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Dual Diagnosis Alcoholics Treatment

Thursday, January 1st, 2009

Treatment response of bipolar and unipolar alcoholics to an inpatient dual diagnosis program

BACKGROUND: Depressed and bipolar alcoholics represent a significant affective subgroup that has a poorer prognosis than either diagnosis alone. To date few systematic treatment programs have been developed to treat dual diagnosis.

METHODS: An inpatient treatment program was developed at St Patrick’s Hospital Dublin to treat dual diagnosis clients with alcohol dependence and either unipolar or bipolar affective disorder.

Clients (N=232) were assessed for depression, anxiety, elation, cravings, drink and drug intake on admission, discharge, 3 and 6 months post-discharge from the program.

RESULTS:

In the overall group there was a reduction in number of drinking days and units per drinking day over the study (p<.01).
There was a 71.8% complete abstinent rate at 3 months and 55.8% at 6 months in the depression group, non-significantly greater than for the bipolar group at 64.7% and 54.1% respectively.
Gamma GT, MCV and craving scores were significantly reduced over time (p<.01).
Mania, depression and anxiety inventory scores fell over time in both groups (p<.01).
15-21-year olds were more severely anxious, had higher illicit drug use, and were more likely to relapse to drug use than older clients.
Bipolar 1 clients were significantly more likely than bipolar 2 clients to be on mood stabilisers at all follow-up stages (p<.001).

LIMITATIONS: No control group was used.

CONCLUSIONS: There is evidence for efficacy of a specifically designed dual diagnosis inpatient treatment program as both depressed and bipolar alcoholics had significant reductions in all measurements of mood, craving, and alcohol/drug consumption by self report and biological markers, suggesting both diagnoses can be effectively treated together.

Research; J Affect Disord. 2008 Mar;106(3):265-72. Epub 2007 Aug 16. Treatment response of bipolar and unipolar alcoholics to an inpatient dual diagnosis program. Farren CK, Mc Elroy S.

See also;

The Dual Diagnosis Recovery Sourcebook : A Physical, Mental, and Spiritual Approach to Addiction with an Emotional Disorder
by Dennis Ortman

Naltrexone Cuts Alcoholics Drinking

Wednesday, December 10th, 2008

Early treatment response in alcohol dependence with extended-release naltrexone.

OBJECTIVE: We sought to determine the time course for onset of effect of intramuscular injectable extended-release naltrexone (XR-NTX), which has demonstrated efficacy for alcohol dependence.

METHOD: A post hoc analysis of a randomized, double-blind, placebo-controlled, multicenter study was conducted. In the study, actively drinking men and women who met DSM-IV-TR criteria for alcohol dependence were randomly assigned to receive injections of XR-NTX 380 mg (N = 205) or 190 mg (N = 210) or placebo (N = 209) every 4 weeks for 24 weeks. Patients also received 12 sessions of adjunctive standardized, low-intensity psychosocial intervention. Drinking data were analyzed by month and, during the first month, by day to explore the time course for onset of effect on heavy drinking days in patients receiving XR-NTX versus placebo. The study data were collected between February 2002 and September 2003.

RESULTS: During the first month following injection, patients receiving XR-NTX 380 mg had 37% fewer heavy drinking days versus placebo (p < .01). By day 2, a significant reduction in the median number of drinks consumed per day was observed in patients given XR-NTX 380 mg compared with placebo (p < .05). By day 3, XR-NTX 380 mg resulted in a significant reduction in the percentage of patients reporting heavy drinking compared with placebo (p < .05); this reduction was maintained throughout the study. A dose-response effect was observed, with intermediate results for XR-NTX 190 mg.

CONCLUSION: XR-NTX 380 mg provided a rapid onset of therapeutic effect in the first 2 days after the first injection that was sustained throughout the 24-week trial. Potential clinical implications of the rapid, early onset of effect of this medication’s delivery system for patients who are dependent on alcohol include facilitation of early engagement in treatment, motivation to continue treatment, and focus on the goals established in counseling.

Research; J Clin Psychiatry. 2008 Feb;69(2):190-5. Early treatment response in alcohol dependence with extended-release naltrexone. Ciraulo DA, Dong Q, Silverman BL, Gastfriend DR, Pettinati HM.

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Tags: alcohol dependence, counseling, drinking, Naltrexone, psychosocial, treatment
Posted in Adjunctive therapy, Alcohol, Alcoholism, Pharmacotherapy, Research | No Comments »

Obstetricians Often Overlook Alcohol Consumption

Sunday, July 27th, 2008

Obstetricians Often Overlook Alcohol Consumption In Pregnancy, says the Australian And New Zealand Journal Of Obstetrics And Gynaecology

One in every two pregnant Australian woman still consume alcohol during pregnancy, according to a study in the Australian and New Zealand Journal of Obstetrics and Gynaecology. The responsibility of providing accurate information about the harmful effects of alcohol and its lifelong effects on the child falls on obstetricians and other health professionals.

