Alcohol use disorder
Alcohol use disorder, treated as a medical condition.
Wanting to drink less, or to stop, and finding that wanting is not enough is the commonest story in alcohol treatment, and it is not a character problem. Alcohol changes the brain's reward and stress systems, and there are medicines that push back on those changes: they lower craving, take the reward out of a drink, or steady the system while new patterns form. None of them is a controlled substance, none requires you to have hit a bottom first, and none works without your part in the plan. This page explains what medication management for alcohol use disorder looks like here, starting with the safety question that has to come first.
PsychMed Care is the medication management practice of Solutions Psychiatry. If you are looking for therapy, or therapy and medication together, the full practice is at psych.us.
Safety first
The withdrawal question comes before any prescription
For a heavy daily drinker, alcohol is not just a habit. The body has adapted to it, and stopping suddenly can be dangerous. That risk decides where treatment starts, and it is screened at the Comprehensive Initial Appointment, before anything is prescribed.
What withdrawal can do
Shakes, sweating, a racing heart, and nausea are the mild end. At the severe end, withdrawal can bring seizures and a delirium that is a medical emergency. This is the one part of alcohol treatment where determination is irrelevant and timing is everything.
How the risk is screened
Your first appointment goes through how much you drink, for how long, what your mornings look like, and what has happened on past attempts to cut down or stop: tremor, seizures, hallucinations, hospital visits. Those answers, not a guess, set the level of care.
When a higher level of care comes first
If the screen shows significant withdrawal risk, the right first step is a medically supervised withdrawal, in a hospital or a dedicated program, before outpatient medication management begins. You will be referred plainly, without a lecture, and this practice can pick the plan up on the other side.
Do not stop suddenly on your own
If you drink heavily every day, do not quit cold on the strength of this page. Call first, at (800) 303-3221, or talk to your primary care physician, and make the stop a planned one. A planned stop is a safer stop.
If alcohol has you feeling out of control, or you are having thoughts of harming yourself, help is available now: call or text 988, text HOME to 741741 for Crisis Text Line, or call the NAMI Helpline at 1-800-950-6264. If someone is in immediate danger, call 911. This practice is not an emergency service. The crisis page lists more options.
Measurement
A count, a score, and an honest log
Change you cannot count is change you cannot steer. The AUDIT-C screening score is taken at the Comprehensive Initial Appointment and at Follow-up Appointments, alongside the measure that matters most in this condition: drinks per week, and heavy drinking days, counted plainly. Between visits, a simple record of what you drank, where, and what was happening shows the pattern that memory smooths over: the Friday cliff, the bad-sleep nights, the workday that ends at the store. The count is reviewed the way a PHQ-9 is reviewed on the depression page, as a trend, without moral arithmetic. A lapse is data about where the plan is thin. It is not a verdict on the person running it.
The medicines, in plain words
Three medicines, none of them controlled
The medicines used here are not controlled substances, they are not habit-forming, and none of them will make you feel medicated. They work on the machinery alcohol has been working on. One blocks the reward: naltrexone sits on the brain's opioid receptors, so a drink delivers less of the payoff that keeps the pattern going, and craving loses volume over weeks. One steadies the system: acamprosate supports the brain chemistry alcohol has been supplying artificially, so the early months of not drinking feel less like a held breath. One is a deterrent: disulfiram, taken daily, makes drinking physically miserable, and some people choose it precisely because the decision is then made once, in the morning, instead of forty times a day.
What is not on this shelf matters as much. There is no sedative substitute here: the benzodiazepine family overlaps with alcohol in the brain, which makes it the wrong tool outside a supervised withdrawal, and it is not started here for drinking. If you are already taking one, that is a separate, slow conversation, of the kind described on the deprescribing page, and it waits until the alcohol plan is stable. And every candidate above is checked against your liver, your kidneys, and everything else on your medication list first. Some of these medicines are wrong for a damaged liver, and the targeted labs this practice runs are part of the decision, not a formality.
The goal is yours
Drink less, or stop: both are legitimate plans
Treatment here does not require a vow of lifetime abstinence before the first prescription. For some people the right goal is stopping entirely. For others it is drinking less, within limits they set and we count together. Your history and the evidence argue for one or the other, and that argument happens out loud, at your appointment, with your numbers on the table. What is not negotiable is an honest count, because a plan built on an edited number fails the person, not the prescriber. Goals can also change as the data comes in: a cut-down plan that keeps failing is information, and so is a stopping plan that starts to work. Progress is possible either way, and it varies by person; what the plan promises is measurement and adjustment, not a result.
Alcohol rarely travels alone. It gets self-prescribed for anxiety, for sleep, and for low mood more often than anything in the medicine cabinet, which is why this page lives in a psychiatry practice. The drinking and the reason for the drinking are treated in the same plan, because untreated anxiety is a standing supplier of craving.
Anxiety, the commonest supplier
When drinking is how the alarm gets turned down, the anxiety plan is part of the alcohol plan.
Sleep, the second supplier
Alcohol borrows sleep from the second half of the night and charges interest. Treating the insomnia removes one of the strongest reasons to pour.
The whole medication picture
Every medicine you take is read against alcohol, and alcohol against it, before anything is added.
Cost and coverage
What it costs, stated plainly
$350 for the 60-minute Comprehensive Initial Appointment, and $250 for each 30-minute Follow-up Appointment. With insurance, copays are typically $0 to $40, and your coverage and exact cost are verified before your first visit. Aetna, Cigna and Evernorth, UnitedHealthcare and Optum, the Blue Cross Blue Shield family, Oscar, Oxford, Carelon, and Providence are in network, plus Medicare in Arizona, California, Colorado, Texas, and Utah. Visits are by secure telehealth in 34 states plus DC, for adults and older teens, ages 17 and up. You can book here, or call (800) 303-3221.
“Wanting to stop is not the treatment. It is the reason to get one.”
Start with a 60-minute evaluation that counts honestly and plans safely