How is problem drinking treated?

Treating alcoholism was once limited to the peer support group Alcoholics Anonymous (AA) founded in the United States in 1935. AA has seen competition in more recent times with newer treatments including Cognitive-Behavioral Therapy, and Motivational Enhancement Therapy (also called Motivational Interviewing. Mood problems (a common trigger for drinking) among individuals with alcoholism can also be helped with antidepressant medications, and new technology—such as email and the Internet—has opened new avenues for diagnosing and treating people with alcoholism as well.

Is my drinking problematic?

We discussed problematic types of drinking in a previous column on this website. To read that column, click here.

What should I do if my drinking (or the drinking of someone close to me) is problematic?

Interventions to address problematic drinking are tailored for the type of problem. Heavy drinking (drinking that does not result in health, psychological, familial or professional problems) can often be addressed by a brief feedback or psychoeducation session about what are considered normal levels of drinking. Armed with such information, individuals are better able to evaluate whether their level or patterns of drinking are on par with others (and in line with their own standards). Such feedback can be had by a visit to a doctor or mental health professional. Binge drinking (episodes of heavy drinking), is quite common among young drinkers, particularly among those in college or university. Research strongly suggests that prevention strategies aimed at these specific groups and used in combination with each other can help reduce the frequency and quantity of problematic binge drinking in college and university. Interventions usually target individual students with therapy, and information and education for the student body as a whole and for the college/university and surrounding community.

Treating alcohol abuse and dependence:

Individuals with alcohol abuse or dependence are often first approached by family or loved ones who are concerned about their drinking. Such interventions are often perceived as threatening or guilt-provoking, and can be easily misperceived. Addressing concerns calmly and non-confrontationally can be beneficial, however. Setting clear and firm limits (and following through with them) can be helpful too. Invite the person to speak with their doctor, and refuse to remain in an aggressive or violent relationship fueled by drinking. If a person is “ready” to admit to themselves that their drinking is causing problems (to themselves, their work or those close to them), then there are a variety of effective treatments available. As with heavy drinking, alcoholic drinking is often first addressed by a brief feedback or psychoeducation session about what are considered normal levels and patterns of drinking. Armed with such information, individuals are better able to evaluate whether their level or patterns of drinking are harmful, on par with others, and in line with their own standards. Such feedback can be had by a visit to a doctor or mental health professional. A next step is often to identify triggers for drinking in the environment and in the person’s reactions to them. For some this could be a negative interaction with a boss or co-worker, for others it could be driving past a liquor outlet. Once drinking triggers (and the emotions that accompany them) are identified, strategies for rebuilding the person’s repertoire of coping mechanisms are discussed. Another common factor in alcoholism treatment is motivation for change. The challenge for many with alcoholism is that alcohol is experienced as a very potent and effective medication for relieving negative moods and reactions. Thus, individuals are sometimes tempted to continue relying on the “devil they know” because it is experienced as an effective coping or avoidance mechanism. In fact, there may be some truth to such an idea since many studies have shown that individuals with alcoholism are at genetic risk for the disorder by virtue of their unique responses to alcohol. Compared with non-alcoholic persons, individuals with alcoholism experience a stronger physical and emotional “high” when intoxicated, greater stress-reductions, and they experience less-severe withdrawal symptoms. Such responses can even become incorporated into the person’s belief system, and alcohol use can become conditioned by such beliefs or expectations.

The three main types of alcoholism treatment are AA, Cognitive Behavioral Therapy, and Motivational Interviewing. The three types of therapy for alcoholism were compared “head to head” in the largest and costliest psychotherapy study ever conducted (called Project MATCH). The study essentially showed that each treatment was effective, and all were about equally effective. You can learn more about Project MATCH by clicking here. (www.commed.uchc.edu/match/)

In AA treatment, general goal is to increase patients’ active participation in the fellowship of Alcoholics Anonymous. The therapy regards such active involvement as the primary factor responsible for sustained sobriety (“recovery”) and therefore as the desired outcome of participation in this treatment program. This therapy is grounded in the concept of alcoholism as a spiritual and medical disease. Indioviduals are encouraged to rely on God (as they conceptualize God), and others in the fellowship, instead of relying on alcohol.

Motivational Interviewing is a systematic therapy approach for helping problem drinkers to change. MI is based on principles of motivational psychology and is designed to produce rapid internally motivated change. This treatment strategy does not try to force or guide and train the client, step by step, through recovery, but instead employs motivational strategies to mobilize the client’s own change resources. Individuals learn about normal “stages” of motivation to change their drinking behaviour, from pre-contemplation, contemplation, action, and consolidation.

Cognitive-Behavioural Therapy for alcoholism and heavy drinking is based on the principles of social learning theory and views drinking behavior as functionally related to problems dealing with major problems in the person’s life. Social learning theory is a perspective that states that drinking behavior is learned primarily by observing and imitating the actions of others. Drinking behavior is also influenced by being rewarded and/or punished for these actions. For example, the person may come to learn that alcohol dampens stress, or makes them feel better emotionally. Emphasis is placed on overcoming coping skill deficits and helping the individual to better cope with high-risk drinking situations. The program aims at training the person to use active behavioral or cognitive coping methods to deal with problems rather than relying on alcohol as a maladaptive coping strategy.

We are here to help you.
For more information on our services, or for help on deciding which of our team psychologists to choose, don’t hesitate to contact our clinic coordinator at 514-337-2473, ext. 0, and it is with great pleasure that we will discuss with you the psychological services we can offer you.