Why Medication and Counseling Work Best Together for AUD

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A few years ago, we published an article on medications for alcohol use disorder, and doctors’ recommendations that they work better when combined with counseling. This principle remains true, and has been confirmed by other sources—including members of Ria Health’s medical team. 

What the Research Says

Discussing medication-assisted treatment (MAT) on its website, the Substance Abuse and Mental Health Services Administration (SAMHSA) notes, “Regardless of what setting MAT is provided in, it is more effective when counseling and other behavioral health therapies are included to provide patients with a whole-person approach.” 

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In an article1 titled “How Do I Choose Between Medication and Therapy?” the American Psychological Association (APA) notes that people don’t have to choose one or the other, depending on their unique situation. They encourage patients to combine both for maximum effectiveness: “People with severe substance use problems may also benefit from the addition of certain medications that reduce cravings or intoxication effects.”

And in a 2019 report2 from the U.S. Department of Health and Human Services, researchers mention counseling supervised by the same physicians prescribing medications. They note, “In most cases, groups are led by behavioral health providers. However, one key informant described a model in which MAT-prescribing physicians co-lead group sessions with a behavioral health provider. The informant said the presence of the physician is highly valued because it helps the physician better understand the patient’s struggles and strengthens the patient-provider relationship.”

It is clear that it is time for new models for treatment. Patients have very real concerns about their alcohol use, and models must address the issue from multiple perspectives. Medications for AUD are highly effective, but they are even more so when combined with psychotherapy. That could mean individual or group counseling, motivational interviewing, or other methods, such as cognitive behavioral therapy3 (CBT). A 1999 study4 in The American Journal of Psychiatry concludes, “Motivated individuals with moderate alcohol dependence can be treated with greater effectiveness when naltrexone is used in conjunction with weekly outpatient cognitive behavioral therapy.”

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What Types of Alcohol Treatment Do People Prefer?

Earlier this year, Ria Health’s Director of Clinical Research, Dr. Gantt Galloway, conducted a pair of surveys5 on consumer preferences for AUD treatment. In the resulting white paper, he notes that few people know about FDA-approved medications that help reduce the desire to drink. Many people are aware of the role of counseling, but far fewer are aware of naltrexone, acamprosate, and others.

“Many people just aren’t aware that there is medication available for AUD, and less than 5% of people who struggle with alcohol misuse use medication. These medications reduce alcohol craving and significantly reduce overall consumption.”

Dr. Gantt Galloway, Director of Clinical Research at Ria Health

Additional research over the last few years corroborates Dr. Galloway’s observations. But it is important to remember that, while medications are invaluable as options in the treatment of AUD, it is shortsighted to assume that they can do the work by themselves. To put it bluntly, there is no “magic bullet.”

Survey Findings

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Dr. Galloway’s surveys turned up several conclusions. To begin with, people prefer a specialized treatment for alcohol use disorder, rather than generalized addiction treatment. It may seem obvious, but someone suffering from liver cancer will seek out a liver expert, rather than a general practitioner. As Dr. Galloway says, “If you ask someone with a particular disorder, they’ll often choose the specialist over the generalist. This is true for anyone with a disease or a specific medical issue.”

Another conclusion from Dr. Galloway’s paper: people generally prefer one-on-one counseling, rather than groups. He notes, “It’s very common among people with AUD to be reluctant to be in groups and speak in public.” And the numbers speak for themselves: 84% of those surveyed expressed a preference for individual counseling, over group sessions. 

Further, accessibility in seeking treatment continues to be a barrier. People have work, family, and other obligations, which often make it more difficult to access treatment. Time and travel add up, too. 

The final key finding was that slightly more people favored reduced consumption over abstinence. Of course, abstinence is the only option for some. But for others, learning to drink moderately is a viable choice. 

Above All, Counseling and Medication Belong Together

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To return to the issue of counseling and medication, the evidence is clear. Previous studies show that a mix of individual counseling as well as medication leads to the most successful outcomes. That combination is also more effective across a longer period of time.

Our research confirms that individual counseling is an important element in treatment for many people, and that many individuals also value moderation as an option, a goal more easily achieved via medication. An ideal treatment approach would make both elements available, to the widest number of people.

That’s the innovative method we offer at Ria Health. We emphasize specialized goal-based treatment, backed by science, and bolstered by accessibility. It’s a combination geared for maximum success. 

Download our latest white paper here.

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Written By:
Bruce Hodges
New York-based writer, editor, and fundraising consultant with over three decades of experience.
Reviewed By:
Evan O'Donnell
NYC-based content strategist with over 3 years editing and writing in the recovery space. Strong believer in accessible, empathic, and fact-based communication.
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