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What's New in Addressing Alcohol Use Disorder

An interview with addiction expert and president of the APA.

Key points

  • There are more avenues than ever before for people struggling with alcohol use disorder.
  • Family members should get help if dealing with a problem drinker becomes too much.
  • Today, community mental health centers often address addiction.

Many people who have a sibling suffering from alcohol use disorder want to keep abreast of what’s happening in society related to drinking and what’s new in the treatment of alcohol use disorder. Recently I asked Dr. Petros Levounis, M.D., M.A., an addiction specialist, to update me on a few topics.

Dr. Levounis and I coauthored the book Sober Siblings: How to Help Your Alcohol Brother or Sister – and Not Lose Yourself. Currently, he is Professor and Chair, Department of Psychiatry, and Associate Dean, Rutgers New Jersey Medical School. In addition, he is President of the American Psychiatric Association.

Q: So much has happened in the last few years regarding drinking, including movements like Dry January and Sober October, Damp January, and Sober Curious. It’s pretty impressive, isn't it?

A: The various approaches to drinking you mention all show that there are more avenues than ever before for people's well-being. When we wrote our book, the thinking was that only abstinence, measured by “days abstinent,” would do as the measure of success of any treatment intervention. But today research has aligned with this new understanding and new appreciation of the plurality of options available.

In 2024, we do count days abstinent, but we also look at reduced heavy drinking as an equally important outcome in research studies, whether they're medication trials, psychotherapy trials, or any other kind of intervention. There was a wonderful study done at NYU Langone Health that showed psilocybin does reduce alcohol use. We're delighted that there are these kinds of promising research findings.

Another thing I’m impressed with that has become a trend and which we also do here at Rutgers ― we don’t give up on a person with alcohol use disorder. We find it particularly helpful to bring in the family when that person does not want to see a professional. We bring the siblings in and I teach them motivational interviewing techniques so they can go home and apply these techniques to advance their sibling to the stage where they at least become ambivalent about continuing to drink. They can at least ask themselves, “What if I were to reduce my alcohol use? What if I were to stop, what would life look like?” So in preparation for the person actually coming in and seeing me or one of my associates, we have not given up.

Q: Regarding advice for siblings of alcoholics, I’m seeing the same suggestions I’ve read about for years: 1) Educate yourself about addiction and recovery, 2) Don’t enable your sibling, 3) Communicate with your sibling about their problem in a supportive, informed way, and 4) Get help yourself for if you need to. Would you say these are still the four main ones?

A: These are all important. I would revise number two to say “Promote anything that goes in the direction of sobriety (such as giving a person a ride to a 12-step meeting) and hold off on everything that goes in the other direction.” Also, number four is really vital: Take some of the burden from your own shoulders and put it on somebody else. Get some help for yourself.

I often get a phone call from a concerned parent or sibling where they say, “My son, or brother, will never go and see anyone,” and I tell them, “YOU need to go to the therapist, even if you feel that you don’t need to go for yourself. You need that kind of support and specific advice on how to navigate this incredibly complex and difficult situation. You need to know how to address someone who is heading toward catastrophe when you feel there’s nothing you can do to help, and you need to understand rehabs, billing, reimbursements and all kinds of things.

Q: If the sober sibling is assisting their brother or sister to find help, should they be looking for a psychiatrist or a psychologist? A psychiatrist, because that person can prescribe medications to stop the craving for alcohol? Does it matter?

A: The most important part here is the human relationship. A lot of people who have and live with alcohol use disorder also have difficulty accepting that they have an illness. So the first step is perhaps one of the most important ones, and that is to connect the person with the alcohol problem to a professional. That could be a psychiatrist, psychologist, social worker, or addiction counselor. If the individual has a co-occurring physical illness or a psychiatric disorder and needs medication, they should see a psychiatrist.

Q: Would you agree that one of the most frustrating challenges for families of those with alcohol use disorder is the case where the person doesn’t have health insurance or a regular doctor so the ER becomes a revolving door for them as they get sicker and sicker? And that it’s a terrible predicament for the health system as well, because they can’t treat the person effectively?

A: It's a shame, really. We have the technology, we have the science, we have the know-how and the enthusiasm to help people with addiction, but the resources are not there, and we cannot hide behind saying that this is true everywhere. There are several countries, especially the Scandinavian ones, that are doing much, much better than we are in the treatment of substance use disorders. One thing we can do is take advantage of community programs, community mental health clinics, which in 2024 offer addiction services as well. It used to be that community mental health centers only addressed schizophrenia, depression and bipolar disorders. But in 2024, very frequently they also address addiction.

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