alcohol dependence = alcohol abuse combined with tolerance, withdrawal, and an uncontrollable drive to drink.[99] The term "alcoholism" was split into "alcohol abuse" and "alcohol dependence" in 1980's DSM-III, and in 1987's DSM-III-R behavioral symptoms were moved from "abuse" to "dependence".[100] It has been suggested that DSM-V merge alcohol abuse and alcohol dependence into a single new entry,[101] named "alcohol-use disorder".[102]
For some individuals whose circumstances or conditions don't require a full-time, residential recovery process, outpatient recovery may be a viable recovery option. In an outpatient recovery program, individuals undergo addiction rehabilitation while living at their own homes. They are able to schedule regular check-ins at a clinic or treatment center for medication and counseling on a regular basis.
Clear communication by parents about the negative effects of alcohol, as well as about their expectations regarding drug use, has been found to significantly decrease alcohol use in teens. Adequate parental supervision has also been found to be a deterrent to underage alcohol abuse. Alcohol, and other drug use, has been found to occur most often between the hours of 3 p.m. and 6 p.m., immediately after school and prior to parents' arrival at home from work. Teen participation in extracurricular activities has therefore been revealed to be an important prevention measure for the use of alcohol in this age group. Parents can also help educate teens about appropriate coping and stress-management strategies. For example, 15- to 16-year-olds who use religion to cope with stress tend to use drugs significantly less often and have fewer problems as a result of drinking than their peers who do not use religion to cope.
There are a number of secular (non-religious) self-help organizations besides SMART recovery, like LifeRing Secular Recovery and Women for Sobriety.  I serve on the Board of Directors for LifeRing.  Women for Sobriety is a women's only group that keeps its meeting times and locations private to ensure the safety of its participants, some of whom are the victims of domestic violence and stalking.
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The immediate physical effects of drinking alcohol range from mild mood changes to complete loss of coordination, vision, balance, and speech -- any of which can be signals of acute alcohol intoxication, or drunkenness. These effects usually wear off in a matter of hours after a person stops drinking. Many law-enforcement agencies regard a .08 percentage of alcohol in the bloodstream as evidence of intoxication. Larger amounts of blood alcohol can impair brain function and eventually cause unconsciousness. An extreme overdose, alcohol poisoning, can be fatal.
Our program focuses on the whole child, with the ultimate goals of abstinence, improved mental health and better family relationships. Our intensive outpatient program (IOP) is the only one in North Texas that offers this level of care specifically for teens. We incorporate medication management, cognitive behavioral therapy, motivational enhancement therapy, group and individual therapy, and family engagement to help your child gain valuable coping skills to end drug abuse, as well as manage emotional or psychological problems.
The Sinclair method is another approach to using naltrexone or other opioid antagonists to treat alcoholism by having the person take the medication about an hour before they drink alcohol and only then.[137][138] The medication blocks the positive reinforcement effects of ethanol and hypothetically allows the person to stop drinking or drink less.[138]
Thank you dr Miller, very important part of recovery of addiction and important tool for our patients that should not be "a dying art". I have heard international lecturer and professional in addiction treatment, state that "Minnesota Model" is one treatment that has been shown ineffective (evidence based medicine... Many correlate that with Twelve step facilitation. Can you help with references to support or counteract that?
Of the over 16 million people in the country who have a potential AUD, 9.8 million men and 5.3 million women respectively have a diagnosable AUD. About 10 percent of children in the US have at least one parent who struggles with problem drinking, and about 31 percent of driving fatalities in the US involve a drunk driver. Unfortunately, very few people every year seek treatment for AUD despite physical, mental, social, financial, and legal ramifications.
The immediate physical effects of drinking alcohol range from mild mood changes to complete loss of coordination, vision, balance, and speech -- any of which can be signals of acute alcohol intoxication, or drunkenness. These effects usually wear off in a matter of hours after a person stops drinking. Many law-enforcement agencies regard a .08 percentage of alcohol in the bloodstream as evidence of intoxication. Larger amounts of blood alcohol can impair brain function and eventually cause unconsciousness. An extreme overdose, alcohol poisoning, can be fatal.

