What to Know About Combining Therapy and Medication for AUD

At Oar Health, we talk a lot about the power of medication to curb alcohol cravings and decrease usage. And for a good reason: naltrexone is highly effective. However, therapy alongside medication for alcohol can also help those seeking to cut back or stop drinking. 

When it comes to combining medication with therapy for alcohol use disorder (AUD), which types of treatment are most effective? Is therapy more or less effective alone? How can therapy be helpful when added to a medicine regimen? A 2022 systematic review examined 21 studies about these very questions (1). 

But first, let’s understand what each intervention does before unpacking how they work together. Naltrexone, one of three medications approved to treat alcohol problems, aims to block receptors in the brain that make alcohol feel pleasurable, thereby decreasing quantities consumed and cravings. Therapy strives to strengthen your mindset to reduce or stop drinking. It can also help you identify why you drink, set goals, and manage triggers. The goal of medication and therapy together is to equip the mind and body to reduce drinking. 

How Is Therapy Alongside Medication Beneficial?

Medication is effective at treating AUD with or without psychotherapy. 

However, psychotherapy in conjunction with medication can be helpful. The aforementioned review found that a combination of medication and psychotherapy is more effective than therapy alone. This finding isn’t widely known, as many think first about rehab programs, mutual peer support, and talk therapy when they hear “alcohol treatment.”

The review found that naltrexone and psychotherapy together result in high clinical efficacy in the treatment of alcohol-dependent patients following 12 to 16 weeks of treatment. Therapy can be a valuable support for working through new coping skills and the reasons that led you to drink. 

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Which Types of Therapies Work Best?

While cognitive behavioral therapy (CBT) is often considered the gold standard for treating AUD, multiple modalities can be effective. The review found that different types of evidence-based therapy yield similar results. What’s most important is to choose a research-supported method. 

Joshua D. Lee, MD, MSc, Chief Clinical Advisor at Oar Health, explained that CBT and motivational enhancement therapy (MET) approaches are common for treating AUD. 

“CBT is often a step-by-step, problem-solving approach to behavior change. MET focuses on patient strengths, preferences, and motivations in terms of what exactly to change and in what order,” Lee said. 

CBT works to help a patient seeking to curb alcohol use by identifying challenging patterns and reframing them. For example, a person notices after each Monday afternoon meeting, they want to head to the bar because their manager never considers their feedback. A CBT therapist can help guide this patient to become aware of the thought pattern and brainstorm healthier approaches to the stressor.  

If you’re looking for a therapist to help with alcohol use, there’s evidence that the most important part of how therapy works is the therapeutic relationship, meaning how connected someone feels to their therapist. The relationship should be collaborative and empathetic. This applies to all therapy modalities (2). 

You’ll likely want to choose a therapist that specializes in addiction or alcohol. With most major therapy directories, you can filter your search to concentrate on this expertise. You can also start looking for a provider by asking your support network. 

“It can be helpful to talk to any friends, family, or trusted providers that have experience with the options and resources in your community,” Lee said.

There are also plenty of group therapy sessions and support groups, like Alcoholics Anonymous (AA), that can be helpful in conjunction with medication. It is important to consider that AA is peer-supported, meaning you won’t have a licensed professional shepherding this care. An advantage of AA is that it is highly accessible, free, and has frequent meetings worldwide and online. Other mutual peer support groups include SMART Recovery and Moderation Management.

How Do You Know You’ve Found the Right Regimen?

Treatment can take time. In the throes of stopping or cutting back on alcohol, it can be hard to think clearly. It might also feel challenging to know immediately whether your treatment is effective. Sometimes, you can feel worse initially, like experiencing withdrawal symptoms, before you get better. However, any treatment is usually better than no treatment.

“With individual therapy and 12-step resources, there isn't much that is harmful, dangerous, or not recommended,” Lee said.

Sometimes, experimenting with a few approaches is part of finding the proper regimen.

“Try a few groups, therapists, or programs out, and look for a good fit for your availability, preferences, and individual needs,” Lee added. Consider your priorities, such as whether the therapist offers telehealth or online sessions, has immediate availability, or is in-network with your insurance.

Lee pointed out that some green lights indicating your regimen is working include whether you like the therapist or treatment, the results you see after a given time, and whether you feel safe and supported.

Sometimes, having a trusted therapist to check in with throughout the week about how naltrexone is going for you can be helpful. For individuals with co-occurring psychiatric disorders alongside AUD, it’s recommended that they seek care from a clinician.

The Bottom Line

“There are no wrong answers here. Patients should look for whatever combination of medications and therapies is most interesting to them,” Lee said.

Ultimately, the right treatment for you depends on you. “It can be enough to work with a provider like Oar, get started on naltrexone, and let the medication help with positive change and less drinking. You do not have to do therapy or 12-step to be successful in recovery,” Lee said.

However, if you are motivated to begin therapy or feel being on medication isn't enough, or it could work better, adding any type of evidence-based therapy can be a bonus, Lee explained.

Clinical studies show that recovery can be stronger when someone adds therapy with medication compared to therapy alone. Therapy combined with medication can increase your support and strengthen your recovery.

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