evidence-based psychosocial treatment for alcohol dependence
TRANSCRIPT
![Page 1: Evidence-Based Psychosocial Treatment for Alcohol Dependence](https://reader034.vdocuments.site/reader034/viewer/2022050719/6256b1ff3018d57f245d4d8c/html5/thumbnails/1.jpg)
Evidence-Based Psychosocial
Treatment for Alcohol Dependence
William R. Miller, Ph.D. The University of New Mexico (USA)
![Page 2: Evidence-Based Psychosocial Treatment for Alcohol Dependence](https://reader034.vdocuments.site/reader034/viewer/2022050719/6256b1ff3018d57f245d4d8c/html5/thumbnails/2.jpg)
Mesa Grande
A Review of Evidence for the Efficacy of Alcohol Treatment Approaches
![Page 3: Evidence-Based Psychosocial Treatment for Alcohol Dependence](https://reader034.vdocuments.site/reader034/viewer/2022050719/6256b1ff3018d57f245d4d8c/html5/thumbnails/3.jpg)
Mesa Grande Review Project
• Conducted 1979-2003
• All controlled trials comparing an alcohol treatment with an alternative condition (control, other treatment, etc.)
• Each study was assigned:
➢A Methodological Quality Score (MQS) Range: 0-17
➢An Outcome Logic Score (OLS) for each interpretable treatment modality Range: +2 +1 -1 -2
• A Cumulative Evidence Score computed for each treatment
➢Range: +390 (strong positive) to -443 (strong negative evidence)
![Page 4: Evidence-Based Psychosocial Treatment for Alcohol Dependence](https://reader034.vdocuments.site/reader034/viewer/2022050719/6256b1ff3018d57f245d4d8c/html5/thumbnails/4.jpg)
Final Version
• 381 controlled trials
• 99 different treatment modalities
• Over 75,000 participants
Miller, W. R., & Wilbourne, P. L. (2002). Mesa Grande: A methodological analysis of clinical
trials of treatment for alcohol use disorders. Addiction, 97(3), 265-277.
Miller, W. R., Wilbourne, P. L., & Hettema, J. E. (2003). What works? A summary of alcohol
treatment outcome research. In R. K. Hester & W. R. Miller (Eds.), Handbook of alcoholism
treatment approaches: Effective alternatives (3rd ed., pp. 13-63). Boston: Allyn & Bacon.
![Page 5: Evidence-Based Psychosocial Treatment for Alcohol Dependence](https://reader034.vdocuments.site/reader034/viewer/2022050719/6256b1ff3018d57f245d4d8c/html5/thumbnails/5.jpg)
What Works?
![Page 6: Evidence-Based Psychosocial Treatment for Alcohol Dependence](https://reader034.vdocuments.site/reader034/viewer/2022050719/6256b1ff3018d57f245d4d8c/html5/thumbnails/6.jpg)
Most Effective Treatments
1. Brief intervention (FRAMES model)
2. Motivational interviewing
3. Community reinforcement approach
4. Self-help manuals (self-control training)
5. Behavioral self-control training
6. Contingency mangement
7. Behavioral coping skills training
8. Behavioral marital therapy44
57
64
85
110
110
189
390
0 100 200 300 400 500
Cumulative Evidence Score
![Page 7: Evidence-Based Psychosocial Treatment for Alcohol Dependence](https://reader034.vdocuments.site/reader034/viewer/2022050719/6256b1ff3018d57f245d4d8c/html5/thumbnails/7.jpg)
Least Effective Treatments
1. Alcoholism education
2. General counseling
3. Insight psychotherapy
4. Confrontation
5. Relaxation training
6. Video self-confrontation
7. Milieu therapy
8. Mandatory AA attendance
Cumulative Evidence Score
-94
-102
-108
-152
-183
-207
-284
-443
![Page 8: Evidence-Based Psychosocial Treatment for Alcohol Dependence](https://reader034.vdocuments.site/reader034/viewer/2022050719/6256b1ff3018d57f245d4d8c/html5/thumbnails/8.jpg)
What’s Changed Since 2003?
