Only a minority of people with drinking problems are able to cut down and drink "in moderation." More often, once a person has lost control of his or her drinking, the safest approach is usually to stop drinking alcohol completely.
The first step in this process is recognizing the problem. The well-known phenomenon of denial, which is a common part of the illness, often turns the illness into a chronic one. Unfortunately, the longer the illness persists, the harder it is to treat.
A doctor or substance abuse expert may be able to help a person look at the consequences of drinking. A nonjudgmental approach to the discussion is essential. If an individual is beginning to think about alcohol as a problem worth trying to solve, educational groups may provide support for weighing the pros and cons of drinking.
It is never easy for family members and friends to identify the problem. A professional may have to help loved ones – kindly, but firmly – talk to the drinker about the painful impact drinking has on them.
Once an individual commits to stopping drinking, the physician will look for and treat withdrawal symptoms. Depending on the amount and duration of drinking and any symptoms, detoxification (often simply called "detox") from alcohol can be done as an outpatient, or as an inpatient in a hospital or drug treatment facility. During the withdrawal process, the doctor may prescribe a class of antianxiety drugs called benzodiazepines for a short period in order to reduce withdrawal symptoms.
After weaning from alcohol, medication in some cases can help reduce cravings. Two medications that fit in this category are naltrexone (ReVia) and acamprosate (Campral). As an alternative, sometimes the drug disulfiram (Antabuse) may be prescribed. Disulfiram does not reduce craving, but it creates an incentive not to drink, because drinking alcohol while taking it causes nausea and vomiting. A drug called topiramate (Topamax), which is used to treat seizures and migraine headaches, may diminish the reinforcing effects of alcohol, but it is not yet approved for this use by the Food and Drug Administration (FDA). Also not approved by the FDA, there is limited evidence that baclofen (Lioresal), a drug used to treat muscle spasticity, could help people quit alcohol use.
After detoxification, many people with alcohol disorders need some form of long-term support or counseling to remain sober. Recovery programs focus on teaching a person with alcoholism about the disease, its risks, and ways to cope with life's usual stresses without turning to alcohol. Psychotherapy may help a person understand the influences that trigger drinking. Many patients benefit from self-help groups such as Alcoholics Anonymous (AA), Rational Recovery or SMART (Self Management and Recovery Training).
It is very important to treat any other problems, such as depression or anxiety, which may contribute to the risk of drinking.
If the doctor suspects that alcohol-related damage to the liver, stomach or other organs, additional tests may be necessary. A healthy diet with vitamin supplements, especially B vitamins, is helpful.