Alcohol Misuse

Introduction to Alcohol Treatment
Many psychotherapists experience a tension between their treatment of a patient’s cognitive and emotional problems and the need to deal with that patient’s alcoholism. Psychotherapy is designed to increase an individual’s personal freedom; but alcohol treatment limits a person’s choices. After all, the almost-universal goal of alcohol treatment is abstinence, which surely limits the person’s freedom.

On the other hand, insight-oriented psychotherapy with an active alcoholic is almost surely doomed to failure, because drinking is a substitute for the kind of self exploration that is central to most psychotherapeutic approaches.

This guide is intended to help integrate the treatment of alcohol misuse into the larger context of psychotherapy. Both behavioral control and insight have their place in the treatment of an alcoholic patient, but the overall treatment plan needs careful organization.

The alcohol treatment map consists of several flow charts linked together to chart the flow of treatment from the beginning through to termination. The blocks on the flow charts are associated with sections of text that explain them more fully.

You can start looking at the map by clicking on Map 1A in the navigation bar. If you have a particular patient in mind, think of him/her as you go through the flow chart. Whenever you have a question about one of the boxes on the map, refer to the associated section of text by clicking on it in the narrative associated with the map.

Three examples of the use of the Alcohol Treatment Map are available to show their use in working with patients.

History:
This map was originally written by Thad Harshbarger, Ph.D. in 1992-94, in collaboration with Gerald Bowen, CSW,CASAC and Stan Feinberg, MA, CASAC, and revised extensively from 1994-2000. It is currently under ongoing revision by Thad Harshbarger.

Contributing:
The alcohol map is now available for critical review and suggestions. Please comment on any errors, lapses, or needed additions. Click the “Contribute” button above, to get directions. Once you register, contribution blogs appear at the bottom of each section of text.

Work to Do:
At some point, this map should be integrated into a broader context of substance abuse, a task that we avoided for our initial work because of the additional complexities. For example, should we consider broad groups of drugs and miss details or consider each common drug separately and risk missing some? Suggestions about this problem and others are welcome.

Additional references would also be helpful, especially if they are very specific.

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