Diagnosis & Treatment
Establishing the diagnosis helps in planning the treatment modality. Making an accurate diagnosis of alcohol dependence (or abuse) may be particularly essential in primary care settings to understand whether alcohol abuse or dependence is the main problem or otherwise contributes to the clinical picture. Hence, the treatment plan can be delineated accordingly.
The Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) includes in Chapter V a detailed classification of over 300 mental and behavioural disorders. Its publication follows extensive field-testing by more than 100 clinical and research centres in 40 countries.
There are two main versions available: Clinical Descriptions and Diagnostic Guidelines and Diagnostic Criteria for Research. The former provides clinical descriptions detailing the principal signs and symptoms of each disorder, together with other important but less specific associated features, as well as comprehensive guidelines for their diagnosis. The latter version is intended to help those researching specific disorders to maximize the homogeneity of study groups. To this end, it sets out criteria that allow the selection of individuals with clearly similar symptoms and other characteristics.
ICD-10 Diagnostic criteria for research pdf, 48kb
Diagnostic categories and terms
- Acute intoxication
- Harmful use
- Psychoactive substance abuse/misuse
- Psychoactive use disorder
- Withdrawal state
The treatment goals vary among individuals. Goals may be classified as:
- Immediate goals – complete detoxification, intervention of psychosocial and medical crisis
- Short-term goals – management of medical and psychiatric co-morbidity and re-integration with family
- Long-term goals – relapse prevention, re-integration into society, occupational rehabilitation and improvement in overall quality of life
The main treatment modalities are:
Certain medications are prescribed for alcohol dependent patients usually after the phase of acute withdrawal is over. Common drugs used include:
- Disulphiram - it works best if the patient is motivated and has a good social support. The dosage prescribed is 250mg/day
- Naltrexone – it is an anti-craving agent and usually works with positive family history of addiction. The dosage prescribed is 50mg/day (once a day)
- Acamprosate – it can be started during detoxification and has the least side effects. The dosage is usually 333mg/tablet (4-6 tablets thrice a day)
- Topiramate – this needs a slow building doe and is contraindicated in renal stone. The dosage prescribed is 200-300mg/day
- Motivational Enhancement
It helps to instill motivation for changing drinking pattern and helps the client become ready, willing and able. Strategies used include resolving ambivalence, facilitation, feedback, identification of high risk situations, developing coping skills, enlisting social and family support
- Network therapy
It involves a multimodal approach in which certain family members and friends help to provide ongoing support and promote an attitude change. The main tasks involve maintaining abstinence, caring for the network and securing future behavior
- Brief Intervention
This is a short term counseling approach focused on helping the person change his or her drinking pattern and behavior. It is based on FRAMES approach: providing Feedback, emphasizing personal Responsibility, providing Advice about changing the drinking patterns, following an Empathic and understanding approach and Supporting Self-efficacy in persons.
- Family and Marital Therapy
It involves working with family members of the client with problem alcohol use by helping them achieve closeness and intimacy, resolve crisis while going through the change process and balancing roles by family reorganization.
- Relapse prevention
This involves strategies to help maintain the necessary changes in drinking patterns. It helps identify high risk relapse triggers and develop strategies to cope with them, provides an understanding of relapse as a process, instill strategies to deal with social pressure and craving, enhance supportive social network and learn methods to cope with cognitive distortions like negative thinking.
- Self Help Groups
Groups of persons with similar problems unite to offer mutual assistance in dealing with changing drinking patterns and overcoming barriers to change
- Workplace interventions
This involves use of Employee Assisted Programs (EAP) to identify and resolve employee’s problems due to drinking. This can be by providing brief intervention modalities as well as referrals to specialists in case of suspected dependent users
- e-Health interventions
The rapid development of e-health technologies not only in developed but also in developing countries offers great opportunities for intervention for substance use disorders. These interventions are delivered online and are based on learning, cognitive/behavioural and problem-solving principles. They contain self tests, customized feedback, monitoring and analysis of alcohol consumption, advice and exercises.