The Hitchhikers' Guide to Alcohol Treatment.
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Biomedical subjects
Publications and source records attributed to M Sanchez-Craig.
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To estimate the pattern and level of alcohol consumption leading to problem drinking, the drinking histories of 70 early stage problem drinkers were examined. An average consumption of four drinks (54 g/ethanol), on an average of three days/week, was the pattern that best separated the phase when patients were problem free from the phase when their drinking led to problems.
Family physicians are in a particularly good position to identify problem drinking in its early stages through the recognition of various psychosocial and medical indicators. Thorough history-taking or the use of a specific questionnaire should provide confirmation. Patients so identified can then be offered treatment designed to help them moderate their drinking, if not to achieve abstinence. The treatment strategy described in this paper involves specifying a safe drinking pattern, instructing the patient in the use of aids to appropriate drinking and seeing the patient at 1- to 2-month intervals for follow-up assessment. In a pilot study of this strategy 16 of 17 patients reduced their drinking substantially, and 8 were abstinent at the last follow-up visit. Only 1 of the 17 dropped out of treatment; the high rate of compliance may have been primarily due to the patient's need to see the family physician for other problems. Visits to the family physician for other medical problems provide an opportunity to motivate patients to continue monitoring their drinking.
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The effect of zimelidine, a specific serotonin-reuptake inhibitor, on alcohol intake was tested in 13 healthy male, nondepressed heavy drinkers who were randomly allocated to receive zimelidine or placebo in a double-blind, crossover experiment. There were five 2-wk experimental periods (baseline, placebo 1 and 2, and zimelidine 1 and 2). Treatment was discontinued in three subjects due to a suspected adverse reaction and three other subjects dropped out. Thus, 13 subjects participated in at least two experimental drug periods and only 10 participated in all the periods. In the 13 subjects zimelidine increased the days of abstinence and decreased the daily number of drinks consumed, whereas in the 10 subjects only the number of days of abstinence increased. Subjects did not report aversive alcohol-sensitizing reactions. Spielberger state-anxiety test scores and depression scores (Montgomery/Asberg and Hamilton) were low at the beginning and throughout the study. Our data suggest that zimelidine modifies alcohol intake by a different mechanism than previously tested drugs, possibly by modulating the central neural mechanism that controls drinking of alcohol.
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Forty male problem drinkers, participants of a treatment follow-up study, were assessed for levels of gamma-glutamyl transpeptidase (GGTP) and high-density lipoproteins cholesterol (HDL-C) in relationship to self-reported alcohol consumption over the previous 3-week period. A composite index of GGTP and HDL-C was superior to GGTP or HDL-C alone in discriminating abstinent/light, moderate, and heavy drinkers.
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