whereas the injection is given once per month. Naltrexone can be started while a patient is still drinking.
    • Acamprosate helps to maintain abstinence by acting on the glutamatergic neurotransmitter system to alleviate the emotional discomfort of anxiety, restlessness, dysphoria, and insomnia that can happen as the brain adjusts to abstinence. (See Core article on neuroscience.) Two acamprosate pills are taken three times per day. Acamprosate should be initiated as soon as possible after withdrawal, when a patient has achieved abstinence.10
    • Disulfiram interferes with alcohol metabolism by blocking the enzyme acetaldehyde dehydrogenase, causing a buildup of acetaldehyde that leads to flushing, nausea, and other unpleasant symptoms when alcohol is consumed. It is a pill taken once per day that helps patients maintain abstinence. Disulfiram should never be administered until the patient has abstained from alcohol for at least 12 hours.

    These medications are vastly underused in treating AUD. They are prescribed for only 1.6% of adults with past-year AUD, according to a 2021 analysis. 11

    Offering medications in primary care can be an effective “foot in the door” and can catalyze change for patients who may be reluctant to seek specialty treatment because of stigma or other barriers.12 Your patients may be unaware of the newer medications (acamprosate and naltrexone) and may consider them more appealing than the older medication (disulfiram) that makes people feel sick if they drink alcohol.13 The American Psychiatric Association also suggests that gabapentin or topiramate be offered as second-line therapy for patients who prefer these medications or haven’t responded to the FDA-approved options.14

    Some patients may hesitate to take AUD medications due to misinformation they’ve heard from peers, some treatment environments, and other sources. You can reassure them that AUD medications are valid treatment options that benefit many people and are non-addictive, well tolerated, and generally not needed indefinitely.

    If you are considering prescribing AUD medications, you can find support in several clinician guidelines (see Resources, below).14–17 Some primary care physicians may be more comfortable prescribing AUD medications if they have prescribing support from addiction specialists or pharmacists as well as behavioral healthcare for follow-up.12 If you would like to partner with a specialist prescriber or therapist, you can find them using the Navigator.

    What mutual support group choices are available?

    Mutual support groups may be beneficial for providing a sense of community for those in recovery. Groups vary widely in beliefs and demographics, so advise patients who are interested in joining a group to try different options to find a good fit. In addition to widely recognized 12-step programs with spiritual components such as AA, a number of secular groups promote abstinence and recovery as well, such as SMART Recovery, LifeRing, Women for Sobriety, Secular Organizations for Sobriety, and Secular AA (see Resources, below, for links).

    Research suggests that three of the largest known secular groups in the U.S.—SMART Recovery, LifeRing, and Women for Sobriety—appear comparable in effectiveness to 12-step programs for people who have a goal of abstinence.18 People in any of these mutual support groups have greater success in achieving abstinence if they become actively involved with their group, as measured by, for example, regular meeting attendance, having a sponsor or close friend in the group, or volunteering for the group.18

    To help patients engage more deeply in their groups and thus obtain optimal outcomes, clinical interventions have been developed such as the twelve-step facilitation treatment mentioned earlier. A systematic review found that together, clinically-delivered twelve-step facilitation and AA can be as effective as cognitive behavioral or motivational enhancement therapy at reducing drinking intensity, promoting abstinence, and reducing alcohol-related consequences at 12 months.19 (See Resources for links to therapist manuals to facilitate participation in 12-step and secular mutual support groups.) 

    What are the different levels of intensity for AUD treatment?

    Evidence-based specialty treatment for AUD is offered at four basic levels of care or intensity. These levels, as defined by the American Society of Addiction Medicine, form a continuum of care in which patients step up and down in treatment intensity as needed:

    • Outpatient: Regular appointments for counseling, medication support, or both. (See below for some "lower intensity" outpatient alternatives.)
    • Intensive outpatient or partial hospitalization: Coordinated outpatient treatment for complex needs.
    • Residential: Low or high intensity programs in 24-hour treatment settings.
    • Intensive inpatient: Medically directed 24-hour services; may manage withdrawal symptoms.

    Most AUD treatment is provided in outpatient settings. 20,21 About half of patients with AUD will have some symptoms of withdrawal when they stop drinking,2,22 and a small proportion need intensive inpatient or outpatient “detox” to manage potentially dangerous withdrawal symptoms. 2,23 Detox alone does not constitute treatment for AUD, however. Continued care in residential or outpatient settings or both is often needed to sustain abstinence and promote long-term recovery. Across settings, a course of AUD treatment is likely to be measured in months, not days or weeks.

