Alcohol “Coding” for Alcoholism: Types of Methods, How to Choose and How to Prepare

What Alcohol Coding Is and How It Works

The term “coding” is widespread in CIS countries and covers methods that work in different ways. The common idea is to create a barrier to drinking for a certain period: a physiological one, where alcohol causes a severe reaction or reduces pleasure, or a psychological one, where a firm commitment to giving up alcohol is formed. The person uses this time to rebuild their life, restore their health and relationships, and learn to live without alcohol.

It is important to be honest: coding does not cure the alcohol dependence syndrome described in ICD-10. It does not remove the reasons the person drank — anxiety, depression, stress, habitual ways of relaxing and socializing. If these reasons are not addressed while the coding is in effect, the risk of returning to drinking after it ends is high. That is why addiction specialists see coding as part of a treatment program, not a substitute for it.

Medication-Based Methods

The doctor administers or prescribes a drug that either blocks the normal breakdown of alcohol, causing a severe unpleasant reaction if the person drinks, or acts on opioid receptors, reducing cravings and the pleasure of drinking. The drugs are given intravenously, intramuscularly or under the skin as an implant. The doctor determines the drug class and route of administration.

Psychotherapeutic Methods

These are based on suggestion, sometimes in an altered state of consciousness, and on forming a commitment to giving up alcohol. Their effect depends largely on trust in the doctor, motivation and the patient’s suggestibility. The evidence base for these methods is more limited than for medication-based and modern psychotherapeutic approaches, which is worth knowing honestly in advance.

Types of Coding Methods and How They Differ

Methods differ in their mechanism of action, duration, health requirements and what happens in case of relapse. Drugs that cause a reaction to alcohol create a physiological barrier, and drinking while on them is dangerous for the heart and blood vessels. Opioid receptor antagonists do not punish drinking but reduce cravings and pleasure, which makes them a gentler option for some patients. Psychotherapeutic methods do not involve administering any substances but require high motivation.

There is no method that suits everyone. For a person with heart disease, drugs that cause a severe reaction to alcohol may be contraindicated. For someone who relapses because of strong cravings, a method that reduces cravings is more useful. For someone who responds well to psychotherapy and trusts the doctor, a psychotherapeutic approach may be suitable. The decision is made together with the addiction specialist after an assessment and an honest conversation about goals.

• Mechanism: physiological barrier, reduced cravings or psychological commitment
• Route: injection, implant, tablets or a psychotherapy session
• Duration: from several months to a year or more, determined by the doctor
• Consequences of relapse: from a severe reaction to loss of effect
• Contraindications: heart and liver disease, mental disorders, pregnancy
• Motivation required: higher for psychotherapeutic methods

How to Choose a Coding Method

Start by honestly answering a few questions. Does the person want to stop drinking themselves, or have they been talked into it? What usually triggers a relapse — cravings, stress, the company they keep, insomnia? Are there chronic heart or liver problems or high blood pressure? Have there been seizures or alcohol withdrawal delirium? Is there depression or an anxiety disorder? Which methods have already been tried, and with what result? The answers will help the addiction specialist suggest a suitable option and help the patient understand what to expect.

Do not choose a method based only on advertising, its name or a “stronger and longer” duration. A long duration without psychotherapy and support does not guarantee results. Check whether the clinic carries out an assessment, explains the mechanism, contraindications and consequences of relapse, and offers follow-up care. Promises to “cure you for good in one session” and a refusal to explain which drug is being used should be red flags.

Motivation Is the Key Factor

No method works reliably if a person gets coded just so others will leave them alone. When the decision is their own, the person is ready to use the period of sobriety to make changes. If there is no motivation yet, it is more useful to start with a consultation with an addiction specialist and a psychotherapist rather than with the procedure.

State of Health

Which drugs are acceptable depends on the state of the heart, liver, blood vessels and nervous system. That is why the assessment before coding is not a formality. Sometimes it reveals illnesses that need to be treated first, and the doctor suggests postponing the procedure or choosing a different approach.

How to Prepare for Coding

Sobriety is a mandatory condition. Before the procedure, the person must not drink alcohol for a certain period, usually at least several days; the doctor will specify the exact period depending on the chosen method. If the person is on a binge, detox and recovery come first. Coding while intoxicated or immediately after a binge is dangerous and unacceptable, and giving drugs without the person’s knowledge is prohibited and can lead to severe consequences.

Before the procedure, the addiction specialist performs an examination and takes a history, orders lab tests and an ECG, and assesses contraindications. The doctor explains in detail how the chosen method works, how long it lasts, what must be avoided during this period and why a relapse is dangerous, and obtains the patient’s written informed consent. Under the law of the Republic of Kazakhstan, any medical intervention is carried out only with the patient’s consent, and coding is no exception.

1. Abstain from alcohol for the period your doctor specifies
2. See an addiction specialist for an examination, get the prescribed lab tests and an ECG
3. Tell the doctor about all illnesses, medications and any past seizures
4. Ask which drug or method is used and how it works
5. Find out which foods, medications and cosmetics containing ethanol must be avoided
6. Discuss a plan for psychotherapy and follow-up after the procedure with your doctor

What Happens After Coding

The period during which coding is in effect is a window of opportunity, not just a wait for it to end. This is exactly the time to engage in psychotherapy, learn to cope with stress, anxiety and insomnia without alcohol, rebuild relationships, and change your social circle and ways of relaxing. The addiction specialist monitors well-being, helps the person get through periods of craving and, if needed, treats co-occurring depression or anxiety.

After some medication-based methods, it is necessary to avoid not only drinks but also foods and medications containing ethanol, since a reaction can occur to them too. If the person does drink, they should seek help immediately: in the event of a severe reaction — chest pain, shortness of breath, a sharp drop in blood pressure, loss of consciousness — call 103 or 112. A relapse does not mean treatment is pointless: it is a reason to review the plan together with the doctor.

How an Online Consultation With an Addiction Specialist Helps Before Coding

The coding procedure itself is carried out in person, but preparation and follow-up work very well online. At Psychiatry Online, an addiction specialist will help you figure out during a video consultation which method suits you, what contraindications there are, which tests you need, and how long you need to stay sober, and will answer questions from family members. This lets you come to the procedure prepared and with realistic expectations.

After coding, online consultations with an addiction specialist and a psychotherapist help you stay sober: regularly discussing well-being, cravings, sleep and mood, working on triggers and returning to the plan on difficult days. If binge withdrawal treatment is needed before the procedure, the doctors will arrange a home visit or inpatient treatment. Family members can also get a consultation on how to support the person without turning coding into a tool of control.

When to see a doctor

• Your attempts to quit drinking on your own end in relapse time after time
• Binges keep recurring, and each one is longer or more severe
• You want to get coded but do not know which method is safe with your health conditions
• After coding, you have strong cravings or thoughts about drinking
• You drank while coded and feel unwell or anxious
• A loved one wants to get coded and you do not know how to support them

Questions and answers

Reviewed by

Assel Omarova, MDPsychiatrist and addiction specialist

Addiction combined with depression and anxiety, crisis states, online consultations for families.