TREATMENT APPROACHES TO ALCOHOL ABUSE
It could be said that alcohol has been around almost as long as the human race and almost certainly has been part of the culture since that first taste of fermented fruit. Through the centuries alcohol has played an important role in human culture and has been used for spiritual, medicinal and recreational purposes.
Though the significance, ideas, morals and uses surrounding alcohol have shifted through the centuries, its use has remained constant.
With enjoyment and the respect often associated with alcohol, history reports that there has always been a dark side to a culture that imbibes. Those individuals in the crowd, who insist on over-drinking and don’t seem to notice when they are obnoxiously or quietly destroying themselves and the world around them, ruin the party for everyone. Through over-indulgence these individuals draw attention to themselves, cause laws to be passed and have marched through time as a dilemma. The Egyptians, Greeks, Romans, Chinese and many cultures up to the present have been presented with the dilemma and probably asked the same question that we ask ourselves today; WHAT DO WE DO WITH THESE PEOPLE?
HISTORY OF ALCOHOL ABUSE TREATMENT
While the history books have ample recounts on the evolution of various alcoholic drinks parading through civilization since the stone ages, there is little record of therapeutic attempts to treat alcohol abuse until more recent times. Attempts to deal with over drinking in earlier civilizations were made by leaders of religions or countries, through encouragement of temperance or legal mandates.
It isn’t until the 1700s that we find clear attempts at treatment for alcohol abuse. Interestingly enough, the earliest approaches have some similarities to methods that are considered most successful today. William White, in his book Slaying the Dragon writes that the first “social movement of mutual support” to deal with alcohol abuse occurred with Native American Indians as early as 1772. Similar to Alcoholic Anonymous and other self-help support groups, individuals with negative drinking experiences supported each other through a recovery based on mutual problems.
A similar system of mutual support, but with delineated steps was created in 1935 when the concept of Alcoholics Anonymous was born. How the group of recovering alcoholics supported each other was described in the first book published about AA The Story of How More Than One Hundred Men Have Recovered From Alcoholism in 1939.
MUTUAL SUPPORT AND SELF-HELP
Alcohol addiction treatment is unique to the field of mental health. In fact, there is no other health or mental field where a majority of the help and intervention is managed, organized and led by non-professionals. Alcoholics Anonymous clearly states the role of mutual support in its preamble, which is usually read at group meetings ; “Alcoholics Anonymous is a fellowship of men and women who share their experience, strength, and hope with each other that they may solve their common problem and help others to recover from alcoholism.”
In the second edition of Substance Abuse by Gary L. Fisher and Thomas C. Harrison the authors note that in 1990 there were” over 15 million people participating in 500,000 twelve step groups.” That was 20 years ago and the numbers are probably much higher now, since alcohol abuse has been on the rise in recent years.
Through the years there has been some conflict between what mental health professionals believe is appropriate treatment and those who advocate self –help support groups such as twelve steps. Yet, those treatment programs that are disease based usually recommend that their patients attend 12 step meetings while in treatment or afterwards. For example, the Minnesota Model is a disease model, which utilizes the philosophic beliefs and steps of AA.
There has been such a blending of ideologies throughout the years through this practice, that the 12 step model has come to be associated with the disease concept of addiction. The actual truth is that AA is not affiliated with any particular model of addiction.
While the practice of self-help through recovery is proven to be effective, not all individuals believe or want to practice the AA concept of spirituality or a “higher power”.
For those who appreciate the value of self- help mutual support groups, yet don’t feel comfortable with AA philosophy, there are alternatives such Many Roads, One Journey, Women for Sobriety and Save Ourselves. Narconon also has a treatment protocol that utilizes the experience and dedication of individuals who have successfully recovered against a background of exact program steps.
IN PATIENT AND RESIDENTIAL
While there are different philosophic and clinical approaches to addiction, there are also many settings in which treatment can take place. An apparently popular one is the 28 day in-patient or residential approach. The choice of 28 days is not researched base, but economically driven by insurance companies. The advantages are twenty four hour supervision, structure and removal from the everyday stresses of life, while the client is immersed in treatment. The disadvantages are learning to live life in an artificial and protective setting where the client will have no trouble maintaining abstinence. However, once in the real world, with very little clean and treatment time under their belt, the client may relapse. According to studies, the longer the treatment, the more chance there is for success, so the likelihood of success of this model increases with longer program times.
PARTIAL HOSPITILIZATION AND DAY TREATMENT
The advantages of treatment in free standing centers is these programs are less expensive and the client’s life is less artificial, as they spend their evenings at home. This facilitates figuring out what the barriers are to the client’s success at abstinence so they can be worked on during treatment.
There are risks to this type of treatment. The client returns home at night to a household that is possibly using drugs, increasing the risk of relapse during treatment.
These programs are usually part-time for 3 or 4 days a week. This type of program would be appropriate for someone who has attended treatment, but still needs support as they are going back to work and getting back into life. The main advantage to this type of treatment is that the client can return to life activities like school and work, while at the same time, still have the support and supervision occasioned by such a schedule.
USE OF MEDICATION
Most of the above described treatment modalities don’t include the long-term use of medication as part of the treatment. In fact AA takes a stand against substituting one addictive drug for another.
The use of medication is often necessary in the beginning stages of treatment in order to prevent medically dangerous situations associated with withdrawal which can include seizures and delirium tremens.
The recurring theme and element of success is the utilization of recovering addicts in the process of alcohol recovery, no matter the model being used. Self-help and mutual support are at the bottom of any successful treatment. However, in order to bring more safety to clients in treatment and indeed more prestige to those individuals who have dedicated themselves to the difficult task of guiding others through recovery; it is important that these counselors receive appropriate training. There are organizations that will certify such individuals, providing that they have met the proper training and on-site experience.
The empathy, motivation and dedication of these people along with the right training are the best ingredients for a successful addiction counselor, no matter the modality of treatment.
Matt Hawk writes about drug and alcohol education and awareness for the Narconon drug rehab network.