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Despite the criticisms and controversies, Alcoholics Anonymous remains a cultural force for treatment, rehabilitation, personal growth, and sobriety. The programs claims it has more than 2 million members globally, and reports that 33 percent of the 8,000 members in North America retained their sobriety for at least 10 years. It’s not for everyone, agrees Psych Central, but for many, it has made a life-changing difference.
Excessive alcohol consumption is correlated with increased risk of stroke, liver disease, and decreased life expectancy. In fact, binge drinking during only the weekends is still enough to damage the liver, studies show, and moderate drinking interferes with sleep quality by interrupting circadian rhythms and REM sleep. However, a number of different treatment options are available to address alcoholic dysfunction.
In 1939, High Watch Farm in Kent, Connecticut was founded by Bill Wilson and Marty Mann. Sister Francis who owned the farm tried to gift the spiritual retreat for alcoholics to Alcoholics Anonymous, however citing the sixth tradition Bill W. turned down the gift but agreed to have a separate non-profit board run the facility composed of AA members. Bill Wilson and Marty Mann served on the High Watch board of directors for many years. High Watch was the first and therefore the oldest 12 step based treatment center in the world still operating today.

According to Vaillant's research, inner-city men began problem drinking approximately 10 years earlier than college graduates (age 25–30 y vs age 40–45 y). Inner-city men were more likely to be abstinent from alcohol consumption than college graduates (30% vs 10%) but more likely to die from drinking (30% vs 15%). A large percentage of college graduates alternated between controlled drinking and alcohol abuse for many years. Returning to controlled drinking from alcohol abuse is uncommon, no more than 10%; however, this figure is likely to be high because it was obtained from self-reported data. Mortality in both groups was related strongly to smoking. Abstinence for less than 5–6 years did not predict continued abstinence (41% of men abstinent for 2 y relapsed).
Depending on the addiction type and intensity, you or someone you care about may require anything from a thirty day in-patient drug or alcohol treatment program all the way up to a 4-month or longer one. Certain drugs may allow for outpatient services while severe cases may need longer-term treatment services. However, you can find a Cheyenne treatment facility to fit just about any personal need.

ASAM’s definition of addiction document concludes that “treatment of addition saves lives,” and it points out that “in some cases of addiction, medication management can improve treatment outcomes,” and that “in most cases of addiction, the integration of psychosocial rehabilitation and ongoing care with evidence-based pharmacological therapy provides the best results.” Much of “what’s new” in the professional treatment of addiction in the past two decades has involved new pharmacological therapies that have been brought into the marketplace. But psychosocial interventions, which are “not as new,” are the foundation of the treatment most persons receive when they seek assistance from an addiction treatment professional or agency.
AA says it is "not organized in the formal or political sense",[25] and Bill Wilson called it a "benign anarchy".[26] In Ireland, Shane Butler said that AA “looks like it couldn’t survive as there’s no leadership or top-level telling local cumanns what to do, but it has worked and proved itself extremely robust.” Butler explained that "AA’s 'inverted pyramid' style of governance has helped it to avoid many of the pitfalls that political and religious institutions have encountered since it was established here in 1946."[27]
At Origins, our goal is seamlessly integrate cutting-edge, evidence-based medical and clinical services within the timeless 12-Step model. We understand that quality treatment addresses all aspects of the person, including the spiritual components of wellness. The 12-Steps are a spiritual program of action that can change our perceptions, and bring new purpose into our lives. By connecting with a deeper sense of meaning, those of us in recovery are able to positively impact the lives of those around us.
