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Evidence Based Practices in Treating Alcohol Use Disorders

This is also 

Chapter 13 Alcohol Use Disorders

In

Evidence Based Practices for Mental Health Professionals

By Jim Messina, Ph.D., CCMHC, NCC, DCMHS


LEARNING OBJECTIVES FOR

ALCOHOL USE DISORDERS

After reading this section you will learn the answers to the following questions:

  1. What are the ICD-9-CM and ICD-10-CM Codes for Alcohol Use Disorders?
  2. What are the clinical descriptors for Alcohol Use Disorders?
  3. What are the common symptoms forAlcohol Use Disorders?
  4. What are some common mental health comorbidities of Alcohol Use Disorders?
  5. What are the common populations which are treated for Alcohol Use Disorders?
  6. What are the common treatment settings for Alcohol Use Disorders?
  7. What are the Evidence Based Practices for treating Alcohol Use Disorders?
  8. What area the common psychopharmacological treatments for Alcohol Use Disorders?
  9. What are some common manuals, guideline books and client workbooks for treating Alcohol Use Disorders?
  10. What are some good references you can use to learn more in-depth information about Alcohol Use Disorders?

ICD-9-CM and ICD-10-CM Codes for Alcohol-Related Disorders in DSM-5

305.00 (F10.10) Alcohol Use Disorder Mild

303.90 (F10.20) Alcohol Use Disorder Moderate

303.90 (F10.20) Alcohol Use Disorder Severe

303.00 (F10.129) Alcohol Intoxication With Use Disorder Mild

303.00 (F10.229) Alcohol Intoxication With Use Disorder Moderate or Severe

303.00 (F10.929) Alcohol Intoxication Without Use Disorder

291.81 (F10.239) Alcohol Withdrawal Without Perceptual Disturbances

291.81 (F10.232) Alcohol Withdrawal With Perceptual Disturbances

291.9 (F10.99) Unspecified Alcohol-Related Disorders

 

American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5th ed.) (DSM-5). Washington, DC: Author.

Maria and Samuel: Alcohol Use Disorder


Maria and Samuel had made this initial appointment with you over a month ago and had said that they could not make any time for an appointment until today given their “busy-busy” schedule. They had filled out all their personal information forms prior to coming in and were ready to begin to work. When you ask: “Why are you here today?” They immediately get into yelling at one another that they have no idea why they are here today and really it will be a waste of time since it does not make sense for them to be here. 


You are somewhat taken back but proceed by saying: “I see that there is some real tension going on between the two of you, why is this so?” Maria begins to cry and sob as she tells you that Samuel accuses her of being an alcoholic and for ruining their marriage and family life. Samuel gets disgusted and says that Maria is right, that she is the cause of their problems and that she cannot drink like he drinks and it is necessary for her to drink socially like he expects her too. When asking what does social drinking mean to Samuel you find out that he will drink half a case of beer a day along with three glasses of wine at dinner and an old fashion or martini to top off the meal. He expects Maria to be able to keep up with his drinking like this but she ends up falling asleep after her first glass of wine. He says, “You see! She blacks out every time she drinks!” 


You ask Maria does she think she is an alcoholic because of this and she continues crying saying “NO! Samuel is the alcoholic and he refuses to admit it and I have filed for divorces and am threatening to leave unless he is willing to get help for his drinking.”


Samuel becomes incensed by Maria’s claim and says that just because he had gotten two DUIs in the past and had lost one job for missing an important meeting at a client’s office out of state due to his not being able to get himself up in the morning because of his normal drinking at dinner the night before. Samuel says that Maria has been bugging him about his drinking since they married over 11 years ago and he is fed up with her accusations. He concludes with “I am not a drunk! But I love Maria and I don’t want our life to be ruined due to the divorce over my drinking and her drinking problem! I want us to stayed married and stop fighting and get back the love we once had. We have two kids and they deserve us to pull our act together”


You look Samuel in the eye and say, “Samuel I cannot work with you and Maria unless you are willing to do the following things.

  1. First you need to stop drinking any alcoholic beverages for at least 30 days or longer, if you cannot go one day without drinking then you will need to admit to yourself and Maria that yes indeed you have an alcohol abuse problem.
  2. If you have not been successful in not drinking for 30 days then you will get yourself to AA meetings in our community and go to at least 90 meetings in 90 days.
  3. At the AA meetings you will meet people like yourself and after 30 days going to the AA meetings you will select a sponsor whom you will give permission for us to meet together with you and Maria to discuss your progress in AA as you will become active in working on your recovery from alcohol abuse by then
  4. I will work with you and Maria weekly over this time educating you both about alcohol abuse and the impact it has on families, marriages and children and what are the healthy steps needed to become sober and abstain from alcohol use in the future.
  5. I will work with you both to recognize how Maria enables Samuel’s problem and how Maria can take steps to stop being a trigger for his drinking problems.


Now if you do now want to agree to these conditions then Samuel and Maria I would strongly support you getting a divorce for the sake of your children so that they do not grow up thinking that abuse of alcohol is a healthy thing and that parents fighting infront of their kids is ok?”


Once you finish, Samuel looks upset and distressed and says: “I don’t want a divorce and I wish my parents had gone for help years ago, Marie is right we need help. My Dad was a drunk and he and mom never faced it and it has ruined my life. Yes I will agree to your plan to quit drinking and save my life with Maria which I don’t want to lose.”

Alcohol use disorders involve heavy alcohol use from a mild to severe level. Intoxication may range from a mild to a severe level and clients may experience withdrawal with or without perceptual disturbances. Research has demonstrated that impaired speed and cognitive functioning come as individuals with alcohol use disorder develop a tolerance to their alcohol intake (Shwizer and Vogel-Sprott, 2008). Research indicates that individuals who have problems with alcohol use disorders have good resilience and self-efficacy. They have the highest potential for successful outcomes from whatever treatment in which they participate (Vielva and Iraurgi, 2001). Freyer-Adams et al. (2008) found that those with alcohol use disorder who are open to “help-seeking” are more motivated to engage in treatment for their alcohol problem.

