The findings have limited applicability to this guideline as it was based on the US healthcare system and no formal attempt was made by the authors to combine cost and clinical-outcomes data, which were collected in the study and reported elsewhere (Project MATCH Research Group, 1998). Of the six included trials, there were two involving a comparison of behavioural therapies versus control which met criteria for inclusion. ALDEN1988 assessed behavioural self-management training versus waitlist control and MONTI1993 assessed cue exposure with coping skills versus control (treatment as usual and daily cravings monitoring). One study assessing cognitive behavioural therapies versus control could not be added to the meta-analyses. Källmén and colleagues 2003 could not be included because the data was presented in an unusable format. The study reported that the control group (unstructured discussion) drank significantly less alcohol at 18-month follow-up than the group receiving coping skills.
Related NICE guidance and evidence
LITT2007 assessed contingency management with network support versus case management (an active control). See Table 52 below for a psychological dependence on alcohol summary of the clinical review protocol for the review of contingency management). Behavioural self-control training is also referred to as ‘behavioural self-management training’ and is based on the techniques described by Miller and Munóz (1976). Patients are taught to set limits for drinking and self-monitor drinking episodes, undergo refusal-skills training and training for coping with behaviours in high-risk relapse situations. Behavioural self-control training is focused on a moderation goal rather than abstinence.
- Again it appears that the data is primarily concerned with children and young people who did not have a high severity of alcohol misuse.
- Behavioral addiction such as internet addiction is similar to drug addiction except that in the former, the individual is not addicted to a substance but the behavior or the feeling brought about by the relevant action.
- A number of factors may contribute to the low implementation of evidence-based psychological interventions.
- In particular, men who developed a ‘male depression’ reported self-managing this state with alcohol 116.
- Thereby, alcohol may exert favourable effects by temporarily overcoming conditioned fear in consensually approaching a potential partner at selected times (e.g., after work, weekend nights) and settings (e.g., bar, party).
- Combined with medications and behavioral treatment provided by health care professionals, mutual-support groups can offer a valuable added layer of support.
7.2. Clinical review protocol (motivational techniques)
- Contributors to this article for the NIAAA Core Resource on Alcohol include the writers for the full article, content contributors to subsections, reviewers, and editorial staff.
- First, there is a lack of availability of reviews of the current evidence in a clear and practical format that can be accessible to practitioners, managers and commissioners.
- In short, the functionality gains of alcohol use need to be weighed against the potential risks.
- The review team conducted a systematic review of RCTs that assessed the beneficial or detrimental effects of social network and environment-based therapies in the treatment of alcohol dependence or harmful alcohol use.
- FALSSTEWART2006 investigated a psychoeducational intervention (as an attentional control) versus BCT (plus individually-based TSF) as well as individually-based TSF alone.
Among those with AUD, about 15-30% overall have co-occurring post-traumatic stress disorder, with increased rates of 50-60% among military personnel and veterans.28 The two conditions may worsen each other. Thus, here, too, it’s important to be cognizant of the signs of PTSD in patients with AUD, and vice versa. Talking about substance use disorder can be tricky, and not just because it’s a sensitive topic. For example, some people have a dependence on their blood pressure medication. But as you continue to drink, you become drowsy and have less control over your actions. Because denial is common, you may feel like you don’t have a problem with drinking.
- While alcohol may not be able to persistently restore homeostasis in mental disorders, it may, nevertheless, cause temporary relief from negative affective states and may support normal behaviour.
- The current guideline utilises the definitions from the antisocial personality disorder guideline.
- One trial relating to clinical evidence met the eligibility criteria set by the GDG, providing data on 49 participants.
- The mood disorders that most commonly co-occur with AUD are major depressive disorder and bipolar disorder.
- In this way, such designs may be more likely to provide interpretable results as well as a clearer understanding of the processes likely to be responsible for such findings.
- Likewise, studies using operant procedures have demonstrated increased alcohol self-administration in mice (Chu et al. 2007; Lopez et al. 2008) and rats (O’Dell et al. 2004; Roberts et al. 1996, 2000) with a history of repeated chronic alcohol exposure and withdrawal experience.
Impact on your safety
Although comorbid depressive and anxiety symptoms are common in adults with harmful drinking and alcohol misuse (Weaver et al., 2006), the extent and severity of the comorbidities often found in children is greater (Perepletchikova et al., 2008). Comorbid disorders such as conduct disorder and ADHD significantly complicate the management of alcohol misuse, and concurrent treatment of them is to be considered. At the heart of all these interventions lies the recognition of the considerable complexity of problems presented by young people who misuse alcohol and drugs, and the need often to develop a multisystem, multi-level approach to deliver integrated care.
15.2. Clinical review protocol (short-term psychodynamic therapy)
Telehealth specialty services and online support groups, for example, can allow people to maintain their routines and privacy and may encourage earlier acceptance of treatment. The NIAAA Alcohol Treatment Navigator can help you connect patients with the full range of evidence–based, professional alcohol treatment providers. As with anxiety and mood disorders, it can help for a healthcare professional to create a timeline with the patient to clarify the sequence of the traumatic event(s), the onset of PTSD symptoms, and heavy alcohol use. One way to differentiate PTSD from autonomic hyperactivity caused by alcohol withdrawal is to ask whether the patient has distinct physiological reactions to things that resemble the traumatic event. Here, we briefly describe the causes and effects of co-occurrence, the mental health disorders that commonly co-occur with AUD, and the treatment implications for primary care and other healthcare professionals. We start with a visual model of care that indicates when to consider a referral.
