Combining pharmacological antagonists and behavioural psychotherapy in treating addictions: why it is effective but unpopular

Article Abstract:

Citing a recently published review of randomized controlled trials of treatments for alcohol abuse, the author notes that only three treatments have been convincingly shown to be effective, while such commonly recommended treatment modalities as Alcoholics Anonymous (AA) have been shown to confer no specific benefit. The most effective and least time-consuming of these treatments (from the therapist's point of view) is disulfiram, also known as Antabuse. Antabuse works by providing a physiological deterrent to alcohol consumption; it induces nausea and vomiting if alcohol is consumed and is, therefore, classified as response-prevention therapy (in much the same way as a driver will not speed if he knows a police car is nearby), rather than aversion therapy. However, Antabuse is a prescription medication and requires supervision to be effective. The benefits of disulfiram are discussed, including its ability to be used in vivo (in everyday life circumstances) and the value of the resulting abstinence in enabling addicted individuals to learn better ways of coping. Abstinence from alcohol improves the chances of changing self-image, especially when combined with behavioral psychotherapies and social support. Disulfiram is likened to naltrexone, which has been used for years in the treatment of opiate addiction, and the potential effectiveness of response-prevention therapy for treating other addictions is discussed. Despite the clear and scientifically demonstrable benefits of disulfiram, it is not widely used in alcohol abuse treatment programs. The author speculates that this reluctance stems from AA itself, as well as from well-motivated, but perhaps resentful, people working in the addiction treatment field who are medically unqualified to prescribe, and who either do not fully understand the techniques and uses response-prevention therapy, or else see medical solutions as threatening to vested interests. In the author's opinion, such lack of acceptance is regrettable, as disulfiram is effective in promoting life skills among people who suffer from alcohol addiction. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Physiological aspects, Drug therapy, Drug addicts, Drug abusers, Disulfiram

---

Group therapeutic factors on an alcohol in-patient unit

Article Abstract:

While it may be useful for therapists involved in the treatment of alcoholics to determine which aspects of a therapeutic program might be most effective, perhaps equally valid are the feelings of the patients themselves. To determine which factors were most important to patients undergoing treatment for alcoholism, 70 patients admitted to inpatient therapy at an alcohol dependence treatment center were surveyed before, during and after a two-part program. The program consisted of an two-week introductory phase, which accompanied the detoxification process, followed by a six-week treatment program in which each patient was involved in several groups addressing different psychological and social aspects of their problem. Patients attended Alcoholics Anonymous meetings, occupational therapy, anxiety management, and focused group therapy sessions. To assess whether the therapeutic program changed the patients' attitudes, a 60-question survey concerning 12 therapeutic factors was administered at four different points. The results of questionnaires completed by 70 patients were evaluated. Factors described on the questionnaires included altruism, cohesiveness (a feeling of togetherness), interpersonal learning, self-understanding, and awareness of personal responsibility for one's own life (existential issues). The factors identified as most important by a majority of the group were self-understanding, existential issues, and cohesiveness. Identification with other group members, guidance by means of advice, family re-enactment and instillation of hope were considered the least helpful. There was some agreement between the therapists' expectations regarding these factors and the patients' own rankings. It is suggested that, if patients who perceive therapy as useful tend to have good outcomes, perhaps more attention should be paid to discussing existential issues and enhancing self-understanding and cohesiveness. Intensive education regarding alcohol dependence may not be particularly useful as a therapeutic technique for certain patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Surveys, Alcoholism counseling

---

Alcoholism: a follow-up study of participants in an alcohol treatment programme

Article Abstract:

Alcoholic patients (92 men and 20 women with an average age of 41 years) in a one-month residential treatment program were followed-up for one year so that treatment outcome could be assessed. The patients tended to be from poor and lower middle-class families, and to be highly alcohol-dependent. The program was not based on the medical model (i.e., did not view alcoholism as a disease), and did not require patients to commit to a goal of total abstinence. Treatment included group therapy, counseling, training in social skills, and relaxation techniques. At intake, patients were assessed for social stability, drinking behavior, neuroticism, self-esteem, satisfaction with life, employment history, and living circumstances. All assessments were repeated at six months and at one year. Eight patients dropped out of the study before six months, and another 13 dropped out before one year had elapsed. At six months, 37 percent of the remaining patients, and at one year, 53 percent of the patients were either abstinent, able to control their drinking, or showed some improvement in drinking status. This 'successful' group demonstrated significant improvements on every social and psychological measure. Since the program evaluation did not include a control or comparison group, the possibility exists that the patients who benefitted from the program may have had equal or better results from another type of treatment approach. (Consumer Summary produced by Reliance Medical Information, Inc.)

Substance abuse, Substance abuse treatment

Similar abstracts:

• Abstracts: Histologic chorioamnionitis and preterm delivery in different patient populations. The fingerprint, a false-positive fern test
• Abstracts: A multicentre study of coagulation and haemostatic variables during oral contraception: variations with four formulations
• Abstracts: Comparison of standard and low serum levels of lithium for maintenance treatment of bipolar disorder. Prospective study of tardive dyskinesia incidence in the elderly
• Abstracts: A common cytogenetic abnormality and DNA content alterations in dedifferentiated chondrosarcoma. Favorable cytogenetic abnormalities in secondary leukemia
• Abstracts: Multifactorial facial pain - differential diagnosis: a case report

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.