Current Evaluation and Management of Patients with Alcohol Dependence
Barcelona, Spain 
70 slide(s) – English – 2010-12-10
After viewing this presentation the participant will be able to:
- Relate data on the worldwide and European prevalence of high-risk drinking
- Review the disease groups causing alcohol-related harm
- Define key alcohol and drug terms according to WHO
- Diagnose alcohol use disorders
- Conduct a bio-psycho-social assessment
- Administer an alcohol detoxification program
- Predict the chance of success with treatments combining medical management and cognitive behavioural intervention
- Review the indications, efficacy and safety of drugs for treatment of alcohol dependency
Dr. Gual begins the presentation by recalling attention to the widespread burden of alcohol use disorders, and the lack of treatment for 75% of alcoholics. According to the WHO, alcohol is the second largest risk factor for DALYs (Disability Adjusted Life Years) in high-income countries. Each DALY represents a year of premature death, or ill-health, adjusted for the severity of the ill-health.
Alcohol use disorders are classified as moderate (2-3 criteria) or severe (4 or more criteria). In addition, the physiological dependence is described as tolerance and/or withdrawal. Dr. Gual stresses the importance of early identification, as population data show that only 25% of alcoholics ever had treatment. The current gold standard tool for screening for risky drinking and alcohol dependence, developed by the WHO is the AUDIT (Alcohol Use Disorders Inventory Test). Comprising ten questions, the test has cut-off points to identify harmful or hazardous drinking, and alcohol dependence. In the primary care setting, the AUDIT-C is a shorter version which can be helpful in identifying individuals who need more thorough investigation. Following identification, a careful assessment of the patient with alcohol dependence ensues. Dr. Gual explains how to approach these individuals for a bio-psycho-social assessment.
Clinical management of alcohol dependency starts with detoxification in selected patients who agree to an abstinence goal. This entails the abrupt cessation of alcohol, and substitution of alcohol with drugs having similar effects. The rehabilitation process is a group of therapeutic processes which are then undertaken in order to promote abstinence from alcohol, and improve the person’s coping skills and quality of life. Dr. Gual shares the results obtained with various rehabilitation programs.
Lastly, Dr. Gual discusses the indications, efficacy and safety of several drugs used for treating alcohol dependency. These include disulfiram which is one of the oldest and least expensive agents; also naltrexone; acamprosate; and topiramate. In conclusion, combined medical and psychosocial treatments are the recommended strategy to treat alcohol dependence.
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Raymond F. Anton et al. "Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence: The COMBINE Study: A Randomized Controlled Trial" JAMA. 2006;295(17):2003-2017.
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