For most people, alcohol is accepted in our culture as a pleasurable accompaniment to social activities. However, a substantial number of people have serious trouble with their drinking. Alcoholism, which is also known as "alcohol dependence syndrome," is a disease that is characterized by the following elements: craving, loss of control, physical dependence, and increased tolerance. According to recent statistics from the National Institute on Alcohol Abuse and Alcoholism, "Nearly 14 million Americans--1 in every 13 adults--abuse alcohol or are alcoholic. Several million more adults engage in risky drinking patterns that could lead to alcohol problems. In addition, approximately 53 percent of men and women in the United States report that one or more of their close relatives have a drinking problem"(http://alcoholism.about.com/library/niaaa01.htm).
In addition, not only does alcohol abuse increase a variety of health risks, it also increases the risk of death from automobile crashes, recreational accidents, and on-the-job accidents. It is estimated that alcohol-use problems cost society approximately $100 billion per year (NIAAA website, 2013). The purpose of this article is to gain a greater understanding about alcoholics and the most effective strategies for treating alcoholism.
There is a plethora of research that is enhancing the practice among involuntary clients, or in this case, alcoholics. Scientists at Medical centers and universities throughout the country are studying alcoholism and have cutting edge information about it. Today, NIAAA funds approximately 90 percent of all alcoholism research in the United States. According to their website, “NIAAA is sponsoring promising research in vital areas, such as fetal alcohol syndrome, alcohol’s effects on the brain and other organs, aspects of drinkers’ environments that may contribute to alcohol abuse and alcoholism, strategies to reduce alcohol-related problems, and new treatment techniques” (NIAAA website, 2013). The goal of this qualitative research interview is to further understand effective ways of treating and preventing alcohol problems.
First and foremost, Alcoholism is a complex issue that involves a multitude of factors; such as biological, psychological and social. “Alcoholism is due to many interconnected factors, including genetics, how you were raised, your social environment, and your emotional health. Some racial groups, such as American Indians and Native Alaskans, are more at risk than other of developing alcohol addiction. People who have a family history of alcoholism or who associate closely with heavy drinkers are more likely to develop drinking problems. In addition, those who suffer from a mental health problem such as anxiety, depression, or bipolar disorder are also particularly at risk, because alcohol may be used to self-medicate.”
Recent research supported by NIAAA has demonstrated that for many people, a vulnerability to alcoholism is inherited. These findings show that children of alcoholics are about four times more likely than the general population to develop alcohol problems. Children of alcoholics also have a higher risk for many other behavioral and emotional problems. But alcoholism is not determined only by the genes your inherit from your parents. It is important to recognize that aspects of a person’s environment, such as peer influences and the availability of alcohol, also are significant influences.
The Addiction Recovery Center in Medford employs the use of several evidence based theoretical frameworks that have shown positive results. She introduced me to the American Society of Addiction Medicine (ASAM), “a professional society representing over 3,000 physicians and associated professionals dedicated to increasing access and improving the quality of addiction treatment; educating physicians, other medical professionals and the public; supporting research and prevention; and promoting the appropriate role of physicians in the care of patients with addictions” (ASAM website, 2013). When a client applies for substance abuse services at the ARC, they are screened and assessed with the ASAM criterion, which evaluates a multitude of factors; such as physiological effects of drug withdrawl, psychological impact, physical complications, readiness to change and history of relapse. (http://www.asam.org/research-treatment/screening-and-assessment)
There are a number of theoretical models that the ARC approves in their treatment program. Depending on the severity of the addiction, the ARC recommends individual counseling, family counseling, group counseling and residential treatment housing. However, due to lack of time, she was only able to talk about a few; such as Motivational Enhancement Programs, Cognitive-Behavioral Therapy, and 12-Step Facilitation Therapy. According to Noel “Treatment varies depending on the type of drug and the characteristics of the patient. The best programs provide a combination of therapies and other services. These models are designed to raise drinkers’ awareness of the impact alcohol has on their lives, as well as the lives of family, co-workers and society. They are encouraged to accept responsibility for past actions and make a commitment to change future behavior. Substance abuse therapists help alcoholic patients understand and accept the benefits of abstinence, review treatment options, and design a treatment plan to which they will commit” (Chaney, 2013).