Sessions led by peers, in which recovering alcoholics meet regularly and provide support for each other's recoveries, are considered among the best methods of preventing a return to drinking. The best-known group following this model is Alcoholics Anonymous (AA), which uses a 12-step program and a buddy (sponsor) system to help people avoid drinking. The AA steps involve recognizing the destructive power that alcohol has held over the individual's life, looking to a higher power for help in overcoming the problem, reflecting on the ways in which the use of alcohol has hurt others and, if possible, making amends to those people. According to the American Psychological Association (APA), anyone, regardless of his or her religious beliefs or lack of religious beliefs, can benefit from participation in 12-step programs such as AA. The number of visits to 12-step self-help groups exceeds the number of visits to all mental health professionals combined.
Herbal treatments include milk thistle (Silybum marianum), which is thought to protect the liver against damage. Other herbs are thought to be helpful for the patient suffering through withdrawal. Some of these include lavender (Lavandula officinalis), skullcap (Scutellaria lateriflora), chamomile (Matricaria recutita), peppermint (Mentha piperita) yarrow (Achillea millefolium), and valerian (Valeriana officinalis).
Caucasians have a much lower abstinence rate (11.8%) and much higher tolerance to symptoms (3.4±2.45 drinks) of alcohol than Chinese (33.4% and 2.2±1.78 drinks respectively). Also, the more acculturation there is between cultures, the more influenced the culture is to adopt Caucasians drinking practices.[175] Peyote, a psychoactive agent, has even shown promise in treating alcoholism. Alcohol had actually replaced peyote as Native Americans’ psychoactive agent of choice in rituals when peyote was outlawed.[176]
When most people think about “alcoholism,” they assume the chronic severe group is the only group. However, adolescents and young adults, both with and without mental illnesses, can struggle with compulsive behaviors around alcohol, and many adults in the US are dependent on alcohol to stabilize their emotions. These conditions, too, indicate a potential AUD. If alcohol abuse remains unaddressed, it can lead to severe health consequences, both acute and chronic.
According to the National Institute on Drug Abuse’s Principles of Drug Addiction Treatment: A Research-Based Guide, short-term residential programs developed the idea of using a modified 12-Step approach to provide a shorter stay in treatment that included follow-up through a 12-Step fellowship. This is seen as a way to provide the important post-treatment structure that helps people maintain long-term recovery. Other programs have also incorporated the 12 Steps, both by encouraging clients to attend 12-Step fellowship meetings, and by incorporating 12-Step ideas into their practices.
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Whether you choose to go to rehab, rely on self-help programs, get therapy, or take a self-directed treatment approach, support is essential. Recovering from alcohol addiction is much easier when you have people you can lean on for encouragement, comfort, and guidance. Without support, it’s easy to fall back into old patterns when things get tough.

Many AA meetings take place in treatment facilities. Carrying the message of AA into hospitals was how the co-founders of AA first remained sober. They discovered great value of working with alcoholics who are still suffering, and that even if the alcoholic they were working with did not stay sober, they did.[74][75][76] Bill Wilson wrote, "Practical experience shows that nothing will so much insure immunity from drinking as intensive work with other alcoholics".[77] Bill Wilson visited Towns Hospital in New York City in an attempt to help the alcoholics who were patients there in 1934. At St. Thomas Hospital in Akron, Ohio, Smith worked with still more alcoholics. In 1939, a New York mental institution, Rockland State Hospital, was one of the first institutions to allow AA hospital groups. Service to corrections and treatment facilities used to be combined until the General Service Conference, in 1977, voted to dissolve its Institutions Committee and form two separate committees, one for treatment facilities, and one for correctional facilities.[78]
The risk of developing alcoholism has a definite genetic component. Studies have demonstrated that close relatives of people with alcoholism are more likely to become alcoholics themselves. This risk exists even for children adopted away from their biological families at birth and raised in a non-alcoholic adoptive family with no knowledge of their biological family's alcohol use. However, no specific gene for alcoholism has been found, and environmental factors (e.g., stress) and social factors (e.g., peer behavior) are thought to play a role in whether a person becomes alcohol dependent.
