June27, 2014.


Alcoholismhas been a major social problem since the history of mankind.However, in the olden days prior the advent of industrialization thetrend in alcoholism was not as marked as it is today. The nature oflife brought about by industrialization, urbanization and change insocial, economic aspects in the society has to a great extentinstigated the proliferation of alcoholism problem. Lifestyle andsocial and economic factors have to a large extent led to alcoholabuse alcoholism was not as prevalent as it has been the case in themodern society. Due to increased poverty, unemployment, idleness andpersonal behaviors many people have resulted to alcohol abuse andalcohol dependence to alleviate the stress occasioned by the economicinequality in the society. The biological mechanism which leads toalcoholism has not been well established.

However,alcoholism is due to large extent social environment, family lineagegender, age, mental health and stress have great predisposing effectto alcoholism. On the other hand, lifestyle change created avenueswhere individuals consume alcoholic beverages as they engage insocial and leisure activities this slowly leads to addiction andcompulsive drinking. Alcoholism is mean the state of alcohol abuse,uncontrolled alcohol consumption and alcohol use disorder arisingfrom a compulsive drinking habit due to In medical termsalcoholism relates to the state of cumulative alcohol toxic effectsthat can cause psychiatric and medical problems. According to medics,alcoholism is considered as a disease that affects the mental andphysical wellbeing of a person. After, significant consumption ofalcohol, the human brain develops some chemistry and structurechanges that lead to alcohol tolerance, physical dependence onalcohol and alcohol withdraw syndrome when the victim wishes to stopalcohol.

Themanagement of alcohol takes a different perspective there are thosewho advocate for medical treatment and other advocate for social andpsychological approaches. However, most treatment aim at assistingvictims regain sobriety and discontinue drinking prevent a relapse.The medical fraternity advocates for abstinence or zero toleranceapproach while others prefer reducing effects of alcohol while thevictim continues drinking. Detoxification treatment followed withmultiple therapies, participating in self-help groups and engaging incoping mechanisms is the most commonly used approach. In general, thecommonly used treatment approaches takes the form of medications,psychological therapies and detoxification. For a long time, thepsychological approaches using mutual help groups such as AlcoholismAnonymous, Smart recovery have been used to assist alcoholic victimsregain sobriety(Ferri et al. 2006).

Itwas not until the advent of 21stcentury that a multidisciplinary approach treatment was establishedwhich incorporated medical treatment to substance abuse without theuse of group therapy approach. There have been several debates inregard to the efficacy of Alcoholism Anonymous (AA) versus themedication treatment by doctors and patients alike. The doctors’claim that AA is ineffective obstructs medication treatment methodsand that some alcoholics are best suited to moderate drinking thanzero tolerance. The group therapies and the Alcoholism Anonymous onthe other hand claim that, their method that is void of medicationcould enhance total sobriety and abstinence from alcohol without arelapse to alcohol. The objective of this research paper is to assessthe efficacy of mutual help groups (AA) versus the medicationapproach (focusingon Naltrexone and Acamprosate drugs)in the management of alcoholism to sobriety level. This discussionpaper seeks to dissectthe notion of whetherthe new medication approach is more effective than mutual help groupsin managing alcoholism. The overall objective will be to clarify onthis efficacy debate between the medical professional and the AA.

Alcoholismtreatment management

Medicationvs. Mutual help groups (focusing on AA and Naltrexone andAcamprosate)

Treatmentof alcohol takes several steps because of the medical conditionsassociated with withdrawal effects. The detoxification process needsto be cautiously applied since it results in medical complicationslike benzodiazepines at times alcoholics might be addicted to thisdetoxification drugs. Successful detoxification should be followed bygroup therapy sessions that enhance individuals to regain theirsobriety. Alcoholism leads to maladaptive behaviors in whichindividuals reverts back to alcoholism habits if not well assisted tocope with the withdrawal effects. Long-term use of alcohol leads toabsolute dependence on alcohol and an increased level of tolerancethat makes victims unable to control consumption.

