Interventions For Alcohol Use Disorder In Patients With Chronic Liver Diseases And Adolescents

Alcohol Related Illness

Concordance between DSM-5 and ICD-10 criteria in alcohol use disorder

Question:

Discuss about the Alcohol Related Illness-An overview on their intervention techniques.

Addictions are the conditions faced by the individuals those results when the individual consumes any form of substance like alcohol, drugs, cocaine or nicotine to get pleasure. The continuation of these sorts of activities results in the compulsion of the behaviour and it interferes with the ordinary responsibilities of the individuals such as work, concerns for family, relationships and health (Terry & Zabara, 2015). The word Addiction can be used in several ways. It generally defines the physical aspects of addictions.

While alcohol use disorder criteria of the DSM-5 and the ICD-10 demonstrate a high level of concordance in patients with very severe alcohol use disorder and in those that would not receive a diagnosis, these criteria exhibit important differences for patients with mild or moderate alcohol use disorder, according to recent findings. The researchers found a high level of concordance between the two diagnostic approaches in patients with severe alcohol use disorder and those that did not receive a diagnosis. Almost all (99.4%) of those diagnosed with an alcohol use disorder under the DSM would get an ICD alcohol dependence diagnosis. In addition, 65% of those with a moderate DSM-5 diagnosis and nearly 10% of those with a mild diagnosis would be diagnosed with dependence based on the clinical ICD-10 criteria. Similarly, a substantial percentage (96.4%) of patients who did not receive a DSM-5 diagnosis would not be diagnosed under the ICD-10.

Alcohol abuse directs to the unhealthy habits of drinking as one of the dangerous habits of regular drinking in a good amount. The abuse to alcohol can degrade the interpersonal relationships, can also cause to miss the works and lead to some legal problems that include drink and drive (Terry & Zabara, 2015). The addictive form of drinking alcohol starts when the individual cannot stop their consumption of alcohol, after knowing that their consumption can degrade their health. The continuous consumptions of alcohol can lead to form the dependence of alcohol (Terry & Zabara, 2015). The other name for alcohol dependency means the abuse of alcohol. The individual always have the urge to drink. The individuals are mentally and physically dependent to alcohol (Galanter, Kleber & Brady, 2014). The major problems that arises due to the excessive drinking includes, uncontrollable drinking even in social gatherings, the individual becomes immune to drinking and to get the same effects the individual needs to consume alcohol in much more amount (Galanter, Kleber & Brady, 2014). However, when the individuals tries to stop drinking their withdrawal symptoms arises that causes the stomachs, fever, sweating, shakiness and anxiety (Galanter, Kleber & Brady, 2014).  Therefore, Alcoholism is a long-term chronic disease. Sometimes, it can be misunderstood as an individual’s lack of will or their weakness. Like any other disease, it also has certain symptoms that can predict the onset of the disease, have its clinical criteria and the genes of their situations in life influence them.

Signs and symptoms of alcoholism

In today’s lifestyle, Alcohol has become a part of the several people’s lives and they have their places in the culture and traditions of the family. Sometimes, it becomes very difficult to know that when the individual is starting to drink in a huge amount.

Some of the major signs of alcoholism includes, drinking alcohol in the morning and continuing to drink for a long period; changing of the drinks due to lower the efficiency to drink more or clubbing the several forms of drinks together. It also includes the feeling of immense guilt due to continuous drinking; making several excuses to hide their drinking habits; having blackouts or completely forgetting about the behaviors that are performed when the individual was drunk and worrying about the source of alcohol (Galanter, Kleber & Brady, 2014).

The essay illustrates the several Literature reviews on the interventions used to control the addiction problems in the population of Singapore. The target group taken for the review is the teenagers, adolescents and the middle-aged men of Singapore. 

