Naltrexone for Alcoholism

Is alcoholism a disease?

Yes. Most experts agree that alcoholism is a disease, just as high blood pressure, diabetes and arthritis
are diseases. Like these other diseases, alcoholism tends to run in families.

Alcoholism is a chronic disease. “Chronic” means that it lasts for a long time or it causes problems again
and again. The main treatment for alcoholism is to stop drinking alcohol. This can be difficult, because
most people who are alcoholics still feel a strong desire for alcohol even after they stop drinking.

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How is naltrexone used to treat alcoholism?

Naltrexone is a medicine that reduces your desire for alcohol. After you quit drinking, naltrexone may help
you stay sober for a long time. This medicine is not a complete cure for alcoholism, but it can help you
stop drinking while you get any other treatments that your doctor recommends.

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How does naltrexone work?

Naltrexone blocks the parts of your brain that “feel” pleasure when you use alcohol and narcotics. When
these areas of the brain are blocked, you feel less need to drink alcohol, and you can stop drinking more
easily. Unlike disulfiram, another medicine that is sometimes used to treat alcoholism, naltrexone does
not make you feel sick if you drink alcohol while taking it.

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What are the side effects of naltrexone?

Nausea is the most common side effect. Other less common side effects include headache, constipation,
dizziness, nervousness, insomnia, drowsiness and anxiety. If you get any of these side effects, tell your
doctor. He or she may change your treatment or suggest ways you can deal with the side effects.

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What should I know before starting treatment with naltrexone?

Because naltrexone blocks the brain areas where narcotics and alcohol work, you should be careful not to
take any narcotics, such as codeine, morphine or heroin, while you are taking naltrexone. Do not take any
cough medicine with codeine in it while you are taking naltrexone. Naltrexone can cause or worsen
withdrawal symptoms in people who take narcotics. You must stop taking all narcotics 7 to 10 days before
you start taking naltrexone.

You shouldn’t take naltrexone if you’re pregnant, so talk about birth control options with your doctor. It’s
not known if naltrexone goes into breast milk, so you should not breastfeed while you’re taking it.

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How long will I take naltrexone?

You and your doctor will decide this. Most people take the medicine for 12 weeks or more. Be sure to take
naltrexone as your doctor prescribes it. Don’t take extra pills, don’t skip pills and don’t stop taking the pills
until you talk to your doctor.

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Will I need other treatments for alcoholism?

Like many other diseases, alcoholism affects you physically and mentally. Both your body and your mind
have to be treated. In addition to medicine, your doctor may recommend some psychosocial treatments.
These treatments can help you change your behavior and cope with your problems without using alcohol.
Examples of psychosocial treatments include Alcoholics Anonymous meetings, counseling, family
therapy, group therapy and hospital treatment. There may be special centers in your area that offer this
kind of treatment. Your doctor can refer you to the psychosocial treatment that is right for you.

Antabuse, or disulfiram as it is also known, was the first medicine approved for the treatment of
alcohol abuse and alcohol dependence by the U.S. Food and Drug Administration.

Antabuse is prescribed to help people who want to quit drinking by causing a negative reaction if the
person drinks while they are taking antabuse.

How Does It Work?

When alcohol is consumed it is metabolized by the body into acetaldehyde, a very toxic substance that
causes many hangover symptoms heavy drinkers experience. Usually, the body continues to oxidize
acetaldehyde into acetic acid, which is harmless.

Antabuse interferes with this metabolic process, stops the process with the production of acetaldehyde
and prevents the oxidation of acetaldehyde into acetic acid. Because of this, antabuse will cause a
build up of acetaldehyde five or 10 times greater than normally occurs when someone drinks alcohol.

What Are the Effects?

The high concentration of acetaldehyde that occurs when someone drinks while taking antabuse can
cause reactions that range widely from mild to severe, depending on how much antabuse and how
much alcohol is consumed, none of which are pleasant.
If you drink while taking antabuse, you can experience these symptoms:
• Flushing
• Nausea
• Copious Vomiting
• Sweating
• Thirst
• Throbbing in the Head and Neck
• Throbbing Headache
• Respiratory Difficulty
• Chest Pain
 • Palpitations
• Dyspnea
• Hyperventilation
• Tachycardia
• Hypotension
• Syncope
• Marked Uneasiness
• Weakness
• Vertigo
• Blurred Vision
• Confusion
Those are the "mild" symptoms. Severe reactions can include respiratory depression, cardiovascular
collapse, myocardial infarction, acute congestive heart failure, unconsciousness, arrhythmias,
convulsions, and death.

Who Can Use Antabuse?

Only someone who wants to try to quit drinking and who is fully aware of the consequences of drinking
while on the medication should take antabuse. Antabuse should never be given to some without their
full knowledge or to anyone who is intoxicated.

Because of the possible severe reactions, antabuse should not be given to anyone with a history of
severe heart disease, psychosis, or an allergy to antabuse. Women who are pregnant should not take
antabuse and no one taking paraldehyde or metronidazole should use antabuse.

What Antabuse Does Not Do

Antabuse serves merely as physical and psychological deterrent to someone trying to stop drinking. It
does not reduce the person's craving for alcohol, nor does it treat any alcohol withdrawal symptoms.

How Effective Is Antabuse?

The effectiveness of antabuse in helping someone quit drinking depends on the person's continued use
of medication. Because antabuse is administered in a daily pill, people can merely stop taking the drug
and begin drinking a few days later.
However, research in Europe, where antabuse is much more widely used than in the United States, has
shown that long-term use of antabuse is very effective in helping people stop drinking, producing
abstinence rates of 50 percent. The longer people take antabuse, the more effective it is, because they
develop a "habit" of not drinking, research revealed.
Sources:
New York Office of Alcoholism and Substance Abuse Services
University of Wisconsin-Madison Chemistry Dept.

Naltrexone is an opioid receptor antagonist used primarily in the management of alcohol dependence
and opioid addiction. Naltrexone hydrochloride is sold as the brand name Revia and Depade. An
extended-release form of Naltrexone is marketed under the trade name Vivitrol.

How Does Naltrexone Work?

For people who have stopped drinking, Naltrexone reduces the craving for alcohol which many alcohol
dependent people experience when they quit drinking. It is not fully understood how Naltrexone works
to reduce the craving for alcohol, but some scientists believe it works by affecting the neural pathways
in the brain where the neurotransmitter dopamine is found.

For those who are addicted to opioids, Naltrexone works by blocking the effects of drugs like heroin
and cocaine in the brain. As an opioid receptor antagonist, Naltrexone simply blocks the normal
reaction of the part of the brain that produces the feeling of pleasure when opioids are taken.

How Is Naltrexone Taken?

In pill form, Naltrexone is usually prescribed to be taken once a day. Generally, it is prescribed for 12
weeks to help people who have stopped drinking to reduce the craving for alcohol during the early
days of abstinence when the risk of a relapse is the greatest. Because Naltrexone blocks the effects of
opioids, it is sometimes prescribed for 12 months for those trying to manage drug dependence.

