Advertisement
Mayo Clinic Proceedings Home

Developments in the Treatment of Alcoholism

      The treatment of alcoholism has changed during the past 2 decades. Notable developments have occurred in pharmacotherapy, psychotherapy, and health-care delivery. A better understanding of the biologic basis for addiction has led to clinical trials of medications that target neuroreceptors. One such medication is the opiate antagonist naltrexone, which decreases the craving for alcohol. Psychosocial interventions continue to be the mainstay of alcohol treatment programs. The efficacy of three different therapies was demonstrated in a study called Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity). This study, however, did not prove the patient-treatment “matching” hypothesis. In addition to therapies provided by addiction specialists, interest is growing in the use of brief motivational techniques in primary-care settings. As the field of addiction responds to an unfolding health-care delivery system, a broader range of treatment options in conjunction with a greater opportunity to individualize patient care is evolving.
      AA (Alcoholics Anonymous), CBT (Cognitive Behavioral Coping Skills Therapy), CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol scale), MATCH (Matching Alcoholism Treatments to Client Heterogeneity), MET (Motivational Enhancement Therapy), NIAAA (National Institute on Alcohol Abuse and Alcoholism), SSRIs (selective serotonin reuptake inhibitors), TSF (Twelve-Step Facilitation)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Winlck C
        Epidemiology of alcohol and drug abuse.
        in: Lowinson JH Ruiz P Millman RB Substance Abuse: A Comprehensive Textbook. 2nd ed. Williams & WilWns, Baltimore1992: 15-29
        • Secretary of Health and Human Services
        Treatment of alcoholism and related problems.
        in: Ninth Special Report to the U.S. Congress on Alcohol and Health. National Institute on Alcohol Abuse and Alcoholism, Washington (DC)1997 Jun: 337-371 (Puolication No. NIH 97-4017)
        • Spear SF
        Mason M. Impact of chemical dependency on family health status.
        Int J Addict. 1991; 26: 179-187
        • Woodside M
        • Coughey K
        • Cohen R
        Medical costs of children of alcoholics—pay now or pay later.
        J Subst Abuse. 1993; 5: 281-287
        • Chou PS
        • Dawson DA
        A study of the gender differences in morbidity among individuals diagnosed with alcohol abuse and/or dependence.
        J Subst Abuse. 1994; 6: 381-392
        • Najavits LM
        Weiss RD. Variations in therapist effectiveness in the treatment of patients with substance use disorders: an empirical review.
        Addiction. 1994; 89: 679-688
        • Loneck D
        • Garrett JA
        • Banks SM
        A comparison of the Johnson Intervention with four other methods of referral to outpatient treatment.
        Am J Drug Alcohol Abuse. 1996; 22: 233-246
        • Project MATCH Research Group
        Matching alcoholism treatments to client heterogeneity: Project MATCH posttreatment drinking outcomes.
        J Stud Alcohol. 1997; 58: 7-20
        • O'Brien CP
        • McLellan AT
        Myths about the treatment of addiction.
        Lancet. 1996; 347: 237-240
        • Kaim SC
        • Klett CJ
        • Rothfeld B
        Treatment of the acute alcohol withdrawal state: a comparison of four drugs.
        Am J Psychiatry. 1969; 125: 1640-1646
        • Fuller RK
        • Gordis E
        Refining the treatment of alcohol withdrawal.
        JAMA. 1994; 272: 557-558
        • Saitz R
        • Mayo-Smith IMF
        • Roberts MS
        • Redmond HA
        • Bernard DR
        • Calkins DR
        Individualized treatment for alcohol withdrawal: a randomized double-blind controlled trial.
        JAMA. 1994; 272: 519-523
        • Sellers EM
        • Naranjo CA
        • Harrison M
        • Devenyi P
        • Roach C
        • Sykora K
        Diazepam loading: simplified treatment of alcohol withdrawal.
        Clin Pharmacol Ther. 1983; 34: 822-826
        • Mayo-Smith MF
        • American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal
        Pharmacological management of alcohol withdrawal: a meta-analysis and evidence-based practice guideline.
        JAMA. 1997; 278: 144-151
        • Spies CD
        • Dubisz N
        • Funk W
        • Blum S
        • Muller C
        • Rommelspacher H
        • et al.
        Prophylaxis of alcohol withdrawal syndrome in alcohol-dependent patients admitted to the intensive care unit after tumour resection.
        Br J Anaesth. 1995; 75: 734-739
        • Sullivan JT
        • Swift RM
        • Lewis DC
        Benzodiazepine requirements during alcohol withdrawal syndrome: clinical implications of using a standardized withdrawal scale.
        J Clin Psychopharmacol. 1991; 11: 291-295
        • Fuller RK
        • Brarnchey L
        • Brightwell DR
        • Derman RM
        • Emrick CD
        • Iber FL
        • et al.
        Disulfiram treatment of alcoholism: a Veterans Administration cooperative study.
        JAMA. 1986; 256: 449-1455
        • Chick J
        • Gough K
        • Falkowski W
        • Kershaw P
        • Hore B
        • Mehta B
        • et al.
        Disulfiram treatment of alcoholism.
        Br J Psychiatry. 1992; 161: 84-89
      1. LeshnerAI. Bridging the “Great Disconnect.” NIDA Notes 1996 Mar-Apr: 11:3–4

