German Guidelines on Screening, Diagnosis, and Treatment of Alcohol Use Disorders: Update 2021

Abstract

<b><i>Introduction:</i></b> Alcohol consumption in Germany is associated with considerable health and economic consequences. In addition to prevention, the early detection and differential treatment of those affected play an important role. The guideline “Screening, Diagnosis, and Treatment of Alcohol Use Disorders” forms the basis of this care for people suffering from alcohol use disorders. Regular updates integrate the current state of research evidence and clinical expertise. <b><i>Methods:</i></b> Under the auspices of the German Society for Psychiatry, Psychotherapy, Psychosomatics, and Neurology and the German Society for Addiction Research and Addiction Therapy e.V. (DG-Sucht), the 2019–2020 S3 guideline on alcohol was revised by eight working groups. Thirty-five professional societies participated in a structured consensus process to deliberate the recommendations. Potential conflicts of interest were examined in advance, documented, and taken into account during the voting on the recommendations. <b><i>Results:</i></b> The guideline provides recommendations on screening and brief interventions for different groups of people, as well as on treatment of individuals in the acute and post-acute phases of withdrawal. Special emphasis was placed on the treatment of comorbid somatic and psychological disorders. In addition, recommendations for specific groups of people (e.g., children and adolescents, pregnant women) have been made and adapted to the German care landscape.

Estimating the prevalence of alcohol-related disorders and treatment utilization in Bremen 2016/2017 through routine data linkage

“…Depending on the type of treatment, different insurances are responsible for the reimbursement of the treatment costs. For example, withdrawal treatment is covered by health insurance funds, whereas rehabilitation treatment in most cases is financed by the German pension insurance (Deutsche Rentenversicherung; hereafter: GPI) ( 5 ). Eligibility criteria for the coverage of rehabilitation treatment by the GPI are, among others, having paid for the insurance for at least 6 months over the past 2 years and not being a civil servant.…”

“…Multiple treatment options for risky, harmful, and dependent alcohol use are discussed in the current German S3 guideline on “Screening, diagnosis, and treatment of alcohol-related disorders.” The goal of the guideline is to give recommendations for professionals as well as people affected by alcohol use and was developed by experts based on the available evidence ( 5 ). The recommendations include brief interventions as well as medical rehabilitation and other forms of post-acute treatment.…”

“…Addiction rehabilitation or other post-acute treatment for alcohol dependence should be preceded by either physical detoxification or qualified withdrawal treatment (QWT). QWT is a German-specific term for an extended withdrawal treatment program, during which psychological and somatic concomitant and secondary diseases are considered, and further treatment for the underlying alcohol dependence is initiated using psychosocial interventions ( 5 ). Despite existing evidence-based procedures for early detection, adequate diagnosis, and the treatment of alcohol-related disorders ( 6 ) as well as the integration of different care systems ( 7 , 8 ), the treatment rates for alcohol use disorders as compared to other mental illnesses are among the lowest globally ( 9 , 10 ).…”

Significance of Fib4 index as an indicator of alcoholic hepatotoxicity in health examinations among Japanese male workers: a cross-sectional and retrospectively longitudinal study

“…Patients with ALD have been treated mainly by addiction specialists in the psychiatric field as alcohol dependence. Recently, harm reduction by reducing alcohol consumption, which has been used as a treatment approach in Europe [ 42 ], has gained recognition in Japan [ 43 ]. Treatment with anti-alcohol drugs, such as nalmefene, has also advanced [ 44 ], and it can be prescribed not only by specialized psychiatrists but also by hepatologists.…”

Phosphatidylethanol (PEth) for Monitoring Sobriety in Liver Transplant Candidates: Preliminary Results of Differences Between Alcohol-Related and Non-Alcohol-Related Cirrhosis Candidates

“…PEth is formed after ingestion of alcohol and can be detected up to 12 days after a single drinking event [23]. PEth has been employed in numerous settings [24], including LT [24][25][26] and is recommended in various contexts in the 2020 German evidence-and consensus-based S3 guideline on alcohol [27]. Furthermore, it is reported to have higher sensitivity compared to uETG and EtS [28].…”