Alcoholism Treatments

There are different types of treatments according to the needs of each person since each one is a different being.

Basically it is a synthesis of these contributions, plus the developments of professional Therapeutic Communities, cognitive-behavioral therapies, group therapies, psychodrama, systemic family therapy, NLP, transactional analysis, gestalt therapy and the contributions of neurosciences and psychiatry, merging and improving them, which allows us to obtain one of the highest recovery percentage in Latin America. Therefore, each treatment is planned taking into account these needs and the resources available for each case.

It is essential to achieve a balance between the environment and the types of treatments, and the particular problems and needs of each individual. In this way, it will be possible for each person who comes for help to succeed and return to function productively in the family, work and society.

The difficulties that may arise in recovery are :  

– Premature abandonment of treatment.
– Relapses
– Thoughts from a scheme of alcoholic pride, of thinking that one is already cured 

The treatments in addition to the therapy of groups with peers and directed by recovered alcoholics, include medical, psychiatric interconsultations and various techniques of proven efficacy such as:

The difficulties that may arise in the appropriate allocation of the different techniques are:
– Premature abandonment of treatment.

Heterogeneity of the alcoholic population based on four types of variables: sociodemographic, alcohol dependence, personality and psychopathological.

COGNITIVE THERAPIES

Theoretical foundations: Maintains a psychological conception based on mental processes (reasoning, memory and attention) and from an intrapsychic point of view. It is used to treat different psychiatric disorders such as anxiety, depression and phobias.

Objectives: To modify the beliefs and wrong thoughts that alcoholic patients have about alcohol consumption.

Psychic Dependence : The person feels an urgent need to use drugs and, if not get it, experiences an upset and emotional downfall. The sensations that he obtains when consuming lead him to look for drugs again.

Development: Generally, 15-20 structured sessions are held, that is, they have a defined method to achieve the objectives. The psychotherapeutic process experienced by the patient depends on the needs recognized by the psychotherapist and the methodology. The most recognized types of cognitive psychotherapies are :
– Beck’s therapy, focused on automatic negative thoughts.
– Ellis therapy, focused on irrational thoughts.

Beck’s therapy, focused on automatic negative thoughts.

Illis therapy, focused on irrational thoughts.

Results: Several studies have shown that in certain groups of patients undergoing this technique an improvement can be observed, and is especially useful for those patients who have depressions, phobias or anxiety.

COGNITIVE-CONDUCTUAL THERAPIES

They are also called “broad spectrum therapies.” They are intended to improve cognitive and behavioral skills to change alcohol consumption and maintain abstinence. In other words, it helps patients recognize consumption situations, avoid them and deal with them. It is a structured therapeutic strategy, oriented towards specific objectives, and focused on immediate problems. However, it is flexible and adaptable to the individual needs of each patient and is compatible with any other type of therapeutic intervention.

Theoretical foundations: Alcoholism is the result of a poorly adapted learning process and the objective is to correct such behavior and replace it with more adapted ones. In the last 15 years, various techniques have appeared that vary in duration, content, space, etc; but they all use the same components:

Functional analysis : it is about identifying the thoughts, feelings, circumstances and external stimuli related to alcohol consumption that facilitate the maintenance of the disease or induce relapses in the future.

Psychic Dependence : The person feels an urgent need to use drugs and, if not get it, experiences an upset and emotional downfall. The sensations that he obtains when consuming lead him to look for drugs again.

Skills training : it is taught, through training, healthier habits and coping strategies to the daily problems of life that they may have forgotten or never learned. At first, learning is intended to control alcohol consumption; Subsequently, the training focuses on achieving interpersonal and intrapersonal skills.

Goals:

Learn skills to maintain abstinence.

Identify high-risk situations or precipitating factors, both internal and external.

Promote the management of painful situations.

Improve interpersonal functioning.

Change contingent reinforcements.

Development: It is a brief therapy, as it consists of 12 sessions (one hour), in which the therapist participates very actively. The development of each session is clearly structured. At the beginning of each session, a review of the tasks performed at home and an assessment of the current status is performed; Afterwards, the topic is explained and developed (there are issues whose development is mandatory and others are freely chosen by the patient). Ultimately, skills learning is performed by staging certain situations.

Results: Different studies have indicated that people undergoing this treatment have a positive evolution. If this technique is compared with others, its effectiveness is similar or greater to them. In addition, this effectiveness is increased when added to other treatments. It is very useful in certain groups of patients such as people with antisocial personality disorder or associated psychopathological disorders, and in patients with few dependence symptoms, as well as in situations of risk of relapse.

