Table of Contents
Introduction
Alcohol is the main substance most commonly abused by people across the globe. The act of addiction is the total dependence of the human body to a drug. The process of alcohol addiction follows a three phases where an individual first uses the substance, the abuses it leading to the last phase which is addiction. According to NIAAA (National Institute of Alcohol Abuse and Alcoholism) surveys, at the end of the year 2015 more than 80% of people above the age of 18 drink alcohol. The same study showed that more than half a million adolescents have alcohol Use Disorder, which is an outcome of alcohol addiction. It accounts for 39% of the total teenager population. At the end of the year 2014, there was an estimation of alcohol fatalities, which accounted for more than 80,000 (Walker, 2013).
Evidence also shows there is use of over 200 Billion dollars spent by the federal government in the US to deal with alcohol addiction. In addition, research identified that 10% of children in the total US population live with an alcohol-addicted parent. Another interesting fact to note still using the United States as an example is the total beverage production in the region that is more than 180 million barrels, which accounts for 89% of the beverages in the nation. The alcohol industry makes annual sales of more 200 billion. Apart from this, production will increase, as there is increase in consumption of alcohol, a value accounting for more than 50% (See Appendix 1). The fact shows the present situation all medical sectors across the globe face.
The statistical evidence shows the need for treatments to address both alcohol abuse and addiction. The most efficient approach deployed is the use of counseling and therapy. The reason for this type of treatment is because studies identified the underlying cause of addiction originates from genetic and environmental factors such as compulsive behaviors, trauma and stress. The use of therapies to address the root of the health problems, which lead to the addiction in the first place. Some of those treatments are such as behavioral therapies, motivation enhancement therapies and family counseling therapies (Sommer & Spanagel, 2013).
Motivational enhancement therapy is the act of engaging patients in an interview process that reduces their uncertainties regarding treatment or stopping the use of drugs such as alcohol or Nicotine. It aims to encourage patients to stop drug or alcohol addiction and drive for change. It is the first technique deployed before behavioral therapy. The methods used under this category are such as Contingency Management and community reinforcement.
Another treatment approach is Family therapies, which counsels family members that have a relation to a person in recovery. It teaches family members to support their loved ones, enabling them to avoid risks such as relapse. It equips them with necessary skills such as communication , which are vital for the transition of the patient. The methods used are such as family behavior therapy, Multisystematic, Functional, Brief-strategic Family Therapies, Assertive Continuing Care and Adolescent Community Reinforcement Approach (Sommer & Spanagel, 2013).
Behavioral therapy is the most common method used to treat substance abuse from alcohol to other drug addictions. The use of this technique ensures that patients understand the cause of the addiction. It also assists them to develop tools that enable them to avoid and cope with the situation. There are many types of approaches under this type of therapy technique such as Cognitive Behavioral Therapy (CBT) and Dialectical behavioral therapy. The study will look into the CBT alcohol treatment approach.
Research has show that CBT is the most effective technique in treating above all other therapies such as the 12-step therapy, Contingency Management, Motivational Enhancement therapy and Adolescent community reinforcement approach (Sommer & Spanagel, 2013).
CBT
It is a psychotherapy treatment type where the patient and therapist actively work together to eradicate negative thoughts that result in a destructive thought pattern leading to addiction. Research shows that negative thoughts are the primary obstacles to change and can cause health implications such as anxiety, depression and addiction.
CBT aims to examine a patient psychology that causes negative and unhealthy thoughts. The process offers insight to the triggers that cause the addiction and its pattern. In addition, it helps them to observe, recognize and develop strategies to cope with alcohol addiction situations. The technique equips patients with skills such as self-control, anger management, emotional regulation, problem-solving skills and emotional regulation strategies. Studies have shown that the method is effective in treating drug addiction and mental illnesses (O’Shea, 2017).
The delivery of the treatment can be in individual sessions or a group session lead by the therapist. These two systems make the approach suitable for individuals, families and groups. Its usage is not discriminatory of age, sex, culture or sexual preferences.
