Alcohol dependence treatment in the EU: A literature search and expert consultation about the availability and use of guidelines in all EU countries plus Iceland, Norway, and Switzerland

Rehm, J., Rehm, M. X., Alho, H., Allamani, A., Aubin, H., Bühringerm G,m Daeppen, J., Frick, U., Gual, A., & Heather, N. (2013). Alcohol dependence treatment in the EU: A literature search and expert consultation about the availability and use of guidelines in all EU countries plus Iceland, Norway, and Switzerland. International Journal of Alcohol and Drug Research, 2(2), 53-67. doi: 10.7895/ijadr.v2i2.89 (http://dx.doi.org/10.7895/ijadr.v2i2.89) Aim: To describe guidelines and common practices for alcohol dependence treatment in Europe. Design: Systematic and qualitative review; for each country, guidelines were identified via systematic literature research, followed by interviews with treatment experts. Setting: European Union (EU) countries plus Iceland, Norway, and Switzerland. Participants: Experts in alcohol dependence treatments and treatment systems. Measure: Semi-structured questionnaire for interviews. Findings: While fewer than half of EU countries have formal national guidelines for alcohol dependence treatment, a majority of these countries have guidelines by professional organizations such as psychiatric or neuropsychopharmacologic societies, and several are currently developing such guidelines. Abstinence is the usual treatment goal, but the majority of countries accept reduction of drinking as an intermediate or secondary goal, in practice even more than in the guidelines. Psychotherapy, mainly cognitive-behavioral approaches, motivational interviewing, and family therapy, is the most common treatment for relapse prevention, in part accompanied by pharmacotherapy (disulfiram, acamprosate and naltrexone being used most often). Conclusions: There are differences in treatment for alcohol dependence in Europe. The introduction of reduction of drinking as one treatment goal may attract more patients. Keywords alcohol dependence, treatment, abstinence, reduced drinking, pharmacotherapy

Alcohol dependence treatment in the EU: A literature search and expert consultation about the availability and use of guidelines in all EU countries plus Iceland, Norway, and Switzerland

Rehm, J., Rehm, M. X., Alho, H., Allamani, A., Aubin, H., Bühringerm G,m Daeppen, J., Frick, U., Gual, A., & Heather, N. (2013). Alcohol dependence treatment in the EU: A literature search and expert consultation about the availability and use of guidelines in all EU countries plus Iceland, Norway, and Switzerland. International Journal of Alcohol and Drug Research, 2(2), 53-67. doi: 10.7895/ijadr.v2i2.89 (http://dx.doi.org/10.7895/ijadr.v2i2.89) Aim: To describe guidelines and common practices for alcohol dependence treatment in Europe. Design: Systematic and qualitative review; for each country, guidelines were identified via systematic literature research, followed by interviews with treatment experts. Setting: European Union (EU) countries plus Iceland, Norway, and Switzerland. Participants: Experts in alcohol dependence treatments and treatment systems. Measure: Semi-structured questionnaire for interviews. Findings: While fewer than half of EU countries have formal national guidelines for alcohol dependence treatment, a majority of these countries have guidelines by professional organizations such as psychiatric or neuropsychopharmacologic societies, and several are currently developing such guidelines. Abstinence is the usual treatment goal, but the majority of countries accept reduction of drinking as an intermediate or secondary goal, in practice even more than in the guidelines. Psychotherapy, mainly cognitive-behavioral approaches, motivational interviewing, and family therapy, is the most common treatment for relapse prevention, in part accompanied by pharmacotherapy (disulfiram, acamprosate and naltrexone being used most often). Conclusions: There are differences in treatment for alcohol dependence in Europe. The introduction of reduction of drinking as one treatment goal may attract more patients. Keywords alcohol dependence, treatment, abstinence, reduced drinking, pharmacotherapy

The most acute period of ischemic stroke: the analysis of patients who received thrombolytic therapy

Baskground. The problem of acute cerebrovascular disorders is one of the priorities in modern medicine due to the high level of disability and mortality. The purpose of the study was to investigate the features of modified and unmodified risk factors for ischemic stroke and other factors that influenced the nature of medical care in patients in the most acute period of pathology. Materials and methods. 180 patients with ischemic strokes were divided into two groups depending on the nature of the treatment in the most acute period of the disease. Group I – 90 patients who underwent thrombolytic therapy (TLT); Group II – 90 patients who received standard drug treatment without TLT. The criterion for inclusion of the study was NIHHS – no more than 12 points (9.2±2.8 points). Among them in group I – 38 women and 52 men with an average age of 66.5±6.7 years. Group II – 47 women and 43 men with an average age 65.6±6.0 years. All patients were divided into subgroups by age intervals – up to 50 years, 50-59 years, 60-69 years, 70 years and older. Unmodified and modified stroke risk factors in both groups of patients and time to thrombolytic therapy were considered. Results. Men predominated in the subgroups of younger patients, and no significant gender difference was observed in the older groups. On average, the youngest (up to 50 years old) had 6.5 risk factors (RF) per woman and 4.0 in men, where behavioral factors were the most significant: reduced drinking and probably related erythrocythemia (blood clotting), decreased adherence to the treatment of hypertension, stress. In the second age subgroup in women – 5.5 RF and in men 3.75 FR, in the third – 4.6 in women and 3.7 in men, an increase in hypertension and hypercholesterolemia, which also related to behavioral factors – insufficient commitment to timely treatment and prevention. Among the oldest women had 4.1, and men 3.3 RF, marked by an increase in hypertension, hypercholesterolemia, extracranial vascular pathology. In the period of more than 120 minutes from the onset of symptoms, men of all ages apply, especially in the group up to 50 years. The reason for not performing TLT in 22 % of patients was the uncertainty of the onset of the first symptoms of stroke. Conclusions. 1. Behavioral FR, such as reduced drinking regime, insufficient adherence to timely treatment for prevention of hypertension and hyperlipidemia, stress dominate in younger patients. These were men of working age who do not seek medical help in a timely manner. All these confirms the need to increase the level of information and prevention work among the population. 2. Patients with more risk factors, especially under the age of 60, are committed to treatment and concerned about their health, so they sought help earlier and were able to receive TLT. 3. Patients with diabetes and obesity had the greatest vigilance and commitment to timely medical treatment in contrast to patients with other FR, so the time to TLT was shorter. 4. The untimely request for medical care was the main reason for not performing TLT in patients of younger age subgroups. In 22 % of all patients, the cause of TLT was the uncertainty of the time of onset of the first symptoms of stroke.

