The Psychologist Online and Treatment of Alcoholism

A first step in treating alcohol addiction is the assessment of the problem which must be multidimensional: interview patients and their relatives on usual drinking patterns of the subject, clinical indicators, biomarkers, specific questionnaires and self-registration. A second step in the treatment of alcoholism is the definition of therapeutic goal: bringing total abstinence or controlled drinking. The indications for total withdrawal are: diagnosis of alcohol dependence, physical and psychological dependence on alcohol, considerable physical deterioration, relapse history, existence of other psychopathological problems, taking medication contraindicated with alcohol, pregnancy, previous failure program controlled drinking, professional liability on third parties and the patient's explicit wish of total abstinence. The indications for controlled drinking are: diagnosis of alcohol abuse, those affected youth, lack of medical contraindications, lack of serious emotional disturbance, lack of use of other drugs, family and social support, job stability, existence of some control impulses, relatively short history of consumption and occurrence of periods sobriedad.Para the goal of total abstinence treatment, the alcoholism treatment programs consist of four phases: A) Phase motivation.

The objective is to design motivational strategies for change. The motivation phase must start from the first moment the patient comes into contact with the clinical treatment. During this phase it is essential that the alcoholic aware of the consequences that drinking causes it, the benefits of abstinence and the real possibility of recovery. To do this, you should take any information from the patient's medical history, family breakdown, problems with children, physical degradation, employment implications, etc .- and thus obtain a motivation for change. A useful strategy at this stage is the use of motivational interviewing, an instrument that offers a variety of techniques aimed at increasing awareness and motivation for therapy, as well as emotional resolve ambivalence about change that have typically addicted patients. In particular it is used, first, a summary strategy in which the therapist returned to the patient the information he provides in summary form in order to feel understood. Also, the therapist seeks at all times show an attitude of reflective listening, in which he expressed appreciation to the patient claims and understanding of your problem in order to make you feel heard and understood and thus strengthen the therapeutic relationship.

This attitude of understanding carefully combined with indications regarding the possibility of overcoming many of their problems by abandoning alcohol.El alcohol consumption is linked to the denial of the problem by the patient and, therefore, treatment begins with the recognizing the problem. It is advisable to convince the patient that you treat when he is sober and not drunk. The biggest current problem in the treatment of alcoholism is not so much create new therapeutic techniques such as motivational design strategies for therapy. When you get an excessive drinker recognize your problem and put on treatment, the chances of recovery are reasonably high. According to Prochaska and DiClemente motivation for change in terms of access by an alcoholic treatment consists of the following phases: a) lack of awareness of the problem, b) assessment of the problem, c) decision to change, d) initiation of Instead, e) the maintenance of change. It is essential at baseline achieving small victories at the start of the intervention to the patient perceives the beginning of treatment has led some cambio.B) phase of detoxification. The goal is to eliminate physical dependence.

It lasts two to four weeks and it eliminates the withdrawal symptoms associated with alcoholism. This phase can be developed on an outpatient basis, provided that the patient has a good motivation for achieving abstinence and close family support to help you through the detoxification, or in detention, when the patient has difficulty in achieving abstinence. The alcohol withdrawal syndrome is highly aversive. Thus, use of tranquilizers that lack addictive potential, chlormethiazole and tetrabamate-, drug-alcohol interdictors Disulfiram and calcium cyanamide, which produce an aversive reaction when alcohol is consumed and psychologically facilitate the extinction of the intake, and drugs that target to control the craving or urge to drink, acamprosate and naltrexone. From a psychological perspective, the use of relaxation techniques can help considerably. Finally, it is important to rehydrate the patient, a diet rich in minerals and vitamin B therapy

When the system takes on an outpatient basis is necessary to rely on family or partner to act as co-therapists outside consultation. They should be informed about the characteristics of alcoholism and the importance of their role in achieving abstinence. If possible, the co-therapist must live in the same household as the alcoholic patient in order to keep a visual inspection of the drinking habits of the patient. In this phase, co-therapist informs the patient and the characteristics of alcohol withdrawal syndrome, the approximate duration of this-about two-three weeks, and the importance of overcoming this phase in the recovery process . Besides establishing a stimulus control program with the goal of eliminating all situations that trigger drinking behavior-p. for example., delete all existing alcoholic drinks at home, do not enter any establishment with alcohol availability, etc. .-. Moreover, because drinking behavior occurs primarily in the evenings, is developed in consultation with the patient a plan of activities to be performed in the time-p.

