What works in alcohol use disorders?

Abstract

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,

Self-Control in School-Age Children

“…Outside the educational context, Schwartz et al (2014) has shown that grocery shoppers can use precommitment contracts (i.e., promising to pay a higher bill if they do not meet a target goal) to help them make healthier food purchases. Likewise, some recovering alcoholics take drugs that create immediate symptoms of a severe hangover upon consumption of alcohol (Krampe et al, 2006;Luty, 2006).…”

Drug and alcohol addiction: do psychosocial treatments work?

“…Previous reviews of settings for treating alcohol misuse have concluded that there is no evidence for the superiority of in-patient over out-patient treatment (Miller 1986; Mattick 1993; Luty 2006). This has led to scrutiny of the more protracted admissions to residential rehabilitation.…”

“…This is the last of three articles updating my overview of what works for addiction published almost 10 years ago in this journal (Luty 2003, 2006). The first two articles considered new challenges for substance misuse services and recent developments in pharmacotherapy (Luty 2014, 2015).…”

O fenômeno da recaída no alcoolismo: uma revisão integrativa das publicações científicas internacionais (2004-2009)

“…Two large studies have been conducted recently, in Europe, the United Kingdom Alcohol Treatment Trial (UKATT), and in U.S., the MATCH Project (Matching Alcoholism Treatments to Client Heterogeneity), the largest and most expensive study of its kind ever conducted (16) . They evaluated the results of different psychotherapeutic interventions.…”

“…The UKATT compared the motivational interviewing and SBNT (social behavior and network therapy), while the MATCH Project compared the motivational interviewing, CBT and facilitation approach of 12 steps. There were no statistical or clinically significant differences between the results of the evaluated treatments, as well as were found no evidence of the supposed beneficial effect of matching the type of therapy to the patient type (16)(17)(18) . Remained the argument that the results reinforced the idea that any kind of treatment would be better than none.…”