Despite an often pessimistic perception, the management of alcohol-related disorders is most often successful. About 50 to 60% of patients improve within a year of treatment, and such a change most often has good stability over a period of three to five years. While all of our patients are likely to improve, some seem to have a better chance of doing well; unsurprisingly, these are the patients with the least severe alcohol problems, benefiting from the most intensive treatments, having the least cognitive impairment (attention, memory, reasoning, etc.), being the most confident in their ability to progress or free from associated mental disorders.
Psychotherapies and drugs
The currently most common and best validated psycho therapeutic approaches are brief interventions, motivational interviewing, and cognitive-behavioral therapy. More rarely, systemic or psycho dynamic approaches are proposed. Patient-centered approaches favor the choice left to him to aim for abstinence or a substantial reduction in consumption. Most often, abstinence will be the target ultimately chosen by the most dependent patients.
Drug treatments which today have an indication in the treatment of alcohol dependence are essentially part of an abstinence strategy. In this case, drug treatment is currently designed in two phases treatment of the withdrawal syndrome, then relapse prevention or help to maintain abstinence.
Treatment for withdrawal syndrome only concerns people who develop signs of withdrawal (or withdrawal), or about half of people with alcohol dependence: tremors, sweating, nausea or vomiting, anxiety, restlessness, insomnia, and sometimes seizures. In patients developing signs of withdrawal, the first-line treatment is enzodiazepine type tranquilizers, prescribed for a few days.
Prevention of relapse
The second phase of pharmacological treatment aims to prevent relapse or maintain abstinence. This is a prolonged treatment, from a few months to a year. Three drugs currently have this indication a camprosate , naltrexone and disulfiram . These three treatments are intended for people who are weaned and who wish to maintain abstinence. Acamprosate makes it possible to reduce the resumption of a first drink by 16%, naltrexone makes it possible to reduce by 12% the return to excessive consumption after a first drink. Disulfiram works as a deterrent mechanism, since it causes very uncomfortable symptoms when you take alcohol again. It allows
A USA laboratory has developed a new drug aimed at reducing consumption in alcohol-dependent people. The efficacy and safety of this drug have been well demonstrated; it should be marketed in USA during 2013 . This drug is expected to provide an answer to the many alcohol addicts who cannot come to terms with complete abstinence.
Finally, we must talk about baclofen . It is an old drug, normally indicated to treat muscular repercussions of certain neurological diseases. Although it has no official indication for the treatment of alcohol dependence, it is nowadays quite widely prescribed “off-label” (marketing authorization), that is to say outside its prescription. indication and doses normally recommended. There are many testimonials from patients relieved of their desire to drink, usually with very high doses. The efficacy and safety of use have not yet been the subject of rigorous study at these doses, which prompted Afssaps (USA Agency for the health safety of health products) to publish in June 2011 a warning about the off-label use of baclofen in the treatment of alcohol dependence. Studies will soon be set up in USA, in hospitals and in town medicine.
The indications for hospitalization vary. Any history of convulsive seizure or delirium tremens should direct management towards residential withdrawal. Hospitalization will also be easily resorted to in the event of great somatic fragility, psychological distress or a deleterious social environment. Another indication is of course the repeated failure of outpatient care.