Barriers and Facilitators of Alcohol Abstinence During Pregnancy - a Qualitative Study in Rural South Africa

Background:Fetal Alcohol Spectrum Disorders (FASD) is a common, important and under-recognised health burden in South Africa. There is a limited understanding of why pregnant women drink in the South African context. Existing qualitative research leaves significant knowledge gaps regarding pregnant women in rural settings, where prevalence of FASD is highest.Objective:To provide a qualitative assessment of factors that influence drinking in pregnant women in a rural community in the Northern Cape province of South AfricaMethods:A descriptive phenomenological approach was undertaken to explore the perceptions and experiences of pregnant women who drink, in a purposive sample of 8 women from a rural ante-natal clinic. A semi-structured interview was conducted with each participant and thematic analysis was conducted. Results:Participants appeared more aware of FASD than described in other study populations. Most reduced drinking after pregnancy recognition, although both recognition and cessation were often delayed. Participants described barriers and facilitators of alcohol abstinence. Barriers included social pressure, life stressors, and cravings and habits. Facilitators included desire to avoid FASD, relationships that were supportive without being stigmatising, availability of other “occupations” especially friendships and relationships not centred on drinking, specific body cues such as nausea, and a sense of personal agency. Conclusion:Various personal and contextual factors can act as barriers or facilitators of alcohol abstinence during pregnancy. Addressing barriers at structural, community and individual levels may aid women in reducing harmful drinking during pregnancy. Facilitators of abstinence should be leveraged to effect change in drinking behaviours, and thereby limit the burden of FASD.

Reduced drinking and harm reduction in the treatment of alcohol use disorders

Purpose The purpose of this paper is to give an overview of the scientific evidence for reduced drinking in alcohol use disorders. While the aim of alcohol use disorders (AUD) treatment usually focuses on abstinence, only a minority of individuals with AUD enter treatment. Lack of alternative treatment goals, including reduced drinking instead of abstinence, have been identified as a potential barrier for treatment entry. Epidemiological and treatment outcome studies reveal that a large proportion of individuals with AUD are able to substantially reduce their alcohol intake for a prolonged duration of time. Design/methodology/approach A narrative review of the literature on prevalence rates and health effects as well as evidence-based approaches fostering reduced drinking in individuals with AUD is presented. Findings Reduced drinking is associated with improvements in both morbidity and mortality. Research has identified evidence-based psychosocial and pharmacological treatment approaches; however, implementation is still scarce. Originality/value Target groups for interventions fostering drinking reduction instead of abstinence are defined and desiderata for further research are outlined.

Effects of evaluative conditioning on implicit evaluation of alcohol and drinking behaviors: A direct replication

Background. Recent research suggests that evaluative conditioning can change implicit evaluation of alcohol and reduce drinking behaviors among college students (Houben, Havermans et al., 2010). This study has been conceptually replicated in two previous studies. To date, however, there is no direct and independent replication of the original study. In this paper, we report a high-powered direct replication of Houben, Havermans et al.’s (2010) study. Method. One hundred and sixty-eight French college students took part in this preregistered study. Drinking behavior was assessed before the intervention and two weeks after. The intervention consisted of 120 trials of words related to alcoholic beverages or to soft drink, paired with neutral, positive, or negative pictures. The two conditions were factually equivalent and only differed by the contingency between alcohol-related words and negative pictures. In the evaluative conditioning condition, but not in the control condition, alcohol-related words were systematically paired with negative pictures. Results. Evaluative conditioning did not change implicit evaluation of alcohol and drinking behaviors. However, evaluative conditioning reduced drinking behaviors specifically among hazardous drinkers. Conclusion. This high-powered pre-registered direct replication of Houben, Havermans et al. (2010) suggests that the original effects are more fragile than initially thought. The effect of evaluative conditioning on drinking behaviors may be restricted to heavy drinkers, and we found no evidence that this effect is mediated by a change in implicit attitudes. Further studies are needed to test the original effects in clinical populations.