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Treatment Options Overall treatment plans consist of three components: medical, psychosocial, and support from loved ones and people who have experienced alcohol dependence or abuse. Each patient will require a combination of resources to suit their individual treatment needs. These are not competing assets but complementary to one another. See Treatment Option Brochure.

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Psychosocial Therapy

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Motivational Treatment
Behavioral Couples Therapy (BCT)
Cognitive-Behavioral Coping-Skills Therapy (CBST)

Motivational Treatment

Brief Motivational Intervention
One to 4, 10- to 60-minute sessions imparting information and advice on the negative consequences of alcohol abuse. The goal is generally to motivate a person to reduce alcohol intake rather than abstinence. This non-confrontational method is done performed by a treatment provider. By explaining health risks and other negative consequences of excessive drinking in a straightforward manner, patients will be motivated to reduce their alcohol intake. For additional reinforcement, pamphlets, or workbooks can be given at the session.1,2 Miller and Sanchez3 offered the basic elements in the FRAMES acronym. Feedback, Responsibility, Advice, Menu of Strategies, Empathy and Self-efficacy. Additionally, Goal Setting, Follow-up and Timing were added as important effective elements.4

Studies have shown that this approach generally works better with people who are not yet Alcohol Dependent but who are alcohol abusers.1,2 Research has shown that brief interventions can decrease consumption of alcohol in many populations – older and younger adults, men and women5 – by an average of 13 to 34 percent6 compared to a control group.2

More information on Brief Interventions

Motivational Interviewing
Motivational interviewing builds on Carl Rogers' optimistic and humanistic theories about people's capabilities for exercising free choice and changing through a process of self-actualization.7 Less motivated patients may benefit from this motivation-enhancing technique based on motivational psychology and the stages-of-change model. It is non-confrontational and assumes that the patient is responsible for changing his or her addictive behavior by exploring and resolving ambivalence to achieve a positive change in behavior.1,8

There are five MI techniques commonly used.

  1. Reflective listening. The therapist paraphrases what the patient says so that the patient knows that s/he is being listened to.

  2. Pros and Cons of Change. Realistically evaluating the current situation of the patient to evaluate if the pros outweigh the cons.

  3. Self-efficacy. Building up the patient's confidence that change can be made so that definitive positive behavioral changes are more attainable.

  4. Interview and assessment. Increasing self-awareness through using a patient's personal data and comparing it to current averages – such as national alcohol consumption – and focusing on the differences.

  5. Self-motivational statements. Eliciting statements from the patient wherein s/he expresses concern of self, recognition of the problem and reflecting on those statements so as to precipitate patients to change.1

References

  1. Carlo C. DiClemente, Ph.D., Lorie E. Bellino, M.Ed., Tara M. Neavins, M.S., Motivation for Change and Alcoholism Treatment. Alcohol and Research, Vol. 23, No. 2, 1999, pp. 86-92, http://pubs.niaaa.nih.gov/publications/arh23-2/086-92.pdf
  2. Alcohol Alert: Brief Interventions, National Institute on Alcohol Abuse and Alcoholism Number 66, July, 2005.
    http://pubs.niaaa.nih.gov/publications/AA66/AA66.htm
  3. Miller, W.R., and Sanchez, V.C. Motivating young adults for treatment and lifestyle change. In: Howard, G., ed. Issues in Alcohol Use and Misuse in Young Adults. Notre Dame, IN: University of Notre Dame Press, 1993.
  4. National Institute on Alcohol Abuse and Alcoholism, Alcohol Alert No. 43, April, 1999.
    http://pubs.niaaa.nih.gov/publications/aa43.htm
  5. Whitlock, E.P.; Polen, M.R.; Green, C.A.; et al. Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: A summary of the evidence for the U.S. Preventive Services Task Force. Annals of Internal Medicine 140:557–568, 2004.
  6. U.S. Preventive Services Task Force (USPSTF). Screening for hepatitis C virus infection in adults: Recommendation statement. Annals of Internal Medicine 140:462–464, 2004.
  7. Miller, W.R. (Ed.) (1999). Enhancing motivation for change in substance abuse treatment. Treatment Improvement Protocol (TIP) Series, No. 35. Rockville, MD: Center for Substance Abuse Treatment. Chapter 3. http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat5.chapter.61302
  8. Motivational Interviewing (resources for clinicians, researchers, and trainers) http://www.motivationalinterview.org/
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Behavioral Couples Therapy (BCT)

This treatment is for married or cohabiting alcohol-dependent persons and their spouses or partners. They must be in a committed relationship, and only one of the two is alcohol-dependent. Oftentimes when both partners are dependent, abstinence is not supported and these couples are more satisfied with their relationship, especially when misusing substances together1 Also excluded are couples whose relationship is destructive to one or both, or if there's a history of physical violence.1,2 Three primary goals strived for are: Abstinence; The family to support the efforts being made by the alcohol-dependent person to change; and Restructuring the dysfunctional interactions that oftentimes sustains the addictive behavior.