Excessivealcohol intake leads to psychiatric problems that predisposeindividuals to high risk of committing suicide. Most victims ofalcohol abuse suffer from severe memory problems like dementia anduse of alcohol leads to brain damage and other psychological healthproblems. In some cases, alcoholics lose their sense of socialperception victims fail to discern facial emotions andunderstanding, increased anxiety, depression, confusion, psychosis,panic disorder and schizophrenia. These psychiatric disorders varyfrom one gender to the other. Men with alcoholism disorder tend tobe narcissistic and antisocial always reverting to violence. Women,on the other hand have bulimia disorder, panic, anxiety anddepression. Socially, alcoholics engage in several social crimes suchas domestic violence, drunk driving, rape, assault, burglary, maritalconflict, child neglect and divorce. Just like other drugs,withdrawal from alcoholism can be fatal if not cautiously managed.

Alcoholismintake leads to stimulation of GABA receptors that in turn leads todepression in the central nervous system. Increased intake of alcoholleads to a reduction in the number of these receptors therebycreating alcohol dependence and tolerance. An abrupt alcohol stoppagemight lead to severe effects on the nervous system that is observablethrough such things as seizures, hallucinations and in some casesheart failure. During the withdrawal process, victims might sufferfrom the kindling effect. Therefore, one approach of managingalcoholism is through the psychological approach. In this method,several forms of psychotherapy or group therapy could be used toaddress the psychological issues related to alcoholism and as amethod of preventing relapse. In the context of the psychologicalapproach, mutual group therapy sessions have been used as the mainmethod of enhancing sobriety to alcoholics.

Mutualhelp groups (Alcoholic Anonymous -AA)

TheAlcoholic Anonymous organization was formed under the pretext ofproviding non-professional therapy to alcohol addicts. While theseprograms advocate for the absolute alcohol abstinence some programsadvocate for the moderation and rationing in alcohol usage (Tiebout,1944).The effectiveness of Alcoholic Anonymous in managing the problem ofalcoholism has been the subject of debate for many years. AlcoholicAnonymous is an international group founded in 1935 in Ohio by BillWilson (Ferriet al. 2006).The main aim of the organization was to promote sobriety among theAmerican societies. The group developed a twelve step process thatfocused on character and spirituality development. During itsformative years, the group adopted an anonymous approach which soughtto cover the group from the media and the public as they strove toassist other alcoholics. As such, the group adopted an anonymousoperation limiting affiliation with other organizations.

Thegroup has been renowned worldwide for assisting alcoholic addictsregain sobriety and have never viewed alcoholism as a medical problem(Tiebout,1944).The group was founded by individuals who sought to strengthen eachother in recovering from alcoholism individuals had realized thatthey could not get sober alone. In the group, alcoholics would beable to establish a common problem of addressing their alcoholismproblem(Moos &amp Moos 2006).The AA program has its scope spread beyond assisting alcoholicsabstain from alcohol through ought its operations, AA main focus isenhancing change in perception and thinking of the alcoholics throughspiritual rejuvenation (Kaskutaset al. 2002).In this case, the program was designed to take twelve steps thatwould awaken the victims’ spirituality and promote their sobriety(Ferriet al. 2006).

Underthe program the victims were required to attend occasional AAmeetings, volunteer with the group and keeping constant contact withthe AA members. Participants are required to find an experiencedsponsor, who was once an alcoholic and had undergone the AA twelvestep program(Kaskutas et al. 2002).In addition, the sponsors are supposed to be of same gender anddesist from forcing their opinions on the sponsored subjects. In thiscontext, both the sponsor and the sponsored benefit from the helpingtherapy principle that is important in preventing recidivism toalcohol. The guiding principle of the Alcoholism Anonymous lies intheir twelve principles and traditions (Tiebout,1944).The twelve principles to recovery involve persuading alcoholics toadmit that, as an individual one cannot control the compulsive urgeor addiction to alcohol, recognize a higher power which can give themstrength to cope with addiction.

Inaddition, the twelve step principles call on participants to examinetheir past errors with their sponsors and find solutions to thoseerrors. Furthermore, individuals should learn new ways of life andassist others suffering from the conditions of addition. Since itsinception, AA is driven by the need to help other alcoholics throughoutreach programs (Tiebout,1944).Addicts who have not resolved to stop substance abuse are notincorporated in the group therapy sessions until they have stoppedby stressing on this aspect, the group seeks to eliminatedistractions and overcoming denial (Ferriet al. 2006).The program helps victims recover from various areas such asemotional, spiritual, mental and physical(Tiebout, 1944).The twelve step process is aimed at replacing individuals’self-centeredness with a moral consciousness and will to sacrificeand engage in constructive actions (Bandura,1971).The process is intended to create gradual steps that lead tospiritual realization over a period. As members interacted withothers who have the same problem, members develop self admission(Moos&amp Moos 2006).

