/ Alcohol Use Disorder
How we Treat Alcohol Use Disorder
What medications are used in this program?
We personalize treatment for every patient, however the medications most commonly prescribed for mild to moderate withdrawal are Librium and other benzodiazepines, gabapentin, or carbamazepine. Beta-blockers and clonidine may be used in addition to benzodiazepines where indicated. For relapse prevention, the FDA has approved three oral medications (disulfiram, acamprosate, and naltrexone) and one injectable medication (extended-release injectable naltrexone).
Do I have to be abstinent from alcohol before I start this program?
No, we expect that you will be drinking when you start the program. We will do lab testing and assessments before you stop drinking to ensure your withdrawal period is managed safely with the appropriate medical oversight.
Am I eligible for outpatient withdrawal management?
Outpatient withdrawal management is reserved for people with little to no risk of dangerous withdrawal symptoms. At your first appointment your provider will assess your risk for severe withdrawal and if warranted, refer you to an inpatient medically-managed withdrawal program. After the withdrawal period is over, you are encouraged to return to us for outpatient relapse prevention treatment.
How soon can I start treatment?
If you are still drinking, your first phase of treatment is withdrawal management. Treatment for withdrawal must be started on a Monday so we can see you daily for 4-5 days after you begin. If you choose to schedule your first appointment with us virtually or on a different day of the week, your provider will use that time to complete your assessments and develop a personalized treatment plan. However, you must visit one of our clinics on the following Monday to get a blood alcohol content (BAC) test and receive a prescription for medication. For your safety, your provider will advise you to continue drinking as normal until you start treatment in order to prevent potentially dangerous withdrawal symptoms. Arkansas patients must attend all appointments in a clinic, per state law.
How often will I have to come to Ideal Option after I start treatment?
During the withdrawal period, we will schedule daily appointments for up to 5 consecutive days, to monitor your medication adherence and assess withdrawal symptoms. You must visit a clinic in person in order to begin treatment so we can measure your blood alcohol content before prescribing medication. After your treatment has started, your provider may allow you to do follow up appointments remotely. If you are already abstinent from alcohol at your first appointment, you provider will determine how often you need to be seen as you progress through relapse prevention. Arkansas patients must attend all appointments in a clinic, per state law.
Why do you do urine and breathalyzer tests?
It's important for your provider to know how much alcohol and other substances are in your system to ensure your safety when prescribing medications. Ongoing testing will help your provider adjust your treatment plan and monitor your progress over time.
How do you diagnose alcohol use disorder (AUD)?
We use the current DSM-5 assessment to confirm a diagnosis of AUD. Under DSM–5, if you meet any two of the 11 criteria during the same 12-month period you will receive a diagnosis of AUD. The severity of AUD—mild, moderate, or severe—is based on the number of criteria met. You can learn more about DSM-5 criteria here.
What if I am not diagnosed with AUD?
If you engage in risky drinking but do not meet the criteria for alcohol use disorder, your provider will discuss whether reducing or abstaining from alcohol is the more appropriate goal. Your treatment goal will be somewhat dependent on factors such as a family history of alcohol problems, your age, and your history of traumatic events related to drinking.
How do you assess for withdrawal severity?
We use the CIWA-Ar clinical rating scale to assess the likelihood and potential severity of withdrawal. The most useful clinical factors are the number and nature of your previous withdrawals (treated or untreated). Three or more withdrawal episodes indicates an increased likelihood that severe withdrawal symptoms will occur unless adequate medical care is provided. You can learn more about the CIWA-Ar rating scale here.
What if I am assessed for severe withdrawal?
Alcohol withdrawal syndrome can be severe and potentially fatal, so it is particularly important to identify when there is a need for inpatient medically-managed withdrawal. If you are assessed for severe withdrawal, you will be referred to an inpatient program that can provide medically monitored withdrawal management.
If I am eligible for outpatient treatment, how long will I be on medication?
Most patients will taper off withdrawal medications in 5-10 days while medications used for relapse prevention may be prescribed indefinitely. Alcohol use disorder is a chronic relapsing disease, so persistence is key. For most people, continuing medication and regularly following up with a treatment provider is critical to preventing relapse and staying abstinent from alcohol over the long term.
Isn't taking medication indefinitely the same as trading one addiction for another?
This is not an uncommon concern, but the short answer is “no.” All medications approved for treating alcohol use disorder are non-addictive. These medicines are designed to help manage a chronic disease, just as someone might take medications to keep diabetes in check, and allow you to lead a normal, productive life, free of the problems caused by misuse of alcohol.
Does your program include counseling?
Weekly or biweekly counseling sessions combined with medication has been proven repeatedly to be an effective treatment for patients in early recovery from AUD. Our Washington State patients will be offered in-house counseling with a licensed substance use disorder professional in addition to referrals to community mutual-help groups such as AA. In other states patients will be referred to outside counseling and/or mutual-help groups.
What if I want to reduce my drinking but not quit completely?
Reducing drinking may be an acceptable goal for some low risk patients. Our providers are trained on the Sinclair method if patients are interested in learning more about this non-FDA approved dosing approach. This method may be beneficial in some cases but overall we recommend using the most evidence-based treatment methods.
Do you treat special populations like youth and pregnant women?
None of the available medications are approved by the FDA for use in people younger than age 18 or proven safe for pregnant women. Younger adolescents and pregnant women in need of treatment will be referred to a clinician or program specializing in methods appropriate for those populations.
What if I have questions or need medical help between appointments?
If you are having a medical emergency during the withdrawal phase, it's essential that you are willing to call 911 or visit your local emergency room for immediate attention. We strongly recommend you have a responsible adult with you at all times during withdrawal phase to assist you as needed. If you are having milder symptoms or have questions, please reach out to the Ideal Option Nurse Care Team at 1-877-522-1275. Our registered nurses are available 24 hours a day, 7 days a week to assist you over the phone.