Alcohol use disorder is continued drinking despite harm, with loss of control, cravings and often tolerance or withdrawal. Effective outpatient treatment combines an FDA-approved medication, usually naltrexone or acamprosate, with cognitive behavioral or motivational therapy and treatment of co-occurring depression or anxiety. Most people reduce heavy drinking within weeks, and roughly one in three achieve lasting remission with treatment.
Stedfast Psychiatry provides outpatient, medication-assisted treatment for alcohol use disorder together with care for the depression, anxiety, PTSD and insomnia that so often drive drinking or follow from it. We offer three FDA-approved medications, evidence-based therapy, and honest planning about withdrawal, including referral for medically supervised detox when it is needed. Treatment is confidential, available in person at 13 offices and by telehealth across Florida and South Carolina, and it does not require you to call yourself an alcoholic to start.
Symptoms of AUD
- Drinking more, or for longer, than you intended
- Wanting to cut down or stop and not managing to
- Spending a lot of time drinking or recovering from drinking
- Strong cravings or urges to drink
- Drinking interfering with work, school or home responsibilities
- Continuing to drink despite relationship problems it causes
- Giving up activities you used to enjoy in order to drink
- Drinking in situations where it is physically dangerous
- Needing more alcohol to get the same effect
- Shakiness, sweating, nausea, anxiety or insomnia when alcohol wears off
Causes and risk factors
Alcohol use disorder is roughly half heritable. Genes affect how alcohol is metabolized, how rewarding it feels, and how strongly it relieves anxiety, and a family history of alcohol problems is the single strongest risk factor. Starting to drink before age 15, heavy drinking in young adulthood, and a social or work culture of heavy drinking raise risk further.
Psychiatric conditions are deeply intertwined with it. Depression, anxiety disorders, PTSD, ADHD, bipolar disorder and insomnia all increase the chance that drinking becomes a way to cope, and alcohol in turn worsens each of them. Chronic stress, trauma, loneliness and grief are common triggers for escalation. Over time, repeated heavy drinking changes the brain's reward, stress and self-control circuits so that drinking becomes less about pleasure and more about relief from discomfort, which is why willpower alone so often fails.
About 28.9 million Americans aged 12 and older, roughly 10.2 percent, had alcohol use disorder in 2023.
Source: SAMHSA, 2023 National Survey on Drug Use and Health
Fewer than 10 percent of people with alcohol use disorder receive any treatment in a given year, and fewer than 2 percent receive one of the FDA-approved medications.
Source: National Institute on Alcohol Abuse and Alcoholism
Naltrexone and acamprosate each reduce return to drinking; about 12 patients need to be treated with acamprosate to prevent one return to any drinking, and about 12 with naltrexone to prevent one return to heavy drinking.
Source: Jonas et al., JAMA, 2014 meta-analysis
Excessive alcohol use is responsible for about 178,000 deaths per year in the United States.
Source: Centers for Disease Control and Prevention
How we diagnose it at Stedfast Psychiatry
The evaluation at Stedfast Psychiatry is frank and nonjudgmental. We take a detailed drinking history, how much, how often, when it escalated, past attempts to cut down and any withdrawal symptoms, and we use the AUDIT questionnaire and DSM-5 criteria to classify severity as mild (two to three criteria), moderate (four to five) or severe (six or more). We assess withdrawal risk directly, because anyone drinking heavily every day may need medical supervision to stop safely; seizures and delirium tremens are rare but dangerous. We screen for depression, anxiety, PTSD, bipolar disorder, ADHD and insomnia, and we ask about other substances.
Labs include liver enzymes (AST, ALT, GGT), a complete blood count, a metabolic panel and, when useful, phosphatidylethanol (PEth) or carbohydrate-deficient transferrin as objective markers of recent drinking. Liver function matters for medication choice. We also review blood pressure, which alcohol raises, and medications that interact with alcohol.
Treatment options
Medication management
Three medications are FDA-approved for alcohol use disorder, and all are underused. Naltrexone, as a daily 50 mg tablet or a monthly 380 mg injection (Vivitrol), blocks the rewarding effect of alcohol and reduces heavy drinking days; it can be started while you are still drinking and works within days, but it cannot be used with opioids and requires normal liver function. Acamprosate, taken three times daily, eases the restlessness, insomnia and anxiety of early abstinence and is safe in liver disease but needs dose adjustment for kidney problems. Disulfiram causes a sharp physical reaction to any alcohol and works for motivated people who want a firm barrier, especially with supervised dosing. Off-label options with good evidence include topiramate and gabapentin, the latter useful when insomnia and anxiety dominate early sobriety. We treat co-occurring depression and anxiety at the same time, usually with an SSRI, rather than waiting for sobriety first. Benzodiazepines are used only for supervised withdrawal, never for ongoing anxiety in someone who drinks.
