______________________________________________________________ Alcohol and Alcohol Use Disorder
the preponderance of evidence supports the effectiveness of 12-step program involvement in sustaining abstinence [10]. Stable and long-term abstinence was associated with living longer, better mental health, better marriages, being more responsible parents, and being successful employees. A brain imaging study by Yale researchers showed that those diagnosed with alcohol use disorder showed disruptions of activity between the ventromedial prefrontal cortex and striatum, a brain network linked to decision making [318]. Time is necessary for re-learning how to be sober but also for brain recovery. The more recent the last drink, the more severe the disruption, and the more likely the individual will relapse to drinking. The Yale researchers also found that the severity of disruption between these brain regions recovers very slowly, day after day, gradually over time. They conclude the longer subjects with alcohol use disorder abstain from alcohol, the better. The number of days of alcohol abstinence at treatment initiation significantly affected functional disruption of the prefrontal-striatal responses to alcohol cues in patients with alcohol use disorder and brain imaging abnormalities [318]. COUNSELING Cognitive-behavioral therapies (CBTs) are among the most frequently evaluated approaches used to treat substance use disorders [319; 320]. CBTs have been shown to be effective in several clinical trials of substance users [321]. Characteristics of CBTs include: • Social learning and behavioral theories of drug abuse • An approach summarized as “recognize, avoid, and cope” • Organization built around a functional analysis of substance use (i.e., understanding substance use with respect to its antecedents and consequences) • Skill training focused on strategies for coping with craving, fostering motivation to change, managing thoughts about drugs, developing problem-solving skills, planning for and managing high-risk situations, and cultivating drug refusal skills • Basic principles of CBTs are that [322; 323]: • Basic skills should be mastered before more complex ones are given. • Material presented by the therapist should be matched to patient needs. • Repetition fosters the development of skills. • Practice is needed for mastery of skills. • The patient is an active participant in treatment. • Skills taught are general enough to be applied to a variety of problem areas.
Structured behavior therapy techniques can be effective components of alcohol use disorder treatment. Contingent incentive procedures are designed to enhance a patient’s motivation to meet treatment goals by offering concrete rewards for specific performance outcomes. Behavioral therapy techniques are often part of CBT. In this approach, substance use is believed to develop from changes in behavior and a reduction in opportunities for reinforcement of positive experience. The goal is to increase the person’s engagement in positive or socially reinforcing activities. Techniques such as having patients complete a schedule of weekly activities, engaging in homework to learn new skills, role-playing, and behavior modification are used. Activity, exercise, and scheduling are major components of this approach based on the following: • Drug abuse patients need motivation and skills to succeed in stopping drug use. • Research has shown that drug abuse behavior can be reduced by offering contingent incentives for abstinence. • The most striking successes have come from positive reinforcement programs that provide contingent incentives for abstinence using money- based vouchers as rewards. • Research provides examples, but treatment
providers may need to be creative in discovering reinforcers that can be used for contingency management in their own clinical settings.
Family therapy is a highly effective treatment for alcohol use disorder, especially in adolescents. While most treatments emphasize the individual as the target of intervention, the defining characteristic of family therapy is the transformation of family interactions. Repetitive patterns of family interactions are the focus of treatment. Changing these patterns results in diminished antisocial behavior including alcohol abuse. Family therapy can work with a broad range of family and social network populations. Family therapy approaches have developed specific interventions for engaging and keeping reluctant, unmotivated adolescents and family members in treatment. MEDICATIONS USED TO TREAT ALCOHOL USE DISORDER Alcohol drinking is an immensely complex human behavior, but it has been modeled in laboratory animals. Two similar strains of alcoholic rats, the alcohol-preferring (P) rats and the high-alcohol-drinking (HAD) rats, have been successfully used to study alcohol use disorders. Like patients with DSM-5-TR qualifying alcohol use disorders, these rats self-administer alcohol, show tolerance, lose control over alcohol, and spend a lot of time. They also have cravings and physical stigmata of withdrawal, providing psychopharmacologic researchers with excellent face validity with animal models. Models have helped us develop anti-withdrawal, anti-craving, and harm-reducing treatments.
75
MDMI1826
Powered by FlippingBook