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Guidelines for Choosing Alcoholism Treatment Options

A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.

Alcoholism is a specific type of addiction.  The range of treatment options for recovery from addictions such as alcoholism is very broad.  Therefore, treatment decisions for alcoholism recovery can become quite confusing.  We hope to reduce some of this confusion by suggesting some guidelines.  These guidelines can help you make wise choices for your own recovery.

1. First, determine if you need help with just alcoholism.  Or, do you need help with other problems as well?  Most people seeking alcoholism treatment have previously attempted to recover on their own without success. This is called "natural recovery."  If you've made a sincere effort to recover without success, perhaps you need additional help.   Maybe you need help with other issues besides alcoholism.  These other types of problems can make recovery more difficult. It may be that people who seek alcoholism treatment do so because they are weighted down by these additional problems. Perhaps the people who succeed with natural recovery are people who "only" have to confront addiction itself.  They may not have additional obstacles to overcome. Therefore, consider what additional issues you face. The common co-occurring problems are: 

  • anxiety
  • depression
  • trauma
  • bipolar disorder
  • attention problems
  • relationship issues
  • personality disorders
  • difficult life situations

If these other sorts of problems complicate your life, be sure to choose a treatment option that specifically addresses these additional concerns.

2. Second, consider your goals. How will you know if your efforts were successful? What does recovery look like to you?  What do you hope to gain by receiving treatment for your addiction?  How will recovery benefit you?  What does recovery mean to you?  Will you abstain altogether or reduce to a level of no problems?  Are you willing to put up with some problems for the sake of continuing to have some of the pleasures of your addiction(s)?  If so, which problems are acceptable?   Which problems are not?  For example, "It's okay if I miss a day of work once in a while.  My boss is pretty easygoing.  It's not okay to upset my wife, or to miss my son's football games."

It can be difficult find a treatment program that focuses on anything other than complete abstinence.  However, this should not deter you if you select moderation as your goal.  Realize that treatment is oriented toward helping you learn how to stop.  You are still free to decide where your personal stop point is. Is it before the first drink, after the third, etc.?   Abstinence is perhaps a simpler goal. It is clear whether you reached that goal or not.  Either you did drink, or you did not.  Moderation is a little trickier because people can keep changing their limit.  "Oh, did I say stop after the third?  I meant to say I would stop after the third on weeknights, but on weekends the sky's the limit."  These changing recovery goals may simply represent legitimate adjustments.  Alternatively, it may represent an avoidance of the problem or ambivalence about the need to make significant changes.

If you are seeking help for the first time, you may want to try moderation first.  For some people, abstinence seems too extreme.  However, if you have tried moderation several times without sustained success, you may be ready to abstain.  You can keep attempting moderation.  However, if it is not working, it may be time for Plan B!

3. Investigate effective treatment options. Determine which options appeal to you.  Are these options available in your locale?  Let's say you've come to the place where you've realized that natural recovery isn't working for you.  You've taken a hard look at the other problems in your life.  You've become clear about your recovery goals.  Now what?  This brings us back to our original question: How does someone find the most effective treatment? 

Luckily, treatment effectiveness has already been researched for you. It is readily available at http://www.nrepp.samhsa.gov. Your task is to choose from among these treatments. Determine which ones match your unique needs, circumstances, and preferences. Treatments with demonstrated effectiveness are called evidence-based practices (EBP). EBP simply means a large body of research supports the effectiveness of that approach.

One of the most well-known sources of EBP is maintained by the federal government of the United States. It is called The National Registry of Evidence-based Programs and Practices (NREPP). The NREPP is intended to improve access to the most recent information about effective mental health treatments, including addictions treatment. Each of the treatments listed in the NREPP have met the basic criteria to be included as an evidenced-based treatment.