            

There is hope that someday there will be medications which address specific genotypes in individuals with alcohol use disorders to improve long-term recovery (Ooteman et al., 2009).


Researchers have recognized Cognitive Behavior Therapy (CBT) as an effective intervention for individuals with alcohol use disorder (Hodge, 2011). Hodge recommends incorporating spirituality into the CBT treatment with spiritually minded clients to enhance their treatment success (2011).


In 2005, after reviewing the Project MATCH results (Matching Alcohol Treatments to Client Hetrogeneity), Cutler and Fishbain concluded that “current psychosocial treatments for alcoholism are not particularly effective” (p. 10).  Initiated in 1989,  Project MATCH was an 8-year, multi-site $27 million investigation that studied which types of alcoholics respond best to what treatments.  The study involved three treatments: Cognitive Behavioral Therapy (CBT), Motivational Enhancement Therapy (MET) and the Alcoholics Anonymous (AA) based Twelve Step Facilitation (TSF), Cutler and Fishbain concluded that “alcoholics who decide to enter treatment are likely to reduce drinking and that those [who] reduce drinking are likely to remain in treatment” (2005, p.10). Their conclusion emphasized the need for treatment programs to help clients regain a sense of control over their lives. Miller (2005), in his response to Cutler and Fisbain, pointed out that after a three year follow up of the MATCH participants: 1) angry patients did better in motivational enhancement therapy (MET); and 2) those who lacked social support did best in twelve step facilitation (TSF) and did much better maintaining abstinence after three years than did those in the CBT and MET groups. Another follow up to Project MATCH found that some clients benefit from motivational enhancement techniques rather than CBT to gain the necessary motivation to be successful in treatment (Witkiewitz, Hurtzler and Donavan, 2010).


Vaillant (2005) found that AA employs four factors which are effective, and similarly used in CBT, to encourage relapse prevention: “external supervision, substitute dependency, new caring relationships and increased spirituality” (p. 431). He concluded that Alcoholics Anonymous probably has no serious side-effects (Vaillant, 2005). Kelly and Myers reviewed adolescent participation in AA and concluded that studies have shown good success (2007). In 2008, 


John Miller reviewed the research up to that time and found that although 12 Step programs were effective, such programs go against the grain and principles of psychotherapeutic traditions because they use: 1) Peer support which appears to be “peer pressuring” participants into social conformity by living a life of abstinence; 2) Open admission of powerlessness over their addiction which is counter to the developmental approach of building one’s self-esteem instead of minimizing it 3) Long term participation in the program to sustain recovery which demands an altering of participants’ desire for a more time efficient solution; and 4) Abstinence as the goal of treatment rather than moderate social drinking which many psychotherapeutic models endorse. 


Unfortunately, there was a bias in the professional mental health community against using 12 Step programs which proved to be short sighted. Kelly, Magill and Stout, in a meta-analysis into the outcomes of AA, identified the specific behavioral changes which result from full participation. These include: enhancing self-efficacy, coping skills and motivation (Kelly, Magill and Stout, 2009), as well as cognitive, affective and behavioral changes (Kelly and Claire, 2013) by participating in an adaptive 12 Step mutual help social network. In 2010, in researching the impact of AA on reducing depression, Kelly, Stout, Magill, Tonigan and Pagano found that “AA leads to improvement in alcohol use and psychological wellbeing which, in turn, may reinforce further abstinence and recovery related change” (p. 626). 


In 2012, Kelly, Hoeppner, Stout and Pagano concluded after conducting a more intensive review of participants in AA that “AA leads to better outcomes through increasing spirituality/religiosity and by reducing negative affect” (p. 289). In their research, Blonigen, Timko, Finney, Moos, and Moos found that people who had actively participated in AA for over eight years had decreased impulsivity which may have resulted from reduced alcohol use (2011). Lederman and Menegatos (2011) reviewed the impact of telling one’s story of addiction and recovery in AA meetings. It helps AA members stay sober because it aids them in defining themselves as a new person. Such sharing helps others and enables them to let go of their past (Lederman and Menegatos (2011). In other terms, AA contributes to identity transformation (Young, 2011). Women have become more active in AA and comprise one third of its membership (Krentzman et al., 2012). 


Over time, women sustain their abstinence longer than men in AA (Witbrodt and Delucci, 2011). Zafridis and Lainas in 2012 sent out a warning that incorporating AA and Narcotic’s Anonymous (NA) into the mainstream of Evidenced Based Practices for treating both alcohol and substance use disorders. The fear is that these 12 Step programs could be compromised from their radical perspective to tone it down to “fit in” rather than challenge and inspire its members toward a recovery lifestyle of abstinence (Zafridis & Lainas, 2012).


A major meta-analysis of using Cognitive Behavior Therapy (CBT) in the treatment for alcohol use disorders reviewed 53 RTCs and found that CBT results were statistically significant, but that they did diminish at the 12 month follow-up (Magill and Ray, 2009). Unless the CBT programs enhanced their delivery by requiring long-term involvement in some 12-Step or other peer recovery group there were not enough gains in the individual short term interventions to overcome the powerful urge to relapse and get back into the abuse of the substances again.

Assignment for Samuel after Maria and his first meeting with you

Step 1 of a 12 Step Program

We admitted that we were powerless over our addictive behaviors and that our lives had become unmanageable. 


Directions: As you systematically work through the twelve steps of any 12 Step program, you will be expected to read and respond to the questions listed below in your journal. Each step in 12 Step programs contain key words or concepts, which need to be explored for each step. Your recovery from the negative impact of addictive behavioral problems is dependent on your honest assessment, admission, and acceptance of the 12 steps you need to take in order to ensure your personal recovery. Most likely over your lifetime you will need to review these twelve steps, so for later reference keep it in a safe place, the 12 Step Journal which you will begin writing by taking Step 1 in this exercise.