In April 2006, the FDA approved an once-a-month injectible form of Naltrexone, which is marketed as
Vivitrol, for the treatment of alcohol dependence. Several studies demonstrated the monthly injection
form of Naltrexone was more effective in maintaining abstinence over the pill form, because it
eliminates the problem of medication compliance.

Rapid Detoxification

An implant form of Naltrexone is used in a controversial process called rapid detoxification for opioid
dependence. In rapid detox, the patient is placed under general anaesthesia and a Naltrexone implant
is surgically placed in the lower abdomen or posterior. This procedure is usually followed by daily
doses of Naltrexone for up to 12 months.

The FDA has not approved the implant form of Naltrexone. Although the rapid detox procedure is
promoted as a one-time "cure" for drug addiction, research has shown that it is really more effective
as an initial step in a long-term rehabilitation process.

What Are the Side Effects?

For some patients, Naltrexone can cause upset stomach, nervousness, anxiety or muscle and joint
pain. Usually these symptoms are mild and temporary, but for some they can be more severe and
longer lasting.

In rare cases, Naltrexone can cause more severe side effects including confusion, drowsiness,
hallucinations, vomiting, stomach pain, skin rash, diarrhea or blurred vision. Anyone experiencing any
of these symptoms should notify their healthcare provider immediately.

Large doses of naltrexone can cause liver failure. Patients should stop taking Naltrexone immediately if
they experience any of the following symptoms: excessive tiredness, unusual bleeding or bruising, loss
of appetite, pain in the upper right part of the stomach, dark urine, or yellowing of the skin or eyes,
according to the warning published on the Naltrexone packaging.

Who Can Take Naltrexone?

Naltrexone is prescribed only after the person has stopped drinking alcohol or taking opioids for seven
to 10 days, because it can cause serious withdrawal symptoms if it is taken while someone is still using
drugs.
People who have acute hepatitis, liver or kidney disease should not take Naltrexone. Patients who are
using narcotic painkillers should not take it nor should anyone who is allergic to any other drugs.
Women who are pregnant or breastfeeding, should not take Naltrexone.

What Naltrexone Does Not Do

Naltrexone does not help someone stop drinking or doing drugs, it is used to help people who have
already stopped maintain abstinence. It does not treat alcohol or drugwithdrawal symptoms.

How Effective Is Naltrexone?

Research has shown that Naltrexone can reduce craving for alcohol and drugs for some people, but it
does not work for everyone. Like most pharmaceutical treatments for alcohol and drug abuse, it works
best if it is used in connection with an overall treatment regime, such as psychosocial therapy,
counseling or support group participation.

Naltrexone does not "cure" addiction, but it has helped many who suffer from alcohol or drug addiction
to maintain abstinence by reducing their craving for alcohol or drugs.

Sources:

Campral (acamprosate calcium) is the most recent medication approved for the treatment of alcohol
dependence or alcoholism in the United States -- approved by the Food and Drug Administration in July
2004 -- but it has been used widely in Europe for many years. More than 1.5 million people have been
treated worldwide with Campral.

How Does Campral Work?

It is not completely understood exactly how Campral works in the brain to help people maintain alcohol
abstinence, but it is believed to restore a chemical balance in the brain that is disrupted by long-term
or chronic alcohol abuse. In other words, it helps the brain begin working normally again.
While Antabuse works by making someone sick if they drink alcohol and Naltrexone blocks the "high"
people get when drinking, Campral reduces the physical distress and emotional discomfort people
usually experience when they quit drinking. According to Forest Laboratories, the distributor the drug
in the U.S., Campral reduces sweating, anxiety and sleep disturbances that many experience during
the early stages of alcohol abstinence.

How Is Campral Taken?

Campral is prescribed in 333mg time-release tablets that are usually taken three times a day. For
some patients, such as those with kidney disease, the standard dose may be adjusted by a physician.
Because Campral tablets are time-release, they should be swallowed whole and never crushed, cut or
chewed.

Because the side effects of Campral are few and mild and because Campral is not addictive, it is
usually prescribed for up to 12 months after ceasing alcohol consumption.

What Are the Side Effects?

Campral was "generally well-tolerated in clinical trials" according to the FDA. The side effects that
were reported are usually mild and temporary. They include:
• Diarrhea
• Dizziness
• Gas
• Dry mouth
• Headache
• Insomnia
• Itching
• Joint or muscle pain
• Loss of appetite
• Nausea
• Sweating
However, in rare cases Campral can cause more severe side effects. Anyone who experiences any of
the following symptoms should stop taking Campral immediately and contact their healthcare
provider:
• Anxiety or nervousness
• Burning, pricking or tingling in arms, legs, hands, or feet
• Depression
• Chest pains
• Passing urine less often
• Suicidal thoughts

Who Can Take Campral?

People who have stopped drinking alcohol can begin taking Campral. It does not work if you are still
drinking, or if you are using illicit drugs or abusing or over using prescription medications.

Campral should not be taken if you have any of the following conditions:

• Depression
• Kidney disease
• Suicidal thoughts
• Allergic reaction to Campral, sulfites or other medicines
• Allergic reaction to foods, dyes or preservatives
• Pregnant or trying to get pregnant
• Breastfeeding

What Campral Does Not Do

Campral does not help someone quit drinking; it helps those who have already withdrawn from alcohol
to maintain abstinence. Campral does not help with withdrawal symptomsexperienced while going
through early detoxification from alcohol.
However, Campral has been shown to reduce sleep disturbances commonly experienced during early
sobriety by recovering alcoholics.

How Effective Is Campral?

As with all other medications approved for the treatment of alcohol dependence, Campral is most
effective as a part of an overall program of recovery including therapy, counseling and/or support
group participation.
During the FDA clinical trials, Campral was three times more effective than a placebo in maintaining
abstinence from alcohol as part of an overall support program. However, the more recent COMBINE
(Combining Medications and Behavioral Interventions for Alcoholism) study, surprisingly found that
Campral was no more effective than a placebo.
In other words, like all other treatments and approaches to maintaining alcohol abstinence, Campral
does not work for everyone. It's not a magic bullet.

Alcohol Withdrawal
What Is It?  Treatment
 Symptoms  When To Call a Professional
 Diagnosis  Prognosis
 Expected Duration  Additional Info
 Prevention

What Is It?
Alcohol withdrawal is the changes the body goes through when a person suddenly stops drinking
after prolonged and heavy alcohol use. Symptoms include trembling (shakes), insomnia, anxiety and
other physical and mental symptoms.

Alcohol has a slowing effect (also called a sedating effect or depressant effect) on the brain. In a
heavy, long-term drinker, the brain is almost continually exposed to the depressant effect of alcohol.
Over time, the brain adjusts its own chemistry to compensate for the effect of the alcohol. It does
this by producing naturally stimulating chemicals (such as serotonin or norepinephrine, which is a
relative of adrenaline) in larger quantities than normal. If the alcohol is withdrawn suddenly, the
brain is like an accelerated vehicle that has lost its brakes. Not surprisingly, most symptoms of
withdrawal are symptoms that occur when the brain is overstimulated.

