Enhancing Abstinence and Preventing Relapse in Alcoholism Research paper Alcoholism Research question: Alcoholism affects approximately 10% Americans time lives. Treatment consists psychosocial intervention, pharmacological intervention,, looming question treatment remains: Which drugs effective enhancing abstinence preventing relapse?.

The purpose of this paper is proposing a study for examining the most effective drug in preventing relapse and enhancing abstinence from alcohol. The negative and positive results of the different drugs would be examined based on the data gathered from the participants. One hundred and seventy eight participants suffering from alcoholism will be examined in the study. The participants will undergo a mandatory detoxification period before they can enroll in the study. The participants are drawn from patients admitted in public hospitals suffering from alcoholism. The study is conducted under voluntary basis, and the results are anonymous. No identifiable patient information is gathered during the study. Patient consent is sought before they can enroll in the study.

Literature review

Alcoholism is a progressive chronic disorder that the American Psychiatric Association and American Medical Association identified as a disease. Alcoholism is a common disorder that poses a heavy burden on families, patients, and society Regier et al., 1990.

Estimates indicate that alcoholism affects approximately 10% of Americans. According to statistics, the number of men affected is higher than for women. When compared to other diseases, the prevalence of alcoholism is high, which highlights alcohol dependence significance in the public health Grant, 1997.

Alcoholism costs the United States approximately $166 billion annually Harwood, Fountain, & Livermore, 1998.

This is in addition to the number of people who die because of alcohol related causes. The number of deaths associated with alcohol is 100,000 annually. Individuals become alcoholics out of continuous social drinking. Within a short period, one finds they have become addicted to alcohol. These people will eventually neglect their responsibilities and families. Alcoholism affects the economy adversely. The abuse of alcohol leads costs the nation approximately $99 billion annually Gordis, 1976()

There are various stages involved in the treatment of alcoholism. Detoxification and acute withdrawal occurs in the initial stages. The later stages attempt at maintaining the patients from relapsing and developing a lifestyle that is compatible with long-term abstinence. Traditionally the later aspect involved the use of psychosocial interventions. Some of the psychosocial interventions are Alcoholics Anonymous and other counseling approaches. Undergoing counseling does help an individual to reform their drinking behavior, but a majority of them end up relapsing within a short period. Alcoholics Anonymous provide support groups that individuals attend regularly, and this ensures that an individual does not relapse. Critics have pointed out that use of counseling and support groups alone does not offer an individual the necessary tools to ensure they do not relapse. The groups are not effective at preventing relapse and enhancing abstinence, which necessitates the use of other interventions together with psychological interventions.

An emerging trend is the use of pharmacological treatment in preventing and enhancing abstinence, which would complement psychosocial interventions Garbutt, West, Carey, Lohr, & Crews, 1999.

The drugs used to compliment psychosocial interventions are disulfiram, naltrexone, nalmefence, and acamprosate Volpicelli et al., 1997.

These drugs would complement the psychosocial interventions and reduce the possibility of an individual relapsing Marlatt & Donovan, 2005.

There is a perplexing challenge posed to modern society when treating alcoholism. Several research studies have indicated the efficacy of drugs in preventing and reducing relapse. The true efficacy is somehow unclear as different studies only focus on short periods. In order to establish the true efficacy, researchers need to monitor the patients for a period of not less than a year. This will provide vital information to determine the efficacy of the various drugs. Armor, Polich, and Braiker (1978)

established in their study that there was improvement in 67% of the patients admitted in publicly funded alcoholism centers. According to Gordis (1976)

, there has been no progress in relapse prevention for the last 25 years. These are contradictory studies, which lead to the need for further research and continuous monitoring of the individuals after the study period. The purpose of this research is establishing the drugs that are most effective in preventing relapse and enhancing abstinence.

There have been various studies conducted to determine the effectiveness of drugs in preventing relapse and enhancing abstinence. The studies have been limited to short periods of two to three months, which led the researchers to believe that some of the drugs are effective in preventing relapse. The studies...

