Broadening the Base of Treatment for Alcohol Problems (1990) / Chapter Skim
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Chapter 6--Is treatment necessary?
Chapter 6--Is treatment necessary?
Pages 152-162
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From page 152... ...
When extravagantly praised for his therapeutic efforts on the battlefield, Ambroise Pare (1517-1590) , the father of modern surgery, commented: "I dressed the wound; God healed it." So powerful is the tendency for human problems to revert to normal unaided by intentional therapeutics that special means must be employed in therapeutic evaluations to 152
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From page 153... ...
Most contemporary evidence for improvement without formal treatment comes from studies of alcohol problems in the general population. By definition, it is not possible to study the phenomenon in a population undergoing formal treatment.
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From page 154... ...
. A summary statement on age, sex, and improvement without formal treatment, drawn from all currently available information, is that there is a higher prevalence of problems in youth, but erratic and non-chronic with a 50-60 percent chance of remission both in the long and short term among men and more than 70 percent chance of remission among women; in middle age, a much lower prevalence, but chronic with a 30-40 percent chance of remission among men and about a 30 percent chance of remission among women; in older age, a great deal lower prevalence of problems, which were more likely chronic, with a 60-80 percent chance of remission among men and a 50-60 percent chance of remission among women.
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From page 155... ...
Potentially harmful alcohol treatment interventions include the use of vigorous negative confrontation techniques with individuals who lack the means to cope with the confrontation in a constructive manner (Annie and Chan, 1983; Miller and Sovereign, 1985~. Focusing on an individual's drinking problem to the exclusion of other disorders that require direct treatment (e.g., coexisting psychiatric disorders)
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From page 156... ...
Without denying that drunken driving is a critical social problem, it must nevertheless be emphasized that those persons who drink and drive constitute a group that overlaps with but is not identical to the group of individuals who have serious alcohol problems (Donovan et al., 1983; Vingilis, 1983; Wilson and Jonah, 1985; Perrine, 1986~. Other important sources of referral to treatment under coercion include civil commitment, diversion from the criminal justice system for public drunkenness and crimes other than DWI offenses in which alcohol has played a role, workplace referrals Unconstructive coercions)
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From page 157... ...
, yet coerced treatment characteristically involves much more than a minimal intervention. Coerced treatment also presents particularly difficult ethical and even legal issues (cf.
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From page 158... ...
Another therapeutic approach has been developed that complements the community reinforcement approach. Rather than dealing with those naturally occurring factors that facilitate the remission of alcohol problems, this approach deals with the naturally occurring factors that make them worse.
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From page 159... ...
Whether from the community reinforcement approach or the relapse prevention approach, or from other approaches that are yet to be developed, an important contribution to the treatment of alcohol problems may arise (along the lines suggested by Ambroise Pare) from encouraging the individual to come increasingly under the sway of naturally occurring factors that will facilitate the resolution of his or her problem.
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From page 160... ...
1982. Alcoholism treatment by disulfiram and community reinforcement therapy.
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From page 161... ...
1988. A longitudinal analysis of unaided smoking cessation.
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From page 162... ...
International Journal of Addictions 2:1-23. State of Conneetieut Drug and Aleohol Abuse Criminal Justice Commission.
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