Reduction in heavy drinking as a treatment outcome in alcohol dependence

Gastfriend, David R.; Garbutt, James C.; Pettinati, Helen M.; Forman, Robert

doi:10.1016/j.jsat.2006.09.008

Cited by 127 publications

(89 citation statements)

References 55 publications

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“…whether they lead all the way to abstinence (the traditional aim of AD therapy, as indicated above), or at least to a reduction in consumption. [136][137] In the following section, we will examine whether these two approaches have any impact on mortality.…”

Section: Do Interventions Affect Survival?mentioning

confidence: 99%

Alcohol Consumption, Alcohol Dependence and Attributable Burden of Disease in Europe: Potential Gains From Effective Interventions for Alcohol Dependence

Rehm¹,

Shield²,

Rehm³

et al. 2012

PsycEXTRA Dataset

116

126

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Step 2 This report provides a timely and comprehensive review of the relationship between alcohol consumption and harm in Europe. While European alcohol strategies have typically focused on reducing alcohol misuse through controls on availability, marketing and price, and drunk-driving countermeasures, this report highlights the considerable potential to reduce alcohol-related harm through wider implementation of individually directed interventions for people with alcohol dependence. There is now a considerable evidence base which supports the effectiveness and cost effectiveness of brief interventions, and a range of specialist treatment for people with alcohol use disorders. However, this report highlights the current gap between evidence and practice. Less than 10%of people with alcohol dependence receive treatment in Europe; and yet alcohol dependence accounts for a substantial proportion of all harm associated with alcohol.Rehm and colleagues provide a compelling case for action in Europe-at both an individual country level and a pan-European level to make treatment for alcohol dependence more widely available. The current patchwork of services for people with alcohol dependence has resulted from a lack of strategic direction and a failure to exploit knowledge we already possess on what works in helping people to reduce or stop drinking alcohol. Many European countries have no national or professional guidelines to inform clinicians and commissioners of health care.Increasing the proportion of people with alcohol dependence who gain access to effective treatment must now be a Europe-wide priority. In doing so, one must not underestimate the potential challenges including training for health professionals and costs of implementation. However, given the proven cost-effectiveness of treatment for alcohol dependence, such investment is likely to yield significant cost savings as well as reduced human suffering.Colin Drummond, MD, FRC Psych Professor of Addiction Psychiatry, National Addiction Centre, Institute of Psychiatry, King's College London, London, UK Wakeup call for Europe's drinking problemThis study is a wake-up call that the European Union has a drinking problem. And not just a drinking problem, but an enormous drinking problem. Any practicing doctor, particularly a family doctor, as I was, or a liver doctor or psychiatrist, will know the devastation that being dependent on alcohol wreaks on the lives not just of the drinker, but also on those of family, friends and work colleagues. It is simply awful. Terrible though alcohol dependence is, as a public health doctor, I always thought it the tip of the iceberg of alcohol-related public health problems. But, according to this study, when it is fully analysed, heavy drinking and alcohol dependence is the iceberg. And at the public health level, it is also simply awful. For all drinking as a whole, one in seven of all male deaths in the European Union in the age range of 15-64 years is due to alcohol, and one in 13 of all female deaths. According to this...

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Section: Do Interventions Affect Survival?mentioning

confidence: 99%

Alcohol Consumption, Alcohol Dependence and Attributable Burden of Disease in Europe: Potential Gains From Effective Interventions for Alcohol Dependence

Rehm¹,

Shield²,

Rehm³

et al. 2012

PsycEXTRA Dataset

116

126

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“…En este particular los investigadores recomiendan usar un sistema sencillo de clasificación , pero además, es necesario lograr que se adopten categorías equivalentes para promover la comparación de los resultados. Recientemente se ha insistido en la importancia de incluir mediciones cuantitativas del consumo de alcohol, que permitan estudiar cambios dentro de las categorías de consumo (Gastfriend, Garbutt, Pettinati y Forman, 2007). El tratamiento cuantitativo del consumo de alcohol sólo está presente en uno de los estudios (Moos y Moos, 2005), lo que representa una importante limitación de los estudios longitudinales en alcoholismo.…”

Section: Discussionunclassified

Investigación longitudinal del alcoholismo tratado: Una revisión sistemática de los seguimientos a largo plazo

2010

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Aims:To analyze the methodological design of long-term longitudinal studies of alcoholics who have undergone treatment. Methods: Systematic review of prospective longitudinal studies of treated alcoholics with follow-up periods of at least 8 years, and published in English, during the period 1983-2009. The review includes 9 studies which analyzed: follow-up evaluations, information sources, the period of reference in the final assessment, the measurement of alcohol use, the operationalization of drinking patterns, and data analysis. Results: 2434 patients (ranging between 57 and 850 per study) were studied on average for a period of 15.3 (D.T. = 3.2) years (range 8-20 years). Studies differ in the number of intermediate evaluations (0, 1, 3, 4) and the length of the period considered for the final evaluation (the whole period, the last 3 years, the last year, last 6 months, last month or present situation). Drinking patterns tend to be used as the main outcome variable, but they are operationalized in non-equivalent forms and the analysis is performed using classical cross-sectional statistical techniques. Alcoholism evolution is studied by analyzing the evolution of drinking patterns and patients' life situation during the period under study. Conclusions:The scarce amount of data available on the evolution of treated alcoholism cannot be compared across studies due to considerable methodological differences. There is a need to promote common methodological criteria in relation to follow-up strategies. New statistical methods that permit longitudinal analysis for non-balanced and correlated data should also be incorporated. Key words: alcoholism, longitudinal studies, methodology RESUMEN ABSTRACTObjetivo: Analizar el diseño metodológico de los estudios longitudinales a largo plazo en el campo del alcoholismo tratado. Método: Revisión sistemática de los estudios longitudinales prospectivos de pacientes alcohólicos con seguimiento de al menos 8 años y publicados en inglés entre 1983-2009. La revisión incluye 9 estudios en los que se analizan: Las evaluaciones de seguimiento, las fuentes de información, el periodo de referencia en la evaluación final, la medición del consumo de alcohol, la categorización del patrón de consumo y el análisis de los datos. Resultados: 2.434 pacientes (rango 57 -850 por estudio) tratados por alcoholismo fueron seguidos en promedio 15.3 (D.T. =. 3.2) años (rango 8 -20 años). Los estudios se diferencian en el número de evaluaciones intermedias (0, 1, 3 y 4) y en el periodo de referencia usado en la evaluación final (todo el seguimiento, últimos 3 años, último año, últimos 6 meses, último mes y actual). Los patrones de consumo (principal resultado de tratamiento) se definen de manera no equivalente y los datos se analizan principalmente de manera transversal usando técnicas estadísticas clásicas. La evolución del alcoholismo se estudia analizando la trayectoria de los patrones de consumo y del estado vital de los pacientes durante los seguimientos. Conclusiones: Los escasos datos disponi...

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“…One of the reasons for avoiding therapy is that some people may want to reduce the amount of alcohol used but are not inclined towards total abstinence (156). To choose harm reduction as a treatment goal can be a important step that may lead to an internalization of consuming less alcohol, possibly leading towards total abstinence (157).…”

Section: Reduction Of Heavy Drinking (Harm Reduction)mentioning

confidence: 99%