Firstly, the essay talks about the importance of the psychosocial interventions in inducing and maintaining the alcohol abstinence in the patients with severe liver disease in the middle aged adults. The aim of the research is reviewing the efficiency of the psychosocial interventions that are to be induced for maintaining the alcohol dependency of the patients with chronic liver diseases. In the study, 13 eligible studies that comprised of 1945 patients were taken out of which five were selected based on the controlled trials that were randomized (Hogue et al. 2015). The therapies that were delivered to the addicted patients included the motivational enhancement therapy, cognitive behavioral therapy, supportive therapy and psycho education either alone or in the combination of the interventions groups and the general health of education or the treatments as the usual in the control groups. It was observed that only the therapy that were integrated which combined CBT and MET with proper medical care were delivered over two years produced a significant amount of increase in the abstinence (Hogue et al. 2015).

The theoretical heritage of the cognitive behavioral intervention for alcohol treatments have been derived from the approach of social learning theory approach for the better understanding of the human behavior that are more recently referred to the social cognitive theory. Based on the empirical studies, the approach of the social cognitive approach has been evolved in psychology that are derived from the earlier theories of behaviour however, it departs from the approach of the behaviour of the individuals by incorporating the principles of the social cognition, reciprocal determinism, observational learning and self regulation. The cognitive behavioral therapy is based on these theories where the patients are treating by regulating their behaviour. The self-regulation of the addicted individuals acts as a key role for improving their addiction prone behaviors. The observational learning also plays a vital role here. The addiction of alcohol can arise due to observational learning. The peer pressure and the external environment create an extreme pressure on the individuals for indulging themselves into addiction. However, the observational learning also helps the addicted individuals to get rid of their addiction by observing others having normal and healthy life who are not into the addiction.  

Efficiency of psychosocial interventions for alcohol dependency in patients with chronic liver disease

In the above systematic analysis of studying the interventions for inducing the alcohol assistance in the patients with chronic liver disorder and alcoholism, integrated the combinations of therapy that included CBT and MET increased the alcohol assistance in the patients (Hogue et al. 2015). Therefore, it was analyzed that CBT was successful in the maintenance of the abstinences in patients.

Secondly, the essay talks about the cognitive-behavioral therapy for prevalence of alcohol addiction disorders in teenagers. The cognitive behavior therapies (CBT) for treating the alcohol addiction are to be demonstrated with efficacy for both the immunotherapy as the part of the combinations of the strategies for treatment (Kissin, 2013). The current article provides the review of the evidences that are supported by the use of CBT, the clinical elements of its applications, the treatment levels that are novel for implementing the strategies for the improvement of the responses of the treatment and the dissemination of the efforts. However, the use of CBT as a treatment for the substance abuse are characterized for the elements of the heterogeneous treatments that includes the operant learning strategies, interventions of the skill buildings and the motivational and cognitive elements (Kissin, 2013).

Thirdly, the essay reviews the evidences that are based on psychosocial interventions in alcohol abuse in adolescents. A literature review has been undertaken by using several electronic forms of databases. The overall psychological interventions are found to be very effective. Some of the interventions included the behavior therapy, relapse preventions and the motivational interviewing, appears to be the effective across the several abuse to drugs. The psychological treatments are found more effectual when they are given substitute prescribing than when the medication or psychological treatment is used alone, particularly in case of the opiate users (Litt et al. 2016). The practices that are evidence based are on the treatments that needed to be expanded and should include the researches that on an optimal combinations of the psychological therapies that have any particular matching effects (Litt et al. 2016). The psychological form of interventions are the major parts of the treatment routine and effective efforts should be taken for integrating the interventions that are based on evidences are implemented for the treatment programs for the alcohol dependent population.

Fourthly, the essay talks about the cognitive behavioral therapy that are given to the alcohol-dependent domestic violence offenders among the middle-aged population. A pilot study have evaluated the ability of the twelve-session form of the cognitive behavioral therapy for the males those who are dependent on alcohol with the co occurring of the violence that are interpersonal in nature. Eighty-five males were alcohol dependent, arrested in for the domestic and violence in the past one year. The seventy-eight adults who were males were randomized in either a cognitive behavioral substance abuse domestic violence where the SADV has N = 40 and the 12 step facilitation has N= 38. There were no significant differences found between the two groups with respect to the number of sessions of therapy the particular groups have attended. Regarding the use of substances there has been no connection with the physical violence that was seen in one of the groups. Therefore the data suggested that the promise of the alcohol dependent violence performed males are with the history of IPV are liable to take the treatments of the substance abuse (Southam-Gerow et al. 2016).

