ผู้วิจัย/Authors: Sawitri Assanangkornchai

ชื่อเรื่อง/Title: Symposium: Alcohol management in clinical settings.

แหล่งที่มา/Source: The 3rd National Alcohol Conference "Alcohol : No Ordinary Commodity", 21st-22nd November 2007, Richmond Hotel, Nonthaburi, Page 53.

รายละเอียด / Details:

Alcohol management in clinical settings Alcohol use disorder-the abuse of or dependence on alcohol is a significant and growing problem in Thailand and worldwide. Alcohol is found to be the most common substance of abuse among people of various age-groups. Clinical Management for alcohol use disorders starts involves several stages-early detection and brief intervention for those with hazardous or harmful drinking, detoxification for drinkers in the alcohol withdrawal state, relapse prevention for dependent individuals and integrated treatment for patients who have both alcohol use disorder and other physical or psychiatric comorbidity. Over the past decades, a lot of progress has been made both in pharmacological and psychosocial interventions for people with alcohol use disorders. Although, some treatments are established, more evidence of the effectiveness of treatments is still needed to improve the clinical services available to treat alcohol-dependent patients. The central aim of this symposium is to provide an up-to-date review of the management strategies for alcohol use disorders and highlight some important and interesting treatment outcome research published in international and national journals during 2005-2007. Featured Speakers: Dr.Sawitri Assanagkornchai will present an overview of the management strategies for individuals with alcohol use disorders in a clinical setting. Dr. Suwanna Arunpongpaisal will describe the current practice guidelines for alcohol detoxification. Dr. Manit Srisurapanont will review the progress on pharmacological and psychosocial treatment of alcohol dependence. And finally, Dr. Pichai Sangcharnchai will present both the psychosocial and medication treatments for those diagnosed with an alcohol-related disorder and one of the following disorders: (a) depression, (b) anxiety disorder, (c) schizophrenia, and (d) bipolar disorder. These presentations will provide a critique of the current state of the literature, identify the direction for future research on clinical management of individuals with alcohol use disorders, and are expected to contribute to the formulation of effective alcohol treatment programs in Thailand. Synopsis: Clinical services for patients with alcohol-related problems start at the earliest step when the patients reach the hospital or health care clinic, either at the emergency unit or the outpatient department. Three levels of care involved: 1) Early intervention, 2) Treatment and rehabilitation and 3) Aftercare services. Early intervention aims to identify individuals at the earliest stage of the problem and provide appropriate intervention to prevent them from progressing into further stage of the disorder. Screening methods include self-report questionnaire, e.g. AUDIT, structured interview and computer-based screening are used in clinical practice. Recent evidence supports the clinical performance of carbohydrate-deficient transferring and gamma-glutamyltransferase as biomakers for chronic alcohol consumption. A lot of research studies indicates the effectiveness of brief intervention programs in various clinical settings, such as the emergency unit, the trauma unit, the prenatal care unit and the inpatient wars. Treatment and rehabilitation are targeted at individuals in the alcohol dependence stage or those with alcohol induced psychiatric or physical illnesses or those with comorbidity of alcohol and other disorders. The goal of the treatment is to help the patients to achieve a total abstinence or to be in a controlled drinking stage. This level of care includes two major steps, i.e. detoxification and relapse prevention. Detoxification can be undertaken either in an ambulatory setting for patients with mild to moderate alcohol withdrawal symptoms (AWS) and in the inpatient unit for those in the moderate to severe state. The goal of detoxification is to control the symptoms of AWS and to prevent alcohol withdrawal seizures, withdrawal delirium, and deaths from complications of AWS. Long acting benzodiazepines, the medications of choice as sedatives for CNS excitation, can be given on a fixed schedule or through “front-loading” or “symptom-triggered” regimens. Sympatholytics, e.g., clonidine and atenolol are effective as adjuvant therapy to treat hyperadrenergic symptoms that persist despite adequate sedation. Clinical practice guidelines, including the standard withdrawal assessment scales and some alcohol withdrawal regimes may be useful in various clinical settings. Well-designed studies have found that psychosocial interventions, such as motivational enhancement therapy, cognitive-behavioral therapy, and 12-step facilitation are effective. Recent evidence shows that other interventions may also be effective. Those include I) social behavior and network therapy, alcohol behavioral couples therapy, viewing delirium tremens videotape, and telephone and mail intervention. Medications approved by the US FDA for alcoholism are disulfiram, naltrexone, and acamprosate. Promising agents are topiramate, high dose oxcarbamazepine, and quetiapine for early-onset (Type B) alcoholism. Although study findings have shown that these treatments are superior to placebo, psychoeducation, or treatment as usual, the response rate of each intervention is relatively low. At present, effectiveness of treatment for alcoholism is not yet satisfactory. Despite the high prevalence and serious consequences of comorbid alcohol use and mental illness, studies about efficacy and effectiveness of the treatments for both psychiatric disorders and alcohol-use disorder are limited. Some studies suggested that efficacious treatments for reducing psychiatric symptoms or for reducing alcohol consumption also tend to work in comorbid patients. Some recent randomized control trials found better drinking outcomes in alcohol-dependent individuals both with and without Axis I psychiatric disorders treated with naltrexone and disulfiram, bipolar I patients treated with valproate, and sertraline-treated participants with less severe alcohol dependence and early-onset PTSD. Although, some promising treatments are found, there are too few studies to effectively or usefully guide treatment practice. Aftercare service aims to keep the post treatment individuals in their society without drinking or causing any alcohol-related problems. The interventions with some evidence of effectiveness included self-help group and community reinforcement program.

Keywords: alcohol, management, clinical setting, abuse, dependence, alcohol use disorder, substance abuse, treatment

ปีที่เผยแพร่/Year: 2007

Address: Overview of alcohol management

Code: 200800152

ISSN/ISBN: 978-974-09-4574-1

Country of publication: Thailand

Language: English

Category: Abstract

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