Alcohol dependence syndrome (pdf)


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Alcohol dependence syndrome (pdf)

  1. 1. Alcohol Dependence Syndrome Niharika Thakkar Child Guidance Centre and Department of Behavioural Sciences and Mental Health, Sahyadri Hospitals ltd, Pune
  2. 2. 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
  3. 3. Types of Alcoholism – Jellinek (1960) Alpha alcoholism Beta alcoholism Gamma alcoholism Delta alcoholism Epsilon alcoholism-Dipsomaniac
  4. 4. Stages of Change- Prochaska andDiClemente (1984)
  5. 5. 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
  6. 6. 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
  7. 7. 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
  8. 8. 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
  9. 9. 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
  10. 10. 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
  11. 11. MotivationalInterviewing Denial Individual is encouraged to reach own decision about change Therapists’ role facilitate the changeAim Cognitive DissonanceGoal Self actualization
  12. 12. 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
  13. 13. Behaviour InterventionsCautions:- Urge has to be targeted- Prevent “inappropriate generalization”- Side effect: anger, resentment, aggression- Lack of co operation
  14. 14. 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
  15. 15. 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)
  16. 16. Relapse Prevention Marlatt &Gordon (1985)-Social Learning-Behavioural rehearsal-Assertiveness training-Lapse-relapse “Emergency plan”How to Say no.mp4
  17. 17. Psychosocial Alcoholics Anonymous group (12 step approach)
  18. 18. FunctionalAnalysis Maintaining factors Triggers and precursors Consequences Problem areas : Relationship, work, legal, medical, interpersonal, financial : Particular “cognitions”
  19. 19. 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
  20. 20. 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
  21. 21. Qualitative Inventory of AlcoholDisorders
  22. 22. Chalo, Bye