The medicalisation of alcohol use has become a prominent discourse that guides policy makers and impacts public perceptions of alcohol and drinking. This book maps the historical and cultural dimensions of the phenomenon. Emphasising medical attitudes and theories regarding alcohol and the changing perception of alcohol consumption in psychiatry and mental health, it explores the shift from the use of alcohol in clinical treatment and as part of dietary regimens to the emergence of alcoholism as a disease category that requires medical intervention and is considered a threat to public health.

This clinical guideline, commissioned by the National Institute for Health and Clinical Excellence (NICE) sets out clear recommendations, based on the best available evidence, for health care professionals on how to work with people with alcohol use disorders, in order to improve their treatment and care. About a quarter of the UK population drink alcohol at a level that is harmful and over 4% are dependent. Alcohol use disorders are also increasing in children and young people. This new guideline reviews the evidence for the diagnosis and assessment of alcohol use disorders, organisation and delivery of care, assisted alcohol withdrawal, and psychological and pharmacological interventions, and includes a chapter on experience of care. It comes with a free CD-ROM that contains all the data used as evidence, including: included and excluded studies, profile tables that summarise both the quality of the evidence and the results of the evidence synthesis, all meta-analytical data, presented as forest plots and detailed information about how to use and interpret forest plots.

Estimates indicate that as many as 1 in 4 Americans will experience a mental health problem or will misuse alcohol or drugs in their lifetimes. These disorders are among the most highly stigmatized health conditions in the United States, and they remain barriers to full participation in society in areas as basic as education, housing, and employment. Improving the lives of people with mental health and substance abuse disorders has been a priority in the United States for more than 50 years. The Community Mental Health Act of 1963 is considered a major turning point in America's efforts to improve behavioral healthcare. It ushered in an era of optimism and hope and laid the groundwork for the consumer movement and new models of recovery. The consumer movement gave voice to people with mental and substance use disorders and brought their perspectives and experience into national discussions about mental health. However over the same 50-year period, positive change in American public attitudes and beliefs about mental and substance use disorders has lagged behind these advances. Stigma is a complex social phenomenon based on a relationship between an attribute and a stereotype that assigns undesirable labels, qualities, and behaviors to a person with that attribute. Labeled individuals are then socially devalued, which leads to inequality and discrimination. This report contributes to national efforts to understand and change attitudes, beliefs and behaviors that can lead to stigma and discrimination. Changing stigma in a lasting way will require coordinated efforts, which are based on the best possible evidence, supported at the national level with multiyear funding, and planned and implemented by an effective coalition of representative stakeholders. Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change explores stigma and discrimination faced by individuals with mental or substance use disorders and recommends effective strategies for reducing stigma and encouraging people to seek treatment and other supportive services. It offers a set of conclusions and recommendations about successful stigma change strategies and the research needed to inform and evaluate these efforts in the United States.

From the President ofthe Research Society onAlcoholism - On behalf of the Research Society on Alcoholism I welcome the important contri bution that Volume 15 of this excellent series on Recent Developments in Alcoh- ism brings to our field. It is not enough for our scientists to develop effective and efficient methods to identify and treat alcohol abuse and alcohol dependence; the availability of these services is often limited and it is certainly nonexistent for the early problem drinker. In nineteen outstanding chapters, Volume 15 deals with organizational issues concerning access to and delivery of substance abuse treatment and the role of managed care. Several chapters deal with economic issues, cost-benefits, and - nancing of these services. Lastly, five address recent treatment outcome studies. Thus, this volume will be of great value to both scientists and practitioners. The Editor and Associate Editors are congratulated for this conceptual and organi- tional accomplishment. Yedy Israel, Ph.D.

This book is the first complete guide to implementing the Community Reinforcement Approach (CRA), an empirically based, highly effective cognitive-behavioral program for treating alcohol problems. CRA acknowledges the powerful role of environmental contingencies in encouraging or discouraging drinking, and attempts to rearrange these contingencies so that a non-drinking lifestyle is more rewarding than a drinking one. Unique in its breadth, the approach utilizes social, recreational, familial, and vocational strategies to aid clients in the recovery process. This authoritative manual is a hands-on guide to applying these therapeutic procedures. The authors present a step-by-step guide to each component of the treatment plan, many of which have been shown to be effective forms of treatment in themselves. Topics include behavioral skills training, social and recreational counseling, marital therapy, motivational enhancement, job counseling, and relapse prevention. Each chapter provides detailed instructions for conducting a procedure, describes what difficulties to expect, and presents strategies for overcoming them. Sample dialogues between clients and therapists, annotated by the authors, further illuminate the treatment process. The book concludes with a chapter that both addresses the common mistakes made when implementing CRA, and emphasizes the flexibility and benefits of this total treatment plan. This book is an invaluable resource for a wide range of practitioners including psychologists, psychiatrists, substance abuse counselors, and social workers.

From the President of the Research Society on Alcoholism On behalf of the Research Society on Alcoholism, I am pleased to introduce this thirteenth volume of Recent Developments in Alcoholism about alcohol and violence. Current concepts are presented in well-organized sections that - cus on epidemiology, neurobiology, psychology, and family issues. It is - coming increasingly clear that age, gender, socioeconomic circumstances, and genetics affect aggressive behavior and vulnerability to alcoholism. This v- ume contains up-to-date discussions of these issues. Indeed, the information presented here will help all alcohol researchers to identify biological and social factors that contribute to the comorbidity of alcoholism and aggression. The editors and associate editors should be congratulated for bringing toge- er such important information. This volume will be a valuable resource for investigators and therapists alike. Ivan Diamond M. D. , Ph. D. President, Research Society on Alcoholism From the President of the American Society of Addiction Medicine The American Society of Addiction Medicine is honored to continue its - sponsorship with the Research Society on Alcoholism of Recent Developmen ts in Alcoholism. The topic of alcohol and violence is a particularly timely one, given the growing number of studies that are examining the relationship between the two. These studies are consistent with the hypothesis that al- hol can increase aggression and contribute to both domestic and criminal violence. Intoxicating blood levels of alcohol have been found to be especially prevalent in those injured in fights and assaults.

From the President ofthe Research Society onAlcoholism - On behalf of the Research Society on Alcoholism I welcome the important contri bution that Volume 15 of this excellent series on Recent Developments in Alcoh- ism brings to our field. It is not enough for our scientists to develop effective and efficient methods to identify and treat alcohol abuse and alcohol dependence; the availability of these services is often limited and it is certainly nonexistent for the early problem drinker. In nineteen outstanding chapters, Volume 15 deals with organizational issues concerning access to and delivery of substance abuse treatment and the role of managed care. Several chapters deal with economic issues, cost-benefits, and - nancing of these services. Lastly, five address recent treatment outcome studies. Thus, this volume will be of great value to both scientists and practitioners. The Editor and Associate Editors are congratulated for this conceptual and organi- tional accomplishment. Yedy Israel, Ph.D.