The Best Outcomes for Group Therapy Treatments for Those who Abuse Alcohol - Coursework Example

The Best Outcomes for Group Therapy Treatments for Those who Abuse Alcohol Contents Abstract This paper is concerned with the long term outcomes for alcoholics who have participated in group therapy. Although there are other interventions available and in use, this has been a method proved to be of some success and is more economic than some alternatives. It has however proved difficult to find valid controlled medical trials on this topic and results are not as conclusive as they might be. Key words, alcoholics, group therapy, outcomes Contents Abstract page 1 Introduction page 2 Thesis page 3 Justification page 4 Methodology page 4 Literature Review page 4 Discussion page 12 Future Practice and Research page 14 Conclusion page 16 References page 17 Introduction Alcohol dependence is a frequent, chronic, relapsing, and incurable disease with enormous societal costs. Thus, alcoholism therapy and research into its outcome are of major importance for public health (Krame et al, 2007). This paper will look at the various reasons why alcoholism develops and how these can be overcome by using methods such as group therapy, both as out patients treatment and also within an inpatient setting. In such groups the patient will learn about the disease model of alcoholism , one which isn’t about controlled drinking, but about abstinence ( Psych Central 2014). According to the Australian National Health and Medical Research Council guidelines in 2001, based upon the 2001 NHMRC longer term guidelines, 10.8% of all Australians aged 18 years or over consumed alcohol at a risky or what was considered to be a high risk level on a regular basis. By 2008 the proportion had risen to 13.3%. As stated by alcoholrehab .com (2014) :- It is estimated that over 3,000 deaths per year are attributed to excessive consumption of alcohol in Australia and over 5,000 (or 5 percent) of all cancers are due to chronic, long-term abuse of alcohol. If the newer 2009 NHMRC guidelines are considered the figures are even worse with the proportion exceeding recommended levels rising to 21.8% in 2005. Not all of these people will be considered to be alcohol dependent, but their habits are leading them to that position. The definition of such a dependence is that an individual is addicted to alcohol physically or mentally or both, and that they continue to use high levels of alcohol despite associated social dysfunction, physical changes and related difficulties. They cannot relax without drinking and so has a psychological dependence. Later there will be a physical dependence when, if blood alcohol levels fall, the body reacts with obvious symptoms such as shaking, nausea and sweating. It can therefore seem to be easier to keep ‘topped up’( Drinkaware, 2014 ). The individual should preferably seek help before such physical dependence occurs , at the stage when they begin to plan events around the consumption of alcohol; when they find they have a compulsion to drink and cannot stop easily once started ; even feeling the need to drink when they first wake, and ,if they do go without, begin to suffer physical symptoms. This is not the same as alcohol abuse which, while it may involve such things as drinking while driving, can be overcome relatively easily, because there is no physical dependence. According to Alcohol Rehab.com (2014) Australia is one of the top countries for heavy drinking. It is a society where quite heavy drinking is accepted as normal despite various legal restrictions upon purchase and consumption. Alcohol can be a factor in many negative aspects of life from crime and violence to an increased risk of cancer, as well as higher percentages of mental health problems. Also indigenous Australians are over represented in these statistics. Historically, as in the ideas of Hazleden in the 1950, alcoholism was seen as a disease and not a symptom of some underlying condition. He also thought that it affected a person, physically, mentally and spiritually and that therefore all three aspects needed to be considered ( cited by Huebner and Kantor, 2011). The authors then go onto describe a long list of possible treatment options. Thesis There is no single defining treatment appropriate for everyone, and generating treatment settings, interventions, and services to an individual’s particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society. (Alcohol Rehab.com, 2014). This paper will consider whether that statement is generally true, and how group therapy can be used to help, as well as what the outcomes of such treatments are likely to be. Justification Alcoholism obviously brings with it huge costs to both individuals and to wider society. It follows that the total cost of treatment must also be very large. It is therefore necessary to evaluate the effectiveness of such treatments. Methodology A literature review will be undertaken using a Boolean search and search terms such as alcohol abuse, group therapy, outcomes. Articles will be considered for their topicality, relevance and the scientific rigor of the research undertaken. On occasions though older references will be made where they are relevant to the topic. As this search got under way it was found that many possibly relevant papers were quoting from, and citing, much earlier works. These, although not so topical, are included on