Psychological Factors And Interventions For Alcohol Use Disorder

Choose one of the health related behaviours and using evidence from recent journal articles (i.e. those within the past 15 years), identify and describe the key psychological factors and / or theories shown as influencing /explaining the behaviour you have chosen, and critically compare psychology-related intervention approaches taken to achieve a beneficial health outcome for this behaviour.

Psychological Factors

Problem drinking that turns out to be severe in an individual can be given the medical diagnosis of alcohol use disorder or AUD. It can be described as the chronic relapsing brain disorder that can be characterized by the compulsive alcohol use, loss of control over the intake of alcohol as well as a negative emotional state when not using. About 5507 alcohol specific deaths have been recorded in the year 2016, which is about 4% higher than the 2015 data and an increase about 11% from the data recorded in the year 2006 (Connor et al., 2016). About 337000 number of hospital admissions were noted in the year 2016-2017 that were primarily due to alcohol consumption in the nation. The statistical analysis had shown that the number of admission of the alcohol related admissions increases with the increase of age and then falls when it reaches the cohort for 45-54. Total number of admissions when analyzed based on sex; it can be found that more men are admitted in comparison to women. In total, about 62% of the patients who were admitted were males (Kunyk, 2015). Hence, this disorder is having a negative impact on the economic condition of the nation and acting as a substantial health burden on the nation. This assignment will mainly try to put light on the psychological factors and related theories that contribute to the development of drinking habits. It will then propose and compare different types of interventions that would help in effective management of the disorder and ensure better quality lives of individuals.

McLean et al. (2015) have stated that certain psychological conditions are seen to greatly impact the likelihood that an individual would develop the alcohol use disorder. The studies conducted by him have shown that individuals who suffer from depression, social anxiety as well as bipolar disorders are more likely to develop addiction towards alcohol consumption. It has been found that about 40% of the sufferers of bipolar disorders abuse or is dependent on alcohol. About 205 of the depression sufferers have been also found to be abusing alcohol o remaining dependent on their consumptions. It is important to understand the main reason that makes such patients more vulnerable to develop the disorder (Krentzman et al., 2015). Such individuals who suffer from psychological illness mainly turn to alcohol as a method of coping with their illness. Participants in the study who were suffering from schizophrenia had stated that alcohol helps in making the voice in the head “become quite”. People who suffer from depression had stated that alcohol helps in “elevating moods” (Lee et al., 2015). The study also shows that such comments are more common in the participants who have not been diagnosed with the disorders or who have found that medication creates unpleasant outcomes and side effects in them. Many types of the psychological disorders can  reduce the ability of the individuals to perceive the reality of their drinking as well as make them ignore the warning signs and symptoms.

Treatments for Alcohol Use Disorder

Another study conducted by Giesen et al. (2015) had tried to research over the fact that why certain people repeat their drinking behaviors even when these behaviors had been found to be harmful. Researchers are of the opinion that this mainly takes place because people learns to anticipate certain important benefits from the addiction even though it is harmful. The main benefits that had been noted in the studies from the personal views of the participants engaged in drinking habits are stress reduction as well as relief from boredom. Moreover, “pleasurable sensations”, “coping with negative feelings or situations “and even “simply the benefit of avoiding withdrawal symptoms” make individuals remain dependent on intake of alcohol. Wakeman et al. (2016) have stated that people indeed have varying abilities in coping with different types of unpleasant emotions as well as circumstances. When individuals are seen to have poor coping skills, they are found to be more vulnerable towards addiction. Similarly, people also have varying degrees of stress as well as varying skills of stress reduction. People with high levels of stress and at the same time, lack stress reduction skills are found to be more vulnerable towards developing addiction to alcohol.

Another important issue that also makes an individual to take up the drinking habit is the peer pressure, which is common mostly in the teenagers. Often individuals are seen to take up the drinking habits by coming under the influence of their peers called the peer pressure. Studies suggest that it often becomes difficult for the teenagers to ignore the social pressure and thereby their psychological impact of the peer pressure makes individuals take up the addiction habits. The psychological thinking procedure of an individual being subjected to such pressure can become of the driving factor for the unhealthy habits (Hallgreen et al., 2015). The psychological impact of peer pressure on the children may be direct or indirect. Direct peer pressure might take place when the peers of an individual encourage him explicitly to drink alcohol or refill his glasses without asking them or buying them another drink from their own. The psychological aspects that play an important role here is to make the individuals believe that such actions of the friends need to be respected to show reciprocal behavior of love, friendliness and dearness. On the other hand, many of the individuals might also have the psychology that denying such offerings might upset their peers and would make them socially excluded. Such psychological thinking might make them probe to development of this disorder as they lack the ability to deny or manage such stressful situations (James et al., 2015). Another form of psychology also comes into play during the times of indirect peer pressure. Per pressure can be less overt and more indirect. This form of peer pressure might occur as social modeling. When particular group of peers drink regularly and are considered ultramodern or “cool”, other individuals will also have the psychology to be in the same light and thereby they would try to participate in the modeled behavior so that they can fit in the social group.  Therefore, this factor can be classified as a “psycho-social” factor that might make individuals more prone to develop the habits.

