Treatment Approaches for Alcohol and Drug Dependence: An Introductory Guide. By Tracey J Jarvis, Jenny Tebbutt and Richard P Mattick. John Wiley amp; Sons #163;14.95. - 0 471 95373 3
The Facts about Alcohol, Aggression and Adolescence may appear at first to be just another book about the apparent increase in alcohol related delinquency. It stands out because it is clearly and exceedingly well written and gives balanced information on one specific issue - how far alcohol can be blamed for juvenile aggression.
It covers the main professional and practical problems that workers with adolescents are likely to meet, and gives research evidence and references to support its conclusions. For example, cause and effect are dealt with at some length.
The highlight is one of the few experimental investigations of alcohol and aggression where there were proper controls and trained harassment "perpetrators" (confederates of the experimenter). Participants were not told till afterwards that aggression was under scrutiny. Blood alcohol level was not found to be related to aggressive responses to harassment. What seemed to matter most was the social context in which harassment took place. If "aggression priming" emanated from the experimenter, that is he encouraged participants to respond aggressively to harassment, they tended to do so. There were however some individuals who appeared to be more prone to show aggression than others.
What is often termed alcohol-related violence may therefore have less to do with alcohol per se than with the social influence that people have on each other. For reducing aggression, particularly in aggression-prone individuals, there are various options. Where physical attack seems premeditated and inevitable, running away is the safest, though self-defence techniques are becoming popular. But usually potential aggression is less serious and probably manageable. It is stressed that a successful outcome is largely in the hands of the person at the receiving end. The aim should be not to get apologies, but to reduce the aggressor's frustration and emotional arousal.
The concepts of arousal and fight or flight are helpful for understanding aggressive confrontations. What in practice is most needed is flexibility and the ability to stay calm and impersonal. Otherwise a difficult situation can escalate into an ugly one. Both body and verbal language should be unthreatening but firm and emotionally neutral. At the same time the aggressor must be shown that he is being taken seriously.
There are no simple "quick fixes". The authors recommend more emphasis on helping the families rather than exclusively the problem drinker and on non-aggressive ways of acting socially. Training in aggression management skills is specially advised for situations involving hooliganism. A neat and helpful small book.
Treatment Approaches for Alcohol and Drug Dependence deals with adults rather than with young people, and with the treatment of dependence on alcohol, opiates and nicotine, seen from Australia, though the foreword by Nick Heather of the UK sets the scene. The survey of literature is international.
The book arose from a Quality Assurance Project in Sydney which was intended to make dealing with alcohol and drug problems more effective, by improving communication between research workers, practitioners and policy makers and so identifying what methods work, consensus difficulties notwithstanding.
Apart from standard strategies it discusses subtler mechanisms such as "covert satisfaction", "couples therapy" and relapse prevention training. Practice sheets and handouts for clients are included, some with enticing titles such as "thought monitoring practice" and are highly useable.
Although the authors insist that it is not a session-by-session guide to teaching clinical skills, informed readers would find much they could use, particularly when stuck and wondering what to do next. Counselling strategies, for example, are described in detail. Empathy, things to avoid,open-ended questions, reflective listening, resistance each have a section under the general heading of "Method", and are called "microskills".
Similarly, "Drink and Drug Refusal Skills" explains how to feel and sound confident about refusing instead of guilty or anxious with a line by line account of what to say, starting with "no thanks", "suggest an alternative", and ending with "change the subject, so as not to get caught up in a long debate about drinking". It warns against excuses and vague answers ("I am on antibiotics"), since they make it difficult to refuse in the future.
Next, clients should be asked to describe situations where previously they had problems with refusing drink or drugs. This is followed by "brainstorming", modelling and role playing of better solutions and, if necessary, by deliberate assertiveness training; this is again described with examples, including six strategies for "Handling Tricky Situations", which include "fogging" (vaguely agreeing with unwelcome opinions) and selectively ignoring another's insistence. All of which may merely sound like applied common sense, but is of much wider reference than just drink, drugs and Australia.
Hannah Steinberg is Visiting Professor of Psychology, Middlesex University.