In recent years, treatment professionals have increased the use of medication-assisted treatment for substance use disorders. The primary driver of this increase is the opioid overdose crisis. Experts consider medication-assisted treatment (MAT) the gold-standard treatment for opioid use disorder (OUD) because it’s incredibly effective. In combination with therapy, counseling, lifestyle changes, and community support, MAT can reduce opioid use, mitigate withdrawal symptoms, prevent cravings, and allow patients to engage in treatment and start the path toward long-term, sustainable recovery.
To learn more about MAT for OUD, please read our treatment page here:
Medication-Assisted Treatment
What many people may not know is that evidence shows medication-assisted treatment can help people with alcohol use disorder (AUD), also. The medications are different, of course, and MAT for AUD always includes an integrated treatment approach, like MAT for OUD. Integrated means that treatment involves more than one modality – counseling/therapy combined with medication, for instance – and addresses all factors that can contribute to the disordered use of alcohol.
To learn about our approach to AUD treatment, please read our page here:
Alcohol Use Disorders
We’re raising awareness about MAT for AUD in this article in response to recent data that shows that consuming alcohol at levels previously considered moderate is associated with significant negative physical outcomes. To learn more about this recent research, and about new information on alcohol and alcohol use in general, please navigate to the blog section of our website and read these articles:
National Alcohol Awareness Month: April 2023
Moderate Drinking, Binge Drinking, and Alcohol-Related Problems
The new view of alcohol use in the medical community is that any level of alcohol use can increase risk of various physical diseases, including cancer. This reverses decades of misunderstanding about alcohol: most people remember hearing that a glass or two of wine with dinner is healthy. While research shows a minor benefit from consuming small amounts of alcohol, increased cancer risk eclipses those benefits.
In light of this new information, it’s important for people who want to reduce their alcohol intake to understand the broad range of treatment options available, including medication-assisted treatment for alcohol use disorder (MAT for AUD).
The Benefits of Medication-Assisted Treatment for Alcohol Use Disorder (MAT for AUD)
The Substance Abuse and Mental Health Services Administration (SAMHSA) published a resource called “Medication-Assisted Treatment for the Treatment of Alcohol Use Disorder: A Brief Guide” that offers in-depth information and creates guidelines for MAT for AUD.
The benefits of MAT for AUD include:
- Reduced alcohol use: evidence shows MAT for AUD can significantly reduce alcohol intake and reduce symptoms of AUD
- Increased mental clarity: MAT for AUD allows patients to rediscover a balanced state of thought and emotion, free from the ups and downs of chronic alcohol use
- Increased ability to participate in counseling and therapy: MAT for AUD can help prepare people for the internal work associated with addiction therapy and counseling
- Reduced cravings: two of the three medications minimize alcohol cravings
- Prevent alcohol use: one of the three medications makes ingesting any alcohol psychologically unpleasant and physically uncomfortable
- Increased ability to make lifestyle changes: MAT for AUD can help patients in recovery make positive changes to their daily routines that promote sustainable recovery
Those benefits make it clear: for people who want to reduce their alcohol intake or stop drinking alcohol altogether, MAT can help. Next, with that in mind, we’ll share the latest data on alcohol use in the U.S., including overall rates of treatment and treatment with MAT.
Alcohol Use in the U.S.: Facts and Figures
It’s true: alcohol is everywhere in our society and culture. People serve and consume alcohol on formal occasions, at informal events, and virtually every type of situation in between those two extremes. Consuming alcohol is a socially acceptable way to relax, socialize, and pass the time. However, for millions of people, casual use can lead to chronic, excessive use. In some cases, it leads to disordered use, which we understand as addiction, or alcohol use disorder.
We retrieved the latest data on alcohol use and alcohol use disorder (AUD) from the 2021 National Survey on Drug Use and Health (2021 NSDUH). Let’s take a look at the real numbers to understand the scope of the alcohol use problem in the U.S.
