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.
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.”
Two main approaches are abstinence and harm reduction. Both approaches seem to work for some people and not for others.
The abstinence approach advocates completely stopping drinking alcohol.
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.
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.
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.
Medications may help people reduce their drinking, or make them less likely to start drinking after they have stopped.
Medications used for alcohol treatment in Canada - more user-friendly than the above list
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.
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.
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.
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.
I'm missing Allen Carr's book (https://www.amazon.com/Allen-Carrs-Easy-Control-Alcohol-ebook/dp/B07B7QRWTH ) in the list of books. I quit drinking after reading that book over 3 years ago, and it was almost like flipping a switch, so fast did it turn off my desire to drink.
There are so many books on this topic that I didn't try to catalogue them. But thanks for the recommendation!
People should be aware that formal treatment for an alcohol problem (or any substance use problem) is risky. It can make it harder to get a job of high public trust (with the government or military, or as a lawyer or doctor). It also means that if future doctors see medical records revealing you have a substance problem, you can have a harder time getting painkillers or other needed drugs. Do your own cost-benefit analysis; but my personal conclusion is that it's always better to attempt to deal with these problems on your own before getting involved in the system. Many people have gotten to abstinence or harm reduction by themselves--Moderation Management is a book that helped me.
On the other hand, if you're willing to get involved in the system, I've seen some great reviews for the Sinclair method (i.e., naltrexone). It's harder to find that other approaches, but, if it works, it allows people to break the conditioned connection between alcohol and the pleasure/relaxation/anxiety relief or whatever you get from drinking.