- Section 1 The Subject Matter of and Approach to Psychiatry
- 1.3 Psychiatry as a worldwide public health problem
- 1.4 The history of psychiatry as a medical specialty
- 1.5 Ethics and values
- 1.6 The psychiatrist as a manager
- 1.7 Descriptive phenomenology
- 1.8 Assessment
- 1.9 Diagnosis and classification
- 1.10 From science to practice
- Section 2 The Scientific Basis of Psychiatric Aetiology
- 2.3 The contribution of neurosciences
- 2.4 The contribution of genetics
- 2.5 The contribution of psychological science
- 2.6 The contribution of social sciences
- 2.7 The contribution of epidemiology to psychiatric aetiology
- Section 3 Psychodynamic Contributions to Psychiatry
- Section 4 Clinical Syndromes of Adult Psychiatry
- 4.1 Delirium, dementia, amnesia, and other cognitive disorders
- 4.2 Substance use disorders
- 4.2.1 Pharmacological and psychological aspects of drugs abuse
- 4.2.2 Alcohol use disorders
- 4.2.2.1 Aetiology of alcohol problems
- 4.2.2.2 Alcohol dependence and alcohol problems
- 4.2.2.3 Alcohol and psychiatric and physical disorders
- 4.2.2.4 Treatment of alcohol dependence
- 4.2.2.5 Services for alcohol use disorders
- 4.2.2.6 Prevention of alcohol-related problems
- 4.2.3 Other substance use disorders
- 4.2.4 Assessing need and organizing services for drug misuse problems
- 4.3 Schizophrenia and acute transient psychotic disorders
- 4.3.6 Aetiology
- 4.3.7 Course and outcome of schizophrenia and their prediction
- 4.3.8 Treatment and management of schizophrenia
- 4.3.9 Schizoaffective and schizotypal disorders
- 4.3.10 Acute and transient psychotic disorders
- 4.4 Persistent delusional symptoms and disorders
- 4.5 Mood disorders
- 4.6 Stress-related and adjustment disorders
- 4.7 Anxiety disorders
- Section 5 Psychiatry and Medicine
- Section 6 Treatment Methods in Psychiatry
- 6.2 Somatic treatments
- Section 7 Social Psychiatry and Service Provision
- Section 8 The Psychiatry of Old Age
- Section 9 Child and Adolescent Psychiatry
Treatment of alcohol dependence
- Chapter:
- Treatment of alcohol dependence
- Author(s):
Jonathan Chick
- DOI:
- 10.1093/med/9780199696758.003.0059
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.
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- Section 1 The Subject Matter of and Approach to Psychiatry
- 1.3 Psychiatry as a worldwide public health problem
- 1.4 The history of psychiatry as a medical specialty
- 1.5 Ethics and values
- 1.6 The psychiatrist as a manager
- 1.7 Descriptive phenomenology
- 1.8 Assessment
- 1.9 Diagnosis and classification
- 1.10 From science to practice
- Section 2 The Scientific Basis of Psychiatric Aetiology
- 2.3 The contribution of neurosciences
- 2.4 The contribution of genetics
- 2.5 The contribution of psychological science
- 2.6 The contribution of social sciences
- 2.7 The contribution of epidemiology to psychiatric aetiology
- Section 3 Psychodynamic Contributions to Psychiatry
- Section 4 Clinical Syndromes of Adult Psychiatry
- 4.1 Delirium, dementia, amnesia, and other cognitive disorders
- 4.2 Substance use disorders
- 4.2.1 Pharmacological and psychological aspects of drugs abuse
- 4.2.2 Alcohol use disorders
- 4.2.2.1 Aetiology of alcohol problems
- 4.2.2.2 Alcohol dependence and alcohol problems
- 4.2.2.3 Alcohol and psychiatric and physical disorders
- 4.2.2.4 Treatment of alcohol dependence
- 4.2.2.5 Services for alcohol use disorders
- 4.2.2.6 Prevention of alcohol-related problems
- 4.2.3 Other substance use disorders
- 4.2.4 Assessing need and organizing services for drug misuse problems
- 4.3 Schizophrenia and acute transient psychotic disorders
- 4.3.6 Aetiology
- 4.3.7 Course and outcome of schizophrenia and their prediction
- 4.3.8 Treatment and management of schizophrenia
- 4.3.9 Schizoaffective and schizotypal disorders
- 4.3.10 Acute and transient psychotic disorders
- 4.4 Persistent delusional symptoms and disorders
- 4.5 Mood disorders
- 4.6 Stress-related and adjustment disorders
- 4.7 Anxiety disorders
- Section 5 Psychiatry and Medicine
- Section 6 Treatment Methods in Psychiatry
- 6.2 Somatic treatments
- Section 7 Social Psychiatry and Service Provision
- Section 8 The Psychiatry of Old Age
- Section 9 Child and Adolescent Psychiatry