How Do Psychiatrists Treat Alcoholism?

Treatment Of Alcoholism

Alcoholism, also called alcohol addiction, is a chronic, relapsing disease that is characterised by the compulsive use of alcohol, despite it having severe negative consequences. It involves an inability to manage drinking habits and is commonly referred to as an alcohol use disorder. Alcohol use disorder is organised into three categories: 

• Mild: 2-3 symptoms present
• Moderate: 4-5 symptoms present
• Severe: 6 or more symptoms present

 How Does Alcohol Work In The Body?

Alcohol is a depressant, which means it slows down or reduces your ability to think clearly. When you drink alcohol, it acts as a stimulus on the brain and triggers the release of dopamine in certain areas of the brain. Dopamine is the primary driver of the brain's reward system, which spikes when we experience something pleasurable. It also increases the production of GABA (a neurotransmitter), which can temporarily make you feel good.

The problem with this process is that over time, it can have negative effects on your body as well as your mind: weight loss occurs, dehydration sets in, breathing becomes laboured, mood swings happen more frequently than normal, and sometimes nausea sets in if alcohol is consumed on an empty stomach. 

It can be difficult for some people who have been dependent on alcohol for many years to quit cold turkey without medical supervision. Once they stop, withdrawal symptoms set in. This may include shaking hands and feeling anxious/nervous when around others who have been drinking regularly throughout their lives; sweating profusely even though it's not hot outside; having trouble sleeping at night due to anxiety & nervousness, and an overwhelming urge to drink again. 

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What Are The Symptoms Of Alcohol Addiction?

The symptoms of alcoholism are similar to those experienced by patients with other substance abuse concerns. 

Symptoms of alcoholism include:

• Being unable to limit the amount of alcohol you drink
• Wanting to cut down on how much you drink or making unsuccessful attempts to do so
• Spending a lot of time drinking, getting alcohol or recovering from alcohol use
• Feeling a strong craving or urge to drink alcohol
• Failing to fulfil major obligations at work, school or home due to repeated alcohol use
• Continuing to drink alcohol, though it's causing physical, social, work or relationship problems
• Giving up or reducing social activities and hobbies to use alcohol
• Using alcohol in situations where it's not safe, such as when
• Developing a tolerance to alcohol so you need more to feel its effect, or you have a reduced impact from the same amount

How Psychiatrists Can Help In Treating Alcohol Dependence?

Alcohol dependence is a chronic condition that requires comprehensive treatment. Psychiatrists play a central role in helping individuals manage alcohol use disorder (AUD) by combining medical interventions, psychological therapies, and structured support systems. Their goal is not only to stop harmful drinking but also to address underlying mental health issues, prevent relapse, and restore long-term well-being.

1. Initial Assessment and Diagnosis

The first step involves a thorough psychiatric evaluation. Psychiatrists assess the severity of alcohol use disorder, mild, moderate, or severe, by examining symptoms, drinking history, withdrawal patterns, and co-occurring mental health conditions such as depression, anxiety, or bipolar disorder. This assessment guides the personalised treatment plan.

2. Detoxification and Withdrawal Management

Many individuals with alcohol dependence experience withdrawal symptoms when they stop drinking. These can include sweating, tremors, insomnia, anxiety, seizures, or even life-threatening delirium tremors (DTs). Psychiatrists manage detoxification in a safe, medically supervised environment. Depending on severity, detox can last several days to weeks. During this period, medications may be prescribed to stabilise the patient, reduce discomfort, and lower the risk of complications.

3. Medications Used in Alcohol De-addiction Treatment

Psychiatrists often prescribe FDA-approved medications that support recovery by reducing cravings or discouraging alcohol use. These include:

• Naltrexone: Blocks the rewarding effects of alcohol by acting on the brain’s opioid receptors. It reduces the desire to drink and prevents relapse into heavy drinking.
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• Acamprosate (Campral): Helps restore chemical balance in the brain disrupted by chronic alcohol use. It reduces post-withdrawal symptoms such as anxiety, restlessness, and insomnia, making long-term abstinence easier.
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• Disulfiram (Antabuse): Creates an unpleasant physical reaction (nausea, headache, flushing, vomiting) when alcohol is consumed. This acts as a strong deterrent for those motivated to stay sober.
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• Topiramate and Gabapentin (off-label use): Sometimes prescribed to reduce cravings and improve mood regulation, especially in patients with co-occurring disorders.
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Just as patients with diabetes or hypertension rely on long-term medication, those with AUD may also benefit from ongoing pharmacological support to maintain sobriety.

4. Therapy Approaches in Alcohol Dependence

Medication alone is rarely sufficient. Therapy plays a crucial role in addressing the psychological and behavioural aspects of alcohol dependence. Psychiatrists may use a combination of evidence-based therapies:

• Cognitive Behavioural Therapy (CBT): Helps patients recognise and change negative thought patterns and behaviours linked to drinking. CBT teaches coping strategies to manage stress, cravings, and high-risk situations.
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• Motivational Enhancement Therapy (MET): Focuses on enhancing a patient’s intrinsic motivation to change their drinking behaviour. Psychiatrists guide patients in setting achievable goals and reinforcing progress.
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• Dialectical Behaviour Therapy (DBT): Especially useful for individuals struggling with emotional regulation and impulsivity, DBT combines acceptance-based strategies with behavioural skill-building.
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• Interpersonal Therapy (IPT): Addresses relationship conflicts, social isolation, or unresolved grief that may contribute to alcohol use. Strengthening interpersonal skills reduces the triggers that lead to relapse.
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• Contingency Management (CM): Uses structured reward systems to reinforce abstinence, making recovery more motivating and sustainable.
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• Family and Couples Therapy: Since alcohol dependence impacts families, involving loved ones in therapy can strengthen support networks and improve recovery outcomes.
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5. Support Systems and Self-Help Integration

Psychiatrists often encourage patients to join peer support groups such as Alcoholics Anonymous (AA) or SMART Recovery. These groups provide accountability, shared experiences, and encouragement outside clinical sessions. Combining professional therapy with community-based support significantly boosts recovery success rates.

6. Relapse Prevention and Long-Term Management

Alcohol dependence is often a relapsing condition, but psychiatrists help patients develop long-term strategies for maintaining sobriety. This includes:

• Regular therapy follow-ups.
• Monitoring and adjusting medications.
• Developing healthy lifestyle habits like exercise, sleep regulation, and stress management.
• Creating relapse prevention plans that identify triggers and coping strategies.
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With ongoing psychiatric care, individuals learn to manage cravings, rebuild self-esteem, and reintegrate into daily life without reliance on alcohol.

Conclusion

Alcoholism is a complex disease, but with the right support and medication, you can overcome it. 

If you're concerned about a loved one who drinks too much, reach out to a psychiatrist experienced in alcohol treatment for advice on how to approach that person.

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