Psychological Treatments In Alcoholism

Most psychological treatments for alcoholism are based on the cognitive-behavioral model. This assumes that said substance is a powerful reinforcer capable of maintaining self-administration of alcohol. Thus, the cognitive-behavioral model offers an alternative to the classical approach to alcoholism as a disease and, therefore, to the medical model.

The ultimate goal of psychological treatments for alcoholism is aimed at reducing the person’s preference for alcohol, while increasing their preference for other activities that will make it possible to maintain adaptive functioning in the long term.

Another objective could be, depending on the patient we meet, their personal resources and the family or social environment, to train in a non-problematic use of the substance. This is what has been called controlled drinking.

Currently, in the psychological treatments in alcoholism we can differentiate two large blocks of intervention: those aimed at abstinence and those that have the objective of achieving a safe consumption, in a controlled way. We will describe them below.

Psychological treatments in alcoholism oriented towards abstinence:

Among the psychological treatments in alcoholism that are aimed at the patient to stop drinking radically, the scientific review indicates the following as useful:

Training in social skills or self-control

It is used in patients who lack adequate inter and intrapersonal skills or who cannot control their emotional state except through alcohol. Drinkers have been seen to consume less alcohol if they have an alternative coping strategy in a stressful social situation.

An example could be the manual by Monti et al. (2002) that provides social strategies for both the patient and his support network without resorting to consumption.

Community reinforcement approach

It is aimed at changing the lifestyle related to the consumption of the substance. It includes techniques such as problem solving, family behavior therapy, social counseling, and job search training. It can also be used for controlled drinking.

Marital behavioral therapy

It consists of moving from alcohol consumption being reinforcing to abstinence being the goal. Involvement in activities that are satisfactory is sought, especially those that do not involve drinking, together with the couple.

Aversive therapy

The goal is to reduce or eliminate the individual’s desire for alcohol. Different stimuli or images are used in such a way as to achieve a negative conditioned response to the signs that are related to drinking (color, smell…).

Different aversive stimuli have been used, from the classic electric shock with Kantorovich in 1929 to chemical or imaginary aversion.

Relapse prevention

The best known is that of Marlatt and Gordon. A great weight is given to the client as responsible for their change in behavior and, therefore, for the maintenance of said change once achieved.

Relapse prevention must take into account increasing your coping strategies in high-risk stressful situations.

Treatments aimed at controlled drinking

They are used when the person does not want to reach complete abstinence or does not have physical problems. The most representative program of this group of psychological treatments in alcoholism is that of Sobell and Sobell.

The Sobell and Sobell Program aims to prevent problem drinkers from becoming chronic. It is part of a self-management approach, since the objective is to make a brief intervention, in which it is the individual who puts into practice many of the strategies that are taught by himself.

The Sobell and Sobell program lasts four weeks and is conducted on an outpatient basis. It is not very intensive in the clinic, but with enough homework. It wants the person to finally bring about their own change.

Some of their recommendations are the following: do not consume more than 3 units of drink a day and do not drink more than 4 days a week, with the aim of reducing the level of tolerance to alcohol. Do not drink in high risk situations, do not drink more than one unit of drink per hour, delay the time between the decision to drink and drink by 20 minutes.

It is a program in which training in problem solving and relapse prevention becomes very important so that the person defines those situations related to consumption in his life and has strategies to deal with them.

conclusion

For both complete abstinence and controlled drinking, the ultimate goal is for the patient to learn alternative strategies to curb the urges to drink alcohol. Either learning social skills in which to say no to people who encourage us to drink or efficiently solving those problems that are solved with alcohol.

In this sense, especially the controlled drinking program, is of great importance today, due to the large increase in young people who face their problems and emotions based on excessive drinking on weekends.

It is a goal to ensure that these young people do not become pathological drinkers and that they learn effective ways of managing their lives that do not involve drug use.