Treating comorbidity of alcohol problems and psychiatric disorder (original) (raw)

Guidelines for the Treatment of Alcohol Problems

PsycEXTRA Dataset

Guidelines for the Treatment of Alcohol Problems 7 EXTENDED CARE STRENGTH OF RECOMMENDATION Attention should be given to the client's retention in treatment and Strong social support networks. Aftercare should be structured and assertive, with follow-up Strong of missed appointments. Clients who show signs of dependence on alcohol should be made Moderate aware of the service offered by meetings of Alcoholics Anonymous (AA). Mandated AA participation is not recommended. Conventional AA meetings should not be viewed as treatment for Moderate alcohol dependence. TREATMENT ISSUES FOR SPECIFIC GROUPS ADOLESCENTS Given the limitations of diagnostic criteria for alcohol use disorders Strong with adolescents, a flexible approach to diagnosis and treatment is needed. Whilst some young people may not meet strict diagnostic criteria for alcohol dependence or abuse, this should not be a barrier to treatment. Clinicians should focus on building and maintaining a relationship Strong with younger clients through outreach, crisis intervention and harm reduction activities, and the use of an empathetic, non-judgemental, developmental approach to counselling. Brief and motivational interventions help to reduce alcohol Strong consumption among adolescent heavy or binge drinkers, across a range of settings. Younger drinkers who require more intensive intervention may Strong have different treatment needs to older drinkers. These needs should start to be identified during the assessment phase, and may include crisis intervention, assertive outreach, and building social support networks. The recommended psychological treatment for young people Moderate is cognitive behavioural therapy. Other potentially useful treatments include social skills training, family therapy, therapeutic support groups, and interpersonal therapy. COGNITIVELY IMPAIRED CLIENTS A brief assessment of cognitive functioning should be a routine Strong part of assessment upon treatment entry. More detailed assessment should be carried out where brief assessment Strong suggests that a patient suffers from significant cognitive deficits. 8 Guidelines for the Treatment of Alcohol Problems TREATMENT ISSUES FOR SPECIFIC GROUPS STRENGTH OF RECOMMENDATION COGNITIVELY IMPAIRED CLIENTS Where cognitive impairment is confirmed, information presented Strong to patients should be concrete and patients should be given opportunities to practise behaviours taught during treatment sessions. Cognitively impaired patients should be engaged in treatment Moderate by the clinician by: Guidelines for the Treatment of Alcohol Problems 9 TREATMENT ISSUES FOR SPECIFIC GROUPS STRENGTH OF RECOMMENDATION COMORBID DISORDERS Alcohol dependent patients with antisocial personality disorder Fair should be considered for treatment with nortriptyline, depending on the severity and nature of their symptoms. GENDER Treatment providers need to be aware of and sensitive to issues Strong particular to women with alcohol problems. Service providers should try to improve the recruitment of women Moderate to their services by improving outreach, setting up referral networks, advertising facilities specifically targeting women, and providing more detailed information about services. This would increase women's awareness of treatment services available, and may decrease any reservations or fears about entering treatment. All clients should be provided with a safe therapeutic environment, Strong Audience for the guidelines This comprehensive version of the guidelines is intended for clinicians who want a full review of the treatment options for alcohol problems. Specific, summarised guidelines are also available (in mid-2003) for general practitioners, drug and alcohol workers, general hospital workers, and consumers. Throughout this document we use the terms "clinician" or "health care worker" to refer to any of the above professionals. Development of the guidelines The guidelines are based on a review of the available evidence of efficacy (the Treatment of Alcohol Problems: A Review of the Evidence) and the knowledge of an expert panel convened to develop the guidelines. Members of the expert panel are listed in the preliminary pages. The procedure used to identify research has involved searching relevant databases for published clinical trials, hand searching journals, searching website bibliographies, canvassing for unpublished research, and contact with major research centres for unpublished research and other relevant guidelines. Databases searched include Medline, Psychinfo, Cochrane Database of Systematic Reviews, the National Clearinghouse for Alcohol and Drug Information, Evidence Based Medicine Reviews, and the Alcohol and Other Drug Council of Australia's (ADCA) Drug Database. 14 Guidelines for the Treatment of Alcohol Problems CHAPTER 1 Introductory Comments 1 Meta analysis is a statistical technique which combines a number of single trials to increase the overall power and certainty of outcomes. Guidelines for the Treatment of Alcohol Problems 15 CHAPTER 1 Introductory Comments Guidelines for the Treatment of Alcohol Problems 17 CHAPTER 1 Introductory Comments CHAPTER 2 Access to treatment: overcoming barriers Chapter 2: Access to treatment: overcoming barriers Guidelines for the Treatment of Alcohol Problems 21 CHAPTER 2 Access to treatment: overcoming barriers Chapter 2: Access to treatment: overcoming barriers CHAPTER AIM The aim of this chapter is to identify barriers that drinkers may encounter in seeking treatment. Many barriers to treatment are equity-based and systemic. For example, lower socioeconomic groups are less likely to be offered brief interventions. [4] Remote Indigenous communities often have very limited access to treatment resources. [5] Types of barriers include: CHAPTER 3 Screening and Assessment Chapter 3: Screening and assessment Guidelines for the Treatment of Alcohol Problems 25 CHAPTER 3 Screening and Assessment Chapter 3: Screening and assessment Chapter Aim The aim of this chapter is to guide screening which might take place prior to a brief and/or early intervention for those patients who may be drinking at risky levels, or have risky patterns of consumption.

