As dependence gets more established, you might find you end up spending most of your time thinking about alcohol or engaging in activities necessary to obtain, consume, or recover from the effects of drinking. It might be surprising to hear that you don’t always have to be drinking to extreme levels to become dependent on alcohol. If you drink heavily over a period of time, the brain’s chemistry adjusts to the effects of alcohol. We take mental health content seriously and follow industry-leading guidelines to ensure our users access the highest quality information. All editorial decisions for published content are made by the MentalHealth.com Editorial Team, with guidance from our Medical Affairs Team.
The Brain’s Reward System
In maintaining abstinence, no significant difference was observed between counselling and other therapies when assessed up to 6-month follow-up. However, bar the 6-month follow-up, these results are based on a single study (OFARRELL1992) whereas in the analyses assessing couples therapies versus other active therapies, more studies were included in the analyses for this outcome. Other therapies (namely couples therapies and coping skills) showed significant benefits over counselling in maintaining abstinence at longer follow-up periods of up to 18 months.
18.3. Studies considered for review
Treatment providers are now required to consider not only treatment efficacy but also cost effectiveness, and for this reason treatment matching has remained an appealing option (Moyer et al., 2000). However, for the findings of matching trials to be meaningful, one must consider a variety of methodological issues. Many of the recent studies considered have involved small samples, physiological dependence on alcohol comparing a diverse range of variables both in terms of sample characteristics and treatment process factors (McLellan & Alterman, 1991). It has been suggested that for trials to provide more meaningful findings, there is a need for a clearer focus on matching questions which then focus upon well-specified treatments that have clear goals with specific patient populations.
16.2. Clinical review protocol (multi-modal treatment)
- Thus, here, too, it’s important to be cognizant of the signs of PTSD in patients with AUD, and vice versa.
- First, the sources of the effectiveness data used in the model were not explicitly described by the authors, who suggested that the data were taken from a methodologically diverse selection of trials, thus suggesting a high level of heterogeneity.
- Identifying and interpreting equivalence of benefit across therapies remains a live debate (for example, Ahn & Wampold, 2001; Stiles et al., 2006) but should also include a consideration of cost effectiveness as well as clinical efficacy (NICE, 2008a).
And there are a few approaches that can identify and combat drinking at an early stage. People can focus on education and support, such as through Alcoholics Anonymous, or take on a sobriety challenge. People can learn mindfulness; rather than trying to soothe uncomfortable feelings with alcohol, mindfulness encourages techniques such as breathing, visualization, and meditation.
- Non-pharmacological treatments are an important therapeutic option for people with alcohol-related problems.
- The study reported that the control group (unstructured discussion) drank significantly less alcohol at 18-month follow-up than the group receiving coping skills.
- This is particularly apparent in alcohol dependence developing later in life following, for example, a bereavement or job loss.
- (See Core article on neuroscience.) As described in the sections to follow, a timeline of your patient’s symptoms is a key tool for a differential diagnosis.
Second, there is the varied composition of the workforce with a range of training experiences, not all of which include training in the delivery of psychological interventions. Furthermore, as noted by Tober and colleagues (2005), training programmes for the management of substance misuse vary widely in content with no consensus on methods to provide and evaluate such training or to maintain its effects. Supervision of psychological interventions is equally varied and not always available. Finally, there is a tendency in the field to eclecticism fuelled by the perception that all approaches are either equally valid or equally ineffective. Psychological approaches vary depending on the theoretical models underpinning them.
Support links
Related NICE guidance and evidence
