Alcohol Use: Assessment, Withdrawal Management, Treatment and Therapy: Ethical Practice

Acknowledgement
Contents
Editor and Contributors
About the Editor
Contributors
1: Introduction
1.1 Introduction
1.2 Description
1.3 Terminology
1.3.1 Alcohol Use
1.3.2 Problem(S) and Disorders
1.3.3 Individual, Person, People
1.3.4 Professional
1.3.5 Never Presume
1.4 Conclusion
2: Alcohol Use
2.1 Alcohol
2.1.1 Current Levels of Alcohol Use
2.1.2 Deaths from Alcohol Dependence
2.1.3 Treatment for Alcohol Use Disorder
2.2 Including the Family in Treatment
2.2.1 Indications and Impacts for Families and Communities: Physical, Psychological, Social
2.2.2 Effects on Family Relationships
2.2.3 Effects on Family Finances
2.2.4 Domestic Violence
2.3 Diagnosis and Assessment for Alcohol Dependency
2.3.1 Assessment
2.3.2 Mental Health Status Examination (See Chap. 5)
2.3.3 Key Assessment Points
2.3.4 Screening Tools: Severity of Alcohol Dependence Questionnaire (SADQ-C)
2.3.5 Screening Tools: The AUDIT Questionnaire
2.4 Effects of Alcohol Consumption
2.5 The Disease Burden from Alcohol Use Disorders
2.6 Mental Health Disorders as a Risk Factor for Alcohol Dependency
2.7 Stigma, Burden, Support, and Best Practice
2.7.1 Guidelines: Safe Levels of Alcohol Consumption
2.8 Intervention and Treatment Options (What Is Out There to Support?)
2.8.1 Interventions: Rehabilitation Services
2.8.2 Detoxification
2.8.3 Relapse Prevention and Harm Minimization (See Chap. 22)
2.8.4 Talking Therapies (Psychological)
2.8.5 Motivational Interviewing (See Chap. 23)
2.8.6 Motivational Interviewing: The Distinct Phases of the Trans-Theoretical Model of Change
2.8.7 Solution-Focused Brief Therapy
2.8.8 Cognitive Behavioral Therapy (CBT)
2.9 Chapter Summary
2.10 Conclusion
References
To Learn More
Useful Resources/Websites
Alcohol Rehabilitation Guide
Hello Sunday Morning
Drinkaware
Alcohol Help Centre
Rethinking Drinking
3: Transcultural Considerations
3.1 Multicultural Treatment in Behavioural Healthcare
3.2 Access and Utilisation of Behavioural Healthcare
3.3 Approaching Multicultural Treatment
3.4 Multicultural Competencies
3.4.1 The MCC Approach Stipulates Three Broad Ideas
3.5 Multicultural Psychosocial Approaches
3.6 Pluralism
3.7 Multicultural Orientation (MCO)
3.8 Illness Myth
3.9 Identifying Professionals’ Multicultural Practices
3.9.1 Feedback-Informed Cultural Practice
3.10 Implications for Practitioners
3.11 Family Considerations
3.12 Ethical Considerations
3.13 Conclusion
References
To Learn More
4: Lesbian, Gay, Bisexual, Transgender and Questioning+ (LGBTQ+)
