Alcohol dependence syndrome (pdf)
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Alcohol Dependence Syndrome
Niharika Thakkar
Child Guidance Centre and Department of Behavioural Sciences and Mental Health, Sahyadri Hospitals ltd, Pune
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Phases of Alcoholism – Jellinek (1960)
PRE-ALCOHOLIC PHASE
CHRONIC PHASE•Benders•Tremors•Protecting the Supply•Unreasonable Resentments•Nameless Fears and Anxieties•Collapse of the Alibi System•Surrender Process
CRUCIAL PHASE•Loss of Control•The Alibi System•Eye-Openers•Changing the Pattern•Anti-Social Behavior•Loss of Friends, Family or Job•Seeking Medical Aid
PRODROMAL PHASE•Gross Drinking Behavior•Blackouts•Gulping and Sneaking Drinks•Chronic Hangovers
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Types of Alcoholism – Jellinek (1960)
Alpha alcoholism Beta alcoholism Gamma alcoholism Delta alcoholism Epsilon alcoholism-Dipsomaniac
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Stages of Change- Prochaska and DiClemente (1984)
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Stages of Change- Prochaska and DiClemente (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
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Stages of Change- Prochaska and DiClemente (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
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Stages of Change- Prochaska and DiClemente (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
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Stages of Change- Prochaska and DiClemente (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
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Stages of Change- Prochaska and DiClemente (1984)
MaintenanceContinued commitment to sustaining new
behavior Post-6 months to 5 yearsTechniques: Plan for follow-up support Reinforce internal rewards Discuss coping with relapse
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Stages of Change- Prochaska and DiClemente (1984)
RelapseResumption of old behaviors:
"Fall from grace" Techniques: Evaluate trigger for relapse Reassess motivation and
barriers Plan stronger coping
strategies
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Motivational Interviewing
Denial Individual is encouraged to reach own
decision about change Therapists’ role facilitate the changeAim Cognitive DissonanceGoal Self actualization
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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
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Behaviour Interventions
Cautions: - Urge has to be targeted- Prevent “inappropriate
generalization”- Side effect: anger, resentment,
aggression- Lack of co operation
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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
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Behaviour Therapy in Substance Use
Therapeutic relationship I-P skills Good outcome (Yalom, Lieberman, Mac Donough,
1971)
Empathy
Cohesiveness Congruence
Poorer Outcomes: Confrontational styles of therapist
Motivational Enhancement : Miller and Rollnick (2002)
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Relapse Prevention
Marlatt &Gordon (1985) -Social Learning-Behavioural rehearsal-Assertiveness training-Lapse-relapse “Emergency
plan”How to Say no.mp4
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Psychosocial
Alcoholics Anonymous group (12 step approach)
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Functional Analysis
Maintaining factors Triggers and precursors Consequences Problem areas :
Relationship, work, legal, medical, interpersonal, financial : Particular “cognitions”
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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
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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
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Qualitative Inventory of Alcohol Disorders
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Chalo, Bye