Clemens Veltrup

Late onset alcoholism

Rather high prevalence rates of alcohol abuse in the elderly have been reported in the literature. However, there is some evidence that many elderly persons with alcohol problems are not identified, probably due to the nonspecificity of alcohol-related presentations in old individuals. Thus, there is an ongoing discussion on appropriate diagnostic criteria for alcohol dependence in elder people who frequently begin to abuse alcohol in late life. This study was aimed to explore whether alcoholics with late onset (beginning after the age of 45) differ from those with an early onset (prior the age of 25). Two hundred and sixty eight subjects consecutively referred to a ward of a general hospital specialized for alcohol detoxification were divided into three groups by the age at onset of harmful alcohol consumption. The duration of harmful drinking was rather similar in all groups. However, alcohol dependence according to the ICD-10 criteria (three or more have to be fulfilled) was diagnosed in 94.1% of the alcoholics with an early onset (</= 25 years), but only in 62.2% of those with late onset (P < 0.0001). Significant differences between these groups were found for the following criteria: preoccupation with drinking (P < 0.0001), impaired capacity to control drinking (P < 0.01), strong desire to drink alcohol (P < 0.01), and a trend towards a lower rate of lifetime psychiatric comorbidity. The alcoholics with late onset reported fewer previous detoxifications and a lower actual alcohol consumption. Moreover, they showed a higher rate of abstinence in the 12 month follow-up. Regarding the difficulties in comparing groups of different ages at onset of harmful alcohol use our results suggest that the alcoholics with late onset differ in many ways from those with early onset.

KOSTEN-NUTZEN-ANALYSE KLINISCH-EVALUIERTER BEHANDLUNGSPROGRAMME : ERWEITERTE ENTZUGSTHERAPIE BEI ALKOHOLABHANGIGKEIT

ZusammenfassungKosten-Nutzen-Analysen neuer Therapieansätze ergänzen klinische Evaluationsstudien und erlauben eine bessere Gesamtabschätzung der Therapieeffizienz. Das Modell einer bereits klinisch evaluierten erweiterten Entzugsbehandlung Alkoholabhängiger (Entzug II) sollte unter Kosten-Nutzen-Gesichtspunkten überprüft werden. Es wurden 57 Patienten nach Entzug II und 37 nach konventioneller Entgiftung (Entzug I) untersucht. In einem retro- und prospektiven Ansatz wurden für 5 Jahre vor und nach Indextherapie Krankenversicherungsdaten zur Hospitalisierungshäufigkeit und -dauer, Arbeitsunfähigkeit und Krankengeldbezug erhoben. Entzug-II-Patienten wurden nach Indextherapie durchschnittlich seltener (3,5+4,4 vs. 7,3+11,3) und weniger lange (66+75 vs. 136+167) hospitalisiert und bezogen weniger lange Krankengeld (67+73 vs. 220+187) als Patienten nach Entzug I. Für den stationären Bereich ergaben sich bei Entzug-II-Patienten um ca. 50% geringere Gesamtbehandlungskosten (Indextherapie und Folgekosten). Insgesamt sprechen bei einer leichten klinischen Überlegenheit in den 12 Monaten nach Indextherapie (ca. 14% höhere Abstinenzrate) erheblich geringere Folgehospitalisierungen und Folgekosten für eine ausreichend hohe Effizienz der erweiterten Entzugstherapie Alkoholabhängiger.SummaryBackground: Cost-effectiveness analyses complete clinical evaluation studies and thereby support the a well based estimation of therapy efficiency. Aim: A qualified (extended) alcohol withdrawal treatment programme (II), which was previously described and evaluated by face-to-face follow-up studies, was analyzed with regard to cost-effectiveness. Sample: 57 alcohol-dependent patients, which had undergone programme II, were compared with 37 patients after a medical detoxification programme (I). Methods: Health insurance data (number and length of all hospitalisations, days of incapacity to work, days of financial substitution for incapacity to work) were assessed for the five years before and after index therapy and for each year, separateley. Results: While there were no substantial differences for the time before index therapy, programme II patients were hospitalized after index therapy (i) less frequently (3.5+4.4 vs. 7.3+11.3 times), (ii) for fewer days (66+75 vs. 136+167) than programme I patients, and they received financial support for fewer days (67±73 vs 220±187 days). Conclusion: Considering a somewhat better clinical outcome of programme II vs. programme I patients (14% greater abstinence rate within one year) the significantly lower rates and fewer days of follow-up hospitalisations support a sufficient efficiency of the extended alcohol withdrawal treatment programme.

Craving shift in chronic alcoholics.

In order to investigate changes in the consumption of substances that stimulate the reward system, 222 recently detoxified alcoholics were asked about their consumptional habits before as compared to after detoxification (mixed prospective and retrospective design). Seventy-eight point two percent reported an increase in consumption of coffee, cigarettes, chocolate and other sweets, while 34.9% managed to reduce at least one of these substances. The increase was significant for coffee, chocolate and other sweets. The desire for consumption of these substances was correlated with the maximum ever experienced desire for alcohol (0.232 for coffee, 0.213 for cigarettes, 0.193 for chocolate and 0.176 for other sweets), and the actual consumption of coffee, cigarettes and sweets was correlated with the actual desire for alcohol (0.172, 0.157 and 0.245, respectively). The results lend some support to the hypothesis that psychotropic substances might serve as a kind of self-regulation against craving in this group. A possible link to biochemical theories is discussed.

Psychiatric Comorbidity in Hospitalized Alcoholics after Detoxification Treatment

The aim of this study is to analyze psychiatric comorbidity of alcohol dependence with respect to prevalence rates, time of onset and indications for the course of alcoholism. 100 hospitalized alcohol

How to Assess Craving for Alcohol

In the recent years several drugs with an anticraving effect have been developed. These drugs should reduce the urge to drink alcohol. In the near future some of these drugs with different pharmacolog

Kurzcharakterisierung der erwähnten Medikamente

Acamprosat ist das bisher einzige in der BRD zugelassene sogenannte ‚Anti-Craving‘-Medikament [→ Kap. 7.1]. In Frankreich bestehen schon seit mehreren Jahren Erfahrungen mit Acamprosat.