Bibliography & Sources

My clinical practice is based on the publications listed here. On the whole they're not easy self-help reading - they're meant for professionals and academics. That's why I've written this guide, to try to make a sensible and easy read out of something complex.

The best and most authoritative sources of evidence

Any claims I make in this guide that I haven't referenced will be backed up by some or all of these authoritative and evidence based sources.

The Effectiveness Review

The Review of the Effectiveness of Treatment for Alcohol Problems is a comprehensive analysis of what works best in alcohol treatment. Published by the NHS's National Treatment Agency for Substance Misuse in 2006.

They say that 'It is expected that most treatment will be rooted in a psychosocial intervention, which may or may not be enhanced by a pharmacotherapy'. In other words, drugs like chlordiazepoxide, acamprosate and disulfiram have their place, but that help in making changes to the way you think, and changes in the way you interact with other people, is going to be what works. They recommend the following therapeutic techniques:

Motivational Enhancement Approach (or Motivational Interviewing)

For clients unsure if they are ready to stop drinking:

  • Employs specific principles and strategies for building client motivation
  • Explores and reflects client perceptions without labelling or correcting them
  • Elicits possible change strategies from the client
  • Responsibility for change methods is left with the client; no training, modelling or practice
  • Natural problem-solving processes are elicited from the client

Cognitive behavioural approaches

Assumes that the client is motivated; no direct strategies for building motivation for change:

  • Seeks to identify and modify maladaptive cognitions
  • Prescribes specific coping strategies
  • Teaches coping behaviours through instruction, modelling, directed practice and feedback
  • Specific problem-solving strategies are taught

Alcoholics Anonymous

  • AA appears to be effective for those alcohol misusers who are suited to it and who attend meetings regularly
  • AA is a highly cost-effective means of reducing alcohol-related harm
  • Not all alcohol misusers find the AA approach acceptable
  • Coercive referral to AA is ineffective
  • Al-Anon and Alateen are effective in providing emotional support to families of AA members

NICE guidelines

The National Institute of Clinical Excellence produces high quality and well researched guidance across all areas of health treatment.

In 2011 they issued produced comprehensive guidelines on the diagnosis, assessment and management of alcohol dependence and harmful alcohol use. Broadly speaking, this outlines the safest and most effective methods of alcohol detoxification.

  • The full guidelines are here
  • The quick reference guide is here
  • 'NICE Bites' - key prescribing points from the guidelines are here
  • The guidance written for 'patients and carers' is here

Other alcohol related NICE guidelines are:

  • Alcohol-use disorders: preventing the development of hazardous and harmful drinking. Public health guidance on the price, advertising and availability of alcohol, how best to detect alcohol misuse in and outside primary care, and brief interventions to manage it in these settings - NICE public health guidance 24 (2010). Available from here
  • Alcohol-use disorders: diagnosis and clinical management of alcohol-related physical complications. A clinical guideline covering acute unplanned alcohol withdrawal including delirium tremens, alcohol-related liver damage, alcohol-related pancreatitis and management of Wernicke's encephalopathy. NICE clinical guideline 100 (2010). Available from here

The British Association for Psychopharmacology

The British Association for Psychopharmacology's 'Evidence-based guidelines for the pharmacological management of substance misuse, addiction and comorbidity' - are comprehensive and excellent.

One of the authors is David Nutt, who was in the news for saying alcohol is more dangerous than cannabis or ecstasy, and then got sacked by the Home Secretary.

Other Sources

Books

The Treatment of Drinking Problems by Griffith Edwards is an old book, but fantastic. Professor Edwards can always be relied on to talk sense about alcohol. (Amazon books by Prof Edwards)

Problem Drinking by Nick Heather & Ian Robinson - I'm not sure this is in print any more, but is full of interesting stuff about drinking. You can google for copies.

Mindfulness-Based Cognitive Therapy for Depression - Zindel Segal et al from MBCT books is full of stuff that I think is as relevant to addiction as well as depression.

Why Choose This Book? - A popular science book by the neurobiologist Read Montague, about how our brains make decisions. Mainly about the astonishing wonders of dopamine.

Websites

Drug & Alcohol Findings gives online summaries of recent research in addiction.

The National Electronic Library for Medicines (NeLM) have a section on addiction.

The AA big book online - is fascinating, and gave me a whole new perspective on the spiritual elements of AA: more Jungian than Christian.

http://wiredin.org.uk was useful to read about 12 step philosophies.

Misc

The Rehab Handbook, available from http://www.exchangesupplies.org, is a handy booklet about rehab for drug users.

My sleep hygiene section was broadly based on University of Maryland Medical Center's page http://www.umm.edu/sleep/sleep_hyg.htm.

Ben Goldacre's Bad Science column, book and website was great background reading, hilarious to read at the same time as I was looking at some of the more bonkers websites claiming to provide (mad) cures for alcohol problems.

Oliver Burkeman, wrote a great article about making significant life changes in the Guardian on 20 June 2009 which was good food for reflection.

I also liked the formula C=Co(SQ)>R(C) "Change happens when the cost of the status quo is greater than the risk of change" which appeared in a recent Howies catalogue: howies.co.uk

The quote from Dr Nicholas Pace was taken from an article in The Guardian on 9 May 2010 'The little pill that could cure alcoholism': http://www.guardian.co.uk/society/2010/may/09/alcoholism-health-doctor-addiction-drug

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