According to multiple reviews, there is clear and consistent evidence that regulating the availability of alcohol is efficacious and cost-effective in reducing overall alcohol consumption and alcohol-related harm.233,234 Limiting alcohol availability is achieved by increasing the price of alcohol, mainly through taxation, which deters consumption because of the increased cost. The use of digital technology to prevent and treat heavy drinking and AUD is often called eHealth (electronic-Health) or mHealth (mobile-Health). Evaluating the efficacy of treatments for AUD should be placed in the context of evaluating the efficacy of medicines for other chronic conditions (e.g., depression, diabetes) in which a “perfect” outcome is not required for treatment to be considered successful. Despite the availability of medications with demonstrated efficacy for treating AUD, they are widely underutilized. Although studies that showed a medium effect size for treating depression also yielded a medium effect size in reducing substance use, studies that showed smaller effects on depression did not yield beneficial effects on substance use behavior, leading to the conclusion that it is necessary to treat both disorders. Evidence has been mixed on the efficacy of these medications, their side effects, and acceptability.180 Baclofen and topiramate currently have the most support for efficacy.181,182
Coaching within Tiered Support Models
The process of an intervention is pivotal in helping the individual recognize the extent of their substance abuse and addiction and the support system’s willingness to assist them. However, actual intervention is much more than mere confrontations; it is a structured approach designed to address alcohol, substance abuse, and offer options to overcome addiction and initiate a natural healing process. This way, the interventionist can present the variety of intervention models that are available and begin to prepare each family member, loved one, friend and colleague before the actual intervention. An intervention can be a highly emotional experience and a trained, qualified interventionist can help walk all the loved ones through the experience and recommend treatment centers if needed.
Family, friends, and colleagues bring unique insights to the process of the intervention through their personal relationships with the loved one. Each team member has the responsibility to communicate their concerns and support for the loved one in a non-confrontational manner. Typically composed of family, friends, colleagues, and a professionally trained and credentialed interventionist, each member plays a distinct role in the process of the intervention. Participants should educate themselves about the disease of addiction to manage the situation effectively when disease symptoms arise during and after the intervention.
Medication assisted treatment (MAT) for heavy drinking and AUD
The presence of professional interventionists increases the likelihood of successful interventions by guiding dialogue and helping the family express their concerns and love effectively. The participation of friends and colleagues in the intervention underscores the message that the individual’s alcohol abuse has repercussions that extend beyond the immediate family. Friends and colleagues can offer a different perspective on the loved one’s behavior, shedding light on the effects of addiction or mental health issues in settings like the workplace and in social activities. They provide personal insights and emotional support that can be pivotal in persuading the loved one to seek treatment.
These strategies can help them stay on track and continue their journey towards a healthier life. When treatment is accepted, it marks the beginning of a new journey towards recovery. Both scenarios represent different challenges and require unique approaches to ensure the best outcome for the individual and their loved ones. In the subsequent subsections, we’ll outline the measures to be taken when treatment is accepted and strategies to manage situations when treatment is refused.
A formal intervention is a gathering where the entire family, or one family member, friends and even colleagues gather together with the drug addict or alcoholic and in a caring way present the reality of their situation to them. The best way to get the attention of someone who is struggling with substance use disorders or an alcohol use disorder is by an intervention. The entire point, after all, is to help convince the person in question to seek help or treatment for their addiction issues. Still, your loved one’s response to intervention can take any number of turns—some better, or worse, than others. If you’re working with an intervention specialist, they’ll further advise you on what types of things to say or not say to your loved one.
Perhaps as important as who gets invited is who shouldn’t participate, including anyone the person doesn’t like or someone who doesn’t like them, or someone who may be at risk of sabotaging the intervention. Given that alcohol use and binge drinking have increased more in adult women than men over the past several years,2,243 more research is needed on prevention and treatment efforts that address the specific needs of adult women. More complete knowledge of how individual-level and socio-ecological-level factors interact in the prevention and treatment of AUD would facilitate better targeting of prevention efforts, a particularly important concern given the limited resources available to minimize alcohol-related morbidity and mortality.
