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Alcohol Dependence Syndrome
Niharika Thakkar
Child Guidance Centre and Department of Behavioural Sciences and Mental Health, Sahyadri Hospitals ltd, Pune
Phases of Alcoholism – Jellinek (1960)
PRE-ALCOHOLIC PHASE
CHRONIC PHASE•Benders•Tremors•Protecting the Supply•Unreasonable Resentments•Nameless Fears and Anxieties•Collapse of the Alibi System•Surrender Process
CRUCIAL PHASE•Loss of Control•The Alibi System•Eye-Openers•Changing the Pattern•Anti-Social Behavior•Loss of Friends, Family or Job•Seeking Medical Aid
PRODROMAL PHASE•Gross Drinking Behavior•Blackouts•Gulping and Sneaking Drinks•Chronic Hangovers
Types of Alcoholism – Jellinek (1960)
Alpha alcoholism Beta alcoholism Gamma alcoholism Delta alcoholism Epsilon alcoholism-Dipsomaniac
Stages of Change- Prochaska and DiClemente (1984)
Stages of Change- Prochaska and DiClemente (1984)
PrecontemplationNot currently considering change:
"Ignorance is bliss" Techniques:Validate lack of readiness Clarify: decision is theirs Encourage re-evaluation of current behavior Encourage self-exploration, not action Explain and personalize the risk
Stages of Change- Prochaska and DiClemente (1984)
ContemplationAmbivalent about change:" Sitting on the fence" Not considering change within the next month
[Miller and Rollnick (1991)] Techniques Validate lack of readiness Clarify: decision is theirs Encourage evaluation of pros and cons of
behavior change Identify and promote new, positive outcome
expectations
Stages of Change- Prochaska and DiClemente (1984)
PreparationSome experience with change and are
trying to change: "Testing the waters" Planning to act within 1monthTechniques: Identify and assist in problem solving Help patient identify social support Verify that patient has underlying
skills for behavior change Encourage small initial steps
Stages of Change- Prochaska and DiClemente (1984)
ActionPracticing new behavior for 3-6 monthsTechniques: Focus on restructuring cues and social
support Bolster self-efficacy for dealing with
obstacles Combat feelings of loss and reiterate
long-term benefits
Stages of Change- Prochaska and DiClemente (1984)
MaintenanceContinued commitment to sustaining new
behavior Post-6 months to 5 yearsTechniques: Plan for follow-up support Reinforce internal rewards Discuss coping with relapse
Stages of Change- Prochaska and DiClemente (1984)
RelapseResumption of old behaviors:
"Fall from grace" Techniques: Evaluate trigger for relapse Reassess motivation and
barriers Plan stronger coping
strategies
Motivational Interviewing
Denial Individual is encouraged to reach own
decision about change Therapists’ role facilitate the changeAim Cognitive DissonanceGoal Self actualization
Behaviour Interventions
Cue Exposure: Compulsion will be reduced if the urge is restricted
Aversive Condition : Chemical or shock
Covert Sensitization: Imagined + taught-Least aversive-Number of trials decided by therapist-Self control (most commonly used, effective)-Flexible-Inexpensive-Tailor cut
Behaviour Interventions
Cautions: - Urge has to be targeted- Prevent “inappropriate
generalization”- Side effect: anger, resentment,
aggression- Lack of co operation
Behaviour Interventions
Procedure: Close eyes Imagine : Target response to be weakened Imagine an aversive stimulus Clarity of image Indicate degree of aversiveness Practice till clarity of image reported 20 scenes- 10 described by therapist, 10 imagined out of
description Taped: listen to tape twice a day In-vivo practice Combine with cover reinforcement: Imagine a pleasant scene
Behaviour Therapy in Substance Use
Therapeutic relationship I-P skills Good outcome (Yalom, Lieberman, Mac Donough,
1971)
Empathy
Cohesiveness Congruence
Poorer Outcomes: Confrontational styles of therapist
Motivational Enhancement : Miller and Rollnick (2002)
Relapse Prevention
Marlatt &Gordon (1985) -Social Learning-Behavioural rehearsal-Assertiveness training-Lapse-relapse “Emergency
plan”How to Say no.mp4
Psychosocial
Alcoholics Anonymous group (12 step approach)
Functional Analysis
Maintaining factors Triggers and precursors Consequences Problem areas :
Relationship, work, legal, medical, interpersonal, financial : Particular “cognitions”
Implementing goals of treatment
Generic treatment plan : Denial- Educate- Facilitate into program like AA
Goal: Total abstinence Sobeil & Sobeil (1976): ‘Controvercial’ Model Goal: Moderated drinking
Behavioural Self control training
Education oriented: Therapist directed; Self directedRationale: Abstinence: Patient refuse; high ADS Choice of goals 1.) Self efficacy 2.) Self control 3.) 6-12 sessions (90mins) + Booster sessionsSteps: Limit setting Self monitoring Rate of drinking Social skills training Contingency managementAlcohol Ads affect.mp4
Qualitative Inventory of Alcohol Disorders
Chalo, Bye