Psychological and social approaches

Systematic reviews indicate that most of the brief approaches that have been trialled are effective in reducing consumption, but that longer-term psychological treatments (including dynamic, behavioural, or supportive psychotherapy, individual or group, on an inpatient or outpatient basis) have little or no additional benefit. The trend is firmly toward inexpensive community treatments with input from health, social, and probation services. However, inpatient alcoholic units still exist, offering intensive group psychotherapy over several weeks or months. Long-term residence in a 'dry' hostel offers support for some severely damaged ex-drinkers.

Alcoholics Anonymous (AA) is a voluntary organization offering self-help group therapy at evening meetings, and it also runs groups for partners and children. The goal of lifetime total abstinence is central to AA's approach. Some people derive great benefit from AA, and continue frequent attendance at meetings for many years to make sure they remain 'dry'. For others, however, the AA approach, which has a quasi-religious aspect, is less attractive.

Motivational interviewing uses a model that can also be applied to other addictive behaviours, describing a 'cycle of change':

• precontemplation

• contemplation

• maintenance/relapse.

Problem drinking is seen as being likely to recur, perhaps more than once, before the drinker gains control; returns to drinking are seen not as moral lapses but as learning experiences. This has the advantage of recognizing that multiple attempts are often necessary before a drink problem can be mastered.

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