Theoretical Underpinnings
As mentioned above CBT is a type of behavioral therapy behavioral therapy (BT). BT is the earliest cognitive and behavioral psychological therapies. It has a basis on extensive researched theories of behavior such as learning theory. From the CBT underpinnings, both cognitive and behavioral models research on the primary duty of cognition when it comes to the development of mental disorders. It researches on many psychological aspect of the human body such as attention, perception, reasoning, decision making and many others. Therefore, CBT has a basis on the principles of learning theory and the cognitive model of emotional disorders. It enables the technique to have a basis of both cognitive and behavioral aspects to understand the human behavior using cognitive and behavioral psychological models (Roth and Fonagy, 2005).
Training and Certification
Advanced Practice Registered Nurses (APRNs) have to undergo certification and training to hold various positions in the hospital setting such as therapist, counselor and psychiatrists. These positions enable them to assist patients undertaking the CBT program effectively.
Certification and training was not necessary required in substance abuse treatment. However, majority of the counselors who involve themselves with the program and are under recovery themselves, will require training. The process equips them with skills such as that of self-disclosure and ethics to implement the program effectively. In addition, there was the aspect of confidentiality is complex for all parties involves, which made it a necessity for the federal government to emphasize on training and licensing. It made 42 states in the US emphasize on the need for certification and training (United States, 2015). The laws also ensure that physicians perform treatment in regards to them while ensuring confidentiality of substance abuse treatment and assessment. These regulations differ from state to state. The training process ensures that counselors or therapists are familiar with laws and regulation.
The aspect of licensing of APRNs to attain certain positions as mentioned above in substance abuse and treatment will have particular requirements. They are such as classroom education of substance abuse and training, which will consume a maximum of 270 hours. The exercise will enable the nurse to attain knowledge on counseling, ethics, assessment, treatment planning, clinical evaluations and many more. After that, there will be onsite exercise, which will consume a maximum of 300 hours. It will equip nurses with professional skills such as the ability to work in diverse backgrounds, understanding and respecting diversity, managing self-care and the ability to think critically for reflection and evaluation. In addition, there also be transfer of therapeutic skills during the onsite training such as relationship skills, effective utilization of the clinical environment, evaluation of patient progress, ability to conduct assessment and many more (Roth and Fonagy, 2005). Finally, there is setting up work experience, which is a minimum of three years.
The Association for Addiction Professionals, otherwise known as the National Association of Alcohol and Drug Abuse Counselors is the agency that provides certification for APRNs. It offers certification from the most basis levels to the highest level. For example the basic revel has few requirements and primarily for counselors. The highest level are for those that want a private practice, which has many requirements such as a master level education in psychology or any other relevant medical practice (Center for Substance Abuse Treatment, 2015).
Treatment approach
The first step in treating alcohol addiction is detox, which is removing the body of toxic waste, which is present due to consumption of alcohol. The second step is therapy treatment to ensure that a patient does not relapse into using alcohol. It is where CBT comes in. As stated before, the treatment can be for families, groups and individuals.
CBT consist of various strategies to achieve its treatment goals. They are such as motivational interventions, which uses the motivational interviewing approach to address issues that hinder motivation in a patient. The next strategy applied is the contingency management technique that enforces the effect of medication. It ensures there is greater efficiency for abstinence against substance use as alcohol and other drug such as cocaine (McHugh, Hearon & Otto, 2011). Studies support the use of the approach as it increase substance abstinence. However, it does face a certain challenge, which is there is limited access to funds to operate the approach.
The last strategy in CBT treatment is relapse prevention, which systematical training process for a patient to implement strategies appropriately that respond to situations, which can trigger the use of alcohol. The method identifies such situation and puts prevention measures in place, reduce the rate a patient is likely to engage in alcohol consumption. In addition, there is also use of community reinforcement approach and behavioral Couples therapies primarily for married couples and families (McHugh, Hearon & Otto, 2011). The choice of treatment approach is will depend of the level of addiction of the patient after assessment.