 

Identify the destructive or negative consequences which resulted from your addictive behavioral problems:

Give examples of how your addictive behavioral problems have resulted in each of the following issues:

  1. Self‑destructive behaviors
  2. Unresolved loss issues
  3. Need for control in your life issues
  4. Unresolved anger issues
  5. Personal adjustment problems
  6. Interpersonal relationship problems
  7. Faulty communication issues

 

Powerless
Powerlessness is a result of one or more of the following circumstances: preoccupation with problem behaviors, numerous failed attempts to control the problem behaviors, and loss of control over the problem behaviors.

  1. Preoccupation: Preoccupation occurs when your thoughts, feelings, hopes, and dreams are so seriously filled with the negative behavioral consequences of your addictive behavioral problem that the mind is not clearly focused on reality. Give examples of when you have been seriously preoccupied and ignored your responsibilities for self, spouse, family, work, school, or community.
  2. Numerous failed attempts to control your addictive behavioral problems: Failed attempts to control the addictive behavioral problem is a mark of powerlessness because no matter what you tried in the past it never worked. Give examples of some of your past failed attempts to control the addictive behavioral problems.


Loss of control: Loss of control over your addictive behavioral problems causes them to become obsessive, compulsive, and unpredictable.

  1. Obsessiveness: Obsessive thinking and uncontrolled ruminating about your addictive behavioral problems render you powerless. Give examples of your obsessive thinking about your addictive behavioral problems:
  2. Compulsivity: Compulsively driven and frenzied acting out your addictive behavioral problems results in a sense of powerlessness. Give examples of where your addictive behavioral problems have taken on the compulsively driven modality:
  3. Unpredictability: When you find yourself to be more the observer than the doer of the action involved, your addictive behavioral problems have become unpredictable. You cannot clearly predict what your next action will be. Give specific examples where you have found your behaviors unpredictable:

 

Unmanageability of life
Your life is affected by the behavioral consequences of your addictive behavioral problems to the extent that there is a deterioration of the quality of your life. This deterioration comes from problem behaviors out of control which result in your life being unmanageable. You are not able to maintain goals, make plans, manage your time, or maintain relationships. The spheres of your life which become unmanageable are: inner feeling, emotional life, spiritual life, family life, social life, work life, school life, and community life.

  1. Inner feelings and emotional life: Give examples of how your feelings and emotions deteriorated and became hard to manage:
  2. Spiritual life: Give examples of the deterioration or lack of management of your spiritual life:
  3. Family life: How have your problem behaviors resulting from your addictive behavioral problems affected your family life? For each member in your current family and family of origin, give examples how they were affected by your addictive behavioral problems:
  4. Social life: How much “real'' fun do you have with other people? What is the status of your social support network? How many close friends do you keep in regular contact with? How isolated and disconnected have you become? Give examples of the breakdown in your social life:
  5. Work life: What is the status of your work life? Have you ever been fired or quit? How are your relationships with your co‑workers and supervisors? Are you happy in your career? Give examples of the effects of your addictive behavioral problems at work:
  6. School life: Have you gotten the highest education you need to in order succeed in your chosen career? Did you feel intellectually inferior in school? Are you an underachiever? Give examples of how your addictive behavioral problems affected your school history:
  7. Community life: How involved in your community are you? Do you reach out to your neighbors? Do you join civic groups or volunteer in community projects? Give examples of how your addictive behavioral problems affect your participation in the community:

 

Admitting powerlessness

Give examples of why it is not easy for you to admit powerlessness over the behavioral consequences your addictive behavioral problems:


Accepting powerlessness

Give examples of why it is not easy for you to accept powerlessness over the behavioral consequences of your addictive behavioral problems:


Denial of the powerlessness over problems keeping you from admittance and acceptance

In order for you to begin your recovery process, you need to admit to yourself that you are powerless over the behavioral consequences of your addictive behavioral problems and accept that the road to recovery is a lifelong process.

Give examples of denying your powerlessness over your addictive behavioral problems through use of:

Pollyanna thinking (things are never as bad as they seem).

Fantasy thinking.

Magical thinking.

Minimizing.

Intellectualization and rationalization.

 

The “panic'' in recovery

Also preventing full admittance and acceptance is the fear, anxiety and terror of being at the beginning stages of recovery when you feel one foot in the "old unhealthy space'' well known to you and the other foot in the "new healthy space'' less known to you and filled with great risks and challenge. There is the "old you'' which you know and are used to, the “you” that feels “normal.” In the healthy world is the “new you,” which is at this beginning stage unknown to you. You fear that if you completely give up the “old you'' before you become the “new you'' there will be "none of you'' left. This makes you feel “sicker'' than you first felt beginning this quest. You see that denial might be a safer alternative to reduce your anxiety over changing. You also realize that you really don't know what “normal'' is so why, you reason, should you take the risk now to become “normal'' since what “you are'' hasn't done so bad for you. But, since you have chosen this recovery road for yourself, something must have made you feel “sick'' enough to reach out for help in the first place. So, why not “let go'' of the fear, anxiety, and terror over change and give the “new healthier normal you'' a chance?

Give examples of how the panic in the initial stages of your recovery keeps you from dealing with you admitting and accepting powerlessness over your addictive behavioral problems. This panic results in:

Fear of unknown “new'' me.

Anxiety over loss of “old'' me.

Terror at the magnitude of change needed.

Sensation of getting “sicker'' as you enter “recovery.''

Reactions of the significant people in your life to your changes.

 

Personal responsibility for change in self

Another source preventing your admitting and accepting your powerlessness over your addictive behavioral problems is that you have always found it easier in the past to blame others for your problems. The 12 Step program of recovery places the responsibility for your problem behaviors on you. You are the only one who needs to improve emotional, rational, and behavioral control in order for you to change. The focus on you as the “target'' for change is foreign to you and you fight and resist this concept. This resistance to focus on personal responsibility for self‑change can lead to denial of the “real'' problems you need to work on. Give examples where you find it difficult to take total control of the efforts to change yourself so that you no longer are affected by the negative behavioral consequences of your addictive behavioral problems. Show how this resistance to taking personal responsibility for self‑change blinds you to the power and strength these problems have over you:

Do this for your:

  • Control over your emotional life.
  • Control over your rational thinking.
  • Control over your behaviors with others.


