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 physical and psychological dependence on the drink. If alcoholism is maintained in the long term it can cause very serious consequences for life, such as suicide due to 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.

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Effective psychological treatments for alcoholism

As we will see, psychological therapies that have been developed to reduce or eliminate alcohol consumption mainly use techniques based on conditioning. classical, as the extinction of the physiological signs of "craving", and in the operant, as the development of alternative reinforcements that replace the one provided by the alcohol.

Often these programs are combined with drugs in order to allow or promote change

. These include anxiolytic drugs such as benzodiazepines and substances that cause effects aversives when combined with alcohol, such as disulfiram (better known by its trade name, "Antabus").

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1. Approach to community reinforcement

Hunt and Azrin developed the Community reinforcement approach in 1973 for the treatment of severe alcoholism. Its efficacy has made it applicable to other types of addiction as well, and it has proven especially useful in the case of heroin when combined with contingency management.

The two main objectives of this treatment, which are closely related to each other, are reducing alcohol consumption and developing alternative habits that reinforce sobriety. In this way, positive reinforcement is used as a key tool; The same is true of fostering motivation for change.

The approach to community reinforcement is based on techniques such as training in communication skills (focused on especially in the close environment), the practice of healthy leisure activities, the acquisition of skills that facilitate job hunting and improving resistance to the temptation to drink through the sensitization covert.

As with other treatments that we will mention, the community reinforcement approach often 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 couples therapies for alcoholism are multicomponent programs whose fundamental objectives are the improved communication between the patient and their closest ones, as well as the increase in positive reinforcement obtained through interaction with them.

At a theoretical level, this type of treatment suggests that a bad relationship with the family, and especially with the partner, favors the consumption of alcohol; conversely, if the interaction is positive, it can be a key source of reinforcement with the potential to modify the behavior of the person who drinks. In addition, the family can provide abstinence support.

An example is the community reinforcement and family training program or CRAFT (“Community reinforcement and family training”) 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. Coping and social skills training

The programs that are included in this category are aimed at acquiring social skills and coping with situations of risk of alcohol consumption. It is based, therefore, on the training of this type of strategy and its practice in contexts that habitually trigger the drinking behavior.

Since there are a large number of alcoholism treatments that have skills training at their core, the effectiveness of these programs may vary depending on the specific case. The intervention developed by Langley et al, called “coping skills for drinking behavior,” is a notable example.

4. Relapse prevention program

Although a few decades ago relapse prevention was seen as an additional module that could enhance the therapeutic effects of other programs, today relapse prevention is itself a differentiated category of treatment and its effectiveness has been demonstrated even when applied Independent.

Marlatt and Gordon's model is especially well known. These authors emphasize the progressive nature of recovery; In this sense, his therapy teaches us to distinguish specific “falls” from “relapses”, which are more chronic in nature. Again coping skills training for risk situations is a central aspect.

5. Signal Exposure Therapy

The therapy of exposure to tracks or signals, abbreviated as "CET" ("Cue Exposure Therapy"), has been applied with moderately effective results in cases of alcohol abuse, as well as in programs to stop drinking tobacco.

It focuses on reducing the reactivity of the person addicted to environmental cues that elicit conditioned craving responses or desire for consumption. For this, exposure and response prevention procedures are used in the presence of antecedent stimuli in order to extinguish the psychophysiological reactions associated with it. craving. The one advantage 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 reducing the intensity of your alcohol consumption without giving it up 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 in which total abstinence programs have failed.

Therapy usually begins by setting goals, performing a functional analysis of drinking situations, and self-recording these behaviors. Subsequently, there is a period of abstinence (approximately one month) that is combined with the alternative coping skills training, also useful for the prevention of relapses.

7. Contingency management based on reinforcement

Contingency management is a therapeutic approach based on the operant conditioning paradigm. Alcohol consumption is conceived as an operant behavior whose maintenance is influenced by reinforcers such as the effects of drinking itself or the situations of social interaction to which it is associated addiction.

These programs consist of replace inadequate reinforcement with adaptive and tangible incentives, mainly articles of personal use such as tickets for cinema sessions or other shows. These rewards are obtained from the demonstration that abstinence has been maintained, often through urine tests.

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