Academic journal article Alcohol Research

Advances in Alcoholism Treatment

Academic journal article Alcohol Research

Advances in Alcoholism Treatment

Article excerpt

Alcoholism treatment, as it exists today, rests on decades of research exploring the most effective ways to help people reduce their alcohol use or to stop drinking. That research has paved the way for the development and application of new methods and therapies and will continue to influence treatment practice in the future.

This article reviews the origins of alcoholism treatment and major studies of behavioral therapies and medications for treating alcohol dependence. It then provides a preview of the topics covered in this issue, including the potential future developments for alcoholism treatment such as medications development, behavioral therapy, advances in technology that are being used to improve treatment, integrated care of patients with alcohol use disorders (AUDs) and co-occurring disorders, the role of 12-step programs in the broader realm of treatment, treating patients with recurring and chronic alcohol dependence, strategies to close the gap between treatment need and treatment utilization, and how changes in the health care system may affect the delivery of treatment.

ORIGINS OF ALCOHOLISM TREATMENT

Alcoholics Anonymous (AA) was founded by Bill Wilson and Bob Smith in Akron, Ohio, in 1935. AA's program of spiritual and character development, the 12 Steps, is based on the premise that turning one's life and will over to a personally meaningful "higher power," is the key to recovery. Another essential idea is that sobriety or recovery depends on the admission of powerlessness with respect to alcohol or other substances of abuse.

The Minnesota Model of addiction treatment was created in a State mental hospital in the 1950s. It was first practiced in a small nonprofit organization called the Hazelden Foundation. In this approach, professional and trained nonprofessional (recovering) staff cooperated in applying the principles of AA. The model called for an individualized treatment plan with active family involvement in a 28-day inpatient setting and participation in AA both during and after treatment. Throughout the 1950s, Hazelden took the stance that (1) alcoholism is a disease and not a symptom of an underlying disorder and that it should be treated as a primary condition and (2) alcoholism affects people physically, mentally, and spiritually and that treatment for alcoholism should take all three aspects into account.

Around the same time that AA and Hazelden treatment methods were being refined and popularized, the study of alcohol abuse and alcoholism was expanding. Alcohol research, including the study of alcoholism treatment, found a home at the National Institutes of Health in 1970, when the National Institute on Alcohol Abuse and Alcoholism (NIAAA) was founded.

SCOPE OF THE PROBLEM

AUDs are prevalent in the United States and often go untreated. NIAAA's National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a large general-population survey conducted in 2001-2002, estimated the prevalence of alcohol abuse and dependence at 4.65 percent and 3.81 percent, respectively (Grant et al. 2004).

Using NESARC results, Cohen and colleagues (2007) reported that only 14.6 percent of those with a lifetime history of alcohol abuse or dependence have received treatment. In another study that used NESARC results, Dawson and colleagues (2005) reported on people who experienced the onset of alcohol dependence at some point before the year prior to the survey. In this group, 25 percent still were alcohol dependent, 27.3 percent were in partial remission, 11.8 percent were in full remission but drinking at levels or patterns that put them at high risk for relapse, 17.7 percent were low-risk drinkers, and 18.2 percent were abstainers during the year prior to the survey.

Only 25.5 percent of these respondents reported ever receiving treatment. Among them, 3.1 percent participated in 12-step programs, 5.4 percent received formal treatment only, and the remaining 17 percent participated in both 12-step and formal treatment programs (Dawson et al. …

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