Conclusion

Now that you have explored Step 1 and the concept of powerlessness, restate for yourself that which you admit and accept as the behaviors and issues which result from your addictive behavioral problems over which you feel powerless.

 

Adapted from: Section 4, Step 1 in: Messina, J.J. (2013). Self-Esteem Seekers Anonymous-The SEA’s Program of Recovery, retrieved at www.coping.us

Substance use disorder is very evident in young adults populiations especially on colleg campuses. Collegiate Recovery Communities (CRC)is an effective effort that started at Texas Tech University, Rutgers University and Augsberg College.  CRC engage students with alcohol or substance use disorders in peer support, family support and community service (Harris, Baker, Kimball and Shumway, 2007). Alcohol abuse is a major concern on campuses and it has been exacerbated by students mixing energy drinks and alcohol (Marczinski, Fillmore, Bardgett and Howard, 2011).


There are a number of mental health disorders which are comorbid with alcohol use disorders. Specifically, Bottlender and Soyka (2006) found that comorbidity with mental health disorders impacted negatively on intervention success for the alcohol disorder. Shaffer et al. (2007) identified bipolar disorder, generalized anxiety, PTSD, intermittent explosive disorder, conduct disorder, ADHD, nicotine dependence, pathological gambling and major depression as comorbidities with individuals with chronic alcohol use disorders.


Research studies on comorbid disorders with alcohol use disorders include:

1) PTSD (Back, Sonne, Killeen, Dansky and Brady, 2003; Back, Waldrop, Brady and Hien, 2006; McDevitt-Murphy, Murphy, Monahan, Flood and Weathers, 2010).

2) Anxiety (Kushner, Donahue, Sletten, Thuras, Abrams, Peterson and Frye, 2006; Farris, Epstein, McCrady and Hunter-Reed, 2012; Kushner, Maurer, Thuras, Donahue, Frye, Menary, Hobbs, Haeny and Van Demark, 2012; Baille, Sanibale, Stapinski, Teesson, Rapee and Haber, 2013).  

3) Depression (Kay-Lambkin, Baker, Lewin and Carr, 2009; Baker et al., 2010; Kelly, Stout, Magill, Tonigan and Pagano, 2010; McDevitt-Murphy, Murphy, Monahan, Flood and Weathers, 2010; Brown et al., 2011; Curry et al., 2012).

4) Social Phobia (McDevitt-Murphy, Murphy, Monahan, Flood and Weathers, 2010).


Age groups most affected by alcohol use disorders include:

1) Adolescents/College age (Birky, 2005; Harris, Baker, Kimball and Shumway, 2007; Deas, 2008; Marczinski, Fillmore, Bardgett and Howard, 2011, Curry et al., 2012).

2) Adults (Long, Kidger and Hollin, 2001; Kelly and Myers, 2007; Farris, Epstein, McCrady and Hunter-Reed, 2012; Kushner, Maurer, Thuras, Donahue, Frye, Menary, Hobbs, Haeny and Van Demark, 2012; Baille, Sanibale, Stapinski, Teesson, Rapee and Haber, 2013). 

3) Older adults (Cooper, 2012).

4) Couples (McCrady, Epstein and Kahler, 2004; Walitzer and Dermen, 2004).

5) Native American and Native Alaskans (Villanueva, Tonigan. and Miller, 2007).


Evidence Based Practices for treating alcohol use disorders include:

1) AA only (Miller, 2005; Vaillant, 2005; Kelly and Myers, 2007; Kelly, Magill and Stout, 2009; Stewart, 2009;  Kelly, Stout, Magill, Tonigan and Pagano, 2010; Blonigen, Timko, Finney, Moos, and Moos, 2011; Lederman and Menegatos, 2011; Witbrodt and Delucchi, 2011; Young, 2011; Kelly, Hoeppner, Stout and Pagano, 2012; Krentzman, Brower, Cranford, Bradley and Robinson, 2012; Zafridis and Lainas, 2012; Kelly and Claire, 2013).

2) Cognitive Behavior Therapy (CBT) only (Long, Kidger and Hollin, 2001; Adamson, Sellman and Glenys, 2005; Birky, 2005; Miller, 2005; Kushner, Donahue, Sletten, Thuras, Abrams, Peterson and Frye, 2006; Connors, Symons, Feeney, Young, and Wiles, 2007;  Deas, 2008; Magill and Ray, 2009; Baker et al., 2010; Brown et al., 2011; Hodge, 2011; Kushner, Maurer, Thuras, Donahue, Frye, Menary, Hobbs, Haeny and Van Demark, 2012; Baille, Sanibale, Stapinski, Teesson, Rapee and Haber, 2013).  

3) Motivational Interviewing only (Monti, Barnett, Colby, Gwaltney, Spirito, Rohsenow and Woolard, 2007; Deas, 2008; Witkiewitz, Hurtzler and Donavan, 2010).

4) CBT and Motivational Interviewing (Cooper, 2012).

5) Family or Couples Therapy (Walitzer and Dermen, 2004; Harris, Baker, Kimball and Shumway, 2007, Deas, 2008).

6) Residential or outpatient with combination of CBT and AA (McCrady, Epstein and Kahler, 2004; Bottlender and Soyka, 2006; Gossop, Stewart and Marsden, 2008; Stewart, 2009).

7) AA as aftercare for either Residential or Outpatient Treatment (Gossop, Stewart and Marsden, 2008).

8) Internet/Virtual Reality: (Lieberman, 2005; Connors, Symons, Feeney, Young, and Wiles, 2007; Lee, Kwon, Choi, and Yang, 2007; Kay-Lambkin, Baker, Lewin and Carr, 2009; Klein and Anker, 2013).

