Alcohol Addiction

What Is Alcohol Use Disorder?

Alcohol use disorder (AUD) is a medical condition characterized by an impaired ability to stop or control alcohol consumption despite adverse consequences. It's not a moral failing or character weakness — it's a brain-based disorder involving changes in how your brain responds to alcohol and other rewards.

The term "alcohol use disorder" is now the standard diagnostic term (replacing older terms like "alcoholism" or "alcohol dependence"). The ICD-11 classification system distinguishes between:

• Alcohol Dependence: A pattern of repeated alcohol use despite harm, with features like tolerance (needing more to feel the effect) and withdrawal symptoms when not drinking.
• Harmful Pattern of Alcohol Use: Continued alcohol consumption despite clear evidence of physical or mental health harm.
• Hazardous Alcohol Use: A pattern of alcohol use that increases the risk of harm, though harmful consequences may not yet have occurred.

AUD affects an estimated 14% of adults at some point in their lives. It ranges from mild (two to three diagnostic criteria) to severe (six or more criteria), and treatment approaches are tailored to the severity and the individual's specific needs.

Signs and Symptoms of Alcohol Use Disorder

AUD is diagnosed based on a pattern of symptoms occurring over a 12-month period. You may have AUD if you experience several of these:

• Drinking more or longer than intended
• Persistent desire to cut down or control drinking, or unsuccessful attempts to do so
• Significant time spent obtaining, using, or recovering from the effects of alcohol
• Craving or strong desire to use alcohol
• Recurrent use leading to failure to fulfill major role obligations at work, school, or home
• Continued drinking despite social or interpersonal problems
• Giving up or reducing important social, occupational, or recreational activities
• Recurrent use in physically hazardous situations
• Continued use despite persistent or recurrent physical or psychological problems
• Tolerance (needing more alcohol to achieve the desired effect)
• Withdrawal symptoms when drinking is reduced or stopped

A clinical diagnosis requires at least two of these criteria occurring over a 12-month period. Severity ranges from mild (2–3 criteria) to moderate (4–5 criteria) to severe (6+ criteria).

Screening and Assessment Tools

Several validated screening tools help identify AUD and assess severity:

AUDIT (Alcohol Use Disorders Identification Test)

A 10-question screening tool developed by the World Health Organization. Scores of 8 or higher suggest hazardous or harmful alcohol use. It's the most widely used and recommended screening tool in primary care.

CAGE Questions

A brief four-question tool asking about: Cutting down, Annoyance at criticism, Guilt, and Eye-openers. Two or more "yes" answers suggest problematic drinking warranting further evaluation.

Formal diagnosis and severity assessment are best done during a psychiatric evaluation where a clinician can conduct a comprehensive interview, review your drinking history, assess for comorbid conditions (depression, anxiety, other substance use), and discuss treatment options.

Health Consequences of Untreated Alcohol Use Disorder

Chronic heavy drinking damages multiple organ systems:

• Liver: Fatty liver disease, alcoholic hepatitis, cirrhosis
• Brain: Memory impairment, cognitive decline, increased risk of dementia, Wernicke-Korsakoff syndrome
• Heart: Hypertension, cardiomyopathy, irregular heartbeat, stroke risk
• Pancreas: Acute and chronic pancreatitis, increased diabetes risk
• Immune system: Increased susceptibility to infections
• Mental health: Depression, anxiety, sleep disorders, suicide risk
• Cancer risk: Increased risk of cancers of the mouth, throat, esophagus, liver, colon, and breast

Beyond physical health, untreated AUD damages relationships, employment, finances, and quality of life. Treatment can reverse some of these consequences and prevent progression.

Overview of Treatment Approaches

Effective treatment for AUD typically combines medication, behavioral support, and psychotherapy. The goal may be complete abstinence or controlled, reduced drinking, depending on the individual's preference and clinical appropriateness.

