The 7 effective psychological treatments for alcoholism
Alcoholism is a disorder that can be characterized both by the abusive use of this substance at specific times and by the physical and psychological dependence on drinking. If sustained over the long term, alcoholism can lead to very serious life consequences, such as suicide from depression or Wernicke-Korsakoff syndrome.
In this article we will describe the main psychological treatment programs for alcoholism , focusing on those whose effectiveness 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 use above all 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 reinforcements to replace those provided by alcohol.
Often these programs are 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. Approach to community reinforcement
Hunt and Azrin developed the “Community reinforcement approach” program for the treatment of severe alcoholism in 1973. Its effectiveness has led it to be applied to other types of addiction as well, and it has proved particularly useful in the case of heroin when combined with contingency management.
The two main objectives of this treatment, which are closely related, are the reduction of alcohol consumption and the development of alternative habits that reinforce sobriety. In this way, positive reinforcement is used as a key tool; the same is true for promoting motivation for change.
The approach to community reinforcement is based on techniques such as training in communication skills (focused above all on the immediate environment), the practice of healthy leisure activities, the acquisition of skills that facilitate the search for employment and the improvement of resistance to the temptation to drink through covert awareness.
As with other treatments we will mention, the approach to community reinforcement is usually 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 couples therapy
Family and couple therapies for alcoholism are multi-component programs that have as their fundamental objectives the improvement of communication between the patient and his/her closest relatives , as well as the increase in 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, favours alcohol consumption; in contrast, if the interaction is positive, it can be a key source of reinforcement with the potential to modify the drinking behaviour. In addition, the family can provide support for abstinence.
An example is the Community reinforcement and family training programme or CRAFT developed by Millar, Meyers and Tosigan in 1999. This therapy uses motivational interviewing, training in contingency management, identification of risk situations and leisure activities with the family.
3. Social and coping skills training
Programs 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 these types of strategies and their practice in contexts that usually trigger drinking behaviour.
Since there are a large number of treatments for alcoholism that have skills training as their core, the effectiveness of these programs may vary depending on the specific case . The intervention developed by Langley and collaborators, which is called “coping skills for drinking behaviour”, is a remarkable example.
4. Relapse prevention programme
Although a few decades ago relapse prevention was seen as an additional module that could enhance the therapeutic effects of other programmes, today relapse prevention is in itself a category of differentiated treatment and its effectiveness has been proven even if applied independently.
Marlatt and Gordon’s model is especially well known . These authors emphasize the progressive nature of recovery; in this sense, their therapy teaches us to distinguish between specific “falls” and “relapses”, which are more chronic. Again, coping skills training for risk situations is a central aspect.
5. Signal exposure therapy
Cue Exposure Therapy, abbreviated as “CET”, has been applied with moderately effective results in cases of alcohol abuse, as well as in programs to stop smoking.
It focuses on reducing the reactivity of the addicted person to the environmental signals that trigger the conditioned responses of “craving” or desire to consume. For this purpose, procedures are used to expose and prevent response to the presence of the previous 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 desire for addiction.
6. Self-control or controlled drinking programs
These treatments are applied when the person wants to reduce the intensity of his 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 where total abstinence programmes have failed.
Normally, therapy begins by setting goals, performing a functional analysis of drinking situations and self-recording 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 behaviour in whose maintenance reinforcers such as the effects of drinking itself or the situations of social interaction to which addiction is associated have an influence.
These programmes consist of replacing inadequate reinforcements with adaptive and tangible incentives , mainly personal use items such as tickets for cinema sessions or other shows. These rewards are obtained by demonstrating that abstinence has been maintained, often through urine tests.