The Role of a Clinical Psychologist in Treating Problem Drinking: Examining Effective Therapeutic Approaches

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Problem drinking is not necessarily alcoholism; alcoholism is, however, a form of problem drinking. For a problem drinker when they drink it can cause problems for them and those around them, but they are not necessarily physically dependent on alcohol. They may be able to go long periods of time without drinking and when they do drink, they are unlikely to show the same withdrawal symptoms more serious categories of drinking show. Even though the extent of their drinking may not be as severe as some would some would identify a problem drinker to have, the issue can still cause a damaging effect on their life.

There are many issues associated with drinking alcohol excessively. This can be physical, or issues caused in their personal lives. Physically it can cause damage to many vital organs such as the liver, heart and digestive system. It was reported that in 2017 there were 7,697 deaths caused by alcohol related issues in the UK with 1,952 of these being specifically due to issues of the liver. Personal issues can include the individual having issues in their personal relationships as drinking impairs your cognitive abilities and so can cause you to say or do things that may be hurtful to those in your life. All these may cause the individual to isolate themselves even more and could cause the problem to continue or even get worse. That is why it is important for those suffering from an alcohol problem to get help.

There are now many methods of treatment available that can be administered by a clinical psychologist such as Cognitive Behaviour Therapy (CBT) and Aversion therapy for example. In this essay I will be discussing the role of a clinical psychologist in the treatment of an alcohol problem and how beneficial this help may be in terms of how each treatment is administered.

Ways of Treatment by a Clinical Psychologist

A clinical psychologist is someone who works with patients to find out what psychological disorder they are suffering from and work out the best form of treatment to bring them back to a “normal” state of being. In terms of alcohol problems, a clinical psychologist will work with the individual to identify which treatment is most suited to their issue and their personality. They will work through the treatment with the patient in order to help them cope better with their disorder and if successful help them overcome it entirely.

One psychological treatment a clinical psychologist may use is CBT. This form of treatment is based on cognitive and behavioural theory. Cognitive psychology looks at the way people think and how their behaviour is acted upon based on these cognitive processes. Behavioural psychology believes all behaviour is a product of environmental factors. It looks at conditioning as an explanation of how we learn. CBT works on the idea that all behaviour is learned so we can unlearn faulty thinking and therefore change unhealthy behaviour into healthy behaviour, and this is what it aims to do. The role of the clinical psychologist in this type of therapy is to help their patient to identify their faulty cognitions regarding their problem drinking and to then look into how they can change the way they think about alcohol to create more healthy drinking patterns. The psychologist will also set the individual homework tasks to do away from the session to put these new changed thought processes into action. They will also be available throughout the week for patients to contact when they feel they are on the verge of a relapse as a way of talking through how they are feeling in order to avoid participating in drinking behaviour. The psychologist being available for the patient is arguably very important in ensuring relapse doesn’t happen as the patient is likely to need support in order to stay motivated with the treatment.

A study conducted by Sundstörm et al. looked at internet-based CBT whereby the participants were given CBT treatment online rather than physically being in the presence of their therapist. The participants were given the therapy through online resources such as presentations and online questionnaires set by the clinical psychologists conducting the study. Throughout the study the psychologist would be accessible through online messenger and it was their job to monitor each participant and their recovery. Each week through the 12 weeks of study each participant was given an assessment called Montgomery Asberg Depression Self-Rating Scale (MADRS-S) which measured levels of ‘suicidal intention’. If a participant scored four or more out of nine it was the psychologist’s role to contact them and discuss what issues they were having. At the start of the study participants drank on average 23 alcoholic drinks per week which dropped to just 5 drinks per week on average three months after the study – a drop of 78.27%. This suggests the treatment had great success in combatting problem drinking behaviour. 

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On the other hand, having the presence of other problem drinkers and substance abusing individuals incorporated in the treatment may have a bigger impact on the success of therapies in combatting the problem behaviour then the role of the psychologist working with them. It can be argued that group therapy sessions involving CBT as the basis of the programme can be more beneficial because the shared experience of the participants may make the individual feel more comfortable as they have people that can relate to them and normalise how they are feeling. A study by Cecilia et al. looked at such treatment I contrast to individual CBT. However, the finding did not support this argument with individual therapy showing more success than group CBT. Problem drinking behaviours in the group therapy participants after the treatment was reported between 7 and 13 whereas those who had individual therapy only reported having had between 4-12 days of problem drinking days since the study. This may be because the sole focus in individual therapy is on the patient and so the psychologist can give all their attention to that one person’s issues and resolving them. Therefore, the role of the psychologist is suggested to be very important here.

