Treatments for Alcoholism Homework Help

Treatments for Alcoholism

Alcoholism refers to uncontrolled and habitual intake of alcohol. Alcoholic refers to an individual suffering from alcoholism. Obsessive intake of alcohol is known to be detrimental to human health and has social repercussions for it affects personal relationships. Alcoholism is considered to be a dual disease in that it has both components of physical and mental. Several factors such as history, social environment, mental health, stress, gender, ethnic group, and age have significant influence on alcoholism. It is imperative for a community to be educated on the dangers of excessive consumption of alcohol. There various recommended treatment for alcohol dependence such as aversion-desensitization treatment, the home detoxification, and the outpatient treatment for women. World Health Organization is working on the improvement of the above treatment methods to increase their effectiveness. Health experts recommend for responsible drinking and advice families with relatives suffering from alcoholism to seek treatment.

Alcoholism is a term used to refer to the uncontrolled and compulsive consumption of alcohol. It leads to health problems for the drinker coupled with problems in the drinker’s personal relationships. This is to the detriment of the drinker’s social standing. Medically, it is considered as a disease which is referred to as a neurological disorder, alcohol dependence or alcohol abuse. The World Health Organization encourages the use of the term alcohol dependence syndrome instead of alcoholism. Alcoholic is the term used to refer to a person who suffers from alcoholism.
Alcoholism is a dual disease because it is considered to include both physical and mental components. There are several factors that influence the risk of alcoholism such as family history, social environment, mental health, stress, gender, ethnic group and age. When there is long term alcohol abuse, changes in the structure of the brain occur and also chemistry such as physical dependence and tolerance (Tsai et. al., 2010). These changes result in the person’s inability to stop drinking usually resulting in alcohol withdrawal syndrome when the person finally quits drinking. The alcohol withdrawal syndrome is used to refer to those symptoms that one experiences after stopping or reducing the consumption of alcohol after a prolonged period of excessive intake of alcohol. The withdrawal syndrome is known to include seizures. Alcohol causes damage to almost all the body’s organ’s including the brain. This paper will discuss on the treatment of alcoholism.
Obstacles to the performing of brief interventions
Healthcare officials play an essential role in the detection and treatment of persons with alcohol problems. However, some physicians have been accused of failure to conduct alcohol interventions campaigns. They cite reasons such as fear of antagonizing the patients, inadequate training, lack of time, belief that the alcoholics are not responsive to interventions and the perception that there is incompatibility between primary healthcare and alcohol (Kaner et al, 1996). United States physicians in family practice are considered the most likely to diagnose problem drinking and also to perform the necessary alcohol interventions after conducting a training program.
There is however a substantial amount of doctors who prefer to transfer patients with alcohol related problems to the nurses for further treatment (Tsai et. al., 2010). A qualitative study in the UK of nurses revealed that most of them are not properly prepared for the treatment of problem alcohol use. Another study in Finland revealed that could be six obstacles that prevent the effective provision of alcohol interventions. These obstacles are lack of guidelines for interventions, difficulty in identifying heavy drinkers who are at an early-phase, uncertainty in the justification of a discussion about alcohol issues with an affected patient, a perception that there is lack of time to perform brief interventions, confusion in understanding what is meant by early-phase heavy drinking and lack of self-efficiency in trying to help patients with problem of drinking (Litt et al., 2003).
There have also been other barriers relating to nurses such as their attitude towards the use of alcohol, negative reactions by the patients, other priorities for both the patients and nurses, lack of proper training for the nurses and nurse confusion about alcohol related issues.
Measures
Measures of alcohol use include the number of drinks that one takes, for example if one is a light, moderate or heavy drinker and the impact on the individual’s health that is whether the it is harmful, hazardous or at-risk binge drinking etc. There are various categories of alcohol use disorders such as alcohol problems, alcohol dependence, heavy drinking, hazardous drinking, alcohol use frequency, at-risk drinking, severe drinking, moderate drinking, light drinking and binge drinking (“Craving intervention predicts changes in negative mood following alcohol treatment.” 2011).
Coping with alcoholism
One of the strategies that were considered to be effective in reducing vulnerability to problem alcohol was the development of coping skills. Mediators first observe cognitive behavioral-treatment when they are examining coping skills. The main aim of cognitive-behavioral treatment is to identify deficits in the abilities of patients to cope with situations that have a high risk of causing relapse. Coping actions are those behaviors or cognitions that a patient takes in the face of challenges that may prevent him from reaching his desired goal. Cognitive-behavioral treatment includes sessions in avoiding situations that are considered of a high risk, controlling the cravings for alcohol, managing stress, controlling anger and other emotions that predispose to the seeking of alcohol and refusing any offers of alcohol drinks. CBT is considered to be effective in the treatment of alcohol dependence.