4.1 Introduction
4.2 Being LGBTQ+
4.2.1 Terminology
4.2.2 Gender Identity
4.2.3 What Do We Mean by ‘Coming Out’?
4.3 A Theoretical Framework: The Minority Stress Model
4.4 Impact of Discrimination on the Individual’s Psychological Health and Well-Being
4.5 LGBTQ+ and the Family
4.6 Conclusions
References
To Learn More
Useful Resources
5: Mental Health Problems Associated with Alcohol
5.1 Problems Associated with Co-occurring Diagnosable Psychological Distress and Alcohol Use
5.2 Language of Addiction and Mental Health
5.3 The Language of Alcohol Use
5.4 Alcohol and Mental Health in the UK: Context and Current Challenges
5.5 Falling Through the Cracks
5.6 Epidemiological Evidence
5.7 Aetiology: The Chicken or the Egg Paradox
5.8 Serial, Parallel and Integrated Treatments
5.8.1 The Serial Treatment Model: One Disorder at a Time Please!
5.8.2 The Parallel Treatment Model: Two Disorders—Two Doors
5.8.3 The Integrated Treatment Model: Two Disorders—One Door
5.8.3.1 Disorder-Centred Care
5.8.3.2 A Different Focus: No Disorders
5.9 Acceptance and Commitment Therapy
5.10 Role of Family
5.11 Ethical Considerations
5.12 Transcultural Considerations
References
To Learn More
6: Physical Problems Associated with Alcohol
6.1 Intoxication
6.1.1 Absorption
6.1.2 Metabolism
6.1.3 Clinical Effects
6.1.4 Effects on Driving
6.2 Acute Confusion and Agitation
6.2.1 Wernicke-Korsakoff Syndrome
6.2.2 Hepatic Encephalopathy (HE)
6.2.3 Hyponatremia and Other Electrolyte Disturbances
6.2.3.1 Hyponatremia Is Common and Can Contribute to Confusion
6.2.3.2 Hypophosphatemia Is Also Common
6.3 Chronic Confusion
6.4 Difficulty with Walking: Cerebellar Ataxia, Wernicke’s Encephalopathy, Peripheral Neuropathy
6.5 Abdominal Pain
6.6 Alcohol-Related Liver Disease
6.7 Alcohol-Related Malignancies
6.8 Conclusion
References
To Learn More
7: Alcohol Use in Forensic Mental Health and Criminal Justice Settings
7.1 Introduction
7.2 Alcohol Use in Forensic Mental Health Services and the Criminal Justice System
7.3 Theories on the Link between Alcohol and Crime
7.4 Framework for Assessment and Treatment
7.5 Assessment
7.6 Therapeutic Treatment Options
7.7 Challenges of Assessment and Treatment
7.8 Family
7.9 Conclusion
References
To Learn More
8: Supporting and Including Families in Professional Care for Alcohol Use
8.1 Family Involvement
8.2 Sometimes a Complex Ethical Dilemma
8.3 The Family and Identification of Alcohol-Related Problems
8.4 The Family and Interventions Related to Alcohol-Related Problems
8.4.1 Why Is It an Ethical Decision to Involve the Family?
8.4.2 The Family and the Treatment Journey
8.4.3 The Family and the Assessment of the Seriousness of an Alcohol Problem
8.4.4 The Family and Withdrawal Management (If Necessary)
8.4.5 The Family and Motivating Problem Alcohol Users to Accept Help
8.4.6 The Family and Involvement in Treatment or Interventions
8.4.7 The Family and Their Own Support Needs
8.5 Cross-Cultural Factors
8.6 Conclusions
References
To Learn More
9: Responses and Referral
9.1 Introduction
9.2 Important Therapeutic Principles
9.3 Trauma-Informed Care
9.4 Core Conditions
9.5 Mentalising Conversations
9.6 Initial Assessment/Screening (See Chap. 10)
9.7 Brief Interventions (See Chap. 17)
9.8 Brief Advice
9.9 Extended Brief Interventions
9.10 Referral to Specialist Alcohol Services
9.11 Service Design and Accessibility
9.12 Conclusion
References
To Learn More
10: Assessment
10.1 Introduction
10.2 Therapeutic Presence and the Assessment of Alcohol Use
10.3 Harmful Use of Alcohol Across the Lifespan
10.4 Ethical Considerations in the Assessment of Alcohol Use
10.5 Conclusion
References
To Learn More
11: Child, Adolescent and Young Adult
11.1 Introduction
11.2 The Prenatal Period and Alcohol
11.3 The Childhood Years
11.4 The Teenage and Young Adult Years
11.5 Conclusion
References
To Learn More
12: Alcohol Use During Pregnancy and Its Impacts on a Child’s Life
12.1 Introduction
12.2 What Is Fetal Alcohol Spectrum Disorder (FASD) and How Common Is It?
12.3 Historical Developments in Awareness of FASD and the Impact of Alcohol on the Developing Fetus
12.4 Diagnosis of FASD
12.5 Diagnostic Process
12.5.1 Overlapping Exposures and Other Adverse Childhood Experiences (ACEs)
12.6 Exposures to ACEs and Other Substances Complicate the Diagnosis of FASD
12.7 Role of the Parent/Carer in Obtaining Diagnosis
12.8 The Impacts of Having FASD on the Individual and the Family