Cognitive behavioral therapy is one of the most effective therapies that have shown positive results on clients who have been suffering from alcohol use disorders.  The therapy is based on the ideas that behaviors and feelings are developed by the thoughts of the person and are not the results of the outside stimuli like situations, people as well as other events. The therapy is based on the principles that it does not always become easier for an individual to change the circumstances by they can successfully change the ways about how they think and perceive the situations (Miller et al., 2014). Similarly, in the treatment of alcohol use disorder, cognitive behavioral does not ensure motivating the patient to cause alteration to change the surrounding environment and circumstances. An individual cannot make changes in the work pressures or cannot change their peer groups who encourage him to drink. In such arenas, cognitive behavioral therapy becomes more effective in individuals who seek for support on overcoming the urge to drink alcohol.  In the treatment of alcohol use disorder, CBT mainly set goals helping to teach the person to effectively recognize the situations in which they are most likely to drink. It mainly guides the individuals with strategies about how to avoid the situations, and thereby cope with the problems and behaviors that lead them to abuse alcohol (Skill et al., 2017). In this approach, the therapists mainly helps the affected individuals identify their negative thoughts and thereby help them to either cope with them or replace them with positive thoughts. “Recognizing the different circumstances leading to alcohol use”, “avoiding triggering situations when appropriate” and “learning to cope using the CBR techniques” are the steps that help in alleviating emotions and thoughts result in alcohol abuse.

Dialectical Behavior Therapy is a form of CBT that can be also applied for the treatment of alcoholism use disorder. However, this therapy is different from the cognitive behavioral therapy in that it puts importance on the acceptance of difficult thoughts feelings, behaviors as well as that of change. One of the most important foundation principles of this therapy is mindfulness where therapists help individuals to learn how they can be aware of themselves and their feelings when being fully present in the current moment. Another is interpersonal effectiveness where the individuals learn to say “no” or ask for what is desired and improve relationship skill (Baer, 2015). Another important part is emotional regulation that might involve learning how to modify emotions that are difficult and not desirable. Another aspect is distress tolerance where individuals start accepting that pain is part of life and thereby individuals learn how to accept it without attempting to change it. This therapy is different from CBT is that unlike CBT this therapy puts focus on the ways how individuals interact with others in the different treatments as well as in other relationships. While CBT puts focus on personal thought procedures of individuals and urges individuals to replace such through procedures leading to their alcohol use, DBT follows another theory. The theory of DBT is that some people are more prone to react in certain intense and out-of-ordinary manner under certain emotional situations like mainly in family, romantic and friendly relationships (Heard & Swales, 2016). Therefore the common strategies used in DBT therapy for alcohol use disorder patients is to help patients seek out environments and per groups that discourage alcohol use. It also focuses on encouraging addicts to remove triggers like that of unhealthy relationships from their daily lives. While gives lesser important to environmental modification by individuals and more focus on individual thought modification, DBT influences to cut out triggers that affect and cause them to drink alcohol. It also enables individuals to develop confidence and self-esteem in helping patients to stay sober through stressful periods. Rather than focusing on replacing negative thoughts by positive thoughts in CBT, the DBT puts more focus on regulating emotions and control them effectively without avoiding the triggers. Another difference is unlike CBT, it also introduces group therapy component in addition to the individual sessions where skills are taught from each of the four sessions discussed above. A group setting is considered to be the idea place of learning and practicing these skills as it helps by offering a supportive and safe environment to t the affected individuals.   