The humanistic approach focuses on the individual. In the humanistic approach it is assumed that everyone has free will and everyone has the innate need to better themselves and the world around them. It also focuses on the subjective experiences of the individual and looks at how this will have shaped them into the person they are. The aim of treatments involving this approach is to get the individual into a state of congruence between the individuals perceived self (how they see themselves) and their ideal self (how they want to be). In terms of problem drinking this means understanding what past experiences have led to the individual adopting these unhealthy behaviours and working towards getting them from these behaviours to more healthy drinking habits. In treatment the psychologist will offer unconditional positive regard which means they will offer support no matter what the individual says or does. This is in order to create a comfortable setting for the individual to express their thoughts and feelings openly.

One form of treatment that is based on the humanistic approach a clinical psychologist can administer is Motivational Enhancement Therapy (MET) which, as the name suggests, aims to increase the motivation the individual has in changing their problem drinking behaviour. It aims to engage the individual in treatment so they will recognise their behaviour needs to change to decrease the negative impact it is having on multiple areas of their lives. In this therapy the psychologist will try to create an environment that makes the individual feel comfortable to express themselves and talk about what they are dealing with – unconditional positive regard. They will also help the patient identify the difference they have between their ideal self and their current perceived self in order to gain a state of congruence. Because this treatment is based upon the humanistic approach it focuses on the individual and looks to keep the patient comfortable throughout treatment. It is the psychologist’s role to guide them through the treatment to help them personally grow. 

MET has been shown to be a successful treatment for mild to severe alcohol problems. A study by Sellman et al. looked at the difference in the success rate of MET compared to non-directive reflective listening (NDRL) and no further counselling (NFC) treatment. The study found that after MET 42.9% were still considered to have problem drinking behaviours. Although this number seems large when compared to 62.5% who were given the NDLR treatment and 65% of the NFT group it shows a greater success rate for MET treatment methods. This success could be due to the role the psychologist plays in creating a safe environment to allow the individual to change their problem drinking behaviour.

The biological approach to psychology says that behaviour is dependent on biological processes within the body. For example, addictive behaviour is due to the dopamine it produces when it enters the body resulting in a pleasure reaction. Therefore, you continue with the behaviour to continue receiving this feeling. It also explains addiction through genetic inheritance by way that some individuals are more at risk of developing an addiction due to their genetic makeup. In terms of treatment it uses pharmaceuticals to try and fix the imbalances within the brain and body. 

Is There a Need for Him?

On the other hand, a clinical psychologist may not be needed in such a large role for changing drinking behaviour. There are biological treatments that require relatively little input from the psychologist. Such treatments it will the psychologist’s role to identify which drug is needed and to ensure the correct dosage is being taken while also monitoring the progress of the patient. One example of a drug used for alcohol problems is acamprosate which targets the neurotransmitter gamma-Aminobutyric acid (GABA) to correct the imbalance of this neurotransmitter. 

A study conducted by Sass et al they looked at the difference in success rate of acamprosate versus a placebo. They found that those given the drug avoided drinking for longer (224 days) than those who received the placebo (163 days) suggesting the drug influenced changing problem drinking behaviour. However, it is suggested that with this drug therapy is given along side it to have the most effective result on changing problem drinking behaviour. A study by Feeney et al found that those who received CBT and acamprosate were more likely to stay abstinent than those just on the drug suggesting the benefit of the role a clinical psychologist plays.

To conclude, a clinical psychologist can have a very important role in helping a person with an alcohol problem change their behaviour. They can act as a support system to guide the individual to healthier drinking behaviours and help them to identify why they may have these unhealth behaviours in the first place so long term they continue with healthy behaviours instead of resorting back to drinking excessively when certain triggering situation arise. Therefore, given the evidence the role of clinical psychologist is very important in changing problem drinking behaviour.  

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