A Controlled Trial of Inpatient and Outpatient Treatment of Alcohol Dependency

Edwards, Griffith; Guthrie, Sally K.

doi:10.1016/s0140-6736(67)92129-0

Cited by 115 publications

(24 citation statements)

References 20 publications

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“…These are provided by around 300 advice and counselling services, 100 day programmes and nearly 200 residential programmes. There has been a striking move away from residential treatment towards communitybased facilities following an influential government report and the increasing popularity of home detoxification and brief interventions in primary care (Edwards 1967(Edwards , 1977; Centre for Reviews and Dissemination 1993). Hence, healthcare commissioners in the UK have progressively withdrawn funding from estab lished treatment centres and diverted it into screening programmes and brief interventions in primary care.…”

Section: Shifting Agendas: From Healthcare To Public Ordermentioning

confidence: 99%

The future of specialised alcohol treatment services: a matter of policy?

Rao¹,

Luty²

2009

Adv. psychiatr. treat

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SummaryAround 7.1 million people in England drink hazardously or harmfully and a further 1.1 million are dependent on alcohol. Motivational interviewing is widely used to treat people with alcohol problems and is probably the best described example of a brief intervention. However, some recent trials have been disappointing. Specialised alcohol treatment services have also suffered from weakness in the evidence base. Investment in treating alcohol misuse has fallen far behind that for drug misuse. The Department of Health's Alcohol Harm Reduction Strategy for England embraces policies that are high-profile and cheap but are ineffective and ignore many effective measures. It recommends stepped care for alcohol treatment, but unlike the equivalent for drugs treatment, it sets no targets and leaves the small (7%) increase in funding to the discretion of local purchasers. UK spending on specialised treatment for drug misuse is estimated to be around £600 million for 2007 – around three times the estimated cost of treatment for alcohol misuse.

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Section: Shifting Agendas: From Healthcare To Public Ordermentioning

confidence: 99%

The future of specialised alcohol treatment services: a matter of policy?

Rao¹,

Luty²

2009

Adv. psychiatr. treat

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“…About 60% relapsed (drank more than the recommended weekly intake) over the 3-month follow-up period. Edwards & Guthrie (1967) reported a classic trial of 40 alcohol-dependent men who were randomly assigned to in-patient or 'intensive' out-patient treatment. Treatment duration for both groups was 7-9 weeks.…”

Section: Home V In-patient Detoxificationmentioning

confidence: 99%

What works in alcohol use disorders?

Luty¹

2006

Adv. psychiatr. treat

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There has been much recent debate and criticism of UK alcohol policy (Drummond, 2004;Hall, 2005). Over the past 20 years, per capita alcohol consumption in Britain has increased by 31%, leading to large increases in the prevalence of alcoholic cirrhosis, alcohol-related violence and heavy alcohol use. Alcohol misuse causes at least 22 000 premature deaths each year and costs the taxpayer an estimated £20 billion (Prime Minister's Strategy Unit, 2003). The key features of alcohol dependence and harmful use are listed in Box 1. About 5% of the UK population are dependent on alcohol (Farrell et al, 2001) and 8 million Britons drink more than recommended levels.An excellent and authoritative review of alcohol treatment literature is provided by the Mesa Grande project (Miller et al, 2001). Updated on a regular basis, it includes a review of seven multicentre studies in the USA and Europe involving over 8000 treatment-seeking individuals. In the 2001 review, overall mortality at 1-year follow-up was about 1.5%. Clients reported an 87% reduction in alcohol consumption, with abstinence on 80% of days. Overall, 24% were abstinent for the entire year, and a similar proportion resumed controlled, problem-free drinking. These results were validated using confidants (often the client's spouse). Most relapses occurred within the first 3 months. These results are supported by other studies, including a recent review of alcohol treatment from the Scottish Executive (Ludbrook et al, 2005). By contrast, Vaillant (1983) estimated that 2-3% of alcohol-dependent individuals in the USA abstain spontaneously each year in the community.Unfortunately there are many uncertainties in the evidence base for treatment of alcohol use disorders -not least of which is the cost-effectiveness of therapy. Many in-patient and residential alcohol services in the UK were downsized following the famous trials by Edwards (see below). Controversies also remain concerning the benefits of disulfiram and controlled drinking.Ideally, trials of alcohol treatment should follow more than 70% of participants for 1 year and confirm alcohol consumption using relatives or other What works in alcohol use disorders? Jason LutyAbstract Treatment of alcohol use disorders typically involves a combination of pharmacotherapy and psychosocial interventions. About one-quarter of people with alcohol dependence ('alcoholics') who seek treatment remain abstinent over 1 year. Research has consistently shown that less intensive, community treatment (particularly brief interventions) is just as effective as intense, residential treatment. Many psychosocial treatments are probably equally effective. Techniques for medically assisted detoxification are widespread and effective. More recent evidence provides some support for the use of drugs such as acamprosate to prevent relapse in the medium to long term.Jason Luty is consultant in addictions psychiatry at the South Essex Partnership NHS Trust (Taylor Centre,

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“…Manche der bisherigen Studien schlossen über 500 Patienten ein [28] (Tabelle 1). Allerdings wurden nur 3 Studien kontrolliert durchgeführt [2,11,15], was bei der Interpretation der Ergebnisse berücksich-tigt werden muss. In welchem Ausmaß die ambulante Entgiftung als Selbstentzug ohne ärztliche Überwachung oder im Rahmen der allgemeinmedizinischen oder nervenärztlichen ambulanten Betreuung stattfindet, ist nicht bekannt.…”

Section: Schlüsselwörterunclassified

Ambulante Alkoholentgiftung

Scherle

Croissant²,

Heinz³

et al. 2003

Der Nervenarzt

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Increasing significance is being attributed to outpatient detoxification treatment of alcohol-dependent patients. Many patients want to undergo outpatient detoxification or even carry it out without professional supervision. In some Scandinavian countries and in the USA, outpatient detoxification under medical supervision has increased substantially. In these countries,numerous studies describe outpatient alcohol detoxification as a safe and cost-reducing method. These studies vary in many aspects, especially regarding the nature and dose of the withdrawal medication, but also concerning the inclusion criteria of patients. Medications to treat or prevent alcohol withdrawal symptoms are rather heterogeneous. Besides well-known standard medication established in inpatient treatment (e.g.,benzodiazepines and carbamazepine), interesting studies report the application of rather uncommon substances such as physostigmine and psychotropic analgesic nitrous oxide (PAN) for alcohol detoxification. This article provides an overview on outpatient alcohol detoxification and discusses its transfer to practical application.

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A Controlled Trial of Inpatient and Outpatient Treatment of Alcohol Dependency

Cited by 115 publications

References 20 publications

The future of specialised alcohol treatment services: a matter of policy?

The future of specialised alcohol treatment services: a matter of policy?

What works in alcohol use disorders?

Ambulante Alkoholentgiftung

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