9) Pharmacotherapy only (Ooteman et al., 2009; Ray, Chin, Heydari and Miotto, 2011: Bortolato, Finn, Ramaker, Barak, Ron, Liang and Olsen, 2013).

Medications used for Alcohol Use Disorders

Classification

Drug Name (Generic Name)

Disulfiram

Antabuse (Disulfiram)

Acamprosate

Campral (Acamprosate)

Naltrexone

ReVia (Naltrexone)

Vivitrol (Naltrexone injection)

New Benzodiazepines

Ativan (Lorazepam)   

Xanax (Alprazolam) 

Atypical Antipsychotics (treat alcohol and cocaine abuse)

Risperdal (Risperdone)
Zyprexa (Olanzapine) 

Seroquel (Quetiapine fumarate)

Geodon (Ziprasidone) 
Abilify (Aripiprazole)   

Invega (Paliperidone palmitrate) 

Clozaril (Clozapine)

Anticonvulsant (treat alcohol and nicotine abuse or cocaine abuse)

Topamax (Topiramate)

Gabitril (Tiagabine)

Baclofen (GABA derivative - gamma-aminobutyric acid) (treat alcohol and cocaine abuse)

Baclosan, Beklo, Gablofen, Kemestro, Liofen, Liorsel (Baclofen)

A listing of medications which were effective in comorbid use and substance abuse included: baclofen, anticonvulsants and atypical antipsychotics (ADIS, 2007). In 2008, Varra, Hayes, Roget and Fisher conducted a study to see what it would take to convince addictions counselors to use the evidenced based pharmacotherapy to treat alcohol use disorder. Results showed that counselors are reluctant to suggest using medication in treating their clients  (2008). In their research, Chin, Heydari and Miotto demonstrated that using an atypicical antipsychotic shows promising results in alcohol cravings and reduces the negative effects of intoxification and alcohol induced sedation (2011). 


Researchers are convinced that over time they will discover genetic markers which are directly relevant to identifying individuals who are at risk for alcohol use disorders (Buck, Milner, Denmark, Grant and Kozell, 2012), as well as the impact of stress reactivity and alcohol use and abuse (Thomas, Bacon, Sinha, Uhart and Adinoff, 2012). 


There are two approved medications currently: 1) Antabuse (Disulfiram) works at deterring alcohol intake by blocking the metabolism of ethanol (alcohol) and can cause vomiting; and 2) Vivitrol (Naltrexone injection), which decreases alcohol craving and dependency. There is a third medication, Campral (Acamprosate), which lessens the effects of alcohol withdrawal. However, there are no US studies that prove its efficacy (Bortolato, Finn, Ramaker, Barak, Ron, Liang and Olsen, 2013). 


There are researchers now working on greatly needed new therapeutic agents for preventing and treating alcohol use disorders. Even with the combination of psychopharmalogical and psychological interventions, rates of uncontrolled heavy drinking remain high resulting in “significant increases in crime, family disruption, underemployment, and Medicare and Medicaid costs” (Bortolato, Finn, Ramaker, Barak, Ron, Liang and Olsen, 2013).

Handouts for Samuel and Maria to better explain the elements involved in his treatment

  1. TEA System
  2. ALERT System
  3. ANGER System
  4. LET GO System
  5. CHILD System
  6. RELAPSE System

All available online at: www. coping.us at: http://coping.us/seastoolsforrecovery.html

Treatment Workbooks for Alcohol Use Disorders

 

Arkowitz, H., Westra, H.A., Miller, W.R. and Rollnick, S. (2008). Motivational Interviewing in the Treatment of Psychological Problems. New York: The Guilford Press.

 

Cleveland, H.H., Harris, K.S. and Wiebe, R.P. (2010). Substance Abuse Recovery in College-Community Supported Abstinence. New York: Springer.

 

Coombs, R.H. (2004). Handbook of Addictive Disorders-A Practical Guide to Diagnosis and Treatment. Hoboken, NJ: John Wiley & Sons, Inc.

 

Coombs, R.H. and Howatt, W.A. (2005). The Addiction Counselor’s Desk Reference. Hoboken, NJ: John Wiley & Sons, Inc.

 

Daley, D.C. and Marlatt, G.A. (2006). Overcoming Your Alcohol or Drug Problem, Effective Recovery Strategies, Workbook, Second Edition. New York: Oxford University Press.

 

DiGuarde, K.I. (2009). Binge Drinking Research Progress. New York: Nova Science Publishers, Inc.

 

Epstein, E.E. and McCrady, B.S. (2009). A Cogntive-Behavioral Treatment Program for Overcoming Alcohol Problems, Workbook. New York: Oxford University Press

 

Finley, J.R. and Lenz, B.S. (2009). Addiction Treatment Homework Planner, Fourth Edition. Hoboken, NJ: John Wiley & Sons, Inc.

 

Ladouceur, R. and Lachance, S. (2007). Overcoming Your Pathological Gambling, Therapist Guide. New York: Oxford University Press.

 

Ladouceur, R. and Lachance, S. (2007). Overcoming Your Pathological Gambling, Workbook. New York: Oxford University Press.

 

Leukefeld, C.G., Gullotta, T.P. and Stanton-Tindall, M. (2009). Adolescent Substance Abuse-Evidenced Based Approaches to Prevention and Treatment. New York: Springer.

 

Marlatt, G.A. and Donavan, D.M. (2005). Relapse Prevention-Maintenance Strategies in the Treatment of Addictive Behaviors, Second Edition. New York: The Guilford Press.