MOTIVATIONAL THERAPIES

They are systematized interventions designed to cause a change in patients with alcohol problems. They are based on the principles of motivational psychology, that is, that people only change if they have sufficient motivation (both internal and external) and, in the transtheoretical model of the change of Prochaska and Di Clemente, according to which the person goes through different phases until the change is reached. The common elements that make up motivational therapies are:

Feedback: show the results and put them in relation to alcohol consumption, or reaffirm the favorable evolution.

Responsibility: show that it is the patient who has to make the decision to change and choose the possibilities of intervention to avoid abandonment.

Warning: state the reasons for the change and recommend how to do it.

Possibilities: offer several alternatives to achieve abstinence.

Empathy: giving support, attention, sympathy; the opposite of confrontation, suspicion and managerial attitude.

Self-efficacy: show optimism about the possibilities of change.

BRIEF INTERVENTIONS


A very frequent problem among people who have problems derived from excessive alcohol consumption is the low percentage of those who go to a service requesting help. A solution to these difficulties is the intervention in primary care.

They are made between 1 and 4 sessions of 30-60 minutes. The brief intervention begins with a global evaluation of the patient and alcohol consumption through a structured interview, questionnaires, and biological tests. Then, the findings of the evaluation are presented in a neutral, objective way, clarifying the findings and asking for the opinion or opinion of the patient. Subsequently, advice is given regarding alcohol consumption or the level of consumption is agreed with the patient. Support material is usually given about the disease and its consequences.

PREVENTION OF RELATIVES


Theoretical foundations: It is argued that relapse is a transitory process in the evolution of the disease, not a therapeutic failure, and begins long before restarting alcohol consumption. A central aspect of this model is the risk factors that can precipitate a relapse, and the responses that the subject gives to these factors. People with ineffective responses to these situations will experience a lack of confidence that, together with positive expectations for alcohol consumption, can cause the same consumption generating feelings of guilt, which with the positive effect of alcohol will induce you to continue drinking.

The risk factors are divided into two classes:

Immediate determinants: high-risk situations (such as negative emotional states) that may be caused by intrapersonal perceptions of certain situations, or, as responses to the environment; situations of interpersonal conflict; situations of social pressure and positive affective states (celebrations). Then the slip happens (occasional alcohol consumption), which may not lead to a relapse, but it is a very big risk. Frequently, after the slip, feelings of guilt usually appear, which together with the positive expectations of alcohol, lead again to consumption and ends in relapse. People who attribute the slip to personal failure experience anxiety, depression, feelings of guilt that can lead to alcohol consumption, but they may think that mistakes are learned from mistakes. Instead,

Hidden history: such as the lifestyle of the patient or the level of stress to which they are subjected, which can lead to the subject being put at risk. Also certain cognitive factors such as rationalization, denial and desire for immediate gratification, which can cause greater vulnerability to alcohol.

Unlimited relationship, abusive, invasive

Goals:

Prevent and anticipate relapses.

Properly manage a relapse so that the adverse consequences are minimal and take advantage of the experience.

Find a balanced lifestyle and reduce the dangers that affect health.

Development: It is a brief technique, very structured, with a perfectly established development of each session and very similar to the previous technique. Tasks are assigned to perform at home and the staging of different risk situations is performed. There are two phases; First, current and/or future risk situations are analyzed, and then skills are learned to better cope with those situations. The strategies used are varied, but all seek to learn coping skills, achieve cognitive restructuring and seek a balance in the patient’s lifestyle.

Results: The studies carried out to date have proven their effectiveness both in reducing the number of relapses and in their intensity. However, the rate of abstinent patients is similar to other types of therapies, although the number of days of alcohol consumption is reduced and the evolution improves if psychopharmaceuticals or other therapeutic modalities are added.

COUPLE/FAMILY THERAPY


Theoretical foundations: It is common to verify that alcohol dependence causes couple conflicts and complicated family situations such as arguments, the appearance of jealousy, separation, divorce, violence and aggressiveness. On the other hand, the family plays an important role in the onset and maintenance of this disease. Impaired relationships can maintain alcohol consumption, as it can have adaptive functions (such as facilitating the expression of feelings or interpersonal contact). In abstinence, conflicts may persist and may precipitate a relapse.

