Editor's note

Alcohol misuse is a complex problem and complex interventions are the norm in its management. This is illustrated well in this chapter in which all the effective treatments are not just complex, but often multi-complex, and it is not always certain what constitutes the most important elements. It is also important to note that the result of an intervention may differ at different levels of dependence. ICD-10 defines a category of ‘harmful use’ that is short of full dependence, and many of the simpler interventions may be more helpful in this group than when full dependence has developed.

Introduction

A complex intervention for alcohol use disorders may be defined as one that utilizes multiple therapeutic components and strategies, based on a common underlying philosophy of treatment and targeted at various facets of the disorder in a complementary and frequently simultaneous fashion. Most treatment for moderately to severely alcohol-dependent patients is complex by this definition and for good reasons. First, alcohol use disorders are heterogeneous and influenced by multiple factors in terms of their etiology, development, and course. Second, no single treatment strategy or technique is effective across all alcohol-dependent patients. Third, the active ingredients of most, if not all, psychosocial therapies for alcohol dependence are unknown.

This chapter will cover four complex interventions for which there is a base of evidence to evaluate them. They are Alcoholics Anonymous (A.A.), the Minnesota Model of treatment, Therapeutic Communities (TCs), and combined pharmacotherapy and psychotherapy.