Alcohol Use Disorder

Question 1

Overview

Answer 1

• 3rd largest risk factor for disability and disease
• 12.5% lifetime prevalence
• 2x prevalence in males over females
• Higher prevalence in individuals 18-29YO over 30-44
• Alcohol use typically starts in early adolescence and escalates. Drinking before 15 –> higher chance of alcohol dependence later in life

Question 2

Culture

Answer 2

• Native Americans have highest rate of alcohol dependence and related health problems
• Asian Americans, African Americans, Hispanics lower rates

Question 3

Psychosocial factors

Answer 3

• Expectancy theory: reinforces the value and benefits of alcohol
• Tension-reduction theory: alcohol reduces tension
• Personality theory: personality plays a causal role. Type A: later onset, fewer childhood risk factors, less severe dependence, fewer alcohol-related problems, less dysfunction. Type B: childhood risk factors, familial alcoholism, early onset, greater dysfunction, more stress
• Social learning theory: learning from social environments - triggers, coping skills

Question 4

Diagnosis

Answer 4

• Clinically significant impairment or distress
• Continued use despite negative consequences: inability to fulfill roles at work, school, home; interpersonal problems; health; tolerance (need for more and more)
• Craving

Question 5

Types of teatment

Answer 5

Mostly outpatient. Brief hospitalization for detox.

Common treatments:

• Detox
• AA
• Pharmacotherapy (used much less than psychosocial)
• Primary care interventions
• Psychosocial

Question 6

Psychosocial interventions

Answer 6

• Brief interventions: provide feedback, negotiate behavior change, promote follow up
• Motivational interview: enhance motivation and commitment to change by adopting an empathetic and non-confrontational therapeutic manner
• CBT: teach skills for coping and drinking urges, identify triggers, prevent relapse
• Behavioral marital therapy: include partner in therapeutic process, sobriety contract, communication skills, alternative activities
• Community reinforcement approach & contingency management: decrease reinforcing value while increasing alternatives
• Cue exposure therapy: repeated exposure to alcohol cues to produce decrease in craving and increase self-efficacy for coping with urges and high-risk situations
• 12 step therapy: promote goal of long term complete abstinence
• Mindfulness: increase awareness of here and now to cope with urges