Griffith Edwards

The Treatment of Drinking Problems: A Guide to the Helping Professions

Introduction Part I. Background to Understanding: 1. The history of treatment for drinking problems 2. Causes of drinking problems 3. Alcohol as a drug 4. The alcohol dependence syndrome 5. Drinking problems and the family 6. Social complications of excessive drinking 7. Drinking problems as cause of neuropsychiatric disorder 8. Alcohol problems and psychiatric comorbidity 9. Alcohol and other drug problems 10. Physical complications of excessive drinking 11. Women with drinking problems 12. Some special presentations 13. Drinking problems and the life course Part II. Screening, Assessment and Treatment: 14. Case identification and screening 15. Assessment as the beginning of therapy 16. Withdrawal states and treatment of withdrawal 17. The basic work of treatment 18. Alcoholics Anonymous 19. Special techniques 20. Working toward normal drinking 21. When things go wrong and putting them right 22. Treatment settings, professional roles, and the organisation of treatment services Index.

The Treatment of Drinking Problems: Frontmatter

Introduction Part I. Background to Understanding: 1. The history of treatment for drinking problems 2. Causes of drinking problems 3. Alcohol as a drug 4. The alcohol dependence syndrome 5. Drinking problems and the family 6. Social complications of excessive drinking 7. Drinking problems as cause of neuropsychiatric disorder 8. Alcohol problems and psychiatric comorbidity 9. Alcohol and other drug problems 10. Physical complications of excessive drinking 11. Women with drinking problems 12. Some special presentations 13. Drinking problems and the life course Part II. Screening, Assessment and Treatment: 14. Case identification and screening 15. Assessment as the beginning of therapy 16. Withdrawal states and treatment of withdrawal 17. The basic work of treatment 18. Alcoholics Anonymous 19. Special techniques 20. Working toward normal drinking 21. When things go wrong and putting them right 22. Treatment settings, professional roles, and the organisation of treatment services Index.

The Treatment of Drinking Problems: Index

Introduction Part I. Background to Understanding: 1. The history of treatment for drinking problems 2. Causes of drinking problems 3. Alcohol as a drug 4. The alcohol dependence syndrome 5. Drinking problems and the family 6. Social complications of excessive drinking 7. Drinking problems as cause of neuropsychiatric disorder 8. Alcohol problems and psychiatric comorbidity 9. Alcohol and other drug problems 10. Physical complications of excessive drinking 11. Women with drinking problems 12. Some special presentations 13. Drinking problems and the life course Part II. Screening, Assessment and Treatment: 14. Case identification and screening 15. Assessment as the beginning of therapy 16. Withdrawal states and treatment of withdrawal 17. The basic work of treatment 18. Alcoholics Anonymous 19. Special techniques 20. Working toward normal drinking 21. When things go wrong and putting them right 22. Treatment settings, professional roles, and the organisation of treatment services Index.

The Treatment of Drinking Problems: Treatment: context and content

Introduction Part I. Background to Understanding: 1. The history of treatment for drinking problems 2. Causes of drinking problems 3. Alcohol as a drug 4. The alcohol dependence syndrome 5. Drinking problems and the family 6. Social complications of excessive drinking 7. Drinking problems as cause of neuropsychiatric disorder 8. Alcohol problems and psychiatric comorbidity 9. Alcohol and other drug problems 10. Physical complications of excessive drinking 11. Women with drinking problems 12. Some special presentations 13. Drinking problems and the life course Part II. Screening, Assessment and Treatment: 14. Case identification and screening 15. Assessment as the beginning of therapy 16. Withdrawal states and treatment of withdrawal 17. The basic work of treatment 18. Alcoholics Anonymous 19. Special techniques 20. Working toward normal drinking 21. When things go wrong and putting them right 22. Treatment settings, professional roles, and the organisation of treatment services Index.

The Treatment of Drinking Problems: Physical complications of excessive drinking

Within a total and balanced approach to drinking problems, the physical element must be seen as often very important. Helping services must be so organized as to cope effectively with diagnosis and treatment in the physical domain and, whatever the particular professional affiliation of the person who is working with the problem drinker, there is need for an alertness towards possible physical pathologies. For instance, voluntary workers in a lay counselling centres are, of course, practising their own special types of skill, and no-one would suggest that they should also cultivate a highly specialized knowledge of liver pathology. It is, though, a reasonable expectation that they should know enough about the liver to understand the significance to their client of a diagnosis of cirrhosis, rather than themselves being mystified by this term and consequently deflecting that client from talking about something of vital importance. A polite conspiracy can be set up which pretends that the body does not exist. Why physical complications matter Alcohol consumption is a significant cause of physical morbidity and poses a substantial burden on hospital services (Royal College of Physicians, 2001). In Great Britain, approximately 15–30% of male and 8–15% of female admissions to general hospitals in urban areas have alcohol-related problems (Chick, 1994; Canning et al., 1999). The equivalent figure in the USA is 20–40% for both men and women (Lieber, 1995). Alcohol consumption is also responsible for considerable mortality from natural causes and contributes to deaths from accidents, suicide and violence (Edwards et al.

The Treatment of Drinking Problems: Drinking problems as cause of neuropsychiatric disorders

In some instances heavy drinking actually causes mental illness. This usually indicates that the drinking problem is serious and of relatively long duration, and that a degree of neuroadaptation is already present (see Chapter 3). This chapter deals with the neuropsychiatric complications seen in individuals with drinking problems. It looks firstly at alcohol-related hallucinatory states as exemplifying conditions for which drinking or withdrawal of alcohol is of undoubted and central causality. Delirium tremens, alcohol hallucinosis and alcohol-induced psychotic disorder with delusions are considered, followed by a review of pathological intoxication and alcoholic blackouts. Finally, the Wernicke–Korsakoff syndrome, alcoholic pellagra encephalopathy and alcohol-related brain damage are discussed. Transient hallucinatory experience Transient hallucinatory experience deserves note for two reasons. First, it may herald the onset of delirium tremens or alcoholic hallucinosis, and can often give early warning of the likelihood of these much more serious illnesses. It may therefore be viewed as continuous with these states, rather than as an altogether discrete clinical entity. Second, it is important to be aware that transient hallucinations may occur without the illness progressing to either of the major presentations. The diagnostician who is unfamiliar with these transient phenomena may be tempted to record incorrectly that the patient has ‘suffered from DTs’, when this was not the case. The essence of this condition is that the patient fleetingly and suddenly experiences any one of a variety of perceptual disturbances, often very much to their surprise and consternation, and with the episode then immediately over.