Standard BCT treatment is 15 to 20 sessions spanning 5 or 6 months. The beginning sessions are about decreasing negative feelings and interactions about past and future alcohol consumption and increasing positive behavioral interactions between the partners. A recovery contract is developed wherein the couple agrees to daily trust discussion. These discussions can be the dependent person pledging abstinence for the next 24 hours and the partner, in turn, expressing thanks and support in return. If there is daily medication involved, the taking of the medication in front of the partner can be done. Thus, the dependent partner reinforces a commitment to abstinence to the non-dependent partner, and the partner reciprocates with a reinforcement of support. Also included in the contract is an agreement not to talk about past addictive behavior and consequences nor project about the future and misuse outside of the therapy sessions. This will reduce conflict, which could be a trigger for relapse.1,3


References

  1. Fals-Stewart, W.; Birchler, G.R.; and O'Farrell, T.J., 1999. Drug-abusing patients and their intimate partners: Dyadic adjustment, relationship stability, and substance use. Journal of Abnormal Psychology 108(1):11-23.
  2. Fals-Stewart, W.; Birchler, G.R.; and O'Farrell, T.J., Behavioral Couples Therapy for Substance Abuse: Rationale, Methods, and Findings. Science & Practice Perspectives pp. 30 – 43, August, 2004 http://www.drugabuse.gov/PDF/Perspectives/vol2no2/04Perspectives-Behavioral.pdf
  3. Elizabeth Fried Ellen, L.I.C.S.W., Family therapy Approaches to Alcoholism, Psychiatric Times Vol. XV, Issue 9, September 1998 http://www.psychiatrictimes.com/p980953.html
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Cognitive-Behavioral Coping-Skills Therapy (CBST)

From the perspective of cognitive-behavior theory, alcohol and drug dependence are viewed as learned behaviors that are acquired through experience. When alcohol consumption provides a positive result – such as euphoria, reduction of stress – repetition of this behavior may lead to alcohol consumption being the preferred way to achieve those results, particularly in the absence of other ways of meeting those desired ends.1

CBST is a group of therapy approaches aimed at improving a patient's behavioral and cognitive skills in order to change problem-drinking behaviors. Primary objectives are to identify what need alcohol is filling and learn alternative ways to meet those needs without alcohol. Or if there are options to meet those needs, provide appropriate coping skills to modify the psychological dependence to make the non-alcohol choice.1,2

The coping skills can be related to a number of different behaviors. Intrapersonal Skills includes developing ways to manage such things as cravings and urges, anger, and negative thinking, to developing skills for relaxation, decision-making, problem-solving and how to deal with emergency situations.1

Interpersonal Skills include how to cope with refusing drinks when offered, learning to graciously turn down favors asked of them, handling criticism, expressing themselves in intimate relationships (which can include the significant other), expanding the outside support system and general social skills if lacking.1

CBST was among the first alcohol dependent treatment approaches to demonstrate efficacy in reducing drinking in randomized clinical trials.3,4 It continues to be widely used, especially in academia and VA Hospitals.2


References

  1. Ronald M. Kadden, Ph.D. Cognitive-Behavior Therapy for Substance Dependence: Coping Skills Training.
    Department of Psychiatry, University of Connecticut School of Medicine, October 9, 2002.
    http://www.bhrm.org/guidelines/CBT-Kadden.pdf
  2. Richard Longabaugh, Ed.D, Jon Morgenstern, Ph.D. Cognitive-Behavioral Coping-Skills Therapy for Alcohol Dependence. Current Status and Future Directions. Alcohol Research and Health. Vol. 23, No. 2, 1999, pages 78- 85 http://pubs.niaaa.nih.gov/publications/arh23-2/078-85.pdf
  3. Oei, T.P.S., and Jackson, P.R. Long-term effects of group and individual social skills training with alcoholics. Addictive Behaviors 5:129–136, 1980.
  4. Chaney, E.F.; O'Leary, M.R.; Andmarlatt, G.A. Skill training with alcoholics. Journal of Consulting and Clinical Psychology 46:1092–1104, 1978.
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This page was last modified on : 10/28/2013

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