occasions. Hopefully out of this study will come some considerations for future practice. It will consider research papers on the topic which looked at long term outcomes, as well as relevant government paper, statistics and in particular those relating to the Australian situation where this is possible, although papers from elsewhere will also be considered. For various reasons, including the difficulty of follow-up long term, and the fact that people often undergo more than one form of therapy concurrently, it could prove difficult to find many proper and topical scientific studies of out-comes. Literature review. The Australian National Health and Medical Research Council have produced guidelines as to safe and appropriate levels of alcohol consumption for all citizens over 18 ( 2001). In guideline one they recommended that men should not consume more than four standard alcoholic drinks in 24 hours, and for women the amount was half that number at only two drinks. In addition it has published guidelines for particular groups of people within Australian society. Their guidelines are concerned with long term drinking patterns, but also the damage which could be caused by a single very heavy drinking binge. Guidelines 2 and 3 give recommendations for those people undertaking activities that involve a degree of risk or skill, and for those who were responsible for drinking environments, both private and public. There are further guidelines, numbered 4 to 12, which provide advice for particular sections of society such as the elderly or those with health problems. Despite this in 13.3 % Australian adults drank more than recommended by 2008. Such a situation demands a positive intervention and this paper considers in particular group therapy and its long term outcomes. The group therapy session is seen as a safe place in which to discuss feelings, including any fears and frustrations, in a non-judgmental situation, as well as being supportive. Every person in such a group understands the problems of addiction, and has also decided that enough is enough and something must change. Treatment for alcoholism begins at the detoxification stage, when the person is suffering from withdrawal symptoms such as hallucinations, shaking , fever and increase in heart rate ( Medline Plus 2014). Detoxification is a period of withdrawal while under medical care. The person is given medications to control symptoms and also some education into his condition. After this stage has been completed though other forms of longer term treatment are required and group therapy can be one of these. Krampe et al ( 2007) state that short term interventions are not to be recommended. As long ago as 1992 the American publication Alcohol Alert (National Institute on Alcohol Abuse and Alcoholism) considered treatment for alcoholism and asked a number of relevant questions:- • Is treatment better than no treatment? • Is treatment worse than no treatment? Is one treatment better than another? • If a treatment is effective, is a little just as good as a lot? • Does quality of life change because drinking has changed? • Are the benefits of treatment worth the cost? It went on to say that although no one study could answer all these questions at one time, and anyone evaluating treatments needs to consider them. A t one time research into alcoholism had not reached the standards reached in research into medical and behavioural treatments which attempt to alter patterns of behaviour ( Alcohol Alert, 1992). For a number of reasons those researching this topic rarely used randomised controlled trials, the most objective methodology for research. There were few studies which used comparison groups. Instead researchers often relied upon self-reporting, even when they were aware that this would give skewed and biased results. Group therapy is of course not the only option available. Raistick, Heather and Godfrey (2006, 12.2.2) describe the use of a self-help manual in mild to moderate cases could be just as effective as group therapy. Also there are a number of different settings in which group therapy can be undertaken ( Web med 2014) , but a common aim of helping a person to deal with the reasons behind their addiction, and an understanding of how to cope without the prop of alcohol. A person may stay in a residential rehabilitation programme for up to a year. Often the treatment is divided into a series of stages that the person goes through. For instance, in the beginning, a patient's contact with non –group members may be quite limited, so that his primary relationships are with other people in the programme. Gradually more outside contact is allowed and he may even go out to work, but return to the residence every evening. For those with supportive families and stable home environments, there are day programmes in hospitals and clinics. There are also more intensive outpatient programmes with anything from 9 to 20 hours attendance required each week for about two months. According to WebMed (2014) these work best for the most motivated people with good support. Despite all these programmes Krame et al ( 2007) found very few valid studies of long term outcomes, and that while self-reported studies showed results of as high as 30% abstinence after two or three years, more objective studies found rates as low as 6 to 18%. These inconsistences show just how hard it is to get proper scientific and objective