ALCOHOLICS ANONYMOUS
AND OTHER 12-STEP PROGRAMS
The grandfather of alcohol treatment is Alcoholics Anonymous. AA is a self-help organization founded in 1935. AA changed the way professionals thought about alcohol dependence and treatment. AA developed a successful 12-step program by combining self-help with a spiritual foundation. It then firmly planted itself in the fellowship of recovering alcoholics.
You do not need to be religious to be in AA
AA is run solely by recovering alcoholics and is in almost every community with specific programs, meeting and locations. If you need to find a meeting go to www.aa.org. It also provides round the clock assistance.
There are no membership dues and it is open to everyone.
AA promotes and provides fellowship. This fellowship can be very positive and can help counterbalance feelings of grief, loss, and shame associated with alcohol dependence.
AA and other 12-step programs provide effective treatment programs which facilitate long-term abstinence after treatment.
AA also provides an important group process therapy for dependent alcoholics.
AA prescribes keeping it simple, taking it one day at a time, and avoiding the people, places, and things associated with their use. This approach is a powerful tool for relapse prevention.
AA also helps recovering alcoholics to develop positive lifestyles and find new ways to solve old problems. The feeling of fellowship, support, and guidance helps make getting sober and staying sober more likely.
The reduction of shame and guilt fostered by AA along with its message of the acceptance of powerlessness over drinking is often reported by alcoholics after attending meetings every day.
One of AA’s principles is the value of performing services that will help other alcoholics.
Prevention of relapse is an active daily process.
COUNSELING
Cognitive-behavioral therapies (CBTs) are the most frequently used treatments for substance use disorders.
CBTs have been shown to be effective in several clinical trials of substance users [82].
Characteristics of CBTs include:
• Social learning and behavioral theories of drug abuse
• An approach summarized as “recognize, avoid, and cope”
• Organization built around a functional analysis of substance use
(for example: understanding the antecedents and consequences of substance use)
• Skill training using strategies for:
coping with cravings
fostering motivation to change
managing thoughts about drugs
developing problem-solving skills
planning for/managing high-risk situations
cultivating drug refusal skills
Basic principles of CBTs include:
• Basic skills should be mastered before more complex ones are given.
• Material presented by the therapist should be matched to patient needs.
• Repetition fosters the development of skills.
• Practice is needed for mastery of skills.
• The patient is an active participant in treatment.
• Skills taught are general enough to be applied to a variety of problem areas.
Structured behavior therapy techniques can be effective components of alcohol dependence treatment.
Behavioral therapy techniques are often used in conjunction with CBT’s.
The goal of a CBT is to increase the patient’s engagement in positive activities and socially reinforcing behaviors.
CBT data confirms that:
Drug abuse patients need motivation and skills to succeed in stopping drug use.
Research has shown that drug abuse behavior can be reduced by offering contingent incentives for abstinence.
The most striking successes have come from positive reinforcement programs that provide contingent incentives for abstinence using money-based vouchers as rewards.
Research provides examples, but treatment providers may need to be creative in discovering reinforcers that can be used for contingency management in their own clinical settings.
MEDICATIONS USED TO TREAT ALCOHOL DEPENDENCE
Some medications are used for detoxification and others are used for relapse prevention. Research has shown that medications must be used in conjunction with talk and other therapies to be most.
ANTABUSE
Also known as Disulfiram. It was approved for treatment of alcohol dependence by the FDA in 1951. It works by blocking an enzyme, aldehyde dehydrogenase, the body uses to metabolize alcohol. Drinking while on Disulfiram causes the alcohol at the acetaldehyde stage to accumulate in the blood. This then produces nausea, vomiting, sweating, and even difficulty breathing.
Disulfiram is not recommended for patients with diabetes, cardiovascular or cerebrovascular disease, or kidney or liver failure. With the advent of more modern and improved medicines, Disulfiram is often used as a last resort.
NALTREXONE
Also called ReVia is an opioid antagonist that interferes with the rewarding or pleasurable effects of alcohol. This allows it to reduce the alcohol craving.
The FDA approved the use of naltrexone in alcohol dependence in December 1994.
Naltrexone has been proven to:
Reduce alcohol relapses
Decrease the possibility of a slip becoming a relapse
Decrease the total amount of drinking.
The most common side effects are light- headedness, diarrhea, dizziness, and nausea. Side effects tend to disappear quickly. It is not recommended for patients with:
acute hepatitis
liver failure
for adolescents
pregnant or breastfeeding women
Naltrexone works best integrated into a complete treatment program including traditional 12-step fellowship-based treatments and /or CBT.
NALMEFENE
Also called Revex is newer opioid antagonist. It is administered intravenously. It shows no liver toxicity, however method of administration makes its use limited in outpatient settings.
ACAMPROSATE
Also known as Campral is a synthetic compound with a chemical structure similar to naturally occurring amino acid neurotransmitters e.g. homotaurine and GABA.
It was approved by the FDA In July 2004 for the maintenance of alcohol abstinence.
It has been used successfully in Europe and around the world for years.
BACLOFEN
Baclofen is a GABA agonist. In a study of alcohol-dependent patients with liver cirrhosis, baclofen was also found to work favor- ably in maintenance of alcohol abstinence. Seventy-one percent of baclofen-treated patients maintained abstinence as compared with twenty-nine percent of the placebo group [208].
ANTICONVULSANTS
Topiramate is effective in reducing heavy drinking in alcohol dependent patients.
Side effects of Topiramate include numbness in the extremities, fatigue, confusion, paresthesias, depression, change in taste, and weight loss.
Carbamazepine has proven effective for treating acute alcohol withdrawal.
Side effects include nausea, vomiting, drowsiness, dizziness, chest pain, headache, trouble urinating, numbness in extremities, liver damage, and allergic reaction.
Oxcarbazepine is a carbamazepine derivative, with fewer side effects than Carbamazepine.
BUSPIRONE HYDROCHLORIDE
Also called Buspar, a dopamine antagonist and partial agonist for serotonin, exhibiting anxiolytic properties.
CLOZAPINE
Also called Clozaril is an atypical antipsychotic approved to treat schizophrenia and its resultant symptoms (e.g., hallucinations, suicidal behavior).
It has shown promise in the treatment of comorbid substance use.
No comments:
Post a Comment