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Alcoholism, Causes, Signs and Symptoms, Diagnosis and Treatment.

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Overcoming Alcohol Use Problems by Elizabeth Epstein is available now for quick shipment to any U.S. location! This is a high quality book that is ready for prompt shipment to any U.S. Location. Over the years we have learned how to provide students with cheap prices on books with fast shipping. We know how overpriced books and textbooks can be so we ensure that students have access to those same books at affordable prices. This 2009 edition book is in good condition or better. Just complete the checkout process for this book and it will be shipped to you for immediate use.

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overcoming alcohol use problems elizabeth epstein mccrady barbara s. oxford university press isbn 9780195322798 0195322797 2009 edition

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Overcoming Alcohol Use Problems by Elizabeth Epstein

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Overcoming Alcohol Use Problems by Elizabeth Epstein is available now for quick shipment to any U.S. location! This is a high quality book that is ready for prompt shipment to any U.S. Location. Over the years we have learned how to provide students with cheap prices on books with fast shipping.

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Many people approach alcohol or drug rehab with pessimism. They may not think sobriety is realistic, or they may not be ready to quit drinking alcohol or using drugs. A part of them may know that substance abuse is ruining their life. But other factors prevent them from admitting that they need to change.

Motivational interviewing is a counseling technique that helps clients build motivation for treatment. It does not address underlying causes of substance abuse or addiction. It's usually used as a complement to other therapies, such as cognitive behavioral therapy.

Motivational Interviewing Assumptions

Motivational interviewing focuses on resolving ambivalence toward recovery. Ambivalence refers to conflicting emotions about substance abuse.

People with addiction usually know that alcohol and other drugs are hurting them. A part of them may want to quit, and another part may simultaneously want them to keep using.

1. Ambivalence toward alcohol and drug abuse is a normal obstacle on the path to recovery.

2. People possess natural motivations and values that can help them overcome ambivalence.

3. The relationship between a therapist and client is a collaborative partnership.

4. An empathetic, supportive and directive approach to counseling can establish conditions for change to occur.

Many people who begin treatment with motivational interviewing sessions are in the early stages of change.

Precontemplation

No desire to change or no recognition of a problem.

Contemplation

Recognition of a problem but inability to recognize a realistic solution.

Preparation

Thinking about steps to change but possessing pessimism or doubt.

Action

Taking steps to change but still possessing skepticism.

Maintenance

Continuing new behaviors. If behaviors are discontinued, relapse is likely.

Motivational interviewing is a type of motivational therapy that helps clients recognize a problem and build motivation to pursue a solution. It doesn't necessarily show patients which actions to take or teach them how to change behaviors.

Principles of Motivational Interviewing

Psychologists William R. Miller and Stephen Rollnick helped develop the motivational interviewing approach to counseling. In their book "Motivational Interviewing: Preparing People to Change Addictive Behavior," they outlined five principles that therapists should adhere to.

1. Express empathy through reflective listening.

2. Develop discrepancy between client goals or values and their current behavior.

3. Avoid argument and direct confrontation.

4. Adjust to client resistance rather than opposing it directly.

5. Support self-efficacy and optimism.

Empathy refers to displays of understanding and sensitivity that help a person relate to the feelings of another. During motivational interviews, therapists create an open environment where clients feel safe to express emotions and attitudes.

Therapists also help clients recognize discrepancies between their current lifestyle and their future goals. By recognizing discrepancies, clients realize the consequences of their actions.

An honest and safe dialogue is created through understanding and empathy. To prevent hostility, therapists should avoid arguing with clients. Clients and therapists naturally take opposite sides of arguments. Instead of forming sides, therapists and clients need to work together.

Still, clients are often resistant to change. Therapists are taught to "roll with resistance." Instead of viewing resistance as defiance, therapists should view resistance as an indicator that the current approach isn't working. They should try a different line of questioning.

Finally, therapists should support a client's internal optimism. Many clients believe that they are incapable of changing. Through motivational interviews, therapists help them develop hope and faith about recovery.

RULE

In 2008, Miller and Rollnick simplified the principles of motivational interviewing so that they could be applied to other health care settings, such as primary care.

Resist the righting reflex

Understand the patient's motivations

Listen with empathy

Empower the patient

RULE is based on the same principles as motivational interviewing for patients with substance use disorders. Doctors and nurses should avoid telling patients about the "right" path to wellness without ensuring that patients are motivated to change. They should recognize motivations, use empathy and empower the patient to choose the right path.

Types of Motivational Interviewing Techniques

Helping clients find motivation for recovery is easier said than done. Therapists use a variety of techniques to elicit responses that change the ways that clients think about their ability to change.

Motivational interviewing techniques are based on patient-centered counseling strategies.

