During the 12-week treatment, patients are detoxed and stabilized. After the 12-week treatment, alcoholic patients are advised to continue in aftercare for an additional six months with approximately one visit per month. In appropriate cases, a treatment program different from the above-described protocol can be devised. The cost of such an individualized program will depend on the length and intensity of the treatment program.

Sometimes patients who are heavily addicted to alcohol will require inpatient detox before starting the outpatient treatment. In these cases, Dr. Chacko will refer the patient to an inpatient detox program (the cost of which will be borne by the patient) for a period of two to seven days before initiating the 12-week outpatient treatment with Dr. Chacko.

Treatment for alcoholism consists of use of the latest FDA approved medications for treatment of alcoholism, as well as other appropriate medications and counseling.

About three in ten U.S. adults drink at levels that elevate their risk for physical, mental health and social problems. Of these about one in four currently has a problem with Alcohol Abuse or Alcohol Dependence.

All heavy drinkers have a greater risk of hypertension, gastrointestinal bleeding, sleep disorders, major depression, hemorrhagic stroke, cirrhosis of the liver and several forms of cancer.

Currently, there are several FDA approved medications for the treatment of alcoholism. These include naltrexone (ReVia, Vivitrol), acamprosate (Campral) and disulfiram. In addition, several other medications have been reported to be of benefit in controlling Alcohol Abuse and associated psychiatric conditions.

All FDA approved drugs for treatment of alcoholism have been shown to be effective. Nevertheless, no matter which alcohol dependence medication is used, persons who have a goal of abstinence are likely to have better outcomes.

Naltrexone: Naltrexone blocks opioid receptors that are involved in the rewarding effects of alcohol and the craving for alcohol. It is available in two forms, oral daily dosing and extended-release injectable.

Oral naltrexone reduces relapse to heavy drinking. Thus, it is especially helpful for curbing consumption in people who have drinking “slips.” It is less effective in maintaining abstinence.

Acamprosate: Acamprosate acts on the GABA and glutamate neurotransmitters systems and is thought to reduce symptoms of protracted abstinence, such as insomnia, anxiety, restlessness and depressed mood. It is available in oral form to be taken three times a day.

Acamprosate increases the likelihood of abstinence in dependent drinkers.

Disulfiram: Disulfiram interferes with the degradation of alcohol, resulting in the accumulation of acetaldehyde, which in turn produces a very unpleasant reaction if the patient drinks alcohol. It is available in oral form.

The risk for relapse to Alcohol Dependence is very high in the first 6-12 months after initiating abstinence and gradually diminishes over several years. Therefore, a minimum initial period of three months to six months of medication treatment is recommended. It is not unreasonable to continue medications for a year or longer in some cases.

If there is no response to the first medication selected, you may wish to consider a second. Since these medications act differently, sometimes more than one medication can be used concurrently.

In a recent large trial, the combination of oral naltrexone and brief medical counseling sessions delivered by a nurse or a physician was found to be effective without additional behavioral treatment by a therapist. Nevertheless, patients are encouraged to attend support groups. Patients are also encouraged to participate in mutual support groups, such as Alcoholics Anonymous.

This medication management program has been tested only in alcoholics for whom abstinence is desired. It is not known whether it would also work if the person’s goal is to cut back instead of abstain.

As a rule, Dr. Chacko encourages total abstinence as a goal; and, in addition to taking appropriate medication, encourages his patients to engage in counseling and participate in 12-step meetings.