Resource on alcohol problems

A few peo­ple in the EA com­mu­nity have asked about how to help friends who seem to have an al­co­hol prob­lem. I wrote this re­source and am cross-post­ing it here.

I’m not an ex­pert on this. Please treat this as the writ­ing of some­one with men­tal health train­ing and some in­ter­net re­search skills, but not ex­pe­rience in treat­ing sub­stance abuse speci­fi­cally.

About re­search:

There is no sin­gle best re­search-based treat­ment for drink­ing prob­lems or other sub­stance prob­lems.

Any kind of sub­stance ad­dic­tion is a hard sub­ject to re­search be­cause there is a large in­dus­try in detox cen­ters, and most of what you can eas­ily find on this topic is writ­ten by com­pa­nies try­ing to sell a par­tic­u­lar pro­gram.

About other prob­lems: Many peo­ple have both a drink­ing prob­lem and a prob­lem with us­ing other sub­stances, or men­tal health prob­lems. In the med­i­cal sys­tem, some­one who has prob­lems with mul­ti­ple sub­stance might be di­ag­nosed with poly­sub­stance use di­s­or­der. Some­one who has both a sub­stance use di­s­or­der and a men­tal health con­di­tion would be con­sid­ered “dual di­ag­no­sis.” This is com­mon—for ex­am­ple some­one might have both prob­lems with drink­ing and also de­pres­sion or an­other men­tal health prob­lem.

Com­bin­ing sub­stances (par­tic­u­larly al­co­hol with other “down­ers” like ben­zo­di­azepines or opi­ate pain med­i­ca­tions) can be deadly. Al­co­hol is in­volved in about 22% of deaths from pre­scrip­tion opi­oids (source).

More on dual di­ag­no­sis. More on treat­ment for mul­ti­ple sub­stances.

It’s best to find a provider (like a doc­tor, ther­a­pist, or treat­ment pro­gram) that knows about any rele­vant prob­lems you have, in­clud­ing med­i­cal or men­tal health con­di­tions, and is will­ing to provide care for those con­di­tions.

About safety: if you’re reg­u­larly drink­ing large amounts, quit­ting sud­denly is med­i­cally dan­ger­ous. Al­co­hol with­drawal is not a prob­lem for ev­ery­one who stops drink­ing sud­denly, but it can cause seizures and can kill you. Your doc­tor can ad­vise you about safely ta­per­ing down drink­ing and may pre­scribe med­i­ca­tion to help with the ta­per. You can also see guides like “How to ta­per off al­co­hol.”

Approaches

Two main ap­proaches are ab­sti­nence and harm re­duc­tion. Both ap­proaches seem to work for some peo­ple and not for oth­ers.

Abstinence

The ab­sti­nence ap­proach ad­vo­cates com­pletely stop­ping drink­ing al­co­hol.

Harm re­duc­tion

The harm re­duc­tion ap­proach aims to help peo­ple be safer while not cut­ting out drink­ing, for ex­am­ple by re­duc­ing dan­ger­ous be­hav­iors like driv­ing drunk or by re­duc­ing drink­ing.

Re­source on harm re­duc­tion from BC Part­ners for Men­tal Health and Sub­stance Use Information

Var­i­ous books such as Over the In­fluence, though none of them are very pop­u­lar.

Meth­ods of treatment

The Na­tional In­sti­tute of Health out­lines differ­ent types of treat­ment and ad­vice for find­ing the best care.

Talk therapy

This might be meet­ing one-on-one with a ther­a­pist or coun­selor, or ses­sions might in­clude your part­ner or fam­ily. Overview from Na­tional In­sti­tute of Health

Some ther­a­pists or coun­selors spe­cial­ize in ad­dic­tion, while oth­ers may have a gen­eral prac­tice but be happy to work on peo­ple with al­co­hol prob­lems. Ses­sions may fo­cus ei­ther on set­ting goals for chang­ing your drink­ing, or for ad­dress­ing other prob­lems such as men­tal health or life situ­a­tions that are caus­ing you pain or dis­tress.

