The Efficacy of Treatment for Drinking Problems

Abstract

Examination of the alcohol treatment literature reveals conflicting opinions on the efficacy of various therapies. To a large extent this reflects the professional background of the reviewer and what is regarded as acceptable evidence. The results of randomised controlled trials are often difficult to interpret since the very acceptance of therapy is often a protracted process, treatment itself even more so and therefore ‘contamination’ by other interventions and life events almost invariable. In this review evidence from natural history studies as well as controlled trials will be taken into consideration. The efficacy of cognitive-behavioural strategies is well documented, at least in the short term, and cue-exposure, response-prevention offers promise. Psychoanalytically-based therapies seem unhelpful. The alcohol-sensitizing drug, disulfiram, appears to improve outcome over the first 3–6 months and is most beneficial when given under supervision. Serotonin uptake inhibitors reduce alcohol consumption and may assist behavioural interventions. Correlational and natural history studies point to the value of Alcoholics Anonymous membership in fostering stable abstinence, though its overall impact is unclear. Greater emphasis is now placed on systematic screening and early intervention for harmful alcohol consumption, and the results from recent studies are highly encouraging. A clearer definition of the scope of individual clinicians and the role of structured programmes is much needed.