The most effective treatment for alcoholism

Are you concerned with your drinking? It can be a very confusing and distressing time when trying to decide whether or not you have a problem. A basic rule of thumb is to consider your alcohol consumption as a problem when it starts to negatively interfere with other aspects of your life. You may have a problem with alcohol when you regularly drink more than planned, when you can’t remember what you did when drinking (blackouts), when your level of drinking negatively impacts on personal relationships and when you start to get into trouble when out drinking. Chronic addiction can entail secret drinking when you start to hide the amount you consume.

It can be helpful to understand the theory behind addiction treatment if looking to access addiction services. There are three broad categories that underpin addiction recovery treatment and these are:

1. The brain disease model

This is a biological view of addiction. In the same way that diabetes changes the way the pancreas works, heart disease changes the way the heart works, and hepatitis changes the way the liver functions, so alcoholism changes the way the brain works. Advocates of the disease model argue that the brain changes with addiction and that addicts have lost control as a result of their drinking. 

Alcoholism was officially designated an illness by the American Medical Association (AMA) in 1967 and this view of addiction stimulated lots of research, as well as the development of useful medications that helped with the symptoms of withdrawal. This model underpins the 12 steps of recovery from Alcoholics Anonymous (AA) and Hazelden's 'Minnesota Model'. These approaches contain key concepts of powerlessness and personal unmanageability as the building blocks for an abstinence based approach to treatment. The 12 steps combine cognitive and behavioural tools and techniques and a concept of a mental and spiritual malady. Heavily influenced by Carl Jung, the 12 steps state that the chronic alcoholic must undergo an entire psychic change in order to recover from a seemingly hopeless state of mind. This approach believes that once an alcoholic always an alcoholic.

The disease model has helped create the huge rehab industry whereby addicts get treated at the hands of experts, generally medical experts (including psychiatrists) but also the burgeoning band of treatment personnel who report to them. The Diagnostic Statistical Manual (DSM), currently in its fifth iteration, states the following: “A substance use disorder describes a problematic pattern, of using alcohol or another substance that results in impairment in daily life or noticeable distress.”

2. The choice model

The choice model is based on cognitive factors rather than on biology and holds that one can affect change by making better decisions. The ethos of the choice model was behind the popular campaign of "just say no" and the war on drugs in America. Treatment involves reviewing one's beliefs and changing one's perspectives, using tools and techniques offered by cognitive behavioural therapy (CBT) and motivational interviewing and invariably proposes total abstinence. Gene Heyman is his book Addiction - A disorder of Choice argues that conventional wisdom about addiction - that it is a disease, a compulsion beyond conscious control - is wrong. For Heyman, addiction is voluntary and he seeks to show that drug use, like all choices, is influenced by preferences and goals. The Choice Model explains why Vietnam veterans stopped taking heroin when they returned to their homes after the war. This builds on the Bruce Alexander "rat park" experiments that showed that rats decided to not consume drugs in controlled trials when their environments improved and offered a better outlook.

The choice model at least explains better than the disease model, how addicts quit but advocates of this approach risk viewing addicts as selfish and self-indulgent moral degenerates.

3. Self-medication model

Past trauma is the root cause of this model. Taking drugs and alcohol make you feel better until they don't. Substance abuse among those with post-traumatic stress disorder (PTSD) is as high as 60-80% and the rate of PTSD among substance abusers is 40-60% (Source: K.S Brady and R. Sinha 2005).

Treatment stresses the need to protect people who are vulnerable to psychosocial pressures and to diagnose and treat underlying developmental issues that have predisposed someone to addiction. Treatment could involve using CBT techniques as well as key concepts from attachment theory and object relations theory, as well as other psychotherapeutic approaches. Treatment could also entail a holistic approach, viewing addiction as a loss of connection, or loss of soul in transpersonal terms. Counsellors and therapists might suggest total abstinence in the long run, but not necessarily so. Working therapeutically on past trauma, can potentially see a personal transformation that entails social drinking at some point in the future for the problem drinker.

Getting help

It would be prudent to chat with your GP about treatment options if you think you are physically addicted to alcohol and are worried about the implications of detoxing. In such circumstances, it can be dangerous to suddenly stop without medical supervision, as appropriate alcohol withdrawal treatments can mitigate the risk of developing withdrawal seizures.

Detox may involve the first phase of recovery from addiction. However, ongoing well-being will be dependent on gaining insight into what makes you tick, who you were as a child and who you could be without the balm of alcohol. Learning to cope with life on life's terms, is essentially how you can manage the difficult feelings that can cause trigger problems with alcohol consumption. Knowledge of addiction treatment theory, can help to better inform your pursuit of the most appropriate addiction specialist for your needs.

The views expressed in this article are those of the author. All articles published on Counselling Directory are reviewed by our editorial team.

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London SE1 & SE26
Written by Noel Bell, MA, PG Dip Psych, UKCP
London SE1 & SE26

Noel Bell is a UKCP accredited clinical psychotherapist in London who has spent over 20 years exploring and studying personal growth, recovery from addictions and inner transformation. Noel is an integrative therapist and draws upon the most effective tools and techniques from the psychodynamic, CBT, humanist, existential and transpersonal schools.

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