This literature review is written to discuss the assessments and treatments associated with alcohol use disorder which is commonly known as alcoholism. It will cover information from the DSM and indicators that social workers should be aware of in order to help their clients. The types of assessments used on the client and the actions used to treat the problem of alcohol use disorder will be covered as well.
Alcohol is used in many of our entertainment activities (Begun, et al. 2015). It is served at celebrations such as weddings, birthday parties and at sporting events (Begun, et al., 2015). Alcohol has been said to have some health benefits for the heart and to have have the ability to lower stress levels (Begun et al., 2015). Alcohol use has increased over the last few years (Begun et al., 2015). It is often misused when people drink large amounts (Begun, et al., 2015). It is one of the most common of the psychoactive substances that people choose to abuse (Begun, et al., 2015). Currently, alcohol use disorder is so common that 17 million people that are over 12 years of age (Putney et al., 2017).
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is used to classify mental disorders into categories for medical use (American Psychiatric Association, 2013). It lists symptoms of disorders and helps with diagnosing those disorders (American Psychiatric Association, 2013). The Diagnostic and Statistical Manual of Mental Disorders (DSM) is also known more commonly as the DSM-5 because it is on its 5th edition (American Psychiatric Association, 2013). There are characteristics listed in the DSM-5 that indicates what classifies as alcohol use disorder (American Psychiatric Association, 2013). If a person meets 2 of the symptoms, they can be said to have alcohol use disorder (American Psychiatric Association, 2013).
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The more symptoms the person has the more severe the disorder (American Psychiatric Association, 2013). Increased drinking and being unable to cut back on drinking are symptoms (American Psychiatric Association, 2013). Needing to drink more each time to have the same effect as before is a symptom (American Psychiatric Association, 2013). Drinking that causes a person to neglect their family or job is a symptom (American Psychiatric Association, 2013) Participating in risky behaviors such as unprotected sex or drinking and driving are also symptoms of alcohol use disorder (American Psychiatric Association, 2013).
Alcohol use disorder is a very common problem that causes many deaths that could be prevented without the use of the drug (Putney et al., 2017). It causes physical and mental problems with a person’s health (Begun et al., 2015). These effects may include increased stress, sleeping less, eating less, being easy to anger, and difficulty concentrating (Harikrishnan and Ali, 2016). It not only affects the individual person but also their families (Begun et al., 2015). Depression and anxiety are common among those who abuse alcohol (Blevins et al., 2017). People with chronic pain are more likely to abuse the substance when they are trying to take care of the pain (Blevins et al., 2017). Alcohol use disorder is also associated with death from heart disease, stroke, and cancer (Begun et al., 2017). Suicide, partner violence, and child abuse are also sometimes related to alcohol as well (Begun et al., 2017).
Alcohol use disorder is usually not the reason a client comes to a social worker but provides the opportunity to combat this issue (Dance et al., 2014). The alcohol abuse could be based on not having their needs met and the client may be using it as a coping mechanism (Dance et al., 2014). Social workers are in a great position when doing assessments to screen a person for alcohol use disorder and are usually the first providers that the clients meet (Putney et al., 2017). They must build a rapport with the client in order to have the client be receptive to the referrals for treatment (Harikrishnan and Ali, 2016).
Often social workers are not adequately trained to identify alcohol use disorder in their clients (Putney, et al., 2017). Social workers generally have their own ideas about alcohol use disorder (Livingston, 2014). Personal experiences from themselves or family tend to shape their attitudes and understandings (Livingston, 2014). It is important for those biases not to be mixed in with the proper knowledge and training a social worker should receive to assess clients for alcohol use disorder (Livingston, 2014).
Confidence is also a factor in social working not screening clients properly (Livingston, 2014). Some may have opinion the treatment can only be done by a specialist (Livingston, 2014). Education and training tools are needed to improve the social worker’s knowledge in this matter (Livingston, 2014). It is key to the effectiveness of a social worker’s practice with a person who has alcohol use disorder (Livingston, 2014).
Treatment attempts started back in the 1750s (Dance et al., 2014). There are several ways to provide treatment. Some of these include medication, therapy, counseling, inpatient treatment and outpatient treatment (Harikrishnan and Ali, 2016). Outpatient treatment gives the patient the freedom to continue normal life and take care of responsibilities while receiving treatment (Klinger et al., 2018). Inpatient treatment involves living at a place that specializes in treatment for a frame of time (Klinger et al., 2018) It provides more structure and is more intense than outpatient treatment (Klinger et al., 2018).
