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Psychological Treatment for Alcohol Abuse/Alcoholism

Psychological Treatment for Alcohol Abuse/Alcoholism. Examples of Research Answers to Six Practical Questions. 1. How effective is the psychological treatment of alcoholism?. 12-month outcomes of U.S. alcoholism treatment (8329 cases). 24% continuously abstinent

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Psychological Treatment for Alcohol Abuse/Alcoholism

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  1. Psychological Treatment for Alcohol Abuse/Alcoholism Examples of Research Answers to Six Practical Questions

  2. 1. How effective is the psychological treatment of alcoholism?

  3. 12-month outcomes of U.S. alcoholism treatment (8329 cases) • 24% continuously abstinent • Among those not totally abstinent: • 87% reduction in alcohol consumption • Most (75%) days abstinent • 60% reduction in alcohol-related problems • <2% mortality Source: Miller, Walters & Bennett (2001). How effective is alcoholism treatment? Journal of Studies on Alcohol, 62, 211-220.

  4. Milwaukee Providence Clinical Research UnitsProject MATCH * Buffalo * Seattle * * * * * WHaven Albuquerque Farmington * * Charleston Houston

  5. Mean Percent Days Abstinent as a Function of Time (Aftercare)

  6. Mean Drinks per Drinking Day as a Function of Time (Aftercare)

  7. Maintaining change across three years after treatment (outpatients)

  8. 2. Is there something more effective than traditional disease-model counseling for alcoholism?

  9. Investigator: Nathan Azrin • Patients in outpatient treatment for alcoholism • Location: Illinois • Treatment: Community reinforcement approach • Comparison: Traditional counseling • Follow-up: 6 months Source: Azrin, N. (1976). Improvements in the community reinforcement approach to alcoholism. Behaviour Research and Therapy, 34:339-348.

  10. 6 Month Outcomes (Azrin) Drinking days reduced by 97%

  11. 6 Month Outcome: CRA in New Mexico % Alcohol-free days Source: Meyers & Miller (2001). A community reinforcement approach for addiction treatment. Cambridge University Press.

  12. 3. Is there something we can do to get our patients more motivated for change at the beginning of treatment?

  13. Investigator: Thomas Bien • Veterans entering outpatient treatment for alcoholism at a VA medical center • Location: New Mexico • Treatment: 1 session of motivational interviewing at intake • Comparison: Usual intake with encouragement • Follow-up: 6 months Source: Bien, Miller & Boroughs (1993). Motivational interviewing with alcohol outpatients. Behavioural and Cognitive Psychotherapy, 21:347-356

  14. 6 Month Outcomes (Bien)

  15. Intoxication level when drinking (BAC)

  16. Patients totally abstinent (Bien)

  17. Investigator: Janice Brown • Patients entering private inpatient treatment for alcoholism • Location: New Mexico • Treatment: 1 session of motivational interviewing at intake • Comparison: Usual intake without MI • Follow-up: 3 months post-discharge Source: Brown & Miller (1993). Impact of motivational interviewing on participation and outcome in residential alcoholism treatment. Psychology of Addictive Behaviors, 7: 211-218.

  18. 3 Month Outcomes (Brown) Doubled % of patients abstaining

  19. Investigator: Lauren Lawendowski • Adolescents entering public outpatient treatment for substance abuse • Location: New Mexico • Treatment: 1 session of motivational interviewing at intake • Comparison: Usual intake without MI • Follow-up: 3 months post-discharge • Source: Lawendowski, L. (1997). Motivational interviewing with adolescents presenting for outpatient substance abuse treatment. PhD. Dissertation, Department of Psychology, University of New Mexico

  20. Adolescent patients totally abstinent from all drugs

  21. Percent days using illicit drugs after adolescent outpatient treatment

  22. Treatment sessions attended

  23. 4. How can I help desperate family members whose loved one refuses to get treatment?

  24. Community Reinforcement and Family Training CRAFT

  25. 130 CSOs randomly assigned to one of three interventions • Al-Anon Facilitation Therapy (AFT) • Johnson Institute Intervention (JII) • Community Reinforcement (CRAFT) Source: Miller, Meyers & Tonigan (1999). Engaging the unmotivated in treatment for alcohol problems: A comparison of three strategies for intervention through family members. Journal of Consulting and Clinical Psychology, 67: 688-697.

  26. Treatment Engagement Rates

  27. CSO Depression Scores (Beck)

  28. 5. Is there an effective treatment for adolescents in the emergency room with alcohol-related injuries?

  29. Investigator: Peter Monti • Adolescents brought to emergency room, injured and intoxicated • Location: Rhode Island • Treatment: 1 session of motivational interviewing (35-40 min) in the ER • Comparison: ER treatment as usual • Follow-up 6 months • Source: Monty, Colby & O’Leary (2001). Adolescents, alcohol and substance abuse: Reaching teens through brief interventions. New York: Guilford Press.

  30. 6 Month Outcomes • 27% fewer cases drinking and driving • 87% fewer new moving traffic violations • 58% fewer new alcohol-related injuries

  31. 6. If you catch them early, can alcohol problems be prevented?

  32. Investigator: Hans Kristenson • Men aged 46-49 participating in a health study, with elevated liver enzymes • Location: Sweden • Treatment: Brief behavioral counseling • Comparison: Risk notification by mail • Follow-up: 5 years • Source: Kristenson et al. (1983). Identification and intervention of heaby drinking in middle-aged men: Results and follow-up of 24-60 months of long-term study with randomized controls. Alcoholism: Clinical and Experimental Research, 7: 203-209.

  33. 5 Year Outcomes (Kristenson)

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