Upon further inquiry, around 95% of the individuals who had undergone pharmacological treatment during the studies had relapsed within two years. This demonstrates that there is need for long-term follow up in order to establish the true efficacy of pharmacological and psychosocial interventions. The failure to monitor and follow-up on the individuals will lead to success stories that have no long-term effects.
The study conducted by Garbutt et al. (1999)

evaluated five drug categories used for treating alcohol dependence. The clinical trial indicated that acamposate and naltrexone were found to be more effective that other drugs. The researchers analyzed 375 articles related to pharmacological treatment of alcoholism. The researchers used Forty-one studies for data abstraction and analysis. The researchers established that there was a mixed outcome from studies involving the use of disulfiram. The study conducted by Fuller et al. (1986)

revealed that disulfiram usage is widespread, but the clinical trials do not support its effectiveness. The researchers did not conduct any research. They instead focused on evaluating the various articles written by other researchers. Analyzing the different articles and researches conducted allowed the researchers to synthesis and extract information regarding the effectiveness of the five drug categories. The assessment of article quality involved a quality rating that covered study design, outcome measures, diagnostics, discussion, and statistical analysis. Each article had a maximum of 40 points, which the researchers rescaled to 100 points.

Another research conducted by Kiefer et al. (2003)

provided evidence that pharmacological treatment is effective in preventing relapse to alcoholism. The researchers focused on two drugs namely naltrexone and acamprostate in their study. The study used 160 patients who had undergone detoxification. The study was carried over a twelve weeks period, and the patients were in groups of 40 patients. The patients received medication in a double blind, randomized design, which ensured that the study was completely random. In the study, there were placebo drugs similar to the two main drugs administered to some group members. The participants were monitored on a weekly basis using interviews, questionnaires, self-reports, and laboratory screening. The primary outcome measures were time to relapse, time to first drink, and cumulative abstinence time. There was psychotherapy sessions conducted on a weekly basis. The sessions were abstinence oriented, and included relapse prevention and coping skills. The group sessions lasted 90 minutes and each group had between 8 and 14 participants. The patients learnt how to identify and handle different situations that could lead to alcohol relapse. In case a patient relapsed, the case was addressed nonjudgmentally, and patient encouraged to resume abstinence.

The study by Vaillant (1988)

, did follow-ups on patients for a period of 12 years. The focus of the study was identifying the factors related to relapse. Having a stable employment history had proved to be more effective in predicting the long-term outcome of relapse. The study sample comprised of 100 individuals with 83 male and 17 female alcoholics. The alcoholics were all patients admitted to Cambridge Hospital in 1971. They all had a mean age of 45 years. The patients stayed in hospital for a maximum of 10 days. All the patients attended Alcoholics Anonymous sessions twice weekly. The study followed up the alcoholics for 10 years at intervals of 18 months. Hospital records and relatives provided information regarding the relapsed patients. Personal interviews provided information regarding the abstinent alcoholics. In a period of over 8 years, the study established that the average alcoholic underwent detoxification 15 times, and they made almost the same number of clinical and emergency visits. Twenty-five percent of the patients remained abstinent for over 12 years. Thirty seven percent died before the age of 65, and 38% were abstinent at the time of death. This study demonstrated that the success rates of short periods need further follow-up to identify the true efficacy of the treatments. Alcoholics Anonymous claim their 12-step approach is effective, but there is no follow-up of the patients once they leave the facility. This presents biased and unreliable information.

Implications

Many studies have focused on usage of medications for enhancing abstinence, but they have not provided long-term follow-up. This has resulted in relapse of many alcoholics. The studies have not given specific attention towards identifying how effective the drugs are in the end. In the study by Vaillant, 1988()

, the researcher demonstrated that a majority of the patients relapsed even after medication. Therefore, the treatment should focus on long-term enhancing and prevention of relapse. The use of questionnaires for self-assessment will assist in determining how the patients rate themselves. Combining the questionnaires with other methods of gathering information ensures that the…