Screening, Brief Intervention, and Referral to Treatment or SBIRT involves using screening tools to determine risk (Putney et al., 2017). The Substance Abuse and Mental health Services Administration gave training grants for SBIRT training of social workers and many students were satisfied with the type of screening and the training for the screening (Putney, et al., 2017). The results of the screening allow a social worker to help a person change their behavior and link them to treatment for their disorder (Putney et al., 2017).
Under a third of patients are screened using this tool leaving many without the much-needed intervention benefits that the SBIRT tool can bring (Putney et al., 2017). Motivation enhancement tools or MET can be used to draw on a client’s resources and motivate them for positive changes (Harikrishnan and Ali, 2016). It is a good tool even when the client will only have a few sessions (Harikrishnan and Ali, 2016).
The outcome that most social workers aim for is a client’s abstinence (Witkiewitz et al., 2016). It is being suggested that low-risk drinking is possible to obtain during treatment (Witkiewitz et al., 2016). In a study about low-risk drinking, it was found that those who were heavy drinkers are likely to go back to heavy drinking with this treatment (Witkiewitz et al., 2016). Those who drink heavily some days but have low-risk drinking on other days had greater abstinence after the treatment (Witkiewitz et al., 2016). Those who only engaged in low-risk drinking also were likely to be abstinent after their treatment (Witkiewitz et al., 2016). 17% of those in the treatment were able to stick to low-risk drinking (Witkiewitz et al., 2016). Negative moods played a factor and resulted in more drinking (Witkiewitz et al., 2016).
Distance to treatment also seems to matter in the outcomes of a client’s treatment (Klinger et al., 2018). Each time the driving distance to treatment is increased by 10 minutes the odds of the client attending the treatment are cut in half (Klinger, 2018). Those who had to travel to areas with more crime also had lower rates in the likelihood that they would continue to attend treatment (Klinger et al., 2018). A client is more likely to complete the needed treatment when they live in urban areas but if the distance was over 4 miles the likelihood decreased (Klinger et al., 2018). When a client does not complete the treatment, stays less time in treatment, or attends outpatient treatment for lessened lengths of time it makes for worse outcomes from the treatment (Klinger et al., 2018).
The distance to a treatment center that does meetings such as Alcoholics Anonymous may also deter the treatment if the client lives further away (Klinger et al., 2018). For clients being near their own family and community seems to have a positive outcome on recovery efforts effectiveness (Klinger et al., 2018). A social worker will need to be aware of this in order to link patient’s with treatment resources that are local to them to improve their recovery prognosis (Klinger et al., 2018)
It is important for a client to have skills to help them overcome cravings and prevent relapse (Harikrishnan and Ali, 2016). Harikrishnan and Ali list the “5 Ds” as skills to manage the cravings. These include delaying, deep breathing, distraction, drinking water, and discussion (Karikrishnan and Ali, 2016). Avoiding the situations in which they will be tempted is a coping skill that is important (Karikrishnan and Ali, 2016). Group work is an intervention that is used in both inpatient and outpatient settings (Karikrishnan and Ali, 2016). The groups consist of other people with alcohol use disorder that share their experiences (Karikrishnan and Ali, 2016). This discussion helps the clients gain coping skills and learn how to solve problems (Karikrishnan and Ali,2016). The discussions also help with the client maintaining abstinence (Karikrishnan and Ali, 2016).
Another version of outpatient treatment that may be used after inpatient treatment is intensive outpatient treatment (Blevins et al., 2017). These include more hours than other outpatient treatments (Blevins et al., 2017). This aftercare treatment increases success rates (Blevins et al., 2017). Sometimes medication is also prescribed and it can improve the rate of success as well (Blevins et al., 2017). Aftercare is vitally important and social workers should attempt to reach out to clients who are not following up with their treatment (Blevins et al., 2017).
It is vitally important for the social worker to have at least a basic understanding of alcohol use disorder, how to do an assessment and available treatment options (Dance et al., 2014). A social worker’s goal is to help the client have their needs met and often the alcohol abuse is a sign of other issues (Dance et al., 2014). When the social worker uses screening techniques, the client can be linked to much-needed services to assist them with alcohol use disorder and other problems in their lives (Harikrishnan and Ali, 2016). With proper training, a social worker can improve a client’s odds of abstinence and help them with aftercare (Harikrishnan and Ali, 2016).
