Guidelines for the Treatment of Alcohol Problems (original) (raw)

Guidelines for the Treatment of Alcohol Problems 7 EXTENDED CARE STRENGTH OF RECOMMENDATION Attention should be given to the client's retention in treatment and Strong social support networks. Aftercare should be structured and assertive, with follow-up Strong of missed appointments. Clients who show signs of dependence on alcohol should be made Moderate aware of the service offered by meetings of Alcoholics Anonymous (AA). Mandated AA participation is not recommended. Conventional AA meetings should not be viewed as treatment for Moderate alcohol dependence. TREATMENT ISSUES FOR SPECIFIC GROUPS ADOLESCENTS Given the limitations of diagnostic criteria for alcohol use disorders Strong with adolescents, a flexible approach to diagnosis and treatment is needed. Whilst some young people may not meet strict diagnostic criteria for alcohol dependence or abuse, this should not be a barrier to treatment. Clinicians should focus on building and maintaining a relationship Strong with younger clients through outreach, crisis intervention and harm reduction activities, and the use of an empathetic, non-judgemental, developmental approach to counselling. Brief and motivational interventions help to reduce alcohol Strong consumption among adolescent heavy or binge drinkers, across a range of settings. Younger drinkers who require more intensive intervention may Strong have different treatment needs to older drinkers. These needs should start to be identified during the assessment phase, and may include crisis intervention, assertive outreach, and building social support networks. The recommended psychological treatment for young people Moderate is cognitive behavioural therapy. Other potentially useful treatments include social skills training, family therapy, therapeutic support groups, and interpersonal therapy. COGNITIVELY IMPAIRED CLIENTS A brief assessment of cognitive functioning should be a routine Strong part of assessment upon treatment entry. More detailed assessment should be carried out where brief assessment Strong suggests that a patient suffers from significant cognitive deficits. 8 Guidelines for the Treatment of Alcohol Problems TREATMENT ISSUES FOR SPECIFIC GROUPS STRENGTH OF RECOMMENDATION COGNITIVELY IMPAIRED CLIENTS Where cognitive impairment is confirmed, information presented Strong to patients should be concrete and patients should be given opportunities to practise behaviours taught during treatment sessions. Cognitively impaired patients should be engaged in treatment Moderate by the clinician by: Guidelines for the Treatment of Alcohol Problems 9 TREATMENT ISSUES FOR SPECIFIC GROUPS STRENGTH OF RECOMMENDATION COMORBID DISORDERS Alcohol dependent patients with antisocial personality disorder Fair should be considered for treatment with nortriptyline, depending on the severity and nature of their symptoms. GENDER Treatment providers need to be aware of and sensitive to issues Strong particular to women with alcohol problems. Service providers should try to improve the recruitment of women Moderate to their services by improving outreach, setting up referral networks, advertising facilities specifically targeting women, and providing more detailed information about services. This would increase women's awareness of treatment services available, and may decrease any reservations or fears about entering treatment. All clients should be provided with a safe therapeutic environment, Strong Audience for the guidelines This comprehensive version of the guidelines is intended for clinicians who want a full review of the treatment options for alcohol problems. Specific, summarised guidelines are also available (in mid-2003) for general practitioners, drug and alcohol workers, general hospital workers, and consumers. Throughout this document we use the terms "clinician" or "health care worker" to refer to any of the above professionals. Development of the guidelines The guidelines are based on a review of the available evidence of efficacy (the Treatment of Alcohol Problems: A Review of the Evidence) and the knowledge of an expert panel convened to develop the guidelines. Members of the expert panel are listed in the preliminary pages. The procedure used to identify research has involved searching relevant databases for published clinical trials, hand searching journals, searching website bibliographies, canvassing for unpublished research, and contact with major research centres for unpublished research and other relevant guidelines. Databases searched include Medline, Psychinfo, Cochrane Database of Systematic Reviews, the National Clearinghouse for Alcohol and Drug Information, Evidence Based Medicine Reviews, and the Alcohol and Other Drug Council of Australia's (ADCA) Drug Database. 14 Guidelines for the Treatment of Alcohol Problems CHAPTER 1 Introductory Comments 1 Meta analysis is a statistical technique which combines a number of single trials to increase the overall power and certainty of outcomes. Guidelines for the Treatment of Alcohol Problems 15 CHAPTER 1 Introductory Comments Guidelines for the Treatment of Alcohol Problems 17 CHAPTER 1 Introductory Comments CHAPTER 2 Access to treatment: overcoming barriers Chapter 2: Access to treatment: overcoming barriers Guidelines for the Treatment of Alcohol Problems 21 CHAPTER 2 Access to treatment: overcoming barriers Chapter 2: Access to treatment: overcoming barriers CHAPTER AIM The aim of this chapter is to identify barriers that drinkers may encounter in seeking treatment. Many barriers to treatment are equity-based and systemic. For example, lower socioeconomic groups are less likely to be offered brief interventions. [4] Remote Indigenous communities often have very limited access to treatment resources. [5] Types of barriers include: CHAPTER 3 Screening and Assessment Chapter 3: Screening and assessment Guidelines for the Treatment of Alcohol Problems 25 CHAPTER 3 Screening and Assessment Chapter 3: Screening and assessment Chapter Aim The aim of this chapter is to guide screening which might take place prior to a brief and/or early intervention for those patients who may be drinking at risky levels, or have risky patterns of consumption.