[Alcoholism as an illness]. / Alkoholismus als Krankheit.

Formerly the term alcoholism has been defined only by alcohol-related conditions. About 20 years ago a WHO committee recommended to differentiate between alcohol abuse and alcohol dependence. The new classifications and manuals followed this proposal: Criteria for alcohol abuse are still alcohol sequelae whereas alcohol dependence is characterized by tolerance and withdrawal syndrome as well as by some specific behavioral states e.g. impaired alcohol control, consumption despite problems. For easier and safer diagnosis of alcoholism some tests have been developed. Most of them use questionnaires and/or clinic and lab data. Two of the tests are mentioned in some detail. Special reference has been given to the 200 years old disease concept of alcoholism which is still under discussion. The debate should start with a general definition of disease. A comprehensive biopsychosocial model will be developed. The last chapter deals with the conditions for the development of alcoholism. A triangle model serves for the explanation of the complicated circular relations between drug (alcohol)-individuum-social background.

[The mortality rate of alcoholic patients 4 years after inpatient treatment]. / Mortalität bei Alkoholikern 4 Jahre nach stationärer Behandlung.

Data on mortality during a 48-month follow-up period in a group of 1410 alcoholics who had received inpatient treatment were evaluated. In 1266 patients known to be either living or deceased the death rate was 7.6%. The percentage of deceased subjects was highest in the group over 50 years of age. The mortality rate was higher for men (9.8%) than for women (4.8%); for those with more than one divorce (16.8%); for those who were not fit for work (18.1%) or were retired at the start of the treatment (43.3%); who were employed in the alcohol business (21.7%); who had reduced their alcohol consumption before treatment (13.4%); who were unemployed 6 months after discharge (12.4%). The mortality rate was higher for those with high scores on a scale assessing calmness in a personality inventory (7.9%) and low scores on a questionnaire assessing motivation (10.9%) and insight into the need of change (12.4%). Alcohol-related illness before the index treatment played an important role: the mortality rate was higher for those who had had Wernicke-Korsakoff-syndrome (40%), delirium tremens (15.3%), pancreatitis (13.9%) or cardiomyopathy (14.1%). The mortality rate was higher for treatment dropouts (12.9%) and for those who regularly or occasionally took sleeping pills (28.5%), psychoactive drugs (15.1%) or other drugs (11.5%) during treatment. In the follow-up periods substance use had a great effect on mortality. The mortality rate for those patients who still abstained from alcohol for after 6 months (4.4%) was only a third of that the patients who had relapsed (12.4%).(ABSTRACT TRUNCATED AT 250 WORDS)

Mortality in alcoholic patients given inpatient treatment.

Data on mortality during a 48-month follow-up period in a group of 1410 alcoholics who had received inpatient treatment were evaluated. In 1266 patients known to be either living or deceased the death rate was 7.6%. The percentage of deceased subjects was highest in the group over 50 years of age. The mortality rate was higher for men (9.8%) than for women (4.8%); for those with more than one divorce (16.8%); for those who were not fit for work (18.1%) or were retired at the start of the treatment (43.3%); who were employed in the alcohol business (21.7%); who had reduced their alcohol consumption before treatment (13.4%); who were unemployed 6 months after discharge (12.4%). The mortality rate was higher for those with high scores on a scale assessing calmness in a personality inventory (7.9%) and low scores on a questionnaire assessing motivation (10.9%) and insight into the need of change (12.4%). Alcohol-related illness before the index treatment played an important role: the mortality rate was higher for those who had had Wernicke-Korsakoff syndrome (40%), delirium tremens (15.3%), pancreatitis (13.9%) or cardiomyopathy (14.1%). The mortality rate was higher for treatment dropouts (12.9%) and for those who regularly or occasionally took sleeping pills (28.5%), psychoactive drugs (15.1%) or other drugs (11.5%) during treatment. In the follow-up periods substance use had a great effect on mortality. The mortality rate for those patients who still abstained from alcohol after 6 months (4.4%) was only a third of that for the patients who had relapsed (12.4%).(ABSTRACT TRUNCATED AT 250 WORDS)

The motivation of alcohol dependents to undergo treatment.

The purpose of this study was to investigate the determinants and factors influencing the motivation of alcohol dependents to undergo treatment. As well as exploring the influence of socio-demographic and illness-related variables, the study concentrated in particular on the influence of the clients' attitudes towards their current life situation, their alcohol problem and the treatment, also the influence of specific interventions aimed at increasing their motivation for treatment. On the basis of the results obtained in the study from 239 alcohol-dependent clients, it is shown to what extent these variables are of value as a means of predicting and modifying the motivation for treatment. In the motivation programme a variety of procedures was applied using a 2 x 2 design: motivation on an individual basis and motivation on a group basis were combined with two different approaches, one client-centred and one in accordance with the principles of cognitive-behavioural therapy. A group placed on a waiting list for 3 weeks was used as a control group. The clients were allocated to the various groups on a random basis. Specific attitudes on the part of the clients and aspects of the motivation programme provided significant indicators of the clients' likelihood to undergo treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

[Alcoholism: definition, diagnosis, illness concept, follow-up, results and costs of treatment]. / Alkoholismus: Definition, Diagnose, Krankheitsbegriff, Ablauf, Ergebnisse und Kosten der Behandlung.

