Understanding the Treatment of Alcohol Use Disorder

Addiction is a pervasive issue within American culture, manifesting in various forms. There are chemical addictions, such as those to coffee, tobacco, alcohol, opiates, and sugar, and there are behavioral addictions like gambling, work, relationships, and sex. A leading researcher in the field of addiction, Dr. Brené Brown, highlights a concerning trend, stating that America is “the most in-debt, obese, addicted, and medicated adult cohort in US history” (2011). Unfortunately, this trend has persisted over the years.

When focusing on chemical use alone, the statistics are staggering. According to the 2022 National Survey on Drug Use and Health, over 44.3 million Americans aged 18 and older qualify for a Substance Use Disorder (SUD) diagnosis. That’s roughly 17% of the adult population*. Among them, 28.7 million people meet the criteria for an Alcohol Use Disorder (AUD).

For a long time, addiction was viewed as a choice—a weakness, a flaw, or a moral shortcoming. The common advice was to “work harder,” “pick yourself up by your bootstraps,” or “find religion.” However, these supposed solutions often do more harm than good. Over time, the disease model of addiction gained traction, allowing for more research into the neurological effects associated with the addictive process. Despite significant advancements in understanding addiction over the past 20 years, much remains unknown.

A New Approach to Addiction Treatment

More than 30 years ago, Stan Stokes, the founder of Bridging the Gaps, recognized the limitations of traditional addiction treatment methods. At the time, conventional wisdom suggested treating psychological issues with psychotherapy and spiritual issues through 12-step programs. While this approach aligns with the psychological definition of addiction—continued use despite negative consequences—Stokes found it lacking. He likened it to a “two-legged stool”—unbalanced and ultimately ineffective.

During this period, orthomolecular research on neurochemical deficits, amino acid therapies, and the roles of diet and exercise in overall well-being began to emerge. Stokes also encountered a more precise definition of addiction, later adopted by the American Society of Addiction Medicine (ASAM): “Addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry” (Blum, 1990). This definition conceptualizes addiction as a brain reward disorder, where the addiction hijacks the normal learning process and essentially tricks the body into prioritizing the substance over basic needs like food, water, and safety.

This discovery led Stokes to the missing piece—the “third leg of the stool.” By addressing unbalanced physiology and working to rebalance it through amino acid therapies, diet, exercise, and lifestyle changes, Stokes created a more stable and effective treatment model. The results were almost immediate, and Bridging the Gaps (BTG) began to evolve.

Bridging the Gaps’ Integrative Approach

Over the years, BTG has matured into a long-term treatment facility that expands upon the original integrative model. BTG focuses on four domains of human experience: Biology, Psychology, Sociology, and Spirituality. By addressing each of these areas, BTG aims to heal the entire individual, providing the best chance for successful reintegration into society. The long-term engagement with clients also helps solidify the lifestyle changes, thought patterns, and interpersonal skills necessary for sustained recovery.

Biology

Biological stabilization is critical for someone recovering from substance use. Prolonged drug and alcohol use often leaves the body deprived of essential nutrients. BTG helps rebalance these deficits through a diet of whole foods and sound nutritional principles. To accelerate the healing process, BTG uses amino acids and their co-factors to support the body’s recovery and natural production of neurotransmitters. Neurofeedback, a form of biofeedback, uses the principles of operant conditioning to teach the brain how to operate in a more optimized way. This subcortical approach has deep lasting effects that are usually outside the awareness of the participant. 

BTG has found that it takes about 30 days for the mind to clear enough to begin retaining information necessary for sustained behavior change. Following dietary and nutritional protocols, along with regular exercise, can shorten this time. This allows for better information retention and provides a jump-start in the healing process. 

Psychology

As the biological aspect stabilizes, psychological work can begin. While initial psychological stabilization is relatively straightforward, it is not easy. Techniques like Motivational Interviewing (MI) and Motivational Enhancement Therapy (MET) have proven effective with this population. Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT) help restructure thought processes and enable behavior change.

