CONTENTS

About This Course

Table of Contents

1. Introduction to the Issues
2. Understanding Alcohol Abuse
3. Understanding Violence Against Women
4. Alcohol and Domestic Violence
5. Alcohol, Sexual Assault, and Rape
6. Prevention and Early Intervention
7. Screening and Assessment
8. Diagnosis and Treatment
9. Legal and Ethical Issues

Supplements
Fact Sheets
Videos
Resources

Silence Hurts
Alcohol Abuse and Violence Against Women

Module Content Objectives Introduction Definitions of Treatment Goals of Treatment: Alcohol Abuse Effectiveness of Alcohol Abuse Treatment -- Diagnosis-Driven Treatment (Alcohol Abuse) -- DSM-IV In Clinical Diagnosis Medical and Psychological Profile of Alcohol Use Levels of Treatment Services Theoretical Approaches: Alcohol Treatment Treatment Modalities Goals of Treatment: Domestic Violence and Sexual Assault Theoretical Approaches to Treatment: Domestic Violence and Sexual Assault Treatment for Women Theoretical Approaches to Treatment: Batterer's Programs Treatment for Men Community Services Summary of Module References Module 8 Quiz

Theoretical Approaches: Alcohol Treatment

Every facility designs their programs based on theoretical approaches accepted in the field. Some of the most widely used include:

• Cognitive-Behavioral and Cognitive-Behavioral Coping-Skills Therapy
• Motivational Enhancement Therapy (MET)
• Relapse Prevention
• Twelve-Step Facilitation and Alcoholics Anonymous

On any given day, more than 700,000 people in the United States receive alcoholism treatment in either inpatient or outpatient facilities.¹⁶ Research in the field continues to assess which approaches are most effective with certain populations and in different settings.

Any professional working in the addiction field needs to understand what alcohol withdrawal entails. The intensity of withdrawal will depend upon the extent to which the person is addicted and how long they have been addicted. All treatment plans address withdrawal, which is considered a regular part of recovery.

The examples that follow are some approaches currently used in many substance abuse treatment centers around the country. For additional information on substance abuse treatment, go to www.samhsa.gov and click on the Center for Substance Abuse Treatment. For a list of treatment facilities in each State, go to www.nattc.org and click on "treatment." The NATTC Web site also has links to other addiction-related sites.

Many forms of treatment exist. Depending on the desired outcome, different approaches may be used. These theoretical approaches include:

Cognitive-Behavioral and Cognitive-Behavioral Coping-Skills Therapy

These related approaches are based on learning theory principles that state that human behavior is largely learned and, therefore, can be changed or adapted. The term "behavioral" is used broadly to include any non-pharmacological therapy for which the objective is to change behavior (e.g., to reduce alcohol consumption). When working with addiction, one of the biggest challenges is preventing relapse.

Internal and external risk factors influence a person's ability to remain sober. Internal factors may include depression, anxiety, or craving. External factors may include seeing a bar, smelling alcohol, having relationship problems, or hearing ice click against a glass. These cognitive therapeutic approaches are intended to train the client to identify those high-risk triggers and to develop alternative coping mechanisms. The central goal of these approaches is to teach the client techniques to replace maladaptive responses and behaviors with those that are healthier.¹⁷

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Motivational Enhancement Therapy (MET)

Motivational Enhancement Therapy is based on motivational and social psychology. Unlike other approaches that guide the client step-by-step through therapy, MET's aim is to motivate clients to use their own resources to change behavior. This approach is largely client centered; the client comes up with his or her own personal decision plan for change. The therapist initially assesses the type and severity of the person's drinking and then provides the basic structure within which the client must work.

MET differs from behavioral approaches in that no direct advice or skill training is provided. The goal of MET is to stop destructive drinking by helping the client to recognize discrepancies between his or her current behavior and personal goals (rational self-interest).¹⁸

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Relapse Prevention

Relapse prevention is a type of coping-focused psychotherapy that aims to teach recovering alcoholics coping skills that will help them avoid relapsing back into using alcohol. The goals include:

1. helping the person identify, anticipate, avoid, or cope with high-risk situations (for relapse);
2. helping the person learn how to keep one lapse from turning into a multiple relapse situation; and
3. helping the person feel as if he/she is capable of controlling his or her own behavior

Many skills are taught in a relapse prevention class. Some of these skills include:

• Learning to recognize the difference between a lapse from a relapse (ongoing detrimental behavior)
• Learning to identify stressful situations and objects, such as a beer bottle or cigarette that can trigger a relapse
• Learning how to avoid or defuse a stressful situation once it is identified
• Learning how to identify, plan, and participate in positive and sober activities that can fill the time otherwise spent drinking or worrying about drinking
• Learning how to turn unhealthy behaviors into healthier behaviors.¹⁹

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Twelve-Step Facilitation and Alcoholics Anonymous

Twelve-Step Facilitation (TSF) is a formal treatment approach that is designed to introduce clients to and involve them in Alcoholics Anonymous (AA) or other similar 12-step programs. AA outlines 12 consecutive steps that alcoholics must follow and achieve during the recovery process. Some of these steps include: Admitting they are powerless over alcohol and that their lives are "insane; making a moral inventory of themselves; admitting the nature of their wrongs; making a list of people they have harmed; and making amends to those people. Alcoholics can become involved in AA before or during treatment. Individuals may experience different levels of involvement (e.g., how often they attend AA meetings or whether they get a sponsor).²⁰

Twelve-Step Facilitation counselors help to guide the client through the first five steps using 12-15 brief, individualized sessions. It is based in behavioral, spiritual, and cognitive principles that form the core of AA. The theoretical framework follows AA's steps and traditions and includes the need to accept the belief that willpower alone is not enough to remain sober. It also teaches that self-centeredness must be replaced by surrender to the group conscience, and that long-term recovery is a process of spiritual renewal. The client must actively participate in a 12-step program and be willing to accept a higher power as the locus of change.²¹ To find out more about Alcoholics Anonymous, go to www.alcoholics-anonymous.org.