results. Krame et al (2007) then go on to describe what they call a successful biopsychological treatment. It deals with the following points:- Aiming at strict abstinence rather than at any attempt at controlled drinking. Supportive, non-confrontational therapy. Lifelong treatment Treating any relapse as an emergency. They describe ‘aggressive aftercare’. If patients miss sessions they are soon contacted, perhaps visited, and friends and relatives are involved. Deterrent medication is used, and regular blood and urine tests are taken. Patients were carefully chosen. They had to live locally, be definitely alcohol dependent, not suffering from dementia, and not having concurrent addictions, except for nicotine and caffeine. The patient progresses over a year from daily sessions of therapy to weekly group therapy. They claim a success rate of as high as 50% of 180 alcoholics ( 144 men and 36 women) after a seven year period – higher even than self-reported studies. In 1992 the National Institute on Alcoholism and Alcohol Abuse produced its report number 17. It described how treatment outcomes are measured by various researchers. These included self-reporting of such measures of improvement as physical and psychological health, drinking patterns and social abilities. These however were often felt to be inaccurate. Raistick, Heather and Godfrey (2006, 6.2) state that not only is the amount consumed underestimated if self-reported, but that binge drinking goes unreported. For this reason periodic testing which shows up long term alcoholic consumption was needed. Rastick, Heather and Godfrey ( 2006, page 62)include measurement of the serum gamma-glutamyltransferase (GGT) in order to check upon self-reporting but also describe many other such methods which can be used to measure outcomes and effectiveness. Exaggerated claims of the effectiveness of any form of treatment can have negative consequences both for patients and their therapists, and is bad science. . As stated by Cutler and Fishbain (2005) ‘Patients who fail an "effective" treatment may feel even more hopeless.’ Exaggerated claims tend to shift the focus of care into the most unproductive directions, and also obscure the facts required in order to move the science forward. WebMed (2014) describes how individuals may be undergoing more than one form of therapy concurrently – receiving medication or individual counselling for instance, alongside group therapy sessions. This leads to difficulties in deciding upon the effectiveness of any one of these methods. Perhaps they only work in combination? Dombeck, (2005) describes the process of group therapy session for alcoholism as opposed to individual therapy sessions. One or more therapists work with a group of perhaps five or ten patients for sessions of about 90 minutes at a time. The aim is to come up with workable coping strategies for the members of the group. Each person is given an opportunity to speak, to support and to be supported, and to discuss things they are finding hard, as well as providing possible solutions. He also describes a slightly different process in which the therapist acts as teacher and the patients as students. The therapist explains a concept and then participants are encouraged to relate this to their personal situations and lives. Dombeck goes on to say that these methods are relatively inexpensive, but are an effective form of therapy, as effective as one to one treatment sessions with a psychologist. A possible reason for this effectiveness is the fact that alcoholics often have a problem with authority figures and so are more likely to accept help and support from their peers. Dombeck does not however back this claim up with statistics and nor does he say how long such sessions are likely to continue for, although many people attend Alcoholic Anonymous sessions for the rest of their lives. These kinds of treatment could be classed as behaviour therapies. They can make treatment using medications more effective, and participants are more likely to avoid relapses because they learn to cope with triggers and cravings. Alcohol rehab.com (2014) describes the stages necessary for recovery :- Precomtemplation - The person cannot see that they have a problem. Positive reinforcement can help at this stage. Contemplation - They admit to themselves that they have a problem, but are not yet committed to doing anything to improve matters. They need help to consider the consequences of their heavy drinking lifestyle. Preparation - The person decides to seek help , but may still back out of appointments unless supported and encouraged. They may plan, but no real change has occurred. Action – Plans become acts. Maintenance and termination – The person is working hard to change their life without relapse. The writer stresses however that this can happen, even after some years. They must then take immediate action to get back on the straight and narrow. For some this will occur many times, as part of an ongoing process. Because recovery is such a long process researchers often tend to look at the effectiveness of therapy after a number of years. In 1999 Gual et al, working in Spain, looked at five year outcomes. They were concerned with the quality of life enjoyed related to such factors as morbidity, mortality, alcohol-related problems, and psychological and social functioning. These were assessed 5 years from the initial contact with the patient. Five years after the initial visit, drinking status was as follows: (43.6%) were found to be abstinent; almost as many, 38% remained heavy drinkers and only 6.5 % were considered to be controlled drinkers. 