IJSP-2010(3-4) - Indian Association For Social Psychiatry

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Mukherjee et al Overconfidence Progressive loss of daily structure 3. Thoughts of controlled use The two central concepts are those of high risk situations and coping strategies. High risk situations may be situations, events, objects, cognitions or mood states which have become associated with drug use and/or relapse. They may include negative mood states, social pressure, social networks, interpersonal conflicts, negative physical states and some positive emotional states. Relapse prevention requires the development of specific coping strategies to deal with high risk situations. These may include skills training and the development or strengthening of more global coping strategies. Treatment Approaches with Limited Evidence of Effectiveness There are also a number of commonly used treatment approaches that do not show any evidence of effectiveness. These approaches comprise the largest number of treatment studies and are summarized below (Heather & Stockwell, 2004). a. Insight Oriented Psychotherapy: Psychotherapy seeks to uncover unconscious causes for a person's alcohol problems. The goal is insight and psychotherapy is frequently studied as an adjunctive component to alcohol treatment. In general, studies do not reveal consistent positive results; in fact, the trend favors patients who did not receive psychotherapy (Miller et al, 1995). b. Confrontational Counselling: Confrontational interventions seek to break down defenses, particularly denial. Historically, confrontation has been considered an essential component of alcohol treatment, yet no studies have shown positive findings for approaches using confrontation (Holder et al, 1991; Finney & Monahan, 1996; Miller et al, 1995). In a controlled evaluation of therapist styles, Miller and colleagues (1993) found that confrontation yielded significantly 96 more resistance and predicted poorer outcomes-one year after a brief intervention. Miller and Rollnick (1991) suggested that confrontation is a goal rather than a procedure and that the occurrence of client resistance during a session should serve as immediate feedback for altering the therapeutic approach. c. Milieu Therapy: Implicit in the use of milieu therapy is the idea that recovery is aided by the place in which therapy occurs. The therapeutic atmosphere is itself thought to be beneficial. This idea is commonly associated with inpatient or residential programmes which seek to promote an atmosphere of healing. Results of controlled research do not provide evidence to support residential/milieu therapy over less costly out patient treatment and in fact, milieu therapy most frequently yields a less positive outcome when compared to a brief intervention (Miller et al, 1995). CONCLUSION Psychosocial treatments, in the form of advice and counseling, psychoeducation, interactive sessions, role-playing, feedback, skills training and providing emotional and social support, can be very useful for both the patient of alcohol dependence and his family. Such treatments may be meted out in professionally guided brief or extended interventions, or in the self-help approaches. All these, sometimes taken together, can be instrumental in achieving maintenance of abstinence, return of the alcohol user to the mainstream of life, and promotion of well being of the patient and his family. However, it needs to be kept in mind that pharmacological and psychosocial approaches to the management of alcohol abuse tend to go hand in hand, they are complementary to each other, and the best results have generally been obtained by a combined approach. REFERENCES Azrin, N.H., Sisson, R.W., Meyers, R.J., et al (1982) Alcoholism treatment by disulfiram and community reinforcement therapy. Journal of Behaviour Therapy and Experimental Psychiatry, 3, 105-112. © 2010 Indian Association for Social Psychiatry
Azrin, N.H., Acierno, R., Kogan, E.S., et al (1996) Follow-up results of supportive versus behavioral therapy for illicit drug use. Behaviour Research and Therapy, 34, 41-46. Azrin, N.H., Donohue, B., Besalel, V.A., et al (1994a) Youth drug abuse treatment: A controlled outcome study. Journal of Child and Adolescent Substance Abuse 3,1-16. Azrin, N.H., McMahon, P.T., Donohue, B., et al (1994b) Behavior therapy for drug abuse: A controlled treatment outcome study. Behaviour Research & Therapy, 32, 857-866. Bandura, A. (1986) Social functions of Thought and Action. Prentice Hall: New Jersey. Barnes, H.N. & Samet, J.H. (1997) Brief Interventions with Substance Abusing Patients. Medical Clinics of North America, 81, 867-879. Beck, A. (1993) Cognitive Therapy and the Emotional Disorders. Penguin: New Jersey. Beck, A.T., Rush, A.J., Shaw, B.F., et al (1979) Cognitive therapy of depression. Guilford Press: New