Summary

There is strong support for the efficacy of cognitive behaviour therapy (CBT) as a standalone treatment. It should be employed as a first-line psychosocial intervention for alcohol dependence. There is also support for motivational interviewing in the short-term and in less severe dependence. Because of its brief duration, motivational interviewing is commonly employed as a prelude to CBT to resolve ambivalence about abstinence and strengthen motivation to change. Individual cognitive-behavioural interventions, when delivered in isolation, vary in their effectiveness and outcomes tend to be better when delivered in combination (e.g., coping skills training combined with relapse prevention). For patients unwilling to pursue abstinence, behavioural self-control training (controlled drinking) is more effective than no treatment and can be offered for patients considered suitable for a moderation goal by their health practitioner.  

Effective CBT involves developing a comprehensive case formulation to guide treatment. This formulation details the cognitive, affective, and situational triggers for drinking as well as related clinical issues faced by the patient (e.g., insomnia, depression, anxiety; see Chapter 21 and Chapter 22). CBT encompasses a large collection of therapeutic strategies. Choice of therapeutic strategy is informed by the case formulation. For example, sleep hygiene alone may be effective for insomnia in some alcohol-dependent patients, but not for insomnia caused by an underlying anxiety disorder. 

There is less evidence for contingency management and residential rehabilitation programs, and insufficient evidence for mindfulness-based relapse prevention, acceptance and commitment therapy, solution-focused approaches, psychodynamic therapy, narrative therapy, or other counselling techniques for alcohol dependence.