Alcohol Treatment: Behavioral Approaches

views updated

Alcohol Treatment: Behavioral Approaches

Imagine that every time you see a red traffic light you get angry. You begin to grit your teeth, curse, and generally become abusive toward everyone riding in the car with you. You know that this response will not change the fact that you will have to wait in traffic until the light changes. And getting angry with other people will not change anything, except that you may lose a few friends and develop an ulcer or high blood pressure in the process. To change this response, or any other kind of unhealthy, undesirable behavior, you might use behavioral therapy . For many years, behavioral treatments or therapy has been used to help people who abuse alcohol. In the nineteenth century, Benjamin Rush, often thought of as the founder of American psychiatry, described a variety of psychological cures for long-term drunkenness. Modern research studies show that behavioral treatments can be effective for alcohol problems. Also, combining behavioral and prescription-drug treatment often produces good results.

Why Use Behavioral Approaches?

The success or failure of any type of treatment is measured by whether and how much a person continues to drink. Many psychological factors influence a person's drinking behavior: beliefs and expectations, the examples of friends and family, the customs for drinking within one's society or social circle, emotions, family dynamics, and the positive and negative consequences of drinking. Treatments that address these factors directly, then, might be expected to help a person overcome alcohol problems. In fact, dozens of studies since the 1960s show the long-term success of behavioral treatments. Typically, they are more effective than treatment using medications.

Behavioral treatment can also prevent relapse, or a return to drinking behavior after treatment. Relapse is less likely when people have a stable relationship, a job, the support of friends, personal coping skills, and self-confidence. Behavioral methods can anticipate the challenges people will face in these aspects of their lives and give them the skills needed to cope.

Goals and Methods

Sometimes the goal of behavioral treatment is total and permanent abstinence: giving up drinking for the rest of a person's lifetime. Sometimes the goal is to reduce drinking to a level that will no longer threaten a person's physical or emotional health. The goals of treatment may also include other important dimensions besides drinking—to get and hold a job, to have a happier marriage and family life, to learn how to deal with anger, and to find new ways of having fun that do not involve drinking. To reach these goals, behavioral therapy makes use of several methods.

Teaching New Skills. People who drink often do so in an attempt to cope with their problems. People may drink to relax or loosen up, to get to sleep, to feel better, to enhance sexuality, to build courage, or to forget painful memories. But alcohol rarely helps people to deal with emotional and relationship problems. In the long run, it often makes such problems worse. When a person relies on drinking to cope, that person is termed psychologically dependent on alcohol.

One behavioral approach, sometimes called broad-spectrum treatment, directly addresses this problem by teaching people new skills to cope with their problems. In social-skills training, people learn how to express their feelings appropriately, ask for things they are uncomfortable about, make their emotional needs known in their relationships, refuse drinks, and carry on rewarding conversations without drinking. Stress-management training teaches people how to relax and deal with stressful life situations without using alcohol or drugs.

Self-Control Training. Self-control training teaches people how to manage their own behavior. They learn how to do the following:

set clear goals for behavior change
keep records of their drinking behavior and urges to drink
reward themselves for progress toward goals
make changes in the way they drink
identify high-risk situations where the temptation to drink is strong
learn strategies for coping with those high-risk situations

Self-control training is often used to help people reduce their drinking to a moderate level that does not cause problems. But it can also be used when total abstinence is the goal. This method is particularly helpful for less severe problem drinkers. It is also more effective than educational lectures for drunk-driving offenders.

Marital Therapy. Problem drinking commonly affects the drinker's partner in negative ways. Treatment that involves the husband or wife of a problem drinker can help both partners. A husband or wife

[Image not available for copyright reasons]

can help to clarify problems and suggest ways that the drinker can change the problem behavior. Marital distress can be an important factor in problem drinking, so direct treatment of marital problems can help to prevent relapse. Research indicates that problem drinkers treated together with a spouse do better than those treated individually.

Aversion Therapy. In another treatment method, drinking is paired with unpleasant images and experiences. For example, the taste of alcohol may be paired with foul odors or with unpleasant experiences in the person's imagination. Whenever the person has a drink, he or she will be reminded of those unpleasant images and sensations. Eventually the person loses the desire for alcohol and drinks less. The person develops an aversion to drinking, which means that the taste and even the thought of alcohol become unpleasant. Aversion therapy may be especially useful for drinkers who continue to feel a strong craving for alcohol.

Psychotherapy. Many kinds of psychotherapy have been tried with alcohol abusers. The goal of psychotherapy is generally to gain insight into the unconscious causes of drinking. This type of therapy has been largely unsuccessful. Group psychotherapy also has a poor track record in the treatment of problem drinking.

Changing the Environment. Yet another behavioral approach aims to change the motivations for drinking by changing the environment of drinking. The goal here is to eliminate consequences of drinking that a person might find rewarding. For example, if a person often visits the same bar and drinks to feel part of the crowd there, a counselor might recommend that the person find a new place or a new way to socialize. The person is encouraged to find alternative ways to have rewarding experiences.

Brief Motivational Counseling. Researchers have discovered that some treatments consisting of only one to three sessions were as effective as longer and more complex treatment regimens. In this approach, a doctor or therapist makes a thorough assessment of a patient's drinking problem and presents feedback of findings to the patient. The doctor then offers clear advice to change, stressing the importance of personal responsibility and optimism . The key seems to be to trigger a decision and commitment to change. Through this brief and simple process, problem drinkers acquire the motivation to change their drinking behavior. People frequently proceed to change their drinking on their own without further professional help. In fact, the personal motivation to change is so important that other treatment approaches that skip over this first step may fail.

Conclusion

It is unlikely that research will ever identify a single superior treatment for alcohol abuse. Drinking and alcohol-related problems are far too complex. Yet the number of approaches that have been successful is a cause for real optimism. The chances that an individual will find an effective approach are good. The most successful treatment strategies will match the method to the individual based on his or her characteristics.

ALCOHOL IN FICTION

Drug and alcohol abuse can turn academic and athletic success into failure. In his novel, Imitate the Tiger (1996), Jan Cheripko wrote about a young adult in a detoxification program (a recovery program), and in a series of flashbacks shows how alcohol turned a football star into a dropout and his long road back.

Drugs, Alcohol, and Tobacco: Learning About Addictive Behavior