Alcoholic therapy

The amount of wine used for therapeutic purposes in the hospitals of pre-Revolutionary Russia exceeded its consumption per capita in the healthy population. The problems of alcohol therapy were most dramatic in pediatric practice often (itj was the doctor who gave children their first wine. (Sidorov 1995,244)... 

Lor a complete history, see Harry W. Paul, Bacchic Medicine Wine and Alcohol Therapies from Napoleon to the French Paradox (New York Rodopi, 2001). 

Supplement vitamin Bi deficiency states, impaired absorption or increased requirements (pregnancy, lactation, alcoholism) Therapy beriberi, Wernicke s encephalopathy, neuritis, polyneuritis (alcoholic and toxic), neuralgia, myalgia, myocardia, disorders of the intermediate metabolism Thiamine chloride and hydrochloride, thiamine mononitrate, cocarboxylase, thiamine pyrophosphate Tablets, sugar-coated pills, dragees, ampules 50-300 mg 0.3-1.2 mg 1.0-1.4 mg... 

Increased risk factors for suffering retinoid side effects are adipositas, alcohol abuse, diabetes, nicotine abuse, familiar lipid metabolism alterations and other concommittant therapies (see below). 

Avoid the use of alcoholic beverages during therapy unless use has been approved by the primary health care provider. 

There is a risk of acute renal failure when iodi-nated contrast material that is used for radiological studies is administered with metformin. Metformin therapy is stopped for 48 hours before and after radiological studies using iodinated material. Alcohol, amiloride, digoxin, morphine, procainamide, quini-dine, quinine ranitidine, triamterene, trimethoprim, vancomycin, cimetidine, and furosemide all increase the risk of hypoglycemia. There is an increased risk of lactic acidosis when metformin is administered with the glucocorticoids. 

Social detoxification, which involves the nonpharmacological treatment of alcohol withdrawal, has been shown to be effective (see Naranjo et al. 1983). It consists of frequent reassurance, reality orientation, monitoring of vital signs, personal attention, and general nursing care (Naranjo and Sellers 1986). Social detoxification is most appropriate for patients in mild-to-mod-erate withdrawal. The medical problems commonly associated with alcoholism (Sullivan and O Connor 2004) may substantially complicate therapy, so that care must be taken to refer patients whose condition requires medical management. 

The authors concluded that antidepressants exert a modest beneficial effect for patients with combined depressive disorder and substance use disorder. They also emphasized that antidepressants are not a stand-alone treatment for depressed alcoholic patients and that concurrent therapy directly targeting the substance use disorder is also indicated. 

Anton RF, Moak DH, Latham PK, et al Posttreatment results of combining naltrexone and cognitive-behavior therapy for the treatment of alcoholism. J Clin Psycho-pharmacol 21 72—77, 2000... 

Anton RF, Pettinati H, Zweben A, et al A multi-site dose ranging study of nalmefene in the treatment of alcohol dependence. J Clin Psychopharmacol 24 421 28, 2004 Aragon CM, Stotland LM, Amit Z Studies on ethanol-brain catalase interaction evidence for central ethanol oxidation. Alcohol Clin Exp Res 15 165-169, 1991 Arizzi MN, Correa M, Betz AJ, et al Behavioral effects of intraventricular injections of low doses of ethanol, acetaldehyde, and acetate in rats studies with low and high rate operant schedules. Behav Brain Res 147 203—210, 2003 Azrin NH, Sisson RW, Meyers R, et al Alcoholism treatment by disulfiram and community reinforcement therapy. J Behav Ther Exp Psychiatry 13 105—112, 1982 Babor TF, Kranzler HR, Lauerman RL Social drinking as a health and psychosocial risk factor Anstie s limit revisited, in Recent Developments in Alcoholism, Vol 5. Edited by Galanter M. New York, Plenum, 1987, pp 373 02... 

Fawcett J, Clark DC, Aagesen CA, et al A double-blind, placebo-controlled trial of lithium carbonate therapy for alcoholism. Arch Gen Psychiatry 44 248-2 56,1987... 

Kahel DI, Petty F A double blind smdy of fluoxetine in severe alcohol dependence adjunctive therapy during and after inpatient treatment. Alcohol Clin Exp Res 20 780-784, 1996... 

