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
		To Learn More
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
		To Learn More
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
		To Learn More