Detoxification from alcohol abuse.

The alcohol withdrawal syndrome (AWS) is a common management problem in hospital practice for neurologists, psychiatrists and general physicians alike.

Although some patients have mild symptoms and may even be managed in the outpatient setting, others have more severe symptoms or a history of adverse outcomes that requires close inpatient supervision and benzodiazepine therapy.

Many patients with AWS have multiple management issues;

• withdrawal symptoms,
• delirium tremens (DT’s),
• the Wernicke–Korsakoff syndrome,
• seizures,
• depression,
• polysubstance abuse,
• electrolyte disturbances and
• liver disease,

These require a coordinated, multidisciplinary approach. Although AWS may be complex, careful evaluation and available treatments should ensure safe detoxification for most patients.

The alcohol withdrawal syndrome; Journal of Neurology, Neurosurgery, and Psychiatry 2008;79:854-862, A McKeon, M A Frye, Norman Delanty.

See also;

• 12-Step Treatment More Effective than Alternative
• Brief-TSF can assist people cease alcohol consumption.
• Alcohol Related Brain Injury

Slaying the Dragon: The History of Addiction Treatment and Recovery in America by William L. White Read more about this title…

A NATURALISTIC COMPARISON OF OUTCOMES AT SOCIAL AND CLINICAL MODEL SUBSTANCE ABUSE TREATMENT PROGRAMS.

Since the 1970s, much of the public treatment system in California has been based on a social model orientation to recovery for alcoholics, but there has been minimal research on program outcomes. This article reports on follow-up interviews conducted with a representative sample of 722 people who had entered treatment about a year earlier in public and private programs, including publicly-funded social model detoxification and residential programs, and clinical model programs in hospitals and HMO clinics.

higher levels of 12-step program involvement during follow-up, which strongly predicted an absence of alcohol problems

• Social model clients came to treatment with more severe legal and employment problems, whereas those seeking treatment at clinical programs reported more severe family problems.
• At follow-up, clients at both types of programs reported attending a similar number of Alcoholics Anonymous (AA) meetings, but social model clients reported going to more Narcotics Anonymous (NA) meetings and being involved in more AA activities.
• Social model clients were less likely than clinical model clients to report problems with alcohol or drugs at follow-up, but the odds of reporting other problems (e.g., medical, psychological, legal, family/social) were similar.

The program effect for better alcohol outcomes at the social model programs was partially explained by their clients’ higher levels of 12-step program involvement during follow-up, which strongly predicted an absence of alcohol problems.

• Social networks supportive of abstinence also were predictive of reporting no alcohol problems at follow-up.

In contrast, subsequent detoxification treatment events between baseline and follow-up were associated with a higher odds of reporting alcohol, drug, psychiatric and family/social problems at follow-up.

These findings are consistent with the growing body of literature reporting higher rates of abstinence among those who are able to construct more positive social networks, and who attend and become involved in 12-step programs during and following treatment.

It is important that these results be replicated, as they suggest that social model programs are successful in engaging their clients in AA activities and in NA meeting attendance, and could represent for some an effective alternative to clinical model treatment programs.

Research; LEE ANN KASKUTAS, LYNDSAY AMMON, CONSTANCE WEISNER. A NATURALISTIC COMPARISON OF OUTCOMES AT SOCIAL AND CLINICAL MODEL SUBSTANCE ABUSE TREATMENT PROGRAMS. International Journal of Self Help and Self Care; Volume 2, Number 2 / 2003-2004, 111 - 133

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A cohort study of male subjects attending an Alcoholics Anonymous program in India: One-year follow-up for sobriety.

A cohort of subjects in India who completed detoxification treatment and a de-addiction program based on the Alcoholics Anonymous (AA) model were followed-up at 1 year to investigate the factors associated with complete abstinence.

Patients (N = 187 men) who were admitted consecutively to an addiction facility and fulfilled Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for alcohol dependence were recruited for the study.

Patients with major psychopathology were excluded. The final outcome at 1 year was determined by visiting the patients and talking to the families and members of the local AA group.

Of the 187 men initially recruited, 5 were excluded because of major psychopathology, 1 committed suicide, and 7 could not be traced.

Of the 174 patients available for follow-up, 58 (33.3%) remained sober (complete abstinence for the past year) at 1 year.

Patients coming from distant places and those with follow-up workers in their localities fared better than those from the local area and those from towns where there was no one to motivate them to continue with AA meetings.

These variables were significantly associated with sobriety even after adjustment for other confounders using multivariate techniques. A third of the cohort remained sober at 1-year follow-up.

The patients’ initial motivation and continued support once they returned to their communities were associated with sobriety at follow-up.