Psychotherapy
Motivational interviewing helps people who are ambivalent about change find their own reasons, and it is where many patients start. Cognitive behavioral therapy for alcohol use teaches you to identify high-risk situations, manage cravings and urges, refuse drinks, and handle the emotions that previously led to drinking. We work with the goal you choose, whether abstinence or a defined reduction, and revisit it as treatment unfolds. Mutual support groups such as AA, SMART Recovery and Refuge Recovery help many people, and we encourage trying them without requiring them. For patients with PTSD or depression driving the drinking, trauma-focused or depression-focused therapy is integrated rather than postponed.
Withdrawal management
If you drink heavily every day, stopping abruptly can be dangerous. We assess withdrawal risk at the first visit using your history and, when needed, the CIWA scale. Mild to moderate withdrawal in a medically healthy person can sometimes be managed as an outpatient with daily contact and medication; people with a history of withdrawal seizures, delirium, heavy daily drinking, significant medical illness or no support at home are referred to a hospital or detox program for three to seven days and return to us for ongoing care. We never ask anyone to quit cold turkey without a plan.
What to expect
Your first visit is a 60-minute psychiatric evaluation, in person or by video. We assess your drinking, your withdrawal risk, your mental health and your goals, and you leave with a plan that often includes a medication started that day, labs, and a therapy schedule. Early follow-ups are weekly or every two weeks, then monthly as drinking stabilizes. Telehealth works well for most of this care, and many patients prefer the privacy of video visits from home or work. We track drinking days, cravings and mood at each visit, and we treat a return to drinking as information to adjust the plan, not as failure.
When to seek help
Seek help if you have tried to cut back and could not, if drinking has caused problems at work or home, if you drink to manage anxiety or sleep, if anyone close to you has expressed concern, or if you feel shaky or anxious when you have not had a drink. You do not have to hit bottom to deserve treatment, and earlier care is easier care. If you are having severe withdrawal symptoms such as confusion, hallucinations or a seizure, call 911. If you are having thoughts of suicide, call or text 988. The SAMHSA National Helpline at 1-800-662-4357 offers confidential referrals around the clock.
Mild, moderate and severe
DSM-5 replaced the old categories of alcohol abuse and alcohol dependence with a single disorder graded by how many of eleven criteria you meet. Two or three is mild, four or five moderate, six or more severe. This matters because treatment and prognosis differ. Mild alcohol use disorder often responds to brief intervention, a reduction goal and naltrexone. Severe disorder with daily drinking and withdrawal needs more structure, possibly supervised detox, and a longer commitment to medication and therapy. Most people with alcohol use disorder fall in the mild to moderate range and never come to clinical attention.
Co-occurring conditions and the order of treatment
An older model held that psychiatric treatment should wait until a person had been sober for weeks or months. Evidence now favors treating both at the same time. Depression, anxiety disorders, PTSD, bipolar disorder and ADHD each roughly double the risk of alcohol use disorder, and alcohol worsens all of them. Treating depression with an SSRI while starting naltrexone, or treating PTSD with trauma-focused therapy while reducing drinking, produces better outcomes on both fronts than sequencing them. The one adjustment we make is to interpret mood and anxiety symptoms carefully in the first few weeks of reduced drinking, since many improve on their own.
Alcohol and the body
Heavy drinking raises blood pressure, damages the liver and pancreas, increases the risk of several cancers, disrupts sleep architecture, depletes thiamine and other nutrients, and worsens diabetes and heart disease. Many of these effects are reversible with reduced drinking. We check liver enzymes and blood counts, coordinate with your primary care physician, recommend thiamine supplementation for anyone drinking heavily, and pay attention to sleep, since insomnia in early sobriety is one of the most common reasons people return to drinking. Treating it with CBT for insomnia or a non-habit-forming medication such as trazodone or gabapentin, rather than alcohol or benzodiazepines, protects recovery.