7.6% of patients died during the course of the study; 3.9% could not be found and 3 of them (0.3%) preferred not to cooperate. It was found, as might be expected, that where abstinence was maintained health issues, as well as measures of socio-economic factors and psychological measures were best. The heavier the drinking the worse the outcome. A similar study looking at outcomes after 10 years was undertaken in 2004 ( Gual et al 2004). This gave very similar results to the five year study, although the percentage of those still abstinent was lower at 37% and 26% were heavy drinkers. The differences can be related to both the passage of time and the number of deaths. In 2009 Soyka and Schmidt undertook what they describe as an observational study of out comes after two years. Results however were based upon patients completing a pair of questionnaires, so despite medical examinations, this is self-reporting, known to be inaccurate. Also the people in this trial were carefully screened, and did not include any who also had drug addictions and did not have social stability, so were the most likely to succeed. Their claim is that the treatment given will help some people who are the most motivated and stable The authors did however cite an earlier study ( Bottlender and Soyka, 2005) which identified various factors likely to lead to failure of treatment . these included being female, having already gone through a number of such treatments , relapses and their length, dropping out of treatment and suicide attempts. The strongest predictor for failure they found was dropping out of treatment. Mention is made of the requirements for patients to be in this study. Patients had to be definitely alcohol dependent according to agreed criteria, and have a stable home address, and also a relative willing to collaborate any information given. Because of these particular criteria it may be that if it were possible to include those from less stable backgrounds then the results might have been somewhat different - on the other hand such people move around a lot and would be hard to follow up with any accuracy, although Bottlender and Soyka ( 2005) , perhaps having included relatively stable people in their study, claim an 88% follow-up rate. Litt et al ( 2003) compared group therapy and cognitive behaviour therapies for alcoholism. They describe how both men and women were included in their study and how these undertook therapy for six months using either group therapy or cognitive behaviour therapy. Coping skills, as well as the amount of alcohol consumed, were assessed both before the study and at 18 months after its completion. It was discovered that in both groups drinking decreased and that better coping skills were found to be a good indicator of likely success with regard to drinking. It was however found that specific skills training was not necessary, and so the authors query this particular part of cognitive behaviour therapy in the treatment of alcoholism. There are newer therapies available such as social network therapy, as described by the UKATT research team in 2005, but such methods, although they can help, have proved no more effective in the long term than group therapy ( UKATT research team , 2005). Discussion Alcoholism is a complex matter which affects the body and brain in a number of ways. Changes may last long after the person has stopped drinking, which is why relapses can occur. According to Alcohol Alert (2014) methods used to evaluate alcoholism treatment have included using of control groups so that comparisons can be made, with the random assignment of participants to different groups and, as far as is possible, follow-up of all participants in a study. Despite this it has proved difficult to find a lot of evidence of such studies in recent times, as most of the studies cited in their report are from the 1990s despite the title ‘New Advances.’ It is however clear that it is necessary to match treatment options to a person’s particular needs. Women may prefer an all female group for instance, and men also in most cases would prefer an all male group( Club Recovery LLC, undated) Group therapy is one option, but may well require supplementary treatments at the same time. Using a self-help manual , as mentioned by Raistick, Heather and Godfrey ( 2006) could perhaps be a useful supplement for some. Treatment must be readily available. This goes for other aspects of care as well as group therapy. Access to medication and medical services, to family therapy or vocational rehabilitation, as well as social and perhaps legal services must be accessible or they will not be used. As with many other conditions early intervention works best. If there are waiting lists then further deterioration and the deeper setting in of negative behaviours will occur. The timing of groups can be important so as to fit in with other commitments. A person in work for instance may find evening sessions more helpful. Much of the research on this topic was done some considerable time ago e.g.Longabraugh et al in 1983 , who only looked in terms of cost and six month outcomes, and Fuller in 1990. Some sources considered, but rejected, quoted data going back 40 