In December 1886, Samuel Gompers founded the American Federation of Labor, organizing only skilled workers and focusing on “pure and simple” unionism that rejected state intervention. Origin of intervention1 Add intervention to one of your lists below, or create a new one.
Mental Preparedness: Understanding Addiction and Recovery
- Could that be about to change with direct intervention from the Oval Office?
- Participants must understand the potential reactions of the loved one, such as denial, anger, or even walking out of the intervention.
- Future research is also needed to examine how mHealth interventions can be better adapted to match the user’s level of alcohol consumption,232 and to investigate the impact of moderators such as sex, age, race, and comorbid psychiatric disorders on the efficacy of technology-based drinking reduction interventions.
- The interventionist can also be there to moderate the flow of the intervention as well as handle any high emotions that may arise.
- Find literacy, mathematics and behavior resources to help intensify interventions
Adopting valid non-abstinent drinking reduction measures may benefit research (and ultimately, treatment) if such drinking reductions are more sensitive indicators of treatment efficacy (including both behavioral and medication-assisted treatment) than the outcome measures now commonly used. Thus far, several clinical studies have demonstrated clinical benefit from reductions in WHO drinking risk levels. For example, MAT efficacy trials for AUD have been small, especially when compared to trials of treatments for other major public health problems such as cardiovascular disease.89 Other methodological challenges faced by trials to treat AUD involve recruitment and retention, inclusion/exclusion criteria, measurement of medication adherence/intervention fidelity, timing of assessments, statistical analyses, and the outcome measures used.191,192 Several other medications are now being evaluated in the United States for treating heavy drinking and AUD, including varenicline, gabapentin, topiramate, zonisamide, baclofen, ondansetron, levetiracetam, quetiapine, aripiprazole, and serotonin reuptake inhibitors.179 Although none of these are FDA-approved for treating AUD, they are sometimes used off-label for that purpose. The latter group of medications may be used “off-label” to treat heavy drinking or AUD, and some are recommended as second-line medications in clinical guidelines published by healthcare entities (e.g., U.S. Veterans Administration and Department of Defense) or professional groups (e.g., American Psychiatric Association). Brief intervention has limited effectiveness among individuals with more severe alcohol problems,42,48-59 including many who screen positive using the most widely used screening instruments.
Another opioid receptor antagonist, nalmefene, is approved for treating AUD in Europe but not the United States.158 A recent meta-analysis of five RCTs among 2,567 participants found that participants taking nalmefene had fewer HDD during treatment and lower total alcohol consumption than those taking placebo.178 However, there was considerable dropout in the nalmefene groups, often due to adverse effects, which may limit its utility in treating AUD. Although the medication is assumed to correct an imbalance between GABA and glutamate, thus easing the negative effects of quitting drinking, a more precise understanding of its mechanism of action is lacking.177 A recent meta-analysis of 27 studies found that although acamprosate had no effect on relapse to heavy drinking, it produced a 9% reduction in the risk of relapse to any drinking.62 From 1949 until 1994, disulfiram was the only medication available in the United States for treating patients with alcohol dependence. CM involves the systematic reinforcement of desired behaviors (using vouchers, privileges, prizes, money, etc.) and the withholding of reinforcement or punishment of undesired behaviors.134 Evidence supports the effectiveness of CM to improve medication adherence for AUD.134 There is less evidence available for the effectiveness of CM to treat AUD in its own right.135 A central challenge in implementing CM is the lack of biomarkers to detect alcohol use beyond the previous 12 hours.136 Adolescence is a critical period for the initiation of alcohol use as the age at first drink occurs, on average, at 14 years in the United States26 and 17 years globally.27 Therefore, efforts to prevent heavy drinking and AUD are often targeted at youth before they usually begin drinking, and most of these efforts are implemented through schools. In this report, we review existing information and recent developments in the prevention, identification, and treatment of heavy drinking and AUD.