Here’s the data:
Alcohol Use: Current, Heavy, Binge Drinking, and Alcohol Use Disorder, Age 12+
- Current use: 133.1 million (45%)
- Binge drinkers: 60.0 million (21.5%)
- Binge drinkers by age group:
- 18-25: 29.2%
- 26+: 22.4%
- 12-17: 3.8%
- Binge drinking among underage people: 8.3%
- Heavy alcohol use among underage people: 1.6%
- Alcohol use disorder by age group:
- 12 + total: 10.6%
- 12-17: 3.4%
- 18-25: 15.0%
- 26+: 10.7%
- Classified as needing treatment for alcohol use: 10.7%
That last bullet point gives us a critical fact. By clinical standards, 32.1 million people each year need treatment for alcohol use. That’s far more than most people realize.
Let’s see how many people who needed treatment received the treatment they needed.
Received Treatment for Alcohol Use
- Received any type of treatment: 0.9% of total
- Location/level of treatment (patients may engage in more than one):
- Hospital Inpatient: 24.5%
- SUD/AUD facility inpatient: 31.4%
- SUD/AUD facility outpatient: 34.5%
- Behavioral health facility outpatient: 27.5%
- Emergency room: 14.8%
- Private doctor: 21.1%
- Self-help group: 49.3%
- Virtual treatment: 42.8%
- While incarcerated: 4.9%
- Received treatment among those classified as needing treatment:
- Any treatment: 10.7%
- At specialty facility: 4.7%
- Received medication-assisted treatment for alcohol use:
- Total: 0.1%
- Among those with AUD: 0.9%
Those figures tell us that MAT for AUD is dramatically underused. Less than one percent of people who need treatment for AUD engage in MAT for AUD. That means that out of the 32.1 million people who need treatment for alcohol use, around 32,100 engage in MAT for AUD.
That’s a treatment gap – with regards to MAT – of 99.9 percent. That’s far too large. We encourage anyone who knows someone trying to reduce or stop drinking to consider medication-assisted treatment, which we’ll discuss in detail below.
What Are the Medications for Alcohol Use Disorder?
There are three medications approved by the Food and Drug Administration (FDA) for the treatment of alcohol use disorder: Naltrexone, Acamprosate, and Disulfiram. We’ll describe each of these medications below, beginning with Naltrexone.
Naltrexone
How it works:
- Blocks brain receptors associated with alcohol reward
- Blocks brain receptors associated with alcohol craving
Method of delivery:
- Oral, daily, or as directed
- Extended-release injection, monthly
Initiation:
- Requires abstinence from opioids
- Abstinence from alcohol preferred – evidence shows Naltrexone is not effective in patients who are drinking upon initiation
Side effects:
- Common: nausea, sleepiness, headache
- Uncommon: Anxiety, vomiting, liver problems, confusion
- Contraindicated for people on long-term opioid treatment for chronic pain
Acamprosate
How it works:
- Affects brain receptors associated with alcohol craving
- Restores balance to brain receptor systems associated with reward
- Does not prevent action of alcohol in brain
- May reduce severity of withdrawal symptoms, but doesn’t prevent withdrawal
Method of delivery:
- Oral, three times per day
- Extended-release injection, monthly
Initiation:
- Requires full detoxification and abstinence from alcohol
Side effects:
- Common: diarrhea
- Uncommon: Anxiety, insomnia, muscle weakness
- Contraindicated for people with kidney problems
Disulfiram
How it works:
- Makes drinking alcohol unpleasant. Causes:
- Shaking
- Sweating
- Anxiety
- Nausea
- Vomiting
- Does not prevent withdrawal, reduce cravings, or affect reward systems in brain, but the severe effects listed above are effective in deterring people from drinking alcohol
Method of delivery:
- Oral, once daily
- Extended-release injection, monthly
Initiation:
- Requires full detoxification/abstinence from alcohol
Side effects:
- Common: drowsiness, metallic taste in mouth, headache
- Uncommon: fatigue, weakness, yellowing of skin/eyes, vomiting
- Contraindicated for people with myocardial disease, hypothyroidism, epilepsy, hepatitis, people with high levels of impulsivity or suicidality, and people over age 60.
