Alcoholism is a disorder that can be characterized both by the excessive consumption of this substance at specific times and by the physical and psychological dependence of the drink. If maintained for the long term, alcoholism can have very serious consequences for life, such as suicide by depression or Wernicke-Korsakoff syndrome.
In this article we will describe the major psychological treatment programs for alcoholism, By focusing on those whose effectiveness has been demonstrated by the conduct of scientific research.
Effective psychological treatments for alcoholism
As we will see, the psychological therapies which have been developed to reduce or eliminate the consumption of alcohol mainly use techniques based on classical conditioning, such as the extinction of physiological signs of “desire”, and in the operator, such as the development of alternatives. reinforcements that replace that provided by alcohol.
Often these programs they are combined with drugs to enable or promote change. These include anti-anxiety drugs such as benzodiazepines and substances which cause aversive effects when combined with alcohol, such as disulfiram (better known by its trade name “Antabus”).
1. Community strengthening approach
In 1973, Hunt and Azrin developed the community strengthening approach for the treatment of severe alcoholism. Its effectiveness has also been applied to other types of drug addiction and has been shown to be particularly useful in the case of heroin when combined with emergency management.
The two main objectives of this treatment, which are closely related to each other, are reduce alcohol consumption and develop alternative habits that reinforce sobriety. In this way, positive reinforcement is used as a key tool; The same goes for the motivation for change.
The community strengthening approach relies on techniques such as training in communication skills (focusing mainly on the immediate environment), practicing healthy leisure activities, acquiring skills that facilitate job hunting and improving resistance to the temptation to drink thanks to a secret conscience.
As with the other treatments that we will mention, the community strengthening approach generally associated with the use of disulfiram in order to strengthen the therapeutic effects of cognitive-behavioral techniques. This drug causes unpleasant reactions when interacting with alcohol, such as nausea and anxiety.
2. Family and couple cognitive behavioral therapy
Family and couple therapies for alcoholism are multi-component programs with the basic objectives of better communication between the patient and his relatives, As well as the increase in positive reinforcement obtained by interaction with them.
Theoretically, this type of treatment suggests that the bad relationship with the family, and especially with the partner, promotes alcohol consumption; on the contrary, if the interaction is positive it can be a key source of reinforcement with the potential to modify the behavior of the person drinking. In addition, the family can support abstinence.
An example is the community strengthening and family training program or CRAFT (“Community strengthening and family training”) developed by Millar, Meyers and Tosigan in 1999. This therapy uses motivational interviews, training in contingency management, identification of risky situations and leisure activities with the family.
3. Training in social and adaptation skills
Programs that fall into this category aim to develop social and coping skills for risky drinking situations. It is therefore based on the formation of such strategies and their implementation in contexts which generally trigger alcohol consumption behaviors.
Since there is a large number of vocational training-oriented alcoholism treatments, the effectiveness of these programs may vary depending on the specific case. The intervention developed by Langley et al, called “coping skills for drinking behavior,” is a notable example.
4. Relapse prevention program
Although a few decades ago relapse prevention was seen as an additional module that could improve the therapeutic effects of other programs, today relapse prevention is itself a different category of treatment and its effectiveness. has been demonstrated even when applied independently.
The Marlatt and Gordon model is particularly well known. These authors stress the gradual nature of recovery; in this sense, his therapy teaches us to distinguish between occasional “falls” and “relapses”, which are of a more chronic nature. Again, training in coping skills for risky situations is a central aspect.
5. Signal exposure therapy
Follow-up or signal exposure therapy, abbreviated as “Cue Exposure Therapy”, has been applied with moderately effective results in cases of alcohol abuse, as well as in cessation programs. to smoke.
It focuses on reducing the responsiveness of the dependent person environmental signals that elicit conditioned “thirst” responses or desire for consumption. For this, exposure and response prevention procedures are used in the presence of antecedent stimuli in order to quench the psychophysiological reactions associated with the urge. One of the advantages of this method is that it gets to the root of the desire for addiction.
6. Self-control or controlled consumption programs
These treatments are applied when the person wishes reduce the intensity of your alcohol consumption without giving up completely. It is usually carried out in young people with an adequate level of social and financial support, as well as in more serious cases where total abstinence programs have failed.
Therapy usually begins with goal setting, performing a functional analysis of alcohol use situations, and self-recording of these behaviors. Thereafter, there is a period of abstinence (about a month) which is combined with the training of alternative coping skills, which are also useful for relapse prevention.
7. Contingency management based on reinforcement
Contingency management is a therapeutic approach based on the operant conditioning paradigm. Alcohol consumption is conceived as a behavior operating in the maintenance of the influence of reinforcers such as the effects of the drink itself or the social interaction situations with which addiction is associated.
These programs consist of replace inappropriate reinforcements with adaptive and tangible incentivesMainly items for personal use such as tickets to film screenings or other shows. These rewards are obtained from demonstrating that abstinence has been maintained, often through urine tests.