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 Disorders Can Be Treated
"Alcohol use disorders can be treated as effectively as chronic diseases such as asthma, diabetes and hypertension," said ESAP Executive Director Eric Goplerud, PhD, in a news release. "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.
Therapies That Can Help
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.
Misunderstanding by Physicians
"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.
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