The most dangerous form of alcohol withdrawal occurs in about 1 out of every 20 people who have
withdrawal symptoms. This condition is called delirium tremens (also called DTs). In delirium
tremens, the brain is not able to smoothly readjust its chemistry after alcohol is stopped. This
creates a state of temporary confusion and leads to dangerous changes in the way your brain
regulates your circulation and breathing. The body's vital signs such as your heart rate or blood
pressure can change dramatically or unpredictably, creating a risk of heart attack, stroke or death.

Symptoms
If your brain has adjusted to your heavy drinking habits, it takes time for your brain to adjust back.
Alcohol withdrawal symptoms occur in a predictable pattern after your last alcohol drink. Not all
symptoms develop in all patients:

• Tremors (shakes). These usually begin within 5 to 10 hours after the last alcohol drink and
typically peak at 24 to 48 hours. Along with tremors (trembling), you can have a rapid pulse,
an increase in blood pressure, rapid breathing, sweating, nausea and vomiting, anxiety or a
hyper-alert state, irritability, nightmares or vivid dreams, and insomnia.
 • Alcohol hallucinosis. This symptom usually begins within 12 to 24 hours after your last
drink, and may last as long as 2 days once it begins. If this happens, you hallucinate (see or
feel things that are not real). It is common for people who are withdrawing from alcohol to see
multiple small, similar, moving objects. Sometimes the vision is perceived to be crawling
insects or falling coins. It is possible for an alcohol withdrawal hallucination to be a very
detailed and imaginative vision.

• Alcohol withdrawal seizures. Seizures may occur 6 to 48 hours after the last drink, and it is
common for several seizures to occur over several hours. The risk peaks at 24 hours.

• Delirium tremens. Delirium tremens commonly begins two to three days after the last
alcohol drink, but it may be delayed more than a week. Its peak intensity is usually four to
five days after the last drink. This condition causes dangerous shifts in your breathing, your
circulation and your temperature control. It can cause your heart to race dangerously or can
cause your blood pressure to increase dramatically, and it can cause dangerous dehydration.
Delirium tremens also can temporarily reduce the amount of blood flow to your brain.
Symptoms can include confusion, disorientation, stupor or loss of consciousness, nervous or
angry behavior, irrational beliefs, soaking sweats, sleep disturbances and hallucinations.

Diagnosis
Alcohol withdrawal is easy to diagnose if you have typical symptoms that occur after you stop heavy,
habitual drinking. If you have a past experience of withdrawal symptoms, you are likely to have
them return if you start and stop heavy drinking again. There are no specific tests that can be used
to diagnose alcohol withdrawal.

If you have withdrawal symptoms from drinking, then you have consumed enough alcohol to
damage other organs. It is a good idea for your doctor to examine you carefully and do blood tests,
checking for alcohol-related damage to your liver, heart, the nerves in your feet, blood cell counts,
and gastrointestinal tract. Your doctor will evaluate your usual diet and check for vitamin deficiencies
because poor nutrition is common when someone is dependent on alcohol.

It is usually difficult for people who drink to be completely honest about how much they've been
drinking. You should report your drinking history straightforwardly to your doctor so you can be
treated safely for withdrawal symptoms.

Expected Duration
Symptoms of alcohol withdrawal typically improve within five days, though a small number of
patients may have prolonged symptoms, lasting weeks.

Prevention
Alcoholism is caused by many factors. If you have a sibling or parent with alcoholism, then you are
three or four times more likely than average to develop alcoholism. Some people with family
histories of alcoholism choose to abstain from drinking since this is a guaranteed way to avoid
developing alcohol dependence. Many people without a family history also develop alcoholism. If you
are concerned about your drinking, speak with your doctor.
Treatment
If you have severe vomiting, seizures or delirium tremens, the safest place for you to be treated is in
a hospital. For delirium tremens, treatment in an intensive care unit (ICU) is often required. In an
ICU, your heart rate, blood pressure, and breathing can be monitored closely in case emergency life-
support (such as artificial breathing by a machine) is needed.

Medicines called benzodiazepines can lessen alcohol withdrawal symptoms. Commonly used
medicines in this group include diazepam (Valium), chlordiazepoxide (Librium) and lorazepam
(Ativan).

Most alcohol abusers who are having withdrawal symptoms have a shortage of several vitamins and
minerals and can benefit from nutritional supplements. In particular, alcohol abuse can create a
shortage of folate, thiamine, vitamin B12, magnesium, zinc and phosphate. It also can cause low
blood sugar.

Ideally, an addiction specialist assists in the care of a person who is experiencing alcohol withdrawal.

When To Call a Professional

Get help if you or someone you love has an alcohol-related problem. Alcoholism is an illness that can
be treated.

If you have an alcohol dependency problem and have decided to stop drinking, call your doctor for
help. Your doctor can advise you and can prescribe medicines to make withdrawal symptoms more
tolerable if they occur. Your doctor can also put you in touch with local resources that will help you
to stay alcohol free.

Prognosis
Alcohol withdrawal is common, but delirium tremens only occurs in 5% of people who have alcohol
withdrawal. Delirium tremens is dangerous, killing as many as 1 out of every 20 people who develop
its symptoms.

After withdrawal is complete, it is essential that you not begin drinking again. Alcohol treatment
programs are important because they improve your chances of successfully staying off of alcohol.
Only about 20% of alcoholics are able to abstain from alcohol permanently without the help of
formal treatment or self-help programs such as Alcoholics Anonymous (AA). Of people who attend
AA, 44% of those who remain free of alcohol for 1 year probably will remain abstinent for another
year. This figure increases to 91% for those who have remained abstinent and have attended AA for
5 years or more.

On average, an alcoholic who doesn't stop drinking can expect to decrease his or her life expectancy
by at least 15 years.

An in-depth report on the causes, diagnosis, and treatment of

alcoholism.
Therapy

The two standard forms of therapy for alcoholism are the following:

• Cognitive-behavioral therapy.
• Interactional group psychotherapy based on the Alcoholics
Anonymous (AA) 12-step program.

Some comparison studies have reported that these approaches are

equally effective when the program was competently administered.
One 2001 study suggested that in general, AA may have a better
abstinence rate than cognitive-behavioral therapy. It is also less
expensive. Specific people, however, may do better with one program
than another. One study, for example, examined the differences in
success rates on type 1 or type 2 alcoholics:

• People in the type 1 group did well with the 12-step approach.
They did not do as well with cognitive-behavioral therapy. (Type 1
individuals become alcoholic at a later age, have less severe
symptoms or fewer psychiatric problems, and have a better
outlook on life than those classified as type 2. They are more likely
to be women.)
• The people in the type 2 group tend to do better with
cognitive-behavioral therapy. (Type 2 people are more likely to be
male, become alcoholic at an early age, have a high family risk for
alcoholism, have more severe symptoms, and have a negative
outlook on life.)