12.9 Treatment and Therapies to Support those Experiencing FASD
12.10 Transition from Child to Adult
12.11 Conclusion
References
To Learn More
Resources
13: Female Adult
13.1 Introduction
13.2 Alcohol Use in Context
13.3 Alcohol-Related Harm
13.4 Context of Vulnerability
13.5 Context of Comorbidity
13.6 Assessment
13.6.1 Aims
13.7 Care Planning
13.7.1 Involvement of Partners
13.8 Treatment
13.9 Withdrawal
13.9.1 Withdrawal Management
13.10 Pharmacotherapy
13.11 Other Interventions
13.12 Pregnancy Care
13.12.1 Pregnancy Advice and Education
13.13 Engagement
13.13.1 Child Protection Notification
13.14 Pregnancy Care Setting
13.15 Care Planning
13.15.1 Content of Care Plans
13.16 Treatment
13.17 Withdrawal
13.17.1 Setting
13.18 Pharmacotherapy
13.19 Ethical Issues and Dilemmas Arising from Harm to a Baby
13.19.1 Pre-discharge Information
13.20 Follow-Up Care
13.21 Ethical Issues and Dilemmas
13.22 Stigmatisation
13.22.1 Impact of Stigma on Healthcare Consumers
13.23 Self-Determination to Cease Treatment
13.24 Partner and Family Members Dominance and Coercive Control
13.25 Domestic Violence
13.26 Conclusion
References
To Learn More
14: Male Adult
14.1 Introduction
14.2 Male Alcohol Use in Context
14.3 Low-Risk Drinking Guidelines
14.4 Alcohol-Related Harm
14.5 Assessment
14.6 Treatment
14.7 Other Interventions
14.7.1 Specific Men’s Health Issues and Need for Education
14.8 Relationship Issues, Relapse and Relationship Counselling
14.9 Loss of Children and Adult Offspring
14.10 Ethical Issues
14.11 Increased Risk for Self-Harm and Suicide
14.12 Stigmatisation
14.13 Domestic and/or Family Violence
14.14 Interventions for Violence
14.15 Family Court Processes
14.16 Conclusion
References
To Learn More
15: Older Adult
15.1 Introduction
15.2 Screening, Prevention, and Intervention Within Primary Care
15.2.1 The Spectrum of Risk
15.2.2 Screening for AUD in Older Adults
15.2.3 Talking with Older Adults About Alcohol Risks and Harms
15.2.4 Care Pathways and Case Studies
15.3 Care Pathway for Moderate-Risk Drinkers
15.3.1 Care Pathway for Moderate-Risk Drinkers with a Moderate Alcohol Use Disorder
15.4 Care Pathway for Severe Alcohol Use Disorder
15.5 Assessment and Withdrawal Management Older Adult Considerations
15.5.1 Cognition
15.5.2 Psychosocial Supports
15.6 Conclusion
References
To Learn More
16: Binge Drinking
16.1 What Is Binge Drinking?
16.2 Epidemiology Perspectives
16.3 Biological Harms
16.4 Societal Harms
16.5 Specific At-Risk Groups
16.5.1 Lesbian, Gay, Bisexual Transgender and Questioning+ (LGBTQ+) Community
16.5.2 18–30 (University Students)
16.5.3 Learning Disabilities
16.5.4 Deaf and Impaired Hearing
16.5.5 Neurodiversity
16.6 Implications of Binge Drinking on the Family System
16.6.1 Binge Drinking During Pregnancy and Its Consequences
16.6.2 The Postnatal Period
16.6.3 Childhood
16.7 Brief Interventions
16.7.1 Assessment
16.8 What Clinical Interventions Are Available to You?
16.9 Interventions
16.10 Plan
16.11 Looking for Triggers
16.11.1 Preparing for Change
16.11.2 Look for Alternatives
16.11.3 Motivation Card
16.11.3.1 Instructions
16.11.3.2 Consideration
16.11.4 Solution-Focused Question to Ask the Individual
16.11.4.1 Questions
16.11.5 Work with the Emotions and Consequences: Visualise a Compassionate Person
16.12 Conclusion
References
To Learn More
17: Brief Intervention
17.1 Brief Intervention
17.1.1 Simple Brief Intervention
17.1.2 Extended Brief Intervention
17.2 Brief Intervention Theory
17.3 Interventions for Alcohol in Hospital Settings
17.4 Interventions for Alcohol in Home and Other Nonmedical Settings
17.5 Conclusion
References
To Learn More
18: Preparation for Detoxification
18.1 Introduction
18.2 Side Effects Associated with Repeated Medically Assisted Withdrawals
18.3 Structured Preparation for Alcohol Detoxification (SPADe)
18.4 Components/Aspects of Structured Preparation for Detoxification
18.4.1 Family Preparation for Detoxification and Abstinence
18.5 Partial Control over Drinking
18.6 Introduction of Lifestyle Changes of the Individual
18.7 Planning Aftercare
18.8 The Role of Medications in Pre-habilitation (See Chap. 19)
18.8.1 Nutritional Supplementation
18.8.2 Medications for Detoxification (See Chap. 19)
18.8.3 Relapse Prevention Treatments (See Chap. 22)
18.8.3.1 Acamprosate
18.8.3.2 Opioid Receptor Antagonists
18.8.3.3 Baclofen
18.9 Conclusion
References
19: Drugs Used in Withdrawal Management and Post-Withdrawal Management
19.1 Medications for Alcohol Withdrawal Treatment