for example., walking, intellectual, artistic activities, sports activities, etc. .-. In this way the patient is active and has a conduct incompatible with drinking, precisely during the same hours that usually did. They are instructed to drink plenty of fluids and begins a program of progressive muscle relaxation to have a quick strategy decreased anxiety when withdrawal began. It also establishes a program of frequent consultations, two or three sessions a week, in order to carry out a close monitoring of patient outcomes. Cognitive biases are corrected, such as "If I drink a drink is not going to happen," "not worth pursuing treatment, take the pills and that's it ', by restructuring cognitiva.C) cessation phase. The goal is to eliminate the psychological dependence and create new habits to replace the addiction. Once past the withdrawal many alcoholics show a fondness for drink that may lead to relapse. Therefore, during this phase is to eliminate the psychological dependence, to extinguish the influence of stimuli associated with alcohol consumption and create new habits to replace the addiction.

The common psychological techniques for achieving cessation are based on the stimulus control of drinking facilitators, development of alternative behaviors to alcohol, the reorganization of the surrounding environment, the role of the family, primarily, and the solution specific problems posed by paciente.Desde a psychological perspective, establishing a program of gradual exposure to stimuli elicited drinking behavior to eliminate the potential trigger for consumer behavior, for example, entering a bar and a coffee or soft drink. Should be accompanied at first, then only. In this way the patient comes into contact with situations that previously had been associated with drinking, but now without it. It is useful to keep practicing the progressive muscle relaxation exercises. In subjects unmotivated or low confidence in their own resources interdictors drugs are used alcohol. Assuming consumption is a clear risk of medication-wise extend Acamprosate and Disulfiram-.D) phase of rehabilitation. The objective is to control and prevent relapse and create a new lifestyle. During this phase is to identify high-risk situations for relapse, the patient providing appropriate coping strategies for these situations and to change the erroneous expectations about the consequences of alcohol consumption.

This phase starts by reducing the medication first and then Disulfiram acamprosate. The patient comes for consultation once a week without the presence of co-therapist. With it still in contact to assess progression of the case. In these individual sessions valued the main high-risk situations for relapse, and strategies available in the patient afrontarlas.Además is carried out training in coping skills, mainly social pressure, how to say no to a supply of drinking-and problem-solving strategies that allow patients to cope with interpersonal conflicts appropriately and without resorting to drink it. Assuming that lead a sedentary life, which is associated with drinking behavior, it is suggested to the patient modify the use of time in an active manner, thereby reducing the likelihood of relapse. In this sense, it is proposed the patient make a list of alternative activities. Priority is given to single-p activities. for example., training courses, expanding circle of friends, phoning friends. The patient is the distinction between a drop-understood as a blip, and relapse-Return to initial consumption.

It is, in the event of accidental consumption of alcohol, the patient does not return to the previous level of consumption, but to call for consultation to analyze the reasons which led to the fall and prevent full relapse. Disulfiram is eliminated completely. Due to the implicit risk to the patient cited in continuous sessions, spaced later. It keeps track of the case, so that the patient comes for consultation and analyzes problems presentados.En as controlled drinking program, a specific form to motivate the patient to engage in treatment is to ask first to enter your reasons for drinking less and to nest in order of importance. It is advisable to go through a period of total abstinence from alcohol two or three weeks before starting the controlled drinking program itself. The duration of these programs after the abstinence period between 10 and 12 weeks. Subjects should reduce alcohol intake to a moderate level can be defined as drinking more than three days a week, do not consume more than 40 gr. -20 grams of alcohol. on women, drink, do so in the company, during or immediately after meals, drinking in places other than the usual, do not go to bars to buy snuff and attend therapy sessions without drinking.

Do not drink ever when the patient feels bad, depressed, irritable, worried, etc. .- or a wear situation físico.Los controlled drinking programs also involve other specific rules: start drinking at a late hour of the usual, limited to two alcoholic drinks per meal, not to use until one is over the glass, put the glass down between sips, take at least 15 minutes for each drink alcohol and consume it in no less than 6 sips, inserted in the long-dinner drink or a festive events without alcohol, change the type of drink to another of lower rank, use smaller amounts, rather minicañas rods, shots instead of drinks-avoid if possible the presence of carbon dioxide in alcoholic beverages, alcohol is less noticeable but it's stronger. Finally, two important rules: to learn to refuse drinks and find new ways to spend your time that do not involve alcohol.Dr consumption. Angel of www.psicologoadistancia.com RetuertoPsicólogo