Academic journal article Alcohol Research

The Past and Future of Research on Treatment of Alcohol Dependence

Academic journal article Alcohol Research

The Past and Future of Research on Treatment of Alcohol Dependence

Article excerpt

Remarkable progress has been made in the treatment of alcohol use disorders (AUDs) over the past 40 years. We have a better understanding of the natural history of heavy drinking and the development of dependence. We understand better the course of recovery and the risk factors and prognostic indicators for AUDs. Most importantly, we have made significant strides in the behavioral and pharmacological treatments available to people, and their families, who suffer from alcoholism. Research supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) has been instrumental in advancing treatment, moving our understanding from anecdotal approaches to those that are based firmly on evidence.

Of course, new scientific findings almost always generate more questions than they resolve, and alcohol treatment research is no different. Research conducted over the past four decades has created a number of new scientific challenges. The most central of these challenges is to truly understand the scientific basis underlying health behavior, such as alcohol consumption. This calls for careful understanding of behavior and the steps involved in decisionmaking, as well as the social determinants that influence those decisions; in short, we need to know who we are and why we do what we do. It is especially important to identify potentially modifiable operators within the systems that determine these behaviors in order to develop new and more powerful ways to help people overcome addiction to alcohol. Medications offer one method to do so, which will require identifying neurophysiological and genomic targets for development of new medications with novel mechanisms (Koob 2006). Better-targeted behavioral approaches that address these habits (such as addiction) also are needed. Ultimately, our goals are to ensure that more people respond to treatment and that they are able to experience long-lasting effects from that treatment.

In addition to addressing these scientific challenges, there is a pressing need to create a new system of providing risk reduction and treatment for heavy drinkers and people with alcohol dependence. The current treatment system model, the Minnesota Model, was developed by professionals at a State hospital in Minnesota and promulgated most famously by the Johnson Institute and the Hazelden Foundation. Based on what was known at the time (primarily through the folk wisdom of Alcoholics Anonymous [AA]), the Minnesota Model combined the first five steps of AA with lectures on the disease concept of alcoholism and some practical supportive psychotherapy. Central to its concept was the use of staff members who themselves were in recovery from alcohol dependence, along with others (Anderson et al. 1999).

Unfortunately, because this model of care was developed without the benefit of a scientific basis, it was not configured in such a way as to rapidly change in response to scientific advances. Currently, more than 90 percent of community treatment programs in the United States offer lectures, group counseling, and referral to AA, and nothing else (McLellan and Meyers 2004). It is common that treatment staff members are poorly trained and supervised, are paid little, and frequently do not stay long (McLellan et al. 2004). In fact, the "counseling" that is provided often consists of casual talk rather than sophisticated psychotherapy (Carroll et al. 2008). To assert this is not to disparage the dedicated professionals who devote their lives to helping others with addiction. However, most addiction counselors have relatively little education and almost no supervision, which is in stark contrast to the counselors who provide behavioral treatment in efficacy trials (Anton et al. 2006; McLellan and Meyers 2004). In addition, very few treatment programs use integrated teams with other professionals such as physicians, psychologists, nurses, and social workers (McLellan and Meyers 2004). As a result, there is a disconnect between what has been discovered through research and what is actually implemented in everyday practice, or, for that matter, what can be implemented given the state of the treatment system. …

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