Essay On Brief Intervention

Treatment Options

Brief intervention has shown to be an effective treatment for individuals that are socially stable problem drinkers; focusing on changing individual behavior with drinking and helping aid in increasing compliance with treatment (Fleming 1999). It has been shown to be valuable in helping with harm reduction and abstinence (Fleming et al. 1997). It has shown efficacy with aiding individuals with alcohol use disorder to choose to enter in to long term treatment, and for treating individuals for whom the goal is abstinence (National Institute on Alcohol Abuse and Alcoholism 1999). Brief intervention is usually conducted in four or fewer sessions, each lasting from a few minutes to an hour depending on the severity of the client’s alcohol use issues (Flemming et al. 1997).

All substance use disorders tend to be fluid. There may be long periods of both remission, whether it be a reduction of alcohol use or abstinence, and relapse. There are three major obstacles that individuals in treatment substance use disorders must overcome are (a) physical dependence (b) psychological dependence, and (c) habit

Alcohol dependence is treated in two stages: withdrawal and detoxification, followed by further interventions to maintain abstinence.

Alcohol withdrawal symptoms may begin within a few hours after cessation or reduction of use of alcohol.

Early symptoms can include tremors, anxiety, restlessness, insomnia, and nausea. In individuals that are only mildly dependent on alcohol these symptoms can be minor enough to go without any medical treatment and resolve on their own after a few days have passed. More serious withdrawal symptoms, however, occur in nearly 10 percent of individuals who are dependent on alcohol (Trevisan et al. 1998). Symptoms included in more serious alcohol withdrawal are rapid breathing, tremors, low-grade fever, and heavy sweating (Trevisan et al.