This difference in response to the two forms of treatment held up

after two years. Other studies have also reported that people with
fewer psychiatric problems do best with the AA approach.

Interactional Group Psychotherapy (Alcoholics Anonymous)

Alcoholics Anonymous (AA), founded in 1935, is an excellent example

of interactional group psychotherapy and remains the most well
known program for helping people with alcoholism. It offers a very
strong support network using group meetings open seven days a
week in locations all over the world. A buddy system, group
understanding of alcoholism, and forgiveness for relapses are AA's
standard methods for building self-worth and alleviating feelings of
isolation.

AA's 12-step approach to recovery includes a spiritual component that

might deter people who lack religious convictions. Prayer and
meditation, however, have been known to be of great value in the
healing process of many diseases, even in people with no particular
religious assignation. AA emphasizes that the "higher power"
component of its program need not refer to any specific belief
system. Associated membership programs, Al-Anon and Alateen, offer
help for family members and friends.
The 12 Steps of Alcoholics
Anonymous

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy (CBT) uses a structured teaching

approach and may be better than AA for people with severe
alcoholism. Patients are given instruction and homework assignments
intended to improve their ability to cope with basic living situations,
control their behavior, and change the way they think about drinking.
The following are examples of approaches:

• Patients might write a history of their drinking experiences

and describe what they consider to be risky situations.
• They are then assigned activities to help them cope when
exposed to "cues" (places or circumstances that trigger their
desire to drink).
• Patients may also be given tasks that are designed to replace
drinking. An interesting and successful example of such a program
was one that enlisted patients in a softball team; this gave them
the opportunity to practice coping skills, develop supportive
relationships, and engage in healthy alternative activities.

CBT may be especially effective when used in combination with opioid

antagonists, such as naltrexone. CBT that addresses alcoholism and
depression also may be an important treatment for patients with both
conditions. Interestingly, however, in one study patients with
alcoholism and social phobias had a poorer outcome with a CBT
program that addressed both problems.

Motivational Interviewing

A technique known as motivational interviewing is aimed at

motivating people with alcoholism to change their own behavior.
Studies suggest that it is very helpful in encouraging people to quit,
even including those with mental illnesses. With this technique, the
therapist uses empathy and a nonargumentative approach to
encourage patients to make their own changes and to solve their own
problems.

Behavioral Therapies for Partners

Partners of people with alcoholism can also benefit greatly from

behavioral approaches that help them cope with their mate. Of note,
children of an alcoholic mother or father may do better if both parents
participate in couples-based therapy, rather than just treating the
parent with alcoholism.

Treating Sleep Disturbances

Nearly all patients who are alcohol dependent suffer from insomnia
and sleep problems, which can last months to years after abstinence.
Sleep disturbances may even be important factors in relapse.
Available therapies include sleep hygiene, bright light therapy,
meditation, relaxation methods, and other nondrug approaches. Many
medications for inducing sleep are notrecommended in people with
alcoholism. [For more information,see Well-Connected Report
#27 Insomnia.]

Alternative Methods

Some people try alternative methods, such as acupuncture or

hypnosis. Such approaches are not harmful. In one study acupuncture
reduced the desire for alcohol in nearly half of people, although it was
not significantly more helpful than conventional treatments.

Treatment for Alcoholism

Treatment for alcoholism should consist of several core components. The most effective
alcoholism treatment programs include all of these elements. If you are in a treatment
program that doesn’t, you should look for the missing part(s) elsewhere. A comprehensive
program that we’ll outline here will give you the best chance of success.

Individual Counseling

Individual counseling is highly recommended, but some alcoholism treatment programs

don’t include it. They rely instead on group counseling. Group counseling is an important
part of an effective program, but individual counseling is needed as well.

Individual counseling is, obviously, where individuals will be able to focus on their own
issues. They can work on the issues that led them to drink in the first place.

If individual counseling is not a part of your treatment program, you should see a counselor
on your own. Make sure to select a counselor with training and experience in treating the
disease of alcoholism.

Group Counseling

Group counseling is an important part of the treatment for alcoholism. It allows group
members to give and receive support from others with similar experiences. Group members
can learn from one another. Group work also lessens the shame of being an alcoholic.
Group counseling is different than self-help groups like AA (Alcoholics Anonymous) because
it is facilitated by a professional counselor. While self-help groups can be useful, group
counseling is a critical component of any treatment program.

Education

Alcoholics need to learn about their disease. They need to be taught a number of coping
skills, such as stress management and problem-solving. They need to learn about relapse
prevention.

Nutritional Counseling

Not all alcoholism treatment programs include nutritional education and counseling, but it is
important for alcoholics. Many alcoholics suffer from malnutrition, particularly vitamin B
deficiencies. Cravings for sugar often accompany cravings for alcohol. Proper nutrition helps
to heal damaged organs and can even help decrease cravings for alcohol.

There is a school of thought that recommends a variety of nutritional supplements in the

treatment for alcoholism. Few treatment programs use this protocol, however. Even so,
good nutrition should be encouraged. Residential treatment programs should provide
healthy, tasty meals. All treatment programs should include information about good
nutrition. If you are in a treatment program that doesn’t, you should see a dietitian on your
own.

Family Counseling and Education

Family counseling is a very important component in the treatment for alcoholism. Family
relationships are often fractured by the disease. The alcoholic often withdraws from the
family as he or she focuses more and more on alcohol. He or she often lies to family
member about the drinking. Families often fight about the scope of the alcohol problem.

Family members also need to be educated about the disease of alcoholism. They need to
learn how they can support the alcoholic in recovery. They and the alcoholic need to learn
positive communication skills.

Aftercare

All alcoholism treatment programs should include aftercare. Aftercare may consist of
individual counseling, group counseling, and/or self-help groups like AA (Alcoholics
Anonymous). A good aftercare program helps to prevent relapse.

How often the alcoholic should attend an aftercare program depends on their individual
needs. Some need to attend an outpatient treatment program for several hours a day,
several days a week. For others, one or two short sessions a week is enough.

Other Treatment for Alcoholism

There are other alcoholism treatment therapies that can be helpful. These include self-help
groups like AA and adjunct therapies like art therapy, music therapy, massage therapy, and
acupuncture. While these modes of treatment can be helpful, they are usually not necessary
to the treatment of alcoholism.
 Alcohol Rehab Programs

Deciding to go into an alcohol rehab program is a very difficult decision to make. Many
times, a person is ordered in a drug alcohol rehab program by the court or compelled to
enter a program by their employer. Other times, family members pressure addicts to get
treatment.

For treatment to be successful, though, the alcoholic

has to engage in the program. They have to decide
that they need help and be willing to accept the help available.