19.2 Medications for Post-Withdrawal Management
19.3 Ethical Issues
19.3.1 Beneficence and Nonmaleficence: Misuse of Benzodiazepines with Alcohol
19.3.2 Beneficence and Fidelity: Gabapentin for AWS and AUD
19.3.3 Justice: Fairness for Vulnerable Populations
19.3.4 Autonomy: Independent Decision-Making
19.3.5 Autonomy, Coercion, and Collaboration: Family Issues
19.4 Conclusion
References
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20: Hospital Withdrawal Management
20.1 Introduction
20.2 Assessment
20.3 Withdrawal Management Complications
20.3.1 Alcohol Withdrawal Seizures
20.3.2 Delirium Tremens
20.3.2.1 Characteristic Symptoms
20.3.2.2 Associated Symptoms
20.3.2.3 Complications
20.4 Family and Significant Others
20.5 Safeguarding and Social Care
20.6 Withdrawal Management
20.7 Choice of Medication Used in Alcohol Withdrawal Management
20.7.1 Other Medications
20.8 Management During Admission and on Discharge
20.9 Post-Detoxification Intervention
20.10 Conclusion
References
To Learn More
21: Home Withdrawal Management
21.1 Home Withdrawal Management
21.2 Definitions
21.2.1 Detoxification
21.3 Introduction
21.4 Assessment
21.4.1 Assessment of Suitability
21.4.2 History Taking within the Home Environment
21.4.3 Home Environment
21.5 Signs and Symptoms of Alcohol Withdrawal
21.6 Frequency of Home Visits
21.7 The Procedure
21.7.1 Physical Tests
21.8 Vitamin Replacement
21.8.1 Commencing Home Alcohol Withdrawal
21.9 Conclusion
References
To Learn More
22: Relapse and Relapse Prevention
22.1 Relapse
22.2 The Stages of Relapse
22.2.1 Emotional Relapse
22.2.2 Mental Relapse
22.2.3 Physical Relapse
22.3 Cause of Relapse
22.3.1 Predisposing Factors
22.3.2 Precipitating Factors
22.3.3 Protective Factors
22.4 The Relapse Prevention Model
22.4.1 Cognitive Behavioral Therapy
22.4.2 Mindfulness
22.5 The Five Rules of Recovery
22.5.1 Rule 1: Change Your Life so That It Is Easier to Not Use
22.5.2 Rule 2: Ask for Help and Develop a Recovery Circle
22.5.3 Rule 3: Be Completely Honest with Yourself and Everyone in Your Recovery Circle
22.5.4 Rule 4: Practice Self-Care
22.5.5 Rule 5: Don’t Bend the Rules or Try to Negotiate Your Recovery
22.6 Relapse Prevention for the Family
22.6.1 Some Things Family Members Can Do for the Individual
22.6.2 Some Things Family Members Can Do for Themselves
22.7 Relapse Prevention and Self-Assessment Scales
22.7.1 AWARE
22.7.2 RAPID
22.7.3 TOPPS
22.7.4 OCDS
22.7.5 MBRP-AC
22.8 Conclusion
References
To Learn More
23: Motivational Interviewing
23.1 Introduction
23.2 MI as an Evidence Base for Shared Decision-Making
23.3 Research Evidence and MI
23.4 Supporting Treatment Concordance
23.5 Improving Readiness to Reduce or Stop Problematic Use of Alcohol
23.6 Effectiveness of MI Brief Alcohol Interventions in Primary Care
23.7 Alcohol Use Assessment
23.8 Further Research in MI
23.9 The Principle of Recovery and MI
23.10 Building MI Knowledge and Skills in Practice
23.10.1 Understanding the ‘Spirit of MI’
23.11 The Foundational Principles of MI
23.11.1 Expressing Empathy
23.11.1.1 MI Practice Application Example
23.11.2 Support Self-Efficacy
23.11.2.1 MI Practice Application Example
23.11.3 Righting Reflex
23.11.4 Rolling with Resistance
23.11.4.1 MI Practice Application Example
23.11.5 Develop Discrepancy
23.11.5.1 MI Practice Application Example
23.12 MI Skills and Strategies
23.13 Micro Skills of Open-Ended Questions, Affirmation of a Person’s Strength, Reflection, and Summaries (OARS)
23.13.1 Open-Ended Questions
23.13.1.1 A Practitioner May Ask an Open Question by Saying
23.13.2 Affirmations
23.13.2.1 A Practitioner May Affirm by Saying
23.13.3 Reflective Listening
23.13.3.1 A Practitioner May Demonstrate Reflective Listening by Saying
23.13.4 Summaries
23.13.4.1 A Practitioner May Summarise by Saying
23.14 Offering Advice and Information (Ask-Share-Ask)
23.15 MI as a Four-Process Method
23.15.1 Engaging
23.15.2 Focus
23.15.3 Evoke
23.15.4 Plan
23.16 Practice Application of MI in Various Parts of the Care Delivery Process in Alcohol Use
23.17 Conclusion
References
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24: Problematic Alcohol Use Within End-of-Life Care
24.1 Introduction
24.2 End-of-Life Care Experiences for People with Problematic Alcohol Use
24.3 Family and Informal Carer Experiences
24.4 Professional Experiences and Responses
24.5 Conclusion
References
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