Practical strategies that reduce drinking
Removing alcohol from the home, planning what to drink at social events, eating before drinking, alternating with non-alcoholic drinks and setting a firm stop time reduce intake for people with a moderation goal. Identifying the two or three situations where most heavy drinking happens, often the evening at home or a particular social group, and planning a specific alternative for each is the heart of CBT for alcohol use. Regular exercise, consistent sleep and treatment of untreated anxiety or ADHD all lower craving. Tracking drinks honestly, in an app or on paper, is itself an intervention.
Prognosis
Alcohol use disorder is more treatable than its reputation suggests. In the largest long-term national survey, about a third of people with past alcohol dependence were in full remission, and many more had cut drinking substantially. With medication and therapy, outcomes improve further, and the risk of return to drinking falls each year of stability. Returns to drinking are common and do not erase progress; they are a signal to adjust the plan. The most important predictor of recovery is simply staying engaged in care, which is what telehealth, confidentiality and treating the whole person are designed to make easier.
Frequently asked questions
Do I have to stop drinking completely before starting treatment?
No. Naltrexone can be started while you are still drinking, and many patients begin treatment with a goal of reducing rather than stopping. Research shows that cutting heavy drinking days produces real health gains even without abstinence, and many people who start with reduction later choose to stop entirely. The exception is that if you drink heavily every day, we plan how to reduce safely to avoid withdrawal, which may mean a supervised taper or a detox stay first.
Is naltrexone safe, and does it make you sick if you drink?
Naltrexone does not cause a reaction with alcohol; that is disulfiram. Naltrexone simply blunts the reward from drinking, so the drink does less for you and the urge to keep going fades. Side effects are usually mild nausea or headache in the first week. It cannot be taken with opioid pain medication, and we check liver enzymes before starting. The monthly injection, Vivitrol, is an option for people who find a daily pill hard to remember. Most patients tolerate it well.
Can I be treated by telehealth?
Yes. Evaluation, medication management and therapy for alcohol use disorder work well by video, and we treat patients across Florida and South Carolina this way. Labs can be drawn at a local lab, and the Vivitrol injection requires an office visit. If withdrawal risk is high, we will ask to see you in person or refer you for detox before starting outpatient care. Telehealth makes it easier to keep weekly appointments in early recovery, when consistency matters most.
Does insurance cover alcohol use disorder treatment?
Yes. Under federal parity law, substance use disorder treatment is covered like any other medical condition, and Stedfast Psychiatry accepts most major commercial plans and Medicare. Naltrexone, acamprosate and disulfiram are inexpensive generics; Vivitrol usually requires prior authorization, which our staff handles. For patients without insurance, a self-pay new-patient visit is $185, and generic naltrexone costs roughly $30 to $50 per month.
What about my anxiety and depression? Alcohol is how I cope.
That is one of the most common reasons people drink, and it is why we treat both at once. Alcohol relieves anxiety for a few hours and then worsens it through rebound, and it deepens depression and wrecks sleep. We typically start an SSRI or another appropriate medication alongside the alcohol medication and begin therapy that addresses both. Many patients find that their anxiety is dramatically better within a month of reducing alcohol, which often surprises them.
Do I have to go to AA?
No. Mutual support groups help many people, and we encourage trying one, whether AA, SMART Recovery, Refuge Recovery or Women for Sobriety, because community and accountability improve outcomes. But they are not required, and medication plus therapy works for people who never attend a meeting. We will support whatever combination keeps you moving toward your goal.
How long does treatment last?
Medication is typically continued for at least six to twelve months after drinking stabilizes, and some people stay on it longer because the risk of return to heavy drinking is highest in the first year. Therapy is usually weekly or biweekly for three to six months, then tapers to check-ins. Treatment for depression or anxiety follows its own timeline. Alcohol use disorder is a chronic condition, and we plan for maintenance rather than a single course.
Will my employer or anyone else find out?
No. Your treatment is protected by HIPAA, and substance use treatment records have additional federal protections. We do not communicate with employers, and nothing is reported to licensing boards or law enforcement. Telehealth visits add another layer of privacy. The one exception is if you ask us to coordinate with another provider or program, which we do only with your written consent.
Where to get treatment for alcohol use disorder
Evaluation and treatment for alcohol use disorder is available at every Stedfast Psychiatry office and by video across Florida and South Carolina.
Related conditions
If you are thinking about harming yourself, call or text 988 now, or go to the nearest emergency room. This page is educational and does not replace an evaluation. Clinical content reviewed by Dr. David Husted, board-certified psychiatrist.