1. Alcohol Dependence Syndrome
Niharika Thakkar
Child Guidance Centre and
Department of Behavioural
Sciences and Mental Health,
Sahyadri Hospitals ltd, Pune

2. Phases of Alcoholism – Jellinek (1960)
PRE-ALCOHOLIC PHASE PRODROMAL PHASE
•Gross Drinking Behavior
•Blackouts
CRUCIAL 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. Types of Alcoholism – Jellinek (1960)
 Alpha alcoholism
 Beta alcoholism
 Gamma alcoholism
 Delta alcoholism
 Epsilon alcoholism-
Dipsomaniac

4. Stages of Change- Prochaska and
DiClemente (1984)

5. Stages of Change- Prochaska and
DiClemente (1984)
 Precontemplation
Not 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. Stages of Change- Prochaska and
DiClemente (1984)
Contemplation
Ambivalent 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. Stages of Change-
Prochaska and
DiClemente (1984)
Preparation
Some experience with change and are
trying to change: "Testing the waters"
Planning to act within 1month
Techniques:
 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. Stages of Change- Prochaska and
DiClemente (1984)
Action
Practicing new behavior for 3-6 months
Techniques:
 Focus on restructuring cues and social
support
 Bolster self-efficacy for dealing with
obstacles
 Combat feelings of loss and reiterate
long-term benefits

9. Stages of Change- Prochaska and
DiClemente (1984)
Maintenance
Continued commitment to sustaining new
behavior
Post-6 months to 5 years
Techniques:
 Plan for follow-up support
 Reinforce internal rewards
 Discuss coping with relapse

10. Stages of Change- Prochaska and
DiClemente (1984)
Relapse
Resumption of old behaviors:
"Fall from grace"
Techniques:
 Evaluate trigger for relapse
 Reassess motivation and
barriers
 Plan stronger coping
strategies

11. Motivational
Interviewing
 Denial
 Individual is encouraged to reach own
decision about change
 Therapists’ role facilitate the change
Aim Cognitive Dissonance
Goal Self actualization

12. Behaviour Interventions
 Cue Exposure: Compulsion
will be reduced if the urge is
restricted
 Aversive Condition :
Chemical or shock
Covert Sensitization: Imagined +
taught
-Least aversive
-Number of trials decided by
therapist
-Self control (most commonly used,
effective)
-Flexible
-Inexpensive
-Tailor cut

13. Behaviour Interventions
Cautions:
- Urge has to be targeted
- Prevent “inappropriate
generalization”
- Side effect: anger, resentment,
aggression
- Lack of co operation

14. Behaviour Interventions
Procedure:
 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. 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. Relapse Prevention
 Marlatt &Gordon (1985)
-Social Learning
-Behavioural rehearsal
-Assertiveness training
-Lapse-relapse “Emergency
plan”
How to Say no.mp4

18. Psychosocial
 Alcoholics Anonymous group (12 step
approach)

19. Functional
Analysis
 Maintaining factors
 Triggers and precursors
 Consequences
 Problem areas :
Relationship, work, legal,
medical, interpersonal,
financial : Particular
“cognitions”

20. 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

21. Behavioural Self control training
 Education oriented: Therapist directed; Self directed
Rationale:
 Abstinence: Patient refuse; high ADS
 Choice of goals
 1.) Self efficacy
 2.) Self control
 3.) 6-12 sessions (90mins) + Booster sessions
Steps:
 Limit setting
 Self monitoring
 Rate of drinking
 Social skills training
 Contingency management
Alcohol Ads affect.mp4

22. Qualitative Inventory of Alcohol
Disorders

29. Chalo, Bye