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
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
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
17.
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