Methods of Intervention in Alcoholism

An Intervention is a term used to describe a planned course of action designed to change a pattern of behaviour which is usually having a significant negative impact on a person’s health.

Both physical and psychological dependency are features of alcoholism so there need to be interventions available that target both of these.

Luckily there have been many interventions developed over the years to help health professionals tackle alcoholism and we will have a look at some of these approaches.

Health professionals have a wide array of techniques in their toolbox which they can utilise when designing treatment programmes for their clients who will be looking to improve their mental health and quality of life.

Interventions for Alcoholism can be placed into two categories; firstly there are interventions that attempt to persuade the person whose behaviour is a concern to think about their drink-related behaviour and to prompt them to admit that they have a problem and to encourage them to seek professional help.

Secondly, once a person has admitted that they have a problem with their drinking and are willing to accept help then there is a wide array of interventions that drug and alcohol practitioners and medical professionals have at their disposal to help them.

Interventions to Encourage Behaviour Change

If family members, close friends and work colleagues are concerned that a person’s alcohol consumption has spiralled out of control then there are interventions that have been devised to help people in close contact with the personal approach them and raise their concerns about their drinking habits.

1. The Johnson Model

This intervention approach is designed to persuade the target person to seek help for their excessive drinking with the objective of persuading them to seek professional help.

Important people in the person’s social network confront the person without them being forewarned about how much harm their drinking is doing to themselves and the people closest to them.

They strongly recommend that the person seek specialist help and, there is often an ultimatum issued, hinting that there will be consequences for them if they refuse help. (8)

2. ARISE (A Relational Intervention Sequence for Engagement)

The ARISE Intervention uses family members and close friends in the person’s social network to encourage them to seek professional help for their problem drinking.

The model is based on the concept of the “Power of Family” (1) which can be a valuable resource in helping a loved one overcome their battle with unhelpful drinking patterns.

The ARISE approach tends to be less confrontational than the Johnson Intervention Model despite sharing common ground.

Family members and close friends guided by experts work together to try and persuade the person to seek help, showing respect and love throughout the process.

This means it will not generate so much resistance from the “Person of Concern” when approached, making the whole situation less emotionally charged.

The Person of concern is fully aware of what is going on and they are not just confronted suddenly when least expected by colleagues, friends and family members. (1, 7)

3. Family/Systemic Approach

The approach is based on the notion that the person’s excessive drinking patterns occurred in a certain context, which led to and enabled the development of the drinking behaviour.

However, it is also true that the actions and behaviour of the person drinking heavily also has a direct effect on family members.

Alcoholism does not happen overnight, so the context in which the person’s drinking developed is explored to see how the whole social and family environment may have led to the person becoming dependent on alcohol.

Trained professionals will help the family identify any unhealthy dynamics which have led to the heavy drinking and seek to discover more healthy ways of interacting with each other.

(13) The person who has become unwell is not seen as solely responsible for the development of their condition and everyone involved can explore their own role in how this situation arose.

Once the person of concern has accepted they require professional help family therapy can also form part of their treatment programme.

A key principle here is an attempt at recovery stands a better chance of being successful if there is family involvement in the treatment programme, supporting the person as they aim to get better.

Intervention after help has been accepted

Treatment interventions for alcoholism adopt a “Bio-Psycho-Social” approach in terms of the types of different interventions that they can utilise.

This means there are interventions available that target the Biological, Psychological and Social factors involved in the development of a person’s excessive alcohol consumption. (3,5)

Depending on the severity of their problem, several treatment options will be reviewed for each individual case.

It is likely that different treatment options will be recommended for someone whose drinking has got out of hand over a period of several months as opposed to a person who has been drinking heavily for 20 years and has only just accepted that he/she requires professional help.

Brief Interventions

These interventions are aimed at people whose drinking behaviour is becoming risky and is a potential cause for concern.

People in this category are not actively seeking help and their health is probably not too much of a concern but there is a danger that they could easily spiral out of control with their drinking very soon.

The techniques used by counsellors in Brief Interventions follow the FRAMES model which:

Provides Feedback to the client about their alcohol consumption
Reminds them of their personal responsibility to change
Offers specific Advice on how to reduce their drinking
Provide a Menu of options for them to choose from
Are always Empathic with clients
Support clients’ Self-Efficacy and encourage them to believe that they can change. (5)

Motivational Interviewing

Motivational Interviewing is one of the main methods s that can be offered to try and encourage behaviour change and is a common technique used by addiction counsellors. Here the therapist aims to support the client and without applying any pressure encourages them to identify strong reasons for changing their behaviour.

This approach works in tandem with the stages of change model developed by Prohaska and Di Clemente (9).

