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Alcohol & Sub. Dep.: Family Struggling with Sobriety
Alcohol & Sub. Dep.: Family Struggling with Sobriety

Section 10
Definition of Alcoholism and Chemical Dependency, Evaluation of the Abuser,
& A Family Intervention Program

Question 10 | Answer Booklet | Table of Contents |
Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

The Definition of Alcoholism and Chemical Dependency and The Evaluation of the Abuser
Recognizing the symptoms of alcoholism and drug addiction

Alcoholism
a. The compulsive consumption of and psychophysiological dependence on alcoholic beverages.
b. A chronic, progressive pathological condition, mainly affecting the nervous and digestive systems, caused by the excessive and habitual consumption of alcohol. Also called chronic alcoholism.
c. Temporary mental disturbance and muscular incoordination caused by excessive consumption of alcohol. Also called acute alcoholism.

Chemical Dependency
A physical and psychological habituation to a mood- or mind-altering drug, such as alcohol or cocaine

Evaluation of the abuser
In assessing need for treatment, keep in mind that patients frequently underestimate their consumption. This underestimation may be attributed to denial, one of the hallmarks of the disease process of substance abuse. Question patients about their drug or drugs of choice and the frequency, amount, and method of use. Obtain information on prior detoxifications, concomitant use of other substances, date of first use, and time interval from last use. Most physicians know and employ the CAGE questioning technique as follows:
C - Has anyone ever felt you should C ut down on your drinking?
A - Have people A nnoyed you by criticizing your drinking?
G - Have you ever felt G uilty about your drinking?
E - Have you ever had a drink first thing in the morning ( E ye-opener) to steady your nerves or to get rid of a hangover?
A single positive response to the CAGE questions is considered suggestive of an alcohol problem, and 2 or more positive responses indicate the presence of such a problem with a sensitivity and specificity approximately 90% in most studies. One report indicated that the CAGE questions are best applied if not preceded by questions attempting to quantify alcohol intake.
These questions may not accurately indicate abuse problems when universally applied across gender and cultural lines. For example, the CAGE score has been shown less accurate in white females; therefore, attempt to gather a complete picture of the patient rather than completely relying on this questioning technique. Several other screening methods exist, with the brief Michigan Alcohol Screening Test (MAST) the most widely used screen suitable for ED use.
One very brief modification of the MAST, which has a reported sensitivity of 91%, requires a positive response to 1 of the following 2 questions:
- Have you ever had a drinking problem?
- When was your last drink? (< 24 h = positive response)

The TWEAK screen has been recommended for white females, and a score of 3 or higher indicates an alcohol problem. The TWEAK involves the following questions:
T olerance (2 points): How many drinks can you hold? (Six or more indicates tolerance.)
W orried (2 points): Have close friends or relatives worried or complained about your drinking in the past year?
E ye openers (1 point): Do you sometimes take a drink in the morning when you first get up?
A mnesia (1 point): Has a friend or family member ever told you about things you said or did while you were drinking that you could not remember?
[K] Cut down (1 point): Do you sometimes feel the need to cut down on your drinking?

Frequent injury and injury while drinking also should prompt screening for alcohol abuse.
Screening and counseling recommendations for reducing alcohol misuse are available from the US Preventive Task Force.

A family intervention program developed by researchers in New Mexico is proving successful in engaging addicts and getting them into treatment. Recent studies have shown that the Community Reinforcement and Family Training (CRAFT) approach to reaching addicts proved far more successful than other traditional approaches.

CRAFT focuses on helping family members persuade their addicted loved ones to start treatment. Recent federally supported randomized studies of the approach found a much higher rate of engagement into treatment than was the case for both the approach used by Al-Anon and a Johnson Institute intervention.

The CRAFT approach contrasts sharply with that of Al-Anon by emphasizing positive reinforcement rather than Al-Anon's detachment philosophy. Family members are taught when and how to communicate with their addicted loved one. They are advised to engage the addict into a discussion of what is important in his or her life and to use this as a motivation to enter treatment.

