Furthermore, no significant difference could be found between behavioural therapies and control in the number of participants who lapsed or relapsed up to 6-month follow-up. In addition, there was no significant difference between behavioural therapies and control in attrition rates. Information about the databases searched and the inclusion/exclusion criteria used for this section of the guideline can be found in Chapter 3 (further information about the search for health economic evidence can be found in Section 6.21 of this chapter). See Table 32 below for a summary of the clinical review protocol for the review of motivational techniques.
The self-management of depression with alcohol is often characterized by a refusal of medical treatment, with alcohol seen as a “quick solution” [116]. Epidemiological surveys revealed that about a quarter of patients with DSM-diagnosed mood disorders consume alcohol with the intention of managing their mood symptoms [117]. These different models are not necessarily irreconcilable when considering the patho-developmental trajectory of addiction. During the early binge/intoxication (impulsive) stage of addiction, the opponent process model would anticipate low levels of negative affect, but during the later stage of negative affect/withdrawal, the model specifies the presence of significant negative affect and drinking to cope. Cross-sectional snapshots of people who have significant alcohol problems might reveal groups with anxiety (Apollonian) and groups without anxiety (Dionysian), but, ultimately, all may become Apollonian types as addiction advances. People who manifest anxiety problems before alcohol problems may transition very rapidly (telescope) from binge/intoxication (Dionysian) to negative affect/withdrawal (Apollonian), whereas others may make this transition more slowly or, perhaps, never.
Psychological Effects of Alcohol Abuse
More recently, however, researchers have been turning their attention to the evaluation of changes in withdrawal symptoms that extend beyond physical signs of withdrawal—that is, to those symptoms that fall within the domain of psychological distress and dysphoria. This new focus is clinically relevant because these symptoms (e.g., anxiety, negative affect, and altered reward set point) may serve as potent instigators driving motivation to drink (Koob and Le Moal physiological dependence on alcohol 2008). Sensitization resulting from repeated withdrawal cycles and leading to both more severe and more persistent symptoms therefore may constitute a significant motivational factor that underlies increased risk for relapse (Becker 1998, 1999). Quitting drinking on its own often leads to clinical improvement of co-occurring mental health disorders, but treatment for psychiatric symptoms alone generally is not enough to reduce alcohol consumption or AUD symptoms.
The public health guidance on the prevention of alcohol-related problems in adults and young people (NICE, 2010a), and also on community interventions for vulnerable young adults (NICE, 2007b), recognise the value of individual and/or group CBT. A number of studies that assess the use of individual- or group-based psychological interventions have been identified and reviewed (Perepletchikova et al., 2008; Tripodi et al., 2010; Waldron & Kaminer, 2004). A potential solution to this problem would be to undertake economic modelling to determine the most cost-effective psychological intervention. However, certain aspects of the effectiveness evidence made it difficult to do so (that is, there was a lack of common comparators and interventions were usually compared with other active interventions, a ‘no treatment/usual care/placebo’ arm was rarely identified). These studies reported a significant effect of mindfulness meditation on alcohol consumption. Overall, there is limited and poor-quality evidence that does not support the use of mindfulness-based meditation for treating alcohol dependence and harmful alcohol use.
7.2. Clinical review protocol (motivational techniques)
Overall, mean monthly costs were US$186 for CBT, US$176 for MET and US$225 for TSF, suggesting that MET had the largest potential healthcare savings over 3 years. The major limitations of this analysis were the lack of descriptive detail on the resource use and costs considered whilst no incremental analysis was presented. The findings have limited applicability to this guideline as it was based on the US healthcare system and no formal attempt was made by the authors to combine cost and clinical-outcomes data, which were collected in the study and reported elsewhere (Project MATCH Research Group, 1998).
Also, if this population has no increased risk for AUD, how is that consistent with the shared neurobiology thesis? Perhaps currently unknown factors—cultural, psychological, or biological—protect these biologically https://ecosoberhouse.com/ vulnerable individuals by discouraging drinking to cope. There is clear evidence that adverse life events can trigger excessive drinking and may predispose to the development of alcohol dependence.
Alcohol Dependence vs. Alcohol Abuse: What’s the Difference?
Further, people who are alcohol dependent are twice as likely as moderate drinkers to visit their general practitioner (GP) (Fuller et al., 2009). Most of the data on the English population’s drinking patterns comes from the General Household Survey, the Health Survey for England and the Psychiatric Morbidity Survey (Craig et al., 2009; McManus et al., 2009; Robinson & Bulger, 2010). In terms of hazardous drinking, in 2008, 21% of adult men were drinking between 22 and 50 units per week, and 15% of adult women were drinking between 15 and 35 units; a further 7% of men and 5% of women were harmful drinkers, drinking above 50 and 35 units per week, respectively. In addition, 21% of adult men and 14% of women met the government’s criteria for binge drinking.
When patients have sleep-related concerns such as insomnia, early morning awakening, or fatigue, it is wise to screen them for heavy alcohol use and assess for AUD as needed. If they use alcohol before bedtime, and especially if they shift their sleep timing on weekends compared to weekdays, they may have chronic circadian misalignment. If they report daytime sleepiness, one possible cause is alcohol-induced changes in sleep physiology.