It is difficult for treatment centers to keep accurate statistics of their success rates because
they are often unable to keep tabs on patients after they complete - or fail to complete - the
program. However, many believe the success rate to be around 50%. Why is it so low?
Probably because many alcoholics are not in treatment because they want to be. The
success rate for those who entered treatment willingly is probably much higher.

The success rate is lowest for adolescents. About 70% of them relapse during the first year
after completing treatment. They are the group most likely to drop out of treatment before
completing the program, as well.

Successful Treatment

Despite these rather grim statistics, there is good help available for those who wish to avail
themselves of it. There are many excellent alcohol rehabilitation centers in the United States
and around the world.

There are several factors that make a drug alcohol rehab program successful:

• Care is tailored to the individual. It is not a one-size-fits-all approach.

• They treat the whole person, not just the drinking problem. They focus on a person’s
strengths, not their weaknesses.
• They take a comprehensive approach. They address the physical/medical problems
caused by alcohol, the mental and emotional issues both leading up to and caused by
drinking, and the spiritual side of things.
• They use a variety of drug alcohol rehab treatment techniques, including individual
and group therapy and self-help groups like Alcoholics Anonymous. They may also
offer art therapy, music therapy, and other complementary treatments.
• They teach new coping skills, stress management skills, and relapse prevention
skills.
• The family is involved in treatment. This is particularly important for adolescents.
 • They offer several levels of treatment, to meet the needs of the individual. Inpatient
care is available. Intensive outpatient care (where you go for several hours, several
days per week) and outpatient care (where you attend a couple of sessions per
week) are both available.
• There is an aftercare component. The patient continues to follow up with the rehab
center for several months or more after completing the main treatment program.
This helps them stay on the right track.

When selecting a rehab center, you should ask about these factors. That way you will have
the greatest chance of successful treatment.

You should also remember that your attitude plays an important role in your treatment. You
should keep an open mind and be willing to learn new ways of coping with your problems.
You should also be willing to participate in all components of the program, even though
some might seem uncomfortable, such as talking in front of a group.

You should be aware, though, that relapse can occur. There is no shame in seeking help a
second time if you need it.

Types of Alcoholism Therapy

Proven types of alcoholism therapy are integral components in comprehensive treatment

programs to help drinkers and their families acquire skills that help advance treatment,
facilitate the mental and physical healing process, and foster abstinence.

Skills that are learned extend past the treatment period and are designed to be applied
throughout life in support of wellness and sobriety.

Following are types of alcoholism therapy that have proven effective in helping problem
drinkers and their families begin the path to recovery.

Motivational Enhancement Programs

These programs are designed to raise drinkers' awareness of the impact alcohol has on their
lives, as well as the lives of family, co-workers and society. They are encouraged to accept
responsibility for past actions and make a commitment to change future behavior.

Therapists help alcoholic patients understand and accept the benefits of abstinence, review
treatment options, and design a treatment plan to which they will commit.

Cognitive-Behavioral Coping-Skills Therapy

Comprised of a group of therapeutic approaches, cognitive behavioral therapy helps alcohol-
dependent people acquire skills to recognize, cope and change problem-drinking behaviors.

By understanding what needs are filled by drinking, a therapist is able to work with an
alcoholic patient to find new ways to address needs that don’t include drinking -- and
modify psychological dependence on the drug.

During therapy sessions, patients are taught essential coping skills to:

• Recognize what triggers the urge to drink

• Manage negative moods and emotional vulnerabilities
• Change social outlets and friendships to focus on something other than drinking

12-Step Facilitation Therapy

This peer-support approach encourages people to become involved with a 12-step or related
program that complements professionally supervised therapy.

Programs like Alcoholics Anonymous, Smart Recovery, SOS and Women for Sobriety are
typically recommended with all forms of alcoholism therapy because they provide alcohol-
dependent individuals with an encouraging, supportive environment.

Support group meetings focus on abstinence and fosters each individual’s physical, mental
and spiritual health.

Behavioral Couples Therapy

This approach combines a focus on alcoholism recovery with efforts to repair and improve
relationships. For the therapy to be effective, both partners must be committed to the
relationship and want to strengthen it.

Only one spouse should be alcohol dependent for the therapy to have impact. If both
couples are alcoholics, different strategies need to be deployed so couples are less likely to
relapse together.

Therapy includes providing the non-dependent partner with training on communication and
support strategies that facilitate the advancement of treatment and sobriety. An integral
component of couples therapy involves developing a "contract" agreeing that:

• The alcoholic-dependent partner will commit to abstinence

• The non-dependent partner will offer continual support and reinforcement
• Neither partner will discuss past addictive behavior and its consequences
• Neither partner will discuss the future and misuse outside of the therapy sessions
Can you fight the disease of alcohol addiction and still be a social drinker? Making such a stance was

heretical only a generation ago. Yet controlled drinking, as it is called, has emerged as an accepted

treatment option for those who find abstinence too daunting.

Two books published last month by the same publisher—one in favor of controlled drinking, and the

other, a tribute to Alcoholics Anonymous, adamantly against it—highlight the diversity of treatment

plans, if not the passion of doctors who treat addiction .

For many Americans, Alcoholics Anonymous is synonymous with alcohol addiction treatment, and for

good reason. AA has helped millions of people get off the bottle. Its system of free support groups, a

12-step program, and confessional meetings over the smell of percolating coffee as members sit in a

circle is part of the popular culture, giving birth to other legitimate groups such as Narcotics

Anonymous and silly parodies such as Chocoholics Anonymous.

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Yet AA is not for everyone. While it is one of the most effective treatment programs, succeeding about

20 percent of the time, it is one method among several, which include other kinds of support groups,

psychotherapy, medication, or a combination of all of these.

The key to 100-percent success is to find the right treatment program for you, says Dr. Michael Levy,

author of "Take Control of Your Drinking...And You May Not Need to Quit" (Johns Hopkins University

Press, 2007). AA, Levy says, doesn't have a monopoly on treatment plans.

Moderation, an option

Levy, a treatment clinic director and a lecturer at Harvard Medical School, is exceedingly careful not to

disparage AA. He in fact encourages people to check it out. But he notes that one of AA's limitations is

its strict reading of its 12 steps.

Some people cannot get past step one, which is admitting that one is powerless over alcohol. Levy

says that's simply not true; heavy drinkers can stop drinking on their own, and his practice is proof of

that.

The second step requires belief in a greater "Power," with a capital P. Six other steps mention God,

with a capital G, presumably a Christian God. Levy says that AA's emphasis on spirituality and

abstinence, along with the belief that one must hit rock bottom before recovery is possible, can

discourage some problem drinkers from seeking help.

In his practice, Levy, a psychotherapist, tries to understand the causes of an individual's reliance on

alcohol—perhaps as a social lubricant or stress reliever—and attempts to remedy the problems that

lead to heavy drinking.

