The Past and Future of Research on Treatment of Alcohol Dependence

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					                         The Past and Future of

                        Research on Treatment of

                          Alcohol Dependence

                                               Mark L. Willenbring, M.D.

           Research on the treatment of alcoholism has gained significant ground over the past 40 years. Studies
           such as the National Institute on Alcohol Abuse and Alcoholism’s Project MATCH, which examined
           the prospect of tailoring treatments for particular people to better suit their needs, and Project
           COMBINE, which examined in­depth, cognitive–behavioral therapy and medical management,
           helped pave the way for a new way of approaching alcoholism treatment. New findings garnered
           through the National Epidemiologic Survey on Alcohol and Related Conditions further defined the
           problem. At the heart of this research has been the development of procedures to characterize,
           measure, and monitor the fidelity to a particular conceptual psychotherapeutic approach so that clear
           comparisons can be made between conceptually and technically distinct approaches. Advances in
           scientific methodology and statistics have provided tools to analyze complex datasets. The resulting
           findings mark an improvement over the first models of treatment developed decades ago, which
           tended to focus on anecdotal findings and assumptions. This hard­earned progress has enabled
           scientists today to move ahead and address the next set of challenges. Future research, coupled with a
           restructured treatment system capable of making new scientific findings rapidly available to the
           community, hold the key to significantly improving treatment outcomes and reducing suffering from
           alcohol­related disorders. KEY WORDS: Alcohol dependence; alcohol use disorders; alcoholism; treatment;
           treatment models; treatment method; treatment research; treatment outcomes; Project MATCH




                                                Of course, new scientific findings     to develop new and more powerful

R
       emarkable progress has been
       made in the treatment of alcohol      almost always generate more ques­         ways to help people overcome addic­
       use disorders (AUDs) over the         tions than they resolve, and alcohol      tion to alcohol. Medications offer one
past 40 years. We have a better under­	      treatment research is no different.       method to do so, which will require
standing of the natural history of heavy	    Research conducted over the past          identifying neurophysiological and
drinking and the development of              four decades has created a number         genomic targets for development of
dependence. We understand better the	        of new scientific challenges. The         new medications with novel mecha­
course of recovery and the risk factors	     most central of these challenges is to    nisms (Koob 2006). Better­targeted
and prognostic indicators for AUDs.	         truly understand the scientific basis     behavioral approaches that address
Most importantly, we have made sig­	         underlying health behavior, such as       these habits (such as addiction) also
nificant strides in the behavioral and	      alcohol consumption. This calls for       are needed. Ultimately, our goals are
pharmacological treatments available	        careful understanding of behavior and     to ensure that more people respond
to people, and their families, who suffer	   the steps involved in decisionmaking,     to treatment and that they are able
from alcoholism. Research supported	         as well as the social determinants that   to experience long­lasting effects from
by the National Institute on Alcohol	        influence those decisions; in short,      that treatment.
Abuse and Alcoholism (NIAAA) has	            we need to know who we are and
been instrumental in advancing treat­	       why we do what we do. It is especially    MARK L. WILLENBRING, M.D., is an
ment, moving our understanding from	         important to identify potentially         adjunct professor of psychiatry at the
anecdotal approaches to those that are	      modifiable operators within the systems   University of Minnesota, Minneapolis,
based firmly on evidence.	                   that determine these behaviors in order   Minnesota.

Vol. 33, Nos. 1 and 2, 2010                                                                                                     55
   In addition to addressing these sci­    what has been discovered through           change. Finally, there is no clear dis­
entific challenges, there is a pressing    research and what is actually imple­       tinction between heavy drinking,
need to create a new system of pro­        mented in everyday practice, or, for       per se, and “addiction.” In fact, non­
viding risk reduction and treatment        that matter, what can be implemented       symptomatic heavy drinking blends
for heavy drinkers and people with         given the state of the treatment system.   imperceptibly into mild then moderate
alcohol dependence. The current                                                       dependence and, in a minority of
treatment system model, the Minnesota                                                 those affected, severe and recurrent
Model, was developed by professionals      Challenging Current                        dependence. Alcohol dependence is
at a State hospital in Minnesota and       Treatment Models                           not inevitably progressive but may
promulgated most famously by the                                                      have long periods of stability or alter­
Johnson Institute and the Hazelden         The first decades of research on treat­    nate back and forth between heavy
Foundation. Based on what was known        ment of alcohol dependence were            and lighter drinking and abstinence
at the
				
DOCUMENT INFO
Description: Research on the treatment of alcoholism has gained significant ground over the past 40 years. Studies such as the National Institute on Alcohol Abuse and Alcoholism's Project MATCH, which examined the prospect of tailoring treatments for particular people to better suit their needs, and Project COMBINE, which examined in-depth, cognitive-behavioral therapy and medical management, helped pave the way for a new way of approaching alcoholism treatment. New findings garnered through the National Epidemiologic Survey on Alcohol and Related Conditions further defined the problem. At the heart of this research has been the development of procedures to characterize, measure, and monitor the fidelity to a particular conceptual psychotherapeutic approach so that clear comparisons can be made between conceptually and technically distinct approaches. Advances in scientific methodology and statistics have provided tools to analyze complex datasets. The resulting findings mark an improvement over the first models of treatment developed decades ago, which tended to focus on anecdotal findings and assumptions. This hard-earned progress has enabled scientists today to move ahead and address the next set of challenges. Future research, coupled with a restructured treatment system capable of making new scientific findings rapidly available to the community, hold the key to significantly improving treatment outcomes and reducing suffering from alcohol-related disorders. [PUBLICATION ABSTRACT]
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