In addition, cognitive behavioural therapies were found to be more effective at maintaining abstinence/light days when assessed up to 18-month follow-up (based on data by CONNORS2001). No significant difference was observed between groups in reducing heavy drinking episodes and the amount of alcohol consumed both post-treatment and up to 18-month follow-up. A single study outcome (ERIKSEN1986B) favoured coping skills over counselling in reducing the amount of alcohol consumed, but, again, this single study was not reflective of other analyses with similar variables.
Effectiveness of Cognitive-Behavioral Approaches
The risks of developing these diseases are related to the amount of alcohol consumed over time, with different diseases having different levels of risk. For example, the risk of developing breast cancer increases in a linear way, in which even small amounts of alcohol increase risk. With alcoholic liver disease the risk is curvilinear, with harm increasing more steeply with increasing alcohol consumption.
4.4. Psychiatric comorbidity
Research for the use of acupuncture in alcohol misuse is rather more limited and to date there are only two systematic reviews of acupuncture for alcohol dependence (Cho & Whang, 2009; Kunz et al., 2007). Addiction-specific auricular acupuncture involves inserting five small needles on each ear at points regarded to be specific to chemical dependence (known as ‘shen men’, ‘sympathetic’, ‘kidney’, ‘liver’ and ‘lung’) (Smith & Khan, 1988; Wen, 1979). A small effect was observed favouring other therapies (that is, psychoeducational) over multi-modal treatment physiological dependence on alcohol in maintaining abstinence when assessed post-treatment. In addition, other therapies (that is, counselling) were significantly better than multi-modal treatment in reducing the number of participants who had lapsed (small effect size). However, this was not the case at 12-month follow-up because no difference between groups was observed. Furthermore, no difference was observed between multi-modal treatment and other therapies in reducing the number of days drinking, the quantity of alcohol consumed and attrition up to 12-month follow-up.
- Its chief goal is to develop a highly reinforcing sober lifestyle that clients will seek to perpetuate, thus addressing not only the drinking problem but also the negative lifestyle factors likely to undermine recovery.
- In the antisocial personality disorder guideline, the meta-analysis of 11 trials assessed the effectiveness of family interventions.
- Alcohol consumption was also linked to a greater risk for stroke, coronary disease, heart failure, and fatally high blood pressure.
- In extrapolating from these datasets the GDG was cautious, recognising that as new evidence emerges the recommendations in this guideline will need revision.
- No difference between groups was observed in attrition rates post-treatment or at 6-month follow-up.
7.3. Studies considered for review33
There are many organized programs that provide the support of peers, usually through frequent meetings. Alcoholics Anonymous is one example; it offers a structured 12-step path toward recovery with a community of support from those who have dealt with similar challenges. In some cases, the first step in treating alcohol use disorder is detoxification—experiencing withdrawal in a safe setting with medical professionals.
Those who received more intensive couples therapy were more likely to be retained for follow-up assessment at 12 months than brief couples therapy (small effect size). The review evidence indicated that contingency management (with network support) was more effective at maintaining abstinence than control post-treatment (large effect size) and up to 15-month follow-up (medium effect size). However, no significant differences were observed between contingency management with network support and control for follow-up periods greater than 15 months.
11. CONTINGENCY MANAGEMENT
Despite limited evidence a reasonably clear picture emerged about the effectiveness of interventions to promote abstinence and prevent relapse in children and young people. There was some evidence for individual interventions such as CBT and less so for MET. There was stronger evidence for the use of multicomponent interventions such as multisystemic therapy, functional family therapy, brief strategic family theraphy, and multi-dimensional family therapy, but little evidence to determine whether one of the interventions had any advantage over the others. The GDG therefore decided that both types of intervention should be made available with CBT reserved for cases where comorbidity is either not present or of little significance; where comorbidity is present, multicomponent interventions should be offered.
9.3. Studies considered for review
MONTI1993 investigated cue exposure with coping skills against control (unspecified treatment as usual and daily cravings monitoring). ROSENBLUM2005B assessed relapse prevention with MET versus control (information and referral only). Information about the databases searched and the inclusion/exclusion criteria used for this Section of the guideline can be found in Chapter 3 (further information about the search for health economic evidence can be found in Section 6.21).
Alcohol use disorder is a problematic pattern of alcohol use that leads to distress in one’s daily life, according to the DSM-5. Experiencing at least two symptoms throughout the course of a year merits a diagnosis, from mild to moderate to severe. Many people with alcohol use disorder hesitate to get treatment because they don’t recognize that they have a problem. An intervention from loved ones can help some people recognize and accept that they need professional help. If you’re concerned about someone who drinks too much, ask a professional experienced in alcohol treatment for advice on how to approach that person. Adelstein and colleagues (1984) found that cirrhosis mortality rates are higher than the national average for men from the Asian subcontinent and Ireland, but lower than average for men of African–Caribbean origin.
- In developing this guideline the GDG drew on a previous review of psychological interventions for carers that had been undertaken for the NICE guideline on psychosocial interventions for drug misuse (NCCMH, 2008).
- Cognitive-behavioral approaches to alcoholism were developed from behavior change principles that have been applied to a wide range of disorders, and their application to alcohol problems has been guided by empirical research findings (George and Marlatt 1983; Abrams and Niaura 1987).
- It should be noted that some trials included in analyses were three- or four-arm trials.
- Anxiety disorders are the most prevalent psychiatric disorders in the United States.
- Adolescents are often victimized and even die from counterfeit drugs that are really fentanyl.
- Three trials relating to clinical evidence met the eligibility criteria set by the GDG, providing data on 355 participants.
- This question should be answered using a randomised controlled design that reports short- and medium-term outcomes (including cost-effectiveness outcomes) of at least 12 months’ duration.
- These data were used to estimate how patients would progress between specific drinking states (problem, moderate or dependent) within the model.
- These individual differences affect drinking behaviour and the potential for alcohol-related harm and alcohol dependence.
The evidence for pharmacological treatments (for example, acamprosate or naltrexone) and psychological treatments (for example, cognitive behavioural therapies and social network and environment-based therapies) is modest at best and the treatments are not effective for everyone. Anecdotal evidence suggests that acupuncture, like psychological treatment, is valued by service users both in alcohol misuse and substance misuse services (although the evidence base for effectiveness is weak). The results of this study will have important implications for increased treatment choice in the NHS for people who misuse alcohol. A limited number of studies, specifically on alcohol-focused interventions, have been undertaken for children and young people. However, a number of studies have considered the treatment of conduct disorder in the presence of drug or alcohol misuse. Individual- and group-based therapies and multicomponent interventions used in the treatment of alcohol dependence and harmful alcohol use in children and young people were considered in the review of the evidence.
5.1. Aim of review
This discrepancy highlights the obstacles in addiction care, such as that clinicians may be unaware of the signs of substance use or not want to alienate patients by bringing it up, and patients may not want to reveal their substance use, among other hurdles. The best approach typically involves working with a professional to either gradually taper off use or stop use altogether while under supervision to manage withdrawal symptoms. If your pattern of drinking results in repeated significant distress and problems functioning in your daily life, you likely have alcohol use disorder.