    If you are uncertain as to which level of care to recommend for a patient, seek a complete assessment by a specialist. If lower intensity outpatient care is appropriate, you can refer to a traditional program, or consider alternatives such as these, which can help maintain your patient’s privacy and routines:

    • Do-it-yourself – build a custom care team. By building a team consisting of a primary care provider, an addiction physician, and an addiction therapist, you can mirror the "active ingredients" of a specialty program.
    • Telehealth – phone or video sessions. Telehealth services have expanded, along with insurance coverage for them, often allowing greater access to treatment.24 Research shows that telehealth AUD treatment can reduce alcohol consumption25,26 and may appeal to young adults and others who may be less inclined to seek treatment.27
    • e-Health – An example of an e-Health program developed with NIAAA support is CBT4CBT, an effective computer-based cognitive behavioral therapy program that can be prescribed by any physician or licensed therapist.

    The Navigator and its portal for healthcare professionals can steer you and your patients to quality treatment at all levels of care, from residential to telehealth services. (See Core article on referral.)

    In closing, because of the complexity of AUD (and of individuals), no single treatment approach is universally successful or appealing to all patients. The different treatment approaches—behavioral healthcare, medications, and mutual support groups—share similar goals while addressing the varied neurobiological, psychological, and social aspects of AUD. Thus, these approaches are complementary and can work well together in an individualized, flexible, and comprehensive treatment plan.

    Resources

    Alcohol Use Disorder Medication Guides

    Mutual Support Groups

    Therapy Guides for Mental Health Specialists

    Resources Related to This Article to Share with Patients

    More resources for a variety of healthcare professionals can be found in the Additional Links for Patient Care.

