Diagnosis, assessment, and management of harmful drinking and alcohol dependence: summary of NICE guidance

Centre for Outcomes Research and Effectiveness, University College London, London WC1E 7HB, UK.
BMJ (online) (Impact Factor: 17.45). 02/2011; 342(feb23 1):d700. DOI: 10.1136/bmj.d700
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Available from: Colin Drummond, Sep 29, 2015
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    • "The present study adds to previous knowledge by indicating various explanations, as perceived by the GPs, of why a " window of opportunity " after an alcohol-related admission is missed. We demonstrate deficient communication to the effect that patients without a previously unrecognised alcohol problem may remain unnoticed by the GP after hospital admission, thus often preventing the patient from receiving adequate health care from his or her GP after discharge from the hospital [25]. The participants in our study viewed implementation of guidelines for diagnosis, assessment, and management of harmful drinking and alcohol dependence as hampered as a result of fragmented pathways of care. "
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    ABSTRACT: Aims: To explore general practitioners' (GPs') follow-up experiences with patients discharged from hospital after admittance for alcohol-related somatic conditions. Design and participants: Two focus groups with GPs (four women and 10 men), calling for stories about whether the intervention given in the hospital had been recognised by the GP and how this knowledge affected their follow up of the patient's alcohol problem. Systematic text condensation was applied for analysis. Findings: A majority of the GPs had experienced patients with already recognised alcohol problems being rediscovered by the hospital staff. Still, they presented examples of how seeing the patient in a different context might present new opportunities. Few participants had received adequate information from the hospital about their patient's alcohol status, and they emphasised that a report about what had happened and what was planned was needed for follow up. Care pathways for patients with alcohol problems were seen as fragmented. Yet they described how alcohol-related hospital admissions might function as an eye-opener for the patient and a window of opportunity for lifestyle change. Conclusions: Hospital admittances provide important opportunities for change, but hospital care is seen as fragmented and poorly communicated to the GPs. For shared responsibility and follow up, all participating agents, including the patient, must be sufficiently informed about what has happened and what will follow. For the patient, hospital admittance is usually brief, while the relationship with their GP is long term, even lifelong. GPs are therefore key partners for programme development.
    Scandinavian Journal of Public Health 08/2012; 40(6):531-6. DOI:10.1177/1403494812456636 · 1.83 Impact Factor
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    ABSTRACT: To explore general practitioners' (GPs') experiences with addressing alcohol in the consultation without prior invitation from the patient. Two focus group interviews were conducted with a purposive sample of 13 Norwegian GPs in the Stavanger region. Participants were invited to talk about situations where the doctor initiated discussion of alcohol. Systematic text condensation was applied for analysis. Participants presented a broad range of examples of what made GPs initiate discussion of alcohol, how they brought up the subject, and what happened when they did so. Sometimes they were just acting on a hunch. Family members were also occasionally prompting the doctor to act, or recent serious incidents worked as cues for asking. Routinely taking or creating an opportunity to explore was also common. Directly confronting the patient was a challenging task, and the participants disclosed experiences of how this had been achieved. Pragmatic case-finding appears to be a field of competence which can be further developed, but should be adapted to the clinical setting and the GP's personal style. It is suggested that strategies for dealing with alcohol problems in general practice should be based on a proper understanding of this specific medical context, and be adaptable to different clinical situations and the individual patient.
    Scandinavian journal of primary health care 06/2012; 30(2):64-9. DOI:10.3109/02813432.2012.679229 · 1.30 Impact Factor
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    ABSTRACT: The alcoholism can also deal with drug treatments." This is the message that emerges from the press conference of presentation of Campral, trade name of acamprosate, a neuromodulator specifically indicated in the maintenance of abstinence in alcohol-dependent patients.Alcoholism is a disease characterized by: craving, loss of control, tolerance and physical dependence.For many years the prevention of relapse in use of alcohol after detoxification was supported almost exclusively by psychosocial procedures and techniques with modest success. Treatment with acamprosate is a valid tool to complement psychotherapy as it does not cause addiction, abuse or withdrawal of its suspension and does not interfere with other medications that patients often alcoholics must take.To evaluate the effectiveness, our study evaluated the effects of Acamprosate compared to GHB in clinical-physiological and social health in a way indicators of a possible therapeutic success in terms of abstinence from alcohol and social reintegration. The hypothesis of the project is that pharmacotherapy anticraving with acamprosate integrated with psycho-social support, can reduce relapse in alcohol together with the reduction of the risk of abuse arising from the use of GHB. This work purports to be an account of 11 months of observation of patients treated with acamprosate. Results: A total of 36 patients were observed, of which 5, 4 men and 1 woman at the Ser.T Alcamo and 31, 21 men and 10 women at the Ser.T of Palermo. In the fight against alcoholism, this therapy with acamprosate offers significant potential: decreases, in fact, the incidence, severity and frequency of relapses (Fig. 1). As regards the craving, during the period of treatment with acamprosate, there has been a change, in the sense of reduction, of craving for alcohol: if before therapy was in 68% of cases, medium-high, becomes after 3-4 months after therapy in low-nil in 89% of patients observed. It has been recorded that, after 3-4 months after receiving acamprosate, the clinical picture of the patient is greatly improved by referring to biological markers (Fig. 2). Conclusions: The study shows that treatment with acamprosate is an exciting opportunity within a project of integrated care for the treatment of alcohol addiction. The acamprosate may also be used early in the pharmacological treatment of dependence on alcohol to prevent the appearance of excitability neuronal associated abstinence.On the other hand, its use must have a duration sufficient to allow neuronal excitability to normalize in the most enduring possible: the treatment, in fact, is recommended for one year. In any case, the use can be continued even in the face of relapses, with the aim to reduce the frequency or severity.In particular, the strong point seems to be the ability for the user to experience a new sense of normalcy and to remove the desire for significant periods of alcohol.
    85° Convegno Società Italiana Biologia Sperimentale, Parma; 11/2012
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