Research shows that preventing relapse to substances following an initial abstinence period heavily rests on the individual’s successful reintegration to their environment without using substances. This can be difficult when things in one’s old familiar environment, including people, places, and things, have previously contributed to the problem. For example, a person with an alcohol addiction may have drunk in the past to cope with interpersonal conflict with her spouse. Thus, when she returns from rehab, it is critical that she has been made aware of this tendency before she is to enter similar situations again. It is ideal that she learns ways to regulate her emotions during conflicts without alcohol. It is also important that she develop an alternative “game plan” when communicating with her husband.
Formal psychotherapy with a trained mental health professional (clinical psychologist, licensed counseling psychologist, social worker) will involve strategies of behavioral, cognitive (talk therapy), cognitive-behavioral nature. These treatments focus on the patient’s addiction, drawing awareness around patient’s patterns and triggers for use, while teaching skills for the future in dealing with stressful or difficult situations. Many psychological treatments provide support and training to family, friends, or spouse.
Evidence-Based Interventions for Alcohol Use Disorder
EB interventions are those that have been developed and subjected to scientific evaluation in randomized clinical trials by doctorate-level professionals. Interventions that receive at least moderate support are regarded as Evidence-Based Treatments (EBTs). Described below are those strategies deemed as EBTs for alcohol use disorders, specifically. Hallmark to these strategies are therapy modules that teach the patient new ways to cope with old situations and aim to improve communication and cooperation in relationships. Other treatments have been recommended for addictive behaviors in general, which may have promise for alcohol use reduction as well. Read more about these treatments on the American Psychological Association’s (APA) website.
- Moderate Drinking (MD) is a patient-tailored approach to monitoring alcohol intake. MD is provided through a web application and the treatment plan is governed by the goals of the patient. Concept for MD is based on principles of behavioral self-control training. The APA describes MD as a, “structured yet interactive, individualized program that guides users to set goals, self monitor their behavior, and get detailed feedback on their progress on the basis of their input.”
- Behavioral Couples Therapy for Alcohol use Disorders (ABCT) has received strong research support. It is an outpatient treatment which involves inclusion of the intimate partner of the patient in weekly sessions spanning 12-20 weeks of therapy. ABCT takes a cognitive-behavioral therapy approach to couples therapy, wherein the ABCT therapist works alongside the couple to target the partner’s behaviors that cue or reinforce the client’s drinking. ABCT also aims to strengthen the partner’s support of the client’s efforts to modify their behaviors through positive reinforcement; increasing frequency and quality of positive couple interactions through activities designed to improve communication; and instilling alcohol-alternative coping skills so as to promote the patient’s abstinence.
- Contingency management (CM) has received modest research support for treatment of alcohol use disorders. They are one of the earliest forms of treatment established in the field. CM programs evolved from behavioral research in animals. Behaviorists consider any behavior to be a result of reinforcement learning. For example, any behavior that is rewarded will increase in frequency. CM is a structured form of behavioral therapy, involving frequent “checks” on the patient’s alcohol status. If the patient reaches their pre-established target goal at a given check point, with goals ranging from total abstinence status or reduction of use to a specific amount, they are given a monetary reward (prizes can range from $1 to $100). Frequent monitoring coupled with rewards incentivize patients’ future success. In modern day, CM is typically provided as a supplement to other psychosocial treatments or 12-step (A.A.) programs.
It is important to enhance effectiveness of interventions for difficult-to-treat problems, such as alcohol addiction. Indeed, clinical research continues to investigate new strategies and refine already-existing ones. One way to increase the potency of an alcohol program may be to combine different psychosocial treatments or to supplement CBT with a community support group.
See page 3 for other resources and general tips for treatment of AUD