Interventions to reduce relapse The evidence

With appropriate help, withdrawing from alcohol is not the dependent drinker's main difficulty. The main difficulty is avoiding later relapse into further problematic drinking or dependence.

Until recently no treatments had been tested in a randomized controlled trial. Therapists explored with patients possible personality or psychological causes of their excessive drinking—trying to find out 'why?'. However, there was no evidence that this reduced relapse. Indeed, it could have had an adverse effect by creating transference problems which triggered drinking and by reinforcing the drinkers's perception of having a need to drink. (9) Similarly, non-directive counselling could act as a confessional, with a sense of absolution allowing further drinking.

Miller et alSl d1,) reviewed 302 controlled trials. A score for each therapy was calculated based on the number of positive and of negative reports and their methodological quality. Some of the apparently most effective treatments, such as systematically helping people anticipate and cope with high risk situations ('relapse prevention'^. 13)) and motivational enhancement,(1..4) had been tested partly in less severe groups of patients. Other effective treatment, such as community reinforcement/.!.5' social skills training, cognitive therapy, behaviour contracting, and behavioural marital therapy, had been tested in patients showing a wider range of severity.(!.0) Miller's review(l°> of disulfiram studies did not separate those where compliance was assured by supervision (where efficacy was demonstrated) from those where supervision was not in place (where the drug was ineffective).(16)

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