Alcohol dependence syndrome (pdf)
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Alcohol dependence syndrome (pdf)






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Alcohol dependence syndrome (pdf) Alcohol dependence syndrome (pdf) Presentation Transcript

  • Alcohol Dependence Syndrome Niharika Thakkar Child Guidance Centre and Department of Behavioural Sciences and Mental Health, Sahyadri Hospitals ltd, Pune
  • Phases of Alcoholism – Jellinek (1960) PRE-ALCOHOLIC PHASE PRODROMAL PHASE •Gross Drinking Behavior •BlackoutsCRUCIAL PHASE •Gulping and Sneaking•Loss of Control Drinks•The Alibi System •Chronic Hangovers•Eye-Openers•Changing the Pattern•Anti-Social Behavior CHRONIC PHASE •Benders•Loss of Friends, Family or Job •Tremors•Seeking Medical Aid •Protecting the Supply •Unreasonable Resentments •Nameless Fears and Anxieties •Collapse of the Alibi System •Surrender Process
  • Types of Alcoholism – Jellinek (1960) Alpha alcoholism Beta alcoholism Gamma alcoholism Delta alcoholism Epsilon alcoholism-Dipsomaniac View slide
  • Stages of Change- Prochaska andDiClemente (1984) View slide
  • Stages of Change- Prochaska andDiClemente (1984) PrecontemplationNot currently considering change: "Ignorance is bliss" Techniques: Validate lack of readiness Clarify: decision is theirs Encourage re-evaluation of current behavior Encourage self-exploration, not action Explain and personalize the risk
  • Stages of Change- Prochaska andDiClemente (1984)ContemplationAmbivalent about change:" Sitting on the fence"Not considering change within the next month [Miller and Rollnick (1991)]Techniques Validate lack of readiness Clarify: decision is theirs Encourage evaluation of pros and cons of behavior change Identify and promote new, positive outcome expectations
  • Stages of Change-Prochaska andDiClemente (1984)PreparationSome experience with change and are trying to change: "Testing the waters"Planning to act within 1monthTechniques: Identify and assist in problem solving Help patient identify social support Verify that patient has underlying skills for behavior change Encourage small initial steps
  • Stages of Change- Prochaska andDiClemente (1984)ActionPracticing new behavior for 3-6 monthsTechniques: Focus on restructuring cues and social support Bolster self-efficacy for dealing with obstacles Combat feelings of loss and reiterate long-term benefits
  • Stages of Change- Prochaska andDiClemente (1984)MaintenanceContinued commitment to sustaining new behaviorPost-6 months to 5 yearsTechniques: Plan for follow-up support Reinforce internal rewards Discuss coping with relapse
  • Stages of Change- Prochaska andDiClemente (1984)RelapseResumption of old behaviors: "Fall from grace"Techniques: Evaluate trigger for relapse Reassess motivation and barriers Plan stronger coping strategies
  • MotivationalInterviewing Denial Individual is encouraged to reach own decision about change Therapists’ role facilitate the changeAim Cognitive DissonanceGoal Self actualization
  • Behaviour Interventions Cue Exposure: Compulsion will be reduced if the urge is restricted Aversive Condition : Chemical or shockCovert Sensitization: Imagined +taught-Least aversive-Number of trials decided bytherapist-Self control (most commonly used,effective)-Flexible-Inexpensive-Tailor cut
  • Behaviour InterventionsCautions:- Urge has to be targeted- Prevent “inappropriate generalization”- Side effect: anger, resentment, aggression- Lack of co operation
  • Behaviour InterventionsProcedure: Close eyes Imagine : Target response to be weakened Imagine an aversive stimulus Clarity of image Indicate degree of aversiveness Practice till clarity of image reported 20 scenes- 10 described by therapist, 10 imagined out of description Taped: listen to tape twice a day In-vivo practice Combine with cover reinforcement: Imagine a pleasant scene
  • Behaviour Therapy in Substance Use Therapeutic relationship Empathy I-P skills Cohesiveness Congruence Good outcome (Yalom, Lieberman, Mac Donough, 1971) Poorer Outcomes: Confrontational styles of therapist Motivational Enhancement : Miller and Rollnick (2002)
  • Relapse Prevention Marlatt &Gordon (1985)-Social Learning-Behavioural rehearsal-Assertiveness training-Lapse-relapse “Emergency plan”How to Say no.mp4
  • Psychosocial Alcoholics Anonymous group (12 step approach)
  • FunctionalAnalysis Maintaining factors Triggers and precursors Consequences Problem areas : Relationship, work, legal, medical, interpersonal, financial : Particular “cognitions”
  • Implementing goals of treatment Generic treatment plan : Denial- Educate- Facilitate into program like AA Goal: Total abstinence Sobeil & Sobeil (1976): ‘Controvercial’ Model Goal: Moderated drinking
  • Behavioural Self control training Education oriented: Therapist directed; Self directedRationale: Abstinence: Patient refuse; high ADS Choice of goals 1.) Self efficacy 2.) Self control 3.) 6-12 sessions (90mins) + Booster sessionsSteps: Limit setting Self monitoring Rate of drinking Social skills training Contingency managementAlcohol Ads affect.mp4
  • Qualitative Inventory of AlcoholDisorders
  • Chalo, Bye