1.6.1 What works in helping people to stop or reduce their alcohol intake?
There is at the moment no known cure for alcoholism. Both psychological and drug treatments are used in treating excessive alcohol intake (Buonopane and Petrakis, 2005). The plethora of different types of treatment in itself may indicate that there are no guaranteed results, and the condition remains hard to resolve.
Throughout England a mapping exercise (Alcohol Concern, 2002) estimated that there were over 300 advice and counselling services, 100 day programmes and nearly 200 residential programmes specifically established to treat alcohol addiction. The range of treatments available at these centres is very diverse and can be baffling to people seeking help. Many of the non-drug-related forms of support have not been subjected to clinical trials that would be able to demonstrate whether or not they are effective. This is not to say that the therapies and supportive interventions do not work, but just that it is difficult to demonstrate their effectiveness in an objective ‘scientific’ way.
A proportion of people with alcohol dependency are able to stop using alcohol without the assistance of outside agencies or formal types of help (Klingemann and Sobell, 2001). For Rachael the shock of the realisation that she was harming her own health might be sufficient for her to resolve to make this major change to her behaviour (Vignette 2).
Vignette 2 Rachael needs treatment
When she was first given the diagnosis of ‘alcoholic fatty liver’, Rachael was determined to find out as much as she could about this condition. After several sessions on the internet and following a further consultation with her own doctor she was able to find out the following information:
Fatty liver always occurs if alcohol consumption exceeds 100 ml of ethanol each day (just over a bottle of wine). (Rachael was drinking three-quarters of a bottle of spirits, about twice this amount).
The condition is usually reversible if no more alcohol is consumed.
The condition may progress to cirrhosis and possibly liver failure if the person continues to drink alcohol (Teli et al., 1995).
For many people, indeed for Rachael herself, the use of alcohol is firmly embedded into social structures that are hard to dislodge. If Rachael stopped drinking how would she relieve the stresses and strains of her life? How could she remain at the core of her organisation when so much ‘business’ is conducted by her peers in the bar? If Rachael doesn't stop drinking, what might happen?
Research studies that have compared groups of problem drinkers with those in treatment have found that amongst the people not receiving recognised forms of treatment a proportion modify their own drinking habits. A major study in the USA (Weisner et al., 2003), found that 12 per cent of the problem drinkers followed up as a ‘control group’ and who had received no formal counselling or psychological help, reported that they were still abstinent of alcohol after 12 months, but this is much less than the 57 per cent under formal treatment who were not using alcohol after 12 months.
If stopping drinking alcohol is difficult in the short term, it becomes even more difficult for people to remain abstinent in the longer term. Many people with dependency on alcohol seem to go through several cycles that include periods of controlled drinking or abstinence, followed by problem drinking that leads to further treatment episodes and so on through their lives. Research in Germany (Mann et al., 2005) followed 96 problem drinkers over 16 years, and confirmed that people drift in and out of problem drinking over many years. Indeed only 22 per cent reported abstinence for the entire 16 years.
Research findings collected from a large number of trials have also indicated which people can be predicted to have the best outcomes from various types of treatment for their problem drinking (Weisner et al., 2003):
Women seem to do better than men, although they often enter treatment later than men and may have more associated mental health problems.
Although some young people ‘mature’ out of their problem drinking behaviour, in general very young people entering treatment have a worse outcome than more mature people.
Lower socio-economic status is associated with less improvement over time.
The worse the problem drinking at the start of treatment and the presence of psychiatric problems, the poorer the outlook for the success of treatment.
Networks and family support can be important predictors of the outcome of treatment. If the person's family and friends are also involved in addictive types of behaviour, the chances of successful treatment are poorer. However, the presence of a supportive family environment is associated with improved chances of successful treatment (Copello et al., 2005).