Posted On: Nov. 21, 2017
Chapter 13 Psychological Therapies for Alcohol Abuse Cognitive and Behavioral therapies Successful long-term recovery centers on changing a person’s behaviors and expectations about alcohol. Many treatment approaches, including mutual-help groups like Alcoholics Anonymous (AA), focus on behavioral principles such as reinforcement and behavior modeling (for instance, these groups provide sponsors who guide participants through the program) to help patients make those changes. Behavioral therapies are especially effective in encouraging self-change—or the ability of some people to quit drinking on their own. These approaches use goal setting, self-monitoring of drinking, analysis of drinking situations, and learning alternate coping skills. Couples and family therapies analyze drinking behaviors and aim to improve relationship factors, such as improving communication, avoiding conflicts, and learning to solve problems that might lead to drinking. Screening A potentially powerful way to improve problem drinkers’ access to treatment is to make routine screening part of primary care. Asking the single question of how often the patient exceeded the daily maximum drinking limits in the prior year (i.e., 4 drinks for men, 3 drinks for women) can screen effectively for unhealthy alcohol use.A simple question can then become the opportune moment for a brief intervention. Mutual-help Groups (MHGs) MHGs remain the most commonly sought source of help for AUDs in the United States.MHGs are groups of two or more people who share a problem and come together to provide problem-specific help and support to one another.Although AA has the largest following, groups catering to populations with different demographics and preferences. One reason for the popularity of MHGs may be their inherent flexibility and responsiveness. People can attend MHGs as frequently and for as long as they want without insurance and without divulging personal information. Often, people can attend MHGs at convenient times, like evenings and weekends, when they are at higher risk of a relapse to drinking. MHGs also are more cost effective than formal treatment. For example, patients can attend AA at no cost, which translates into about 45 percent lower overall treatment costs than costs for patients in outpatient care while achieving similar outcomes. Some scientists believe the improvement in participants’ social network and the support they receive for abstinence may explain the success of MHGs. Emerging Technologies The Internet is changing the way people communicate and obtain information. Internet and computer-based technologies are infiltrating many levels of AUD care, from screening to recovery. Early evidence suggests that they improve access to services and promote treatment effectiveness. The Internet gives patients the option of receiving treatment 24 hours a day, 7 days a week. It enables a patient in a rural setting to access much of the same care as those in urban settings provided he or she has Internet access. These tools are cost-effective ways of engaging people in treatment. For those who want to reduce their drinking, Internet tools can provide drinking diaries, goal-setting exercises, and relapse-prevention techniques. These may prove useful for patients most interested in self-help. Keeping Patients in Treatment Unfortunately, even after entering treatment, many patients drop out—either during the initial phases or later during follow-up care. Research shows that interventions with a longer duration (i.e., at least 12 months) or in which patients are actively engaged through telephone calls, home visits, or by involving a patient’s support network—such as family, friends, and employers—have the most success. Aversion Therapy Aversion therapy works by attempting to break the association between alcohol and pleasure. The therapy, in the case of alcoholism, involves the 'patient' drinking while at the same time having a negative stimulus administered. This negative stimulus could be an emetic drug (i.e. one that makes the patient vomit when drinking alcohol) such as disulfiram, or an electric shock administered whenever the subject drinks. ContingencyManagement Contingency management principles involve giving patients tangible rewards to reinforce positive behaviors such as abstinence. Controlled Drinking Controlled drinking is a strategy in which you reduce your alcohol consumption to a moderate level. The belief is that by reigning in consumption to lower levels, the negative outcomes that heavy drinking produces will be greatly reduced. Sometimes called “moderation drinking”, this approach – as a treatment option for alcohol addiction – has generated a lot of controversy among mental health and addiction experts for decades. Biological Therapies for Alcohol Abuse Biological treatments for alcohol abuse include Antabuse, Naltrexone, Busiprone, Acamprosate and Clonidine. Disulfiram has a simple mechanism of action. It makes the use of alcohol aversive. Disulfiram produces an unpleasant interaction with symptoms including facial flushing, headache, palpitations, nausea, and vomiting. This aversive interaction deters further drinking. The usefulness of disulfiram has been limited by poor patient compliance. Naltrexone is a mu opiate receptor antagonist. The effectiveness of oral naltrexone is postulated to be based on the reduction of the euphoric effects of alcohol. In clinical trials and in human laboratory studies, naltrexone has been shown to reduce the “high” associated with drinking alcohol. Naltrexone has been shown in clinical trials to be effective mainly in reducing relapse to heavy drinking in alcoholics. Injectable naltrexone has been shown to be safe, well tolerated, and efficacious for the treatment of alcohol dependence long-acting naltrexone was significantly better than placebo in reducing days of heavy drinking during the 6-month trial. Acamprosate mechanism of action is not known. One of the proposed mechanisms of action of acamprosate is reduction of glutamatergic activity in alcohol-dependent individuals during early abstinence. Glutamatergic activity in the brain is thought to be increased as a result of chronic alcohol administration.19 This increase in glutamatergic activity is thought to contribute to symptoms of alcohol withdrawal during early abstinence. By reducing glutamatergic activity, acamprosate may reduce symptoms of alcohol withdrawal during the post-acute phase and may reduce negatively reinforced relapses to drinking. Buspar is primarily used to treatGAD. Unlike most drugs predominantly used to treat anxiety, buspar is not related to benzodiazepines or barbitutares so it does not carry the risk of physical dependence and withdrawal. Buspar has shown to help with alcohol abuse. Clonidine is used for Alcohol Withdrawal. It is used for safe withdrawal. Chapter 15 Rationale for including personalities disorders in the DSM-IV.