Long-term issues, such as deep-seated wounds from guilt, shame, unresolved grief, and trauma, also need to be addressed. Advanced techniques based on polyvagal theory, Internal Family Systems (IFS), Parts Psychology, Somatic Experiencing, and Brainspotting are used to treat underlying trauma, working on the intra-personal relationship and rescripting the narrative of these events in the individual’s life. The latter two, Brainspotting and Somatic Experiencing, have been shown to operate at the subcortical level. These techniques bypass the cognitions that tend to slow down the healing process. 

Sociology

Addiction is a systemic issue—people do not exist in a vacuum. Just as a person with an addiction affects their family, friends, coworkers, and society at large, so too do these groups impact the individual with addiction. Issues of attachment, interpersonal relationships, family legacy, and codependency must all be addressed for sustained healing.

Living skills, or the ability to function in society, are also important. Basic activities like maintaining physical hygiene, developing good sleep hygiene, creating and balancing a budget, and maintaining stable employment are critical for long-term success. The latter portions of BTG’s treatment model are designed to facilitate and support the individual with implementation of these skills on their own. 

Spirituality

BTG views spirituality as connection and the search for meaning and purpose, distinct from religious ideology, though the two can overlap. Human beings are wired for connection, and the presence or absence of connections—to self, others, and something greater—significantly impacts one’s ability to function and thrive. The sense of meaning and purpose also provides motivation and direction. Significant disruptions in the ability to connect, also called “spiritual injuries,” often go unseen and unaddressed, making healing and recovery from trauma and addictions much harder. The basic spiritual principles of honesty, openness, and willingness are keys to sustained behavior change and living a fulfilled life.

Curriculum

The BTG curriculum is divided into two main groups: Fundamental Education and Advanced Education. The fundamental curriculum introduces clients to the issues within each of the four domains, using didactic lectures, handouts, and discussions to teach basic principles. Advanced education is more process-based, designed to expand on these principles, create a deeper understanding of the material, and apply the learning to each individual’s situation. This process helps build awareness, create insight, and enable effective changes in one’s life.

Looking Ahead

In the coming months, BTG will post a series of articles that delve deeper into various facets of its integrative program. Topics will include treating addiction through nutrition and exercise, using the latest neurological research in treatment (neurofeedback, polyvagal theory), advanced therapeutic techniques like Brainspotting and Internal Family Systems, addressing grief and loss, and the role of family in treatment.

By addressing the whole person—biologically, psychologically, socially, and spiritually—BTG sets individuals up for the best chance of long-term recovery and reintegration into society.

*Based on a population of 258.3 million from the 2020 Census.

Works Cited

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. Arlington, VA: American Psychiatric Association, 2022

Brown, B. (2011, January 3) The power of vulnerability | Brené Brown | Ted. YouTube. https://www.youtube.com/watch?v=iCvmsMzlF7o

McCauley, K (2009) Pleasure unwoven [Film]. The Institute for Addiction Study.

SAMHSA (2022). 2022 National Survey on Drug Use and Health. SAMHSA.gov. https://www.samhsa.gov/data/release/2022-national-survey-drug-use-and-health-nsduh-releases

United States Census Bureau (2020) 2020 Census. Data.census.gov. https://data.census.gov/table/ACSST1Y2022.S0101?g=010XX00US

Works Referenced

Blum, K. and Payne, J. (1991). Alcohol and the addictive brain. Free Press. 

Hamilton, G. and Mayfield N. () Nutrition and addiction: A plan for recovery from and prevention of addictive disorders. 

Mathews-Larson, Joan. (1997). Seven weeks to sobriety. Ballantine Books 

Miller, D. and Blum, K. (1996). Overload: Attention deficit disorder and the addictive brain. Andrews McMeel Pub.

Miller, M. and Miller, D (2017). Staying clean and sober: Complementary and Natural Strategies for healing the addictive brain (Third edition). Woodland Pub.

Bryon Powell, MS, LPC, CAADC, CCTP-II | Clinical Supervisor

Starting as a BTG intern in 2011, Bryon returned as a full-time clinician in 2016 after earning his LPC. With advanced certifications in addiction and trauma treatment, plus specialized Brainspotting training, he brings depth to our clinical team. Beyond his Loyola University counseling degree, he's achieved Master rank in Taekwondo.