______________________________________________________________ Alcohol and Alcohol Use Disorder
MOTIVATIONS FOR CHANGE
Patients are more likely to seek treatment if: • There are few actual or perceived barriers to treatment. • The expectation is that treatment will work and that it is a positive change. • They think they need help. • They “hit bottom.” • They no longer feel in control. • They cannot change on their own. • They want to change their behavior. • They perceive that treatment will suit their needs. • There is social pressure to stop drinking or get treatment. • They experience notable or multiple problems (e.g., black-outs, DUI arrest, etc.). Patients are less likely to seek treatment if: • There are numerous real or perceived barriers to treatment. • They fear being unable to cope without alcohol. • There are negative perceptions of treatment or changing behavior. • They think that treatment will not work. • There is fear of withdrawal. • They think they will be stigmatized. • They believe that they will be unable to stop. • They fear failure. • They perceive continued use as positive.
Source: [305]
Table 2
PHASES OF TREATMENT To understand treatment and make the right treatment choices, it helps to have an overview. Treatment should be seen as having three phases. • Phase 1: Assessment and evaluation of disease symptoms and accompanying life problems including co-occurring medical and psychiatric conditions utilizing ASAM Criteria, detoxification (withdrawal management), acute stabilization of comorbid conditions, making treatment choices, and developing a plan • Phase 2: Residential treatment or therapeutic communities, intensive and regular outpatient treatment, medications to help with alcohol craving and to discourage alcohol use, medications to treat concurrent psychiatric illnesses, treatment of concurrent medical conditions, trauma and family therapy, 12-step programs, other self-help and mutual-help groups • Phase 3: Maintaining sobriety and relapse prevention with ongoing outpatient treatment as needed, facilitated group meetings, contingency management, 12-step programs, other self-help and mutual-help groups
the risks of continued alcohol consumption and benefits of decreasing or eliminating alcohol consumption. Physicians can help motivate the patient to become ready for treatment if the patient appears ready to change. Is the patient ready to change? The role of motivation is an important part of changing behavior. Table 2 summarizes the “pros” and “cons” of changing [305]. The Stages of Change Model is also useful in determining where a patient is in the process of change [306]. The stages of change include: • Precontemplation • Contemplation • Preparation • Action • Maintenance • Relapse TREATMENT Treatment works. People who make the decision to stop drinking will be able to find the treatment and support they need to quit, remain sober, and regain their lives. However, as with treatment for any other disease, it is important to have a good idea of the options available in order to make informed choices.
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MDMI1826
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