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Alcohol Abuse and Dependence: Treatment
Despite advances in its understanding and treatment, alcohol abuse remains a challenge for individuals and professionals, as well as an important public health problem. Treatment for alcohol abuse has a long and complex history. Over time, many models have been proposed to conceptualize and explain alcohol abuse and its problematic effects, as well as to guide the development of treatment approaches.
In the past, treatment practitioners often were trained to employ only one treatment modality based on the disease model of alcoholism, whereas presently, an eclectic approach is considered most appropriate. Furthermore, the use of single, traditional paradigms have often failed to address the complexity of the individual's motivation to change. Providing treatment appropriate to an individual's readiness to change, as well as co-occurring disorders, and designing a treatment plan that is most effective for the individual, may prove most helpful. The following list of brief descriptions of various treatment approaches is by no means exhaustive, but should give the reader an idea of what is available.
Self-Help
Utilizing personal resources or seeking the help of others with similar problems, referred to as self-help or mutual aid, has become a common source of assistance for individuals with alcohol problems. Support may be found in a group format with other recovered or recovering problem drinkers, such as with Alcoholics Anonymous (AA), the earliest contemporary and most well-known self-help organization, founded in 1935 with groups throughout the world. AA and similar groups often have several things in common, such as voluntary participation, membership for anyone who wishes to stop drinking, and a variety of meeting formats, which may include speakers. Many self-help groups such as AA employ a 12-step model toward recovery, with members following the 12 steps with abstinence as the primary goal, as they receive strong support and ideas for how to cope with life's problems without alcohol. In addition, family members and friends may attend their own support groups.
AA may be differentiated from other group models by its emphasis on abstinence as the only viable goal, as well as its conceptualization of alcoholism as a disease for which individuals do not have voluntary control. In addition, AA is a spiritual fellowship where members rely on a “higher power” to help them through recovery. Examples of the 12 steps to recovery are Step 1, We admitted we were powerless over alcohol—that our lives had become unmanageable, and Step 5, Admitted to God, to ourselves and to another human being the exact nature of our wrongs.
Smart Recovery (SR), originally based on the work of Albert Ellis and “rational recovery,” is another selfhelp program that uses professional assistance in addition to role models and fellow members who are working to change or already have changed their own drinking behavior. Unlike AA, SR emphasizes selfreliance rather than reliance on a higher power. Other key components of SR are enhancing motivation, learning to refuse to act on urges, managing life difficulties in a sensible manner without alcohol or other substances, and developing a healthy and balanced lifestyle overall. Furthermore, SR does not view addiction as a disease, but rather as a complex maladaptive behavior over which one has control and can change. To aid this change, a cognitive-behavioral (thinking/doing) strategy is used to help people learn to manage beliefs and emotions that lead to drinking.
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