        • Anton RF
        Medications for treating alcoholism.
        Alcohol Health Res World. 1994; 18: 265-271
        • Chick J
        • Erickson CK
        Conference summary: consensus conference on alcohol dependence and the role of pharrnacotherapy in its treatment.
        Alcohol Clin Exp Res. 1996; 20: 391-402
        • Volpicelli JR
        • Clay KL
        • Watson NT
        • Volpicelll LA
        Naltrexone and the treatment of alcohol dependence.
        Alcohol Health Res World. 1994; 18: 272-278
        • O'Malley SS
        • Jaffe AJ
        • Chang G
        • Schottenfeld RS
        • Meyer RE
        • Rounsaville B
        Naltrexone and coping skills therapy for alcohol dependence: a controlled study.
        Arch Gen Psychiatry. 1992; 49: 881-887
        • Volpicelli JR
        • Alterman AL
        • Hayashida M
        • O'Brien CP
        Naltrexone in the treatment of alcohol dependence.
        Arch Gen Psychiatry. 1992; 49: 876-880
        • Litten RZ
        • Allen J
        • Fertig J
        Pharmacotherapies for alcohol problems: a review of research with focus on developments since 1991.
        Alcohol Clin Exp Res. 1996; 20: 859-876
        • Paille FM
        • Guelfi JD
        • Perkins AC
        • Royer R
        • Steru L
        • Parot P
        Double-blind randomized multicentre trial of acamprosate in maintaining abstinence from alcohol.
        Alcohol Alcohol. 1995; 30: 239-247
        • Lovinger DM
        Serotonin's role in alcohol's effects on the brain.
        Alcohol Health Res World. 1997; 21: 114-120
        • Gorelick DA
        • Paredes A
        Effect of fluoxetine on alcohol consumption in male alcoholics.
        Alcohol Clin Exp Res. 1992; 16: 261-265
        • Kranzler HR
        • Burleson JA
        • Horner P
        • Del Boca FK
        • Bohn MJ
        • Brown J
        • et al.
        Placebo-controlled trial of fluoxetine as an adjunct to relapse prevention in alcoholics.
        Am J Psychiatry. 1995; 152: 391-397
        • Kavanagh DJ
        • Sitharthan T
        • Sayer GP
        Prediction of results from correspondence treatment for controlled drinking.
        Addiction. 1996; 91: 1539-1545
        • Bien TH
        • Miller WR
        • Tonigan JS
        Brief interventions for alcohol problems: a review.
        Addiction. 1993; 88: 315-335
        • Miller WR
        • Sanchez VC
        Motivating young adults for treatment and lifestyle change.
        in: Howard G Alcohol Use and Misuse by Young Adults. University of Notre Dame Press, Notre Dame (IN)1994: 55-82
        • Prochaska JO
        • DiClimente CC
        Toward a comprehensive model of change.
        in: Miller WR Heather N Treating Addictive Behav tors: Processes ol Change. Plenum Publishing, New York1986: 3-27
        • Dunn CW
        • Ries R
        Linking substance abuse services with general medical care: integrated, brief interventions with hospitalized patients.
        Am J Drug Alcohol Abuse. 1997; 23: 1-13
        • Botelho RJ
        • Richmond R
        Secondary prevention of excessive alcohol use: assessing the prospects of implementation.
        Fam Pract. 1996; 13: 182-193
        • Durand MA
        General practice involvement in the management of alcohol misuse: dynamics and resistances.
        Drug Alcohol Depend. 1994; 35: 181-189
        • Heather N
        The public health and brief interventions for excessive alcohol consumption: the British experience.
        Addict Behav. 1996; 21: 857-868
        • Israel Y
        • Hollander O
        • Sanchez-Craig M
        • Booker S
        • Miller V
        • Gingrich R
        • et al.
        Screening for problem drinking and counseling by the primary care physician-nurse team.
        Alcohol Clin Exp Res. 1996; 20: 1443-1450
        • National Institute on Alcohol Abuse and Alcoholism
        How to Cut Down on Your Drinking. National Institutes of Health, Bethesda (MD)1996 (Publication No. NIH 96-3770)
        • Spicer J
        The Minnesota Model: The Evolution of the Multidisciplinary Approach to Addiction Recovery. Hazelden Educational Materials, Center City (MN)1993
        • Gallagher TC
        • Andersen RM
        • Koegel P
        • Gelberg L
        Determinants of regular source of care among homeless adults in Los Angeles.
        Med Care. 1997; 35: 814-830
        • Hemingway H
        • Saunders D
        • Parsons L
        Social class, spoken language and pattern of care as determinants of continuity of care in maternity services in east London.
        J Public Health Med. 1997; 19: 156-161
        • Cockram A
        • Gibb R
        • Kalra L
        The role of a specialist team in implementing continuing health care guidelines in hospitalized patients.
        Age Ageing. 1997; 26: 211-216
        • Flocke SA
        • Stange KC
        • Zyzanski SJ
        The impact of insurance type and forced discontinuity on the delivery of primary care.
        J Fam Pract. 1997; 45: 129-135
        • Kitchiner D
        • Davidson C
        • Bundred P
        Integrated care pathways: effective tools for continuous evaluation of clinical practice.
        J Eval Clin Pract. 1996; 2: 65-69
        • Anderson DJ
        Delivery of essential services to alcoholics through the “continuum of care”.
        Cancer Res. 1979; 39: 2855-2858
        • Knott DH
        • Lerner WD
        • Davis-Knott T
        • Fink RD
        Decision for alcohol detoxication: a method to standardize patient evaluation.
        Postgrad Med. 1981 May; 69: 65-69
        • Morgan T
        • Kofoed L
        • Peterson DB
        Clinical pathway effects on treatment of the alcohol withdrawal syndrome.
        S D J Med. 1996; 49: 195-200
        • Hoffman NG
        • Halikas JA
        • Mee-Lee D
        • Weedman RD
        Patient Placement Criteria for Treatment of Psychoactive Substance Use Disorders. American Society of Addiction Medicine, Washington (DC)1991