Asking open-ended questions

Listening reflectively

Summarizing

Affirming

Eliciting self-motivating statements

Open-ended questions enable two-way communication because their phrasing prevents clients from answering with a single word or phrase. The questions force the client to do the talking and help the therapist avoid making judging statements.

Why are you here today?

What do you think about going to rehab?

What do you like about drinking or using?

What makes you think you have a problem?

What worries you about substance abuse?

Why do you think you need to change?

How would you change?

When clients speak, therapists listen carefully. Then therapists issue reflective statements that show clients that they understood what the client meant. The reflective responses also elicit responses from the client.

Therapists can also affirm a client's difficulties to show that they understand the client's perspective. Affirming at the right time can build trust and support a client's belief in his or her ability to change. At the beginning or end of a session, therapists summarize earlier conversations to identify and promote their understanding of any discrepancies.

Throughout each session, therapists try to elicit self-motivational statements that help clients recognize that life can be better if they choose to change. These statements can be elicited through reflective statements, affirming statements and nonverbal cues.

Looking for the right therapy?

We have programs designed specifically for you.

Motivational Enhancement Therapy

Motivational interviewing is a broad therapeutic approach to helping clients overcome ambivalence toward change. Motivational enhancement therapy is a specific type of motivational interviewing that involves structured feedback and future planning.

Motivational enhancement therapy begins with an extensive assessment of the client's history of substance abuse and co-occurring mental health issues.

Session one

Discuss assessment results, problems with substance abuse, reasons for change and future plans. Identify and enhance motivations for change.

Session two

Enhance motivation and build commitment to change.

Sessions three and four

Reinforce motivations discussed in earlier sessions. Review progress, and reaffirm commitment to change.

The entire process can last multiple weeks. A client may engage in the first two motivational enhancement therapy sessions during the first two weeks of substance abuse treatment. The third and fourth sessions may be held near the middle and end of treatment.

Effectiveness of Motivational Interviewing

The National Institute on Drug Abuse and the Substance Abuse and Mental Health Services Administration recognize motivational interviewing and motivational enhancement therapy as effective approaches that assist with substance use disorder treatment.

A 1997 review of 11 clinical trials involving motivational interviewing concluded that the therapy appeared "to be an effective, efficient and adaptive therapeutic style" for problem drinkers and drug users. The review was published in the Journal of Substance Misuse.

No treatment

Standard treatment

Extended treatment

Being on a waiting list

Two studies that used authoritarian approaches did not find motivational interviewing to be effective.

Two studied problem drinkers who were given feedback about problem drinking but no additional treatment.

Three analyzed motivational interviewing as a complement to other treatments.

Five studied patients in general health settings who were receiving treatment for other health conditions.

A 2005 analysis of 72 randomized and controlled clinical trials that studied motivational interviewing for a variety of lifestyle problems found that motivational interviewing was more effective than "traditional advice giving." The review was published in The British Journal of General Practice.

Motivational interviewing is an important complement to traditional therapies for substance abuse and addiction. Without motivation for change, clients may be resistant to the lessons that rehab tries to teach. Motivated clients are more likely to buy into the rehab process and benefit from other therapies.

Medical Disclaimer: DrugRehab.com aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.

View Sources

Hall, K., Gibbie, T. & Lubman, D.I. (2012, September). Motivational interviewing techniques - facilitating behaviour change in the general practice setting. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22962639

Miller, W.R. et al. (1999). Motivational Enhancement Therapy Manual. Retrieved from https://casaa.unm.edu/download/met.pdf

National Institute on Drug Abuse. (2012, December). Motivational Enhancement Therapy (Alcohol, Marijuana, Nicotine). Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-2

Noonan, W.C. & Moyers, T.B. (1997). Motivational interviewing. Retrieved from http://www.tandfonline.com/doi/abs/10.3109/14659899709084610

Ruback, S. et al. (2005, April 1). Motivational interviewing: a systematic review and meta-analysis. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1463134/

SMART Recovery. (n.d.). Stages of Change. Retrieved from http://www.smartrecovery.org/resources/library/Articles_and_Essays/Stages_of_Change/Stages_of_Change.pdf

Stewart, E.E. & Fox, C. (2011, May-June). Encouraging Patients to Change Unhealthy Behaviors With Motivational Interviewing. Retrieved from http://www.aafp.org/fpm/2011/0500/p21.html

Substance Abuse and Mental Health Services Administration. (1999). Chapter 3-Motivational Interviewing as a Counseling Style. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK64964/

Substance Abuse and Mental Health Services Administration. (2013). Enhancing Motivation for Change in Substance Abuse Treatment. Retrieved from https://store.samhsa.gov/shin/content/SMA13-4212/SMA13-4212.pdf

U.S. Department of Veterans Affairs. (2015, December 18). Motivational Interviewing and Motivational Enhancement Therapy. Retrieved from https://www.mentalhealth.va.gov/substanceuse/met-sud.asp

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Motivational Interviewing for Substance Abuse

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Many people approach alcohol or drug rehab with pessimism. They may not think sobriety is realistic, or they may not be ready to quit drinking alcohol or using drugs. A part of them may know that substance abuse is ruining their life. But other factors prevent them from admitting that they need to change.