The National Institute on Drug Abuse released a publication (2012) titled “Principles of Drug Addiction Treatment: A Research-Based Guide” that highlights several evidence based treatment models that are working in treating alcoholism and other addictions. Each approach is designed to address certain aspects of drug addiction and its consequences for the individual, family, and society. Some of the approaches are intended to supplement or enhance existing treatment programs, and others are fairly comprehensive in and of themselves. The two approaches they mention are: Pharmacotherapies and Behavioral Therapies. The Pharmacotherapies consist of an assortment of medications that can be used in conjunction with individual, group and family therapies; such as Naltrexone, Acamprosate, Disulfiram and Topiramate. When used in combination with counseling, these prescription drugs lessen the craving for alcohol in many people and helps prevent a return to heavy drinking.
According to the National Institute of Drug Abuse, “Behavioral approaches help engage people in drug abuse treatment, provide incentives for them to remain abstinent, modify their attitudes and behaviors related to drug abuse, and increase their life skills to handle stressful circumstances and environmental cures that may trigger intense craving for drugs and prompt a relapse” (NIDA, 2013, 34). They identify a number of behavioral therapies shown to be effective in addressing substance abuse; such as Cognitive-Behavioral Therapy, Contingency Management Interventions/Motivational Incentives, Community Reinforcement Approach, Motivational Enhancement Therapy, The Matrix Model and 12 Step Facilitation Therapy.
While I can’t discuss all of these theoretical models, I will discuss Motivational Enhancement Therapy and 12-Step Facilitation Therapy. Using a nonjudgmental approach, Motivational Enhancement Therapy (MET) employs Motivational Interviewing (MI) to analyze feedback gained from client sessions. The goal of MET is to aid the client in clarifying his or her own perceptions and beliefs in order to direct him or her in a decisive way. According to GoodTherapy.Org: http://www.goodtherapy.org/motivational-enhancement-therapy.html
MET is administered in a receptive atmosphere that allows a client to receive feedback from the therapist for the purpose of fortifying the client’s resolve for transformation and to empower the client with a feeling of self-control. Rather than engaging the client’s defense mechanisms through confrontational discourse, the therapist works with the client to create positive affirmations and a sense of inner willingness to facilitate change. Once that is achieved, the client becomes receptive to the healing process and progresses toward wellness (2013, 23).
Motivational interviewing principles are used to strengthen motivation in the client and build a plan for change. Coping strategies are suggested and discussed with the patient and the therapist continues to encourage commitment to change or sustained abstinence.
Another effective treatment model is 12-Step Facilitation Therapy. This peer-support approach encourages people to become involved with a 12-step program that complements professionally supervised therapy. Programs like Alcoholics Anonymous, Smart Recovery and Women for Sobriety are typically recommended with all forms of alcoholism therapy because they provide alcohol-dependant Individuals with an encouraging, supportive environment. These support group meetings focus on abstinence and fosters each individual's physical, mental, emotional and spiritual health.
While there is a lot of cutting edge research on alcoholism and methods of effective treatment, there is always room for further investigation. Not only is there a need for more genetic research, there is a need for alternative treatment approaches and effective medications that can be used in conjunction with therapy. In addition, addiction recovery treatment programs aren’t able to meet the needs of everyone; therefore, there is a need for research on alternatives methods for the treatment of alcoholism. Supposedly NIAAA has sponsored a study called project MATCH, which tested whether treatment outcome could be improved by matching patients to three types of treatment based on particular individual characteristics. This study found that all three types of treatment reduced drinking markedly in the year following treatment.
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