He Treatment of alcoholism Has scientific evidence that supports it, because alcohol is one of the drugs that demand greater care, hence the need to have updated treatments available.
Alcoholics are those people who abuse or are dependent on alcohol, the Central Nervous System depressant drug. Along with tobacco, are the legal substances most consumed by both the general population and students. Men are those who abuse it the most and the beginning is given to low middle ages.
Therapeutic lines of action for alcoholism
In the treatment of alcoholism there are two possible lines of action, on the one hand:
- Drug-free programs, whose purpose is complete abstinence from the substance, in this case alcohol. Medical models adopt this orientation. This does not exclude that psychological models also assume drug-free programs, although their underlying explanatory models are different from biological-medical ones.
Within this orientation we find aversive therapies, contingency management, therapy Cognitive , he Social skills training , Relapse prevention, the multicomponent broad spectrum program and behavioral therapy and from couple .
- Harm reduction programs. Its purpose is not abstinence but to minimize the consequences derived from consumption.
Within these we find the controlled drinking program and the motivational interview.
General aspects of the psychological treatment of alcoholism
The objective of the psychological treatment of alcoholism is focused on changing the behaviors in direct relation with the consumption of alcohol, since the subject alone is responsible for its problem.
The treatment seeks to reduce the person's interest in alcohol, while seeking to increase their preference for other activities linked to long-term adapted functioning.
Treatments of this type are not carried out in a hospital setting, but in the person's own environment. It must be taken into account that, if the person presents abstinence syndrome To finish drinking, it would be convenient to detox the latter, with tranquilizers, in the hospital or outpatient. In these cases, the support of the couple is fundamental, as it helps to take an important step towards the cessation.
Psychological treatments of alcoholism
1-Aversive therapy
The goal of this therapy is to reduce or eliminate the person's desire for alcohol through a series of stimuli or images that are intended to be associated with certain signs of drinking (eg, color, taste, smell...). Aversive therapies can be given in several ways:
Chemical Aversion
It matches a particular stimulus of the drink as the flavor, with an aversive stimulus like nausea and vomiting created by a drug that causes vomiting (emetics). Once you are given the emetic drug and begin to feel nausea and vomiting, you are asked to drink. You have to taste, smell, spin the drink in your mouth and then swallow it.
Currently the use of Emetics Is more used as a relapse prevention.
Respiratory arrest
The same stimuli are paired, but with a respiratory arrest by a drug called Anectine. Currently out of stock.
Electric shock
Stimuli of a variety of alcoholic beverages are matched with an electric shock.
Covert sensitization
Different options are posed, on the one hand, different types of highly aversive images are used for the subject, contingent on a maladaptive approach to alcohol.
Another option is an aversion-relieving procedure, in which unpleasant images end with the imagination of an appropriate response such as rejecting the drink. The most commonly used current option is a combination of both contingent aversion and escape procedures linked to appropriate behaviors.
A wide range of beverage situations and types of beverages are used.
A good predictor is the appearance of conditional nausea. It is not recommended for use in certain cases (eg: Severe depression , psychosis , heart disease, Gastrointestinal disorders , etc.).
Some variations are assisted sensitization (eg, use of an unpleasant odor?) Or emotional sensitization (use of scenes not linked to alcohol with a high emotional load).
2-Management of contingencies
From this approach, alcohol consumption is considered as Operant behavior Maintained by the social reinforcing effects and the substance.
As a reinforcement, exchangeable vouchers are usually used, in order to reinforce abstinence behaviors or assistance to therapy, goal compliance and other adaptive behaviors.
Contingency management increases adherence to treatment and decreases relapse.
3-Lane Exposure Therapy
Based on the principles of classical conditioning, it starts from the idea that certain stimuli initially neutral to behavior, after repeated pairings, eventually become triggers of the conditioned response of consuming. These stimuli can be environmental or individual signals ( anxiety , State of mind ??).
This therapy works best when combined with coping strategies.
4-Cognitive Therapy
It includes training in problem solving and craving management (desire to consume); The former is an important element of many cognitive-behavioral treatments and is a strategy included in almost all relapse prevention programs.
Behavioral treatments also include craving control, Control of emotions And the stress .
5-Cognitive-behavioral treatment
It focuses on training certain skills to adequately respond to the environmental and consequential background and individual that maintains drinking behavior.
Social skills training and coping skills
From here it is considered that the patient does not have adequate interpersonal and social skills to cope with social pressure, or handle the stress of these situations and not trigger drinking behavior.
The objective is to provide the individual with coping and self-control skills to handle risky situations that trigger drinking.
It can be conducted in group therapy format, and include techniques such as modeling, therapist training, group feedback, behavioral testing and repeated practice.
Self-control training
Multi-component educational procedure. It can be applied either in group format, as individual, or in self-help manual. The therapist introduces the components and sends tasks home.
The procedure consists in self-observation of behavior; The planning of objectives to be achieved; Control of antecedent stimuli of drinking behavior; Training in what and how to drink to reduce the negative consequences of alcohol; Reduction of drinking in favor of other more adaptive behaviors; The reinforcement of the goals achieved and the learning of skills, such as knowing how to refuse the offer of alcohol from an acquaintance??
Relapse prevention
These programs use techniques to identify high risk situations, teaching coping skills, coping strategies, coping with falls and problem solving . It is important to pay attention to stressful situations, as these often precede those at high risk of drinking.