Core Treatment Components

• Comprehensive assessment: Psychiatric evaluation, medical history, comorbidity screening, psychosocial assessment
• Medication (when appropriate): FDA-approved medications to reduce craving, prevent relapse, or deter use
• Behavioral therapies: CBT, motivational interviewing, relapse prevention, contingency management
• Psychosocial support: Individual and group therapy, peer support (12-step, SMART Recovery), family involvement
• Monitoring and follow-up: Regular assessment of progress, adjustment of treatment as needed

Medication-Assisted Treatment (MAT) for Alcohol Use Disorder

Three FDA-approved medications are currently available for AUD, each working through different mechanisms:

Naltrexone (Revia, Vivitrol)

Classification: Opioid receptor antagonist

How it works: Naltrexone blocks opioid receptors in the brain, reducing the "reward" you experience from drinking. It decreases cravings and helps prevent relapse if you slip.

Evidence: Research shows naltrexone reduces heavy alcohol use and increases the number of abstinent days. Number needed to treat (NNT) is approximately 12 — meaning that among 12 people taking naltrexone, one additional person will return to abstinence or reduced drinking compared to placebo.

Formulations: Available as a daily oral tablet (Revia) or as a monthly intramuscular injection (Vivitrol). The injection provides consistent dosing and can improve compliance.

Considerations: Naltrexone does not cause the "flushing" reaction of disulfiram; it's well-tolerated by most people. Note: the precipitated withdrawal risk applies to individuals with opioid dependence, not alcohol users specifically. For alcohol use disorder, naltrexone can generally be started without a withdrawal-free period, though it is best initiated after acute alcohol withdrawal has resolved.

Acamprosate (Campral)

How it works: Acamprosate modulates neurotransmitter systems affected by chronic alcohol use, helping restore balance in the brain's chemistry after you stop drinking.

Evidence: Moderate evidence supports acamprosate for maintaining abstinence. NNT is approximately 12, similar to naltrexone. It is particularly helpful for people who have already achieved initial abstinence and want to prevent relapse.

Key advantage: Can be started immediately without waiting for alcohol withdrawal to resolve (unlike naltrexone). Can be used safely in people with mild liver disease.

Dosing: Taken three times daily. More frequent dosing than naltrexone, which may affect adherence for some people.

Disulfiram (Antabuse)

How it works: Disulfiram blocks an enzyme (aldehyde dehydrogenase) necessary for metabolizing alcohol. If you drink while taking disulfiram, acetaldehyde accumulates, causing unpleasant symptoms: flushing, nausea, vomiting, chest pain, rapid heartbeat, and headache. These reactions can be dangerous and are intended as a deterrent.

Evidence: Insufficient evidence from randomized controlled trials. Used clinically as a deterrent rather than a therapeutic agent for symptom reduction.

Limitations: Relies on motivation not to drink; doesn't reduce cravings or provide therapeutic benefit for the brain. Requires careful monitoring. Not recommended for patients with cardiac disease or significant medical comorbidities.

Comparative Effectiveness

A comprehensive review by the Agency for Healthcare Research and Quality found moderate evidence supporting naltrexone and acamprosate as more effective than disulfiram. No medication monotherapy is recommended; all are used as adjuncts to behavioral and psychosocial treatment.

Behavioral and Psychosocial Therapies

Psychotherapy is a critical component of AUD treatment. Evidence-supported approaches include:

Cognitive-Behavioral Therapy (CBT)

Focuses on identifying triggers, developing coping skills, and changing thought patterns that maintain alcohol use. Effective for co-occurring depression and anxiety.

Motivational Interviewing

A collaborative conversation style that helps resolve ambivalence about change. Particularly effective for individuals early in treatment who are uncertain about their commitment to reducing or eliminating drinking.

12-Step Facilitation and Peer Support

Alcoholics Anonymous (AA) and similar peer support groups provide community, accountability, and spiritual support. Attendance correlates with better long-term outcomes.

Relapse Prevention

Teaches strategies for identifying high-risk situations, managing cravings, and recovering from lapses without progressing to full relapse.