The idea in motivational interviewing is to understand that there will be some resistance on the part of the client, but by showing empathy, understanding and patience the therapist can work with the client to help them find the motivation to change their behaviour.

(9, 10) For example, they may realise how important their family is to them and that could be a huge motivating factor for them to change their alcohol-related behaviour.

Biological – Detoxification (Detox) Programmes

Detox programmes are an important part of many people’s recovery plans and target a key aspect of the addictive process, namely physical dependence.

The objective of the Detox process is to reduce the severity of the withdrawal symptoms that a person is experiencing, which occurs when a person stops consuming alcohol after a period of prolonged heavy drinking. (8c, 11)

Drugs Treatments

There are also several drugs available to help people try and reduce their need to drink alcohol.

1. Disulfiram

This is used to act as an aversive intervention as taking this drug will lead to very unpleasant physical symptoms when you drink alcohol, such as nausea, dizziness and vomiting. It also prevents the high feeling that some people experience when drinking alcohol which reduces people’s impulsive tendency to drink alcohol. (8a, 8c)

2. Naltrexone

Taking this drug blocks the pleasurable and rewarding effects of alcohol. If someone drinks to feel relaxed for example Naltrexone will prevent people from feeling this effect when drinking. This reduces people’s motivation to drink alcohol as the psychological reason for them drinking alcohol will be taken away from them. (8a,8c)

Psychological Therapies

And of course, there are a variety of psychological therapies available to help people reach a state of sobriety and curb their addictive tendencies.

1. Cognitive Behavioural Therapy

There is a wide range of psychological therapies offered by qualified mental health professionals, all of which differ in the perspective that they take.

For example, Cognitive Behavioural Therapy (CBT) will help the person identify and combat the unhelpful thought patterns that have contributed to a person’s negative emotions.

It will also help people increase the amount of stress that they are able to tolerate by establishing new ways of responding to stressful situations rather than the usual, automatic response of drinking alcohol. (3)

CBT technique can also improve people’s self-esteem and the way they view themselves and interpret events that happen in the world around them.

\CBT can help people view events more realistically rather than their usual tendency to blame themselves when things go wrong.

2. Psychodynamic Counselling

Psychodynamic counselling will help the individuals become aware of any inner conflicts and/or unconscious influences that drive their defence mechanisms(2), some of which could contribute to the development of heavy alcohol consumption.

This may stem from early traumatic childhood events and experiences within the family environment.

Trauma has been identified as a key factor in the development of mental health conditions, particularly addictions. (12)

3. Transactional Analysis (TA)

Many theorists are of the belief that addiction is a relational or attachment disorder (6), therapists trained in TA can help clients address any unhelpful patterns of behaviour that they tend to exhibit that has contributed to their condition.

The main area of focus in TA is the way their clients relate to and interact with the people around them.

They may for example show a total lack of respect and disregard for people which may be seen through their bullying or coercive behaviour, or conversely, they may let people take advantage of them and are afraid to stand up for themselves.

Some people are too aggressive and overbearing whereas others lack the ability to be assertive when stating their boundaries and needs. (4)

4. 12 Step Approaches

This is drawn from the principles of AA and includes a series of steps or challenges that have been identified as extremely helpful in enabling people to work towards recovery from alcoholism.

The 12 step approach believes that addiction is a disease that is a long term condition and involves a loss of control as a major symptom.

Recovery from this is achieved by regular attendance at meetings and working through its steps with the support of others who are striving to achieve the same goals (abstinence from drinking alcohol). (14)

The main goals of the programme help members understand the importance of fellowship, to help them to obtain an ability to reflect on, and change their thinking and behaviour.

Another goal of the programme is to encourage members to think about their own spirituality and how this can help them in their recovery.

A 12 step approach called Minnesota Model structures therapy programmes based on the challenges of the 12 steps and is used in many treatment centres for addiction. (14)

Support Groups – Alcoholics Anonymous AA

Attending support groups is an integral part of a treatment programme for all people in recovery from addiction, whether it be a behavioural addiction such as gambling or a substance misuse disorder such as alcohol.

Bearing in mind the strong tradition of the AA movement then it would seem imperative that any treatment programme for alcoholism would include regular attendance of AA meetings.

Everyone who attends an AA meeting is there to seek support for their quest for recovery from alcoholism.

Everyone attending the meeting is perceived as equal, there are no mental health professionals in attendance that would offer any specialist therapy or advice.

The atmosphere is one of support, understanding and being non-judgemental.

In short one, the reason for this is because one of the main principles of the AA is fellowship and the importance of the collective in helping each other recover. (13)

AA Groups for Family Members

AL-Anon is a support group for family members of people whose drinking has got out of control and started to negatively impact the other members of the family.