Research report; Kuruvilla PK; Vijayakumar N; Jacob KS. A cohort study of male subjects attending an Alcoholics Anonymous program in India: One-year follow-up for sobriety. Journal of Studies on Alcohol 65(4):546-549, July 2004.

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Long-term effects of pharmacotherapy on relapse prevention in alcohol dependence.

Background: There is growing evidence that pharmacological treatment with two of the best validated anticraving medications, acamprosate and naltrexone, is efficacious in promoting abstinence in recently detoxified alcohol-dependent subjects.

Objective: The stability of effects after termination of treatment remains to be answered, especially when combining both the drugs.

Method: After detoxification, 160 alcohol-dependent subjects participated in a randomized, double-blind, placebo-controlled trial. Patients received naltrexone or acamprosate or a combination of naltrexone and acamprosate or placebo for 12 weeks. Patients were assessed weekly by interview, self-report, questionnaires and laboratory screening. Additionally, follow-up evaluation based on telephone interview of participants, general practitioners and relatives was conducted 12 weeks after terminating the medication.

Results: At week 12, the proportion of subjects relapsing to heavy drinking was significantly lower in the group with combined medication compared with both placebo and acamprosate (P < 0.05).

No difference was detectable between acamprosate and naltrexone, both of which were superior to placebo (P < 0.05).

12 Week Relapse rates were;

• 28% (combined medication),
• 35% (naltrexone),
• 50% (acamprosate) and
• 75% (placebo).

After follow-up (week 24), combined medication led to relapse rates significantly lower than placebo, but not lower than acamprosate.

Again, both naltrexone and acamprosate were superior to placebo.

24 Week Relapse rates were

• 80% (placebo),
• 54% (acamprosate),
• 53% (naltrexone) and
• 34% (combined medication).

Conclusions:

The results of this study highlight the stability of effects of pharmacotherapy on relapse prevention in alcohol dependence.

Research; Kiefer F; Andersohn F; Otte C; Wolf K; Jahn H; Wiedemann K. (2004), Long-term effects of pharmacotherapy on relapse prevention in alcohol dependence. Acta Neuropsychiatrica, October 2004, vol. 16, no. 5, pp. 233-238(6)

The Role of Nutritional Therapy in Alcoholic Liver Disease

By Christopher M. Griffith, M.D., and Steven Schenker, M.D.

Alcoholic liver disease (ALD) evolves through various stages, and malnutrition correlates with the severity of ALD.

Poor nutrition is caused both by the substitution of calories from alcohol for calories from food and by the malabsorption and maldigestion of various nutrients attributed to ALD.

The only established therapy for ALD consists of abstinence from alcohol. Sufficient nutritional repletion coupled with appropriate supportive treatment modalities may be effective in reducing complications associated with ALD-particularly infection. Nutrition makes a significant positive contribution in the treatment of ALD, especially in selected malnourished patients.

Goals of Nutritional Supplementation in Chronic Liver Disease

• Prevent or correct protein-calorie malnutrition
• Prevent or correct hepatic encephalopathy
• Aid hepatic healing and regeneration insofar as possible
• Improve quality of life
• Prolong life and improve prognosis after liver transplantation
• Control the costs and discomforts of therapy insofar as possible
• Avoid potential unwanted side effects of therapy, including encephalopathy, azotemia, electrolyte or water imbalance, aspiration, venous thrombosis or thrombophlebitis, and sepsis. (SOURCE: Nompleggi and Bonkovsky 1994, with permission)

Research; Alcohol Research & Health, Vol. 29, No. 4, 2006

Alcohol and drug dependence approach

Synopsis - diagnosis and management

An empathetic and non-judgemental attitude to the patient is required when managing drug dependence problems.

Careful assessment to establish the nature and extent of drug use must precede any attempts at management (more than one consultation is likely to be necessary).

The active cooperation of the patient in any management plan is essential, as the patient’s readiness for change will be a powerful influence on the success of any intervention.

Goals for stopping or reducing drug use must be agreed with the patient and must be attainable. Abstinence from drugs will not be every patient’s goal; harm reduction (through education to avoid collateral risks or efforts to cut down on drug consumption) is a worthwhile objective.

Detoxification is only part of the process. Many lifestyle adjustments are required to maintain a drug-free existence, and these changes may require social support and/or psychological therapies.

Relapse is common but can be used as a learning experience. Patients who relapse into drug use should be encouraged to try again.

With empathy and positive management, many drug dependent people can be liberated from their addictions.

Research extract from; Tobie L Sacks and Nicholas A Keks. Alcohol and drug dependence: diagnosis and management. Medical Journal of Australia Practice Essentials #14.