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Acknowledging that you're an alcoholic is a significant moment. What you do next matters more than how you got here.
What You'll Discover:
• What acknowledging alcoholism means in practical terms.
• Why you don't need to have everything figured out right away.
• The range of treatment options available to you.
• Why starting with a medical assessment makes sense.
• How medication can make recovery significantly easier.
• Alternatives to traditional programs like AA.
• What to realistically expect in early recovery.
• How to take the first step today.
According to the National Institute on Alcohol Abuse and Alcoholism, approximately 29 million Americans had alcohol use disorder in 2022. If you've reached the point of saying "I am an alcoholic," you're not alone, and effective treatment options exist that don't require residential rehab or lifelong attendance at meetings.
What matters now is understanding your options and taking the next step. This article covers what that looks like in practical terms.
What Acknowledging Alcoholism Actually Means
Saying "I am an alcoholic" can feel like a heavy statement. Understanding what this acknowledgment means in modern medical terms can be helpful.
The first thing to know is that medical professionals now use the term "alcohol use disorder" (AUD) rather than "alcoholic." This shift reflects the understanding that alcohol problems exist on a spectrum from mild to severe. The DSM-5, the diagnostic manual used by healthcare providers, classifies AUD based on how many of 11 criteria a person meets:
• Mild AUD - Meeting 2 to 3 criteria
• Moderate AUD - Meeting 4 to 5 criteria
• Severe AUD - Meeting 6 or more criteria
This spectrum matters because it affects your treatment options. Someone with mild AUD may successfully reduce drinking with medication and coaching support. Someone with severe AUD might benefit from more intensive intervention. There's no single approach that works for everyone.
Acknowledging you have a problem doesn't mean you've failed at something. It means you're being honest with yourself about a pattern that isn't serving you. That honesty is the foundation for making changes.
For more on how alcohol use disorder is defined, see our article on understanding alcohol use disorder.
You Don't Have to Have All the Answers Right Now
A common response after acknowledging alcoholism is feeling overwhelmed by what comes next. You might feel pressure to immediately commit to a specific approach, announce your intentions to everyone, or make dramatic life changes.
If it seems like there's an enormous amount to figure out, that's because thinking about everything at once makes it feel that way. In practice, recovery unfolds one step at a time.
Taking the next small step is more useful than having a perfect plan. That next step might be:
• Talking to a doctor about your drinking
• Taking an online assessment to understand your situation better
• Telling one trusted person what you're going through
• Researching your options without committing to anything yet
• Scheduling a telehealth appointment to explore medication
A good example of how this works is someone who has been drinking heavily for years and finally acknowledges they're an alcoholic. Instead of immediately checking into rehab or announcing sobriety to everyone they know, they might start by taking an online assessment. That assessment leads to a telehealth appointment. The appointment leads to a prescription for naltrexone and a coaching session. Each step reveals the next one.
You don't need to know the entire journey before you start.
Understanding Your Treatment Options
Once you've acknowledged "I am an alcoholic," it helps to understand what treatment options actually exist. The range is broader than many people realize.
Medication-assisted treatment - FDA-approved medications can reduce cravings and make it easier to cut back or stop drinking. Naltrexone is the most commonly prescribed medication for this purpose. It's taken as a daily 50mg tablet and doesn't require complete abstinence to be effective.
Outpatient counseling - Working with a therapist who specializes in alcohol issues can help you understand patterns and develop coping strategies. Sessions typically happen weekly and don't require disrupting your life.
Telehealth programs - Many people now access evaluation, medication, and coaching entirely online. This provides privacy and convenience that in-person programs can't match. You can have an appointment from your car during lunch or from your bedroom after the kids are asleep.
Coaching programs - These combine medication with regular check-ins focused on accountability and behavior change. They're typically less intensive than therapy but provide more structure than going it alone.
Intensive outpatient programs (IOP) - These involve several hours of treatment per week, usually 9 to 12 hours spread across 3 to 4 days. You live at home and can often continue working.
Residential treatment - Inpatient rehab provides 24-hour care in a structured environment. This is typically reserved for people with severe AUD, those who need medically supervised detox, or those who haven't succeeded with less intensive options.
Support groups - Options include AA and its 12-step approach, as well as alternatives like SMART Recovery, which uses cognitive-behavioral techniques and doesn't require belief in a higher power.
The right option depends on several factors: the severity of your drinking, your physical health, your work and family obligations, and your personal preferences. Many people start with less intensive options and adjust from there if needed.
Starting With a Medical Assessment
If you've acknowledged that you're an alcoholic, talking to a medical professional is a practical first step. There are several reasons for this.
Safety evaluation - Depending on how much and how long you've been drinking, stopping abruptly can cause withdrawal symptoms. For heavy, long-term drinkers, withdrawal can be medically serious and occasionally dangerous. A doctor can assess your risk level.
So, what counts as heavy drinking that might cause withdrawal? The answer depends on several factors, but generally, drinking more than 8 drinks per week for women or 15 for men on a regular basis for months or years creates some risk. Daily drinking of 6 or more drinks significantly increases withdrawal risk.
