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Alcohol Abuse
Treatment: Psychosocial Interventions
 A variety of
components of alcohol abuse treatment may be delivered within the
context of alcohol rehabilitation services. In many alcohol abuse
treatment programs, a variety of therapeutic interventions are
provided to all individuals based upon the assumption that by
providing a multitude of treatment components, you may have a greater
probability of meeting at least some of an individual’s treatment
needs. Therapeutic approaches most often used in both residential and
outpatient programs include behavior therapy, group therapy, family
therapy and the use of medications. Research has found that
behavioral treatment seem to be more effective at the present time
than insight-oriented or family therapies. Also, research continues
to dictate that 12-step facilitation, based upon the principles of
Alcoholics Anonymous (AA) is probably as effective as more theory
based therapies. Controlled studies provide little support for the
effectiveness of psychodynamic psychotherapy as an appropriate alcohol
abuse treatment intervention.
Among the most
heavily investigated theory-based treatments are the cognitive
behavior therapy approaches. Some of the cognitive behavioral elements
most frequently employed in these programs facilitate relapse
prevention, improve social skills and assertiveness training,
contingency management, muscle relaxation, self-control training and
cognitive restructuring. Aversion therapy based upon the theories of
Pavlov’s conditioning theory, have been virtually abandoned in the
United States. Although it has been demonstrated that pairing the
taste, sight and smells of alcohol with noxious stimuli (i.e.
chemically induced nausea and vomiting), procedures are very expensive
and have not been shown to be superior to other much less drastic
alcohol abuse treatment interventions.
Behavior therapists
stress the importance of teaching new adaptive skills designed to
alter the conditions that precipitate and reinforce drinking as well
as developing alternative ways of coping with feelings, events and
persons that serve to maintain the drinking pattern. A number of
studies related to effective alcohol abuse treatment have demonstrated
the benefits of teaching social and other coping skills. Also,
researchers have tested a treatment model characterized as "relapse
prevention" which focuses on identifying and coping with situations
that represent high risk to resume heavy drinking, and have stated
that alcoholics who received this skills training and have attended
aftercare groups regularly, were found to have less severe relapses
than other individuals in control groups who did not receive these
interventions. These and other trials of cognitive behavioral alcohol
abuse treatments have provided the empirical basis for the elaboration
of a relatively generalized relapse prevention strategy.
The terribly
destructive effects of alcoholism on marriages and families has been a
source of concern to both clinicians, researchers, and families for
many decades. Alcoholism creates a major stress on the family system
by threatening health, economic functioning, and interpersonal
relationships and exerts many other deleterious effects on the
family. Although research has found a relatively strong association
between healthy family functioning and a positive outcome following
alcohol abuse treatment, little systematic evaluation has been
undertaken to assess the efficacy of “family approaches” to either
reduce alcohol problems or to improve family functioning.
The majority of
studies have focused on marital treatment rather than family treatment
approaches. In several studies that have been conducted, it has been
shown that behavioral marital therapy seems to be superior to
individuals in control groups in both the reduction in drinking and
the maintenance of sobriety.
In addition to
specific alcohol abuse treatment for alcoholic couples or families,
self-help groups for family members of alcoholics have grown
substantially and have proven to be effective. Al-Anon, although not
formally affiliated with AA, shares the basic structure and many of
the tenants of the 12-step program. Al-Anon and AA meetings are often
held jointly and are sometimes also joined by Alateen groups sponsored
by Al-Anon for children of alcoholics. Overall, these programs have
been found to be important adjuncts to successful alcohol abuse
treatments.
From DSM-IV-TR Mental
Disorders: Diagnosis, Etiology and Treatment by Michael B. First and
Allan Tasman
Additional
Information and webpage by
Paul Susic
MA
Licensed Psychologist Ph.D. Candidate
(Health and Geriatric Psychologist)
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