    References

    1. Witkiewitz K, Falk DE, Litten RZ, et al. Maintenance of World Health Organization Risk Drinking Level Reductions and Posttreatment Functioning Following a Large Alcohol Use Disorder Clinical Trial. Alcohol Clin Exp Res. 2019;43(5):979-987. doi:10.1111/acer.14018
    2. Witkiewitz K, Litten RZ, Leggio L. Advances in the science and treatment of alcohol use disorder. Sci Adv. 2019;5(9):eaax4043. doi:10.1126/sciadv.aax4043
    3. McCrady BS, Wilson AD, Muñoz RE, Fink BC, Fokas K, Borders A. Alcohol-Focused Behavioral Couple Therapy. Fam Process. 2016;55(3):443-459. doi:10.1111/famp.12231
    4. McCrady BS, Flanagan JC. The Role of the Family in Alcohol Use Disorder Recovery for Adults. Alcohol Res Curr Rev. 2021;41(1):06. doi:10.35946/arcr.v41.1.06
    5. Twelve Step Facilitation Therapy Manual: A Clinical Research Guide for Therapists Treating Individuals with Alcohol Abuse and Dependence. National Institute on Alcohol Abuse and Alcoholism Accessed December 10, 2021. https://pubs.niaaa.nih.gov/publications/projectmatch/match01.pdf
    6. Humphreys K, Blodgett JC, Wagner TH. Estimating the efficacy of Alcoholics Anonymous without self-selection bias: an instrumental variables re-analysis of randomized clinical trials. Alcohol Clin Exp Res. 2014;38(11):2688-2694. doi:10.1111/acer.12557
    7. Miller W. COMBINE Monograph Series, Volume 1. Combined Behavioral Intervention Manual: A Clinical Guide for Therapists Treating People With Alcohol Abuse and Dependence. DHHS Publication No. (NIH) 04-5288 Accessed July 1, 2021. /sites/default/files/publications/Combine_monograph_2.pdf
    8. McPheeters M, O’Connor EA, Riley S, et al. Pharmacotherapy for Alcohol Use Disorder. JAMA. 2023;330(17):1653-1665. doi:10.1001/jama.2023.19761
    9. Mason B. Alcohol Use Disorder: The Role of Medication in Recovery. Alcohol Res Curr Rev. 2021;41(1):07. doi:10.35946/arcr.v41.1.07
    10. CAMPRAL® (acamprosate calcium) Delayed-Release Tablets Label. Published online 8/5. https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/021431s013lbl.pdf
    11. Han B, Jones CM, Einstein EB, Powell PA, Compton WM. Use of Medications for Alcohol Use Disorder in the US: Results From the 2019 National Survey on Drug Use and Health. JAMA Psychiatry. 2021;78(8):922-924. doi:10.1001/jamapsychiatry.2021.1271
    12. Williams EC, Achtmeyer CE, Young JP, et al. Barriers to and Facilitators of Alcohol Use Disorder Pharmacotherapy in Primary Care: A Qualitative Study in Five VA Clinics. J Gen Intern Med. 2018;33(3):258-267. doi:10.1007/s11606-017-4202-z
    13. Wallhed Finn S, Bakshi AS, Andréasson S. Alcohol consumption, dependence, and treatment barriers: perceptions among nontreatment seekers with alcohol dependence. Subst Use Misuse. 2014;49(6):762-769. doi:10.3109/10826084.2014.891616
    14. Reus VI, Fochtmann LJ, Bukstein O, et al. The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder. Am J Psychiatry. 2018;175(1):86-90. doi:10.1176/appi.ajp.2017.1750101
    15. Substance Abuse and Mental Health Services Administration and National Institute on Alcohol Abuse and Alcoholism. Medication for the Treatment of Alcohol Use Disorder: A Brief Guide. Substance Abuse and Mental Health Services Administration; 2015:39. https://library.samhsa.gov/product/medication-treatment-alcohol-use-disorder-brief-guide/sma15-4907
    16. Center for Substance Abuse Treatment. Incorporating Alcohol Pharmacotherapies Into Medical Practice. Substance Abuse and Mental Health Services Administration (US); 2009. Accessed June 11, 2021. http://www.ncbi.nlm.nih.gov/books/NBK64041/
    17. McPheeters M, O’Connor EA, Riley S, et al. Pharmacotherapy for Adults With Alcohol Use Disorder in Outpatient Settings: Systematic Review. Agency for Healthcare Research and Quality (US); 2023. Accessed November 20, 2024. http://www.ncbi.nlm.nih.gov/books/NBK597431/
    18. Zemore SE, Lui C, Mericle A, Hemberg J, Kaskutas LA. A longitudinal study of the comparative efficacy of Women for Sobriety, LifeRing, SMART Recovery, and 12-step groups for those with AUD. J Subst Abuse Treat. 2018;88:18-26. doi:10.1016/j.jsat.2018.02.004
    19. Kelly JF, Humphreys K, Ferri M. Alcoholics Anonymous and other 12‐step programs for alcohol use disorder. Cochrane Database Syst Rev. 2020;2020(3). doi:10.1002/14651858.CD012880.pub2
    20. National Survey of Substance Abuse Treatment Services. Substance Abuse and Mental Health Services Administration; 2018:179. https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSSATS-2018.pdf
    21. Edlund MJ, Booth BM, Han X. Who Seeks Care Where? Utilization of Mental Health and Substance Use Disorder Treatment in Two National Samples of Individuals with Alcohol Use Disorders. J Stud Alcohol Drugs. 2012;73(4):635-646. doi:10.15288/jsad.2012.73.635
    22. Schuckit MA, Danko GP, Smith TL, Hesselbrock V, Kramer J, Bucholz K. A 5-year prospective evaluation of DSM-IV alcohol dependence with and without a physiological component. Alcohol Clin Exp Res. 2003;27(5):818-825. doi:10.1097/01.ALC.0000067980.18461.33
    23. Foy A, Kay J. The incidence of alcohol-related problems and the risk of alcohol withdrawal in a general hospital population. Drug Alcohol Rev. 1995;14(1):49-54. doi:10.1080/09595239500185051
    24. Perumalswami PV, Adams MA, Frost MC, et al. Telehealth and delivery of alcohol use disorder treatment in the Veterans Health Administration. Alcohol Clin Exp Res. 2024;48(5):944-954. doi:10.1111/acer.15305
    25. Hallgren KA, Galloway GP, Witkiewitz K, Linde P, Nix B, Mendelson JE. Treatment retention and reductions in blood alcohol concentration (BAC) during the first 90 days of a telehealth program for alcohol use disorder. Am J Drug Alcohol Abuse. 2023;49(2):249-259. doi:10.1080/00952990.2023.2175322
    26. Kruse CS, Lee K, Watson JB, Lobo LG, Stoppelmoor AG, Oyibo SE. Measures of Effectiveness, Efficiency, and Quality of Telemedicine in the Management of Alcohol Abuse, Addiction, and Rehabilitation: Systematic Review. J Med Internet Res. 2020;22(1):e13252. doi:10.2196/13252
    27. Palzes VA, Chi FW, Metz VE, Campbell C, Corriveau C, Sterling S. COVID‐19 pandemic‐related changes in utilization of telehealth and treatment overall for alcohol use problems. Alcohol Clin Exp Res. 2022;46(12):2280-2291. doi:10.1111/acer.14961
    Complete the Brief Continuing Education Post-Test

    We invite healthcare professionals to complete a post-test to earn FREE continuing education credit (CME/CE or ABIM MOC). This continuing education opportunity is jointly provided by the Postgraduate Institute for Medicine and NIAAA. Learn more about credit designations here.

    There are two credit paths—please choose the one that aligns with your profession.

