Ensuring Solutions to Alcohol Problems (ESAP),
a research-based project at George Washington University Medical
Center, has identified 13 active ingredients of effective
alcohol treatment. The findings are included in its latest
educational primer, released today.
The nation’s system for treating alcohol
problems continues to fall short of the comprehensive model
envisioned more than 10 years ago by the Institute of Medicine
(IOM). While several of the active ingredients identified
by ESAP have long been prescribed for treating alcohol-dependent
individuals, many, including the use of prescribed medications
to support clinically-proven psychosocial therapies, are not
widely found in clinical practice.
“Alcohol use disorders can be treated as
effectively as chronic diseases such as asthma, diabetes and
hypertension,” said ESAP Executive Director Eric Goplerud,
PhD. “Unfortunately, most people enter alcohol treatment only
when their illness reaches a critical stage. Their treatment
typically ends after an intervention of limited duration because
they stop coming, their insurance coverage runs out, or because
treatment ends. This acute care model may work for treating
broken bones but it fails as a treatment strategy for the
chronic disease of alcoholism.”
In a 1990 congressionally-mandated report,
Broadening the Base for the Treatment of Alcoholism, the Institute
of Medicine (IOM) found that people who used alcohol in harmful
or risky ways, but who were not dependent on alcohol, could
benefit from early detection and brief treatments. Neither
was common when the IOM released its report, and neither is
widely practiced today.
Since the IOM report, advances in pharmacology
and rigorous research trials have proven the effectiveness
of several medications and psychosocial therapies that can
help people with more severe alcohol problems. The IOM recommended
continuing care as a critical ingredient of alcohol treatment
for such chronically-ill individuals. Now, even more clinically-proven
active ingredients have become available that have the potential
to improve recovery rates substantially.
“The philosophical orientation of many programs
and individuals who work in the treatment field has focused
more on participation in support groups to prevent relapse
than the use of prescription medications such as disulfiram
and naltrexone for this purpose,”
observed Goplerud.
“This, coupled with many physicians’ misunderstanding
of alcoholism, has meant that people with alcoholism have
been denied medication to support psychosocial therapy for
behavior change, a combination of active ingredients that
has proven necessary for the effective treatment of chronic
illnesses such as asthma, diabetes and hypertension.”
Ensuring Solutions to Alcohol Problems identified
these and other active ingredients of alcohol treatment (see
below) after a review of research literature and consultation
with a variety of treatment professionals. The Active Ingredients
of Effective Alcohol Treatment is available online at www.ensuringsolutions.org.
It is the fourth in a series of educational primers developed
by ESAP to inform business leaders and policymakers about
a drug problem that directly affects an estimated 14 million
Americans as well as their families, workplaces and communities.
In April, ESAP released The Alcohol Cost Calculator, a Web-based
tool for U.S. businesses.
ACTIVE INGREDIENTS OF EFFECTIVE ALCOHOL TREATMENT:
-
Early
detection, including screening and brief interventions
(for non-dependent problem drinkers)
-
Comprehensive
assessment and individualized treatment plan
-
Care
management
-
Individually
delivered, proven professional interventions
-
Contracting
with patients
-
Social
skills training
-
Medications
-
Specialized
services for medical, psychiatric, employment or family
problems
-
Continuing
care
-
Strong
bond with therapist or counselor
-
Longer
duration (for alcohol dependent persons)
-
Participation
in support groups
-
Strong
patient motivation
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