In a recent study funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), 130 family members of alcoholics were randomly assigned to either CRAFT, the Al-Anon approach or the Johnson Institute intervention.
The study found that 65 percent of the participants assigned to CRAFT successfully engaged their family members in treatment, while only 30 percent of participants assigned to the Johnson Institute intervention and 13 percent of participants assigned to the Al-Anon approach engaged their family members into treatment, according to Robert Meyers, Ph.D, associate director of the Center for Family and Adolescent Research at the University of New Mexico.

Another study, using family members of drug addicts, found similar results for CRAFT. The study found that of 62 family members using the CRAFT approach, 74 percent were successful in engaging their family members into treatment, Meyers told O&A.

Meyers said that a second randomized study in progress, using family members of drug addicts, is yielding results that are almost identical to those in the randomized study of families of alcoholics.

Results of the randomized study using family members of alcoholics were published in the September issue of the Journal of Consulting and Clinical Psychology, while the completed study of family members of drug addicts was published in the August issue of the Journal of Substance Abuse.

CRAFT was developed in the late 1980s by Meyers and Bill Miller, a professor at the University of New Mexico and director of research at the university's Center on Alcoholism, Substance Abuse and Addictions. Despite the program's success, the approach has not been replicated on a widespread basis.

Meyers is in the process of writing a training grant that would allow him to travel around the country to train other therapists in the approach. While Meyers has spoken at conferences, he is aware of only one replication of the approach (in Philadelphia), though researchers in Canada are attempting to use the approach on families of gambling addicts.
However, interest in the program has increased since publication of the studies, said Meyers.

Meyers has taught the approach to about 14 therapists. He said that a positive aspect of disseminating the approach is that the skill level of the therapist does not seem to alter the approach's effectiveness.

The CRAFT approach emphasizes activities involving the addict and family members in which an addict remains sober. "We want to increase their positive times together," said Meyers. "For instance, if an alcoholic never drinks at his in-laws' house, we schedule more time over there."

Family members are advised to ignore loved ones when they are under the influence.

Therapists typically meet with family members for about 12 hours of sessions before the addicted loved one is persuaded to enter treatment. Family members also benefit from receiving their own mental health treatment in the sessions. Depression and anxiety levels among family members usually drop considerably after the sessions.

A different therapist treats the addict. This can be appealing to addicts because they won't feel that a family member's therapist is coercing them, said Meyers.

- Outcomes & Accountability Alert; Family Intervention Program Getting Addicts into Treatment; Outcomes & Accountability Alert, Jan 2000, Vol. 5, Issue 1.
- The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company
- The American Heritage® Stedman's Medical Dictionary
Copyright © 2002, 2001, 1995 by Houghton Mifflin Company. Published by Houghton Mifflin Company.
- Amy Cohagan, DO; Chief Editor: Barry E Brenner, MD, PhD, FACEP, Alcohol and Substance Abuse Evaluation, Medscape Reference


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Personal Reflection Exercise Explanation
The Goal of this Home Study Course is to create a learning experience that enhances your clinical skills. We encourage you to discuss the Personal Reflection Journaling Activities, found at the end of each Section, with your colleagues. Thus, you are provided with an opportunity for a Group Discussion experience. Case Study examples might include: family background, socio-economic status, education, occupation, social/emotional issues, legal/financial issues, death/dying/health, home management, parenting, etc. as you deem appropriate. A Case Study is to be approximately 250 words in length. However, since the content of these “Personal Reflection” Journaling Exercises is intended for your future reference, they may contain confidential information and are to be applied as a “work in progress.” You will not be required to provide us with these Journaling Activities.

Personal Reflection Exercise #1
The preceding section contained information about a family intervention program for getting addicts into treatment.  Write three case study examples regarding how you might use the content of this section in your practice.

QUESTION 10
The CRAFT approach advises family members to do what when a loved one is under the influence?
To select and enter your answer go to Answer Booklet.

 

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