Brief intervention, alcoholism

A number of psychosocial treatments for alcohol and other substance use disorders exist and are widely used. In this chapter, we discuss six of these psychotherapies as they are applied to alcohol, cocaine, and opioid dependence brief interventions, motivational enhancement therapy, cognitive-behavioral therapy, behavioral treatments (including contingency management and community reinforcement approaches), behavioral marital therapy, and 12-step facilitation. We also describe studies that examined the efficacy of a medication in combination with one or more of the six psychotherapies. In the second section of the chapter, we highlight research that directly studied the interaction between psychosocial and pharmacological treatments. 

Brief interventions have been applied in pharmacotherapy trials with alcohol-dependent individuals as well (Bohn et al. 1994 Kranzler et al. 1997 Kranz-ler et al. 2003 Naranjo et al. 1995 O Connor et al. 1997). In an open-label... 

Azrin NH, Sisson RW, Meyers R, et al Alcoholism treatment by disulfiram and community reinforcement therapy. J Behav Ther Exp Psy 13 105-112, 1982 Bickel WK, Amass L, Higgins ST, et al Effects of adding behavioral treatment to opioid detoxification with buprenorphine. J Consult Clin Psychol 65 803—810, 1997 Bien TH, Miller WR, Tonigan JS Brief interventions for alcohol prohlems a review. Addiction 88 315-335, 1993... 

Fiellin DA, Pantalon MV, Pakes JP, et al Treatment of heroin dependence with bu-prenorphine in primary care. Am J Drug Alcohol Abuse 28 231-241, 2002 Fleming M, Manwell LB Brief intervention in primary care settings a primary treatment method for at-risk, problem, and dependent drinkers. Alcohol Res Health... 

Paokolainen K Effectiveness of brief interventions to reduce alcohol intake in primary health care populations a meta-analysis. Prevent Med 28 503-509, 1999... 

Furthermore, the success of brief interventions in treating alcohol problems has led more recently to evaluations of their effectiveness in treating people who have problems with other drugs, such as marijuana and amphetamines (Baker, Boggs, Lewin, 2001 Stephens, Roffman, Curtin, 2000). 

Brief interventions can be as simple as feedback about the consequences of heavy alcohol use for a person (for example, You have some liver problems, and we can trace it to your drinking ) or advice to cut down or stop drinking. They are based on the idea that alcohol problems exist on a continuum of severity and that interventions can occur at any point along that continuum. The research has shown that for the most part brief interventions have been used with people who have mild to moderate alcohol problems they are effective compared to no treatment in reducing alcohol consumption to below risk levels. There is some speculation about who is most helped by brief interventions and why they work. These clearly are topics for future research. 

The findings about brief interventions have great practical implications for alcohol treatment providers and for saving society a lot of money and suffering. They also have implications for theories of the causes of alcohol problems. For example, what do you think disease or biological model adherents might say about brief interventions ... 

NIAAA. (1999). Brief interventions for alcohol problems. Alcohol Alert, No. 43. 

M. F. Fleming, M. R Mundt, M. T. French, L. Baier-Manwell, E. A. Stauffacher, and K. F. Lawton-Berry, 2002. Brief physician advice for problem drinkers Longterm efficacy and benefit-cost analysis. Alcoholism Clinical and Experimental Research 26 36-43 A. I. Wilk, N. M. Jensen, and T. C. Havighurst, 1997. Meta-analysis of randomized control trials addressing brief interventions in heavy alcohol drinkers. Journal of General Internal Medicine 12 274-283. 

Naranjo CA, Bremner KE, Lanctot KL Effects of citalopram and a brief psychosocial intervention on alcohol intake, dependence, and problems. Addiction 90 87-99, 1995... 

The cocaine addict most often presents during withdrawal after a binge of cocaine use. Cocaine withdrawal is not life threatening and does not require medical intervention in the same sense as alcohol or opiate withdrawal. It is, however, associated with a profound depression that can render the addict suicidal for 24-48 hours. The crashing cocaine addict should be assessed for suicide risk and, if indicated, the patient should be monitored in an emergency psychiatric setting or may require a brief 1-2 day inpatient psychiatric admission until the withdrawal resolves and the suicide risk is relieved. 

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