 

McCrady, B.S. and Epstein, E.E. (2009). Overcoming Alcohol Problems, Workbook for Couples. New York: Oxford University Press

 

Messina, J.J. (2013). Tools for Coping Series: (1) Self-Esteem Seekers Anonymous-The SEA’s Program Manual; (2) Laying the Foundation: Personality Traits of Low Self-Esteem; (3) Tools for Handling Loss; (4) Tools for Personal Growth; (5) Tools for Relationships; (6) Tools for Communications; (7) Tools for Anger Work-Out; (8) Tools for Handling Control Issue; (9) Growing Down-Tools for Healing the Inner Child; (11) Tools for a Balanced Lifestyle, retrieved at www.coping.us

 

Miller, P.M. (2009). Evidence-Base Addiction Treatment. Brulington, MA: Elsevier, Inc.


Miller, W.R. and Rollnick, S. (2002). Motivational Interviewing-Preparing People for Change. New York: The Guilford Press.

 

Perkinson, R.R. and Jongsma, A.E. (2009). The Addiction Treatment Planner, Fourth Edition. Hoboken, NJ: John Wiley & Sons, Inc.

 

Rosengren, D.B. (2009). Building Motivational Interviewing Skills-A Practitioner Workbook. New York: The Guilford Press.

 

Ross, D., Kincaid, H., Spurrett, D. and Collins, P. (2010). What is Addiction? Cambridge, MA: The MIT Press.

 

Shah, J.Y. and Gardner, W.L. (2008). Handbook of Motivation Science. New York: The Guilford Press

 

Springer, D.W. and Rubin, A. (2009). Substance Abuse Treatment for Youth and Adults-Clinicians Guide to Evidence-Based Practice. Hoboken, NJ: John Wiley & Sons, Inc.

References for Alcohol Use Disorder


Adamson, S.J., Sellman, J.D. and Glenys, M.D. (2005). Therapy preference and treatment

outcome in clients with mild to moderate alcohol dependence. Drug and Alcohol Review, 24. 209-216. doi: 10.1080/09595230500167502   

 

ADIS International (2007). Few pharmacotherapies appear effective in the treatment of dual

substance abuse and dependence. Drugs and Therapy Perspectives, 23(8), 13-15,

 

Back, S.E., Sonne, S.C., Killeen, T., Dansky, B.S. and Brady, K.T. (2003). Comparative profiles

of women with PTSD and comorbid cocaine or alcohol dependence. The American Journal of Drug and Alcohol Abuse, 29(1), 169-189. DOI: 10.1081/ADA-120018845

 

Back, S.E., Waldrop, A.E., Brady, K.T. and Hien, D. (2006). Evidenced-based time-limited

treatment of co-occurring substance-use disorder and civilian-related posttraumatic stress disorder. Brief Treatment and Crisis Intervention, 6, 283-284.

 

Baille, A.J., Sanibale, C., Stapinski, L.A., Teesson, M., Rapee, R.M. and Haber, P.S. (2013). An

investigator-blinded, randomized study to compare the efficacy of combined CBT for alcohol use disorders and social anxiety disorder versus CBT focused on alcohol alone in adults with comorbid disorders: The combined alcohol social phobia (CASP) trial protocol. BMC Psychiatry, 13, 199-211. doi:10.1186/1471-244X-13-199

 

Baker, A.L., Kavanagh, D.J., Kay-Lambkin, F.J., Hunt, S.A., Lewin, T.J., Carr, V.J. and

Connolly, J. (2010). Randomized controlled trial of cognitive-behavioural therapy for co-existing depression and alcohol problems: Short-term outcomes. Addiciton, 105, 87-99.  doi:10.1111/j.1360-0443.2009.02757.x

 

Birky, I. (2005). Evidence-based and empirically supported college counseling center treatment

of alcohol related issues. Journal of College Student Psychotherapy, 20(1), 7-21. doi:10.1300/J035v20n01_02 

 

Blonigen, D.M., Timko, C., Finney, J.W., Moos, B.S. and Moos, .H. (2011). Alcholics

anonymous attendance, decreases in impulsivity and drinking and psychosocial outcomes over 16 years: Moderated-mediation from a developmental perspective. Addiction, 106, 2167-2177. doi:10.1111/j.1360-0443.2011.03522.x

 

Bottlender, M. and Soyka, M. (2006). Efficacy of an intensive outpatient rehabilitation program

in alcoholism: Predictors of outcomes 6 months after treatment. European Addiction Research, 11, 132-137.  doi: 10.1159/000085548   

 

Brown, R.A., Ramsey, S.E., Kahler, C.W., Palm, K.M., Monti, P.M. Abrams, D., Dubreuil, M.,

Gordon, A. and Miller, I.W. (2011). A randomized controlled trial of Cognitive-behavioral treatment for depression versus relaxation training for alcohol-dependent with elevated depressive symptoms. Journal of Studies on Alcohol and Drugs, 72(2), 286-296.

 

Buck, K.J., Milner, L.C., Denmark, D.L., Grant, S.G.N. and Kozell, L.B. (2012). Discovering

genes involved in alcohol dependence and other alcohol responses. Alcohol Research: Current Reviews, 34(3), 367-374.

 

Connors, J.P., Symons, M., Feeney, G.F.X., Young, R.M. and Wiles, J. (2007). The application

of machine learning techniques as an adjunct to clinical decision making in alcohol dependence treatment. Substance Use and Misuse, 42, 2193-2206. DOI: 10.1080/10826080701658125

 

Cooper, L. (2012). Combined motivational interviewing and cognitive-behavioral therapy with

older adult drug and alcohol abusers. Health and Social Work, 37(3), 173-179.   doi: 10.1093/hsw/hls023

 

Curry, J., Silva, S., Rohde, P., Ginsburg, G., Kennard, B., Kratochvil, C., Simons, A., Kirchner,

J., May, D., Mayes, T., Feeny, N., Albano, A.M., Lavanier, S., Reinecke, M., Jacobs, R., Beckner-Weidman, E., Weller, E., Emslie, G., Walkup, J., Kastelic, E., Burns, B., Wells, K. and March, J. (2012). Onset of alcohol or substance use disorders following treatment for adolescent depression. Journal of Consulting and Clinical Psychology, 80(2), 299-312. DOI: 10.1037/a0026929

 

