By: Valerie J.
Slaymaker, Kirk J. Brower and Mike Crawford
Alcohol misuse is a complex problem and complex interventions are the norm in its management. All the effective treatments are not just complex, but often multi-complex, and it is not always certain what constitutes the most important elements.
Alcohol misuse is a complex problem and complex interventions are the norm in its management. All the effective treatments are not just complex, but often multi-complex, and it is not always certain what constitutes the most important elements.
It is also important to note that the result of an intervention may
differ at different levels of dependence. ICD-10 defines a category of ‘harmful use’
that is short of full
dependence, and many of the simpler interventions may be more helpful in this group than
when full dependence has
developed.
A complex intervention for alcohol use disorders may be defined as one that utilizes multiple therapeutic components and strategies, based on a common underlying philosophy of treatment and targeted at various facets of the disorder in a complementary and frequently simultaneous fashion.
A complex intervention for alcohol use disorders may be defined as one that utilizes multiple therapeutic components and strategies, based on a common underlying philosophy of treatment and targeted at various facets of the disorder in a complementary and frequently simultaneous fashion.
Most treatment for moderately to severely alcohol dependent
patients is complex by this definition and for good reasons.
First, alcohol use disorders are heterogeneous and influenced
by multiple factors in terms of their etiology, development, and course.
Second, no single treatment strategy or technique is effective across
all alcohol-dependent
patients.
Third, the active ingredients of most, if not all,
psychosocial therapies for alcohol dependence are unknown.
Complex interventions for which there is a base of
evidence to evaluate them.
They are Alcoholics Anonymous (A.A.),
The Minnesota Model of treatment,
Therapeutic Communities (TCs), and
Combined pharmacotherapy and psychotherapy.
With the exception of A.A., complex interventions are generally
delivered within
specialized addiction treatment settings. By contrast, A.A. is a
non-professional intervention available within the broader community.
References
Peter
Tyrer and Kenneth R. Silk, Cambridge Textbook of Effective Treatments in
Psychiatry, Cambridge University Press 2008.
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