Moderation, a blasphemy

Moderation goes against the AA's core belief that alcoholics are in denial about being in control of their

drinking. Thus, advocates for AA often rail at those who offer the wishy-washy solution of controlled

drinking.

Depending on the extent of addiction, the AA's stance is true. Brain imaging studies have revealed

that heavy drinkers actually have damaged the part of the brain that can help control a drinking habit,

which makes the pursuit of moderation not just a matter of strong will but rather a physical

impossibility.

Dr. Jack Hedblom, a psychotherapist in Maryland, is a firm believer in the AA program and attempts to

demystify the organization in his book, "Last Call" (Johns Hopkins University Press, 2007). He

emphasizes the importance of spiritual development, for example, but refutes the idea that the 12

steps are part of an organized religion. He sees no hope in controlled drinking for alcoholics.

Recovery, by the numbers

The 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions foundabstinence and

moderation to be equally effective. Among the 43,000 alcoholics surveyed, nearly 36 percent were in

recovery—18.2 percent were abstainers and 17.7 percent were moderate drinkers.

What remains controversial is the definition of alcohol dependency (alcoholism) and abuse. The AA's

stance, for example, is that anyone who can recover by drinking moderately was never an alcoholic in

the first place.

Rather than play word games, Levy says that if you think you have a problem—be it dependency or

abuse—get help. Both his book, "Take Control of Your Drinking," and "Last Call" were published nearly

simultaneously, perhaps in an attempt to keep the alcoholism treatment debate lively.

Imagine that every time you see a red traffic light you get angry. You begin to
grit your teeth, curse, and generally become abusive toward everyone riding in
the car with you. You know that this response will not change the fact that you
will have to wait in traffic until the light changes. And getting angry with other
people will not change anything, except that you may lose a few friends and
develop an ulcer or high blood pressurein the process. To change this response,
or any other kind of unhealthy, undesirable behavior, you might
use behavioral therapy. For many years, behavioral treatments or therapy
has been used to help people who abuse alcohol. In the nineteenth century,
Benjamin Rush, often thought of as the founder of American psychiatry,
described a variety of psychological cures for long-term drunkenness. Modern
research studies show that behavioral treatments can be effective for alcohol
problems. Also, combining behavioral and prescription-drug treatment often
produces good results.

Why Use Behavioral Approaches?

The success or failure of any type of treatment is measured by whether and
how much a person continues to drink. Many psychological factors influence a
person's drinking behavior: beliefs and expectations, the examples of friends
and family, the customs for drinking within one's society or social circle,
emotions, family dynamics, and the positive and negative consequences
of drinking. Treatments that address these factors directly, then, might be
expected to help a person overcome alcohol problems. In fact, dozens of studies
since the 1960s show the long-term success of behavioral treatments. Typically,
they are more effective than treatment using medications.

Alcoholics Anonymous participants are

sometimes awarded key-chain medallions for extended lengths of sobriety. This medallion reminds its
keeper to enjoy life one day at a time.
Behavioral treatment can also prevent relapse, or a return to drinking behavior
after treatment. Relapse is less likely when people have a stable relationship, a
job, the support of friends, personal coping skills, and self-confidence.
Behavioral methods can anticipate the challenges people will face in these
aspects of their lives and give them the skills needed to cope.

Goals and Methods

Sometimes the goal of behavioral treatment is total and permanent abstinence:
giving up drinking for the rest of a person's lifetime. Sometimes the goal is to
reduce drinking to a level that will no longer threaten a person's physical or
emotional health. The goals of treatment may also include other important
dimensions besides drinking—to get and hold a job, to have a happier marriage
and family life, to learn how to deal with anger, and to find new ways of having
fun that do not involve drinking. To reach these goals, behavioral therapy
makes use of several methods.
Teaching New Skills. People who drink often do so in an attempt to cope with
their problems. People may drink to relax or loosen up, to get to sleep, to feel
better, to enhance sexuality, to build courage, or to forget painful memories.
But alcohol rarely helps people to deal with emotional and relationship
problems. In the long run, it often makes such problems worse. When a person
relies on drinking to cope, that person is termed psychologically dependent on
alcohol.
One behavioral approach, sometimes called broad-spectrum treatment, directly
addresses this problem by teaching people new skills to cope with their
problems. In social-skills training, people learn how to express their feelings
appropriately, ask for things they are uncomfortable about, make their
emotional needs known in their relationships, refuse drinks, and carry on
rewarding conversations without drinking. Stress-management training teaches
people how to relax and deal with stressful life situations without using alcohol
or drugs.
Self-Control Training. Self-control training teaches people how to manage
their own behavior. They learn how to do the following:

• set clear goals for behavior change

• keep records of their drinking behavior and urges to drink
• reward themselves for progress toward goals
• make changes in the way they drink
• identify high-risk situations where the temptation to drink is strong
• learn strategies for coping with those high-risk situations

Self-control training is often used to help people reduce their drinking to a

moderate level that does not cause problems. But it can also be used when total
abstinence is the goal. This method is particularly helpful for less severe
problem drinkers. It is also more effective than educational lectures for drunk-
driving offenders.
Marital Therapy. Problem drinking commonly affects the drinker's partner in
negative ways. Treatment that involves the husband or wife of a problem
drinker can help both partners. A husband or wifecan help to clarify problems
and suggest ways that the drinker can change the problem behavior. Marital
distress can be an important factor in problem drinking, so direct treatment of
marital problems can help to prevent relapse. Research indicates that problem
drinkers treated together with a spouse do better than those treated
individually.
Aversion Therapy. In another treatment method, drinking is paired with
unpleasant images and experiences. For example, the taste of alcohol may be
paired with foul odors or with unpleasant experiences in the person's
imagination. Whenever the person has a drink, he or she will be reminded of
those unpleasant images and sensations. Eventually the person loses the desire
for alcohol and drinks less. The person develops an aversion to drinking, which
means that the taste and even the thought of alcohol become unpleasant.
Aversion therapy may be especially useful for drinkers who continue to feel a
strong craving for alcohol.
Psychotherapy. Many kinds of psychotherapy have been tried with alcohol
abusers. The goal of psychotherapy is generally to gain insight into the
unconscious causes of drinking. This type of therapy has been largely
unsuccessful. Group psychotherapy also has a poor track record in the
treatment of problem drinking.
Changing the Environment. Yet another behavioral approach aims to change
the motivations for drinking by changing the environment of drinking. The goal
here is to eliminateconsequences of drinking that a person might find
rewarding. For example, if a person often visits the same bar and drinks to feel
part of the crowd there, a counselor might recommend that the person find a
new place or a new way to socialize. The person is encouraged to find
alternative ways to have rewarding experiences.
Brief Motivational Counseling. Researchers have discovered that some
treatments consisting of only one to three sessions were as effective as longer
and more complex treatment regimens. In this approach, a doctor or therapist
makes a thorough assessment of a patient's drinking problem and presents
feedback of findings to the patient. The doctor then offers clear advice to
change, stressing the importance of personal responsibility and optimism. The
key seems to be to trigger a decision and commitment to change. Through this
brief and simple process, problem drinkers acquire the motivation to change
their drinking behavior. People frequently proceed to change their drinking on
their own without further professional help. In fact, the personal motivation to
change is so important that other treatment approaches that skip over this first
step may fail.