Cutler, R.B. and Fishbain, D.A. (2005). Are alcoholism treatments effective? The project

MATCH data. BioMed Central Public Health, 5(75), 1-10. doi:10.1186/1471-2458-5-75

 

Davies, D.L., Bortolato, M., Finn, D.A., Ramaker, M.J., Barak, S., Ron, D., Liang, J. and Olsen,

R.W. (2013). Advances in the discovery and preclinical testing of novel compounds for the prevention and/or treatment of alcohol abuse disorders. Alcoholism: Clinical and Experimental Research, 37, (1), 8-15. DOI: 10.1111/j.1530-0277.2012.01846.x

 

Deas, D. (2008). Evidence-based treatments for alcohol use disorders in adolescents. Pediatrics,

121 (Supplement), S348-S354. DOI: 10.1542/peds.2007-2243G

 

Farris, S.G., Epstein, E.E., McCrady, B.S. and Hunter-Reed, D. (2012). Do co-morbid anxiety

disorders predict drinking outcomes in women with alcohol use disorders? Alcohol and Alcoholism, 47(2), 143-148. doi: 10.1093/alcalc/agr155

 

Freyer-Adam, J. Beate, C., Bischof, G., Baumeister, S., Rumpf, H., John, U., and Hapke, U.,

(2008). Predicting utilization of formal and informal help among general hospital inpatients with alcohol use disorders. International Journal of Methods in Psychiatric Research 17(1), 70-75. doi: 10.1002/mpr.252 

 

Gossop, M., Stewart, D. and Marsden, J. (2008). Attendance at narcotics anonymous and

alcoholics anonymous meetings, frequency of attendance and substance use outcomes after residential tratmetn for drug dependence: A 5-year follow-up study. Addiction, 103(1), 119-125. doi:10.1111/j.1360-0443.2007.02050.x

 

Harris, K.S., Baker, A.K., Kimball, T.G. and Shumway, S.T. (2007). Achieving systems-based

sustained recovery: A comprehensive model for collegiate recovery communities. Journal of Groups in Addiction and Recovery, 3(2-4), 220-237. doi: 10.1080/15560350802080951

 

Hodge, D.R. (2011). Alcohol treatment and cognitive-behavioral therapy: Enhancing

effectiveness by incorporating spirituality and religion. Social Work, 56, 1, 21-31.

 

Kay-Lambkin, F.J., Baker, A.L., Lewin, T.J. and Carr, V.J. (2009). Computer-based

psychological treatment for comorbid depression and problematic alcohol and/or cannabis use: A randomized controlled trial of clinical efficacy. Addiction, 104(3), 178-188. doi:10.1111/j.1360-0443.2008.02444.x

 

Kelly, J.F. and Myers, M.G. (2007). Adolescents’ participation in alcoholic anonymous and

narcotics anonymous: Review, implications and future directions. Journal of Psychoactive Drugs, 39(3), 259-269.

 

Kelly, J.F., Magill, M. and Stout, R.L. (2009). How do people recover from alcohol dependence?

A systematic review of research on mechanisms of behavior change in alcoholics anonymous. Addiction Research and Theory, 17(3), 236-259. doi: 10.1080/16066350902770458 

 

Kelly, J.F., Stout, R.L., Magill, M., Tonigan, J.S. and Pagano, M.E. (2010). Mechanisms of

behavior change in alcoholics anonymous: Does alcoholics anonymous lead to better alcohol use outcomes by reducing depression symptoms? Addiction, 105, 626-636. doi:10.1111/j.1360-0443.2009.02820.x

 

Kelly, J.F., Hoeppner, B., Stout, R.L. and Pagano, M. (2012). Determining the relative

importance of the mechanisms of behavior change withing alcholoics anonymous: A multiple mediator analysis. Addiction, 107, 289-299. doi:10.1111/j.1360-0443.2011.03593.x

 

Kelly, J.F. and Claire, G.M. (2013). The twelve promises of alcoholics anonymous:

psychometric measure validation and mediational testing as a 12-step specific mechanism of behavior change. Drug and Alcohol Dependence, 133(2), 633-640. DOI: 10.1016/j.drugalcdep.2013.08.006

 

Klein, A.A. and Anker, J.J. (2013). Computer-based recovery support for patients receiving

residential treatment for alcohol/drug dependence: Relationship between program use and outcomes. Telemedicine and e-Health, 19(2), 104-109.  DOI: 10.1089/tmj.2012.0107.

 

Krentzman, A.R., Brower, K.J., Cranford, J.A., Bradley, J.C. and Robinson, E.A.R. (2012).

Gender and extroversion as moderators of the association between alcoholics anonymous and sobriety. Journal of Studies on Alcohol and Drugs, 73(1), 44-52.

 

Kushner, M.G., Donahue, C., Sletten, S., Thuras, P., Abrams, K., Peterson, J. and Frye, B.

(2006). Cognitive behavioral treatment of comorbid anxiety disorder in alcoholism treatment patients: Presentation of a prototype program and future directions. Journal of Mental Health, 15(6), 697-707. DOI: 10.1080/09638230600998946

 

Kushner, M.G., Maurer, E.W., Thuras, P., Donahue, C., Frye, B., Menary, K.R., Hobbs, J.,

Haeny, A.M. and Van Demark, J. (2012). Hybrid cognitive behavioral therapy versus relaxation training for co-occuring anxiety and alcohol disorder: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 81(3), 429-442. DOI: 10.1037/a0031301

 

Lederman, L.C. and Menegatos, L.M. (2011). Sustainable recovery: The self-transformative

power of storytelling in alcoholics anonymous. Journal of Groups in Addiction and Recovery, 6, 206-227. DOI: 10.1080/1556035X.2011.597195

 

Lee, J.H., Kwon, H., Choi, H. and Yang, B.H. (2007). Cue-exposure therapy to decrease alcohol

craving in vitural environment. Cyberpsychology and Behavior, 10(5), 617- 623.  DOI: 10.1089/cpb.2007.9978

 