People who abuse alcohol may experience acute problems associated with problem drinking, but continuing to drink in spite of the negative effects puts them at risk of developing chronic health problems. Alcohol abuse damages most organs in the body, especially the liver, cardiovascular system, gastrointestinal system, and brain. Chemical changes to the brain that lead to addiction may also cause harm to memory and cognition.

Some of the divide between 12-Step recovery and academic addiction medicine came about because of resistance by some AA members to the use of any pharmaceuticals whatsoever. Newcomers were told to abandon any and all medications. While this attitude is receding, stories of members with advanced cancer refusing opiates are still told with admiration in meetings. 
Prevention must begin at a young age since the first instance of intoxication usually occurs during the teenage years. It is particularly important that teenagers who are at high risk for alcoholism-those with a family history of alcoholism, early or frequent use of alcohol, a tendency to drink to drunkenness, alcohol use that interferes with school work, a poor family environment, or a history of domestic violence -receive education about alcohol and its long-term effects. How this is best achieved, without alienating these young people and thus losing their attention, is the subject of continuing debate and study.
Michael, while one of the above posters felt that the anti-medication bias of many AA members (as well as its entire leadership) is receding, I have not seen that at all. Patients on methadone, buprenorphine and even (very recently) Vivitrol, are told that they are not "clean," cannot speak at the meeting, cannot receive sobriety tokens, cannot join in on committments and in fact are still using.  They are urged routinely to stop their medications.  While it has perhaps receded with some psychiatric medications, it has NOT with many other medications, including Disulfiram, Campral and Naltrexone.

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Added fat and scar tissue on the liver due to excessive alcohol consumption can lead to all sorts of problems, but most often either cirrhosis or alcohol-induced hepatitis. Liver failure among those who drink heavily for many years is likely. Pancreatitis, or the consistent inflammation of the pancreas, can also cause damage to the body, including high blood sugar leading to diabetes.
Non-12-step support groups provide a secular alternative to the 12-step programs and may be more comfortable for those not wanting to place such an emphasis on a higher power for recovery. Non-12-step groups sometimes involve fewer group sharing scenarios—which can provide some relief for those individuals who aren't as comfortable sharing sensitive personal information in group settings. Below are a few examples of non-12-step programs:
Based on this study, those who abstain altogether from substances – as advised in the 12-Step model – have better mental health outcomes than those who don’t abstain. The 12-Step model gives people a framework from which to surrender their addiction, process their experience, and move forward into new patterns. As described in an article on Psych Central called Recovery Using the 12 Steps, following the model assists an individual by helping build the following mental and emotional transformative practices and tools:
Twelve-step programs approach alcoholism and drug addiction as diseases that can only be managed by surrendering one’s will to a higher power. In spite of their reliance on the disease model of addiction, 12-step groups offer rewarding experiences that reinforce healthy, sober behaviors. In this sense, the 12 steps reflect the principles of positive psychology, notes the Journal of Substance Abuse Treatment. Positive psychology is based on the belief that gratifying experiences will encourage the individual to repeat a healthy behavior, such as attending meetings or reading AA literature, rather than reverting to a self-destructive behavior, such as drinking or using drugs.
PaRC's team of physicians and specialists evaluate, treat, educate and guide the chronic pain sufferer through the process of pain and addiction recovery. Two primary goals of PaRC's Pain Recovery Program are pain relief to the highest degree possible and stopping or reversing the negative impact and downward course of a patient's pain condition, lifestyle, work, interpersonal relationships and overall wellbeing. 
Mike, I applaud you for this excellent treatise supporting the relevance of 12-Step recovery in modern addiction treatment.  Upon careful study, the goal is to achieve "A A" = autonomy and agency.  That this method is unwaveringly spelled out, is freely and widely available, requires no Prior Auth or co-pay, has no drug-drug interactions or side effects and enjoys a success rate commensurate with all other offerings is compelling.  For some validated evidence of things that work in recovery (including 12-Step) I invite you to visit our (RRI) website.
