The literature reviewed in this section is focused on a reduction or cessation of drinking and hence assesses any outcomes pertaining to this. Most of the literature in the field is focused on adults over the age of 18 years. However, for young people under the age of 18 years old, literature assessing the clinical efficacy of psychological therapies for alcohol misuse alone (without comorbid drug misuse) is limited. The psychological evidence below is for an adult population only and a review of the evidence for the treatment of young people is described in Section 6.22.

Specific studies of the role of the alliance in drug and alcohol treatment programmes have been conducted. Luborsky and colleagues (1985), Connors and colleagues (1997) and Ilgen and colleagues, (2006) reported a relationship between treatment outcomes, but others (for example, Ojehagen et al., 1997) have not. This is consistent with other studies; for example, Feeley and colleagues (1999) reported that alliance quality was related to early symptom change. Therefore, it seems reasonable to debate the extent to which a good alliance is necessary for a positive outcome of an intervention, but it is unlikely to be sufficient to account for the majority of the variance in outcome.

Support links

Childhood trauma can fuel problematic drinking in adulthood, because the person might use alcohol to cope with feelings of anger, depression, anxiety, loneliness, or grief. Compared to people without a drinking problem, men and women who sought treatment for alcohol addiction had https://ecosoberhouse.com/ a higher prevalence of childhood trauma, research finds. Furthermore, the greater the abuse or neglect experienced, the more severe their drinking problem was. Therapy can help people who suffered as a child to address those challenges and develop healthier coping skills.

Alcohol dependence is thought to represent a persistent dysfunctional (i.e., allostatic) state in which the organism is ill-equipped to exert appropriate behavioral control over alcohol drinking. Although currently few treatments are available for tackling this significant health problem and providing relief for those suffering from the disease, there is hope. Some studies using animal models involving repeated withdrawals have demonstrated altered sensitivity to treatment with medications designed to quell sensitized withdrawal symptoms (Becker and Veatch 2002; Knapp et al. 2007; Overstreet et al. 2007; Sommer et al. 2008; Veatch and Becker 2005). Moreover, after physiological dependence on alcohol receiving some of these medications, animals exhibited lower relapse vulnerability and/or a reduced amount consumed once drinking was (re)-initiated (Ciccocioppo et al. 2003; Finn et al. 2007; Funk et al. 2007; Walker and Koob 2008). Indeed, clinical investigations similarly have reported that a history of multiple detoxifications can impact responsiveness to and efficacy of various pharmacotherapeutics used to manage alcohol dependence (Malcolm et al. 2000, 2002, 2007). Future studies should focus on elucidating neural mechanisms underlying sensitization of symptoms that contribute to a negative emotional state resulting from repeated withdrawal experience.

Anxiety

Homeless people who misuse alcohol have particular difficulties in engaging mainstream alcohol services, often due to difficulties in attending planned appointments. Al-anon uses the same 12 steps as AA with some modifications and is focused on meeting the needs of friends and family members of alcoholics. Again, meetings are widely available and provide helpful support beyond what can be provided by specialist treatment services.

Of the residential programmes, 45% provide inpatient medically-assisted alcohol withdrawal and 60% provide residential rehabilitation with some overlap between the two treatment modalities. The alcohol withdrawal programmes are typically of 2 to 3 weeks duration and the rehabilitation programmes are typically of 3 to 6 months duration. As noted above, many people will recover from alcohol-use disorders without specialist treatment and many will reduce their alcohol intake following a change in circumstances, such as parenthood, marriage or taking on a responsible job. Hazardous and harmful drinkers may respond to a brief intervention provided in primary care without requiring access to specialist treatment (NICE, 2010a). For others, their alcohol problems are overcome with the help of a mutual aid organisation, such as Alcoholics Anonymous (AA; see Section 2.10).

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