Alcohol Addiction Treatment

Alcohol addiction has its own code in the international classification of diseases: F10.2 in ICD-10 and 6C40.2 in the newer ICD-11. The diagnosis rests on the criteria set out in that classification, not on the number of drinks consumed or on how many years someone has been drinking.

The loss of control over drinking has a biological basis. Years of daily drinking change how the brain works in two areas: the reward system, responsible for the feeling of pleasure, and the system that responds to stress. Once this change has taken place, relaxation comes only after alcohol, and tension builds up without it. This is how alcohol craving develops: the urge to drink returns despite a genuine decision to stay sober.

A doctor makes the diagnosis only when several symptoms occur together over a longer period. The patient feels a strong urge to drink and cannot control how much they drink or when they start. Tolerance rises: the amount of alcohol that used to be enough stops working, so the patient drinks more and more. Drinking continues despite illness, conflict at home and problems at work, and a break in drinking ends in withdrawal symptoms. A single episode of getting drunk does not meet these criteria.

Alcohol addiction is a chronic, relapsing illness. A few weeks without alcohol do not end the treatment, and a drink taken after several months of abstinence does not undo those months. This is why we plan treatment in months and adjust it every time the patient drinks during that period.

In everyday language, a person either drinks normally or is an alcoholic. The classification of diseases distinguishes three situations. Risky drinking has not yet caused damage to health, but it increases the risk of that damage, and it has no diagnostic code of its own. Harmful drinking has the code F10.1 in ICD-10, because damage has already occurred: raised blood pressure, abnormal liver function test results, falling behind at work, arguments at home. Alcohol addiction (F10.2) goes further than harmful drinking: alcohol craving, tolerance and withdrawal symptoms after a break in drinking are added to that damage.

Patients can check for themselves which of these three situations applies to them. The tool for this is AUDIT, a questionnaire developed by the World Health Organization: ten questions about how much and how often the patient drinks and what has happened in their life because of drinking; the shortened AUDIT-C version covers the first three questions. The score from the test is not a diagnosis. It only shows that drinking is worth discussing with a doctor, because the diagnosis is made by a doctor after taking a history and carrying out an examination. Patients can fill in the AUDIT test on our website and bring the result to the consultation.

There is no amount of alcohol that is safe for health, and the World Health Organization stated this plainly in 2023. That is why, at the consultation, we do not ask only about the number of drinks per week. We also ask whether the patient reaches for alcohol to fall asleep or to ease tension after work, and what they have not done in the past six months because of drinking.

Alcohol addiction treatment begins with a medical consultation. We take a history, examine the patient's state of health, ask about chronic illnesses and other medication they take, and finally decide whether they can stop drinking without medical supervision. Only then do we draw up the treatment plan.

The plan is made up of several elements that work together: stabilising the patient's health, oral pharmacotherapy or the Esperal implant, addiction psychotherapy, and supportive care in the following months. A single procedure or a tablet on its own does not remove alcohol addiction, because it does not change the reasons why the patient drank. Psychotherapy carried out over many months addresses those reasons, while medication is meant to help the patient stay sober before psychotherapy starts to take effect.

We draw up the treatment plan for one month, three months, six months or a year. One month is enough to stop drinking, stabilise health and start medication. Changing habits and working on the reasons for drinking takes longer, which is why we suggest a six-month or a year-long option straightaway to patients who have already made several unsuccessful attempts to stop drinking.

We treat patients privately and are bound by medical confidentiality: without the patient's written authorisation, we do not pass on information about their treatment to family members or to an employer. No medical facility, however, provides anonymous treatment, because the law requires every patient to have medical records, kept for a period the regulations themselves set out (generally 20 years).

We choose the treatment setting at the consultation according to three criteria: how high the risk of complications after stopping drinking is, how advanced the illness is, and whether abstinence can be maintained at the patient's home. The patient's convenience decides only once these three criteria allow more than one setting. During treatment we switch to a different setting if the patient's health or home situation changes.

Outpatient alcohol addiction treatment

In the outpatient setting we treat patients without severe health complications, for whom stopping drinking does not carry a risk of seizures and who can travel to appointments. The patient comes in for scheduled visits and, outside of those, continues to work and live as before; we fit appointment times to their schedule.

