Alcohol dependence, Ax and Tx

Question 1

What is alcohol dependence?

Answer 1

Edwards and Gross

• Narrowing of life repertoire
• Salience of drinking
• Urges to drink
• Withdrawal symptoms, relief or avoidance of withdrawal symptoms
• Increased tolerance
• Reinstatement after abstinence

Question 2

How would you assess alcohol dependence?

Answer 2

Clinical interview: personal history and drinking history
Functional analysis
CAGE, AUDIT, SDS

Question 3

What do you assess during clinical interview?

Answer 3

Personal history
- Personal milestones
- Use of other substances
- Recent drinking: timeline follow back for past 1-2 weeks, typical day
- Assess anxiety and depression
Drinking history
- Evolution of drinking ('firsts')
- Evolution of drink-related problems: impact on health and social functioning
- Evolution of dependence

Question 4

What are the components of functional analysis?

Answer 4

1. Antecedents: Environment, interpersonal, emotions/thoughts, physical
2. Thoughts: ‘I can’t stand this, I need a drink’
3. Drink: Was it what was intended? Did one lead to another.
4. Positive consequences
5. Negative consequences

Question 5

What are the most widely used empirically supported approaches to alcohol use disorder?

Answer 5

Brief intervention
CBT
MI
Stepped care recommended

Question 6

What are the recommended CBT approaches?

Answer 6

1. Behavioural self control
2. Behavioural contracting
3. Social skills training
4. Cue exposure
5. Behavioural marital therapy
6. Relapse prevention

Question 7

What are the components of Self Management Plans?

Answer 7

1. Managing the environment
2. Setting and keeping to limits
3. Managing cognitions
4. Decisional matrix
5. Drink refusal skills
6. Emotions and alcohol
7. Dealing with cravings
8. Mindfulness
9. Relapse prevention

Question 8

Describe possible intervention goals for alcohol use

Answer 8

1. Negotiated
2. Specific and observable
3. Achievable
4. Short term
5. Priorities