Psychological Treatments for Alcoholism

October 4, 2019
In this article, we provide you with a description of a variety of effective psychological treatments for alcoholism. The two major groups focus on either abstinence or controlled drinking and the treatment chosen depends on the type of patient.

Most of the psychological treatments for alcoholism have the cognitive behavioral model as a foundation. This model treats this substance as a powerful reinforcement mechanism that maintains a person’s habit of using it for self-treatment. The cognitive behavioral model offers an alternative approach to the traditional one that assumes alcoholism is a disease.

The ultimate objective of these psychological treatments for alcoholism is to reduce a person’s preference for alcohol. At the same time, they seek to increase their preference for other activities, which allow the maintenance of long-term adaptive functioning.

Depending on the patient, their personal resources, and family environment, another objective could be to train them to just stop their problematic use of alcohol. Experts call this “controlled drinking”.

Currently, among psychological treatments for alcohol, there are two major schools of intervention. One focuses on trying to achieve complete abstinence. The other aims to get the person to consume the drink in a safe and controlled way. We’re going to describe each of these below.

The behavioral model aims to change the behaviors directly related to alcohol consumption. This approach places the responsibility for the problem squarely on the individual. As such, change is solely in their hands.

This man is thinking about his drink while considering treatments for alcoholism.

Psychological treatments for alcoholism aimed toward abstinence

Social skills or self-control training

Experts tend to use this for patients who lack adequate inter and intrapersonal skills. It’s also a good way to help those who can’t control their emotional state without the use of alcohol. Experts have observed that drinkers consume less alcohol in stressful social situations if they have an alternate strategy for tackling issues.

One example is the manual by Monti et. al (2002). This work provides social strategies both for the patient as well as for their support group. These allow the patient to avoid the need to drink alcohol.

Community reinforcement approach as one of the treatments for alcoholism

This approach tries to change the lifestyle linked to the consumption of the substance. This includes techniques such as problem-solving, family behavioral therapy, social counseling, and employment-seeking training. You can also use this approach in the context of controlled drinking.

Behavioral marriage therapy

This involves going beyond the consumption of alcohol as a reinforcement mechanism and has abstinence as its goal. It tries to get the couple to engage in satisfying activities together. Activities that don’t involve any sort of drinking are better.

A good example is the Sisson and Azrin program. This program aims to teach the partner who isn’t an alcoholic some skills for dealing with an alcoholic spouse. Some of these are teaching them how to reduce the possibility of physical abuse, encourage sobriety, and encourage their partner to seek treatment.

Aversion therapy

The objective of these therapies is to reduce or eliminate a person’s desire for alcohol completely. Therapists who make use of these will employ various stimuli or images. They use these in such a way as to condition a negative response toward the characteristics of the alcohol (ex. its colour, smell, etc.).

Experts have used various adverse stimuli. These range from the classic electric shock that Kantarovich used in 1929 to chemical tools or even just visualization.

One example of this treatment is the covert sensitization approach that Cautela proposed in 1970. Eight sessions tend to be sufficient in order to see results with this treatment.

Preventing relapse

The most well-known is that of Marlatt and Gordon. Here they place the main part of the burden on the client as the one responsible for changing their behavior. By extension, they’re also responsible for maintaining that change once they achieve it.

Relapse prevention needs to take into account the fact that strategies for dealing with the issue need to be stronger in high-risk situations.

Treatments for alcoholism that aim to achieve normal drinking levels

Experts opt for these when the person in question doesn’t want to quit drinking completely as they don’t have physical problems. The most representative program from this group is that of Sobell and Sobell.

The Sobell and Sobell program aims to steer problem drinkers away from a chronic drinking problem. Its foundation is teaching self-management skills, as its objective is to use only a brief intervention. In this intervention, the individual should put many of the strategies the therapist teaches them into practice.

These drinkers tend to be young, with a high level of education. They’re usually employed and have few severe episodes of alcohol withdrawal. Most of them have been abusing alcohol for a period from five to ten years. In terms of their personal social and economic resources, they’re not much different from those of the rest of the population. That means that they’re in a good position to make important changes in their lives without too many obstacles.

A man staring at bottle sof alcohol on a table.

The Sobell and Sobell program takes four weeks and the expert administers it on an outpatient basis. It’s not very intensive in terms of the work the patient does in the clinic, but it entails a lot of homework. Ultimately, it tries to have the patients make the change for themselves.

Sobell and Sobell program guidelines

These are some of the suggestions laid out by this program: do not consume more than three units of alcohol per day and don’t drink more than three days a week. If you follow this rule, your tolerance for alcohol will be lower. Additionally, you should never drink in high-risk situations and you shouldn’t have more than one drink per hour. Another important piece of advice is to be sure to wait at least 20 minutes between the time you decide to drink and the time you actually do.

Training in problem-solving and relapse prevention are very important in this program. This will help the patient identify those situations in their lives linked with alcohol use. They can then use the strategies they learned to face these situations.

Conclusion

For both of the types of treatments for alcoholism we discuss here, the ultimate aim is for the patient to learn alternate coping strategies. These strategies should serve to put a brake on the impulse to drink alcohol. These could be as simple as social techniques for learning to say “no” to people who incite the person to drink. Another example is to learn new ways to efficiently solve the problems that the alcoholic tries to solve by thinking.

The aim is to disconnect you from the addiction and start on a new path. It’s true that the process can be uncomfortable. However, with focus, you can face any problem that comes up.

In today’s age, psychological therapies for alcoholism are extremely important, especially those that focus on controlled drinking. That’s because there has been a huge increase in young people who choose alcohol as a way to deal with their problems and emotions.

A huge goal of all this is to succeed in stopping these young people from becoming pathological drinkers. Instead, it’s much better for them to learn effective ways to manage their lives free from alcohol consumption.

  • Vallejo, P, M.A. (2016). Manual de Terapia de Conducta. Editorial Dykinson-Psicología. Tomo I y II