Alcohol Use Disorder Treatment Overview

AUD is prevalent, affecting diverse demographics and socioeconomic backgrounds.
At least 25% of clients in medical and mental health settings present with AUD.
Treatment should adopt an "alcohol problems perspective" rather than solely a diagnosis.
Treatment plans should be multidimensional, using brief interventions, motivational interviewing, cognitive-behavioral therapy, and medication.
Treatment intensity and length are determined by severity.
Concomitant problems (physical, psychological, social, occupational, legal) should be addressed.
Realistic client expectations are essential, acknowledging the chronic, relapsing nature of AUD.
Client motivation, therapy relationship, and perception of drinking consequences influence treatment.
Assessments include drinking patterns, antecedents, and urges through questionnaires, self-monitoring, and mobile apps.
Treatment setting is chosen based on severity, withdrawal, co-occurring conditions, support systems, resources, and client attitudes towards treatment.
Treatment modalities include mutual-help groups (e.g., Alcoholics Anonymous), individual and group therapy, couple and family therapy, and pharmacotherapy.
Pharmacotherapy includes benzodiazepines (for withdrawal), and FDA-approved medications like Disulfiram, Naltrexone, and Acamprosate to manage cravings and support abstinence.
Relapse prevention is critical, including recognizing relapse warning signs, coping strategies, and challenging positive alcohol expectancies.

Assess and address housing, transportation, income, legal, and family dynamics problems.
Be sensitive to client variables (emotional experiences, beliefs, attitudes, physical state, and social context).
Clinicians should know how to calculate standard drinks to educate clients on alcohol consumption.

CBT is a leading behavioral therapy for alcohol or other drug use disorders.
CBT is more effective than minimal or non-specific treatment.
Research on CBT's efficacy against other specific therapies continues.
CBT includes:
- Addressing cognitive, affective, and environmental risks for substance use.
- Training in coping skills, managing cravings, and developing coping mechanisms.

Effective treatment extends beyond drug abuse to address medical, legal, social, familial, and vocational needs.
Treatment plans should adapt to changing needs.
Medications combined with behavioral therapies are critical, especially for opioid use disorder.
Medically assisted detoxification is a first stage requiring comprehensive treatment for successful long-term results.
Monitor drug use during treatment, as relapses are possible.
Screens for HIV/AIDS, hepatitis B and C, tuberculosis, TB, and other infectious diseases are crucial.

Cognitive Behavioral Therapy for Insomnia (CBT-I) is the preferred first-line treatment for insomnia.
CBT-I targets behavioral and cognitive processes that maintain insomnia, involving changes to sleep habits, schedules, and worries.
CBT-I is a structured, time-limited intervention (typically 6-8 sessions).
Client collaboration is emphasized with active participation in implementing recommendations.
Assessment incorporates subjective sleep data (clinical sleep history, questionnaires), objective measurements (polysomnography, actigraphy), and sleep diaries.

Multielement interventions (combining therapies) can be a common treatment practice.
Examples include the CRA + vouchers intervention for cocaine use disorder.

Methadone, buprenorphine, and naltrexone are FDA-approved for opioid use disorder.
Methadone is dispensed by licensed opioid treatment programs (OTPs) requiring daily clinic attendance for supervised dosing.
Buprenorphine can be dispensed by licensed OTPs or via office-based opioid treatment (OBOT) with retail prescriptions.
Naltrexone can be prescribed by any clinician without facility regulations.

Schizophrenia is a severe mental disorder, characterized by positive symptoms (hallucinations, delusions) and negative symptoms (reduced emotional expression, motivation).

Chronic pain is a complex experience influenced by biological, psychological, and social factors, persisting beyond expected healing times (often ≥3 months).
Cognitive-behavioral therapy (CBT) is a vital psychological intervention for chronic pain.
Key components of CBT for chronic pain include relaxation training, cognitive restructuring, time-based activity pacing, and graded homework assignments.
Patient variables (comorbidities, concurrent pharmacological treatment) and therapy context (setting, format) influence treatment planning.

BPD is characterized by instability in relationships, self-image, and behavior, with intense emotions, impulsivity, self-harm, and suicidal ideation.
Dialectical Behavior Therapy (DBT) is the currently most empirically supported treatment for BPD.
DBT emphasizes the integration of acceptance with change, aiming to replace maladaptive behaviors.
DBT incorporates skills training groups, individual psychotherapy, and consultation from both the therapist and the treatment team.

Cognitive behavioral therapy (CBT) is the first-line, evidence-based treatment for PDA.
Practice guidelines from both the American Psychiatric Association and the Canadian Psychiatric Association recommend CBT for PDA.

EFT is a well-supported couple therapy approach rooted in attachment theory, humanistic principles, and systemic perspectives.
The principle objective in EFT is to create a safe and secure bond, enabling partners to recognize, explore, and openly share their vulnerable emotions and needs, linked to their attachment.
EFT is effective in improving couple satisfaction.

Misuse of prescription opioids is a significant concern among adolescents.
Consequences including school dropout, polysubstance abuse, and severe depression are tied to adolescent opiate use.
Medication-Assisted Treatment (MAT) is often used in combination with psychosocial interventions, particularly for opioid use disorder.
Naltrexone reduces opioid effects by blocking opioid receptors.
Buprenorphine is a partial opioid agonist showing promise for adolescent treatment with advantages like a ceiling effect, reducing abuse and overdose risk.