Problem drinking and alcoholism: diagnosis and treatment

American family physician, 2002

Alcoholism is one of the most common psychiatric disorders with a prevalence of 8 to 14 percent. This heritable disease is frequently accompanied by other substance abuse disorders (particularly nicotine), anxiety and mood disorders, and antisocial personality disorder. Although associated with considerable morbidity and mortality, alcoholism often goes unrecognized in a clinical or primary health care setting. Several brief screening instruments are available to quickly identify problem drinking, often a pre-alcoholism condition. Problem drinking can be successfully treated with brief intervention by primary care physicians. Alcohol addiction is a lifelong disease with a relapsing, remitting course. Because of the potentially serious implications of the diagnosis, assessment for alcoholism should be detailed. Alcoholism is treated by a variety of psychosocial methods with or without newly developed pharmacotherapies that improve relapse rates. Screening for problem drinking and alc...

The treatment of alcohol dependence

Current Opinion in Internal Medicine, 2007

Copyright Status This manual was constructed, with permission, from several pre-existing manuals that included medical management as part of their interventions. These manuals are cited below. The Medical Management Subgroup (authors), with the assistance of Kelly Tobin Murray (University of North Carolina, COMBINE Coordinating Center), rewrote and edited sections to provide a focused, cohe sive set of guidelines for medical practitioners to follow in delivering Medical Management (MM) treatment. We also acknowledge the individual contributions of

Assessment and management of alcohol use disorders

Alcohol can impact on both the incidence and the course of many health conditions, and nearly 6% of all global deaths in 2012 were estimated to be attributable to its consumption. 1 A quarter of the UK adult population drinks alcohol in a way that is potentially or actually harmful to health. 2 Between 2002 and 2012 in England the number of episodes where an alcohol related disease, injury, or condition was the primary reason for hospital admission or a secondary diagnosis doubled. 3 Despite the large numbers of people drinking alcohol at higher risk levels, a relatively low number access treatment. 4 Possible causes for this include missed opportunities to identify problems, limited access to specialist services, and underdeveloped care pathways. International studies have shown that more than 20% of patients presenting to primary care are higher risk or dependent drinkers, 5 yet the problem of alcohol is inadequately addressed. This review focuses on practical aspects of the assessment and treatment of alcohol use disorders from the perspective of the non-specialist hospital doctor or general practitioner.

Treatment of Alcohol Abuse: An Evidence-Based Review

Alcoholism: Clinical & Experimental Research, 2003

This article represents the proceedings of a symposium at the 2002 annual meeting of the Research Society on Alcoholism in San Francisco, CA, organized and cochaired by Mats Berglund and Sten Thelander. The presentations were (1) Preventive interventions against hazardous consumption of alcohol, by Mikko Salaspuro; (2) Treatment of alcohol withdrawal, by Johan Franck; (3) Psychosocial treatment for alcohol problems, by Sven Andréasson and Agneta Öjehagen; and (4) Pharmacological treatment of alcohol dependence, by Mats Berglund.

Prevention and treatment of alcohol-related problems

Academic Medicine, 1996

This article summarizes the major themes, conclusions and recommendations of a 2-year study conducted for the National Institute on Alcohol Abuse and Alcoholism by the Institute of Medicine. The study is devoted to the identification of research opportunities that will improve knowledge about the prevention and treatment of alcohol problems. In the first part of the report, the study committee examines the social and personal aspects of alcohol-related problems toward which prevention efforts are directed; delineates the features of a public health orientation that it deems most appropriate for the prevention task; discusses individual vulnerability to alcohol misuse; and reviews genetic9 developmental and social learning perspectives on prevention. In the second part of the report, which is devoted to treatment research, the committee considers the underlying philosophical issues as well as the formidable methodological problems in conducting treatment research. Central to this is a broad review of promising treatment modalities and the research needed for developing effective patient-treatment matching schemes. In the final part of the report, the committee concludes that cooperative multisite research efforts are indispensable to the implementation of the research directions it recommends. (J. Stud. Alcohol 53: 5-16, 1992) LCOHOL-RELATED PROBLEMS continue to exact a great toll on individuals and societies. In the United States, alcohol use is involved in nearly 100,000 deaths annually and plays a major role in numerous medical and social problems. The National Institute on Alcohol Abuse and Alcoholism (NIAAA), which was given responsibility by Congress for fostering research on the prevention and treatment of alcoholism, asked the Institute of Medicine (IOM) to undertake a study to assess the cur

Management of Alcohol Use Disorder

Journal of Addiction and Therapies, 2017

This monograph is a review article on the spectrum of alcohol use disorders.We discuss the pharmacological properties of ethanol along with its metabolism. The historical, physical and laboratory elements that may assist in diagnosis of an alcohol use disorder are examined. The concepts of motivational interviewing and stages of change are mentioned, along with the ASAM patient placement criteria to determine the best level of treatment when the subject is ready to take action. Various therapeutic management options are reviewed including psychologic, pharmacologic, and complementary/alternative choices. The purpose of this article is to give the clinician a basic understanding of the tools available to diagnose and treat this "Cunning and baffling" brain and multisystem disease.

Management of alcohol abuse

Clinics in liver disease, 2012

This article reviews the spectrum of alcohol use disorders. The pharmacologic properties of ethanol and its metabolism, and the historical, physical, and laboratory elements that may help diagnose an alcohol use disorder are examined. The concepts of motivational interviewing and stages of change are mentioned, along with the American Society of Addiction Medicine patient placement criteria, to determine the best level of treatment for alcoholism. Various therapeutic management options are reviewed, including psychological, pharmacologic, and complementary/alternative choices. This article provides a basic understanding of available tools to diagnose and treat this cunning and baffling brain and multisystem disease.