The 7 effective psychological treatments for alcoholism

Psychology offers several forms of intervention to quit alcohol in a safe and effective way.

Alcoholism is a disorder that can be characterized both by abusive consumption of this substance at specific times and by physical and psychological dependence on drinking. If sustained over the long term, alcoholism can lead to very serious life-threatening consequences, such as suicide due to depression or Wernicke-Korsakoff syndrome.

In this article we will describe the the main psychological treatment programs for alcoholism, focusing on those whose efficacyfocusing on those whose efficacy has been demonstrated through scientific research.

Effective psychological treatments for alcoholism

As we shall see, the psychological therapies that have been developed to reduce or eliminate alcohol consumption mainly use techniques based on classical conditioning, such as the extinction of the physiological signs of craving, and on operant conditioning, such as the development of alternative reinforcers to replace the reinforcement provided by alcohol.

Often these programs are combined with drugs are often combined with drugs to enable or promote change.. These include anxiolytic drugs such as benzodiazepines and substances that cause aversive effects when combined with alcohol, such as disulfiram (better known by its trade name, "Antabus").

1. Community reinforcement approach

Hunt and Azrin developed the "Community reinforcement approach" program for the treatment of severe alcoholism in 1973. Its effectiveness has led to its application to other types of addiction as well, and it has proven particularly useful in the case of heroin when combined with contingency management.

The two main objectives of this treatment, which are closely related to each other, are the reduction of alcohol consumption and the development of alternative habits that reinforce sobriety. habits that reinforce sobriety. Positive reinforcement is thus used as a key tool; the same is true for the promotion of motivation to change.

The community reinforcement approach is based on techniques such as training in communication skills (focused mainly on the immediate environment), the practice of healthy leisure activities, the acquisition of skills that facilitate job search, and improving resistance to the temptation to drink through covert awareness-raising. through covert sensitization.

As with some of the other treatments we will mention, the community reinforcement approach is often combined with the use of disulfiram in order to enhance the therapeutic effects of cognitive-behavioral techniques. This drug causes unpleasant reactions when interacting with alcohol, such as Nausea and anxiety.

2. Cognitive-behavioral family and couple therapy

Family and couple therapies for alcoholism are multicomponent programs that have as their main objectives the improvement of communication between the patient and those closest to him/her.as well as the increase of positive reinforcement obtained through interaction with them.

At a theoretical level, this type of treatment suggests that a poor relationship with the family, and especially with the partner, favors alcohol consumption; on the other hand, if the interaction is positive, it can be a key source of reinforcement with the potential to modify the behavior of the person who drinks. In addition, the family can provide support for abstinence.

One example is the community reinforcement and family training program or CRAFT ("Community reinforcement and family training") developed by Millar, Meyers and Tosigan in 1999. This therapy uses motivational interviewing, contingency management training, identification of risk situations and leisure activities with the family.

3. Social and coping skills training

The programs included in this category are aimed at acquiring social and coping skills for situations of risk of alcohol consumption. It is therefore based on the training of this type of strategies and their practice in contexts that usually trigger drinking behavior.

Since there are a large number of alcoholism treatments that have skills training at their core, the effectiveness of these programs may vary in different countries, the effectiveness of these programs may vary from case to case.. The intervention developed by Langley and colleagues, which is called "coping skills for drinking behavior," is a notable example.

4. Relapse prevention program

Although a few decades ago relapse prevention was seen as an additional module that could enhance the therapeutic effects of other programs, relapse prevention now constitutes a distinct treatment category in itself and its efficacy has been demonstrated even when applied independently.

Marlatt and Gordon's model is particularly well known.. These authors emphasize the progressive nature of recovery; in this sense, their therapy teaches to distinguish one-off "falls" from "relapses", which have a more chronic character. Again, the training of coping skills for risk situations is a central aspect.

5. Cue exposure therapy

Cue exposure therapy, abbreviated as "CET", has been applied with moderately effective results in cases of alcohol abuse, as well as in smoking cessation programs.

It focuses on reducing the addicted person's reactivity to environmental cues that provoke conditioned responses. environmental cues that provoke conditioned craving responses. or craving for consumption. This is achieved by using exposure and response prevention procedures in the presence of the antecedent stimuli in order to extinguish the psychophysiological reactions associated with craving. One of the advantages of this method is that it goes to the root of the addiction craving.

6. Self-control or controlled drinking programs

These treatments are applied when the person wants to to reduce the intensity of his or her alcohol consumption without abandoning it completely. It is usually carried out in young people with an adequate level of social and economic support, as well as in more severe cases in which total abstinence programs have failed.

Therapy is usually initiated by setting goals, conducting a functional analysis of drinking situations and self-reporting these behaviors. This is followed by a period of abstinence (approximately one month) which is combined with training in alternative coping skills, also useful for relapse prevention.

7. Contingency management based on reinforcement

Contingency management is a therapeutic approach based on the paradigm of operant conditioning. Alcohol consumption is conceived as an operant behavior whose maintenance is influenced by reinforcers such as the effects of drinking or the social interaction situations associated with addiction.

These programs consist of replace inappropriate reinforcement with adaptive and tangible incentives, mainly personal use items such as tickets to movies or other entertainment.These are mainly personal use items such as tickets to movies or other entertainment. These rewards are obtained from the demonstration that abstinence has been maintained, often through urine testing.