Patients with a liver transplant for alcoholic liver disease are advised to abstain permanently from alcohol. To measure the recurrence of alcohol use after liver transplantation, researchers assessed 167 liver recipients every 3 months during the first year after the transplant and then every 6 months for 4 years thereafter. At routine appointments, patients received recommendations for complete abstinence from alcohol and additional counseling if they had returned to drinking. The majority of patients had alcohol dependence (alcoholism), and were sober for an average of 40 months before transplantation.
During the first year after transplantation, 22% of subjects had at least 1 drink. Ten percent had at least 1 heavy drinking episode (6 drinks a day for men and 4 drinks a day for women). And 5% returned to frequent drinking (4 drinking days per week).
By the fifth year after the transplant, 42% had at least 1 drink, 26% had at least 1 heavy drinking episode, and 20% returned to frequent drinking.
Longer sobriety before the transplant delayed the time to first drink and heavy drinking.
Alcoholism and depression predicted significantly higher alcohol use after the transplant.
Conclusion: This study shows that although the majority of liver recipients do not drink heavily, a substantial proportion returns to some alcohol use after transplantation for alcoholic liver disease. The findings highlight the need for supportive strategies, particularly those that increase the length of sobriety before the transplant, to minimize alcohol use after the transplant.
Therapy should include attendance at Alcoholics Anonymous for alcoholism which is known to increase alcohol abstinence.
Reference: DiMartini A, Day N, Dew MA, et al. Alcohol consumption patterns and predictors of use following liver transplantation for alcoholic liver disease. Liver Transplant. 2006;12(5):813–820.
Brief-TSF will assist breakdown of denial and sustained recovery.
Alcohol & Other Drug Recovery by Belleruth Naparstek
Nurse-delivered brief interventions for hazardous drinkers with alcohol-related facial trauma: a prospective randomised controlled trial.
AIMS: To assess the impact of two methods of brief nurse-delivered brief interventions in reducing drinking variables in hazardous drinkers with alcohol-related facial injuries.
METHODS: A randomised controlled trial of two brief interventions involving hazardous drinkers with facial trauma in three Oral and Maxillofacial Surgery outpatient clinics in the West of Scotland; 194 patients were recruited and randomised to have either a nurse-led brief motivational intervention (intervention group) or a leaflet about alcohol misuse (control group). Patients were followed up at 3 and 12 months after the intervention and drinking variables reassessed.
RESULTS: A brief motivational intervention for alcohol provided by a nurse was more effective than a leaflet in helping some patients with facial trauma to reduce their alcohol consumption 12 months after the intervention (p<0.05).
CONCLUSIONS: Facial trauma in the West of Scotland is strongly associated with alcohol misuse and is a recurrent disease, particularly among those who drink heavily. A nurse-delivered brief motivational intervention is effective in helping patients with high scores in the Alcohol Use Disorders Identification Test (AUDIT) to reduce their drinking, and this effect was apparent 12 months after the intervention.
Goodall CA, Ayoub AF, Crawford A, Smith I, Bowman A, Koppel D, Gilchrist G. Br J Oral Maxillofac Surg. 2008 Mar;46(2):96-101. Epub 2007 Dec 21. Nurse-delivered brief interventions for hazardous drinkers with alcohol-related facial trauma: a prospective randomised controlled trial
Alcoholics can be distinguished from controls in terms of cyclothymic traits
Ninety-four consecutive responders to treatment alcoholics, 39 with and 55 without psychiatric comorbidity, were compared, regarding affective temperaments, according to the formulation of Akiskal and Mallya, with 50 healthy volunteers displaying the same social characteristics and belonging to the same environment.
No differences were observed between alcoholics and controls on the hyperthymic scale.
Significant discrepancies were measured on the depressive, cyclothymic, and irritable scales, where alcoholics scored higher, regardless of the presence or absence of dual diagnosis.
In a multivariate discriminant analysis, mainly cyclothymic, but also depressive traits to a lesser degree, make it possible to distinguish between alcoholics and controls, but not between alcoholics with and without a dual diagnosis.
The present study shows the main ways in which alcoholics can be distinguished from controls in terms of cyclothymic traits, with a depressive component, and why these characteristics are unrelated to the presence of dual diagnosis.
Research report; Pacini M, Maremmani I, Vitali M, Santini P, Romeo M, Ceccanti M. Affective temperaments in alcoholic patients. Alcohol. 2009 Aug;43(5):397-404.
Brief Twelve Step Facilitation (Brief-TSF) is a new synthesis of experience and research covering the last 65 years. Varied forms of TSF have been devised and utilised by a variety of helpers since Twelve Step Fellowships originated by Alcoholics Anonymous (AA). These range from simple advice to ‘Go to AA’ through various forms of counseling, mandated attendance and coercion to long-term residential treatment.
Brief-TSF, unlike full TSF, is for use by generalist healthcare workers as an adjunctive intervention to their normal practice. It is brief in that Brief-TSF only requires one dedicated session.
Brief-TSF can be used as;
a discrete structured assertive intervention,
in an opportunistic supportive mode or,
simply as a knowledge base for healthcare workers who wish to respect a clients/patients choice of recovery through a twelve step fellowship.
Brief-TSF is intended to be utilised in ‘mainstream’ healthcare as an earlier intervention to prevent harms such as family breakdown, legal sanctions, medical complications, anti-social behaviour, employment interruption & etc.
Brief-TSF consists of a brief and structured approach to facilitating early recovery from alcoholism. It is intended to be implemented on an individual basis and is based in behavioural, spiritual, and cognitive principles that form the core of 12 step fellowships such as Alcoholics Anonymous (AA). It is suitable for those who are alcohol dependent.
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