What Works?
What works?
Excerpted from "What works? A summary of alcohol treatment research" in R. K. Hester & W.R. Miller (Eds.), Handbook of alcoholism treatment approaches: Effective alternatives (3rd ed.), 2003, Allyn & Bacon.
In an extensive review of studies of different approaches to sobriety, the authors found the following 5 treatments had the highest success rates:
Brief interventions
Your … personal physician … can screen you for possible alcohol problems and assess whether your drinking or drug use is putting your health at risk or causing problems of which you might not be aware [and may] suggest a more comprehensive assessment.
Motivational enhancement
….Done by a psychologist, counselor, or therapist … also known as a brief motivational intervention. [Usually 1 – 4 sessions, which include:]
* A thorough assessment….
* Objective feedback … provided in a low-key way that does not label you or push you into doing anything you don't want to do
* Motivational enhancement that helps you consider the good things and not-so-good things…to help you resolve your ambivalence.
GABA agonist (Acamprosate)
Acamprosate is a medication that reduces urges and cravings to drink.
Community Reinforcement
…a treatment program provided by psychologists and counselors. …to help the problem drinker or drug user's environments (family, social, work) so that the environment reinforces sobriety and withdraws those reinforcers if the person drinks or uses drugs.
Self-change manual (Bibliotherapy)
… mostly oriented towards moderate drinking as a goal of change. [Examples:]
-- Responsible Drinking: A Moderation Management approach for problem drinkers.
--A good self-help manual for addictions in general and for abstinence from alcohol is Sex, Drugs, Gambling, and Chocolate, by Thomas Horvath
The opiate antagonist (Naltrexone), and a technique called behavioral self-control training, ranked next. Aversion therapy via nausea (Antabuse) ranked 11th.
Some selected other treatments and how they ranked:
• Family therapy: 16th
• Acupuncture: 17th
• Antidepressants (SSRI): 23rd
• Hypnosis: 31st
• Psychedelic medication: 32nd
• Twelve-step facilitation (guided 12 step): 37th
• Alcoholics Anonymous: 38th
• Psychotherapy: 46th