Clear communication by parents about the negative effects of alcohol, as well as about their expectations regarding drug use, has been found to significantly decrease alcohol use in teens. Adequate parental supervision has also been found to be a deterrent to underage alcohol abuse. Alcohol, and other drug use, has been found to occur most often between the hours of 3 p.m. and 6 p.m., immediately after school and prior to parents' arrival at home from work. Teen participation in extracurricular activities has therefore been revealed to be an important prevention measure for the use of alcohol in this age group. Parents can also help educate teens about appropriate coping and stress-management strategies. For example, 15- to 16-year-olds who use religion to cope with stress tend to use drugs significantly less often and have fewer problems as a result of drinking than their peers who do not use religion to cope.

If you think you have a problem with drinking, or know someone who does, we can help. The primary purpose of Alcoholics Anonymous is to help the alcoholic who is still suffering. If you are experiencing a medical emergency, please contact your local hospital or health care provider. To contact someone in Alcoholics Anonymous, please visit our Find A Meeting page, and click on the city or district nearest you. This will provide meeting locations, meeting times, and phone numbers to contact someone nearest you for help.
Given the malnutrition that many alcoholics suffer from, gradual correction of that condition is also important, both to prevent or correct the consequences of malnutrition (like low thiamine level) and to prevent the potential results of correcting nutrition problems too rapidly. One example of the latter is that people with chronic alcohol-induced low sodium levels in the bloodstream (hyponatremia) are at risk for severe neurological problems due to a loss of the outer, insulating covering of nerve cells in parts of the brain (central pontine myelinolysis) if low sodium levels are corrected too rapidly.
Severe acute withdrawal symptoms such as delirium tremens and seizures rarely occur after 1-week post cessation of alcohol. The acute withdrawal phase can be defined as lasting between one and three weeks. In the period of 3–6 weeks following cessation increased anxiety, depression, as well as sleep disturbance, is common;[65] fatigue and tension can persist for up to 5 weeks as part of the post-acute withdrawal syndrome; about a quarter of alcoholics experience anxiety and depression for up to 2 years. These post-acute withdrawal symptoms have also been demonstrated in animal models of alcohol dependence and withdrawal.[66] A kindling effect also occurs in alcoholics whereby each subsequent withdrawal syndrome is more severe than the previous withdrawal episode; this is due to neuroadaptations which occur as a result of periods of abstinence followed by re-exposure to alcohol. Individuals who have had multiple withdrawal episodes are more likely to develop seizures and experience more severe anxiety during withdrawal from alcohol than alcohol-dependent individuals without a history of past alcohol withdrawal episodes. The kindling effect leads to persistent functional changes in brain neural circuits as well as to gene expression.[67] Kindling also results in the intensification of psychological symptoms of alcohol withdrawal.[65] There are decision tools and questionnaires which help guide physicians in evaluating alcohol withdrawal. For example, the CIWA-Ar objectifies alcohol withdrawal symptoms in order to guide therapy decisions which allows for an efficient interview while at the same time retaining clinical usefulness, validity, and reliability, ensuring proper care for withdrawal patients, who can be in danger of death.[68]
Using “I” statements reduces accusation and lets you be an active participant in the discussion. It may be helpful to bring up a specific concern. You may mention when alcohol caused an unwanted effect, such as violent behavior or economic problems. Rather than saying, “You’re an alcoholic — you need to get help now,” you can say, “I love you and you’re very important to me. I’m concerned about how much you’re drinking, and it may be harming your health.”
No conversation about alcoholism or substance abuse recovery is complete without mentioning Alcoholics Anonymous. The group has become synonymous with the concept of addiction rehabilitation in general, and it was instrumental in changing the conversation in how people with drinking problems came to be understood and regarded. As the science and psychology of addiction evolves, the role of Alcoholics Anonymous is also changing, but it remains a cornerstone of the aftercare experience.
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