Kranzler HR, Del Boca F, Korner P, et ah Adverse effects limit the usefulness of flu-voxamine for the treatment of alcoholism.] Subst Abuse Treat 10 283-287, 1993 Kranzler HR, Burleson JA, Del Boca FK, et ah Buspirone treatment of anxious alcoholics a placebo-controlled trial. Arch Gen Psychiatry 31 720—731, 1994 Kranzler HR, Burleson JA, Korner P, et ah Placebo-controlled trial of fluoxetine as an adjunct to relapse prevention in alcoholics. Am] Psychiatry 152 391-397, 1995 Kranzler HR, Burleson JA, Brown J, et al Fluoxetine treatment seems to reduce the beneficial effects of cognitive-behavioral therapy in type B alcoholics. Alcohol Clin Exp Res 20 1534-1341, 1996... 

Swift RM Drug therapy for alcohol dependence. N Engl J Med 340 1482-1490,1999... 

Although the evidence base for this relatively rare disorder is not well developed, patients who are dependent on GHB appear to benefit from cognitive and motivational psychosocial therapies and from support of recovery in a manner similar to alcohol-dependent patients. However, because of the high likelihood of amnesia and cognitive dysfunction during the acute and subacute phases of GHB withdrawal, psychosocial interventions should, when possible, include significant others who can review and reinforce with the patient the negative consequences of GHB dependence. 

Cionidine. Clonidine dampens sympathetic activity originating at the locus coeruleus by stimulation of presynaptic a2-adrenergic receptors in the sympathetic chain (Covey and Classman 1991 Hughes 1994). It appears to have some efficacy for alcohol and opioid withdrawal and thus was evaluated for treatment of nicotine withdrawal as well (Covey and Classman 1991 Hughes 1994). Several clinical trials used oral or transdermal clonidine in doses of 0.1—0.4 mg/day for 2—6 weeks with or without behavior therapy. Three meta-analytic reviews reported that clonidine improved quit rates (Covey and Classman 1991 Courlay and Benowitz 1995 Law and Tang 1995). 

Hall SM, Reus VI, Munoz RF, et al Nortriptyline and cognitive-behavioral therapy in the treatment of cigarette smoking. Arch Gen Psychiatry 55 683-690, 1998 Hall SM, Humfleet GL, Reus VI, et al Psychological intervention and antidepressant treatment in smoking cessation. Arch Gen Psychiatry 59 930-936, 2002 Hayford KE, Patten CA, Rummans TA, et al Efficacy of bupropion for smoking cessation in smokers with a former history of major depression or alcoholism. Br J Psychiatry 174 173-178, 1999... 

A number of psychosocial treatments for alcohol and other substance use disorders exist and are widely used. In this chapter, we discuss six of these psychotherapies as they are applied to alcohol, cocaine, and opioid dependence brief interventions, motivational enhancement therapy, cognitive-behavioral therapy, behavioral treatments (including contingency management and community reinforcement approaches), behavioral marital therapy, and 12-step facilitation. We also describe studies that examined the efficacy of a medication in combination with one or more of the six psychotherapies. In the second section of the chapter, we highlight research that directly studied the interaction between psychosocial and pharmacological treatments. 

Cognitive-behavioral therapy (CBT) is based on the theoretical assumption that alcohol and other substance use problems are related to maladaptive so-... 

A number of randomized chnical trials have demonstrated the efficacy of CBT for treating substance use disorders, compared with no-treatment control conditions (see Carroll 1996 for review). However, the superiority of CBT over other psychosocial treatments is not as clear. Although some studies have found CBT to be more effective than other treatments, others have found this method to be comparable to other treatment approaches (Carroll 1996). In Project MATCH, for instance, CBT, MET, and 12-step facihtation produced similar outcomes, with each therapy leading to substantial improvement in alcohol-related symptoms during the 12-week treatment period (Project MATCH Research Group 1997). 

Studies have shown that CM can be used to directly reinforce adherence to medication treatments as well (Petty 2000). Liebson et al (1978) found that methadone-maintained alcohol-dependent patients reduced alcohol use when methadone treatment was contingent on disulfiram consumption. To date, one of the most common applications of CM techniques to pharmacotherapy has been the provision of vouchers or cash contingent upon naltrexone consumption in recently detoxified opioid-dependent patients (Carroll et al. 2001, 2002 Preston et al. 1999). These studies have generally reported significant increases in retention and reductions in opioid use among patients receiving the CM treatment, relative to other therapies. 

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