Addiction treatment options may include treating disease symptoms for not only substance use disorders but medical procedures that have been pushed to the side due to addiction. Qualified mental health professionals with specific training and experience in addiction treatment are often are trained and certified interventionists. You can also give yourself the best chance possible at making an impact by planning the intervention for a time and day when your loved one is less likely to be drinking and more likely to be relaxed and open-minded. Most intervention specialists have the credentials to facilitate group therapy sessions but many also have additional training in dealing with mental health crises that may arise during or after interventions.
In general, brief interventions to reduce heavy drinking in primary care are effective in reducing drinking36,40-42 and improving health outcomes.43 Brief interventions can range in practice from very brief advice to theory-driven intervention, such as trained motivational interviewing.40-42,44,45 Despite the different evidence-based behavioral treatment frameworks available (see discussion below),46 current brief intervention efforts in the United States focus mostly on MI approaches aimed at motivating clients to change substance use patterns.47 The number of sessions of brief treatment offered depend on the program and the patient, including his or her severity of drinking. Although practitioners not specializing in alcohol treatment are often unaware of the guidelines for preventing, identifying, and treating heavy drinking and AUD, consensus on certain guidelines does list of deaths through alcohol wikipedia exist, and valuable tools are available.34 Efforts are underway to continue developments in this area, with a focus on preventing, identifying, and treating heavy drinking and AUD among individuals who also suffer from psychiatric and drug use disorders. Although several clinical studies have assessed the efficacy of disulfiram in treating AUD,159,160 most have not used a rigorous clinical trial methodology,161 and a systematic review published in 1999 concluded that that the evidence for the efficacy of disulfiram was inconsistent.162 A more recent meta-analysis of 22 randomized clinical trials using various outcome measures (e.g., continuous abstinence, number of days drinking, time to first relapse) showed a higher success rate for disulfiram than for controls, though the drug was effective only when its ingestion was supervised, and not when providers were blinded to the patients’ treatment condition.163 Despite the potential clinical utility of disulfiram, it is not considered a primary medication for relapse prevention among patients with alcohol dependence164 due to its adverse effects, poor adherence rate, and ethical objections to disulfiram among some clinicians.165 One exception was an effort to implement computerized screening for alcohol and drug use among adults seeking outpatient psychiatric services within a large managed care system, which identified heavy drinking among 33% of patients who participated.102 Given the high levels of heavy drinking and AUD among individuals with psychiatric disorders,3,17,21-23 this area warrants further research.
- The importance of mHealth is greater in low- and middle-income countries where people lack access to medical care but, oftentimes have a mobile phone.220 A recent review identified six studies of mHealth interventions that targeted alcohol consumption in low- and middle-income countries (Brazil, Thailand, and Uruguay), all of which demonstrated efficacy in reducing drinking.220
- Once an intervention kicks off, it can be very hard to predict a person’s behavior.
- In many cases of an Intervention, the interventionist will ask each involved person to write a letter to the addict.
- The process of an intervention is pivotal in helping the individual recognize the extent of their substance abuse and addiction and the support system’s willingness to assist them.
- Other mHealth interventions have been developed to address high-risk drinking in specialized populations.
Careers
In December 1886, Samuel Gompers founded the American Federation of Labor, organizing only skilled workers and focusing on “pure and simple” unionism that rejected state intervention. Origin of intervention1 Add intervention to one of your lists below, or create a new one.
What Is an Intervention? Types, Purpose, and Outcomes
Providing a stable environment that minimizes stress and triggers can significantly support someone who has accepted treatment, giving them time to heal without enabling substance use behaviors. Continuing care, also known as aftercare or follow-up care, consists of ongoing treatment and support following the completion of a structured program. After an intervention, clear steps and expectations should be communicated to maintain the momentum towards recovery, with interventionists guiding clients towards appropriate community treatment facilities and resources. A personalized treatment plan that caters to an individual’s unique needs is crucial in addiction recovery. Treatment options can range from medication-assisted treatment, behavioral therapies, and support groups. Gaining knowledge on the available treatment types marks an essential step towards a loved one’s recovery.