    These professionals can earn 0.75 credits for reading this single article:

    • Physicians (and others who can earn AMA credit)
    • Physician Assistants
    • Nurses
    • Pharmacists

    To earn AMA, AAPA, ANCC, ACPE, or ABIM MOC credit, review this article, then use the link below to log into or create a CME University account. Answer 3 out of 4 questions correctly on the post-test to earn 0.75 credits.

    These professionals can earn 1.5 credits for reading a pair of articles as indicated below:

    • Licensed Psychologists (and others who can earn APA credit)
    • Social Workers

    To earn APA or ASWB credit, review this article and Topic 13—Support Recovery: It’s a Marathon, Not a Sprint, then use the link below to log into or create a CME University account. Answer 7 out of 10 questions correctly on the combined post-test to earn 1.5 credits.

    Released on 5/9/2025
    Expires on 5/10/2026

    Learning Objectives

    After completing this activity, the participant should be better able to:

    • Describe evidence-based treatment options for alcohol use disorder (AUD).
    • Identify potential components of an individualized, flexible, and comprehensive treatment plan for alcohol use disorder (AUD) to maximize patient choice and outcomes.
    • Identify patients who will likely need a referral for behavioral health treatment to licensed therapists for lasting positive change.

    Contributors

    Recommend Evidence-Based Treatment: Know the Options

    Contributors to this article for the NIAAA Core Resource on Alcohol include the writers for the full article, content contributors to subsections, reviewers, and editorial staff. These contributors included both experts external to NIAAA as well as NIAAA staff. All those listed below contributed to the original Core Resource launched in 2022. Those marked with an asterisk (*) also contributed to the recertification update launched in 2025.

    NIAAA Writers and Content Contributors

    *Raye Z. Litten, PhD
    Editor and Content Advisor for
    The Core Resource on Alcohol;
    Former Director,
    Division of Treatment and Recovery, NIAAA

    *Laura E. Kwako, PhD
    Editor and Content Advisor for
    The Core Resource on Alcohol;
    Chief, Treatment, Health Services, and Recovery Branch;
    Credentialed Clinician (Psychologist),
    Division of Treatment and Recovery, NIAAA

    *Maureen B. Gardner
    Project Manager and Technical Writer/Editor for
    The Core Resource on Alcohol,
    Division of Treatment and Recovery, NIAAA

    External Reviewers

    *Sudie Back, PhD
    Professor, Medical University of South Carolina,
    Ralph H. Johnson VA Medical Center, Charleston, SC

    *Douglas Berger MD, MLitt
    Staff Physician, VA Puget Sound;
    Associate Professor of Medicine,
    University of Washington, Seattle, WA

    *Randall Brown MD, PhD
    Professor, School of Medicine and Public Health,
    University of Wisconsin, Madison, WI

    Westley Clark, MD, JD, MPH
    Dean's Executive Professor of Public Health,
    Santa Clara University, Santa Clara, CA

    *Barbara J. Mason, PhD
    Professor, Department of Molecular Medicine,
    The Scripps Research Institute, La Jolla, CA 

    NIAAA Reviewers

    *George F. Koob, PhD
    Director, NIAAA

    *Patricia Powell, PhD
    Deputy Director, NIAAA

    *Nancy Diazgranados, MD, MS, DFAPA
    Deputy Clinical Director, NIAAA

    Falk W. Lohoff, MD
    Lasker Clinical Research Scholar;
    Chief, Section on Clinical Genomics and
    Experimental Therapeutics, NIAAA

    *Lorenzo Leggio, MD, PhD
    Clinical Director and Deputy Scientific Director, NIDA;
    Branch Chief and Senior Investigator, NIDA/NIAAA,
    NIH Intramural Research Program, Baltimore, MD

    Aaron White, PhD
    Senior Scientific Advisor to the NIAAA Director, NIAAA

    Editorial Team

    NIAAA

    *Raye Z. Litten, PhD
    Editor and Content Advisor for
    The Core Resource on Alcohol;
    Former Director,
    Division of Treatment and Recovery, NIAAA

    *Laura E. Kwako, PhD
    Editor and Content Advisor for
    The Core Resource on Alcohol;
    Chief, Treatment, Health Services, and Recovery Branch;
    Credentialed Clinician (Psychologist),
    Division of Treatment and Recovery, NIAAA

    *Maureen B. Gardner
    Project Manager and Technical Writer/Editor for
    The Core Resource on Alcohol,
    Division of Treatment and Recovery, NIAAA

    Contractor Support

    *Elyssa Warner, PhD
    Technical Editor, Ripple Effect

    *Daria Turner, MPH
    Reference and Resource Analyst, Ripple Effect

    To learn more about CME/CE credit offered as well as disclosures, visit our CME/CE General Information page. You may also click here to learn more about contributors.

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