Alcohol addiction treatment at a residential centre

We suggest a stay at a residential centre after multi-day drinking binges, when serious coexisting illnesses are present, after unsuccessful attempts at outpatient treatment, and when someone else at the patient's home also drinks. During the hardest weeks, the patient then has constant supervision from medical staff and no access to alcohol.

Online alcohol addiction treatment and e-prescriptions

We hold follow-up appointments and part of the psychotherapy sessions remotely, and we also issue e-prescriptions. This setting is chosen most often by patients living outside the cities where we have a practice, and by people who work on the road. We refer a patient with acute withdrawal syndrome to the practice or to a centre instead, because the severity of hand tremor, sweating and disturbed consciousness cannot be assessed through a screen.

The doctor decides which medicine a patient receives at the consultation: after examining the patient, reviewing blood test results and establishing whether the goal for the coming months is full abstinence or a reduction in the amount of alcohol consumed. The doctor also takes into account liver and heart conditions and any other medication the patient takes regularly.

Two medicines reduce the urge to drink, each in a different way. Naltrexone blocks the brain receptors through which alcohol produces pleasure and relief. Alcohol then lifts the mood and relaxes less, so it becomes easier to turn down another drink, and drinking turns into a binge less often. Acamprosate does not affect the pleasure from drinking; instead it lowers the overactivity of the nervous system that persists for many weeks after alcohol is stopped. The patient feels less tension and anxiety, which makes it easier for them to stay sober in the first months.

Nalmefene has a different task and a different way of being taken. The patient takes it as needed, before a situation in which they expect to drink, for example before a wedding or a work event; the doctor sets the dose. Nalmefene then dulls the pleasure of the first drinks and is meant to reduce the amount of alcohol consumed. The goal here is not full abstinence but a reduction in the amount of alcohol drunk, so we offer this medicine to patients who are not yet ready to commit to abstinence.

Disulfiram does not reduce alcohol craving. It blocks the enzyme that breaks down acetaldehyde, a product of how the body processes alcohol. Acetaldehyde then builds up in the blood and, after a drink, triggers a disulfiram reaction: the skin flushes, the heart starts pounding, blood pressure drops and vomiting occurs. The reaction can be dangerous, above all for the cardiovascular system, which is why the doctor checks for contraindications before the procedure and the patient is told what will happen if they drink alcohol afterwards. Awareness of this reaction discourages drinking, but it does not treat the addiction. We give disulfiram as tablets or as an implant, and we describe the qualification and the course of the procedure on the page about the Esperal implant.

Medication alone does not cure alcohol addiction, because it does not remove the reasons why the patient drank. It lowers alcohol craving and tension enough for the patient to get through the first weeks without alcohol and have the strength to work in psychotherapy. This is why we carry out pharmacotherapy alongside psychotherapy, not instead of it.

In a patient who has been drinking every day for weeks, stopping alcohol triggers withdrawal syndrome: hand tremor, drenching sweats, a fast pulse, nausea, restlessness and insomnia. Alcohol detox means treating these symptoms under the supervision of medical staff. We give medication that calms the overactive nervous system, replace deficiencies in fluids, electrolytes and B vitamins, and monitor blood pressure and heart function.

Stopping a multi-day drinking binge without help can end in seizures or alcohol-related delirium, and both of these states are life-threatening. The risk is highest in patients who have had seizures or delirium before, in people with heart or liver disease, and in older patients. We do not treat such a patient remotely. We describe the scope of tests, the course of the first day and how long detox takes on the page about alcohol detox.

Detox stops the drinking binge and brings withdrawal symptoms under control, but it does not treat alcohol addiction: alcohol craving and the reasons for drinking remain. That is why we arrange the date of the first psychotherapy session and the medication for the following weeks before detox even begins. A patient who feels well after two days often concludes that they no longer need further treatment.

Before a patient returns to drinking, several signs usually appear that can be noticed in advance. First the patient stops taking their medication because they feel well, then they cancel a psychotherapy session, insomnia comes back, tension builds up at home, and finally the thought arrives that one beer will not do any harm. In psychotherapy the patient learns to recognise this sequence in themselves and to act before they drink.

If the patient drinks despite this, what happens next depends on how long the drinking lasted. After a single evening a quick appointment and an adjustment of medication doses is usually enough. After a two-week binge, treatment starts again with stabilising the patient's health, and the risk of seizures and alcohol-related delirium returns. This is why we ask patients and their families to call the same day; a conversation about a return to drinking is part of treatment and never ends in a refusal of further help.

