Alcohol is the substance most people quietly worry about long before they ever say it out loud. Alcohol use disorder is the most common and in many ways the most socially complicated substance use disorder in the United States. Alcohol is legal, widely available, deeply embedded in cultural rituals, and actively marketed in ways that normalize heavy use, which makes the line between social use and clinical disorder frequently invisible to the person crossing it.
Roanoke Refuge provides outpatient PHP and IOP for adults with alcohol use disorder, using evidence-based behavioral therapies and on-siteMAT for clients who are candidates for naltrexone, acamprosate, or disulfiram. Ourtreatment approach grounds the clinical framework, and the level-of-care recommendation is made during the admissions assessment using an ASAM level-of-care assessment.
29.5M — adults in the United States had alcohol use disorder in 2023, yet fewer than 8% received any treatment. (NIAAA, 2024)
Understanding Alcohol Use Disorder
Most of the people who walk into our intake calls have been quietly meeting the diagnostic criteria for years and never knew there was a name for it. Alcohol is legal, it is everywhere, and it is stitched through the way a lot of families across this valley unwind on a Friday. That cultural pressure is the part the DSM does not capture, but it matters when you are trying to recognize a line you may have crossed.
Alcohol use disorder, the clinical term for what families recognize as alcohol addiction, is defined in the DSM-5 on a spectrum from mild to severe based on the number of diagnostic criteria met. The criteria include drinking more or longer than intended, persistent desire or failed efforts to cut down, time spent obtaining or recovering from alcohol, craving, failure to meet obligations, continued use despite social problems, giving up valued activities, hazardous use, continued use despite physical or psychological harm, tolerance, and withdrawal.
Meeting two or more criteria in the past 12 months indicates AUD. Six or more indicates severe AUD. The threshold for a clinical diagnosis is lower than most people realize.
Alcohol Withdrawal: A Medical Reality
This is the part of alcohol that most people do not realize is medically serious. Alcohol withdrawal is one of the most medically dangerous withdrawal syndromes of any substance. In physically dependent individuals, abrupt cessation can cause seizures, severe cardiovascular instability, and delirium tremens, a life-threatening syndrome that can be fatal without medical intervention. Symptoms typically begin six to 24 hours after the last drink, peak between 24 and 72 hours, and may persist for a week or longer.
FDA-Approved Medications for Alcohol Use Disorder
Naltrexone (Oral or Extended-Release Vivitrol)
Naltrexone blocks the euphoric and reinforcing effects of alcohol, reducing cravings and the rewarding aspects of drinking. In plain language, it takes the punch out of the drink. It is available as a daily oral tablet or as a monthly extended-release injectable (Vivitrol). Naltrexone is one of the most well-studied and most underutilized pharmacological treatments for alcohol use disorder in the United States, and adherence is improved substantially by the monthly injectable formulation.
Acamprosate (Campral)
Acamprosate works on the post-acute symptom cluster that often drives return to alcohol use during the first weeks and months of sobriety. Persistent anxiety, sleep disruption, low mood, and a chronic sense of restlessness all respond to the medication’s stabilizing effect on glutamate signaling. Acamprosate is the right tool once the client has reached abstinence, taken three times daily, and works in tandem with the behavioral therapy that builds the durable side of recovery.
Disulfiram (Antabuse)
Disulfiram creates a severe aversive reaction if alcohol is consumed. The medication requires strong motivation and medical monitoring and is used less commonly than naltrexone or acamprosate because of adherence challenges, though it remains a useful tool for clients whose clinical picture and personal preference fit the model.
Roanoke Refuge prescribes FDA-approved MAT medications on-site, including naltrexone (oral and Vivitrol), acamprosate, and disulfiram. The medication and therapy are integrated as one plan, not run in parallel.
Our Treatment Approach for Alcohol Use Disorder
Here is what the work looks like once you are in the door. Roanoke Refuge addresses alcohol use disorder through a combination of evidence-based behavioral therapies, peer community connection, family involvement, and MAT services where clinically appropriate. The pieces of a typical treatment plan look like this.
- Individualized treatment planning — Built around the severity of AUD, the medical history, the co-occurring conditions, and the client’s personal recovery goals.
- Cognitive Behavioral Therapy (CBT) — Targeting alcohol-specific triggers, cognitive distortions, high-risk social situations, and recurrence-prevention skills.
- Motivational Interviewing — For clients carrying ambivalence about abstinence or treatment goals, which is common in the early phase of alcohol-disorder treatment.
- Dialectical Behavior Therapy skills — For clients who use alcohol primarily as a strategy for managing overwhelming emotions, where distress tolerance and emotional regulation skills are the central clinical need.
- Family therapy: To address the relational impact of AUD on the household and to build a recovery-supportive home environment. TheFamily Program covers the structure.
- Peer community introduction — AA, SMART Recovery, Refuge Recovery, and other community-based recovery options across the Roanoke Valley.
- MAT prescribed on-site — For clients who are candidates for naltrexone (oral or Vivitrol), acamprosate, or disulfiram, our medical team prescribes the medication directly as part of treatment.
- Recurrence-prevention planning — Specific to alcohol triggers and the high-risk social situations that surround alcohol use in the Roanoke Valley and elsewhere.
Dual Diagnosis and Alcohol Use Disorder
If you have ever said the words “I drink because” to yourself in the car, you are in the right paragraph. Alcohol use disorder co-occurs frequently with depression, anxiety, post-traumatic stress disorder, and bipolar disorder. Many clients describe alcohol use as a strategy for managing an underlying mental health condition that has never been properly treated. We hear that story almost daily on our intake calls.
Treating the alcohol use without treating the underlying mental health condition is like treating the smoke while leaving the fire burning. Ourdual diagnosis program addresses both at the same time, in the same setting, and by the same clinical team.
Levels of Care for Alcohol Use Disorder
- PHP at full-day outpatient: Most often the right starting level after detox, with 25 or more clinical hours weekly across five days.
- IOP at part-day outpatient: The step-down level after PHP, or the initial level for clients with moderate AUD and a stable living environment, with nine or more hours weekly.
- Telehealth IOP: The same curriculum delivered virtually for clients across Botetourt, Bedford, and the rest of Southwest Virginia where the commute is a barrier.
Local, regional, and accessible.
Treatment for this substance is delivered from our Salem facility at 1630 Braeburn Drive — just off I-81 exit 137. The Roanoke Valley service area covers Roanoke City, Salem, Vinton, and the surrounding counties of Roanoke, Botetourt, and Bedford. The Salem VA Medical Center sits roughly two miles away and serves as a referral partner for veterans transitioning to civilian outpatient care.
The path in is a single phone call. The admissions team walks through fit, level of care, insurance, and what the first week of treatment will actually look like — at no cost and with no clinical commitment until you are ready. Insurance benefits get verified during the same call. Call (540) 900-0353 to start the conversation.