Psychosocial or Behavioral Therapies

The American Psychiatric Association (APA) guidelines for the treatment of addictive disorders involving alcohol, cocaine, and opioids (1995) were developed based on intensive literature reviews and input from many clinical and research experts. These guidelines recommend psychosocial treatment as an essential element of treatment for addiction. As with treatment setting, however, the specific type of therapy needed varies and must take into account a variety of patient factors. The APA guidelines specifically endorse therapies that address cognitive and behavioral approaches, psychodynamic and interpersonal therapies, group and family therapies, and participation in self-help groups (e.g., AA).

A well-known literature review of psychosocial and other treatments for alcohol problems conducted by Hester in 1994 identified several approaches that have ''good evidence of effectiveness." These included behavioral marital therapy, brief interventions, community reinforcement approach, self-control training, social skills training, and stress management. These are described briefly below.

Behavioral marital therapy emphasizes improving communication and problem solving between spouses and increasing praise and other positive interactions.

Brief interventions, which may be provided by addiction specialists but are often provided by internists or other health care professionals in primary care settings, generally consist of the professional providing objective information about the patient's individual drinking problem, giving the patient the opportunity to take responsibility for changing his or her behavior, and one or two counseling sessions. These have been found in a number of studies to be as effective as longer-term inpatient and outpatient treatment (Bien et al., 1993; Hester, 1994; Kahan et al., 1995). It is important to note that these interventions often target at-risk individuals, do not necessarily result in total abstinence, and may vary in effectiveness in different populations (e.g., gender or different severity of drinking).

The Community Reinforcement Approach consists of a patient and therapist developing several strategies to address individual problems associated with alcohol abuse, such as taking Antabuse® (disulfiram), a drug that prevents drinking by causing an extremely unpleasant and potentially life-threatening physical reaction to alcohol; behavior-oriented marital counseling; and participation in healthy leisure time activities.

Self-control training teaches patients self-management skills that can be used to decrease or prevent alcohol consumption. These include setting goals, self-monitoring, rewarding oneself when goals are met, and learning new coping skills.

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