01 / 09
Alcohol Treatment From Intake to Aftercare
From assessment through aftercare, alcohol care can be separated into five phases:
Assessment. This includes determining the level of care needed and identifying strengths and weaknesses.
Detoxification. Withdrawal symptoms are addressed.
Inpatient treatment and residential programs. Inpatient involves 24-hour supervision; residential does not but still provides a high level of supervision.
Outpatient treatment programs. These involve several hours per week in structured sessions and can include counseling, support groups, and medications for addiction or other mental health disorders.
Continuing care or aftercare. Care may continue for years to help maintain abstinence.
A common misconception is that "detox" is the only thing necessary for people with alcohol use disorder (AUD). But detoxing is just one part of treatment, and without further counseling it has little effect on long-term sobriety.
02 / 09
When Drinking Has Become a Problem
Drinking has become a problem when a person feels that their drinking is out of control or if someone else (such as a spouse, family member, friend, co-worker) says that your drinking is problematic. A person with alcohol dependence may be preoccupied with getting and using alcohol and recovering from its effects.
A person who drinks large amounts of alcohol on a regular basis can develop tolerance to it over time. This means the person has to drink larger or more frequent amounts of alcohol in order to feel its desired effect, such as relaxation. Over time, when a person stops drinking they may experience unpleasant symptoms such as anxiety, shakiness, nausea, sweating, insomnia, or even seizures.
When people continue to use alcohol despite negative consequences, such as missing work or getting into fights, this can indicate a need for treatment. A healthcare provider will consider the frequency and severity of symptoms to diagnose AUD.
AUD can range from mild to severe. The DSM-5 categorizes it as follows:
- Mild: 2 to 3 symptoms
- Moderate: 4 to 5 symptoms
- Severe: 6 or more symptoms
Some people with an AUD may also have mental health conditions such as depression, which can make it harder to stop drinking.
03 / 09
Withdrawal Care and Medical Stabilization
Alcohol withdrawal can need medical supervision when it involves moderate-to-severe symptoms.
04 / 09
Ohio Care Ladder: Outpatient, Intensive Outpatient, and Live-In Programs
Ohio programs span outpatient through live-in care settings that provide medication management, counseling, social services, education, and peer support. These range from one-on-one therapy sessions to multi-day residential programs.
Treatment options include:
- 12-step groups such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), or Al-Anon
- Outpatient treatment programs: individual, group, family therapy, relapse prevention
- Intensive outpatient treatment: intensive treatment with frequent scheduled visits
- Inpatient treatment or residential treatment centers: round-the-clock care and support
SMART Recovery is a secular, science-based recovery program that uses cognitive behavioral therapy techniques to help people achieve sobriety.
Women for Sobriety is a women-only support group.
05 / 09
Medicines Used for Alcohol Use Disorder
Approved medicines for alcohol use disorder include:
- Naltrexone (brand names Vivitrol, ReVia)
- Acamprosate (brand name Campral)
- Disulfiram (brand name Antabuse)
Naltrexone (ReVia, Vivitrol) blocks the euphoric effect of alcohol. It does not make you feel sick if you drink while taking it. Instead, naltrexone prevents the feeling of intoxication or pleasure that can lead to overdrinking.
Naltrexone is available as a pill or as an injection.
Acamprosate (Campral) may help reduce cravings for alcohol. It doesn't block intoxication, but it does help reduce the symptoms that make you feel bad after stopping drinking.
Disulfiram is a pill that causes an unpleasant physical reaction when you drink alcohol. It blocks the action of an enzyme that is involved in the metabolism of alcohol. This prevents alcohol from being processed normally by the liver.
The resulting buildup of acetaldehyde, a toxic chemical produced during normal alcohol metabolism, causes flushing, throbbing headache, vomiting, blurred vision, confusion, and weakness or dizziness upon drinking alcohol while taking disulfiram.
Disulfiram works best when combined with behavioral treatment, such as group or individual therapy.
A doctor or other health care provider can determine which medicine is best for you based on your needs, medical history, and other factors. The medications may be prescribed alone or in combination with counseling.
06 / 09
Counseling Approaches and Peer Groups
Counseling and peer groups both support recovery from alcoholism and other drug problems. Both are helpful, but in different ways.
Behavioral therapy teaches you to identify the situations that trigger excessive drinking. It helps you develop strategies for managing those situations and coping with alcohol cravings without giving in. It can also help you learn how to avoid behaviors that result in relapse (such as poor self-care).
Individual therapy is usually based on cognitive-behavioral principles. You learn coping skills that help you manage the stress and other emotions that trigger alcohol use.
Motivational enhancement therapy (MET) may be used in both individual and group settings. It uses techniques based on the principles of motivational interviewing, which helps you recognize the benefits of changing your behavior and become motivated to achieve those changes.
They provide a way of connecting with other people who have similar problems and issues. These groups help members realize they're not alone.
A peer is someone who has faced similar challenges as the person being helped. It may be someone at home or in the community. Or it could be someone at a support group meeting. Peers are usually people with lived experience but may also include family members, friends, coworkers, clergy, or others who know you well.
Some examples of peer groups are Alcoholics Anonymous (AA), Al-Anon/Alateen, and Narcotics Anonymous (NA). AA is for people having problems with alcohol. Al-Anon/Alateen supports the family and friends of those with drinking issues. NA is for people struggling with drug abuse.
Peer groups let you connect with others who have had similar experiences. They offer support, advice, and encouragement. You can share your feelings in group discussions, and learn about what works for others. Peer groups do not provide professional counseling or medical treatment.
07 / 09
How Ohioans Pay for Alcohol Treatment
Ohioans may pay for alcohol treatment through Medicare, Medicaid or private insurance.
Ohio’s mental health and addiction recovery system is made up of a network of providers and agencies that deliver a wide range of prevention, treatment, and recovery support services.
Local boards do not deliver the treatment continuum themselves. They contract with local community providers to provide the actual service to individuals.
Local boards use public and private funds, which are allocated through the block grant system to purchase a range of prevention, treatment, and recovery supports services.
08 / 09
Locating an OhioMHAS-Certified Program
County ADAMH boards plan local care and contract with agencies for treatment and support services, which are provided at multiple locations throughout each board area.
Ohio has many public and private alcohol and other drug treatment providers. Not all programs are the same or meet the same quality standards.
Certified programs must meet specific criteria set by OhioMHAS.
OhioMHAS certification means a program met state-mandated standards for quality care in providing alcohol or drug addiction treatment, mental health treatment and/or recovery support programs. This is not the same as Medicare, Medicaid or insurance certification.
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Staying Supported After a Program Ends
Recovery housing and peer supports continue after a treatment program ends. Recovery housing is an option to stay connected with your peers while transitioning back to your community. Peer support specialists can connect you with resources in your community and offer mentorship.
After a program ends, ongoing supports can make recovery more successful. These include:
- 12-step programs like Alcoholics Anonymous or Narcotics Anonymous
- Recovery groups, such as SMART Recovery
- Local support groups and other services
- Continued medical care, including medications that reduce cravings and relapse
Some of the programs that can help you maintain your recovery include:
- RecoveryOhio
- Project DAWN (Deaths Avoided With Naloxone)
- Ohio CareLine
- Recovery Housing