• Add to the list of effective treatments:
–12-Step Facilitation Therapy
–Mindfulness Meditation
• Stronger support for:
–Community Reinforcement + CRAFT
–Contingency Management
–Naltrexone
2019
![Page 9: Evidence-Based Psychosocial Treatment for Alcohol Dependence](https://reader034.vdocuments.site/reader034/viewer/2022050719/6256b1ff3018d57f245d4d8c/html5/thumbnails/9.jpg)
Themes in Effective Treatment Methods
1. Even brief intervention can make a difference
Don’t limit care to specialist settings
Screen for and address alcohol use in primary care
Don’t have waiting lists
![Page 10: Evidence-Based Psychosocial Treatment for Alcohol Dependence](https://reader034.vdocuments.site/reader034/viewer/2022050719/6256b1ff3018d57f245d4d8c/html5/thumbnails/10.jpg)
Themes in Effective Treatment Methods
1. Even brief intervention can make a difference
2. Be empathic rather than confrontational
Therapists have a large effect on client outcomes
It matters what you do, and how you do it
Accurate empathy is learnable
![Page 11: Evidence-Based Psychosocial Treatment for Alcohol Dependence](https://reader034.vdocuments.site/reader034/viewer/2022050719/6256b1ff3018d57f245d4d8c/html5/thumbnails/11.jpg)
Themes in Effective Treatment Methods
1. Even brief intervention can make a difference
2. Be empathic rather than confrontational
3. Enhance clients’ own motivation for change
Motivational interviewing in treatment
Contingency management
Working with family (CRAFT)
![Page 12: Evidence-Based Psychosocial Treatment for Alcohol Dependence](https://reader034.vdocuments.site/reader034/viewer/2022050719/6256b1ff3018d57f245d4d8c/html5/thumbnails/12.jpg)
Themes in Effective Treatment Methods
1. Even brief intervention can make a difference
2. Be empathic rather than confrontational
3. Enhance clients’ own motivation for change
4. Focus on making sober life better than drinking
Community Reinforcement Approach
![Page 13: Evidence-Based Psychosocial Treatment for Alcohol Dependence](https://reader034.vdocuments.site/reader034/viewer/2022050719/6256b1ff3018d57f245d4d8c/html5/thumbnails/13.jpg)
Themes in Effective Treatment Methods
1. Even brief intervention can make a difference
2. Be empathic rather than confrontational
3. Enhance clients’ own motivation for change
4. Focus on making sober life better than drinking
5. Empowerment: Strengthen coping skills
Coping with craving
Mood management
Relationship skills / marital therapy
Self-help materials
The Comtined Behavioral Intervention manual is available free online:https://web.3rdmil.com/assets/guides/research/Miller%20%20Combined%20Behavioral%20Intervention%20Thearpist%20Manual.pdf
![Page 14: Evidence-Based Psychosocial Treatment for Alcohol Dependence](https://reader034.vdocuments.site/reader034/viewer/2022050719/6256b1ff3018d57f245d4d8c/html5/thumbnails/14.jpg)
Themes in Effective Treatment Methods
1. Even brief intervention can make a difference
2. Be empathic rather than confrontational
3. Enhance clients’ own motivation for change
4. Focus on making sober life better than drinking
5. Empowerment: Strengthen coping skills
6. Have shared goals and plans for reaching them
![Page 15: Evidence-Based Psychosocial Treatment for Alcohol Dependence](https://reader034.vdocuments.site/reader034/viewer/2022050719/6256b1ff3018d57f245d4d8c/html5/thumbnails/15.jpg)
Themes in Effective Treatment Methods
1. Even brief intervention can make a difference
2. Be empathic rather than confrontational
3. Enhance clients’ own motivation for change
4. Focus on making sober life better than drinking
5. Empowerment: Strengthen coping skills
6. Have shared goals and plans for reaching them
7. Attend to social support system
Include significant others in treatment
12-Step Facilitation & mutual support groups
Community Reinforcement & Family Training (CRAFT)
![Page 16: Evidence-Based Psychosocial Treatment for Alcohol Dependence](https://reader034.vdocuments.site/reader034/viewer/2022050719/6256b1ff3018d57f245d4d8c/html5/thumbnails/16.jpg)
130 concerned significant others randomly assigned to one of 3 interventions
All 12 hours of contact:
• Al-Anon Facilitation Therapy (AFT)
• Johnson Institute Intervention (JII)
• Community Reinforcement (CRAFT)
![Page 17: Evidence-Based Psychosocial Treatment for Alcohol Dependence](https://reader034.vdocuments.site/reader034/viewer/2022050719/6256b1ff3018d57f245d4d8c/html5/thumbnails/17.jpg)
CRAFT
• Up to 12 sessions of unilateral family therapy
• Empowerment to influence change
• Training in behavior change skills
• Improvement of family life quality
• Preparation for treatment engagement
![Page 18: Evidence-Based Psychosocial Treatment for Alcohol Dependence](https://reader034.vdocuments.site/reader034/viewer/2022050719/6256b1ff3018d57f245d4d8c/html5/thumbnails/18.jpg)
Treatment Engagement Rates
13,6
22,5
64,4
0
10
20
30
40
50
60
70
p<.0001
Al-Anon Johnson CRAFT
Average time to treatment entry: 47 days
![Page 19: Evidence-Based Psychosocial Treatment for Alcohol Dependence](https://reader034.vdocuments.site/reader034/viewer/2022050719/6256b1ff3018d57f245d4d8c/html5/thumbnails/19.jpg)
Themes in Effective Treatment Methods
1. Even brief intervention can make a difference
2. Be empathic rather than confrontational
3. Enhance clients’ own motivation for change
4. Focus on making sober life better than drinking
5. Empowerment: Strengthen coping skills
6. Have shared goals and plans for reaching them
7. Attend to social support system
8. Address concomitant medical/psychosocial problems
Integrated behavioral health treatment
Case Management
![Page 20: Evidence-Based Psychosocial Treatment for Alcohol Dependence](https://reader034.vdocuments.site/reader034/viewer/2022050719/6256b1ff3018d57f245d4d8c/html5/thumbnails/20.jpg)
Treating Alcohol Problems in Healthcareand Social Service Systems
• People with alcohol problems are already there
• High prevalence
• High impact on other health outcomes
• Potential for earlier intervention
• Efficacy of brief interventions
• Effective pharmacotherapies
• Decrease in stigma
• Blending of prevention and treatment
![Page 21: Evidence-Based Psychosocial Treatment for Alcohol Dependence](https://reader034.vdocuments.site/reader034/viewer/2022050719/6256b1ff3018d57f245d4d8c/html5/thumbnails/21.jpg)
Three Models for Intervention in Healthcare Systems
• 1. Refer out to specialist treatment
• 2. Management by primary care provider
• 3. Integrated care: On-site behavioral health specialists
![Page 22: Evidence-Based Psychosocial Treatment for Alcohol Dependence](https://reader034.vdocuments.site/reader034/viewer/2022050719/6256b1ff3018d57f245d4d8c/html5/thumbnails/22.jpg)