Alcoholism - Medications

Psychotherapy and Behavioral Methods

Standard forms of therapy for alcoholism include:

• Cognitive-behavioral therapy
• Combined behavioral intervention
• Interactional group psychotherapy based on the Alcoholics Anonymous (AA) 12-step program

Comparison studies have reported that these approaches are equally effective when the program is competently administered. Specific people may do better with one program than another.

Interactional Group Psychotherapy (Alcoholics Anonymous)

AA, which was founded in 1935, is an excellent example of interactional group psychotherapy. It remains the most well-known program for helping people with alcoholism. AA offers a very strong support network using group meetings open 7 days a week in locations all over the world. A buddy system, group understanding of alcoholism, and forgiveness for relapses are AA's standard methods for building self-worth and alleviating feelings of isolation.

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AA's 12-step approach to recovery includes a spiritual component that might deter people who lack religious convictions. AA emphasizes that the "higher power" component of its program need not refer to any specific belief system. Associated membership programs, Al-Anon and Alateen, offer help for family members and friends.

The 12 Steps of Alcoholics Anonymous

1. We admit we were powerless over alcohol -- that our lives have become unmanageable.
2. We have come to believe that a Power greater than ourselves could restore us to sanity.
3. We have made a decision to turn our will and our lives over to the care of God, as we understand what this Power is.
4. We have made a searching and fearless moral inventory of ourselves.
5. We have admitted to God, to ourselves and to another human being the exact nature of our wrongs.
6. We are entirely ready to have God remove all these defects of character.
7. We have humbly asked God to remove our shortcomings.
8. We have made a list of all persons we had harmed and have become willing to make amends to them all.
9. We have made direct amends to such people wherever possible, except when to do so would injure them or others.
10. We have continued to take personal inventory and when we were wrong promptly admitted it.
11. We have sought through prayer and meditation to improve our conscious contact with God as we understand what this higher Power is, praying only for knowledge of God's will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these steps, we have tried to carry this message to alcoholics and to practice these principles in all our affairs.

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy (CBT) uses a structured teaching approach and may be better than AA for people with severe alcoholism. Patients are given instruction and homework assignments intended to improve their ability to cope with basic living situations, control their behavior, and change the way they think about drinking. The following are examples of approaches:

• Patients might write a history of their drinking experiences and describe what they consider to be risky situations.
• They are then assigned activities to help them cope when exposed to "cues" (places or circumstances that trigger their desire to drink).
• Patients may also be given tasks that are designed to replace drinking. An interesting and successful example of such a program was one that enlisted patients in a softball team. This gave them the opportunity to practice coping skills, develop supportive relationships, and engage in healthy alternative activities.