What Is the Best Alcohol Treatment?
~A. Tom Horvath, Ph.D., ABPP
There are three myths about alcohol treatment, according to some of the foremost researchers in the area, led by psychologist William R. Miller (Handbook of Alcoholism Treatment Approaches: Effective Alternatives, 3rd edition, edited by Hester & Miller, published in 2003 by Allyn & Bacon). The first myth, and possibly the worst, is that there is one and only one effective approach to addiction recovery. If you are seeking treatment and a facility tells you a version of this myth, it would be better to look elsewhere for help. Alcohol treatment research, and addiction treatment research generally, shows there is no single approach that is best for all individuals.
Many paths to addiction recovery
The first principle of the 12 Guiding Principles adopted by SAMHSA’s Center for Substance Abuse Treatment’s National Summit on Recovery is: There are many pathways to recovery. Their list was generated by leaders in treatment and recovery, and included recovering individuals, treatment providers, researchers, faith-based providers and state and federal officials. A similar document of 10 principles, addressed to the problems of individuals with co-occurring mental health issues, produced at a Substance Abuse and Mental Health Services Administration (SAMHSA) conference, stated: There are multiple pathways to recovery.
The other two myths are that “nothing works” and “everything works.” Put another way, there is a popular but incorrect belief that all treatments for addictions are equally good or bad.
Drs. Miller and Hester have been comparing the research contrasting the various approaches.* Their scientifically sophisticated review of alcoholism treatment outcome research demonstrates that some treatment modalities are especially effective for most people. Rank ordered, the evidence is strongest for:
1. Receiving honest but non-confrontational one-on-one feedback regarding one’s alcohol- related health from a health professional;
2. Non-confrontational strategic Motivational Interviewing;
3. The medication acamprosate;
4. A complex set of cognitive and behavioral methods called the Community Reinforcement Approach
5. The assigning of a Self-Change Manual, also called Bibliotherapy
6. The medication naltrexone;
7. Behavioral Self-Control Training (a moderation approach);
8. Behavioral Contracting for rewards given in exchange for clean drug test results:
9. Social Skills Training
10. Behavioral Marital Therapy
A common theme in all of these treatments is that they are delivered with empathy and without confrontation. These treatments are often mentioned in media articles about improving our poor record in helping people with addictions. Unfortunately, few addiction treatment centers offer them. However, with the aid of the internet one can find them more easily than before.
Alcohol treatment with weak evidence of effectiveness
Of the 48 approaches ranked, the evidence is weakest for:
48. Educational tapes, lectures and films, upon which much time is spent in some rehabs;
47. General Alcoholism Counseling;
45. Confrontational Counseling;
44. Relaxation Training;
43. Videotape Self-Confrontation or watching oneself behaving badly while intoxicated;
42-39.These four included three medications and Milieu Therapy;
38. Alcoholics Anonymous
37. Twelve-Step Facilitation Therapy, a one-on-one teaching and support of the 12-Steps.
Of course, even these treatments will be helpful to some. However, it would appear most sensible, if seeking treatment for oneself or a loved one, to start with a treatment that had a better record of success. Further, common sense would suggest that if one approach does not work, it is not necessarily the individual’s fault. If an alcohol treatment does not help much, try something else!
Source: Practical Recovery Reprinted with permission
* The complete list, including the criteria for ranking all 48 treatment approaches may be found here.