- The best way to make the professional intervention successful is by including an interventionist so there is a professional party involved.
- Hence, professional guidance is vital to enhance the likelihood of a the intervention’s success.
- Addressing the marketing of alcohol has the potential to be efficacious and cost-effective in reducing overall alcohol consumption and alcohol-related harm as well.
- Residential treatment programs provide a long-term recovery environment at a treatment center, with programs varying from one month to a year.
- In this section, we discuss medications that are approved by one or more regulatory agencies (e.g., European Medicines Agency, U.S. Food and Drug Administration) for treating AUD.
Population-level interventions to prevent and treat heavy drinking and AUD
However, a recent systematic review concluded that digital interventions were not consistently effective in people with AUD, and the heterogeneity of interventions, particularly in terms of their complexity, made reaching a consensus about their overall effectiveness challenging.219 The review also noted that many interventions did not report on outcomes other than changes in drinking levels, such as psychological health or social functioning.219 The complexity of AUD, which is characterized not only by compulsive alcohol use, but also by loss of control over alcohol intake and a negative emotional state when not using, may increase the challenge of addressing it through a digital platform. Research to identify and develop medications with greater efficacy that can gain widespread clinical acceptance in treating heavy drinking and AUD remains a high priority.20 However, several methodological barriers impede this effort and the ability to marshal stronger evidence of efficacy for approved medications. Early efforts that used medications such as antidepressants, benzodiazepines, and lithium based on their efficacy in treating the primary psychiatric disorder had mixed success.183 Such efforts were based on the hypothesis that a reduction in psychiatric symptoms would reduce drinking by reducing the motivation for self-medication with alcohol. Another medication, nalmefene, is approved by the European Medicines Agency (EMA) for treating AUD.158 U.S. guidelines recommend that MAT, often in combination with a behavioral intervention, be offered to patients with a clinical indication (e.g., a positive screening test or relevant physical symptoms) of AUD.34,62 We describe and review the evidence of efficacy and acceptability for each of these medications, and discuss medications that may be used off-label to treat AUD. Consensus exists that there are several evidence-based behavioral interventions that can be used to treat heavy drinking and AUD (Table 1). SBIRT has been implemented across a range of clinical care settings around the world, including hospital emergency departments, community health clinics, specialty medical practices (e.g., sexually-transmitted disease clinics), primary care, and other community settings.93 In the United States, in response to an Institute of Medicine call for increased community-based screening for health risk behaviors (including alcohol use),94 SBIRT has been scaled up substantially over the past 15 years.37 For example, the U.S.
Word of the Day
Perhaps even more important than the intervention itself is what happens afterward. Still, even if your loved one doesn’t lash out, he or she may still refuse your request to go to rehab. Open body language, positive affirmations, and controlled tempers during the intervention are also useful. In terms of what non-professionals can do, a good strategy is to plan ahead on how to address any possible objections your loved one may raise. Once an intervention kicks off, it can be very hard to predict a person’s behavior. It’s quite possible that the response to the intervention will not be good, and you should hope for the best, but prepare for the worst.
Contributions from Friends and Colleagues
Their role is crucial in managing the emotional landscape during the intervention, preventing confrontations, and ensuring a constructive atmosphere. Professional interventionists drive the process of an intervention. The success of an intervention lies in its structure and the roles of those involved. Some may perceive them as unhelpful or even detrimental, an inevitable outcome of the lack of empirical support and the misconceptions surrounding them.