Lieberman, D. (2005). Clinical characteristics of individuals using an online alcohol evaluation

program. American Journal on Addictions, 14, 155-165. doi: 10.1080/10550490590924818 

 

Long, C. G., Kidger, T. and Hollin, C. R. (2001). The evolution of an evidence-based

programme for problem drinking: treatment components. Clinical Psychology and Psychotherapy, 8(6), 458-467. doi: 10.1002/cpp.300 

 

Magill, M. and Ray, L.A. (2009). Cognitive-behavioral treatment with adult alcohol and illicit

drug users: A meta-analysis of randomize controlled trial. Journal of Studies on Alcohol and Drugs, 70(4), 516-527

 

Marczinski, C.A., Fillmore, M.T., Bardgett, M.E. and Howard, M.A. (2011). Effects of energy

drinks mixed with alcohol on behavioral control: Risks for college students consuming trendy cocktails. Alcoholism: Clinical and Experiental Research, 35(7), 1282-1292. DOI: 10.1111/j.1530-0277.2011.01464.x

 

McCrady, B., Epstein, E., and Kahler, C. (2004). Alcoholics anonymous and relapse prevention

as maintenance strategies after conjoint behavioral alcohol treatment for men: 18-month outcomes. Journal of Consulting and Clinical Psychology, 72(5), 870-878.  doi: 10.1037/0022-006X.72.5.870 

 

McDevitt-Murphy, M.E., Murphy, J.G., Monahan, C.J., Flood, A.M. and Weathers, F.W. (2010),

Unique patterns of substance misuse associated with PTSD, depression and social phobia. Journal of Dual Diagnosis, 6, 94-110. DOI: 10.1080/15504261003701445

 

Miller, J.C. (2008). 12-step treatment for alcohol and substance abuse revisted: Best available

evidence suggests lack of effectiveness or harm. International Journal of Mental Health and Addiction, 6, 568-576. DOI 10.1007/s11469-008-9146-4

 

Miller, W.R. (2005). Are alcoholism treatments effective? The project MATCH data: Response.

BioMed Central Public Health, 5(76), 1-4. doi:10.1186/1471-2458-5-76

 

Monti, P., Barnett, N., Colby, S., Gwaltney, C., Spirito, A., Rohsenow, D. and Woolard, R.

(2007). Motivational interviewing versus feedback only in emergency care for young adult problem drinkers. Addiction, 102(8), 1234-1243. doi:10.1111/j.1360-0443.2007.01878.x 

 

Ooteman, W., Naassila, M., Koeter, M.W.J., Verheul, R., Shippers, G.M., Houchi, Hakim,

Daoust, M. and van den Brink, W. (2009). Predicting the effect of naltrexone and acamprosate in alcohol-dependent patients using genetic indicators. Addiction Biology, 14, 328-337. doi:10.1111/j.1369-1600.2009.00159.x

 

Ray, L.A., Chin, P.F., Heydari, A. and Miotto, K. (2011). A human laboratory study of the

effects of quetiapine on subjective intoxication and alcohol craving. Pharmacology, 217, 341-353. DOI 10.1007/s00213-011-2287-3

 

Scweizer, T.A. and Vogel- Sprott, M. (2008). Alcohol - impaired speed and accuracy of

cognitive functions: A review of acute tolerance and recovery of cognitive performance. Experimental and Clinical Psychopharmacology. 16(3), 240-250. doi: 10.1037/1064-1297.16.3.240 

 

Shaffer, H.J., Nelson, S.E., LaPlante, D.A., LaBrie, R.A., Albanese, M. and Caro, G. (2007). The

epidemiology of psychiatric disorders among repeat DUI offenders accepting a treatment-sentencing option. Journal of Consulting and Clinical Psychology, 75(5), 795-804. DOI: 10.1037/0022-006X.75.5.795

 

Stewart, C. (2009). The co-relation of alcoholic's anonymous participation to alcohol and other

drug (AOD) treatment outcomes. Alcoholism Treatment Quarterly, 27:19-37.doi: 10.1080/07347320802586684 

 

Thomas, S., Bacon, A.K., Sinha, R., Uhart, M. and Adinoff, B. (2012). Clinical laboratory

stressors used to study alcohol-stress relationships. Alcohol Research: Current Reviews, 34(4), 459-467.

 

Vaillant, G.E. (2005). Alcoholics anonymous: Cult or cure? Austrailian and New Zealand

Journal of Psychiatry, 39, 431-436.

 

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treatment for alcohol dependence: A systematic review of controlled evaluations. Social Work Research, 28(1), 41-53. doi:1076-5309/04 

 

Varra, A.A., Hayes, S.C., Roget, N. and Fisher, G. (2008). Randomized control trial examining

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Vielva, I. and Iraurgi, I. (2001). Cognitive and behavioral factors as predictors of abstinence

following treatment for alcohol dependence. Addiction, 96, 297-303. DOI: 10.1080/09652140020021035

 

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Walitzer, K.S. and Dermen, K.H. (2004). Alcohol-focused spouse involvement and behavioral

couples therapy: Evaluation of enhancements to drinking reduction treatment for male problem drinkers. Journal of Consulting and Clinical Psychology, 72(6), 944-955. DOI: 10.1037/0022-006X.72.6.944

 

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WHERE DO I GO FROM HERE?

CONCERNING ALCOHOL USE DISORDERS

Now that you have read this section, in “My Mental Health Professional Practitioner Journal” record your answers and reactions to the following questions:

  1. How will this information help me as a Mental Health Professional?
  2. How interested am I in implementing Evidence Based Practices concerning Alcohol Use Disorders in my clinical practice?
  3. Why is it important that I learn more about Alcohol Use Disorders?
  4. What more do I need to know about this Alcohol Use Disorders?
  5. Where can I go to obtain more information about Alcohol Use Disorders and their mental health comorbidities?
  6. Where can I go to obtain the journal articles, manuals, workbooks or guidebooks on Alcohol Use Disorders?