Evidence-Based Treatments for Alcohol Use Disorder


Alcohol use disorder (AUD) is a medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.  It encompasses the conditions that some people refer to as alcohol abuse, alcohol dependence, alcohol addiction, and the colloquial term, alcoholism.  In the U.S., approximately one-third of all adults will meet criteria for AUD at some point during their lives with approximately 15 million individuals meeting criteria within the last 12 months.  Each year in the U.S., 95,000 people die from alcohol-related causes, and it is estimated that AUD costs the U.S. at least $249 billion annually.  People with AUD may need medical help to avoid life-threatening alcohol withdrawal symptoms if they decide to abruptly stop drinking.  Withdrawal symptoms can include anxiety, tremors, nausea, and insomnia.  In severe cases, withdrawal can progress to seizures and delirium tremens, which is characterized by visual hallucinations, profound confusion, agitation, hyperthermia, and cardiovascular collapse.  Delirium tremens has a mortality rate of up to 37% without appropriate treatment.  All individuals suffering from AUD deserve treatment and can recover, no matter the severity of the disorder.  In general, treatment goals of AUD are to reduce and manage symptoms and improve health and functioning.

There are multiple effective and evidence-based treatment approaches for AUD including medications, behavioral treatments, and mutual support groups.  Treatment modalities can be utilized across all levels of care ranging from the community to outpatient and inpatient healthcare settings.  Despite good evidence to support these treatments, less than 10% of people with AUD in the past year received any treatment, and less than 4% were prescribed a medication approved by the U.S. Food and Drug Administration (FDA).  Further information about these evidence-based treatments is listed below.

Medications: Three medications are currently approved by the FDA to help people stop or reduce their drinking and prevent relapse.  They are naltrexone (oral Depade or long-acting injectable Vivitrol), acamprosate (Campral), and disulfiram (Antabuse).  These medications are non-addictive and have been shown to be effective in the treatment of AUD.  Naltrexone and acamprosate help manage alcohol cravings and reduce heavy drinking.  Disulfiram blocks breakdown of alcohol which causes unpleasant symptoms if alcohol is consumed.  Depending on the individual, these medications can be used alone, in combination with each other, and combined with the other non-pharmacologic modalities of treatment. 

Behavioral treatments: Another name for behavioral treatment for AUD is alcohol counseling, which involves working with a healthcare professional to identify and help change behaviors that are contributing to distressing aspects of drinking.  Evidence supports multiple therapy modalities as well as brief interventions and reinforcement approaches.  Cognitive-behavioral therapy (CBT) helps to identify feelings and situations that can lead to heavy drinking and teaches coping skills and stress management techniques to change the thoughts that cause a desire to drink.  Motivational enhancement therapy aims to strengthen a person's motivation to change drinking behavior including formulating a plan to change, building up confidence, and developing skills to be able to stick to the plan.  Mindfulness-based interventions often utilize meditation to purposefully yet non-judgmentally focus on the present moment which allows for choosing thoughts, emotions, and sensations instead of habitually reacting to situations. Behavioral therapies can also help people develop skills to avoid and overcome triggers that might lead to relapse.

Mutual support groups: These groups are comprised of peers (i.e., other individuals struggling with alcohol or drugs) that offer support to each other in recovering or maintaining recovery from alcohol or other drug dependence or problems.  They are not led or guided by healthcare professionals and, thus, are not considered therapy or behavioral treatments.  There are several types of mutual support group organizations for treatment of AUD including twelve-step (e.g., Alcoholics Anonymous), secular non-twelve-step (e.g., SMART Recovery), and religious (e.g., Celebrate Recovery).  These meetings are available in most communities at low or no cost, at convenient times and locations, and more recently with increasing presence online.  For example, Alcoholics Anonymous can be found in approximately 180 nations worldwide with estimated global membership at over 2 million people.  Scientific studies continue to demonstrate that these mutual support groups are effective.

The good news is that no matter how severe the problem may seem, evidence-based treatment with medications, behavioral therapies, and mutual-support groups can help people with AUD achieve and maintain recovery. Recovery is an ongoing process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. The time is now for health care professionals and the community at large to educate themselves on these evidence-based therapeutic options in order to increase treatment engagement of those struggling with AUD so they can begin their journey of recovery.


  1. NIAAA. “Understanding Alcohol Use Disorder." https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder
  2. NIAAA. “Alcohol Facts and Statistics." https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics
  3. Worley, J. “Alcohol Use Disorder Providing Better Care." J. Psychosoc. Nurs. Ment. Health Serv. 2021. 
  4. Witkiewitz, K, et al. “Advances in the science and treatment of alcohol use disorder." Science Advances 2019.
  5. Adelman-Mullally, T, et al. “Alcohol Abstinence Self-Efficacy and Recovery Using Alcoholics Anonymous." J. Psychosoc. Nurs. Ment. Health Serv. 2021.
  6. Rahman A, Paul M. “Delirium Tremens." 2021 Aug 27. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. PMID: 29489272.
  7. Recovery Research Institute. “Peer Based Recovery Support." https://www.recoveryanswers.org/resource/peer-based-recovery-support/
  8. Alcoholics Anonymous. “AA around the World." https://www.aa.org/aa-around-the-world​

Contact Information

Dorothy van Oppen, MD- dorothy.vanoppen@hsc.wvu.edu