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Alcoholism is a dependency that often goes undiagnosed and untreated for a variety of reasons. Alcohol is the most commonly abused psycho-addictive drug worldwide, as an estimated 14 million Americans meet the clinical criteria for alcohol use disorder. Unlike opiates or other illegal substances, alcohol is readily available, legal, and highly commercialized.
Repeated intake of high doses of alcohol can affect nearly every organ system, especially the gastrointestinal tract, cardiovascular system, and central and peripheral nervous system. Severe alcohol intoxication also contributes to feelings of sadness and irritability, which contribute to some instances of suicide.
Alcohol use is so widely acceptable that it can be challenging to determine whether or not a person has a problem. Paradoxically, alcoholism is so stigmatized that asking for help or getting help presents vast obstacles. If you or a loved one has a problem with alcohol dependency, please don’t hesitate to call Fifth Avenue Psychiatry for a confidential consultation.
The best treatment options for Alcohol Use Disorder are a combination of different modes of psychotherapy, including but not limited to Cognitive Behavior Therapy and Motivational Interviewing. Many medications can be used to help with cravings and even to reduce or help control drinking (these include Naltrexone, Vivitrol, Campral, Topamax, and Baclofen). Assessment by an Addiction Psychiatrist or other Physician is an extremely important part of treatment. Alcohol Use Disorder, though more common than any other drug dependence, can also be one of the most dangerous withdrawal syndromes. In the evaluation stage of treatment, we assess for alcohol dependence and whether detox is indicated. If someone is alcohol dependent, they likely have experienced early stages of alcohol withdrawal in the morning or when they have stopped drinking. These include shakiness or jitteriness in the hands, sweating, nausea, and increased heart rate and blood pressure. Alcohol withdrawal must be treated medically.
A common detox regimen includes treatment with a long-acting benzodiazepine like Librium or a muscle relaxant like Baclofen. Later stages of withdrawal may last for weeks or months. This is called Protracted Withdrawal, and it can occur with the stoppage of any addiction. Protracted withdrawal from alcohol dependence can be experienced as ongoing insomnia, difficulty concentrating, intense craving for alcohol, and, in some cases, an over-excitable state. If necessary, these symptoms can also be treated with medications like Gabapentin, Baclofen, Campral, or cognitive behavioral therapy.
Fifth Avenue Psychiatry’s treatment combines pharmacological and non-pharmacological methods customized for maximum efficacy. An outpatient detox can be arranged using medication and providing counseling, education, and support. Ongoing Alcohol Use Disorder Treatment is then focused on the individual, using psychotherapy, relapse prevention, and office-based treatment.
According to research, 20% of adult males abuse alcohol or suffer from alcoholism-related complications. Men are at higher risk of developing alcoholism than women. While studies have yet to pinpoint an exact reason for this phenomenon, it’s believed that men have stronger expectations that drinking will increase social and physical pleasure. There is some evidence that being in the white-collar workforce, including finance and law, can increase the risk of developing an alcohol use disorder. This is mirrored by statistics that show much higher rates of alcohol and drug abuse by women since they have been more relevant in the workforce.
At Fifth Avenue Psychiatry, we provide comprehensive treatment programs for men with an alcohol use disorder. Our therapies and medication management are highly confidential and offer a place for men to overcome their addiction and rebuild their confidence and self-esteem.
Women face unique challenges with alcoholism, with about 60% of American women drinking and 13% exceeding daily recommendations. Approximately 5.3 million women risk their health due to alcohol abuse, often facing hidden addiction stigmatization. Physiologically, women react differently to alcohol, posing more significant risks to their health, including liver disease, certain cancers, impaired fertility, and congenital disabilities during pregnancy. Additionally, heavy drinking increases the risk of accidents, violence, and sexual assault.
Our private office provides a safe space for women to seek treatment, offering an individualized approach with options such as psychotherapy, relapse prevention, and office-based treatment. In addition, women can choose to work with a female psychiatrist, addressing their unique needs and promoting a path to recovery.
Alcoholism or Alcohol Use Disorder, Severe is a disorder that millions suffer from in the U.S. If one is physically dependent on alcohol, abruptly stopping drinking can cause serious withdrawal symptoms that professionals throughout the detox process should monitor.
