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Chapter 7 - Alcohol Use Disorders: Clinical Features and Treatment

Published online by Cambridge University Press:  02 November 2021

By
Duncan Raistrick  and
Gillian Tober
Edited by
Ed Day
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Summary

This chapter considers the assessment and diagnosis of alcohol use disorders, including the use of screening and a comprehensive assessment process, incorporating an evaluation of substance use and dependence alongside psychological and social wellbeing. A spectrum of treatment approaches are then described, beginning with strategies for managing the intoxicated patient and reducing the harms of alcohol consumption. The importance of preparation and planning for successful medically assisted withdrawal or detoxification is emphasised. Psychosocial interventions form the core of treatment of alcohol use disorders, delivered alongside pharmacotherapies for relapse prevention. Comorbid mental health disorders are considered, before reviewing the importance of patient-reported outcome measures in establishing the outcome of effective treatment for alcohol use disorders.

Keywords

alcoholdependenceassessmentpatient reported outcome measure (PROM)harm reductionmedically assisted withdrawalpsychosocial interventioncomorbidityrelapse preventionoutcomes of treatment
Type
Chapter
Information
Seminars in Addiction Psychiatry , pp. 128 - 146
Publisher: Cambridge University Press
Print publication year: 2021

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References

Weaver, T., Madden, P., Charles, V., Timso, GS., Renton, A., Tyrer, P. et al. Comorbidity of substance misuse and mental illness in community mental health and substance misuse services. British Journal of Psychiatry. 2003; 183: 304–13.Google Scholar
Saitz, R., Cheng, D. M., Allensworth-Davies, D., Winter, M. R., Smith, P. C. The ability of single screening questions for unhealthy alcohol and other drug use to identify substance dependence in primary care. Journal of Studies on Alcohol and Drugs. 2014; 75 (1): 153–7.Google Scholar
Conigrave, K. M., Davies, P., Haber, P., Whitfield, J. B. Traditional markers of excessive alcohol use. Addiction. 2003; 98 Suppl2: 31–43.CrossRefGoogle ScholarPubMed
Oluyase, A. O., Raistrick, D., Abbasi, Y., Dale, V., Lloyd, C. A study of the psychotropic prescriptions of people attending an addiction service in England. Advances in Dual Diagnosis. 2013; 6.Google Scholar
Terwee, C. B., Bot, S. D., de Boer, M. R., van der Windt, D. A., Knol, D. L., Dekker, J. et al. Quality criteria were proposed for measurement properties of health status questionnaires. Journal of Clinical Epidemiology. 2007; 60 (1): 34–42.CrossRefGoogle ScholarPubMed
Jacobson, N. S., Truax, P. Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology. 1991; 59 (1): 12–9.CrossRefGoogle ScholarPubMed
Del Boca, F. K., Noll, J. A. Truth or consequences: The validity of self-report data in health services research on addictions. Addiction. 2000; 95 (11s3): 347–60.Google Scholar
Raistrick, D. S., Tober, G. W. A summary of selected scales, 2018 [Available from: www.result4addiction.net.]Google Scholar
Iveson-Brown, K., Raistrick, D. A brief Addiction Recovery Questionnaire derived from the views of service users and concerned others. Drugs: Education, Prevention and Policy. 2016; 23 (1): 41–7.Google Scholar
Raistrick, D., Tober, G., Sweetman, J., Unsworth, S., Crosby, H., Evans, T. Measuring clinically significant outcomes – LDQ, CORE-10 and SSQ as dimension measures of addiction. Psychiatric Bulletin. 2014; 38 (3): 112–5.Google Scholar
Najavits, L. M., Weiss, R. D. Variations in therapist effectiveness in the treatment of patients with substance use disorders: An empirical review. Addiction. 1994; 89 (6): 679–88.Google Scholar
Chafetz, M. E., Blane, H. T., Abram, H. S., Golner, J., Lacy, E., McCourt, W. F. et al. Establishing treatment relations with alcoholics. The Journal of Nervous and Mental Disease. 1962; 134 (5): 395–409.Google Scholar