Enlist A Professional
However, evidence suggests that self-regulation of alcohol marketing within the beverage industry is not effective in enforcing these rules.30,31 Other reviews note there is also strong evidence that alcohol-related policies regarding drunk driving implemented through legislation and its enforcement are effective, i.e., lowering the legally allowable blood alcohol concentration level, establishing sobriety checkpoints, and mandating treatment for alcohol-impaired driving offenses.30,31 EHealth and mHealth interventions could potentially become more effective if they are adjusted to the individual needs of users, which are often influenced by psychiatric problems such as depression, anxiety, and personality disorders. Other mHealth interventions have been developed to address high-risk drinking in specialized populations. In summary, non-abstinent drinking reductions could extend the repertoire of tools available to clinicians to treat heavy drinking and AUD by strengthening clinical trial design and broadening interest in treatment.
Participants should be mentally and emotionally prepared, with contingency plans in place to handle potential reactions from the loved one, such as acceptance, denial, or defensiveness. The journey to a successful intervention begins long before the actual event. Careful planning is crucial for the success of an intervention to prevent conflict and resentment. Laying the groundwork for transformation forms a vital component of an intervention.
Adopting valid non-abstinent drinking reduction measures may benefit research (and ultimately, treatment) if such drinking reductions are more sensitive indicators of treatment efficacy (including both behavioral and medication-assisted treatment) than the outcome measures now commonly used. Thus far, several clinical studies have demonstrated clinical benefit from reductions in WHO drinking risk levels. For example, MAT efficacy trials for AUD have been small, especially when compared to trials of treatments for other major public health problems such as cardiovascular disease.89 Other methodological challenges faced by trials to treat AUD involve recruitment and retention, inclusion/exclusion criteria, measurement of medication adherence/intervention fidelity, timing of assessments, statistical analyses, and the outcome measures used.191,192 Several other medications are now being evaluated in the United States for treating heavy drinking and AUD, including varenicline, gabapentin, topiramate, zonisamide, baclofen, ondansetron, levetiracetam, quetiapine, aripiprazole, and serotonin reuptake inhibitors.179 Although none of these are FDA-approved for treating AUD, they are sometimes used off-label for that purpose. The latter group of medications may be used “off-label” to treat heavy drinking or AUD, and some are recommended as second-line medications in clinical guidelines published by healthcare entities (e.g., U.S. Veterans Administration and Department of Defense) or professional groups (e.g., American Psychiatric Association). Brief intervention has limited effectiveness among individuals with more severe alcohol problems,42,48-59 including many who screen positive using the most widely used screening instruments.
Another opioid receptor antagonist, nalmefene, is approved for treating AUD in Europe but not the United States.158 A recent meta-analysis of five RCTs among 2,567 participants found that participants taking nalmefene had fewer HDD during treatment and lower total alcohol consumption than those taking placebo.178 However, there was considerable dropout in the nalmefene groups, often due to adverse effects, which may limit its utility in treating AUD. Although the medication is assumed to correct an imbalance between GABA and glutamate, thus easing the negative effects of quitting drinking, a more precise understanding of its mechanism of action is lacking.177 A recent meta-analysis of 27 studies found that although acamprosate had no effect on relapse to heavy drinking, it produced a 9% reduction in the risk of relapse to any drinking.62 From 1949 until 1994, disulfiram was the only medication available in the United States for treating patients with alcohol dependence. CM involves the systematic reinforcement of desired behaviors (using vouchers, privileges, prizes, money, etc.) and the withholding of reinforcement or punishment of undesired behaviors.134 Evidence supports the effectiveness of CM to improve medication adherence for AUD.134 There is less evidence available for the effectiveness of CM to treat AUD in its own right.135 A central challenge in implementing CM is the lack of biomarkers to detect alcohol use beyond the previous 12 hours.136 Adolescence is a critical period for the initiation of alcohol use as the age at first drink occurs, on average, at 14 years in the United States26 and 17 years globally.27 Therefore, efforts to prevent heavy drinking and AUD are often targeted at youth before they usually begin drinking, and most of these efforts are implemented through schools. In this report, we review existing information and recent developments in the prevention, identification, and treatment of heavy drinking and AUD.