Contents

Disclaimer

Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding.

Show Summary Details
Page of

Treatment of alcohol dependence 

Treatment of alcohol dependence
Chapter:
Treatment of alcohol dependence
Author(s):

Jonathan Chick

DOI:
10.1093/med/9780199696758.003.0059
Page of

PRINTED FROM OXFORD MEDICINE ONLINE (www.oxfordmedicine.com). © Oxford University Press, 2021. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy and Legal Notice).

date: 24 July 2021

Some people repeatedly put themselves or others at risk by drinking. One view is that such people could drink sensibly if they were more considerate and used more will power. Another increasingly accepted view is that many such individuals are in a state, existing in degrees of severity, in which the freedom to decide whether to change their drinking, and to adhere to that decision, is reduced compared with other drinkers. This state partly depends on perceived pay-offs for changing, and on acquired dispositions, which are less accessible to conscious control. Such persons become aware of a wish, or urge, to drink, which overcomes rational thought. They may then make up an explanation, for example, ‘No wonder I feel like a drink, I've had a hard day’. Such individuals benefit from help to unlearn those patterns, and to learn different approaches to problems. Discussion, care, and encouragement from others can bolster their will to do so. Assistance to set-up controls within or from outside themselves may help. Some people can do this without external help, and others with the help of Alcoholics Anonymous (AA) alone. This approach argues that dependence on alcohol should be managed like other relapsing disorders, such as diabetes and asthma, by using long-term monitoring coupled with intermittent or continuous treatment. Research into alcoholism spanning 50 years has shown that the attitudes of the agency and the therapist influence patients’ outcome, as they may do for many illnesses. The therapeutic alliance is a strong predictor of outcome in the treatment of alcohol dependence. However, agencies must also be prepared to set limits on drunken behaviour at the clinic and telephone calls when intoxicated. And for patients who repeatedly relapse, resumption of treatment should sometimes be made conditional on complying with a new treatment plan, such as supervision of medication. Showing respect, enhancing dignity, conveying accurate empathy, adopting objective and not moral criteria, involving the family, and reducing hurdles to seeking help have been shown to improve compliance, and often outcome, for alcohol dependence.

Access to the complete content on Oxford Medicine Online requires a subscription or purchase. Public users are able to search the site and view the abstracts for each book and chapter without a subscription.

Please subscribe or login to access full text content.

If you have purchased a print title that contains an access token, please see the token for information about how to register your code.

For questions on access or troubleshooting, please check our FAQs, and if you can't find the answer there, please contact us.