years . It has proved difficult to find more recent scientifically rigorous research into this topic. This could be because group therapy has proved itself to be useful and nothing better has come along. In 2005 Cutler and Fishbain published the results of what is described as the largest, and therefore the most expensive, alcoholic treatment trial conducted up until that point. The authors expressed their disappointment with the results, as three very different treatments methods produced more or less identical results. They found that those who received no treatment were able to maintain abstinence on average for 72 days. The results as reported are somewhat difficult to understand, but in those who received a full course of treatment three quarters of such improvement was occuring among those who received no treatment at all. It was found that nearly all the improvement reported took place very early on, in week one, and that attending for all twelve weeks of therapy only made 4% difference in the outcomes. These results go against the majority of results found elsewhere. It was found that, despite using manuals and highly qualified and experience counsellors, matches between the therapies offered and results were no more than random. The results suggest that present psychosocial treatments for alcoholic addiction are not very effective. Any improvements in abstinence seem to be due to the effects of selection. Those who decide to undergo treatment are more likely to be motivated to reduce their drinking, and those who succeed in doing so are more likely to continue in treatment. This seems to be saying treatment is only as effective as the person wants it to be. Whatever the treatment offered, and how long for, it needs to be appropriate to a person’s cultural background, gender and age. This may mean a number of therapy groups are required rather than one. It also needs to take into account not just the addiction but also any associated problems, whether medical, psychological, legal, social or work related. According to the National Institute on Drug Abuse (2012) the length of time a person stays in treatment is very important, with best results following longer terms of involvement in programmes. They also say that medication is important as well, and that a person’s needs can vary over time and so reassessment is necessary. This idea that long duration is very important is backed up in chapter seven of Rockville’s book (2009). Future Practice and Research Despite a comparative scarcity of well conducted research on this topic, it is clear that group therapy can help many overcome their reliance upon alcohol in the long term and is an inexpensive option. It is also clear however that this alone does not work for some people, who will also require other therapies such as medication and individual counselling. The aggressive aftercare model as described by Krame et al (2007) would require more staff time and commitment, as well as involvement with families and friends, than merely running therapy sessions, but brings with it excellent results. Treatment must be available in the long-term and also be available immediately so that if someone lapses, as is so often the case, they can seek help as soon as possible. It must also be fitted to individual need and gender as discussed by Bottlender and Soyka (2005). Raistrick, Heather and Godfrey, (2006, page 64) suggest that service users be more involved in giving feedback with regard to the acceptability of assessment tools used. The tools, they say, need updating for both language and content used. They also state that the skill mix needed in order to interpret results needs careful consideration. Further they state that there should be more sharing of results with other agencies ; that screening tools in use be evaluated independently; that predictability according to pre-treatment measures needs further investigation, and finally that both biological markers and non-invasive measuring should be developed further. These authors also state (2006, page 135) that such things as the cost-effectiveness of relapse prevention medication be considered in order to arrive at an optimum duration time for such medication. This method of treatment in groups would require a comparatively small amount of funding as compared to the costs if these people went untreated and so required treatment for the consequences of their drinking such as liver conditions, imprisonment and exclusion from the work force. A good assessment tool is required (Raistrick, Heather and Godfrey, 2006, 6.2), one with high levels of reliability and validity. Their report goes into great detail on this matter. Such tools need trained staff to administer them and to recognise the import of results obtained. Despite Hazleden’s conclusions in the1950s ( Cited by Huebner and Kantor, 2011) alcoholism can be a complicated condition with drinking used as a means of dealing with life’s upsets. This means that just not drinking will not necessarily solve all a person’s problems. They will need support to do so, whether in the form of housing , relationship counselling or whatever. Conclusion Alcoholism is a problem all around the world, even among societies where alcohol consumption is banned, but Australia which has a long history of alcohol consumption. It is relatively cheap and easy to obtain and the problem affects all levels of society. This situation