[Treatment and rehabilitation programs for young alcoholics: acquiring the ability through group therapies and cognitive-behavioral therapies to communicate with others to lead a new life].
The number of young alcoholics increased rapidly around Tokyo during these several years has resulted in the emergence of AA (Alcoholics Anonymous) groups consisting mainly of 20- 30-year-olds. It is well known, however, that young alcoholics are difficult to be treated in traditional alcoholic wards where most of the patients are 50- 60-years old and are treated through group therapy, such as AA or Dansyu-kai (Japanese style AA). With their immature brains and limited experience, young people are extremely vulnerable to the effects of alcohol. Young alcoholics have missed the opportunities for self-investigation and for acquiring the ability to communicate with others without drinking. Even after successfully giving up alcohol, it is sometimes difficult for them to find employment, or to continue to be employed. They do not feel comfortable when they stop drinking because their thinking and cognition have been distorted by the consequences of their alcohol use. We provide cognitive-behavioral therapy (CBT) for young alcoholics to change their behavior and emotional state, giving opportunities for self-investigation according to the 12-step program of AA for young addicts, in conjunction with an introduction to our program by motivational interviewing. Our treatment program aims to enable the participants to begin new lives without drinking and to find jobs. In treatment and rehabilitation programs of such patients, serious consideration is required for social and emotional development in order to gain the ability to communicate with other members of society. Groups in our therapy programs consist of 8-15 patients who are mostly aged below 40, or who were physically and emotionally abused as children by their alcoholic parents. In such a non-judgmental and intimate atmosphere, addicts feel accepted and encouraged to talk about their real thoughts and feelings. This kind of group involvement helps them to attend community AA group or Dansyukai where sometimes they might feel anxious or frustrated because the members remind them of their frightening parents. In this article we examine the effectiveness of participation in our treatment programs together with AA meetings and the rehabilitation program of the therapeutic community known as MINOWA-MAC.


OBJECTIVE
24- 35-year-old male alcoholics admitted to our acute psychiatric ward from 2000 to 2005. All of the patients had stopped drinking and found employment. A few of the patients were married or in stable relationships.


METHODS
20 male alcoholics were examined retrospectively after participating in the 5 programs below: (1) Cognitive-behavioral therapy (CBT) in a small group and/or individual counseling to alter their distorted cognition, emotion and behavior; (2) Completing the 12-step workbook for self-investigation; (3) Attending community AA meetings (and/or Dansyukai); (4) Attending MINOWA-MAC day-care program; (5) Joining MINOWA-MAC (or DARC) residential care program.


RESULTS
Young alcoholics who participated in both daily AA meeting and MINOWA-MAC have successfully found new full-time employment. All of them have been employed for more than one year. Those who regularly attended mutual support groups became capable of expressing their opinions in public. This seems to help them feel comfortable socially and in the work place. The 12-step workbook for self-investigation helps patients understand that they are loved and gives them confidence so that they feel encouraged to change their attitudes and behavior. Cognitive-behavioral therapies are also effective in changing the emotions, thoughts and behavior of the patients. Only a few of the patients complete CBT group therapy as well as individual counseling of CBT to change their irrational cognition and deteriorated behavior. They made great advances in developing life-management skills and have secured new jobs or have opened new AA meetings. Even joining CBT group therapy for one to two years enables them to realize that their perfectionism and dichotomous thinking disrupted the development of their lives. Protective types of treatment and rehabilitation such as day-care programs in hospitals or Dansyukai are often insufficient for young alcoholics, from the viewpoint of altering their way of life.


CONCLUSIONS
AA and the therapeutic communities are especially effective for young alcoholics. Cognitive-behavioral therapy is also effective, though not all the male alcoholics could complete our program, which aims not only to change the patients' perception of drinking but also to enable them to correct their distorted feelings, thoughts, cognition and behavior. The 12-step workbook for self-investigation is a useful tool in changing attitude and behavior.
Gotoh
Megumi
M
Narimasu-kousei Hospital, 1-19-1 Misono, Itabashi-ku, Tokyo 175-0091, Japan.
D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000534:rehabilitation* / Q000628:therapy*; D001521:Behavior Therapy / Q000379:methods*; D002648:Child; D003071:Cognition; D003142:Communication; D006801:Humans; D008297:Male; D011615:Psychotherapy, Group / Q000379:methods*; D012189:Retrospective Studies