Alternativas psicoterapéuticas efectivas en el tratamiento del paciente alcohólico / Effective psychotherapy alternatives in the treatment of the alcoholic patient

Fundamento: En la actualidad existe un amplio rango de formas de intervención psicológicas que se emplean para el tratamiento del alcoholismo; no obstante, los estudios que documentan la efectividad de estas alternativas hacen énfasis en un grupo de acciones que son más efectivas en el tratamiento del paciente alcohólico Objetivo: Resumir las principales evidencias sobre la efectividad de los distintos enfoques existentes en el tratamiento de la dependencia alcohólica, a partir de un análisis de las pruebas existentes y diferenciarlas de las alternativas que han demostrado una limitada efectividad. Desarrollo: En los últimos años ha aumentado el interés por conocer la efectividad de las distintas alternativas de intervención en el alcoholismo, en gran parte por el interés marcado que existe en la administración adecuada de recursos de los que se dispone para el enfrentamiento de esta enfermedad. Los estudios sobre efectividad de las intervenciones además de necesarios para los profesionales que prestan ayuda psicoterapéutica, son cruciales para los decisores políticos que manejan los recursos dedicados a la salud, fundamentalmente para la toma de decisiones sobre el destino de los fondos basándose en el análisis de costo-beneficio. Conclusiones: Entre los enfoques interventivos con efectividad documentada se destacan las intervenciones breves, entrevistas motivacionales, entrenamiento en habilidades sociales y de afrontamiento cognitivo-conductual, el reforzamiento comunitario, el contrato conductual, las terapias aversivas y la prevención de las recaídas. Entre las terapias con limitaciones se pueden mencionar la psicoterapia del insight, consejería confrontacional, el entrenamiento en relajación, consejería y el empleo de recursos educativos.

Background: Actually there is a wide rank of psychological intervention that are used for the treatment of alcoholism , otherwise , the studies that document the effectiveness of the alternatives make emphasis in a group of actions which are more effective in the treatment of alcoholic patient. Objective: To recapitulate the main evidences about the effectiveness of the different views in the treatment of this alcoholic dependence, starting by an analyzing the existing evidence and differentiate them from the alternatives which have proved a limited effectiveness. Development: In the last few years there has been an increase in the interest for knowing the effectiveness of the different alternatives of intervention in alcoholism, in great part due to the marked interest that there is in the adequate management of the resources which are available for facing this disease. The studies about the effectiveness of the interventions although they are necessary for professionals that give psychotherapeutic help, are essential for politicians who handle the resources dedicated to health mainly to taking decisions about the destination of capitals based on the cost- benefit analysis. Conclusions: Brief interventions, motivational interviews, training in social abilities and of cognitive-behavioral coping, communitarian reinforcement, behavioral contract, aversive therapies and the prevention of relapses are found among the approaches of intervention with documented effectiveness. Insight therapy, confrontational counseling, training in relaxation, counseling and the use of educative resources are found among the therapies with limitations.

Effects of nutrition education on nutrition-related knowledge, dietary habits, and nutrient intakes of alcoholic patients / 한국영양학회지

PURPOSE: The aim of this study was to examine the characteristics of nutrition-related knowledge, dietary habits, and nutrient intakes of alcoholic patients and how nutrition education affects these nutritional behaviors. METHODS: Subjects included 37 adult male alcoholic patients who were hospitalized. The nutrition education program consisted of five lessons over a five-week period. An each 80-minute nutrition education program per week was implemented for the alcoholic patients over a five-week period. Both before and after the implementation of nutrition education, their nutrition-related knowledge and dietary habits were assessed and nutrient intakes were investigated. RESULTS: The subjects showed drinking habits of considerably high frequency, a large quantity of alcohol consumption, and preference for soju (a liquor) over beer. They had proper weight, height, and BMI, and came from relatively poor socioeconomic backgrounds with a low-level of self-rated health status and a comparatively high rate of suffering from disease. Mean score of their nutrition-related knowledge and dietary habits was quite low. They consumed less energy, dietary fiber, vitamin C, thiamin, riboflavin, folic acid, Ca, and K, but more Na compared to each Dietary Reference Intake (DRI). After implementing the nutrition education, mean score of nutrition-related knowledge and dietary habits showed significant improvement. In addition, the meeting rate of each DRI of several nutrients was increased significantly, including energy, carbohydrate, dietary fiber, vitamins A, C, and B6, thiamin, riboflavin, niacin, pyridoxine, folic acid, Ca, P, K, Fe, and Zn, while that of Na decreased. CONCLUSION: The findings of this study indicate that alcoholic patients had various nutritional problems, such as lack of nutrition-related knowledge, bad dietary habits, and insufficient nutrient intakes, however, these problems can be positively modified by implementation of a relatively short-term nutrition education program.