During alcohol detox, our medical team will watch your vitals and aid you with the side effects of withdrawal. If deemed necessary, your doctor may prescribe you medication to help with the detox process by reducing cravings.
Alcohol withdrawal symptoms include:
Alcoholism is often a family problem. A family is understood as a system, and the behavior of all family members impacts each other. When one family member is an alcoholic, it has far-reaching psychological effects on every member of the family.
Similarly, a person with an alcohol use disorder may be drinking to alleviate the pain of an abusive or controlling relationship. We take the effects of alcoholism and the interplay of the entire family into account at Fifth Avenue Psychiatry.
Our team believes that even if only one family member is addicted, it can be helpful for the entire family to be involved in the treatment process. This is done through family therapies where a clinically licensed psychologist will work closely with everyone involved to make sure their voice is heard, and they can equip valuable tools and knowledge to help their loved one recover.
The idea of a controlled drinking program versus total abstinence as a way to effectively manage alcohol use disorder has been a controversial discussion that has recently gained even more attention. Traditional treatment programs are generally based on a model of total abstinence as a goal for all people with alcohol use disorders.
But today, with a better understanding of neuroscience, the development of new psychotherapies and medications since the founding of Alcoholics Anonymous, and the abstinence model 85 years ago, the concept of controlled drinking seems more of a real possibility for many who identify as having an alcohol problem. There is a great deal of new evidence suggesting that high-functioning people may be able to manage a controlled drinking program. The idea of “harm reduction” as a way to cope with any substance abuse problem has recently been considered more acceptable in the addiction field.
Many people come for treatment for whom one drink truly is too many, and, in that case, abstinence as a goal is genuinely their best path forward. It is also true that most people do better with a goal of abstinence. We have seen this in our practice over the years. But the insistence on “abstinence-only” can repel many people from looking for help in the first place. Abstinence as the only solution defies the idea that we are all individuals with different circumstances, motives, and goals.
Alcoholism is on a spectrum that, like any other disease, depending on where one is on that spectrum, guides treatment. At Fifth Avenue Psychiatry, we view it as more of a risk/benefit analysis of one’s drinking behavior. If controlled drinking fits into an acceptable risk/benefit equation, it is possible. A critical caveat, however, is that one must have a careful assessment of one’s drinking patterns and previous consequences before embarking on a controlled drinking program.
As there are many different definitions of alcoholism, there are many kinds of people who come to treatment with varying patterns of drinking. At Fifth Avenue Psychiatry, our alcohol addiction psychiatrists do not believe in a one-size-fits-all approach, nor do we believe a complete alcohol abstinence program serves every client right. In fact, only 7% of the 14.5 million Americans with AUD received treatment in the past year, and while there are some effective medications to help treat alcoholism, less than 4% were prescribed an FDA-approved medication for AUD. Additionally, people were more likely to see their doctor for an AUD-related medical problem than to get help for their AUD itself.
Binge drinking and heavy alcohol use are not, in themselves, disorders but can increase an individual’s risk of developing an Alcohol Use Disorder. The goal of any treatment for Alcohol Use Disorder (AUD) is seen as the restoration of a person’s medical and social well-being by controlling alcohol drinking and its consequences.
There are many reasons why people do not get treatment for substance use disorders and alcoholism. There is shame and embarrassment in admitting a problem, and there is denial (in that one may not even know they have a problem).
At Fifth Avenue Psychiatry, our addiction doctors believe two obstacles to getting help are the stigma of a one-size-fits-all program:
For these reasons, our doctors truly tailor treatment to an individual and one’s personal goals. We understand that not everyone can accept “abstinence as a goal” at first.
At Fifth Avenue Psychiatry, our controlled drinking program is composed of two different phases:
Medications, such as the following, can be added to reduce cravings and reduce consumption of alcohol:
It is usually within this second phase that a person can honestly assess whether they benefit from a controlled drinking program. It is not always clear early on whether controlled drinking is possible. With a good alliance with their therapist and honesty, one can be at peace with finding the right path—whether it be staying with a controlled drinking program or a self-directed decision to make abstinence the goal.
