Alcoholism Health Article

Psychosocial treatment options

Most alcoholics are treated with a variety of psychosocial approaches, including regular attendance at Alcoholics Anonymous (AA) meetings, group therapy, marital or family therapy, so-called community-based approaches, social skills training, relapse prevention, and stress management techniques. Insight-oriented individual psychotherapy by itself is ineffective with the majority of alcoholics.

The most effective psychosocial treatments of alcohol dependence incorporate a cognitive-behavioral approach. Relapse prevention utilizes cognitive-behavioral approaches to identifying high-risk situations for each patient and restructuring his or her perceptions of the effects of alcohol as well as of the relapse process. Network therapy, which combines individual cognitive-behavioral psychotherapy with the involvement of the patient's family and peers as a group support network, is a newer approach to alcohol dependence. One recent study found that while cognitive-behavioral therapy is effective in treating alcohol dependence, the reasons that are usually offered to explain its effectiveness should be reexamined.

Prognosis

The prognosis for recovery from alcoholism varies widely. The usual course of the disorder is one of episodes of intoxication beginning in adolescence, with full-blown dependence by the mid-20s to mid-30s. The most common pattern is one of periodic attempts at abstinence alternating with relapses into uncontrolled drinking. On the other hand, it is thought that as many as 20% of persons diagnosed as alcohol-dependent achieve longterm sobriety even without medical treatment. As of 2001, it is difficult to compare the outcomes of the various treatment approaches to alcoholism, in part because their definitions of "success" vary. Some researchers count only total abstinence from alcohol as a successful outcome, while others regard curtailed drinking and better social adjustment as indicators of success. The role of genetic factors in the prognosis is still disputed. Available evidence suggests that such factors as the presence of a spouse, partner, or close friend in the alcoholic's life, or religious commitment, can outweigh genetic vulnerability to the disorder.

BOOKS

"Alcoholism." The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Washington, DC: American Psychiatric Association, 1994.

Batey, Robert G., MD. "Alcohol-Related Problems." In Conn's Current Therapy, edited by Robert E. Rakel, MD. Philadelphia: W. B. Saunders Company, 2000.

Gearheart, W. W. "Alcoholism." In Encyclopedia of Genetics, vol. I, edited by Jeffrey A. Knight. Pasadena, CA: Salem Press, Inc., 1999.

Goodwin, Donald W. "Alcoholism." In Encyclopedia of Neuroscience, vol. I, edited by George Adelman. Boston, Basel, and Stuttgart: Birkhaeuser, 1987.

Hobbs, William R., Theodore W. Rall, and Todd A. Verdoorn. "Hypnotics and Sedatives; Ethanol." Chapter 17. In Goodman & Gilman's The Pharmacological Basis of Therapeutics, 9th edition, edited by Joel G. Hardman and Lee E. Limbird. New York: McGraw-Hill, 1995.

Lyon, Jeff, and Peter Gorner. Altered Fates: Gene Therapy and the Retooling of Human Life. New York and London: W. W. Norton & Co., Inc., 1996.

O'Brien, Charles P. "Drug Addiction and Drug Abuse." Chapter 24. In Goodman & Gilman's The Pharmacological Basis of Therapeutics, 9th edition, edited by Joel G. Hardman and Lee E. Limbird. New York: McGraw-Hill, 1995.

Seixas, Judith S., and Geraldine Youcha. Children of Alcoholism: A Survivor's Manual. New York: Harper & Row Publishers, 1985.

PERIODICALS

Anton, R. F., et al. "Posttreatment results of combining naltrexone with cognitive-behavior therapy for the treatment of alcoholism." Journal of Clinical Psychopharmacology 21 (February 2001): 72-77.

Bowers, B. J. "Applications of transgenic and knockout mice in alcohol research." Alcohol in Research and Health 24 (2000): 175-84.

Bradley, K. A., et al. "Alcohol screening questionnaires in women: A critical review." Journal of the American Medical Association 280 (July 8, 1998): 166-71.

Crum, R. M., and J. C. Anthony. "Educational level and risk for alcohol abuse and dependence: Differences by race-ethnicity." Ethnicity and Disease 10 (Winter 2000): 39-52.

Cunradi, C. B., et al. "Alcohol-related problems and intimate partner violence among white, black, and Hispanic couples in the U.S." Alcoholism: Clinical and Experimental Research 23 (September 1999): 1492-1501.

Enoch, M. A., and D. Goldman. "The genetics of alcoholism and alcohol abuse." Current Psychiatry Reports 3 (April 2001): 144-51.

Galanter, M., and D. Brook. "Network therapy for addiction: Bringing family and peer support into office practice." International Journal of Group Psychotherapy 51 (January 2001): 101-22.

Heath, A. C., et al. "Towards a molecular epidemiology of alcohol dependence: Analysing the interplay of genetic and environmental risk factors." British Journal of Psychiatry Supplement 40 (April 2001): s33-s40.

Holtzman, D., et al. "State-and sex-specific prevalence of selected characteristics—Behavioral Risk Factor Surveillance System, 1996 and 1997." Morbidity and Mortality Weekly Report CDC Surveillance (July 2000): 1-39.

Larimer, M. E., et al. "Relapse prevention. An overview of Marlatt's cognitive-behavioral model." Alcohol Research and Health 23 (1999): 151-60.

Morgenstern, J., and R. Longabaugh. "Cognitive-behavioral treatment for alcohol dependence: A review of evidence for its hypothesized mechanisms of action." Addiction 95 (October 2000): 1475-1490.

Nurnberger, J. I. Jr., et al. "Evidence for a locus in chromosome 1 that influences vulnerability to alcoholism and affective disorder." American Journal of Psychiatry 158 (May 2001): 718-24.

Paschall, M. J., et al. "Alcohol misuse in young adulthood: Effects of race, educational attainment, and social context." Substance Use and Misuse 35 (September 2000): 1485-1506.

Rodriguez, E., et al. "Family violence, employment status, welfare benefits, and alcohol drinking in the United States: What is the relation?" Journal of Epidemiology and Community Health 55 (March 2001): 172-78.

Steinbauer, J. R., et al. "Ethnic and sex bias in primary care screening tests for alcohol use disorders." Annals of Internal Medicine 129 (September 1998): 353-62.

Stromberg, M. F., et al. "Effect of acamprosate and naltrexone, alone or in combination, on ethanol consumption." Alcohol 23 (February 2001): 109-16.

Wall, T. L., et al. "A genetic association with the development of alcohol and other substance use behavior in Asian Americans." Journal of Abnormal Psychology 110 (February 2001): 173-78.

Wall, T. L., et al. "Hangover symptoms in Asian Americans with variations in the aldehyde dehydrogenase (ALDH2) gene." Journal of Studies on Alcohol 61 (January 2000): 13-17.