Treatment Modalities for Alcoholism
When you have a drinking problem, you go to Alcoholics Anonymous. The advise is so ubiquitous, you might think it is a well-proven scientific fact. That's not the case. Widely known as AA, the free mutual self-help program that features 12 steps to sobriety ranked number 38 in a scientific comparison of effectiveness among 48 treatment modalities for alcoholism.If you or a loved one suffers from alcoholism you need to know what modalities---ways of treating the problem---work and which ones don't. In the "Handbook of Alcoholism Treatment Approaches," Reid K. Hester and William R. Miller survey treatment modalities for alcoholism, and review research that proves which ones work. Their systematic review found that the top five most effective treatment modalities for alcoholism are brief interventions; brief motivational enhancement; using Acamprosate; the community reinforcement approach; and self-help manuals.
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Brief Interventions
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Short and to the point, brief interventions scored the highest in the scientific comparison of studies that reviewed various treatment modalities for alcoholism. Healthcare providers and social workers most often offer brief interventions.
A brief intervention consists of a professional review of a person's drinking habits and an assessment to determine whether the habits are negatively affecting the person's health or well-being. The result is often a referral for more extensive, ongoing treatment. Brief interventions might work better than other approaches because people with alcoholism often require repeated interventions. Repeated, quick assessments by a healthcare provider who considers a person's readiness and ability to change course can be more effective than repeated stays in a residential treatment facility.
Brief Motivational Enhancement
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Usually performed by a trained therapist or psychologist, here is a treatment modality for alcoholism you can learn. Variously called motivational interviews or brief motivational Interventions, the modality focuses enhancing a person's motivation to change habits. Motivational enhancement focuses on a person's inner ability to change, as opposed to applying pressure from the outside. Interviewers try to discover a person's indecision about continuing to drink alcohol, then lead the person to resolve her own indecision. This modality recognizes that direct persuasion is not an effective way to encourage a person not to drink.
Rather, the interviewer, through a quiet, nonjudgmental approach, attempts to create an environment where the person will consider his desire to change. However, practitioners recognize that desire to change is not a character trait. They, instead, see it as the result of effective interaction between the problem drinker and an empathetic, reflective interviewer.
Acamprosate: a GABA Agonist
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Approved for use in the United States in 2004, Acamprosate works on chemicals in the brain that can be set out of balance by chronic alcohol use. It's not without side effects, though. Some people suffer allergic reactions, irregular heartbeats, changes in blood pressure, headaches, insomnia or impotence.
Naltrexone, another pharmaceutical treatment modality for alcoholism that is ranked number six on the list of most effective treatments, blocks opiate receptors in the brain to chemically impair the craving for alcohol. A National Institutes of Health study published in the "Journal of the American Medical Association" under the title Combining Medications and Behavioral Interventions for Alcoholism, found Naltrexone equally effective as 20 sessions of alcoholism counseling by a behavioral specialist.
Community Reinforcement Approach
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Psychologists and therapists enlist concerned friends and family members of problem drinkers in the community reinforcement approach. Therapists work with clients to increase motivation to stop drinking; help the client start her sobriety; analyze the person's drinking habits; increase positive reinforcement; and learn new coping skills. Caregivers using this treatment modality for alcoholism work with the client's friends and family to develop support and reinforcement that extends beyond the therapist's office.
Self-Help Manuals
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Pulling yourself up by your bootstraps might not seem the likely solution for a person who is chronically falling-down drunk, but Hester's and Miller's systematic research says it works better than dozens of other modalities, including regular attendance at Alcholics Anonymous meetings. Formally known as bibliotherapy, digital technology has now expanded this alcoholism treatment modality to include interactive online resources.
A Smorgasboard of Modalities
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Hester and Miller ranked alcoholism treatment modalities by the number, quality and results of all studies they identified for each of 48 recognized approaches. Though some clearly ranked more effective than others, and some widely known approaches---like AA---scored no better than unpopular or unapproved approaches like psychedelic therapy, the researchers urged an eclectic approach.
They recommend an informed decision to use whatever works in the life of a particular problem drinker. They caution problem drinkers and their concerned loved ones to prepare for a long-term struggle against a problem that can impair social interactions and destroy personal health.
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