Conclusion
It is unlikely that research will ever identify a single superiortreatment for
alcohol abuse. Drinking and alcohol-related problems are far too complex. Yet
the number of approaches that have been successful is a cause for real
optimism. The chances that an individual will find an effective approach are
good. The most successful treatment strategies will match the method to the
individual based on his or her characteristics.

Alcohol in Fiction
Drug and alcohol abuse can turn academic and athletic success into failure. In
his novel, Imitate the Tiger (1996), Jan Cheripko wrote about a young adult in a
detoxification program (a recovery program), and in a series of flashbacks
shows how alcohol turned a football star into a dropout and his long road back.

See Also
Alateen; Al-Anon; Alcohol Treatment: Medications; Alcoholics Anonymous
(Aa); Diagnosis of Drug and Alcohol Abuse: an Overview; Treatment: History
Of, in the United States; Treatment Programs, Centers, and Organizations: a
Historical Perspective;Treatment Types: an Overview.

This is the complete article, containing 1,316 words (approx. 4 pages at 300

More than one-third (35.9 percent) of U.S. adults with alcohol dependence
(alcoholism) that began more than one year ago are now in full recovery,
according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

The fully recovered individuals show symptoms of neither alcohol

dependence nor alcohol abuse. They either abstain or drink at levels below
those known to increase relapse risk. They include roughly equal proportions
of abstainers (18.2 percent) and low-risk drinkers (17.7 percent).

The analysis is based on data from the 2001-2002 National Epidemiologic

Survey on Alcohol and Related Conditions (NESARC), a project of NIAAA.
Based on a representative sample of 43,000 U.S. adults aged 18 years and
older, the NESARC is the largest survey ever conducted of the co-occurrence
of alcohol and drug use disorders and related psychiatric conditions. The
NESARC defines alcohol use disorders and their remission according to the
most recent clinical criteria established by the American Psychiatric
Association.

One-quarter (25.0 percent) of individuals with alcohol dependence that

began more than one year ago now are still dependent and 27.3 percent are
in partial remission (that is, exhibit some symptoms of alcohol dependence
or alcohol abuse). About twelve percent (11.8%) are drinkers with no
symptoms but whose consumption increases their chances of relapse (for
men, more than 14 drinks per week or more than four drinks on any day; for
women, more than 7 drinks per week or more than three drinks on any
day).

These research findings are summarized below.

Lead author Deborah Dawson, Ph.D. and her colleagues in the Laboratory of
Biometry and Epidemiology in NIAAA's intramural research program released
the latest NESARC analysis in an article in Addiction entitled "Recovery From
DSM-IV Alcohol Dependence: United States, 2001-2002."

Research has produced evidence for decades that some alcoholics could
return to moderate or controlled drinking. However, Alcoholics Anonymous
and other influential and powerful groups have tended to define an alcoholic
as a person who can never drink in moderation. Thus, their conceptions and
definitions have caused them to reject this mounting evidence. For example,
they tend to argue that if researchers identify alcoholics who can now drink
in moderation, that simply means that the alcoholics were falsely diagnosed
and really weren’t alcoholics or they wouldn’t have been able to drink in
moderation.

Historical approaches to substance abuse treatment

[edit]Disease model and twelve-step programs
The disease model of addiction has long contended the maladaptive patterns of alcohol and substance
use displayed by addicted individuals are the result of a lifelong disease that is biological in origin and
exacerbated by environmental contingencies. This conceptualization renders the individual essentially
powerless over his or her problematic behaviors and unable to remain sober by himself or herself, much
as individuals with a terminal illness are unable to fight the disease by themselves without medication.
Behavioral treatment, therefore, necessarily requires individuals to admit their addiction, renounce their
former lifestyle, and seek a supportive social network who can help them remain sober. Such approaches
are the quintessential features of Twelve-step programs, originally published in the book Alcoholics
Anonymous in 1939.[12] These approaches have met considerable amounts of criticism, coming from
opponents who disapprove of the spiritual-religious orientation on both psychological [13] and
legal [14] grounds. Nonetheless, despite this criticism, outcome studies have revealed that affiliation with
twelve-step programs predicts abstinence success at 1-year follow-up for alcoholism. Different results
have been reached for other drugs, with the twelve steps being less beneficial for addicts to illicit
substances, and least beneficial to those addicted to the physiologically and psychologically
addicting opioids, for which maintenance therapies are the gold standard of care.[15]

[edit]Client-centered approaches
In his influential book, Client-Centered Therapy, in which he presented the client-centered approach to
therapeutic change, psychologist Carl Rogers proposed there are three necessary and sufficient
conditions for personal change: unconditional positive regard, accurate empathy, and genuineness.
Rogers believed the presence of these three items in the therapeutic relationship could help an individual
overcome any troublesome issue, including alcohol abuse. To this end, a 1957 study [16]compared the
relative effectiveness of three different psychotherapies in treating alcoholics who had been committed to
a state hospital for sixty days: a therapy based on two-factor learning theory, client-centered therapy,
and psychoanalytic therapy. Though the authors expected the two-factor theory to be the most effective, it
actually proved to be deleterious in outcome. Surprisingly, client-centered therapy proved most effective.
It has been argued, however, these findings may be attributable to the profound difference in therapist
outlook between the two-factor and client-centered approaches, rather than to client-centered techniques
per se.[17] The authors note two-factor theory involves stark disapproval of the clients’ “irrational behavior”
(p. 350); this notably negative outlook could explain the results.

There are newer, more-client-specific methods of delivering addiction and alcoholism treatment. One
incredibly effective - though prohibitively expensive - method of delivering treatment is the Sober Coach.
In this approach, the client is serviced by provider(s) in his or her home and workplace.

[edit]Psychoanalytic approaches
Psychoanalysis, a psychotherapeutic approach to behavior change developed by Sigmund Freud and
modified by his followers, has also offered an explanation ofsubstance abuse. This orientation suggests
the main cause of the addiction syndrome is the unconscious need to entertain and to enact various kinds
of homosexual and perverse fantasies, and at the same time to avoid taking responsibility for this. It is
hypothesised specific drugs facilitate specific fantasies and using drugs is considered to be a
displacement from, and a concomitant of, the compulsion to masturbate while entertaining homosexual
and perverse fantasies. The addiction syndrome is also hypothesised to be associated with life
trajectories that have occurred within the context of traumatogenic processes, the phases of which
include social, cultural and political factors, encapsulation, traumatophilia, and masturbation as a form of
self-soothing.[18] Such an approach lies in stark contrast to the approaches of social cognitive theory to
addiction—and indeed, to behavior in general—which holds human beings regulate and control their own
environmental and cognitive environments, and are not merely driven by internal, driving impulses.
Additionally, homosexual content is not implicated as a necessary feature in addiction.

