Academic journal article Alcohol Health & Research World

Alcoholism Treatment in the United States

Academic journal article Alcohol Health & Research World

Alcoholism Treatment in the United States

Article excerpt

Almost 600,000 patients are treated for alcohol abuse and alcohol dependence in the United States each year. Yet no one treatment approach has been shown to be successful for all these patients. Innovative treatment modalities are being studied in an effort to make alcoholism treatment more effective and more economical.

It is estimated that 9.6 percent of men and 3.2 percent of women in the United States will become alcohol dependent at some time in their lives (Grant 1992); many more men and women will exhibit drinking behavior that can be classified as alcohol abuse. Alcohol dependence is a chronic, primary psychiatric disorder characterized by a cluster of recognizable symptoms, including alcohol tolerance (i.e., needing more alcohol to become intoxicated); physical withdrawal; loss of control over drinking; and continued use of alcohol despite social, medical, family, or occupational problems (American Psychiatric Association [APA] 1994). Alcohol abuse is less severe than alcohol dependence. It is characterized by harmful consequences of drinking (e.g., failure to fulfill major social, family, or vocational obligations; recurrent alcohol use in physically dangerous situations; and repetitive legal problems) but without the development of alcohol tolerance, physical withdrawal, or compulsive alcohol use (APA 1994).

Both alcohol dependence and alcohol abuse are disorders that can and should be treated. According to a 1991 survey of alcoholism and other drug abuse treatment facilities and their clients, almost 575,000 clients were treated in 8,929 facilities in the United States (U.S. Department of Health and Human Services [USDHHS] 1993). Of these clients, 12 percent were admitted to inpatient programs, and 88 percent were treated as outpatients. Sixty-seven percent of the clients were white; 17 percent were African-American; 12 percent were Hispanic; and 4 percent were Asian, Native American, and other ethnic groups. About 60 percent of the clients were in their twenties and thirties, 6 percent were adolescents under 18, and 5 percent were over age 55. Twenty-five percent of the clients in treatment were women.

This overview describes current types and innovative components of alcoholism treatment and evidence of their effectiveness. In addition, treatment needs of priority populations,(1) including older persons, women, and minority patients, are discussed. Current interest in patient-treatment matching as a means to increase the individualization of services and, consequently, their effectiveness are considered. Finally, cost-effectiveness and financing trends are addressed briefly.

TREATMENT SETTINGS

Alcoholism treatment services are delivered in two general settings--inpatient and outpatient. Inpatient settings mostly consist of short-term residential programs. They often are used for the early phases of treatment, particularly acute detoxification. Outpatient settings provide more long-term maintenance treatment, with group meetings and individual counseling offered once or twice a week. Because of current concern over increasing health care costs, more emphasis now is being placed on outpatient care during all stages of recovery. As a result, successful models of outpatient detoxification and intensive day treatment services have been developed.

Inpatient Treatment

Residential 28-day treatment programs traditionally have been considered the foundation of the early recovery period. These programs often are based on the disease model of alcoholism and on the 12-step or Alcoholics Anonymous (AA) philosophy and practices. Abstinence from alcohol and other drugs (AOD's) is the primary treatment goal in these programs. Patients participate in frequent AA meetings and ideally are linked to an AA sponsor and a local AA chapter prior to discharge.

Inpatient settings, such as hospitals, provide intensive, highly structured treatment, such as group therapy and alcoholism education, for several hours daily. …

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