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I personally would find this a difficult case to take on because of the severity of the case. The client is very persistent and adamant about not giving up drinking. He recognizes that it is a problem that is negatively impacting his life but yet chooses to reject anyone who suggests he seek help to stop excessively drinking. I wouldn't even know where to begin.

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An added complexity to this case is also the suicidal ideation. Granted, the means is "drinking himself to death" which is something that will take much longer to complete than a more immediately lethal method such as shooting oneself or asphyxiation. This means that there is a greater window of opportunity to possibly reach him, treat him and reverse as much damage as can be feasibly and realistically done.

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Be patient

Be understanding

Be compassionate

Be empathetic

Be supportive

Be a source of accountability

Be a source of positive reinforcement

Be realistic

Be flexible

Just be there for them and remember that the person has a problem not the other way around (the person is the problem).

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“People with family histories of alcoholism tend to have lower levels of endorphins- the endogenous morphine that is responsible for many of our pleasure responses- than do people genetically disinclined to alcoholism. Alcohol will slightly raise the endorphin level of people without the genetic basis for alcoholism; it will dramatically raise the endorphin level of people with that genetic basis. Specialists spend a lot of time formulating exotic hypotheses to account for substance abuse. Most experts point out, strong motivations for avoiding drugs; but there are also strong motivations for taking them. People who claim not to understand why anyone would get addicted to drugs are usually people who haven't tried them or who are genetically fairly invulnerable to them.”
― Andrew Solomon, The Noonday Demon: An Atlas of Depression

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“Millions of deaths would not have happened if it weren’t for the consumption of alcohol. The same can be said about millions of births.”
― Mokokoma Mokhonoana

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There are three cultural factors that may exacerbate Sanderson's alcoholism:

Sanderson is white, which is among the demographic with the greatest number of individuals having alcohol use disorder(only preceded by Native Americans).

Sanderson is male, and males have higher rates of drinking and related disorders than females.

Sanderson works in the entertainment industry, where use of substances, including but not limited to alcohol, is simply part of the culture and almost can't be escaped.

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Pros:

Sanderson has isolated himself and pushed people away due to his alcoholism. Having a group of people who can understood his predicament and instill hope in him will be beneficial.

Sanderson longs for social connection, as evidenced by his relationship with Sera. Being a part of this self help group with people who will not judge him, but be there for him and support him would be helpful to his recovery.

Being able to hear stories of how others have overcome alcoholism and interacting with people in different stages of their journey an help combat the hopelessness that he feels.

Cons:

AA tends to promote an abstinence model, which may be an unrealistic model for Sanderson given his current state. A more harm reduction approach would be better suited for him.

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Supporting Articles for Effectiveness & Efficacy of AA:

Humphreys, K., Blodgett, J. C., & Wagner, T. H. (2014). Estimating the efficacy of Alcoholics Anonymous without self-selection bias: an instrumental variables re-analysis of randomized clinical trials. Alcoholism, Clinical and Experimental Research, 38(11), 2688–2694. https://doi-org.tcsedsystem.idm.oclc.org/10.1111/acer.12557

Kelly, J.F., Humphreys, K., Ferri, M. Alcoholics Anonymous and other 12‐step programs for alcohol use disorder. Cochrane Database of Systematic Reviews 2020, Issue 3. Art. No.: CD012880. DOI: 10.1002/14651858.CD012880.pub2.

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Demographic Info:
Benjamin Anderson

Middle Aged

White

Male

Heterosexual

Upper Class

Was employed as screenwriter, but recently lost job due to poor performance

Was married with one kid, but is now separated from wife and his child

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Presenting Problems:

Excessive alcohol consumption

Symptoms of withdrawal, including nausea, vomiting, hand tremor, sweating and psychomotor agitation

Suicidal ideation

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Level of Care:

Due to his severe withdrawal symptoms, it will be prudent to have Sanderson be medically detoxed to ensure safety and wellbeing.

Due to his current physical and mental state, as well as his suicidal ideations, Sanderson should be admitted for medically managed intensive inpatient services.

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How I overcame alcoholism | Claudia Christian | TEDxLondonBusinessSchool