Theoretical heritage of cognitive-behavioral interventions in alcohol treatments

Fifthly, the essay illustrates the efficacy of family therapy for the drug abuse and alcoholism in adolescents. The abuse of drugs is an enormous problem of the public health with the consequences that are not only generalized for the individuals who have used drugs but also their families, society and the communities. Although the research evidences and the clinical experiences agree that, the drug abuses are the major problem that needs to be treated (Rohde et al. 2015). Despite the considerable research on the connections of the drug abuse and the family factors are the few forms of the controlled efficacy studies that have been conducted (Rohde et al. 2015). The article presents the critical analysis of the of the controlled form of the treatments that are that can outcome the research in the areas of the family therapy for the abuse of the drug in both the adults and the adolescents. The number of studies from the clinical researches of the group demonstrates the different versions of the family interventions that can be used in the different family interventions and can be engaged in retaining the drug users and the other problems that are related to the behaviors and for the enhancements of the particular domains of the pro social functioning. In addition, the smaller number of the comparative efficacy studies that have been shown in the family oriented therapy more the effective than the therapies that are not directed to the families. The family therapies are the adolescent drug abusers is the more developed than the family therapies of the adult drug abusers (Rohde et al. 2015). Moreover, the consequences of the reviewed studies are promising; a blanket confirmation of efficacy of the family therapy cannot be made at the time, as there is a relatively small amount of the noted methodological limitations of the studies that are published up to date. However, the substantial progress in the clinical area of research that has occurred if the research and the funding support that can continue or expand with the significant form of breakthroughs in the interventions of the drug abuses that are using the family based treatments that are possible (Schaub et al. 2014).

The treatments for alcohol abuse and their treatments (family therapy) are very distinct in their concepts and histories, professional organizations, preferred intervention techniques, and focuses of treatment. The therapies are based on the various psychological theories as it has been discussed above. The clients after attending their clinical sessions, needs to be satisfied with their treatments. The alcohol-addicted individuals cannot be treated in few days. They also cannot be treated through any antibiotics courses. They need to modify their behavior. Alcoholism is a kind of bad behavior, which the individuals tend to adapt due to external pressures from the external environment. Therefore, through the various psychological therapies the individual needs to adapt themselves through the process of learning that how they could lead their lives without addiction. The licensed clinicians should be able to understand the needs of their clients and give them proper guidance to overcome their problems.  These differences in the approach of therapy have been significantly giving good effects on how the practitioners approaches the clients, understand their problems, and takes the concerned steps to treat them.

Evidences on psychosocial interventions in alcohol abuse in adolescents

Despite of the variations, the providers from both the approaches will continue for treating the same clients. Therefore, for the clinicians in each approach should be aware of the treatments to draw the knowledge to improve the prospects of the professional collaboration (Schaub et al. 2014).With the increased knowledge in the fields of professional family therapy the occurrences of alcohol and substance abuse can be decreased. Further, within each discipline, theory and practice differ. Although of the two, substance abuse treatment is generally uniform in its approach, in both cases certain generalizations apply to the practice of the majority of providers. Therefore, the above essay concludes the severe form of alcohol dependency can be reduced through the above-mentioned intervention techniques.

References

Carroll, K. M., Kiluk, B. D., Nich, C., Gordon, M. A., Portnoy, G. A., Marino, D. R., & Ball, S. A. (2014). Computer-assisted delivery of cognitive-behavioral therapy: efficacy and durability of CBT4CBT among cocaine-dependent individuals maintained on methadone. American journal of Psychiatry, 171(4), 436-444.

Galanter, M., Kleber, H. D., & Brady, K. (Eds.). (2014). The American Psychiatric Publishing textbook of substance abuse treatment. American Psychiatric Pub.