Thesponsor helps the alcoholic cope in their recovering process bysharing their experiences, strengths and advice. However, the sponsoris not a therapist, but another recovering alcoholic who has moreexperience in the twelve step program (Bandura,1971).Sponsors and their sponsees engage in activities that promotespiritual growth through such practices as discussing literature,writing and meditation (Ferriet al. 2006).In the fifth step, participants are required to review their moralsas required in the fourth step. Although the sponsor and sponseedevelops a relationship, the goal is to help them both recover frombehavioral problems of addiction since the relationship between thesponsor and sponsee is based on spiritual principles and behavioralissues (Tiebout,1944).

Afterthe completion of the twelve step process, one is consideredcompetent and is required to sponsor a new member. The AA meetingsare informal in nature and are run by individuals recovering fromalcohol. These meetings are informal in nature and adopt a ‘closedgroup’ and ‘open group’ platform (Moos&amp Moos 2006).Closed groups meeting are only for individuals who have stoppedsubstance use and resolved to change as such they remain closed toother individuals who may be addicts but have not stopped theirhabits (Kaskutas,2007).Open groups are for anyone addicts, no-addicts and observers. In themeetings, quality time is given to discussion in which individualsshare their stories while in some meeting session’s time is spentin studying AA literature. In a onetime study, it was revealed that,AA meetings enhanced more spirituality growth and reduction inalcohol consumption (Ferriet al. 2006).

Effectivenessof Alcoholic Anonymous (AA)

Ideally,AA is presumed to be the most cost effective method of assistingalcoholics recover and regain their sobriety. An objective analysisof the effectiveness of AA has never been fully established asresearch on this program polarizes the researchers’ objectivity. Inaddition, the selection of participants is biased individuals couldhave stopped drinking long before joining AA and that in someinstances it is difficult to conduct objective research based on thenature and composition of the group sessions. As a result of thesedivergent study results, there have been many debates on the efficacyof AA approach of alcoholism management.

However,according to many studies there has been a strong relationshipbetween alcohol abstinence and attendance to AA sessions. In many ofthese studies, recommendations have been that individuals be madeaware that the process of AA does not have the experimental proof toascertain its effectiveness(Ferriet al. 2006).In one study by Rudy Moos, he observed that alcoholics should bereferred to the AA group sessions before undertaking other treatmentsbecause the program was effective in reducing alcohol consumption.For decades, literature reviews, Meta-analysis and various studieshave given varying results on the effectiveness of AA program. Theproblem could be due to the criterion used in these studies, samplesand bias in self-selection of the study participants.

Whilethis issue continues to generate varying debates, at the heart of itare the critics who equate AA to a religious cult relying on Godpowers to address the problem of alcoholism. However, independentstudies by AA organizations indicate that individuals who attend AAmeetings in the first year continue doing so in the following year.In addition, majority of the members are able to retain theirsobriety after a period of more than a year while stillfellowshipping with the group the nature of those who remained soberafter leaving AA is not known (Kaskutaset al. 2002).

Ina more recent study conducted in the 1997, 80% of the researchedindividuals’ indicated that many patients were referred to the AAprogram before receiving any other treatment (Humphreys, 1997). Justlike with other substance abuse problem treatment, dropout rates andretentions is a major problem in the AA program (Moos&amp Moos 2006).It is recorded from empirical studies that, about 50% of theindividuals admitted at AA drops out in the first three months. About40% of the participants attending the program in less than a yearremained sober after a year in the AA program. While over 80% whoattended the program over one year abstained from alcohol andremained active in the program (Kaskutas,2007).In other studies, it was found that, in 100% of the people whoenrolls at the AA program, only half attends the sessions (Ferriet al. 2006).Of these attendees, only few make full attendance to the programafter one year.