Treatment recommendations - A medical professional can evaluate your specific situation and suggest appropriate options. They can also prescribe medication if it's a good fit for you.
Health evaluation - Chronic heavy drinking affects multiple body systems. A doctor can check for liver function abnormalities, vitamin deficiencies, and other alcohol-related health issues that may need attention.
You don't need a specialist for this initial conversation. Your primary care doctor can assess your situation and make referrals if needed. Telehealth programs also offer medical evaluation, often with faster access than scheduling with your regular doctor.
For information on what withdrawal involves, see our article on how long alcohol withdrawal lasts.
How Medication Can Help
One of the most effective tools for recovery that many people don't know about is medication. Naltrexone is an FDA-approved medication that reduces alcohol cravings and the rewarding effects of drinking.
So, how does naltrexone actually work? The short answer is that it blocks opioid receptors in the brain. When you drink alcohol, your brain normally releases endorphins that bind to these receptors and create pleasurable feelings. This is the "buzz" that makes drinking feel rewarding. Naltrexone prevents those endorphins from producing their usual effect.
The result is that drinking feels different. You don't get the same reward, and the urge to keep drinking diminishes. Over time, this breaks the learned association between alcohol and pleasure. Your brain essentially unlearns the craving.
Naltrexone is taken as a daily 50mg tablet. The medication stays active in your system for about 20 to 24 hours. It doesn't make you sick if you drink, and it doesn't require complete abstinence. Many people take naltrexone while gradually reducing their drinking.
Research consistently shows that naltrexone helps people drink less and have fewer heavy drinking days. Studies indicate that people taking naltrexone often go from drinking 4 to 5 or more drinks to stopping after 1 to 2. The medication is most effective when combined with some form of behavioral support.
For that reason, programs like Choose Your Horizon combine naltrexone prescriptions with coaching. The medication handles the biological aspect while coaching addresses the behavioral and psychological aspects.
Our article on how naltrexone helps you regain control explains the medication in more detail.
Building Support Without Traditional Programs
When people think about alcoholism treatment, they often picture AA meetings or 30-day rehab stays. While these work for some people, they're not the only options, and they're not required.
If traditional programs don't appeal to you, consider:
Telehealth programs - Access medical evaluation, medication, and coaching entirely online. Appointments can be scheduled around your life, and no one needs to know you're in treatment unless you tell them.
SMART Recovery - This science-based alternative to 12-step programs uses cognitive-behavioral techniques. Meetings are available both in-person and online. There's no requirement to accept powerlessness or believe in a higher power.
Individual therapy - Working one-on-one with a therapist who specializes in alcohol issues allows you to address personal factors contributing to your drinking. This can be done via telehealth or in person.
Coaching - Alcohol-specific coaching provides accountability and practical guidance focused on changing drinking behavior. It's typically less formal than therapy and more action-oriented.
Online communities - Forums and groups for people working on their drinking exist across various platforms. These provide peer support and can be accessed anonymously from anywhere.
All that said, some people do well with AA or traditional programs. The key is finding an approach that fits your life, values, and preferences. If one option doesn't work, you can try another.
What to Expect in Early Recovery
If you've said "I am an alcoholic" and you're ready to make changes, having realistic expectations about the process helps.
Days 1 through 3 - If you've been drinking heavily, withdrawal symptoms may begin 6 to 12 hours after your last drink. Symptoms can include anxiety, shakiness, sweating, nausea, headache, and trouble sleeping. For most people, symptoms peak around 24 to 72 hours and then improve. Heavy drinkers may need medical supervision during this period.
Week 1 - Sleep is often disrupted initially. Energy levels may fluctuate. Cravings can be strong but typically come in waves that pass within 15 to 30 minutes. If you're taking naltrexone, it may help reduce craving intensity even in the first week.
Weeks 2 through 4 - Physical symptoms of withdrawal have typically resolved. Sleep usually starts improving. Many people notice increased mental clarity. If drinking felt like a necessary coping mechanism, you may need to develop alternative ways to handle stress during this period.
Months 2 through 3 - If you're consistently taking naltrexone, cravings typically become easier to manage. Your body continues healing. Energy and mood often improve. This is when many people start feeling genuinely better.
Beyond 3 months - Recovery becomes more about building a sustainable lifestyle. This includes addressing any underlying issues that contributed to drinking, developing new routines, and finding sources of meaning and connection.
Something to consider is that setbacks happen to many people who ultimately recover successfully. A slip doesn't mean failure. What matters is getting back on track quickly rather than letting one drink turn into a full relapse.
Taking the First Step
Saying "I am an alcoholic" is a moment of honesty that opens the door to change. The options available now are more accessible and varied than ever, from telehealth programs you can access from home to medications that reduce cravings without requiring total abstinence.
The next step doesn't have to be dramatic. It can be as simple as taking an assessment to better understand your situation.
Take the online Alcohol Use Assessment to learn more about your drinking patterns and explore whether naltrexone could help you meet your goals.