García?García, I., Horstmann, A., Jurado, M. A., Garolera, M., Chaudhry, S. J., Margulies, D. S., … & Neumann, J. (2014). Reward processing in obesity, substance addiction and non?substance addiction. obesity reviews, 15(11), 853-869.

Hogue, A., Dauber, S., Henderson, C. E., Bobek, M., Johnson, C., Lichvar, E., & Morgenstern, J. (2015). Randomized trial of family therapy versus nonfamily treatment for adolescent behavior problems in usual care. Journal of Clinical Child & Adolescent Psychology, 44(6), 954-969.

Kissin, B. (Ed.). (2013). The Biology of Alcoholism: Volume 1: Biochemistry. Springer Science & Business Media.

Kissler, J. L., Sirohi, S., Reis, D. J., Jansen, H. T., Quock, R. M., Smith, D. G., & Walker, B. M. (2014). The one-two punch of alcoholism: role of central amygdala dynorphins/kappa-opioid receptors. Biological psychiatry, 75(10), 774-782.

Liddle, H. A. (2016). Multidimensional family therapy: evidence base for transdiagnostic treatment outcomes, change mechanisms, and implementation in community settings. Family process, 55(3), 558-576.

Litt, M. D., Kadden, R. M., Tennen, H., & Kabela-Cormier, E. (2016). Network Support II: Randomized controlled trial of Network Support treatment and cognitive behavioral therapy for alcohol use disorder. Drug and alcohol dependence, 165, 203-212.

Litten, R. Z., Ryan, M. L., Falk, D. E., Reilly, M., Fertig, J. B., & Koob, G. F. (2015). Heterogeneity of alcohol use disorder: understanding mechanisms to advance personalized treatment. Alcoholism: Clinical and Experimental Research, 39(4), 579-584.

Mann, K., Lemenager, T., Hoffmann, S., Reinhard, I., Hermann, D., Batra, A., … & Zimmermann, U. S. (2013). Results of a double?blind, placebo?controlled pharmacotherapy trial in alcoholism conducted in Germany and comparison with the US COMBINE study. Addiction biology, 18(6), 937-946.

Rohde, P., Waldron, H. B., Turner, C. W., Brody, J., & Jorgensen, J. (2014). Sequenced versus coordinated treatment for adolescents with comorbid depressive and substance use disorders. Journal of consulting and clinical psychology, 82(2), 342.

Schaub, M. P., Henderson, C. E., Pelc, I., Tossmann, P., Phan, O., Hendriks, V., … & Rigter, H. (2014). Multidimensional family therapy decreases the rate of externalising behavioural disorder symptoms in cannabis abusing adolescents: outcomes of the INCANT trial. BMC psychiatry, 14(1), 26.

Smith, J. L., Mattick, R. P., Jamadar, S. D., & Iredale, J. M. (2014). Deficits in behavioural inhibition in substance abuse and addiction: a meta-analysis. Drug and alcohol dependence, 145, 1-33.

Southam-Gerow, M. A., McLeod, B. D., Arnold, C. C., Rodríguez, A., Cox, J. R., Reise, S. P., … & Kendall, P. C. (2016). Initial development of a treatment adherence measure for cognitive–behavioral therapy for child anxiety. Psychological assessment, 28(1), 70.

Stavro, K., Pelletier, J., & Potvin, S. (2013). Widespread and sustained cognitive deficits in alcoholism: a meta?analysis. Addiction biology, 18(2), 203-213.

Tanner-Smith, E. E., Wilson, S. J., & Lipsey, M. W. (2013). The comparative effectiveness of outpatient treatment for adolescent substance abuse: A meta-analysis. Journal of substance abuse treatment, 44(2), 145-158.

Terry Jr, R. S., & Zabara, J. (2015). U.S. Patent No. 9,216,290. Washington, DC: U.S. Patent and Trademark Office.

Weisz, J. R., Kuppens, S., Ng, M. Y., Eckshtain, D., Ugueto, A. M., Vaughn-Coaxum, R., … & Weersing, V. R. (2017). What five decades of research tells us about the effects of youth psychological therapy: A multilevel meta-analysis and implications for science and practice.