Thereis less evidence on the characteristics of individuals who attend theAA program on the basis of age, gender, severity of drinkingproblem, marital status, employment or non-alcoholics. However, manyargue that, patients referred to AA program had past serious drinkingproblems and wished to control their problem. It is observed that,most of the participants of the AA programs have a spiritualorientation to the program. Others have presented their argumentsthat, AA programs are not effective for mild alcoholics but thoseindividuals with severe drinking problems. However, the program hasbeen found to be ineffective for individuals who are social patheticor have a mystic disbelief on the efficacy of AA program in assistingpatients regain their sobriety (Moos&amp Moos 2006).

Inmost cases, most patients have been referred to AA programs by otheragencies for the 12 step treatment program. Analysts observe thatthere are some reasons that impede some patients been referred to theAA program patients with atheists, psychiatrist or psychotropicconditions are less likely to conform to AA program therapy(Kaskutas,2007).There are consistent results on the strength of association in AAgroups with alcohol abstinence. In many studies conducted,researchers revealed that, after one year of follow-ups on the 12step program, individuals abstained from alcohol even if they did notcontinue with the group therapy sessions. Inpatient and outpatientwho attended the AA program showed positive results of abstinencefrom alcohol (Kaskutaset al. 2002).

Assessingthe level of involvement in the AA groups and alcohol abstinencerevealed that, majority of alcoholics who were involved in the groupsessions for a longer period, showed positive alcohol abstinencethis is attributed to psychological adjustment. Although, dropoutrates are higher in AA programs, it was revealed that past attendanceto such programs produced positive results in which individualscommitted them to alcohol abstinence (Moos&amp Moos 2006).Other studies indicated that, AA sponsors enhanced more patientrecovery from alcoholism.

Inshort, higher levels of AA attendance resulted in higher levels ofalcohol abstinence among the addicts (Thurstinet al. 1987),individuals who attended few sessions of AA were found to have lowerrates of alcohol abstinence. It is for this reason that Ruddy Moosargued that, alcoholics should be taken to the AA group therapysessions before been given other treatments. In regard to consistencyassociation and abstinence, some studies indicated that, majority ofthose who consistently attended AA weekly meetings showed positiveabstinences results compared to those who did not(Kaskutas,2007).

Inshort, individuals who consistently followed the one year 12 stepprogram were more likely to abstain from alcohol use than those whodid not(Thurstinet al. 1987).AA program therapy has been found to be consistent with psychologicaltheoretical perspective. Ideally, alcoholics have problems ofregulating their drinking behavior that leads to low self-esteem. Inturn, many addicts’ results to narcissistic acts and more drinkingto nurse their ego, as such the AA 12 step program is important inproviding an opportunity to the addicts to share their burdens thisincreases their motivation to stop drinking. In the social learningtheory by Bandura, he observed that social influences lead one toimitating behaviors from others for instance, alcoholics whoassociate with other alcoholics might find it had to abstain.

Therefore,AA meetings present change in the social environment whereindividuals associate with sober people this enhances role modelingand self-efficacy. Under the 12 step program, individuals learn howto desist from alcohol consumption, prevents relapse and behavioralmodifications. As such, AA programs have a basis of enhancing alcoholabstinence through psychological and spiritual awakening, moremotivation on abstinence and changes in social influence havingnetwork of supportive friends who improves on individualself-efficacy to stop drinking. In addition, AA programs areeffective in that they enhance social learning and behavioralmodifications, good environment for coping and preventing relapse(Kaskutas,2007).

Onthe basis of AA program being a standalone approach to alcoholtreatment, there is little evidence on this assumption. There arestudies that indicate that, patients who attend the AA program arepoorer and less educated than those who seek medical interventions.In other cases, scholars have argued that, there are similar outcomesfor patients undergoing AA program with those who seek medicaltreatment. As such, some scholars’ cautions individuals againstreferring patients to the AA programs because as many studiesindicate, such patients had made a resolve to stop drinking prior theAA programs (Kaskutas,2007).

Inmost cases of AA treatment programs, the nature of referredindividuals is through order, coercion which probably explains thehigh rate of attrition, relapse and recidivism in the AA programsthan other treatments (Thurstinet al. 1987).As such, scholars observe that, coercion referral to AA programs isill-advised AA program therapy works best where individuals havemade their personal choice to stop drinking and join AA. It is alsoargued that, the present justice and correctional facilitiesdirective to refer alcoholic offenders to the AA programs, underminesthe philosophical basis that underlies AA operation traditions.

