Alcoholism - Therapy

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy (CBT) uses a structured teaching approach and may be better than AA for people with severe alcoholism. Patients are given instruction and homework assignments intended to improve their ability to cope with basic living situations, control their behavior, and change the way they think about drinking. The following are examples of approaches:

Patients might write a history of their drinking experiences and describe what they consider to be risky situations.
They are then assigned activities to help them cope when exposed to "cues" (places or circumstances that trigger their desire to drink).
Patients may also be given tasks that are designed to replace drinking. An interesting and successful example of such a program was one that enlisted patients in a softball team; this gave them the opportunity to practice coping skills, develop supportive relationships, and engage in healthy alternative activities.

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CBT may be especially effective when used in combination with opioid antagonists, such as naltrexone. CBT that addresses alcoholism and depression also may be an important treatment for patients with both conditions. Interestingly, however, in one study patients with alcoholism and social phobias had a poorer outcome with a CBT program that addressed both problems.

Motivational Interviewing

A technique known as motivational interviewing is aimed at motivating people with alcoholism to change their own behavior. Studies suggest that it is very helpful in encouraging people to quit, even including those with mental illnesses. With this technique, the therapist uses empathy and a nonargumentative approach to encourage patients to make their own changes and to solve their own problems.

Behavioral Therapies for Partners

Partners of people with alcoholism can also benefit greatly from behavioral approaches that help them cope with their mate. Of note, children of an alcoholic mother or father may do better if both parents participate in couples-based therapy, rather than just treating the parent with alcoholism.

Treating Sleep Disturbances

Nearly all patients who are alcohol dependent suffer from insomnia and sleep problems, which can last months to years after abstinence. Sleep disturbances may even be important factors in relapse. Available therapies include sleep hygiene, bright light therapy, meditation, relaxation methods, and other nondrug approaches. Many medications for inducing sleep are not recommended in people with alcoholism. [For more information, see In-Depth Report #27: Insomnia.]

Alternative Methods

Some people try alternative methods, such as acupuncture or hypnosis. Such approaches are not harmful. In one study acupuncture reduced the desire for alcohol in nearly half of people, although it was not significantly more helpful than conventional treatments.