Apodaca, T. R., Longabaugh, R. Mechanisms of change in motivational interviewing: A review and preliminary evaluation of the evidence. Addiction. 2009; 104 (5): 705–15.CrossRefGoogle ScholarPubMed
Tober, G., Raistrick, D., eds. Motivational Dialogue: Preparing Addiction Professionals for Motivational Interviewing Practice. Abingdon: Routledge; 2007.Google Scholar
Lingford-Hughes, A. R., Welch, S., Peters, L., Nutt, D. J., Ball, D., Buntwal, N. et al. BAP updated guidelines. Evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: Recommendations from BAP. Journal of Psychopharmacology. 2012; 26 (7): 899–952.Google Scholar
Sullivan, J. T., Sykora, K., Schneiderman, J., Naranjo, C. A., Sellers, E. M. Assessment of alcohol withdrawal: The Revised Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar). British Journal of Addiction. 1989; 84: 1353–7.CrossRefGoogle ScholarPubMed
Day, E., Patel, J., Georgiou, G. Evaluation of a symptom-triggered front-loading detoxification technique for alcohol dependence: A pilot study. Psychiatric Bulletin. 2004; 28: 407–10.CrossRefGoogle Scholar
Dawson, D. A., Grant, B. F., Stinson, F. S., Chou, P. S., Huang, B., Ruan, W. J. Recovery from DSM-IV alcohol dependence: United States, 2001–2002. Addiction. 2005; 100 (3): 281–92.Google Scholar
Moos, R. H. Theory-based active ingredients of effective treatments for substance use disorders. Drug and Alcohol Dependence. 2007; 88 (2–3): 109–21.Google Scholar
McCrady, B. S. To have but one true friend: Implications for practice of research on alcohol use disorders and social networks. Psychology of Addictive Behaviors. 2004; 18 (2): 113–21.Google Scholar
Anton, R. F., O’Malley, S. S., Ciraulo, D. A., Cisler, R. A., Couper, D., Donovan, D. M. et al. Combined pharmacotherapies and behavioral interventions for alcohol dependence. The COMBINE study: A randomized controlled trial. JAMA. 2006; 295 (17): 2003–17.CrossRefGoogle ScholarPubMed
Laaksonen, E., Koski-Jännes, A., Salaspuro, M., Ahtinen, H., Alho, H. A randomized, multicentre, open-label, comparative trial of disulfiram, naltrexone and acamprosate in the treatment of alcohol dependence. Alcohol and Alcoholism. 2008; 43( 1): 53–61.Google Scholar
Skinner, M. D., Lahmek, P., Pham, H., Aubin, H.-J. Disulfiram efficacy in the treatment of alcohol dependence: A meta-analysis. PLOS ONE. 2014; 9 (2): e87366.Google Scholar
Palpacuer, C., Duprez, R., Huneau, A., Locher, C., Boussageon, R., Laviolle, B. et al. Pharmacologically controlled drinking in the treatment of alcohol dependence or alcohol use disorders: A systematic review with direct and network meta-analyses on nalmefene, naltrexone, acamprosate, baclofen and topiramate. Addiction. 2018; 113 (2): 220–37.Google Scholar
Gueorguieva, R., Wu, R., Fucito, L. M., O’Malley, S. S. Predictors of abstinence from heavy drinking during follow-up in COMBINE. Journal of Studies on Alcohol and Drugs. 2015; 76 (6): 935–41.CrossRefGoogle ScholarPubMed
Adamson, S. J., Sellman, J. D., Framptom, C. M. A. Patient predictors of alcohol treatment outcome: A systematic review. Journal of Substance Abuse Treatment. 2009; 36: 75–86.Google Scholar
Moyers, T. B., Miller, W. R. Is low therapist empathy toxic? Psychology of Addictive Behaviors. 2013; 27 (3): 878–84.Google Scholar
Gilburt, H., Drummond, C., Sinclair, J. Navigating the alcohol treatment pathway: A qualitative study from the service users’ perspective. Alcohol and Alcoholism. 2015; 50 (4): 444–50.CrossRefGoogle ScholarPubMed
Orford, J., Dalton, S., Hartney, E., Ferrins-Brown, M., Kerr, C., Maslin, J. How is excessive drinking maintained? Untreated heavy drinkers’ experiences of the personal benefits and drawbacks of their drinking. Addiction Research and Theory. 2002; 10 (4): 347–72.CrossRefGoogle Scholar
Witkiewitz, K., Pearson, M. R., Hallgren, K. A., Maisto, S. A., Roos, C. R., Kirouac, M. et al. Who achieves low risk drinking during alcohol treatment? An analysis of patients in three alcohol clinical trials. Addiction. 2017; 112 (12): 2112–21.CrossRefGoogle ScholarPubMed

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