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Alcohol abuse treatment: Matching
individuals with the right treatment
Alcohol abuse treatment matching:
 The
most appropriate decisions related to alcohol abuse treatment can only
occur by matching individuals with their treatment needs. The
individual’s screening results should differentiate between mild and
more severe levels of physical dependence to determine whether
detoxification should be part of an individual's early alcohol abuse
treatment. If their withdrawal risk is low, it may be appropriate to
refer them to an outpatient treatment setting. If the risk for
withdrawal is moderate to high, outpatient or inpatient detoxification
may be indicated as an absolute imperative for effective alcohol abuse
treatment.
There are a large number of life-threatening
factors that must be considered in order to determine if alcoholics
are at increased risk. Any of the following factors may warrant
immediate attention: acute alcohol withdrawal (with the potential for
seizures and delirium tremens), serious psychiatric illness (e.g.
psychosis, suicidal intentions or behavior), serious medical or
surgical disease ( e.g. acute pancreatitis, bleeding esophageal
varices). If you notice the presence of any of these emergent
problems, acute stabilization should be the first priority for the
individual’s alcohol abuse treatment.
The presence of
these complicating medical and psychiatric issues is a key determinant
in whether an individual receives alcohol abuse treatment in an
inpatient or outpatient alcohol rehabilitation setting. Other
circumstances include the patient’s current living circumstances and
whether they have a social support network. Women with children are
frequently unwilling to enter alcohol rehabilitation in residential
settings if other family members need to be taken care of. Homeless
people may be very willing to enter residential placement even when
their medical and psychiatric needs do not warrant it.
After an
individual’s acute medical and psychiatric conditions have stabilized,
and if they do not have any of the previously referred to conditions,
the focus needs to then be on the establishment of a therapeutic
alliance. The presence of a trusting relationship will make the
alcoholic's consideration of various alcohol abuse treatment options
more viable. In addition to participation in a structured alcohol
rehabilitation program, the individual should be made aware of the
availability of Alcoholics Anonymous (AA) as well as its wide
diversity of membership.
Another key factor
in determining the optimum alcohol rehabilitation setting is that you
should always consider matching the individual with the most
appropriate alcohol abuse treatment at the lowest level of intensity
required, and then having the alcoholic step up to the next higher
level of intensity if the lower level does not work adequately. This
approach is consistent with the American Society of Addiction Medicine
(ASAM) criteria, which states that inpatient treatment should not be
required unless an individual has failed in outpatient alcohol
treatment. Matching individuals with appropriate alcohol
rehabilitation options includes matching alcoholics guided by
theoretically derived hypothesis. This strategy relies upon research
evidence that suggests that certain kinds of treatments are more
likely to provide improved outcomes for different individuals over
other alternatives. An example may be the assignment of individuals
with ASPD to cognitive behavioral treatment based upon evidence that
these individuals may have better outcomes with more structured
alcohol rehabilitation therapy.
The matching of
individuals with optimum alcohol abuse treatment continues to attract
significant attention, and there appears to be some evidence
suggesting that alcoholics with certain characteristics (e.g. severe
dependence, high levels of anger, social networks that support
drinking) may respond slightly better to certain types of specific
therapy (e.g. 12-step programs, motivational enhancement, cognitive
behavioral therapy etc.). One study looking at individuals in alcohol
rehabilitation programs in both inpatient and outpatient settings
found that in certain areas related to their health, employment,
family, and psychiatric needs, those provided with alcohol
rehabilitation that met their needs in each of these particular areas
showed the greatest improvements after discharge. These findings and
others may suggest the importance of incorporating a range of alcohol
abuse treatment services within specialized alcohol rehabilitation
facilities to meet the diverse psychosocial needs of alcoholics.
Despite their
efforts at alcohol rehabilitation, some alcoholics repeatedly
relapse. For many medical and mental health professionals, the
multiple recidivist alcoholic seems to personify the disorder.
Clinicians involved in the delivery of alcohol abuse treatment
frequently find the individual’s apparent unresponsiveness to
treatment a significant source of frustration about the apparent
futility of alcohol rehabilitation. Currently, long-term care in
residential treatment appears to be the only option these alcoholics
respond well to, rather than the more limited alcohol rehabilitation
efforts. Unfortunately, the availability of these intensive
residential types of services in many states is limited due to cost
considerations and the efforts at the deinstitutionalization of
psychiatric patients.
Finally, the
importance of continuing care through aftercare groups and other
mutual support organizations such as Alcoholics Anonymous (AA) cannot
be overestimated for individuals in need of alcohol abuse treatment.
The use of these resources as well as some of the newer
pharmacological and non-pharmacological alcohol abuse treatment
options have been developed in the past two decades and will be
discussed on subsequent pages of this series.
From DSM-IV-TR Mental
Disorders: Diagnosis, Etiology and Treatment by Michael B. First and
Allan Tasman
Additional
Information and webpage by
Paul Susic
MA
Licensed Psychologist Ph.D. Candidate
(Health and Geriatric Psychologist)
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