Evidence Based Assessment
Studies using both randomized samples and single case methodologies have provided support on the efficiency of CBT treatment approach in treatment of various diseases from mental compulsive disorders such as anger, emotional pain to physical health problems such as insomnia. It is the best treatment choice in dealing with depression or intellectual disability, which can cause physical health problems and alcohol addiction. The use of the approach will be advantageous in the medical sectors to address alcohol addiction. The reason for this is there is constant development and refinement of the therapeutic approach using clinical methods o address abnormal psychological process in human development and emotion. The rapid development of CBT enables its application in many different medical sectors such as public health, forensic or sports psychology and many others.
Issues affecting the CBT treatment
There challenges the program experiences are such as collaboration, where there is no positive or equal relationship between the patient and the therapist. The relationship only works when the therapist uses his or her skills and techniques to help the client resolve his or her current problem while the patient brings his own resources, which contribute positively to the partnership. The sharing of these resources ensures there is collaboration. The aspect of collaboration present other issues such as poor observational experiments such as Homework do not have active performance from the patient, which can result in a low level of treatment efficiency.
The act of formulation, which involves the act of mapping present problems of the patient within a CBT framework can be difficult as it uses theory and evidence based practice. In addition, the Socratic dialogue cannot measure the effectiveness of treatment, as the patient may fail to correspond with the patient, giving him or her necessary information to address the addiction.
Environmental factors associated with the program
There are two distinct factors, which illustrate how a patient will respond to the treatment. They are such as genetic and cultural factors. Culture has direct link to a cognitive phenomenon. It can result is certain emotions such as shame, which can lead to addiction or the lack of acceptance of a person’s sexuality, which can increase substance abuse among adolescents. It can be the builder of both positive and negative thoughts as it dictates a person’s towards oneself and other people in the society. It is for these reason the program is undergoing modification to increase its effectiveness regardless of cultural impacts.
Genetic factor tends to affect a person’s biological configuration. There is a direct link between individual responses to the environment. It also dictates their behavior when in a negative environment and the response a patient displays in a positive environment. It is the major cause of social problems and results in acts, which led to particular mental illnesses such as depression (Ifran, 2016).
Controversies regarding the CBT program
Some misguided assumptions regarding CBT are such as the effectiveness of the treatment targets current life situations and does not delve into early life experiences that resulted in the addiction. The effectiveness of CBT receives support from available scientific evidence such as uncontrolled trials and case studies. Other controversies regarding the program are such as it does not deal with patient emotions. It is a target approach, which shifts negative thoughts to positive. It treats the symptoms of the illness and not the patient (Lazarus, 2013; Tartakovsky, 2017).
Relevant research
A study by Hofmann, Anu, Vonk, Sawyer & Fang (2012) tried to find out the effectiveness of treating the CBT program in treating various illness from substance use disorders, psychotic disorders to anxiety disorders. It is a systematic qualitative study. The sample used comes primarily from more than 200 analytic studies, which resulted in 100 meta-analysis sample. The result of the study showed that the CBT was very effective for drugs such as nicotine. However, it was less effective in addressing alcohol dependence.
Conclusion
Despite the presence of the program, APRNs face other challenges that hinder its effective implantation such as lack of funds to implement the program. It results in many nurses not participating in the program, as the reimbursement level is low. Other issues are such as legislation that governs medical prescription, which prohibit the ability of the nurses in providing treatment (Robinson, Shattel & Naegle, 2015). The research paper shows that CBT is the most common therapeutic approach used in treating substance disorders. However, based on the research example findings shows that the approach is less effective in treating alcohol addiction, but this conclusion is not definitive, as it contradicts with the literature review. A future research area is to conduct studies, preferably quantitative, which will have to prove the effectiveness CBT in addressing alcohol addiction.
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