Approximation of community reinforcement
It is a broad spectrum behavioral treatment for substance abuse and with ample evidence, aimed at changing the Lifestyle Related to the consumption of the substance.
It aims to reduce alcohol consumption and increase the person's functional behavior. It can be applied in group or individually and both to outpatients and hospitalized patients.
At the beginning of therapy, sobriety testing is usually requested. This consists in negotiating a withdrawal period of at least 90 days (never less than 60 days) at the same time as the introduction of the Disulfiram , A drug to maintain abstinence because if you ingest alcohol under the effects of this one produces a fast and intense hangover. Disulfiram is given under the supervision of the partner (if possible).
The motivational techniques and the positive reinforcement . Through the reinforcement of alternative activities to alcohol, it is intended to include elements that increase the maintenance of the abstinence .
Components:
- Use of disulfiram plus operative techniques to increase adherence.
- Training in communication skills More behavior therapy for couples and families to promote social reinforcement activities.
- Set up??? abstain social club?? With social activities.
- Recreational activities not related to alcohol.
- Training to face the urges and urges to drink and deal with the pressure.
6-Behavioral and couple therapy
They are multicomponent programs and they are part of the idea that one or more members of the family maintain alcohol abuse through reinforcement. Besides, marital problems are not rare.
The treatment will consist of reinforcing abstinence while the person with alcoholism is involved in activities that are satisfactory and not related to drinking.
The techniques normally included are:
- Training in communication skills.
- Increase in the rate of positive reinforcement in family relationships.
7-Psychological treatments whose goal is not complete abstinence
Controlled drinking program
It was created by Davis, who, in 1962, pointed out that it was possible to get control of drinking. This program starts from the difficulty of totally controlling the consumption of alcohol in some drinkers, as well as of the existence of some people who refuse to look for complete abstinence.
Suitable patients for this program are those who reject abstinence as an objective, who have strong external demands for social drinking, are young and with good family and social support and who fail in previous abstinence-oriented treatments.
They are behavioral programs, based on self-control models, that teach a set of strategies and that usually consist of the following components:
- Delimitation of the objectives.
- Self-registration.
- Functional analysis of beverage situations (antecedents, consequent, maintainers??)
- Specific changes in drinking behavior.
- Reinforcement to achieve the objectives (points system)
- Learning alternative coping skills.
- Relapse prevention.
8-Motivational Interview
Before discussing what this interview consists of, it is important to be clear about the stages proposed by Prochaska and Diclemente, in their transtheoric model, on motivation. They spoke of the existence of 7 stadiums.
- Precontemplation : Drinking behavior is not seen as a problem and the subject shows little desire to change in the next 6 months.
- Contemplation : The drinker begins to be aware that there is a problem and is already actively seeking information and has raised the change seriously in the next 6 months.
- Preparing for action : The drinker has considered changing his behavior in the next 30 days, in addition to making an attempt to abandon at least 24 hours in the last year.
- Action : The drinker has actively initiated the modification of his behavior, reaching to achieve it successfully.
- Maintenance : The drinker has been abstinent for more than 6 months.
- Relapse : The drinker interrupts the phase of action or maintenance, causing a cyclical movement backwards, to the initial stages of precontemplation and contemplation.
- Ending : The problem has totally disappeared, producing abstinence for 5 years.
The motivational interview was created by Miller and Rollnick (1991) and it is a type of intervention focused on increasing the patient's motivation when he is in the stages of precontemplation and contemplation.
The procedure of this interview consists in paying attention to the following aspects:
- Give information and advice, providing clear and objective information.
- Identify your problem and the risks it entails.
- Remove obstacles and facilitate the person to go to treatment.
- Short intervention in a short period of time, more than a long waiting list.
- Give various options to the client so that he can choose.
- Transmit that the person has different options from which to choose. It is important that the person feel that he has chosen her, without feeling coerced, in this way will achieve the improvement of adherence to treatment and its follow-up.
- Decrease factors that make drinking behavior desirable.
- To diminish the positive consequences that maintain the drinking, emphasizing the negative consequences inevitably associated. You can use the analysis of pros and cons, costs and benefits, etc.
- Promote Empathy , Reflective listening and the ability to understand.
- Give Feedback , Return information on how the therapist sees the patient, their situation, etc.
- Clarify and set realistic goals, achievable and accepted by the patient.
- Active help since, although it is the patient who decides to change, the role of the therapist is important.
- When the patient does not go to therapy, it may be useful to make a call, send a letter, etc.
CONCLUSIONS
Studies of empirical evidence put the approach of community reinforcement, training in social skills coping, relapse prevention and family and couple behavior therapy as well established treatment.
Exposure therapy To clues and medication as disulfiram, as probably effective and handling contingencies as an experimental treatment.
References
- Olivares Rodríguez, J., Méndez Carrillo, F.X. (2010). Behavior modification techniques. Madrid. New library.
- Pérez Álvarez, M et al. (2010) Guide to effective psychological treatments I. Adults Madrid: Pyramid.
- Ruíz, M.A., Díaz, M.I., Villalobos, A. (2012). Manual of cognitive-behavioral intervention techniques. Madrid. Desclée de Brouwer, S.A.
- Vallejo, M.A. (2012) Behavioral therapy manual. Volume II. Cambridge: Cambridge University Press.