The term "self-help" is widely used in the addictions field; more and more, that term is being used to apply specifically to approaches that really are used by an individual on his or her own.

In contrast then, approaches like Alcoholics Anonymous (AA), Women for Sobriety, or Moderation Management, are now more accurately referred to as "mutual help" or "mutual aid". (See article on Mutual Aid in Section 3).

There are few true "self-help" approaches available: one of the best is DrinkWise: How to Quit Drinking or Cut Down, a self-help book written by Dr. Martha Sanchez-Craig, retired ARF senior scientist.

It is intended for non-dependent problem drinkers who have concerns about their use of alcohol and who wish to quit or cut down their consumption. When it was first published as Saying When in 1993, it received considerable media exposure and favourable book reviews (e.g., Addiction (1994) 89: 99-104).

Its second printing included a French version: C'est Assez!: Comment Arrêter de Boire ou Réduire Votre Consommation D'Alcool.

DrinkWise uses a cognitive-behavioural approach to help people modify the patterns that influence their drinking behaviour. Behaviour change is achieved through education on safe limits, self-monitoring of consumption, feedback, goal setting, and identifying and developing strategies for high risk drinking situations.

The five-step process outlined in DrinkWise should be considered as a refinement of Dr. Sanchez-Craig's work over her distinguished twenty-year career.

The five steps include:

Taking Stock - this helps readers assess for themselves their current drinking pattern and the appropriateness of the DrinkWise approach;

Setting a Short Term Goal - which assists the reader in discovering how s/he currently copes with temptations to drink (an initial two week period of abstinence is
recommended);

Setting a Long Term Goal - this helps readers to determine whether a goal of moderation or abstinence is best for them;

Strategies to Reach Their Goal - includes keeping a diary of drinking experiences, pacing one's drinking, avoiding high risk situations and developing alternatives to alcohol use;

and additional suggestions for Maintaining Progress.

Saying When was studied as a telephone intervention in the context of rural communities, using a randomized study design to evaluate the effects of the intervention alone, versus the effects of the intervention when a degree of therapist involvement by telephone was included.

Full results can be found in the Journal of Consulting and Clinical Psychology (1996) Vol.64 (4): 694-700. Briefly, the project found that overall reduction in weekly alcohol consumption was about 55%, and that significantly more women than men (71% vs 52%) were rated as moderate drinkers after one year.

The benefits of this kind of approach to readers include its portability, privacy, anonymity, low cost, flexibility and freedom of choice. It is also well laid-out and easy to read, and available in both English and French.

The fact that consumer input helped with the book's development and that it has undergone extensive outcome evaluation should also be considered as advantages. And, although it is a self-help approach, addictions counsellors across the province have incorporated it into their interventions as an adjunct with clients for whom they feel it is a useful tool.

In addition, a therapist-assisted form of DrinkWise is available by phone through Homewood Health Services in Guelph.

This aspect of DrinkWise was recently profiled as part of an article entitled "Just a glass... or two" published in the December, 1998 edition of Chatelaine (as a sidebar called "Getting with the program").

DrinkWise's limitations are obvious: it requires a certain degree of literacy (or access to somebody who could guide the problem drinker through the steps), it is only available in normal print format (as opposed to braille, large print for seniors, or CD-ROM), and it is not intended for persons with more serious and/or complicated alcohol problems. Although, as noted above, its cost is low, nonetheless it does have a purchase price.

Relevance to Integrated Service Planning

Because of its quality, and because of the scarcity of Canadian self-help material, Saying When is a useful adjunct to the Rationalization process.

In particular, it has clear advantages for clients who are geographically or otherwise isolated from easy access to other addictions services--in that sense, it is one way of "bringing the service to the client" in a variety of formats, including ‘pure' self-help, and as a telephone intervention with therapist support.

There are also aspects of the intervention that make it particularly useful for women (see also article on Women in Section 4).

Recommended Readings

Sanchez-Craig, Martha. DrinkWise: How to quit drinking or cut down. A self-help book. Toronto: Addiction Research Foundation.

Resources

The CAMH library has a reading list of "‘self-help' books for problem drinkers"--as of mid-August 1999 it is temporarily unavailable due to the restructuring of all the Centre's websites, but watch for it at http://sano.arf.org/libs/bib40.htm

Some of the books listed are core reading for some mutual help groups like Rational Recovery, Women for Sobriety, AA, etc., so they are not truly ‘self-help' in the same sense as DrinkWise. And some of them are specific to particular aspects of ‘recovery', like stress, or nutrition.

There's another reading list ‘on the addictions' at http://sano.arf.org/libs/bib39.htm
(same caveat regarding accessibility, mid-August 1999) that has a couple of books that refer to ‘self-help' as well (e.g., Corey, Kicking the Drug Habit, Geide, Beyond Addiction, Podsadowski, Recovery from Addictions, and The TRY Book);
you may want to review these.

On-line Resources

CAMH Treatment Applications

OPTIONS (Guided Self-Change and Structured Relapse Prevention)
Addictions Clinical Consultation Service
Brief Treatment for Youth (BTY)
Choosing to Change: Clinical Materials for Professionals Working with Older Adults
Methadone

Please check the most recent CAMH Product Listing, or contact
Marketing, at 595-6059 or 1-800-661-1111, for the most up-to-date information
on CAMH products, their availability, and pricing.

Also, keep an eye on CAMH's on-line Product Catalogue at:
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