1998).
Delirium tremens (DT’s) and withdrawal seizures are the more serious withdrawal symptoms associated with alcohol withdrawal. DT’s consist of mental confusion, hallucinations, both auditory and visual, and mental disorientation. If individuals exhibiting DT’s are not medically treated they can die. The majority of alcohol withdrawal seizures happen within the first 48 hours after an individual that is dependent on alcohol stops drinking, it is not common for these types of seizers to take place once the individual has been abstinent for a week or longer, although it can happen (Trevisan et al. 1998).
Assessment tools may be used to determine withdrawal severity and to determine whether pharmacotherapy is an appropriate course of action for the withdrawal condition. The Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) instrument is one such tool (Sullivan et al. 1989). Benzodiazepines can significantly diminish the risk of seizure and symptoms of alcohol withdrawal. Individuals with alcohol dependence, especially those with withdrawal symptoms should be admitted to the hospital for detoxification; if it is suspected that they may have severe, life-threatening symptoms or they may have serious medical conditions, suicidal or homicidal tendencies, disruptive family or job situations, or are unable to attend outpatient facilities, then they should also be admitted to the hospital for detoxification (Fuller & Hiller 1999).
There is a substantial amount of evidence that supports that the lasting cravings that individuals that are dependent on alcohol have is due to long-lasting neurobiological changes in their brains due to their dependence. Due to these long-lasting neurobiological changes, relapse can be triggered by internal factors, such as craving alcohol, anxiety or depression, or by external factors such as, social pressures, life events, people, or places (Fuller & Hiller 1999). It is important that treatments focus on the psychosocial aspects of helping patients to understand, anticipate and prevent relapse.
There are several treatment options for alcohol use disorder that focus on behavior. Twelve-Step Facilitation (TSF) is a formal treatment approach incorporated in AA and similar 12-step programs (Humphries 1999). Alcohol Anonymous (AA) is a free program that especially supportive for individuals that are poor, isolated, lonely, or who come from a heavy-drinking social background. The program consists of group meetings in the community and onsite, following the 12 steps, working the 12 steps, reading the Big Book (the main text of AA, which shares AA's philosophies as well as many of members' life stories) and other AA literature, and accepting the identity of alcoholic.
Another treatment approach for alcohol use disorder that focuses on behavior is Cognitive Behavioral Therapy (CBT). The goal of CBT is to teach individual, through role-playing and practice, to identify and manage situations that might jeopardize their sobriety and for them to identify and manage their cravings (Longabaugh et al.1999).
Motivational Enhancement Therapy (MET) is another approach used to treat alcohol use disorder that is rooted in behavior. This counseling approach can help individuals to resolve any ambivalence they may have about participating in treatment and ending their drug use. MET is also used to help motivate individuals to use their own resources to change their behavior with alcohol use (DiClemente et al. 1999). The goal of MET is to bring about quick change that is motivated from within the client, instead of having the client guided or stepped through the process of recovery.
According to results from the multistate study, Project MATCH (1997), no difference was found in the in the efficacy of CBT, MET, and TSF during the year following treatment, however, MET was found to be most effective in those individuals that presented with high levels of anger, and TSF and AA involvement was particularly effective in individuals that had a heavy drinking background.
In the range 30 to 60 percent of individuals with alcohol use disorder sustain a minimum of one year of sobriety utilizing psychosocial therapies only (Finley et al. 1996). According to the American Psychological Association however, over 20 percent of individuals with alcoholic use disorder achieve continuing abstinence from alcohol without any active treatment.
It is clear that more effective techniques are needed to treat alcohol use disorders, and pharmocothrapeutic agents have started to come about that may be useful to aid in helping the current psychosocial treatments that are currently in use be more effective to treat this disorder. Two such medications that are showing promise in this area are the opioid antagonist, naltrexone (Revia), and Acamprosate, and glutamate antagonist. They can be used both separately and together and they are possibly the first of many pharmacotherapies targeting multiple neurotransmitters.
Currently there are numerous studies that have results showing that naltrexone (50 mg once daily) decreases alcohol intake in both male and female individuals with alcohol use disorder, and results also show that it is effective when used in combination with psychosocial treatment in lowering the rates of relapse (Anton et al. 1999 & O’Malley 1996). More recently preliminary studies have found that taking naltrexone two hours prior to situation that is expected to be high risk actually lessens the alcohol consumption in individuals that have alcohol related disorders, specifically early problem drinkers, the best results were seen in women (Kranzler 2001). Considerable testing on Acamprosate, has shown the drug to be both safe and tolerated well it has also shown to almost twice the abstinence rate among individuals in recovery for alcohol (Sass et al. 1996).
Another way to use pharmacotherapy is aversively. Disulfiram, commonly known as Antabuse (250 to 500 mg daily) has been available since the late 1940s and has a bit of a reputation for having a less than pleasant effect on the user if they choose to take it with alcohol (Chick 1999). Disulfiram blocks the metabolism of acetaldehyde so that if the individual consumes alcohol once the medication has been taken there is a flushing reaction that results in the user becoming very ill. Individuals that use this medication under supervision show marked improvement in the decrease of their intake of alcohol (Chick et al. 1992).
Pharmacotherapy is also helpful for treating comorbid conditions. It is common for individuals with alcohol use disorder to have depression and anxiety, sometimes these conditions were present prior to the alcohol dependence, but sometimes they are a result of the alcohol use disorder. It is important that a history be carefully taken to recognize the main concerns before medications are prescribed. In cases where depression and alcohol use disorder are present Fuoxitine (Prozac), a selective serotonin reuptake inhibitor (SSRI) and has been found to be efficacious in diminishing depressive symptoms as well as the level of alcohol consumed (Cornelius et al. 1997).
Individuals with alcohol use disorder struggle, without treatment their lives may be completely unmanageable, and they will die from their disease. Their disorder effects those people around them, often in negative ways as well, and because of the social stigma surrounding the disorder, and the pain of withdrawal, it isn’t always easy for individuals with alcohol use disorder to be honest about their struggle; not just with others, but even with themselves. This is why it is so imperative that both mental health workers and health care workers assess more, ask the hard questions, and refuse to shy away from the uncomfortable topics, it is part of the job; it is how we help.