is unlikely to change easily, even with widespread education programmes. The research above does though offer some hope for those affected, although in many cases the damage will already have been done, to their bodies, their mental state and to relationships and job opportunities. Any treatment needs to take into account that this is a life-long condition. Treatment doesn't just deal with the consumption of alcohol. The person needs to be able to manage their daily life without turning to alcohol and to be aware of good reasons to be sober. These will vary from their own health and economic situation, but also the building and maintenance of relationships. Group therapy can be a valuable part of the ongoing process to a life beyond alcoholic dependence. Addiction in any form is a chronic illness, and so people face an extended recovery period. Over time situations and needs will change. This must be allowed for, and even in group sessions treatment can and should aim at particulars of an individual situation. It is important to keep abreast of any future developments , and also to be able determine whether a particular treatment, including group therapy, that seems to be effective under more or less ideal conditions with high levels of patient compliance and where staff are well-trained, will also work, at least to some extent, under pressure from large numbers and where poor compliance is a factor, as well perhaps as varying abilities among staff, that is what the National Institute on Alcohol Abuse and Alcoholism ( 1992) called "real world" conditions. People still must be treated in such a real world and treatment outcome research will support new and helpful approaches. Treatment which includes group therapy can help people to overcome their alcohol dependence, but it doesn't happen all at once. Some of the reports mentioned looked at recovery after six months, others looked somewhat longer term, but none were able to extend their research over lifetimes. Any degree of recovery from alcohol abuse or dependence upon it, that is staying sober—is a process that must be worked at each and every day and this takes considerable commitment and effort, as well as support and acceptance. References Alcohol Alert (2014) New Advances in Alcoholism Treatment http://alcoholism.about.com/od/pro/l/blnaa49.htm Alcohol Rehab.com (2014 ) retrieved from, http://alcoholrehab.com/alcoholism/alcoholism-in-australia/ Alcohol Rehab.com, (2014), Make a decision for rehab, retrieved from http://alcoholrehab.com/decide-for-rehab/ Australian Bureau of Statistics, Australian National Health and Medical Research Council, (2001), http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/4832.0.55.001Main%20Features32007-08?opendocument&tabname=Summary&prodno=4832.0.55.001&issue=2007-08&num=&view= Bottlender, M. and Soyka,M. (2005), Outpatient alcoholism treatment: predictiors of outcome after 3 years, Drug and Alcohol Dependence, 80(1) pp 83-89, retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15878808?dopt=Abstract&holding=f1000,f1000m,isrctn Club Recovery LLC, (undated), Group Therapy to Treat Drug Addiction and Alcoholism, retrieved from http://clubrecoveryllc.com/group-therapy-to-treat-drug-addiction-and-alcoholism/ Cutler, R. and Fishbain, D. (2005) , Are alcoholism treatments effective? The Project MATCH data, retrieved from http://www.biomedcentral.com/1471-2458/5/75 Dombeck, M., (2005), Group and Individual Therapy Formats for Alcohol and Substance Abuse, MentalHealth.net, retrieved from http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=8094&cn=14 Drinkaware, (2014), Alcohol dependence, Retrieved from https://www.drinkaware.co.uk/check-the- facts/health-effects-of-alcohol/mental-health/alcohol-dependence Fuller, R.K. , (1990) Controlled clinical trials. Alcohol Health & Research World 14(3):239-244, Gual, A., Lliqoña , A., and Colum , J., (1999) Five-year outcome in alcohol dependence. A naturalistic study of 850 patients in Catalonia, Alcohol Alcohol, Mar-April 34(2) pp 183, 92, retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10344779 Gual,A., Lliqoña , A., Costa,S., Segura L and Colum ,J.,(2004) Long term impact of treatment in alcoholics. Results from a 10-year longitudinal follow-up study of 850 patients, Med Clin ( Barc) Sept. 25 123(10) pp364-9 retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15482699 Huebner,R. and Kantor, L. (2011) , Advances in Alcoholism Treatment, Volume 33, number 4, retrieved from pubs.niaaa.nih.gov/publications/arh334/295-299pdf Krampe, H., Stawicki, S., Hoehe, M. and Erenreich, H. (2007), Outpatient Long-term Intensive Therapy for Alcoholics (OLITA): a successful biopsychosocial approach to the treatment of alcoholism, Dialogues in Clinical Neuroscience, 9(4)pp 399-412 Litt, M., Kadden,R., Cooney, N. and Kabala ,E., (2003), Coping skills and treatment outcomes in cognitive-behavioral and interactional group therapy for alcoholism, Journal of Consultant Clinical Psychology, Feb 71 (1) pp 118-28, Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12602432 Longabaugh, R., McCrady B., Fink,E., Stout , R., McAuley, T. ,Doyle C. and McNeill D (1983) Cost effectiveness of alcoholism treatment in partial vs inpatient settings. Six- month outcomes. Journal of Studies on Alcohol, 44(6) pages 1049-1071 retrieved from http://www.ncbi.nlm.nih.gov/pubmed/6420619 Medline Plus, Alcohol