However, a recent systematic review concluded that digital interventions were not consistently effective in people with AUD, and the heterogeneity of interventions, particularly in terms of their complexity, made reaching a consensus about their overall effectiveness challenging.219 The review also noted that many interventions did not report on outcomes other than changes in drinking levels, such as psychological health or social functioning.219 The complexity of AUD, which is characterized not only by compulsive alcohol use, but also by loss of control over alcohol intake and a negative emotional state when not using, may increase the challenge of addressing it through a digital platform. Research to identify and develop medications with greater efficacy that can gain widespread clinical acceptance in treating heavy drinking and AUD remains a high priority.20 However, several methodological barriers impede this effort and the ability to marshal stronger evidence of efficacy for approved medications. Early efforts that used medications such as antidepressants, benzodiazepines, and lithium based on their efficacy in treating the primary psychiatric disorder had mixed success.183 Such efforts were based on the hypothesis that a reduction in psychiatric symptoms would reduce drinking by reducing the motivation for self-medication with alcohol. Another medication, nalmefene, is approved by the European Medicines Agency (EMA) for treating AUD.158 U.S. guidelines recommend that MAT, often in combination with a behavioral intervention, be offered to patients with a clinical indication (e.g., a positive screening test or relevant physical symptoms) of AUD.34,62 We describe and review the evidence of efficacy and acceptability for each of these medications, and discuss medications that may be used off-label to treat AUD. Consensus exists that there are several evidence-based behavioral interventions that can be used to treat heavy drinking and AUD (Table 1). SBIRT has been implemented across a range of clinical care settings around the world, including hospital emergency departments, community health clinics, specialty medical practices (e.g., sexually-transmitted disease clinics), primary care, and other community settings.93 In the United States, in response to an Institute of Medicine call for increased community-based screening for health risk behaviors (including alcohol use),94 SBIRT has been scaled up substantially over the past 15 years.37 For example, the U.S.
What is Involved with an Intervention?
Participants should be mentally and emotionally prepared, with contingency plans in place to handle potential reactions from the loved one, such as acceptance, denial, or defensiveness. The journey to a successful intervention begins long before the actual event. Careful planning is crucial for the success of an intervention to prevent conflict and resentment. Laying the groundwork for transformation forms a vital component of an intervention.
Heavy drinking and alcohol use disorder (AUD) are major public health concerns
- The use of different measures of alcohol consumption (e.g., heavy drinking, binge drinking) and alcohol-related disorders (e.g., harmful drinking, alcohol dependence, AUD) throughout the literature poses challenges to generalizability across studies.
- Although studies that showed a medium effect size for treating depression also yielded a medium effect size in reducing substance use, studies that showed smaller effects on depression did not yield beneficial effects on substance use behavior, leading to the conclusion that it is necessary to treat both disorders.
- Another good way to determine if it’s the right time for an intervention is to assess whether the person seems out of reach.
The presence of professional interventionists increases the likelihood of successful interventions by guiding dialogue and helping the family express their concerns and love effectively. The participation of friends and colleagues in the intervention underscores the message that the individual’s alcohol abuse has repercussions that extend beyond the immediate family. Friends and colleagues can offer a different perspective on the loved one’s behavior, shedding light on the effects of addiction or mental health issues in settings like the workplace and in social activities. They provide personal insights and emotional support that can be pivotal in persuading the loved one to seek treatment.
Evidence-based behavioral interventions for heavy drinking and AUD
Definition of intervention noun from the Oxford Advanced Learner’s Dictionary Could that be about to change with direct intervention from the Oval Office? The restructuring is also to align better with district literacy and intervention goals, which will make a larger impact, Mitchell said.
Family Members’ Involvement
Perhaps as important as who gets invited is who shouldn’t participate, including anyone the person doesn’t like or someone who doesn’t like them, or someone who may be at risk of sabotaging the intervention. Given that alcohol use and binge drinking have increased more in adult women than men over the past several years,2,243 more research is needed on prevention and treatment efforts that address the specific needs of adult women. More complete knowledge of how individual-level and socio-ecological-level factors interact in the prevention and treatment of AUD would facilitate better targeting of prevention efforts, a particularly important concern given the limited resources available to minimize alcohol-related morbidity and mortality.
The use of technology to prevent and treat heavy drinking and AUD
Family, friends, and colleagues bring unique insights to the process of the intervention through their personal relationships with the loved one. Each team member has the responsibility to communicate their concerns and support for the loved one in a non-confrontational manner. Typically composed of family, friends, colleagues, and a professionally trained and credentialed interventionist, each member plays a distinct role in the process of the intervention. Participants should educate themselves about the disease of addiction to manage the situation effectively when disease symptoms arise during and after the intervention.