A person’s drinking can disturb the way the family functions and disrupt regular routines and can have extremely negative consequences if there is violence associated with the drinking behaviour.

There is also the chance a person’s excessive drinking can affect a family’s finances, for example, the money that was intended to be allocated to house repairs, furniture or holidays has been spent on buying alcohol instead.

Here the family members (usually spouses) affected can express how alcoholism has affected their lives and also listen to similar stories from other people in the group. Everyone in attendance can support each other as they seek to rebuild their lives. (13)

Professional Group Therapy

In group therapy, an experienced psychotherapist will facilitate the group’s growth as well as help each individual gain valuable insight into how their addictive behaviour started and what they need to reflect on to enhance their recovery.

Just like AA meetings, this is a valuable intervention as it helps each member feel supported and being involved in such a group offers many therapeutic benefits.

For example, they have been known to instil a sense of hope for the future in people, they also provide a sense of universality in that people start to realise that they are not alone in their suffering and because of this they slowly develop the ability to connect to others. (15)

Group therapy also helps people develop the social skills such as empathy that they may have been lacking The group setting also allows people to display altruistic behaviour by showing concern and support for others, which in itself makes people feel more positive about themselves and help them achieve their recovery goals (15)

Conclusion

There is a wide range of specialist treatment interventions available to people and it is more than likely any individual in treatment for alcoholism will have a programme designed for them that features several of the interventions mentioned.

References

(1) Association of Intervention Specialists (2021) What is an ARISE intervention? Available@

What is an Arise Intervention? – AIS (associationofinterventionspecialists.org)

(2) Bateman. A., Brown, D. & Pedder, J. (2000) Introduction to Psychotherapy: An Outline of Psychodynamic Principles and Practice

(3) Bennett, P. (2003) Behavioural and Cognitive Behavioural Approaches to Substance Misuse Treatment in Peterson, T. & McBride, A. (ed) Working with Substance Misusers: A Guide to Theory and Practice London. Routledge.

(4)Cornell, W.F., de Graaf, A., Newton, T. & Thunnissen, M. (2016) Into TA: A Comprehensive Textbook on Transactional Analysis. Abingdon: Routledge.

(5) Cunningham, J., Hodgins, D. (2014) Brief Interventions for At Risk Drinking in Herie, M. & Skinner, W. (ed) Fundamentals of Addiction: A Practical Guide for Counsellors. CAMH. Canada

(6) Flores, P. (2004) Addiction as an Attachment Disorder. Jason Aronson. Maryland

(7) Garrett, J. Landau, J. Shea, R., Stanton, M. Baciewitz, G., Brinkman-Sall, D. (1998) The Arise Intervention: Using Family and Network Links to Engage Addicted Persons in Treatment.

(8) Loneck, B, Garret, J.A. & Banks, S.M. (2009) The Johnson Intervention and Relapse During Outpatient Treatment. The American Journal of Drug and Alcohol Abuse. Journal of Substance Misuse Treatment. Jul – Aug 1998

(8a) Mack, A.H., Harrington, A.L. & Frances, R.J. (2010) Clinical Manual for Treatment of Alcoholism and Addictions. APP. London

(8c) McBride, A. (2004) Medical Approaches and Prescribing: Alcohol in Peterson, T. & McBride, A. (ed) Working with Substance Misusers: A Guide to Theory and Practice London. Routledge.

(9) Miller, W. & Rollnick, S. (1991) Motivational Interviewing: Preparing to Change Addictive Behaviour. Guilford Press. New York

(10) Peterson, T. & Davies, M. (2003) Motivationally Based Interventions for Behaviour Change in Peterson, T. & McBride, A. (ed) Working with Substance Misusers: A Guide to Theory and Practice London. Routledge.

(11) Raistrick, D. (2004) Alcohol Withdrawal and Detoxification in Heather, N., & Stockwell, T. (ed)

The Essential Handbook of Treatment and Prevention of Alcohol Problems by (2004). John Wiley & Sons. Chichester

(12) Van de Kolk, B. (2014) The Body Keeps the Score. Viking Press. NewYork

(13) Velleman, R. & Templeton, L. (2003) Family Interventions in Substance Misuse in Peterson, T. & McBride, A. (ed) Working with Substance Misusers: A Guide to Theory and Practice London. Routledge.

(14) Williams, C. (2003) 12 Step Approaches in Peterson, T. & McBride, A. (ed) Working with Substance Misusers: A Guide to Theory and Practice London. Routledge.

(15) Yalom, I.D. (1995) The Theory and Practice of Group Psychotherapy