Alcohol Dependency: Problem Drinking

Alcohol Dependency & Problem Drinking John Greenwald Edinboro University Introduction It is difficult to locate someone in the United States who feels that alcohol dependency and problem drinking is not a national problem. (Anton, R. 2010) Alcohol dependency and problem drinking has been at the forefront of policy debates at the micro, mezzo, and macro levels regarding healthcare expenses and outcomes, legal matters, and social implications for generations. Most times it is addressed in conjunction with drug abuse. (Anton, R. 010) A general population survey conducted earlier last decade estimated that the prevalence of problem drinking at 4. 65% and alcohol dependence at 3. 81% respectively in the United States. (Huebner & Wolfgang-Kantor, 2011) There are numerous ways to treat alcohol related disorders. Here are three of those interventions auricular acupuncture, 12 step based recovery programs, and moderation management program. Auricular Acupuncture Auricular acupuncture is a holistic approach that originated in the United States during the 80’s.

This form of acupuncture is widely used to treat alcohol dependency in the United States and United Kingdom as an alternative holistic approach. (Alster, M. 2010) The treatment uses five auricular acupuncture points referred to as NADA protocol, the acupuncture points are located in the ear. This intervention is rooted in traditional Chinese medicine. (Alster, M. 2010) The acupuncture points used during this treatment are similar from client to client. (Alster, M. 010) The treatment modality is used in conjunction with traditional alcohol detoxification protocols, as to protect the client from physiological harm from detoxing from alcohol. One study the reported short term benefits of this intervention included feelings of relaxation, contentment, and enjoyment mixed with more long term benefits like analgesia, increases in sleep quality, and a reduction in alcohol consumption, anxiety, and cravings. (Alster, M. 2010) In addition to the positive short term benefits there were some negative side effects that were reported such as feelings of light eadedness, burning sensations, and feelings of heat at needle sites. (Alster, M. 2010) Furthermore, there were some initial reports of anxiety even before treatment started which was found to be largely attributed to a client’s fear of needles, doubt of effectiveness, and fear of something foreign. (Alster, M. 2010) Many of these negative side effects dissipated as time passed. (Alster, M. 2010) The aforementioned study of this modality paints an overall positive view of this approach however another study drew correlations that were not as positive.

The later study did find similar short term results which included a reduction in alcohol consumption and an improvement in overall psychological well-being. (Ashton, Nodiyal, Green, Moore, & Heather, 2009) However, the long term results failed to indicate significant indications of the overall effectiveness of auricular acupuncture in long term reduction in consumption, anxiety, and cravings. (Ashton et al. , 2009) 12-Step Based Recovery Programs Alcoholics Anonymous (AA) was founded in 1935, by Bill Wilson and Dr.

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Bob Smith, as self-help 12-step abstinence based approach to spiritual and character development. (Huebner & Wolfgang-Kantor, 2011) To this day, the AA fellowship is free to join for anyone who is alcoholic and wants to be a member which makes it an appealing option for many resource strapped clients and social workers. Later in the 1950’s the (AA) model was introduced into a professional setting by a non-profit organization called Hazelden Foundation, which is still used widely by many treatment facilities today. (Huebner & Wolfgang-Kantor, 2011)

The Hazelden model calls for an individualized intervention plan, which includes family involvement, in the context of a 28 day inpatient setting combined with participation in AA while in treatment and post treatment as a part of an aftercare plan. Typically in this model clients also undergo cognitive-behavioral therapy and/or motivational enhancement therapy which focuses on negative consequences resulting from alcohol use and identification of triggers which can be people, places, things, and events. (Huebner & Wolfgang-Kantor, 2011) In one study researchers found hat clients who suffered from alcoholism only, whom did not have a dual diagnosis or a co-occurring diagnosis, who utilized this intervention, had more abstinent days than those treated by other methods. These individuals showed significant positive outcomes which included a higher percentage of abstinent days and a decreased number of drinks consumed on drinking days. (Huebner & Wolfgang-Kantor, 2011) Additionally those who used medications to help manage side effects such as cravings and anxiety reported even better outcomes. (Huebner & Wolfgang-Kantor, 2011)

