What types of treatment are successful for alcoholism and addiction?

Jes Aaron

Jes:

Before identifying treatments that work, let me make the following five points:

1. Allowing the person to select a treatment — and treatment goals — is critical to treatment success, with people showing superior results when they feel engaged in the treatment and the options it offers and when these are consistent with their values and self-image;
2. Treatment is not necessary — indeed, most people recover on their own from every variety of addiction, including alcoholism, without formal treatment or support groups, although they often rely on informal resources for assistance;
3. The nature of treatment is not usually the critical ingredient in treatment outcomes — the characteristics of the treated person are critical, such as whether they are married, have stable social supports, have work skills and a job, etc.;
4. Also critical is the follow-up to treatment — even very brief, informational sessions can have a strong impact on addiction if the person is tracked and knows he or she is to be contacted regularly about progress;
5. Treatment outcomes, as above, occur in a social milieu — the best treatment outcomes will occur in environments which offer the most practical assistance (e.g., housing, work, legal and medical assistance, et al.) and social support.

Having made these critical points about treatment choice, natural recovery, the person in treatment, the follow-up to treatment, and the environment in which the treated person lives, there are treatments which make use of these principles and offer more successful outcomes for the treatment buck.

Among these useful treatments are the following:

1. Community Reinforcement Approach (CRA)

   This is the therapy best supported by research. It's a moderately low-cost form of outpatient treatment; it was devised and first tested over a quarter-century ago; every study of its efficacy — with alcohol and a variety of drugs — has shown extremely positive results; and it is not in regular use at a single treatment center in the United States.

   The basic premise of the community reinforcement approach — most often a one-on-one therapy, although it can be used in group settings — is that substance abuse does not occur in a vacuum, that it is highly influenced by marital, family, social, and economic factors. CRA attempts to help the client improve his or her life in all of these areas, in addition to giving up drinking or using drugs. Thus, a CRA program will typically include at least the following components: (1) communications skills training; (2) problem-solving training; (3) help finding employment; (4) social counseling (that is, encouraging the client to develop nondrinking relationships); (5) recreational counseling (that is, encouraging the client to find rewarding nondrinking activities); and (6) marital therapy. Other treatment components are sometimes used — for example, rewarding the client materially for abstinence or use of disulfiram or other drug therapy to reduce, substitute for, or eliminate drug use — but these six above-listed components form the core of the very successful CRA approach.

2. Social Skills Training (SST)

   This form of group therapy is another very well supported approach. The basic premise of social skills training is that alcohol/drug-abuse clients lack basic skills in dealing with work, family, and other interpersonal relationships, as well as in dealing with their own emotions. Thus, they benefit from skills training in communications, anger management, conflict resolution, drink and drug refusal, assertiveness, relaxation, expressing feelings constructively, et al.

3. Behavioral Marital/Family Therapy

   The single most frequent request/complaint I receive begins, "My boyfriend/husband. . ." Thus, marital counseling with an emphasis on altering behaviors related to drinking and drug use is important, particularly helping the non-substance-abusing spouse to abandon futile nagging about drinking and drug use and instead begin to reward sober behavior. This requires that the couple learn constructive marital negotiation techniques, so that the non-substance-abusing spouse will also make modifications/concessions in her behavior. The remainder of the therapy involves typical couples counseling, the goal being to repair substance-abuse-caused damage to the relationship, as well as dealing with non-substance-based problems.