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In general, the greater the disorder, the more external control is required to
manage it. Individuals who have become
physically dependent on alcohol generally require more
external structure to achieve long-term sobriety than than those who have mild alcohol
abuse problems. In fact, to have any chance of achieving good long-term
outcome dependent alcoholics often require lengthy and intrusive external guidance and
supervision. Unfortunately most chemically
dependent alcoholics do not receive sufficient support
for a long enough period, and they tend to relapse shortly after the program has ended and the
external support is gone.
However, for individuals with less severe addictive disorders, less intense
and briefer treatments are often superior to more intrusive and longer duration
treatments:
- Stephens and his colleagues compared a brief Motivational Interviewing
intervention with a more intensive conventional treatment program on outcome for marijuana
abusers. The authors conclude: "The results suggest that brief treatments
may be more cost-effective for some adult marijuana users. Two sessions of individualized
feedback and advice on how to quit produced reductions in marijuana use comparable to that
of a 14-session group intervention, with additional sessions for supporters and ongoing
self-help meetings."1
- The Sobels2 argue: "When alcohol treatment services were first
developed, they were not based on research but on folklore largely reflecting the
influence of Alcoholics Anonymous (AA) and its 12 steps. As the field developed, it
came to be dominated by Minnesota Model treatment programs, structured to be similar to
the program used at the Hazelden Foundation in Minnesota. Until recently, these
28-day residential programs were the rule rather than the exception for treatment of
alcohol problems in the United States. These programs have continued despite
considerable epidemiological data showing that there is an imbalance between treatment
needs and the types of services available. In particular, there is a deficiency of
treatment resources for individuals who have less severe alcohol problems."
- In reviewing treatment efficacy studies, Miller et al.3 concluded
that brief interventions have the greatest evidence for efficacy. One example:
Orford, Oppenheimer, & Edwards4 found that alcohol abusers given either one
session of advice/counseling or a standard regimen of individualized care - that could
have included inpatient as well as extended outpatient treatment - showed no difference in
outcome. A recent review of the original data shows that even those
individuals with more severe problems did as well with one session of treatment as with
the standard treatment.
- This does not mean that treatment is ineffective or that all treatment is the
same. Quite the contrary! While brief interventions [1-3 sessions] are
comparable in impact to more extensive treatments, brief treatment is substantially more
effective than no treatment.5
Footnotes
1. Comparison of Extended Versus Brief Treatments for Marijuana Use. Robert S.
Stephens, Roger A. Roffman, & Lisa Curtin - Journal of Consulting and Clinical
Psychology 2000 Vol. 68, No. 5, 898-908
2. Stepped Care as a Heuristic Approach to the Treatment of Alcohol Problems
Mark B. Sobell Linda C. Sobell Journal of Consulting and Clinical Psychology 2000 Vol. 68,
No. 4, 573-579
3. Miller, W. R., Brown, J. M., Simpson, T. L., Handmaker, N. S., Bien, T. H.,
Luckie, L. F., Montgomery, H. A., Hester, R. K. & Tonigan, J. S. (1995). What works? A
methodological analysis of the alcohol treatment outcome literature.(In R. K. Hester &
W. R. Miller (Eds.), Handbook of alcoholism treatment approaches: Effective alternatives
(2nd ed., pp. 12—44). Boston: Allyn & Bacon
4. Orford, J., Oppenheimer, E. & Edwards, G. (1976). Abstinence or control:
The outcome for excessive drinkers two years after consultation. Behaviour Research and
Therapy, 14, 409-418
5.Leshner, Alan, PhD [director NIDA], 1999, NIH Pub No.
99-4180. Principles of Drug Addiction Treatment
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To know the road ahead, ask those coming back.
- Chinese proverb
Liberty means responsibility. That is why most men dread it.
- G.B Shaw
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