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Alcoholism Treatment Choices

A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.

There are four basic approaches to alcoholism treatment:  Biological, Psychological, Socio-cultural, and Spiritual.  People can combine these various approaches to match their individual needs and circumstances as they work to develop their own individualized, custom-tailored approach to recovery.

1. Biological approaches to alcoholism treatment attempt to correct or modify the presumed underlying biological causes of addiction. This approach follows a logical rationale.  If we know what caused something to become broken, we can fix it. Then, we can repair or restore the broken "thing" to its original purpose and function.  According to biological models of addiction, a "broken" or damaged brain causes addiction. For example, perhaps someone's brain chemistry makes a particular drug a little bit too enjoyable.  This would make drug use very difficult to resist.  One way to fix this problem is to make drug use less rewarding.  For instance, a person could take a medication that causes them to become sick if they consume the drug.  Thus, this faulty brain chemistry is "fixed" via the addition of corrective chemicals; i.e., medications. The specific medications used in addiction treatment and their purposes are reviewed in our addiction topic center on Biological Approaches to Addictions Treatment.

2. Psychological approaches to alcoholism recovery aim to increase a person's motivation for change.  Helping people to accurately appraise the costs and benefits of their addiction increases their motivation.
Once a person is motivated to change, they must actually take steps to change.  It seems rather obvious, but wanting to change is not the same thing as completing said change.  People in recovery must make some very difficult changes in the way they think, feel, and behave.  In this way, they can make wiser, healthier choices.  Psychological approaches are ideal for helping people to make these needed changes.

In addition to changing thoughts, feelings, and behaviors, individuals embracing recovery may also need to restructure their social world.  Our relationships with other people greatly determine whether addiction or relapse is likely. Thus, another psychological approach helps people to evaluate whether or not their social circle is supportive of the changes they wish to make.  Psychotherapy may also help addicted individuals to correct for developmental immaturity.

It is difficult to change behavior.  It requires a significant amount of motivation.  Therefore strengthening the motivation for recovery is very helpful.  One such approach is called Motivational Interviewing.  There are also several effective types of psychotherapy.  These are:  Relapse Prevention Therapy, Contingency Management, Cognitive-Behavioral Therapy, Dialectical Behavioral Therapy, Acceptance and Commitment Therapy.  These psychological approaches to addictions treatment are discussed in much greater detail in our addiction topic center. We also discuss what does not work such as confrontational "interventions."

3. Socio-cultural approaches to addictions recovery emphasizes the important influence of social groups on individuals as they attempt to recover.  There are several socio-cultural approaches to addictions treatment.  These include:  1) harm reduction strategies such as needle exchange programs, or public campaigns such as designated drivers, 2) family approaches to addictions treatment, and 3) the social support approach to addictions treatment.

Social support groups (or simply "support groups") refer to groups of people who meet to share their common problems and experiences.  Support groups are not the same as therapy groups. Trained professional facilitate therapy groups with a specific therapeutic purpose.  In contrast, support groups are led by non-professional volunteers. Social support groups include two basic types.  There are self-empowering support groups and 12-step support groups such as Alcoholics Anonymous. 

Each of these socio-cultural approaches to addictions treatment is discussed in greater detail in our addictions topic center.

4. Spiritual approaches to alcoholism recovery are based on research that has repeatedly demonstrated that spirituality can have a positive effect on recovery from many diseases and disorders.  It is unknown the precise source of this effect.  Whether recovery does indeed originate because of a "power greater than ourselves" (aka, God), or whether it is due to the psychological benefit of hope that such a belief instills, the fact remains that many people's health is benefitted by their spiritual beliefs and practices.  As God and related concepts do not lend themselves to scientific research, we are in no position to comment upon the reasons for this effect.  What we can say is that research has indicated that a spiritual faith or practice can be beneficial in the recovery from many diseases and disorders.  

We must also emphasize while the most well known spiritual approach to recovery are the 12-step support groups such as Alcoholics Anonymous (AA).  However, spirituality is not limited to a belief in a power greater than oneself.  Spirituality might more broadly include a belief that life has a meaning and purpose. Such a belief might provide a guideline for living according to that meaning and purpose.  Restoring a meaning and purpose to life is one of the four key ingredients to any successful recovery effort.  For more information, see our Addictions topic center on Spiritual Approaches to Addiction Recovery.