Therapeutic Modalities: Nonpharmacological
A variety of treatment components are delivered within the con-text of rehabilitation services. In many programs a combination of therapeutic interventions is provided to all clients, based on the assumption that multiple components have a greater chance of meeting at least some of each client’s needs. Therapeutic ap-proaches most often employed in both residential and outpatient programs include behavior therapy, group therapy, family treat-ment and pharmacotherapy. Regarding specific treatment modal-ities, the weight of evidence suggests that behavioral treatments are likely to be more effective than insight-oriented or family therapies.
Nevertheless, recent research also indicates that Twelve Step Facilitation, which is based on the principles of AA, is as effective as more theory-based therapies.
Cognitive and behavior therapies are among the most investigated theory-based treatments. Behavioral elements most frequently employed in treatment programs are relapse prevention, social skills and assertiveness training, contin-gency management, deep muscle relaxation, self-control train-ing and cognitive restructuring. Behavior therapists stress the importance of teaching new, adaptive skills designed to alter the conditions that precipitate and reinforce drinking, as well as developing alternative ways of coping with persons, events and feelings that serve to maintain drinking. A number of stud-ies have demonstrated the benefits of teaching social and other coping skills. Patients who received skills training attended aftercare more regularly and they had less severe (though no less frequent) relapses than patients in control groups. These and other trials of cognitive–behavioral treatments have pro-vided the empirical basis for elaboration of a generalized relapse prevention strategy.
In addition to specific treatment for alcoholic couples or families, self-help groups for family members of alcoholics have grown substantially. Al-Anon, although not formally affiliated with AA, shares the structure and many of the tenets of the 12 Steps of AA. Al-Anon and AA meetings are often held jointly. Alateen groups, sponsored by Al-Anon for children of alcoholics, are available as well.