Providing a stable environment that minimizes stress and triggers can significantly support someone who has accepted treatment, giving them time to heal without enabling substance use behaviors. Continuing care, also known as aftercare or follow-up care, consists of ongoing treatment and support following the completion of a structured program. After an intervention, clear steps and expectations should be communicated to maintain the momentum towards recovery, with interventionists guiding clients towards appropriate community treatment facilities and resources. A personalized treatment plan that caters to an individual’s unique needs is crucial in addiction recovery. Treatment options can range from medication-assisted treatment, behavioral therapies, and support groups. Gaining knowledge on the available treatment is marijuana addictive national institute on drug abuse nida types marks an essential step towards a loved one’s recovery.
According to multiple reviews, there is clear and consistent evidence that regulating the availability of alcohol is efficacious and cost-effective in reducing overall alcohol consumption and alcohol-related harm.233,234 Limiting alcohol availability is achieved by increasing the price of alcohol, mainly through taxation, which deters consumption because of the increased cost. The use of digital technology to prevent and treat heavy drinking and AUD is often called eHealth (electronic-Health) or mHealth (mobile-Health). Evaluating the efficacy of treatments for AUD should be placed in the context of evaluating the efficacy of medicines for other chronic conditions (e.g., depression, diabetes) in which a “perfect” outcome is not required for treatment to be considered successful. Despite the availability of medications with demonstrated efficacy for treating AUD, they are widely underutilized. Although studies that showed a medium effect size for treating depression also yielded a medium effect size in reducing substance use, studies that showed smaller effects on depression did not yield beneficial effects on substance use behavior, leading to the conclusion that it is necessary to treat both disorders. Evidence has been mixed on the efficacy of these medications, their side effects, and acceptability.180 Baclofen and topiramate currently have the most support for efficacy.181,182
These strategies can help them stay on track and continue their journey towards a healthier life. When treatment is accepted, it marks the beginning of a new journey towards recovery. Both scenarios represent different challenges and require unique approaches to ensure the best outcome for the individual and their loved ones. In the subsequent subsections, we’ll outline the measures to be taken when treatment is accepted and strategies to manage situations when treatment is refused.
Careers
The process of an intervention is pivotal in helping the individual recognize the extent of their substance abuse and addiction and the support system’s willingness to assist them. However, actual intervention is much more than mere confrontations; it is a structured approach designed to address alcohol, substance abuse, and offer options to overcome addiction and initiate a natural healing process. This way, the interventionist can present the variety of intervention models that are available and begin to prepare each family member, loved one, friend and colleague before the actual intervention. An intervention can be a highly emotional experience and a trained, qualified interventionist can help walk all the loved ones through the experience and recommend treatment centers if needed.
Higher Education Faculty
That group will then go on to form the intervention team—the larger group of friends and relatives who will be participating in the intervention. Most intervention specialists will also sit through the actual intervention with you, in order to help facilitate conversation and be on hand should anything go wrong during or after the event. This person will help guide you through the difficult process, with advice on where to hold the intervention, who to invite, and how the event should play out. Another good way to determine if it’s the right time for an intervention is to assess whether the person seems out of reach. Before preparing for an intervention, you might want to consider whether it’s the right time for an intervention.
Emotional Readiness: Bracing for the Intervention
Addiction treatment options may include treating disease symptoms for not only substance use disorders but medical procedures that have been pushed to the side due to addiction. Qualified mental health professionals with specific training and experience in addiction treatment are often are trained and certified interventionists. You can also give yourself the best chance possible at making an impact by planning the intervention for a time and day when your loved one is less likely to be drinking and more likely to be relaxed and open-minded. Most intervention specialists have the credentials to facilitate group therapy sessions but many also have additional training in dealing with mental health crises that may arise during or after interventions.
Perhaps even more important than the intervention itself is what happens afterward. Still, even if your loved one doesn’t lash out, he or she may still refuse your request to go to rehab. Open body language, positive affirmations, and controlled tempers during the intervention are also useful. In terms of what non-professionals can do, a good strategy is to plan ahead on how to address any possible objections your loved one may raise. Once an intervention kicks off, it can be very hard to predict a person’s behavior. It’s quite possible that the response to the intervention will not be good, and you should hope for the best, but prepare for the worst.