Themedical approach

TheAA program has faced rising grumbles from the patients and doctorsalike who argue that AA relies on divine powers in its process. Inparticular, the medical fraternity have pointed out that, AA programhas obstructed the efficacy and spread of medical treatment toalcohol addicts AA philosophy is termed as uncompromising medicalefforts. For long, doctors have advocated for the pharmaceuticalapproach in the management of alcoholism problem. However, there isinclination by some medical physicians referring patients to mutualself-help groups as a supportive mechanism in addressing the problemof alcoholism. On the other hand, mutual self-help groups like AA hasnever taken any stand in recommending drug use, or any othermoderation method in enhancing alcohol abstinence to them that is apersonal issue between the doctor and the patient.

Thegoal of any method used in alcoholism treatment is limit alcoholdependence and promote abstinence. Several studies indicate that,majority of patients’ relapses back to heavy drinking after a shortperiod of treatment. Therefore, one method of alcoholism cannot bethe sole approach used in treating alcoholism problem when onemethod fails to enhance alcohol abstinence, other methods could beused (Miller, 1997). Recent reports abound that, despite AA stance onmedical treatment, today, the organization boast of numerous doctorsand psychiatrists. The history of mutual help groups indicates that,the organization has had distrust for medication towards alcoholism.In the 19thcentury, doctors tried all manners of medication including cocaine,marijuana and morphine with no positive results. In the early 20thcentury, physicians tried steroids that showed little benefits.Later, benzodiazepines or barbiturates were used in the late 20thcentury resulting in complications to the victims such as anxiety,sleeplessness and agitation (Anton et al. 2001).

Thedebate over which method is effective on moderation or absoluteabstinences from alcohol transcends to argument on the efficacy ofdrug prescription ability to treat alcoholism. The currently usedmedication drugs in the treatment of alcoholism are the acamprosatesand the naltrexone other several drugs are still under research toinvestigate their effectiveness (Litten et al. 1996). These drugshave been found to improve alcohol problem treatment when combinedwith other supportive mechanisms like the group therapies (Miller,1997). These drugs have been found to reduce alcohol consumption andrelapse after abstaining from alcohol use (Anton et al. 2001). Theacamprosates stabilize the brain by altering the chemical balance inthe brain to reduce alcohol dependence through antagonizing theneurotransmitter in a process known as glutamates the drugs acts onthe GABA by lowering craving for alcohol (Litten et al. 1996). It isrecorded that, these acamprosate drugs works well when the patientshave abstained from alcohol and is attending group therapy sessions(Miller, 1997).

However,acamprosate drugs are associated with severe side effects such asallergies, diarrhea, blood pleasure, insomnia, impotence andheadaches. As such, they are not recommended for pregnant women orindividuals with kidney problems (Miller, 1997). Studies indicatethat the drugs are able to enable patients abstain from drinkingwhile, in some cases, the acamprosate drugs have been found to beneuroprotective protecting brain neurons from damage and death. Inaddition, acamprosate drugs are capable of protecting the culturedcells from severe damage due to inefficient blood flow (Litten et al.1996). These drugs also protect infant hamsters from extensive braindamage. In July, 2004 the drugs were approved by the food and drugadministration (FDA) in the United States. It is understood that thedrugs act on the brain pathways affected by alcohol consumption torestore normalcy (Anton et al. 2001). In many controlled clinicalstudies, the drugs have been found to be effective for alcoholdependent patients who had detoxed from alcoholism (Streeton &ampWhelan, 2001). In many treated subjects, it was revealed that, thedrugs were able to enhance abstinence from alcohol consumption(Litten et al. 1996).

Inaddition, the acamprosate drug has been found to have low levels ofaddiction. However, the drug is known to have adverse effects such asdiarrhea, flatulence, nausea and headache (Streeton &amp Whelan,2001). In other studies conducted to examine the effectiveness ofacamprosate drugs and the psychotherapy approach, it was found thatthe drug was safer and effective in the number of days the patientremained sober (Litten et al. 1996). In another study in Brisbane,Princes Alexandra Hospital, it was found that a combination ofacamprosate, naltrexone and cognitive behavioral therapy producedmore improved results (Roozen et al. 2006).