Medication-Assisted Treatment for Alcohol Use Disorder: How Assessment and Initiation Work
The process for starting MAT for AUD is similar to starting any alcohol or substance use treatment program. The first thing that happens – after an initial contact call/meeting with a potential provider – is a comprehensive biopsychosocial assessment.
During a biopsychosocial assessment, a licensed and qualified provider collects information in the following areas:
Biological:
- Complete medical history
- Family history of medical and mental illness
- Substance Use/Misuse history
- Developmental history
- Current level of physical function and abilities
Psychological:
- Current psychiatric symptoms or illnesses
- Past psychiatric symptoms or illnesses
- Current mental/psychological status
- Family history of mental illness
- Current psychiatric medication/treatment
- Past psychiatric medication/treatment
- Current psychological stressors
- History of trauma or traumatic experiences
Social:
- Current level of social function
- Current home situation
- Status of family, peer, and other relationships
- Gender identity and sexuality
- Family history
- History of trauma
- Educational background
- Legal history
- Work history
Once a qualified provider completes an assessment and confirms the need for treatment, one treatment they offer may be medication-assisted treatment (MAT) with one of the three medications we describe above. If a patient agrees to MAT for AUD, then the provider and patient collaborate to create an individualized treatment plan.
Treatment Plans for MAT with AUD: Essential Components
SAMHSA clearly outlines the guidelines for medication-assisted treatment for alcohol use disorder. The most important thing to understand is that in any MAT program – whether for alcohol or opioids – the medication is one part of a complete treatment plan.
SAMSHA indicates treatment plans using MAT for AUD should include:
- Detailed information about the medication, including:
- The need to inform all medical providers about the medication
- Any symptoms or side effects that should be reported to a doctor immediately
- Clear dosage/use instructions
- Detailed information on additional treatment components, including:
- Therapy
- Counseling
- Lifestyle changes, including healthy eating, activity/exercise, sleep hygiene
- Community/peer support
- Complementary support, such as yoga, mindfulness, and stress management
- The purpose and importance of the non-medication components of treatment
- Educational workshops on the following:
- The science of addiction and AUD
- Relapse prevention
- Relationship repair
- Practical recovery tips
- A schedule for follow-up office visits and tests to monitor progress and assess any side effects related the medication in use
- Participation of family or significant other, when possible and deemed beneficial
- A plan for treating any co-occurring psychiatric conditions
- A plan for treating any other substance use disorders or issues
- Clear benchmarks and criteria for:
- Discontinuing the use of medication
- Discharge from treatment
- Referral to a more immersive level of care, if needed
We would add one component to this list: a robust aftercare plan that stresses the value of community support, relapse prevention plans, and what to do in case of relapse. An aftercare plan includes medical resources, psychiatric resources, substance use treatment resources, and information on community support groups like Alcoholics Anonymous (AA) and others.
Ongoing Support for AUD: What Happens After Discharge?
A patient who engages MAT for AUD may continue to take medication for a long period of time after their formal treatment program ends. However, they still need to engage in an active recovery plan and refine their stress management and recovery skills over time. That’s another – and perhaps the most important – component of an aftercare plan: a list of all the things that worked for each patient during treatment. What works for one person may not work for another. That’s why each aftercare plan is unique, like each treatment plan.
For instance, some patients may love exercise, and find that for them, daily activity keeps them on track and helps them maintain sustainable, long-term recovery. On the other hand, some patients may feel the same way about yoga, mindfulness, and meditation: it works and keeps them on track. In addition, still others may find daily community support meetings keep them on their program: accountability and frequent contact with recovery peers makes all the difference.
What we want people seeking treatment and support for alcohol use for themselves or for a friend or loved one to know is that MAT is a safe, effective option that can help reduce alcohol consumption and begin their recovery journey. Finally, we want people seeking treatment for AUD to know and understand this:
The sooner a person who needs treatment for AUD gets the treatment they need, the better the outcome.
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