York. Beck, A., Wright, F.D., Newman, C.F., et al (1993) Cognitive therapy of substance abuse. Guilford Press: New York. Beck. A.T. (1976) Cognitive Therapy and the Emotional Disorders. International Universities Press: New York. Bien, T.H., Miller, W.R., Boroughs, J.M. (1993) Motivational interviewing with alcohol outpatients. Behavioural and Cognitive Psychotherapy, 23, 347-356. Bigelow, G.E. (2001) An operant behavioral perspective on alcohol abuse and dependence. In: N. Heather, T.J. Peters, T. Stockwell (Eds), International Handbook of Alcohol Dependence and Problems, pp. 299-315. John Wiley & Sons: Chichester, UK. Blagden, J.C. & Craske, M.G. (1996) Effects of active and passive rumination and distraction: A pilot replication with anxious mood. Journal of Anxiety Disorders, 10, 243-252. Blakely, R. & Baker, R. (1980) An exposure approach to alcohol abuse. Behaviour Research and Therapy, 18, 319-325. Blumenthal, S., Gudjonsson, G., Burns, J. (1999) Cognitive distortions and blame attribution in sex offenders against adults and children. Child Abuse and Neglect, 23, 129-143. Bowen, M. (1978) Family therapy in clinical practice. Aronson: New York. Burke, P., Del Beccaro, M., McCauley, E., et al (1985) Hallucinations in children. Journal of the American Academy of Child Psychiatry, 24, 71-75. Catalano, R., Howard, M., Hawkins, J., et al (1988) Relapse in the addictions: Rates determinants, and promising prevention strategies. Office of Smoking and Health, Gov't. Printing office: Washington DC. Cheung, B.K.L. (1997) Management of Alcoholic and Drug Disorders. Substance Abuse Assessment Clinic. Kwai Chung Hospital: N.T. Mukherjee et al Collins, R.L. (1990) Family treatment of alcohol abuse: Behavioral and systems perspectives. In: R.L. Collins, K.E. Leonard, J.S. Searles (Eds.), Alcohol and the family: Research and clinical perspectives. Guilford Press: New York. Daley, D.C. (1988) Surviving addiction: A guide for alcoholics, drug addicts, and their families. Gardner Press: New York. Daley, D.C. (1993) Dual Disorders: Consoling Clients with Chemical Dependency and Mental Illness. Hazelden: Centre City. Daley, D.C. & Marlatt, G.A. (1997) Therapist's Guide for Managing Your Alcohol or Drug Problem. Psychological Corporation: San Antonio, TX. De Leon, G. (1995) Therapeutic communities for addictions: A theoretical framework. International Journal of the Addictions, 30, 1603-1645. DiClemente, C.C. & Prochaska, J.O. (1998) Toward a comprehensive model of change. In: R.M. William & N. Heather, (Eds.), Treating addictive behaviours, pp.3-27, Plenum Press: New York & London. Drobes, D.J., Saladin, M.E., Tiffany, S.T. (2001) Classical conditioning mechanisms in alcohol dependence. In: N. Heather, T.J. Peters, T. Stockwell, (Eds), International Handbook of Alcohol Dependence and Problems, pp. 281-297. John Wiley & Sons: Chichester, UK. Ellis, A.E., Mclnerney, J.F., DiGiuseeppe, R., et al (1988) Rationalemotive therapy with alcoholics and substance abusers. Pergamon Press:New York. Finney, J.W. & Monahan, S.C. (1996) The cost-effectiveness of treatment for alcoholism: A second approximation. Journal of Studies on Alcohol, 57, 229-243. Galanter, M. (1992) Office management of the substance abuser: The use of learning theory and social networks. In: J. Lowinsohn, P. Ruiz, R. Millman, (Eds), Comprehensive textbook of substance abuse, pp. 543-549, Williams & Wilkins: Baltimore. Gorski, T. (1986) Relapse prevention planning-A new recovery tool. Alcohol Health and Research World, 63, 6-11. Gorski, T.T. & Miller, M. (1986) Staying sober - A guide for relapse prevention. Herald House Independence Press: Missouri. Halikas, J.A. (1993) Treatment of drug abuse syndromes. Psychiatric Clinics of North America, 16, 693-702. Havassy, B.E., Hall, S.M., Wasserman, D.A. (1991) Social support and relapse: Commonalities among alcoholics, opiate users, and cigarette smokers. Addictive Behaviours, 165, 235- 246. Heather, N. & Stockwell, T. (2004) The Essential Handbook of Treatment and Prevention of Alcohol Problems, (Eds), John Wiley & Sons Ltd: New York. Hohman, M. (1998) Motivational interviewing: An intervention tool for case workers working with substance abuse parents. Child Welfare, 3, 275-289. © 2010 Indian Association for Social Psychiatry 97
Page 3 and 4: ISSN 0971-9962 Editor Vinod K. Sinh
Page 5 and 6: Indian Journal of Social Psychiatry
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as a grossly subjective affair of a
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adjustment of these patients. This
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Book Review... Cognitive science is
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temporal order judgment (TOJ) and a
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The Indian Journal of Social Psychi
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