The success of CBT as has been shown by many studies is attributed to the successful acquisition and also performance of the coping skills. It has been determined from numerous researches that relapse is primarily determined by the lack of a proper or appropriate coping response to be used instead of resorting to drinking (Litt et al.,, 2003). However, there are also a number of researches that argue against this notion citing that there are other factors that could be of primary importance in the occurrence of a relapse. Severe stress that comes after treatment has also been attributed to relapse. It has been noted that those patients that are still recovering may be pushed back into drinking by the stressful circumstances that they may face.
There are also other researchers who argue that some coping skills are not necessary to bring about good treatment outcomes. There are those patients that engage in treatment at a critical period when they have requisite confidence or motivation to deal with the treatment experience. The high levels of confidence lead the patient in establishing or adopting cognitive-behavioral coping skills that help the patient achieve good outcomes once s/he begins treatment. Self-efficacy in abstinence and readiness for change are therefore considered to be good candidates in treatment of alcohol dependence.
Aversion-desensitization treatment
Aversion-desensitization treatment is given to patients whereby a patient is made to watch his own audio-video that has been recorded with his drinking ‘confessions’ while the patient is derogated by two therapists and later desensitized on anxieties related to drinking. Five out of seven patients who had undertaken the aversion-desensitization treatment were discovered to have been abstinent through six to nine months of follow-up interviews (Primo et al, 1972).
There were three treatments that were usually conducted with aversion-desensitization being considered to be the most effective of them all. The other treatments were interpersonal aversion that was followed by a controlled procedure of friendly interaction and a group discussion. The aversion therapy was conducted on several occasions. In the first session, the patient was taken in a room where he sat in an arm chair with recording equipment and two therapists. The patient was interviewed in depth for about an hour on aspects concerning his daily life which were affected by the drinking.
The therapists elicited defensive reactions from the patient by questioning the inconsistencies in his answers and also confronting the patient with his self-defeating behaviors. The videos were later edited to 25 minutes and left with the data that portrayed the patient’s most vivid conflicts. In the next sessions, the patient watched the recording as he sat in the armchair while the therapists drew the patient’s attention to the problems that were affecting him, to all that appeared aversive to him and also showed him how drinking had deteriorated his life.
The end result was that these sessions associated feelings and thoughts about alcohol with interpersonal experiences that were negative. After every aversion therapy session, a half hour was used to give aversion-desensitization to the patient in another room. A follow-up of six to nine months was conducted on the patients. The follow-ups included sending the patient the test material, a cover letter and a return envelope. The results of the 21 patients who took the various treatments were recorded. Five out of the seven who took the aversion-desensitization treatment were abstinent while two were still drinking, one out of the seven who took the aversion counselling treatment were abstinent while the rest were still drinking and one out of the seven who took the group discussion treatment was abstinent while three were still drinking. Three of the patients could not be traced. It is therefore clear that the most effective treatment in this case was the aversion-desensitization treatment (Primo et al., 1972).
Outpatient alcoholism treatment
The treatment was done on women with alcohol problems who were seeking outpatient treatment. The women were accompanied by their partner or their male spouse. The partner was supposed to be someone they were married to, cohabitating for a period of at least six months or in a non-cohabitating relationship that had lasted for at least a year. The women were eligible if they were 18 yrs of age or above, in a heterosexual relationship that was stable, with a partner who was willing to take part in treatment as well as the follow-up, met dependence diagnosis test in the past 12 months and had at least used alcohol once in the two months prior to the recruitment. There was a time-line follow back interview conducted to assess drug and alcohol use for both the partner and the woman in the 90 days before the baseline interview. There were also questionnaires offered to identify the consequences of use and readiness to change. There was a structure clinical interview that was done to assess drug and alcohol use in the past thirty days among many other measures (Graff et. al., 2009).
The procedures for the treatment were as follows: There was a telephone screen which took about 10 minutes. It was meant to describe the treatment project to the patient and to also determine the eligibility of the caller. Next followed a clinical screen interview which was approximately two hours and was meant to create a rapport with the participant and further assess the eligibility of the individual. Then there was a baseline research assessment that assessed the psychosocial functioning of the woman, the extent and nature of her social networks and the collection of the partner’s and the woman’s and alcohol use statistics in the last 90 days.
After the baseline interview, the woman was now ready for the treatment. Couples were assigned to the Alcohol behavioural Couples Treatment or the Alcohol Behavioural Individual Treatment randomly. The two included 26 week program that had 20 sessions. Abstinence from alcohol was emphasized. Results identified that the women in the individual program were retained in treatment for a longer period than those who had undertaken the couples program. Older women who had stable marital relationships, fewer children, less alcohol dependence symptoms attended more treatment sessions and also completed more homework as compared to those who were in less satisfying relationships. However, the study had several limitations with the sample being middle to upper class and mostly Caucasian and also having a high retention. The treatment also required that the woman have a male partner willing and ready to participate in the treatment.