Family and Couples Therapy

Addiction damages relationships; family involvement in treatment improves outcomes and addresses relationship dynamics that may have contributed to or resulted from the AUD.

Levels of Care in Alcohol Treatment

Treatment settings range from outpatient to inpatient, depending on severity, medical complications, and psychosocial factors:

• Outpatient: Appointments at a clinic (KwikPsych, psychiatry, therapy). Best for mild-to-moderate AUD with stable housing, strong support, and low withdrawal risk.
• Intensive Outpatient Program (IOP): 9+ hours per week of structured programming including individual therapy, group therapy, and psychoeducation.
• Residential/Inpatient: 24-hour structured environment for severe AUD, significant medical/psychiatric comorbidities, or failed outpatient treatment. Includes medical monitoring, group therapy, and structured activities.
• Medically-supervised detoxification: If withdrawal is severe or medical complications present, inpatient or day hospital detox with medications to manage withdrawal safely.

How KwikPsych Helps with Alcohol Addiction

KwikPsych's role in alcohol use disorder treatment is comprehensive psychiatric evaluation and medication management combined with coordinated care partnerships.

Step 1: Psychiatric Evaluation

During your initial 45–60 minute appointment with Dr. Monika Thangada, M.D., we conduct:

• Detailed drinking history: Onset, pattern (daily vs. episodic), quantities, previous periods of abstinence, prior treatment attempts
• Withdrawal risk assessment: Signs of physical dependence (morning shakes, sweats, seizure history)
• Comorbidity screening: Depression, anxiety, PTSD, other substance use, trauma history (all common in AUD)
• Medical assessment: Liver function, cardiac status, other organ involvement
• Psychosocial evaluation: Work, relationships, housing stability, support system, legal issues
• Safety assessment: Suicide risk, violence risk, medical emergency risk

Step 2: Medication Management

If medication-assisted treatment is appropriate, we discuss options — naltrexone, acamprosate, or disulfiram — based on your specific situation, liver function, medical history, and treatment goals. We explain how each works, expected benefits, side effects, and monitoring requirements.

Step 3: Comorbidity Treatment

If you have depression, anxiety, PTSD, or other psychiatric conditions, these are treated simultaneously. Untreated mental illness significantly increases relapse risk; treating both together improves outcomes.

Step 4: Therapy Referrals

KwikPsych does not provide therapy directly (we have no therapists on staff), but we maintain relationships with licensed therapists and counselors experienced in addiction treatment. We provide referrals based on your needs and preferences, and we coordinate care with your therapist.

Step 5: Ongoing Monitoring

Regular follow-up appointments (typically 2–4 weeks initially, then monthly) allow us to monitor medication response, adjust dosages if needed, assess for relapse risk, and address any emerging concerns.

Insurance and Cost

KwikPsych accepts most major insurance plans, including:

• Aetna
• Blue Cross Blue Shield Texas (BCBSTX)
• Cigna
• UnitedHealthcare
• Superior HealthPlan / Ambetter
• Baylor Scott & White
• Oscar
• First Health Network
• Optum
• Medicare
• Self-Pay

Self-Pay Rates

• Initial Psychiatric Evaluation (45–60 minutes): $299
• Follow-Up Visit / Medication Management (15–30 minutes): $179

We handle prior authorization for insured patients and can verify your benefits before your first appointment. Contact 737-367-1230 for insurance questions.

How to Get Started

Step 1: Request an Appointment

Request an appointment online or call 737-367-1230. Let us know if you prefer telehealth (Texas-only) or in-person at our Austin clinic.

Step 2: Initial Evaluation

During your first visit, Dr. Thangada will conduct a comprehensive assessment of your drinking, medical status, mental health, and social situation.

Step 3: Treatment Planning

We'll discuss treatment options, medications if appropriate, and therapy referrals. We'll explain what to expect and establish a timeline for follow-up.

Step 4: Ongoing Care

Regular appointments allow us to monitor your progress, adjust treatment, and provide the support and monitoring you need to maintain recovery.

Frequently Asked Questions