Currently, the theoretical model of family approach that predominates is the systemic model that puts the emphasis on family interactions known as “Alcoholic Family.” Alcoholic behavior can have two functions: the alarm signal of a family malfunction and can have an organizing function of the family system and favor its maintenance as a unit. Both factors can be an added difficulty for the extinction of alcoholic behavior. In the short term, alcohol consumption may have an adaptive function in the family that reinforces the maintenance of that behavior. Subsequently, alcohol consumption, probably with nuances of alcohol dependence, is integrated into the family system affecting rituals, problem solving and other specific family behaviors. At this time, the family seeks and implements coping mechanisms that compromise their own growth and development.

Goals:

Eliminate or reduce alcohol consumption and support the patient’s efforts to change, for which it is necessary to change the patterns (past or future) of alcohol-related interaction.

Improve and modify the family system, recover social relationships and resolve conflicts.

Maintain withdrawal.

Development :

After some assessment sessions, both of the dependency and of the marital relationships, and in which some inconveniences may arise (such as attending the session under the influence of alcohol, risk of violence or family crisis situation), therapy begins It takes place over 10-20 perfectly structured sessions. The first sessions focus on the reduction and withdrawal of alcohol through the establishment of a commitment, which specifies the tasks that each member of the couple/family must perform and the possibility of taking alcohol aversives under the supervision of the family . Once abstinence is achieved, the sessions focus on marital relationships, marked by resentment and fear of the spouse’s future, and guilt and desire for recognition in the patient, which can cause tension. For this, it is necessary to increase the positive exchanges (perform activities thinking about the other person, plan recreational activities together, introduce objects and events of special significance to the couple) and resolve conflicts through training in communication skills, problem solving and behavior changes

Results :

Multiple studies indicate that the family’s participation in the treatment of alcoholism is positive: there is a better therapeutic compliance, the evolution is more favorable and, in the follow-up, “abstinent” families function better than the families of alcoholic patients who have relapsed

SELF-HELP GROUPS


Theoretical foundations : Alcohol dependence is a disease with emotional and physical components that can be stopped, but not completely cured.

Objectives : To achieve abstinence by accepting that it is a chronic and progressive disease, that people have an inability to control alcohol consumption and that absolute abstinence is the only alternative. For this it is necessary to know that the help of a higher power is needed.

Development : All self-help groups arise when one or more patients with alcohol dependence found that existing resources were inadequate to their needs. All organize meetings with different models or formats; The development and direction of the meeting varies widely between different groups. A very important part of the groups is the help of the partner or sponsor; veteran who helps and shares his experience with the newest people.

Results : In a comparative study between group therapy of alcoholics anonymous, cognitive therapy and motivational therapy, during three years of follow-up, patients in all three groups experienced improvement of their disease, but those who went to self-help groups were more committed to The treatment of your disease.

GROUP THERAPY


For many authors, group therapy is the method of choice in the treatment of alcoholism. However, there is no technique specifically designed for the treatment of this disease; rather, there are multiple theoretical orientations. There are group therapies of dynamic orientation, psychodrama, Ellis corrective emotional therapy, cognitive behavioral therapy (many of the techniques explained above can be done in groups) and discussion groups.

Group therapy can be a supportive, therapeutic and educational experience, which can motivate and keep patients in withdrawal. The therapeutic factors involved are: identification, understanding of the influence that alcohol consumption has on your life, understanding of your reactions and of others and learning in the communication of feelings.

CONSUMER REDUCTION STRATEGIES

The objective of the psychological techniques, described above, is alcohol withdrawal. Some patients who do not meet dependency criteria, although they present some or several problems derived from their consumption, have not considered abandoning alcohol consumption so it is convenient to use other strategies such as control and reduction of consumption. In these cases, various psychological strategies have been used, such as:

Goals:

Alcohol consumption monitoring: it consists of recording the number of alcohol units consumed on each occasion, together with the calculation of the weekly total. It should be noted the duration of the period of consumption, as well as other circumstances such as situations in which it was performed, companies, consequences and if you used any strategy to reduce consumption.

Set specific objectives to reduce consumption: Although the objectives should be set by the patient, it may be useful to provide guidelines such as:

  • Maximum number of units per week.
  • Number of days of withdrawal per week.
  • Do not consume in high risk situations.
  • Frequency of consumption in each unit of time.
  • Reduce or change the type of drink.

Use cognitive behavioral techniques to learn to respond differently in risk situations and modify consumption.

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