A Systematic Review of Treatment Modalities for Alcohol Use Disorder - Abstract
Currently, there is an increasing recognition of the importance of treatment for alcohol use disorder, and how this condition has major impacts on a large percentage of the population. Given current economic conditions, the move from inpatient treatment to outpatient treatment, and several different recommended approaches, it is appropriate to review the range of treatment available for alcohol use disorder to determine if there can be a single recommended treatment approach.
Detoxification is the initial step toward recovery, and may be accompanied by brief interventions to effect changes in alcohol use through the harm reduction approach. For some individuals, this may be the final form of therapy while others will engage in therapy that increases in duration and intensity through a stepped care approach.
From this review it is clear that there are multiple possible treatment modalities for alcohol use disorders. These include programs focusing on elements of social control, behavioural economics, behavioural choice, social learning, and stress and coping mechanisms.
In addition, the length and duration of therapy varies; however, elements of motivational interviewing (MI), motivational enhancement therapy (MET), cognitive behavioural therapy (CBT), and mindfulness meditation (MM) are found in brief interventions during detoxification, harm reduction approaches, inpatient and residential care programs, and self-help programs. These therapies enable the individual to restructure their thought processes, perception of events, and enhance coping skills and self-efficacy. However, the research data for all of these proposed approaches is relatively limited, certainly in terms of frequent studies demonstrating significant improvements in abstinence at 12-months or longer. Nonetheless, despite a large variety of options, the current research evidence is not strong enough to identify optimal treatment strategies for diverse populations.
For example, when discussing alcohol dependence, it is unclear what components of a treatment pathway are necessary and sufficient to produce positive outcomes for specific populations. Long term prospective studies including sustained remission as an outcome for each approach are lacking, with most literature reporting outcomes within the first year post-treatment. In addition, studies on alcohol use disorders do not always incorporate a control or comparator groups. Variations in design and demonstrated difficulties in reproducing results across study sites further contribute to the challenge of developing treatment guidelines from available research.