Information for the public

Treatments for adults who misuse alcohol

Treatments for adults who misuse alcohol

Treatments for adults (aged 18 or over) who misuse alcohol may include:

  • planned withdrawal from alcohol, which can help people to safely stop drinking, and

  • psychological treatments and medication, which can help people to stay alcohol-free or reduce their drinking to a less harmful level.

These treatments are explained in the sections below.

Most treatments can be provided in a clinic near your home or, in some cases, in your own home. If you are homeless and alcohol dependent, you may be offered a place in a residential rehabilitation unit (sometimes called 'rehab' for short). This should usually be for a maximum of 3 months and care staff should help you to find accommodation before you leave the unit.

You should be regularly monitored to see whether the treatment is working. If there are no signs of improvement or your condition is becoming worse then your care staff should review your treatment and you may be offered a different treatment.

Treatments for harmful drinking (high-risk drinking) and mild alcohol dependence

If you drink in a way that is harmful, or have mild alcohol dependence, you should be offered a psychological treatment (these are listed in the glossary). This should be specifically focused on the alcohol problem and how it affects your thoughts, behaviour and relationships.

If psychological treatment on its own does not help you, you may be offered medication (acamprosate or naltrexone) at the same time as a psychological treatment. See below for further information about this medication.

Treatments for moderate and severe alcohol dependence

Planned withdrawal from alcohol programmes

This section contains information about what should happen during a planned withdrawal from alcohol (sometimes called detoxification or 'detox'). For information about what should happen if you go to hospital in an emergency because of alcohol withdrawal, see the NICE guideline on alcohol-use disorders: diagnosis and management of physical complications.

If you have moderate or severe alcohol dependence, it is more effective and safer to stop or reduce your drinking in a planned way with medical help. Depending on how severe your drinking problem is, you may be offered a planned withdrawal programme in a clinic or sometimes in your own home. If there are safety concerns (see below) you may be offered support in a specialist alcohol treatment centre.

Planned withdrawal programmes usually consist of medication along with psychological treatment and support.

Taking medication during planned withdrawal from alcohol can help to reduce withdrawal symptoms (see alcohol dependence). The medication usually offered is called a benzodiazepine (but you should not be offered this medication if your liver is badly damaged). You should see care staff at least every other day so that they can check how well the medication is helping you. A family member or carer should preferably help you to take the medication correctly in case you become unwell or confused. If you have severe withdrawal symptoms, or you feel very drowsy, your care staff should look at whether the dose of your medication needs to be changed.

You should not be offered medication called clomethiazole to help with planned withdrawal from alcohol in a clinic or at home because of safety concerns.

You may be offered planned withdrawal from alcohol in hospital or in a residential rehabilitation unit if one or more of the following apply to you:

  • you drink more than 30 units of alcohol a day

  • you have epilepsy or have had delirium tremens during a previous planned withdrawal from alcohol

  • you are dependent on benzodiazepines and need to withdraw from them as well as alcohol

  • you regularly drink between 15 and 30 units of alcohol a day and also have a severe physical or mental illness or a severe learning disability.

Vulnerable groups such as older people may be offered planned withdrawal from alcohol in hospital or a residential rehabilitation unit.

Treatments to help you stay alcohol-free after planned withdrawal from alcohol

Some treatments may not be suitable for you, depending on your exact circumstances. If you have questions about specific treatments and options covered in this information, please talk to a member of your care team.

After a successful planned withdrawal from alcohol you may be offered medication to help you stay alcohol-free together with a psychological treatment. Acamprosate or naltrexone are more effective than other medications and should be offered to you first. If neither drug is suitable for you, you may be offered a medication called disulfiram (together with psychological treatment). Care staff should explain the risks of taking each medication (for the risks of taking disulfiram see box below).

You should not be offered either antidepressants or gammahydroxybutyrate (GHB) for treating alcohol problems. You should not be offered benzodiazepines for treating alcohol dependence in the long term.

Acamprosate and naltrexone

Before starting acamprosate or naltrexone, you should have a full medical assessment, which should include blood tests.

Treatment with acamprosate should start as soon as possible after you have finished planned withdrawal from alcohol.

If you are offered naltrexone, you should be told about the information card that comes with it explaining that naltrexone will stop painkillers that contain opioids (such as morphine or codeine) from working. If you feel unwell when taking naltrexone, you should stop the medication immediately and seek advice from care staff.

You can take acamprosate or naltrexone for up to 6 months, or longer if the medication is helping and you would like to continue with it. While you are taking either of these medications, care staff should see you regularly (and at least every month for the first 6 months). If you are still drinking while taking either medication, care staff should review with you whether to continue with the treatment.

Disulfiram

Before starting disulfiram, you should have a full medical assessment, which should include blood tests. You should not be offered disulfiram if you are pregnant, or if you have ever had a severe mental health problem, stroke, heart disease or high blood pressure.

Treatment should start at least 24 hours after your last alcoholic drink. Care staff should see you at least every 2 weeks for the first 2 months and then every month for the following 4 months. After this you will need a medical check-up at least every 6 months. If possible, a family member or carer should be with you when you take disulfiram.

What you should know about disulfiram

Care staff should warn you and your family and carers that:

  • Disulfiram can react with alcohol. Some foods, perfumes, aerosol sprays, and other everyday substances may contain alcohol and so can react with disulfiram.

  • If disulfiram reacts with alcohol this can make you unwell (for example you may feel flushed or nauseous, feel your heart racing, or feel dizzy or faint).

  • In rare circumstances, people may feel very unwell or develop a fever or jaundice. If this happens you should stop taking disulfiram and contact a member of your care team straight away.

Questions you might like to ask your care team about treatments for alcohol misuse

  • When can I start treatment?

  • Where will I have treatment?

  • Do I have a choice about treatment?

  • What does planned withdrawal from alcohol (detox) involve?

  • What support is available during planned withdrawal from alcohol?

  • What help can I have to stay off alcohol after planned withdrawal?

  • Do I need to take medication to help me to stay alcohol-free?

  • What are the choices of medication?

  • How long would I need to take medication for?

  • Are there any side effects with the medication you have offered to me?

  • Might psychological treatment help me?

  • Information Standard