After such a call we ask how much the patient drank and for how many days, check for withdrawal symptoms and decide whether detox is needed. We then return to the interrupted treatment plan: we change the dose of the medication or the medication itself, and schedule more frequent appointments for the following weeks. Many patients return to drinking during treatment; an episode like this does not undo the months of work already done.

After the intensive stage of treatment comes the maintenance stage, and it decides whether the patient stays abstinent. The risk of relapse is highest in the first months without alcohol, when withdrawal symptoms have long since gone, the patient feels well, and the habits formed during the drinking period have not yet changed. Appointments are less frequent at this stage than before, but each one has a topic set in advance.

We spend most of this time on relapse prevention. Together with the therapist, the patient writes down their own risky situations: payday, a family wedding, a business trip, an argument at home, a lonely evening after a shift. A concrete plan is drawn up for each one: who the patient will contact, what they will use instead of alcohol, what time they will leave a party. We then practise these plans in sessions, because at this stage a simple resolution not to drink is not enough on its own.

We stop medication when the doctor decides it is time, not on the day of the last psychotherapy session; some patients continue taking naltrexone or acamprosate for many more months. A self-help group also helps many patients, because it meets more often than we schedule appointments and gives them contact with people in the same situation. Finally, we agree with the patient and their family in which situations they should call us without waiting for the next scheduled appointment.

Before a family asks for help for themselves, they usually have years of their own attempts behind them: searching the flat, pouring alcohol away, paying off debts, explaining absences from work. Actions like these shield the person who drinks from the consequences of their drinking, which keeps the drinking going. When the whole household's daily routine starts to depend on whether one person is sober, we call this codependency. Adult children of alcoholics later carry some of these patterns into their own homes.

Relatives can come to a consultation before the person who drinks agrees to treatment. At that appointment we work out what the relatives need to stop doing in order to stop shielding the drinking, which boundaries need to be maintained in that household, and how to talk about treatment without issuing an ultimatum. It is worth preparing such a conversation in advance with a therapist, rather than having it after another binge.

There is also a formal route. The family can file a report with the municipal commission for solving alcohol problems (GKRPA, the local body handling such cases) responsible for the area where the person who drinks lives or stays, and the commission can apply to a court for an obligation to undergo addiction treatment. The court then orders an obligation to undergo treatment, not a forced cure. The procedure takes months, so at the same time we offer relatives their own therapy, so that they do not wait for the court's decision before getting help for themselves.

In the short term alcohol acts like a sedative and sleep aid, which is why patients with insomnia, anxiety or depression turn to it. An evening drink shortens the time it takes to fall asleep and lowers anxiety briefly, but after a few weeks of drinking like this, sleep becomes shallow, anxiety returns stronger, and the amount of alcohol consumed grows. This is why we ask about depression, anxiety disorders, post-traumatic stress disorder and persistent insomnia as early as the first consultation.

When untreated depression exists alongside alcohol addiction, treating the drinking on its own rarely produces a lasting result. Depression takes away the strength a patient needs for addiction psychotherapy, and drinking makes it impossible for a psychiatrist to reliably assess whether an antidepressant is working. Some anxiety and depressive symptoms actually ease after a few weeks without alcohol, which is why the psychiatrist assesses the patient again once withdrawal symptoms have resolved.

We treat both diagnoses according to one plan, on one schedule of appointments. The psychiatrist takes charge of treating the mental health condition, the addiction therapist of the work on drinking, and the two keep each other informed about how treatment is progressing. When depression is severe, we start by treating the depression, because addiction psychotherapy requires an effort the patient cannot make in that state.

The first appointment is a medical consultation; we book it by phone or through the online registration on this page. The doctor then examines the patient, assesses the risk of complications after stopping drinking and draws up the treatment plan. Results of earlier tests and a list of medication the patient takes are useful even at this first visit, because the choice of medicine depends on them.

We run practices in 21 cities in Poland. There we carry out consultations and tests, place the Esperal implant and carry out alcohol detox, and we run addiction psychotherapy either in person or remotely. For patients who cannot stay at home during the first weeks, we offer a stay at a residential centre.

Patients from outside the cities with a practice usually start with an online consultation, and travel to the nearest practice for an examination, a procedure or detox. We give the address and phone number of every practice on its city page, and links to all the city pages are below.