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UNIVERSITY of NEW YORK in PRAGUE Department of Psychology Alcohol Use Disorder and Key Factors in Successful Treatment Master

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UNIVERSITY of NEW YORK in PRAGUE Department of Psychology Alcohol Use Disorder and Key Factors in Successful Treatment Master UNIVERSITY OF NEW YORK IN PRAGUE Department of Psychology Alcohol Use Disorder and Key Factors in Successful Treatment Master’s Thesis Supervisor: Submitted by: PhDr. Michal Miovsky Mgr. Karin Kempf Prague 2021 Alcohol Use Disorder and Key Factors in Successful Treatment 2 Declaration I hereby declare that I wrote this thesis individually based on literature and resources stated in the references section. In Prague: 5.5.2021 Signature: Karin Kempf Alcohol Use Disorder and Key Factors in Successful Treatment 3 Acknowledgments I would like to thank my advisor, PhDr. Michal Miovský for his advice, support, patience and good will. He has helped to acquaint me with the field of AUD, and was open and responsive to all of my questions and ponderings. I am grateful to have had someone well-versed and passionate about this field as a mentor. I would also like to thank my family for their patience, support and cheerleading as I embark on this new phase of my life. It has been a good reminder of what an important role support plays for us as social beings, and I hope to not only return the favor to my family, but to also pay it forward in other areas of my personal and professional life. Alcohol Use Disorder and Key Factors in Successful Treatment 4 TABLE OF CONTENTS Abstract................................................................................................................. 7 Prologue……………………………………………………………………….... 8 Introduction……………………………………………………………………... 9 1. Purpose of the Study……………………………………………………… 10 1.1 Description of the Work…………………………………………....12 2. Alcohol Use Disorder – What is it?.............................................................. 12 2.1 The Biopsychosocial Model of AUD…………............................. 14 2.2 AUD in the DSM IV vs. DSM V……………………………....... 15 2.3 AUD in the ICD 11…………………………………………................. 18 2.4 The Biomedical Model of AUD……………………………….... 19 2.1.2 Epigenetics…………………………………………………… 21 3. Development of AUD……………………………………………….…….. 22 3.1 Biological Factors in AUD Development.......………………….. 23 3.2 Psychological Factors in AUD Development………………...... 25 3.3 Social Factors in AUD Development…………………………… 28 4. The Adverse Childhood Experiences (ACE) Study………………………. 30 4.1 ACE Study Findings……………………………………………. 32 4.2 ACEs and AUD…………………………………………………. 33 4.3 Screening for ACEs and Trauma………………………………. 34 5. Stress, Trauma and AUD……………………………………………........ 36 6. Phases of AUD Development……………………………………………. 37 Alcohol Use Disorder and Key Factors in Successful Treatment 5 6.1 Jellinek’s Phases of Alcohol Addiction........................................38 6.2 The Jellinek Curve.........................................................................41 7. Diagnosing AUD – Diagnostic Tools..........................................................42 8. Complicating Factors in AUD Diagnosis and Treatment.......................... 45 8.1 Underdiagnosis of AUD.............................................................. 46 8.2 AUD Research............................................................................. 46 9. The Alcohol Burden.................................................................................. 48 9.1 Drinking Statistics in the Czech Republic...................................48 9.2 Consequences of Alcohol Consumption..................................... 50 9.3 AUD Epidemic?.......................................................................... 52 10. Personal Reflection................................................................................... 53 11. AUD - Is it a Disease?.............................................................................. 58 11.1 The Brain Disease Model of Addiction..................................... 59 11.2 Brain Disease Model of Addiction vs. Biopsychosocial Model.61 11.3 Personal Reflection.................................................................... 62 11.4 The Benefits of Viewing AUD as a Disease.............................. 65 11.5 The Drawbacks of Viewing AUD as a Disease........................ 67 12. AUD Treatment and Recovery................................................................ 70 12.1 AUD Treatment in the Czech Republic................................... 71 12.2 A History of AUD Treatment in the Czech Lands - Velké Kunčice................................................................... 72 12.3 Treatment at the Tuchlov Facility........................................... 74 12.4 Inpatient Treatment in the Czech Republic Today.................. 76 Alcohol Use Disorder and Key Factors in Successful Treatment 6 12.5 Therapeutic Communities....................................................... 77 12.6 Personal Reflection................................................................. 79 12.7 Outpatient Day Treatment...................................................... 80 12.8 Ambulatory/Outpatient Care................................................... 81 12.9 Self-Help Groups.................................................................... 81 13. Alcoholics Anonymous.......................................................................... 83 13.1 The Twelve Steps.................................................................. 84 13.2 Honza – AA........................................................................... 86 13.3 AA Sponsorship.................................................................... 89 13.4 AA in the Czech Republic.................................................... 89 14. Effectiveness of AUD Treatment......................................................... 90 15. The Cochrane Review.......................................................................... 93 15.1 Possible Explanations for TSF/AA Success......................... 95 16. Importance Factors to AUD Recovery............................................... 97 17. Methods.............................................................................................. 98 18. Results.................................................................................................100 18. Discussion...........................................................................................102 18. Limitations of the Study.....................................................................104 19. Conclusion..........................................................................................106 20. References..........................................................................................108 Alcohol Use Disorder and Key Factors in Successful Treatment 7 Abstract The purpose of this study is to examine alcohol use disorder (AUD), including its etiology and contributing factors to its development, its impact on the individual as well as on society, and the related economic implications. The study looks at the history and development of AUD treatment with a focus on the Czech Republic. Finally, this study seeks to determine the key facets of successful AUD treatment. The methods used in undertaking this research are primarily literature review, with a small-scale survey regarding key factors in AUD recovery. The responses to the questionnaires used in the survey were compared with the findings of this study, and the answers were found to reflect the information gathered during the literature review. Key factors in successful AUD treatment/maintenance of sobriety are: the support and care of a group and/or individual, personal resolution and persistence in maintaining a treatment regime, whether formal (i.e. professional therapy) or informal, for example, Alcoholics Anonymous (AA). The results strongly suggest that these factors are of greater importance than the actual mode of therapy. This is significant because this information can be used by people working with AUD clients to better support them, and secondly, because it means that AA, which is free, easily accessible in many cities, and does not require appointments may be a viable and effective mode of AUD recovery, or recovery support, both for maintaining recovery after formal treatment, or as a form of treatment itself. Keywords: AUD, alcohol, biopsychosocial, trauma, treatment, support, recovery Alcohol Use Disorder and Key Factors in Successful Treatment 8 Prologue “Not every story has a happy ending, ... but the discoveries of science, the teachings of the heart, and the revelations of the soul all assure us that no human being is ever beyond redemption. The possibility of renewal exists so long as life exists. How to support that possibility in others and in ourselves is the ultimate question.” (Maté, 2018, p. 3) “Having spent years working closely with addiction researchers and clinicians, I had guessed that the primary driver of numbing would be our struggles with worthiness and shame: We numb the pain that comes from feeling inadequate and “less than.” But that was only part of the puzzle. Anxiety and disconnection also emerged as drivers of numbing in addition to shame. As I’ll explain, the most powerful need for numbing seems to come from combinations of all three – shame, anxiety and disconnection.” (Brown, 2012, p. 138) Alcohol Use Disorder and Key Factors in Successful Treatment 9 Introduction About a year ago, I came across a New York Times article titled “Alcoholics Anonymous vs. Other Approaches: The Evidence Is Now In” (Frakt & Carrol, 2020), with a subtitle that read: “An updated review shows it performs better than some other common treatments and is less expensive.” This piqued my interest because I have long thought about what
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