Withdrawal,(2014) retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/000764.htm National Institute on Alcohol Abuse and Alcoholism, (1992) No 17 PH 372, retrieved from http://pubs.niaaa.nih.gov/publications/aa17.htm National Institute on Drug Abuse (2012) Principles of Effective Treatment, retrieved from http://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment Raistrick,D. Heather, N. and Godfrey,C., (2006), Review of the Effectiveness of Treatment for Alcohol Problems , NHS., retrieved from www.nta.nhs.uk/.../nta_review_of_the_effectiveness_of_treatment_for_alc. Soyka, M. and Schmidt, P.,(2009), Outpatient alcoholism treatment – 24-month outcome and predictors of outcome retrieved from www.substanceabusepolicy.com/content/4/1/15 Psych Central, (2014) , Medical Treatment, retrieved from http://psychcentral.com/disorders/sx16t.htm Rockville, (2009), Treatment Improvement Protocols (TIP) series no 51 , Center for Substance Abuse Treatment. , Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK83252/ UKATT Research Team, (2005), Effectiveness of treatment for alcohol problems: findings of the randomised UK alcohol treatment trial, British Medical Journal, 301, pages 331-541, retrieved from http://www.bmj.com/content/331/7516/541 WebMed,( 2014), Alcoholism Treatment Directory, retrieved from http://www.webmd.com/mental- health/addiction/alcoholism-treatment-directory Read More

According to Alcohol Rehab.com (2014) Australia is one of the top countries for heavy drinking. It is a society where quite heavy drinking is accepted as normal despite various legal restrictions upon purchase and consumption. Alcohol can be a factor in many negative aspects of life from crime and violence to an increased risk of cancer, as well as higher percentages of mental health problems. Also indigenous Australians are over represented in these statistics. Historically, as in the ideas of Hazleden in the 1950, alcoholism was seen as a disease and not a symptom of some underlying condition.

He also thought that it affected a person, physically, mentally and spiritually and that therefore all three aspects needed to be considered ( cited by Huebner and Kantor, 2011). The authors then go onto describe a long list of possible treatment options. Thesis There is no single defining treatment appropriate for everyone, and generating treatment settings, interventions, and services to an individual’s particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society.

(Alcohol Rehab.com, 2014). This paper will consider whether that statement is generally true, and how group therapy can be used to help, as well as what the outcomes of such treatments are likely to be. Justification Alcoholism obviously brings with it huge costs to both individuals and to wider society. It follows that the total cost of treatment must also be very large. It is therefore necessary to evaluate the effectiveness of such treatments. Methodology A literature review will be undertaken using a Boolean search and search terms such as alcohol abuse, group therapy, outcomes.

Articles will be considered for their topicality, relevance and the scientific rigor of the research undertaken. On occasions though older references will be made where they are relevant to the topic. As this search got under way it was found that many possibly relevant papers were quoting from, and citing, much earlier works. These, although not so topical, are included on occasions. Hopefully out of this study will come some considerations for future practice. It will consider research papers on the topic which looked at long term outcomes, as well as relevant government paper, statistics and in particular those relating to the Australian situation where this is possible, although papers from elsewhere will also be considered.

For various reasons, including the difficulty of follow-up long term, and the fact that people often undergo more than one form of therapy concurrently, it could prove difficult to find many proper and topical scientific studies of out-comes. Literature review. The Australian National Health and Medical Research Council have produced guidelines as to safe and appropriate levels of alcohol consumption for all citizens over 18 ( 2001). In guideline one they recommended that men should not consume more than four standard alcoholic drinks in 24 hours, and for women the amount was half that number at only two drinks.

In addition it has published guidelines for particular groups of people within Australian society. Their guidelines are concerned with long term drinking patterns, but also the damage which could be caused by a single very heavy drinking binge. Guidelines 2 and 3 give recommendations for those people undertaking activities that involve a degree of risk or skill, and for those who were responsible for drinking environments, both private and public. There are further guidelines, numbered 4 to 12, which provide advice for particular sections of society such as the elderly or those with health problems.

Despite this in 13.3 % Australian adults drank more than recommended by 2008. Such a situation demands a positive intervention and this paper considers in particular group therapy and its long term outcomes. The group therapy session is seen as a safe place in which to discuss feelings, including any fears and frustrations, in a non-judgmental situation, as well as being supportive.

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