When to Use Psychosocial Interventions
Psychosocial interventions are used to engage a person’s interest and commitment to change and to teach the requisite skills to maintain that change. It is the preferred treatment modality for problem drinking by those with heavy alcohol use. They can be used by a range of health practitioners in a variety of treatment settings, but over 50% of people who drink prefer psychiatric or addiction specialist treatment. Specialist treatment produces better outcomes in patients with high severity of dependence. Psychosocial interventions can be implemented individually or in groups. Some health practitioners prefer to use motivational strategies in the early stages of therapy, to increase preparation for change, supplementing with more cognitive-behavioural or other specialised therapy, as appropriate. Clinicians who use these approaches must be appropriately trained and competent in their application.
Psychosocial interventions vary in intensity, from brief to intensive and specialised (e.g. Cognitive Behaviour Therapy, couples therapy). Brief interventions are most suited for people with non-dependent alcohol use (see Chapter 6). More intensive psychosocial interventions, described in this chapter, are appropriate for people with more established alcohol problems for whom brief interventions are not sufficient (i.e., alcohol dependence).
In general, low intensity psychosocial interventions are indicated for people with less severe dependence (e.g., Motivational Interviewing), increasing the level of intensity for those with more severe dependence. Models of care to help clinicians make decisions about appropriate interventions are presented in Chapter 5.