[edit]Cognitive models of addiction recovery

[edit]Relapse prevention

An influential cognitive-behavioral approach to addiction recovery and therapy has been Alan Marlatt’s
(1985) Relapse Prevention approach.[19] Marlatt describes four psychosocial processes relevant to the
addiction and relapse processes: self-efficacy, outcome expectancies, attributions of causality, and
decision-making processes. Self-efficacy refers to one’s ability to deal competently and effectively with
high-risk, relapse-provoking situations. Outcome expectancies refer to an individual’s expectations about
the psychoactive effects of an addictive substance. Attributions of causality refer to an individual’s pattern
of beliefs that relapse to drug use is a result of internal, or rather external, transient causes (e.g., allowing
oneself to make exceptions when faced with what are judged to be unusual circumstances). Finally,
decision-making processes are implicated in the relapse process as well. Substance use is the result of
multiple decisions whose collective effects result in consumption of the intoxicant. Furthermore, Marlatt
stresses some decisions—referred to as apparently irrelevant decisions—may seem inconsequential to
relapse, but may actually have downstream implications that place the user in a high-risk situation.

Consider Figure 1 as an example. As a result of heavy traffic, a recovering alcoholic may decide one
afternoon to exit the highway and travel on side roads. This will result in the creation of a high-risk
situation when he realizes he is inadvertently driving by his old favorite bar. If this individual is able to
employ successful coping strategies, such as distracting himself from his cravings by turning on his
favorite music, then he will avoid the relapse risk (PATH 1) and heighten his efficacy for future
abstinence. If, however, he lacks coping mechanisms—for instance, he may begin ruminating on his
cravings (PATH 2)—then his efficacy for abstinence will decrease, his expectations of positive outcomes
will increase, and he may experience a lapse—an isolated return to substance intoxication. So doing
results in what Marlatt refers to as the Abstinence Violation Effect, characterized by guilt for having gotten
intoxicated and low efficacy for future abstinence in similar tempting situations. This is a dangerous
pathway, Marlatt proposes, to full-blown relapse. Figure 1 presents a schematic diagram, adapted from
Marlatt & Gordon (p. 38),[19] which has been modified to present examples of the cognitive and behavioral
processes that may occur at each juncture of the model.
[edit]Cognitive therapy of substance abuse

An additional cognitively-based model of substance abuse recovery has been offered by Aaron Beck, the
father of cognitive therapy and championed in his 1993 book, Cognitive Therapy of Substance Abuse.
[20]
This therapy rests upon the assumption addicted individuals possess core beliefs, often not accessible
to immediate consciousness (unless the patient is also depressed). These core beliefs, such as “I am
undesirable,” activate a system of addictive beliefs that result in imagined anticipatory benefits of
substance use and, consequentially, craving. Once craving has been activated, permissive beliefs (“I can
handle getting high just this one more time”) are facilitated. Once a permissive set of beliefs have been
activated, then the individual will activate drug-seeking and drug-ingesting behaviors. The cognitive
therapist’s job is to uncover this underlying system of beliefs, analyze it with the patient, and thereby
demonstrate its dysfunctionality. As with any cognitive-behavioral therapy, homework assignments and
behavioral exercises serve to solidify what is learned and discussed during treatment.

[edit]Emotion regulation, mindfulness, and substance abuse

A growing literature is demonstrating the importance of emotion regulation in the treatment of substance
abuse. For the sake of conceptual uniformity, this section uses the tobacco cessation as the chief
example; however, since nicotine and other psychoactive substances such as cocaine activate similar
psychopharmacological pathways,[21] an emotion regulation approach may be similarly applicable to a
wider array of substances of abuse. Proposed models of affect-driven tobacco use have focused
on negative reinforcement as the primary driving force for addiction; according to such theories, tobacco
is used because it helps one escape from the undesirable effects of nicotine withdrawal or other negative
moods.[22] Currently, research is being conducted to determine the efficacy ofmindfulness based
approaches to smoking cessation, in which patients are encouraged to identify and recognize their
negative emotional states and prevent the maladaptive, impulsive/compulsive responses they have
developed to deal with them (such as cigarette smoking or other substance use).[23]

[edit]Behavioral models
Main article: Community reinforcement and family training

Behavioral models make use of principles of functional analysis of drinking behavior. Behavior models
exists for both working with the substance abuser (Community reinforcement approach) and their family
(community reinforcement and family training). Both these models have had conierable research success
for both efficacy and effectiveness.

Relapse prevention (RP) is a type of coping-focused psychotherapy or psycho-education that

strives to teach drug or alcohol dependentpersons coping skills to help them avoid relapsing back
to using drugs and/or alcohol. Goals of a relapse prevention program include: 1) teachingcoping
skills to allow the recovering person to "identify, anticipate, avoid and/or cope" with high risk
situations (for relapse), 2) to help recovering persons learn how to keep a single 'lapse' from
turning into a multiple 'relapse' situation, and 3) to help the recovering person feel as though he
or she is really capable of controlling his or her own behavior.

Multiple skills are taught in a relapse prevention class. Such skills include:

 Learning to discriminate a 'lapse' from a 'relapse'

 Learning to identify stressful situations and objects ("people, places and things") in the

environment that can trigger relapse

 Once a stressful situation, person, place or thing is identified, learningcoping skills which help

people to avoid or defuse that situation, person, place or thing so that it doesn't trigger relapse

 To learn how to identify, plan and participate in positive and fulfilling sober activities that can fill in

time formerly devoted to using drugs or alcohol, or fill in blank spots in the addict's schedule (which
would otherwise be filled with cravings and stress)

 To learn how to identify and change unhealthy habits for healthier ones.
One of the first things taught is frequently, how to discriminate a lapse from a
relapse. RP teaches that addiction is extremely powerful, recovery difficult (but not impossible),
and reversion to drinking and/or drugging likely (at least at first). A single 'lapse' (use of drugs
or alcohol on asingle occasion), does not need to necessarily need to become a 'relapse'
(multiple uses of drugs and/or alcohol) if the recovering person can catch him or herself and take
corrective actions. Important parts of keeping 'lapses' from becoming relapses are 1) recognizing
that lapses are likely to occur, 2) not shaming one's self or treating the lapse as an unforgivable
failure, and 3) taking immediate steps to keep the lapse from repeating (e.g., removing the
temptation, getting away from the stress, etc.).

One of the important coping skills which may be taught in a relapseprevention class is called
mindfulness. To become mindful means to develop awareness, but to do so in a non-judgmental
manner. Working on mindfulness skills helps addicted people learn to become more aware and
accepting of the constant stream of subtle thoughts and triggers they are likely experiencing
which push them towards relapse. Becoming aware and conscious of a trigger helps people to
gain a degree of control over that trigger so as to be able to choose to not react to it.