It was also discovered that women in individual treatment attended more of the sessions for treatment than the women in the couples’ treatment. There were found to be associations between the relationship variables and the treatment. Factors such as the drinking status of the spouse, marital stability, and the encouragement offered by a spouse for drinking played a significant role in retention and treatment engagement. It is also essential to offer patients choices in their treatment as was shown by the research. The choices made by the patients have an implication in the matching of the treatment. More study should also be done on the relationship factors as they would give more insight on their role in the full treatment of a patient (Graff et al., 2009).
Home detoxification of alcohol dependency
In England, alcohol dependency is considered to be one of the major health issues that affect approximately 4 percent of the population under the age interval of between 16 to 65 years. The country’s annual expenses, that is related to the alcohol harm is estimated to amount to £12.6 billion. The impact of alcohol goes well beyond ill health. In United Kingdom, the number of deaths related with alcohol has increased and report from the Office of National Statistics indicates that the death rates more than doubled from 6.9 per hundred thousand people in 1991 to 18.7 per a hundred thousand people in 2008 (Carlebach et al. (2011). In 2009, it reached its highest level of 8,664 deaths. The United Kingdom government considers legal, the daily intake of a maximum of four units alcohol for men and three for women, however 24 percent of the population take more than what is recommended thus affecting their wellbeing.
The voluntary sector and the NHS in England provided a community alcohol service to be used for the home detoxification of alcohol dependant persons. An alcohol service nurse assessed the service users to determine their suitability for the home detoxification. Two community NHS nurses delivered the home detoxification service. The staff of the voluntary sector provided a range of psychological services that included complementary therapies and counselling. A steering group managed the service. The aim of this treatment was to identify the experiences of those users that were involved in the exercise, their family members and the staff.
Semi-structured comment sheets and interviews were used to collect data from the participants. The home detoxification service had been used by many of the participants. It included counselling, one to one support, complementary therapies and the reintegration done by voluntary organisation with clinical interventions on the substitute subscription and brief interventions. The findings were structured in such a way that they followed the journey of the service user from beginning to completion of the treatment. Most of the users had been referred to the detoxification service through the self-harm liaison team, the G.P and social services. There were also barriers to the service such as not all people referred took part in the service and the staff also discovered that some people were not yet ready to give up alcohol. The services were provided in a building that was viewed as providing support for drug misuse. Several of the participants had at one point relapsed.
Many users valued the home detoxification service and it was also highly effective. Relationships developed between the users and the nurses were highly valued. There was however complains about the waiting interval from the time one was referred to the time the treatment began (Carlebach et al., 2011).
Conclusion
In a nutshell, excessive use of alcohol has very adverse effects as it usually affects almost all organs in the body. It is crucial for health sector of a country to introduce education programmes that provide insight about alcohol intake, its effect on the illness of people as well as the treatment. In addition, the health sector needs to develop and improve facilitators and find ways of reducing the hurdles for intervention for a problem associated with the intake of alcohol (Tsai et. al., 2010). Nurses enrolled for role playing in training programmes would have the opportunity to exercise their skills. It is crucial for emergency department nurses to be informed about the importance of their role in alcohol assessment and intervention. This would give them the knowledge of how to provide a better care to emergency department patients.
The general public as well as the policy makers needs to be educated about alcohol. The community should therefore be sensitized on the dangers of excessive alcohol use. The aversion-desensitization treatment, the home detoxification and the outpatient treatment for women were particularly successful in the treatment of alcohol dependence and the affected person can use the choice they prefer for treatment (Tsai et. al., 2010). There are also improvements that are being done on these treatment methods to increase their effectiveness as the World Health Organization tries to deal with the increasing problem of alcohol dependence. Responsible drinking is usually recommended by health care experts to those who feel they are just not ready to quit drinking alcohol. Support by family members is also very essential in helping a person who is having an alcohol dependence problem and therefore family members are advised to encourage the person to seek treatment rather than alienate the individual.

References:
Anonymous, (2011). Craving intervention predicts changes in negative mood following alcohol treatment. The Brown University Digest of Addiction Theory and Application, 30 (4), 4-6.
Carlebach, S et al. (2011). Experiences of Home Detoxification for Alcohol Dependency. Nursing Standard, 26 (10), 41-47.
Graff, F. et al. (2009). Engagement and Retention in Outpatient Alcoholism Treatment for Women. American Academy of Addiction Psychiatry, 18,277-288.
Litt, M. D. et. al (2003). Coping Skills and Treatment Outcomes in Cognitive-Behavioral and Interactional Group Therapy for Alcoholism. Journal of Consulting and Clinical Psychology, 1(7), 118-128.
Primo, R., Terrell, F. & Wener, A. (1972). An Aversion-Desensitization Treatment for Alcoholism. Journal of Consulting and Clinical Psychology, 3 (38), 294-398.
Tsai, Y. et. al. (2010). Facilitators and barriers to intervening for problem alcohol use. Journal of advanced nursing, 66(7), 1459-1468.