Another form of therapy is the interpersonal therapy, which is actually a time-limited therapy useful for the treatment of depression. This therapy is primarily used for addiction but has found to bring out successful outcomes when an individual suffers from a mental health disorder along with addiction as dual diagnosis. This therapy mainly remains guided by two important principles. The first is the fact that mental disorders like depression as well as alcohol use disorder occur due to adverse life events as well as dysfunctional interpersonal relationships. The second principle is that the disorder is treatable by focusing on the building of stronger interpersonal skills (Miller et al., 2014). These aspects are quite similar to the DBT that also focuses on skill development of controlling the different emotions resulting in adverse events as well as handling the dysfunctional impersonal relationships with expertise. However, interpersonal therapy differs from the CBT in the sense that it also focuses on relationship development and management as an important controllable part unlike CBT. The therapy is different from CBT is that it takes the aim in resolving the problem of the person or the troubling life events that result in developing unhealthy habits of alcohol drinking (Lee et al., 2015). CBT focuses on modifying thoughts of the individuals making him develop motivation and positive thoughts rather than helping him to handle and manage the problems effectively. CBT also does not help in developing social skills that interpersonal therapy ensures. Thereby, in this way, interpersonal therapies can help in handling patients suffering from alcohol use disorder.

Conclusion:

From the above discussion, it is clear that alcohol use disorder has become one of the leading concerns of the nation as huge number of individuals is affected by it. Poor psychological factors like inability to cope with mental disorders, poor coping ability, increased stress, psychological impact due to peer pressure and many others make people prone to develop this issue. Hence, it becomes important for them to attend therapists. The therapists should be knowing about different interventions like CBT, DBT, interpersonal therapy and others in details so that they can provide best care that aligns with their requirements.

References:

Baer, R. A. (Ed.). (2015). Mindfulness-based treatment approaches: Clinician's guide to evidence base and applications. Elsevier.

Caselli, G., Gemelli, A., & Spada, M. M. (2017). The experimental manipulation of desire thinking in alcohol use disorder. Clinical psychology & psychotherapy, 24(2), 569-573.

Connor, J. P., Haber, P. S., & Hall, W. D. (2016). Alcohol use disorders. The Lancet, 387(10022), 988-998.

Giesen, E. S., Deimel, H., & Bloch, W. (2015). Clinical exercise interventions in alcohol use disorders: a systematic review. Journal of substance abuse treatment, 52, 1-9.

Hallgren, M., Kraepelien, M., Lindefors, N., Zeebari, Z., Kaldo, V., & Forsell, Y. (2015). Physical exercise and internet-based cognitive–behavioural therapy in the treatment of depression: randomised controlled trial. The British Journal of Psychiatry, 207(3), 227-234.

Hallgren, M., Kraepelien, M., Lindefors, N., Zeebari, Z., Kaldo, V., & Forsell, Y. (2015). Physical exercise and internet-based cognitive–behavioural therapy in the treatment of depression: randomised controlled trial. The British Journal of Psychiatry, 207(3), 227-234.

Heard, H. L., & Swales, M. A. (2016). Dialectical behaviour therapy: distinctive features. Routledge.

James, A. C., James, G., Cowdrey, F. A., Soler, A., & Choke, A. (2015). Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews, (2).

Krentzman, A. R., Mannella, K. A., Hassett, A. L., Barnett, N. P., Cranford, J. A., Brower, K. J., ... & Meyer, P. S. (2015). Feasibility, acceptability, and impact of a web-based gratitude exercise among individuals in outpatient treatment for alcohol use disorder. The journal of positive psychology, 10(6), 477-488.

Kunyk, D. (2015). Substance use disorders among registered nurses: prevalence, risks and perceptions in a disciplinary jurisdiction. Journal of Nursing Management, 23(1), 54-64.

Lee, J., Kresina, T. F., Campopiano, M., Lubran, R., & Clark, H. W. (2015). Use of pharmacotherapies in the treatment of alcohol use disorders and opioid dependence in primary care. BioMed research international, 2015.

Linehan, M. M. (2018). Cognitive-behavioral treatment of borderline personality disorder. Guilford Publications.

McLean, C. P., Su, Y. J., & Foa, E. B. (2015). Mechanisms of symptom reduction in a combined treatment for comorbid posttraumatic stress disorder and alcohol dependence. Journal of consulting and clinical psychology, 83(3), 655.

Miller, A. L., Carnesale, M. T., & Courtney, E. A. (2014). Dialectical behavior therapy. In Handbook of borderline personality disorder in children and adolescents (pp. 385-401). Springer, New York, NY.

Skills, D. B. T., & Regulation, E. (2017). Dialectical Behavior Therapy.

Wakeman, S. E., Pham-Kanter, G., & Donelan, K. (2016). Attitudes, practices, and preparedness to care for patients with substance use disorder: results from a survey of general internists. Substance abuse, 37(4), 635-641.