And yet, almost half of the obstetricians interviewed said they did not routinely ask about alcohol consumption in pregnancy.

An editorial by Professor Elizabeth Elliot from the University of Sydney titled “Alcohol and Pregnancy: the Pivotal Role of the Obstetrician”, discusses the state of awareness about the adverse effects of alcohol consumption during pregnancy and the obstetricians’ participation in educating against maternal drinking.

Only 16% of the obstetricians routinely provided information about the consequences of alcohol in pregnancy, while only 5% gave advice which were consistent with the latest guidelines of The National Health and Medical Research Council of Australia (NHMRC) - which states that, for pregnant women, ‘no drinking is the safest option’.

Professor Elliot says, “Failure to provide information about the dangers of alcohol consumption in the antenatal consultation represents a lost opportunity. Accurate recording of antenatal alcohol exposure will help identify children who require pediatric assessment, since the effects of alcohol may not be obvious at birth.”

“More importantly, identifying the women who are unable to stop drinking provides an important opening for the management of problem drinking and prevention of exposure to alcohol in future pregnancies,” added Professor Elliot.

Alcohol consumption during pregnancy has been associated with increased risks of miscarriage, stillbirth, intrauterine growth restriction, pre-term birth and low birth-weight. However, the best known adverse effect of alcohol exposure on the fetus is the fetal alcohol syndrome (FAS) - which is associated with a wide range of birth defects and ongoing educational, behavioral and psychological problems.

This paper is published in the June 2008 issue of Australian and New Zealand Journal of Obstetrics and Gynaecology (Vol. 48, Issue 3, 2008).

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Tags: Australia, drinking, fetus, intrauterine, miscarriage, New Zealand, NHMRC, obstetrician, pre-term, Pregnancy, stillbirth
Posted in Alcohol, Alcoholism, Assessment, Family, Symptoms of addiction, Training, Women | No Comments »

Hazardous alcohol use among hospital doctors in Germany

Saturday, May 17th, 2008

Aims; To describe alcohol use, and the prevalence and predictors of hazardous drinking, among hospital doctors.

Methods. Data were collected by anonymous mail survey in 2006, from a representative national sample of 1917 (58% response rate) hospital doctors in Germany. Alcohol use was measured using the AUDIT-C, scores of 5 or more for males and females indicating “hazardous drinking.”

Results. There were;

9.5% abstainers,
70.7% moderate drinkers, and
19.8% hazardous drinkers.
The majority of doctors (90.5%) used alcohol—mainly at a sensible level, e.g., 2–4 times a month (32%) or 2–3 times a week (29%), and 1–2 glasses on one occasion (83%).
Binge drinking was common (53%), but for most occurred less than once in a month (39%).
When hazardous drinking was controlled for certain confounders, being male (OR 4.7; 95% CI 3.4–6.5) and having a surgical specialty (OR 1.4; 1.1–1.8) were significantly correlated to hazardous drinking.
Age had no influence on this model.
By contrast, the age group 40 years and younger (OR 2.1; 1.4–3.0) was a significant predictor of abstinence.

Conclusions. There is a higher rate of abstainers and a lower rate of binge drinkers among hospital doctors in Germany than in the general population. However, some hospital doctors drink hazardously, the risk being greater among males and among surgeons, which should be paid due attention in the interest of their health and their function as doctors.

Alcohol and Alcoholism 2008 43(2):198-203.Hazardous alcohol use among hospital doctors in Germany, Judith Rosta

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Tags: abstain, audit, binge, doctors, drinking, Germany, hospital
Posted in Alcohol, Alcoholism, Assessment, Demographics, Men, Research | No Comments »

Men and Women Alcoholics have Differing Medical History

Thursday, May 1st, 2008

Difference in medical history classified by ICD-10 between male and female alcoholics.

The drinking history and current medical history of patients with alcohol dependence were surveyed in Japan and they were analyzed by demographics; gender, age and changes with time (2 stages).

The results showed that in the course of continued habitual drinking by patients with alcohol dependence, a wide range of physical complications occurred.

The main complications

in men were gastrointestinal diseases and
in women were mental and behavioral disorders, showing a gender difference in the medical history.

This result suggested that there is a high possibility that this will contribute to early discovery and early measures against alcohol related problems in women, which are difficult to bring out into the open.

Better alcohol education including mental health is important from an early age.

Nihon Arukoru Yakubutsu Igakkai Zasshi. 2008 Feb;43(1):25-34. Difference in medical history classified by ICD-10 between male and female alcoholics. Shinoda R, Mizukami Y, Nakagawa Y, Maruyama K.

See also;

Counseling the Culturally Diverse: Theory and Practice
by Derald Wing Sue, David Sue

Brief-TSF.com

Posts Tagged ‘drinking’

Dual Diagnosis Alcoholics Treatment

Naltrexone Cuts Alcoholics Drinking

Obstetricians Often Overlook Alcohol Consumption

Hazardous alcohol use among hospital doctors in Germany

Men and Women Alcoholics have Differing Medical History

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