A combination of behavioral therapies, counseling, and medication is the most effective form of treatment for alcoholism. Cognitive behavioral therapy (CBT), in particular, has been shown to improve behaviors and symptoms associated with alcohol use disorder. Using FDA-approved medication like Naltrexone or Campral can aid in reducing cravings. Naltrexone works by blocking opioid receptors in the brain and halting the euphoric effects of alcohol use.
Once these primary items are established, consistent accountability and support are critical to continued sobriety. For some, this may look like weekly AA meetings with a sponsor; others may continue taking part in CBT or other individual and group therapies.
We receive many calls from family members, spouses, and parents asking for help for their loved ones. One of the biggest misconceptions is that it is the identified person with Alcohol Use Disorder who needs to go to therapy alone.
If you are reading this, you yourself will likely need help in getting a loved one to go for alcoholism treatment. You are likely experiencing symptoms and thoughts that an addiction therapist can better understand.
It might make sense for you to consult alone with our addiction psychologists to fully understand the dynamics of the disease and its impacts on you and to strategize. This can include learning how to better communicate with your loved one and better set limits and boundaries around their behavior and their need for help.
There are many options as an outpatient before one needs to do an “intervention” or send someone to inpatient rehab.
Many people struggle with their relationship with alcohol. Despite having consequences that affect their relationships and sometimes work and health, they avoid treatment. For some, avoidance of treatment is indeed just that, combined with denial. However, many people who struggle with alcohol misuse can benefit from an approach where they can explore and get comfortable with their goals over time.
For some, the idea of abstinence or 12-step programs may repel them from getting any help at all, and it may not be the appropriate solution. At Fifth Avenue Psychiatry, we carefully assess and work with each client or family member to find the right treatment goals, whether that be a controlled drinking program or abstinence as a goal.
Though not diagnostic, behavior where someone misses many obligations (especially Mondays), misses emails at night, seems to disappear some weekends or nights, or is always leading the charge to get drinks may indicate alcohol abuse. The best definition of an alcohol use disorder, or any addiction for that matter, is the continued use of a substance (in this case, alcohol) despite negative consequences to oneself or someone they love. Consequences (some of many) can include loss of control when drinking, leading to a DWI, problems with relationships, physical accidents or falls, missed work or family obligations, or adverse effects on physical or emotional health. It’s difficult to pinpoint the personality traits of alcohol abusers. In general, alcoholics can have the psychological traits of impulsiveness, low self-esteem, and approval-seeking or people-pleasing behavior.
While alcohol may appear to provide temporary relaxation from stress, ongoing use for coping can lead to a worsening of depression and anxiety. Alcohol is a depressant, and the long-term effects on the nervous system can cause mental health problems and depression. Likewise, alcohol dependence will require the user to increase intake to get the same effects, and when they’re not able to do so, anxiety can increase.
The co-existence of substance use disorders like alcoholism and mental illness is called dual diagnosis. As of 2024, approximately 50% of individuals with severe mental conditions are affected by substance abuse. Among these, 37% of alcohol abusers have at least one serious mental health disorder.
The American Addiction Centers shares that anxiety disorders are a common symptom of heavy drinking. Many times, a night of drinking will lead to next-day anxiety, sometimes called “hangxiety.” Drinking can also exacerbate existing anxiety problems.
Research has pointed to alcoholism as a genetic disorder that runs in families. While environment and experiences play a role in substance abuse as well, studies show that genes are responsible for about half of the risk for AUD. Some studies show this genetic predisposition may be as simple as that they enjoy alcohol more (are energized by it) and suffer less physical consequences like hangovers and thus are prone to drinking more, which, of course, is more likely to lead to an AUD.
One can detox from alcohol both as an inpatient and on an outpatient basis. Alcoholism is a serious health condition, and for those with alcohol dependence, it’s important to seek an addiction doctor or a detox center where you can be safely supervised. Untreated alcohol withdrawal can cause seizures, DTs, and, at times, death. Detox professionals can provide you with support and necessary medications like Baclofen or Librium during detoxification to reduce withdrawal symptoms and cravings.
Delirium tremens is the most dangerous and severe form of alcohol withdrawal. It can cause various moderate to serious side effects, including visual hallucinations, tachycardia, hypertension, hyperthermia, agitation, and diaphoresis. It can result in death. Delirium tremens is uncommon and usually occurs in malnourished or physically ill people with longstanding severe alcohol use disorder.
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