Transtorno de estresse pós-traumático em dependente do álcool: [relato de caso] / Post-traumatic stress disorder and alcoholism: [case report]

CONTEXTO: Os transtornos comórbidos entre dependentes químicos têm se mostrado a regra e não a exceção. O transtorno de estresse pós-traumático (TEPT) é um transtorno de ansiedade que se desenvolve após evento traumático, com importante sintomatologia. Quase 100 por cento dos dependentes químicos que procuram tratamento relatam história de traumas, e as prevalências de TEPT têm variado entre 30 por cento e 60 por cento. Entre os alcoolistas, as prevalências de TEPT variam de 10 por cento a 40 por cento. Apesar das altas prevalências, tais transtornos carecem de investigação pelos clínicos. OBJETIVOS: Tem-se como objetivo relatar o caso de um alcoolista com transtorno bipolar e sintomas de TEPT há alguns anos, cujo resultado de tratamento deveu-se ao reconhecimento da última comorbidade e abordagem conjunta das patologias. MÉTODOS: Paciente masculino, 40 anos, participou em uma pesquisa do Instituto de Prevenção e Pesquisa em Álcool e outras Dependências (IPPAD), que investiga a exposição a eventos traumáticos e TEPT em dependentes químicos, respondendo a vários instrumentos. Realizou entrevistas com uma das pesquisadoras visando a este relato de caso. Os resultados foram avaliados por entrevistas com o paciente e aplicação da Davidson Trauma Scale (DTS). RESULTADOS: A DTS foi respondida por ocasião da participação na pesquisa e um ano após, para avaliar resultados de tratamento. No primeiro momento, o paciente pontuou um escore total de 75 pontos e, no segundo, de 40 pontos. A melhora deveu-se ao reconhecimento do TEPT e seu tratamento com psicoterapia psicodinâmica, terapia cognitivo-comportamental e abordagem familiar como estratégias terapêuticas utilizadas. Para o tratamento psicofarmacológico foram utilizados carbonato de lítio, sertralina e clonazepan. CONCLUSÕES: A investigação de traumas e TEPT deve ser rotina no atendimento de alcoolistas. O reconhecimento precoce desta comorbidade pode prevenir sua cronicidade, favorecer a aderência...

BACKGROUND: Psychiatric comorbidity is common among addicted patients. Post-traumatic stress disorder (PTSD) is a highly symptomatic anxiety disorder of acute onset after a major distressing life-event. OBJECTIVES: In clinical practice, patients suffering from drug addiction invariably report the occurrence of psychologically stressful episodes, with frequencies of PTSD ranging from 30 percent to 60 percent. Among patients suffering from alcohol dependence, the prevalence of PTSD is estimated to range between 10 percent and 40 percent. METHODS: We report the case of a 40-year old alcoholic man presenting with comorbid bipolar disorder and long-lasting symptoms of PTSD. The subject was an outpatient at the Institute for Prevention and Research on Alcohol and Other Addictions (Instituto de Prevenção e Pesquisa em Álcool e Outras Dependências - IPPAD), being assessed for the occurrence of PTSD with the aid of several psychometric instruments. RESULTS: Data derived from clinical sessions and research interviews include the Davidson Trauma Scale (DTS), which was administered at baseline and after one year of follow-up, yielding scores of 75 and 40 respectively. Global response to treatment was achieved after the recognition and appropriate treatment of the latter condition, along with the combined approach to other comorbid disorders. DISCUSSION: The investigation of traumatic events should be encouraged in the clinical management of alcoholic patients.