Sup­port groups

SlateS­tarCodex post on “More than you ever wanted to know about Al­co­holics Anony­mous
Ex­cerpt: “So does Al­co­holics Anony­mous work? Though I can­not say any­thing au­thor­i­ta­tively, my im­pres­sion is: Yes, but only a tiny bit, and for many peo­ple five min­utes with a doc­tor may work just as well as years com­plet­ing the twelve steps. As such, in­di­vi­d­ual al­co­holics may want to con­sider at­tend­ing if they don’t have eas­ier op­tions; doc­tors might be bet­ter off just talk­ing to their pa­tients them­selves.”

Al­co­holics Anony­mous is the best-known type of group but may not be a good fit for you. If you don’t like the “higher power” as­pect of AA, Sec­u­lar Or­ga­ni­za­tions for So­bri­ety pro­vides a list of non-re­li­gious sup­port groups.

Nar­cotics Anony­mous is an­other 12-step pro­gram fo­cused on any kind of drug use.

SMART Re­cov­ery is a non-12-step pro­gram offer­ing meet­ings for peo­ple with var­i­ous kinds of ad­dic­tions as well as for fam­ily and friends.

Brief op­por­tunis­tic in­ter­ven­tion

Scott Alexan­der de­scribes this in the AA post above as “Your doc­tor tells you ‘HELLO HAVE YOU CONSIDERED QUITTING ALCOHOL??!!’ and sees what hap­pens.” It takes a few min­utes and seems to work in about 1 in 8 peo­ple. More re­search

Schedul­ing an ap­point­ment with a pri­mary care provider /​ GP ba­si­cally to hear them say this might be worth­while.

Medication

Med­i­ca­tions may help peo­ple re­duce their drink­ing, or make them less likely to start drink­ing af­ter they have stopped.

Med­i­ca­tions used in US

Med­i­ca­tions used for al­co­hol treat­ment in Canada—more user-friendly than the above list

Out­pa­tient treatment

Out­pa­tient treat­ment might mean vis­it­ing your usual med­i­cal provider for more reg­u­lar vis­its. An out­pa­tient pro­gram might offer daily classes or groups that you at­tend for weeks or months. Th­ese op­tions work best for peo­ple with a fairly sta­ble home life and re­li­able trans­porta­tion.

Res­i­den­tial treatment

Most on­line re­sources about al­co­holism are try­ing to sell you a par­tic­u­lar pro­gram!

This might be the best op­tion for you if

  • Your home en­vi­ron­ment makes it very hard for you to change your drink­ing

  • The le­gal sys­tem re­quires you to be­cause you have been arrested

In­pa­tient (hos­pi­tal) treat­ment or med­i­cal detox

This might be the best op­tion for you if

  • Your drink­ing is se­vere, or you have med­i­cal prob­lems that would make ta­per­ing off al­co­hol on your own med­i­cally dangerous

  • Your men­tal health is also in crisis — a hos­pi­tal unit that han­dles dual di­ag­no­sis (men­tal health and sub­stance abuse) may be the best lo­ca­tion.

Gen­eral resources

SAMHSA (US agency on sub­stance abuse) hotline

NHS (UK) al­co­hol re­sources and find an al­co­hol ad­dic­tion service

Al­co­hol Change—UK di­rec­tory of resources

Re­think­ing Drink­ing—in­for­ma­tion for peo­ple as­sess­ing their drink­ing and con­sid­er­ing change

Books on al­co­hol recovery

Sup­port for friends and family

De­spite pop­u­lar de­pic­tions of con­fronta­tional “in­ter­ven­tions,” most sources con­sider a sup­port­ive, non-con­fronta­tional ap­proach to be most likely to work.

Al­co­hol treat­ment nav­i­ga­tor—sup­port­ing some­one else in get­ting treatment

Ad­dic­tion: the next step in­clud­ing a crisis toolkit with sup­port for differ­ent scenarios

Al-Anon pro­vides sup­port groups for friends and fam­ily who are af­fected by some­one else’s drink­ing. Word­wide, UK & Ire­land.

UK list of re­sources for fam­ily members

More about fam­ily therapy

Pay­ing for treatment

Short an­swer in the US is: talk to your in­surance provider about what they’ll cover.

US resource

In the UK—NHS cov­ers some out­pa­tient and in­pa­tient treat­ment. Ju­lia definitely does not know how to tell what’s cov­ered so I’d say con­tact your GP.