Another study suggests that there is a lack of effectiveness and perhaps even harm inflicted by the 12 step model. (Miller, J. 2008) This study implies, “that despite decades of dominance of approaches based on 12 step principles, there have been no rigorously controlled research designs comparing 12 step treatment outcomes to no-treatment controls, and a recent review found no gains in outcome for 12 step interventions over alternative interventions. ” (Miller, J. 2008) The counter research suggests that interventions which are based off of the Hazelden model “appear at best ineffective and perhaps even harmful. (Miller, J. 2008) Additionally it is noteworthy that there seems to be a lack of evidence based research that supports positive outcomes greater than negative outcomes. (Miller, J. 2008) The ethics and values of many helping professions are to empower clients to overcome their own issues and to achieve the right to self-determination. With that being said the 12 step model instills moral guilt, deviance, and labeling while infusing its members with feelings of powerlessness and dependence on the fellowship of AA thus using external rather than internal forces to effect change. Miller, J. 2008) The disease concept of alcoholism is a central tenant to the 12 step model; it “pathologizes” individual clients by removing focus from social and mental processes that may attributing to the alcoholic behaviors. (Miller, J. 2008) The intervention appears to “reinforce counter therapeutic cognitions and behaviors. ” (Miller, J. 2008) Furthermore it has been noted that the 12 step culture itself can be hostile and scrutinizing towards non-adherents. (Miller, J. 2008) Moderation Management In the 1960’s professionals in the addiction field started to ask the uestion, can alcoholics learn to control their drinking or must they abstain completely from alcohol? Moderation Management (MM) is a mutual help fellowship designed for problem drinkers, not alcohol dependent people, who wish to pursue a goal of moderate drinking. (Lembke & Humphreys, 2012) MM’s is based on the problem drinkers individual ability to adhere to MM guidelines, which first includes a 30 day period of abstinence which is then followed by limits on daily alcohol intake. (Lembke & Humphreys, 2012) The primary goal being moderate drinking, not abstinence, which can be obtained by following a 9 step approach. Lembke & Humphreys, 2012) One study found that alcohol dependent clients found more positive outcomes with the 12-step recovery model. Data showed that people who reported to be only problem drinkers, without alcohol dependence, were able to recover from a diagnosed problem by a rate of 30-60% depending on whether they received treatment or just attended MM. (Lembke & Humphreys, 2012) There were reports of people who identified as problem drinkers, but were really alcohol dependent, who eventually left MM because they realized they could not drink in moderation and needed an abstinence based intervention. Lembke & Humphreys, 2012) MM widens the range of attractive options available to people with alcohol disorders. Some clinicians feel that MM is a good place to start because it can be appealing to alcohol dependent people who are adamantly opposed to abstaining entirely. (Lembke & Humphreys, 2012) These same people eventually realize, because of MM’s 9 step program, that they are not able to drink in moderation and after defeat in this avenue may become more willing to try an abstinent only intervention such as AA thus serving as a starting point for anyone with an alcohol disorder. Lembke & Humphreys, 2012) Interventions such as MM reinforces many helping professions code of ethics in the sense that it puts the client in the control of finding what works best for them and aids them in achieving self-efficacy. (Miller, J. 2008) Conclusion To pick one intervention that I feel is the best pick for evidence based practice in Social Work would be difficult. This is something that each clinician will have to decide on a client by client basis. Starting where the client is will help the Social Worker determine which intervention is best.

I found that there is a lack of scientific research which gave any kind of correlations to any one of these interventions. Much of the research suggests that a combination of interventions along with starting where the client is what produces the best results and that no exact intervention was a smoking gun. If I had to pick one intervention that I feel is most useful in terms of helping a client who presented with alcohol dependency or who described themselves as problem drinkers, the intervention I would chose would be Moderation Management, if ethically appropriate.

MM allows the client to choose his or her direction with where they are at in their alcohol dependency or problem drinking. Thus, allowing them to decide for themselves if they want to simply moderate their consumption or abstain entirely. References Zemore, S. , & Kaskutas, L. (2008). 12-step involvement and peer helping in day hospital and residential programs. Substance Use & Misuse, 48, 1882-1903. Huebner, R. , & Wolfgang Kantor, L. (2011). Advances in alcoholism treatment. Alcohol Research & Health, 33(4), 295-299. Lembke, A. & Humphreys, K. (2012). Moderation management: A mutual-help organization for problem drinkers who are not alcohol dependent. Journal of Groups in Addiction & Recovery, 7, 130-141. Alster, M. (2010). Auricular acupuncture at calvary alcohol & other drug services: The first year. Journal of the Australian Traditional-Medicine Society, 16(2), 73-75. Ashton, H. , Nodiyal, A. , Green, D. , Moore, B. , & Heather, N. (2009). Acupuncture or counseling: outcomes and predictors of treatment choice in a non-statutory addiction service.

Journal of Substance Use, 14(3-4), 151-160. Anton, R. (2010). Substance abuse is a disease of the human brain: Focus on alcohol. Journal of Law, Medicine & Ethics, Winter 2010, 735-744. Miller, J. (2008). 12-step treatment for alcohol and substance abuse revisited: Best available evidence suggests lack of effectiveness or harm. Int J Ment Health Addiction, 6, 568-576. AA Intergroup. (n. d. ). Online intergroup Alcoholics Anonymous publications. In online Intergroup: Alcoholics Anonymous. http://www. aa-intergroup. org/.

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