Naltrexoneis another medication drug used in the treatment of alcoholism. Thedrug antagonizes the opioid receptors to avert alcohol dependence. Itis commonly marketed as Revia, Hydrochloride salt or Depade. Unlikeearlier medications for alcohol treatment, naltrexones have beenfound to be less addictive and help in antagonizing opioid receptorsin the brain. The drug has other uses but the main use is in thetreatment of alcoholism dependence. It was approved after consecutivestudies produced positive results of its efficacy in the 1994.

Inone study by the combined study, the drug was found effective withoutusing other combination therapeutic methods. Individuals are supposedto take a 50mg per day. Naltrexone is effective in preventing relapseafter abstinence according to several clinical studies. Among theheavy drinkers, the drug was found to be effective in reducingdrinking level while patients continued taking the drug. As such,some researchers have argued that the drug is more effective forindividuals who have not yet abstained from alcoholism. Naltrexonehas been found to be more effective in treating alcohol dependencethan treating opioid addictions it reduces cravings and the euphoriceffects of alcohol (Miller, 1997).

Thedrug is administered through intramuscular once in a month in a doseof 380mg. Result studies indicate that after alcoholics wereadministered with the drug, it resulted into decreased alcoholconsumption among heavy drinkers. The approval of the drug waspraised for the significant results produced in reducing patients’alcohol cravings. However, the naltrexone has been found to causeadverse effects on patients. In some cases, naltrexone was found tocause liver damage, abdominal cramping and diarrhea (Streeton &ampWhelan, 2001). Many clinical studies support the effectiveness ofnaltrexone and acamprosate drugs in managing alcoholism problem. In apool of many placebo clinical studies, collected data indicates thatmany patients remained sober after getting drug treatment.

Controlledtrials have been used to investigate the efficacy of naltrexonedrugs. In these studies, results indicated that patients had lowcravings after a period of naltrexone drug use. When paired withother psychotherapy methods such as the AA, coping skills therapy andsupportive therapy, the drug medications were found to be moreeffective in enhancing total abstinence (Streeton &amp Whelan,2001). Naltrexone does not lead to total abstinence from alcoholism,but it reduces heavy drinking, cravings for alcohol and prolongs therelapse time (Roozen et al. 2006). Therefore, naltrexone is usefulfor patients who cannot control their cravings for alcohol in theinitial stages of recovery. The efficacy of naltrexone depends on thelength of the time patients’ uses the medications as well as acombination of other psychosocial therapies (Miller, 1997).Naltrexone drugs are effective in breaking the vicious cycle ofself-destruction in which alcoholics are unable to control theirdrinking habits. Using these drugs helps in minimizing the clinicalharm that may be associated with heavy drinking (Streeton &ampWhelan, 2001).

Inpractical terms, medication drugs are effective in that they enhancemotivation to proceed with the treatments, avoid relapse and whencombined with necessary psychosocial therapies leads to positiveresults. In the case of naltrexone drugs, prior abstinence fromalcohol is not required, and extended use of the drugs is helpful(Streeton &amp Whelan, 2001). Other drugs used in the treatment ofalcoholism include the Benzodiazepines, calcium carbamide andDisulfiram among others. Benzodiazepines are used when there areacute withdrawal problems, and its prolonged use is prohibited. Inthis medication, alcoholics have a lower chance of attainingabstinence and as such it is only effective in managing anxiety andinsomnia effects (Maxwell &amp Shinderman 2000).

Theuse of benzodiazepines leads to relapse cases and individuals usingit should not be abruptly withdrawn from its usage rapid withdrawalleads to extreme anxiety and panicking. Calcium Carbamide interfereswith alcohol metabolism when used by patients leading to severecomplications such as respiratory problems, nausea, and headache andvomiting. Disulfiram drugs create severe discomfort to victimsbecause it inhibits elimination of acetaldehyde (ethanol metabolismbyproduct) in the body this in turn discourages alcoholics fromdrinking (Miller, 1997).

Researchershave argued that, a combination of medication and psychotherapy is aneffective method of managing alcoholism. Combining acamprosate andnaltrexone produces positive results in reducing alcoholism intakeand cravings acamprosate reduces cravings after alcohol withdrawalwhile the naltrexone reduces cravings during heavy drinking. As such,a combination of the two drugs prevents the patient from relapsingback to alcohol and aid in abstaining. However, good timing, dosage,managing side effects and the duration of treatment is required toproduce effective results. Several debates have also been raised onthe effectiveness of the doctor method (use of drugs) in treatingalcoholism (Roozen et al. 2006).

Thereexists strong evidence on the efficacy of pharmacotherapy naltrexoneand acamprosates effectiveness is rated higher than that ofdisulfiram and calcium carbamide (Miller, 1997). However, theeffectiveness of this pharmacotherapy involved the supportive effortsof psychosocial therapies. It is recommended that all patients whoare alcohol dependent undertake both the psychosocial and themedication treatment to facilitate a more effective treatment ofalcoholism problem. It has been revealed that, patients attainedabstinence after receiving medication and psychosocial treatments(Maxwell &amp Shinderman 2000). The effectiveness of naltrexonetreatment is supported by many Meta-analysis studies when comparedto placebos, naltrexone treatment was found to reduce alcoholconsumption and relapse rates. Therefore, the drugs are moreeffective in alleviating relapses and abstinence among individuals(Miller, 1997). Evidence from different studies suggests thatcombining acamprosate and naltrexone produced more positive resultsin the relapse rate than when using A single drug. However, otherstudies indicate that the drugs are more effective when used alonesince the drugs operate differently in the brain, it is not advisableto use them at the same time (Streeton &amp Whelan, 2001).

SummaryDrugs or group therapy? Which is effective?

Insummary, it can be deduced that there is sufficient evident that themedical approach works in assisting alcoholics regain their sobriety.Drugs such as naltrexone and acamprosates have shown positive effectsin reducing cravings for alcohol consumption. The group therapy, onthe other hand, has shown effectiveness in attaining sobriety onpatients participating in group sessions. In all cases, there appearsevidence that patients were able to regain sobriety and maintainabstinence from alcohol.

However,assessing each of these methods of treating alcoholism indicatesunderlying differences. The AA group therapy has high attrition ratesthat affect the recovery of alcoholics there is strong evidence thatmajority of patients who joins the group therapies do not completethe full process. The medication approach is faced with side effectsthat may pose a threat to patient life. Although, in the medicaltreatment the rate of attrition or relapse is low, this method doesnot result in full abstinence from alcohol as most patients have notresolved to abstain from alcoholism. In most cases, individualsundergoing medication are referred to the psychosocial therapies tofacilitate effective treatment and eventual abstinence fromalcoholism.

Inthis case, evidence from different studies indicates that, foreffective alcoholism treatment, a combination of pharmacotherapy andpsychosocial therapy is important. The AA program combined withmedication would reduce dropout rates in the meeting as individualsalcohol cravings are reduced by drugs. The group therapy helps inbehavioral and psychological adjustment where individuals learn howto avoid alcohol consumption, associate with sober people. Notreatment is effective on its own both approaches have limitationsthat can only be rectified through combining the two methods.Alcoholics who take prescriptions for alcoholism may not achievealcohol abstinence if there are social influencers.

Inaddition, abstinence from alcohol is an individual resolve, and noamount of medication can alter this aspect. Therefore, a combinationof doctors’ prescriptions and group therapy creates a favorablecondition in which the drugs taken combined with behavioral andpsychological adjustment leads to easier alcohol abstinence. Inaddition, these combination leads to low side effects, and lowrelapse rate as individuals use less drug medication.


Fromthe assessment of this discussion easy, it is apparent that thereexist great controversies on the most effective method of addressingalcoholism. While the group therapy sessions and the medical approachprovide some grain of evidence on their effectiveness, more concretestudies based on unbiased approach need to be undertaken to delineatethe effectiveness of each method. Nonetheless, after a review ofMeta-analysis studies, it is evident that both psychosocial (grouptherapy) and medication are effective in assisting alcoholics refrainfrom uncontrolled alcohol consumption.

Thegroup therapy AA uses the theoretical perspective in influencingchanges on individuals’ psychological and behavioral aspects.Through sponsorships, regular meetings and undertaking a 12 steptherapy program, alcoholics are able to refrain from alcohol use,reduce alcoholism and relapse rates. On the other hand, medicationhas been found to be effective in reducing heavy drinking andenhancing a longer period of relapse among the patients. However, inmany studies a combination of doctors’ prescription andpsychotherapy methods have been touted as the most effective methodof creating positive results on abstinence, reducing recidivismeffects, enhancing behavioral changes and enhancing a productive lifefor the victim.


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