The article starts with a review on the definition of alcoholism stressing the useful differentiation between alcohol abuse and alcohol dependence. On the basis of this definition the principles of the diagnosis of alcoholism are demonstrated. The disease concept of alcoholism is discussed in detail. Then the aims, the structure and the results of the therapy for alcoholics are briefly described. The article concludes with a short cost-benefit analysis of the alcoholism treatment.

Treatment for alcoholics in German speaking countries.

This article was triggered by suggestions given by the editors of the British Journal of Addiction (Edwards, 1989). The main question addressed was: what do therapists really know and believe about how (alcoholic) patients are helped? In addition some more detailed issues were borne in mind, namely: the underlying philosophy of alcoholism (disease concept) and its treatment; patients' socio-cultural background and abuse practices; the special socio-cultural factors which influence the therapists' practice and patients' expectations; treatment goals and outcome definitions; the therapists' approaches to the patients' assessments; the treatment modalities (attempts to strengthen motivation; the form of initial contact, duration, termination and intensity of treatment).

[2 to 3 years following inpatient crisis intervention: further inpatient treatment, present adjustment and subjective assessment of the index treatment in retrospect]. / Zwei bis drei Jahre nach stationärer Krisenintervention: weitere stationäre Behandlungen, momentane Befindlichkeit und subjektive Beurteilung der Indexbehandlung im Rückblick.

2-3 years after having been treated in a special crisis intervention inpatient department, 404 patients were asked to write down in an anonymous letter what kind of therapy they had since undergone, how they feel at present, and how they rate the treatment in retrospect. The main reasons for the crisis had been conflicts in partnership relations such as separation or divorce. The patients covered by the inquiry--about 40% of them had been treated directly after attempted suicide--had again consulted their family doctor (almost 80%) or a psychiatrist (slightly more than 40%). 50% of the patients who could be contacted, had since participated in individual or group therapy. 23% had to return to inpatient treatment. Feeling tone (according to a standard rating scale) was depressive in only 40% of the patients and normal in far more than one-half. Index treatment was considered as "unhelpful" by only 3.4% of the patients. More than 95% of the patients would recommend the crisis intervention ward to other patients, too.

A prospective multicentre study of in-patient treatment for alcoholics: 18- and 48-month follow-up (Munich Evaluation for Alcoholism Treatment, MEAT).

In a prospective multicentre study of 1410 alcoholics (73% men) data were collected at five different times: admission, discharge, 6, 18 and 48 months after discharge. The details from the 21 treatment centres involved were acquired from staff-members; follow-up data on patients were collected by personal interviews and/or mailed questionnaires. In all, 85%, 84% and 81% of the patients could be traced, respectively. Additionally, data of patients' sick leave days and in-patient treatment were provided by the health insurance and pension insurance institutions, respectively. Outcome criteria were drinking behaviour, working and partner situation, and subjective complaints. The drinking behaviour was divided into three rough categories: abstinent, improved and unimproved. For 18 months 53% of the patients remained abstinent, 8.5% improved and 38% did not improve. For 48 months 46% remained abstinent, 12% improved and 42% did not improve. During the last 6 months prior to the 48-month data collection 66% were abstinent, 4% improved and 30% did not improve. Only 3% of patients succeeded in maintaining controlled drinking. The percentage of days of sick leave was reduced by 64% and of in-patient treatment from 34.7% to 14.6% during the 18-month period after discharge (in comparison with the 18-month period prior to treatment). Only 21% of the patients regularly attended self-help groups. Out of the patients' variables, ten for men and five for women could be identified as prognostically relevant. In the 48-month follow-up these factors were reconsidered. In men almost all, in women only three of the five factors were confirmed. The treatment variables were evaluated according to the prognosis factors (positive vs negative group). In the 48-month follow-up the treatment variables relevant in the 18-month follow-up were also reassessed. In the positive prognosis group five variables were confirmed, in the negative prognosis group only one. In addition, differentiated indication variables for the three treatment lengths were developed and applied to a model. The following appeared to be clues regarding the length of desirable treatment. For an unfavourable prognosis in both men and women no short-term treatment should be given; medium- or long-term treatment is to be preferred. For a medium prognosis men do better with short-term treatment; for women medium-treatment is preferred. For a favourable prognosis for men medium-term treatment should be avoided; long-term is preferred; for women short-term treatment may also be preferred.

[A hospital unit for psychiatric crisis intervention 5 years later]. / Eine Station für psychiatrische Krisenintervention fünf Jahre später.

On 7 January 1981 a special ward for crisis intervention and emergency psychiatric cases went on stream at the Max Planck Institute of Psychiatry in Munich. The article reports on the development of this ward between 1981 and 1985. First of all, a brief outline of the structure of the ward is given explaining indications and contraindications for acceptance and the treatment concept. This is followed by statistical evaluation of 1981 to 1985 data in respect of number of admissions and readmissions, duration of stay, percentage distribution of the referring institutions, age distribution, distribution of diagnosis, rates of attempted and committed suicides and onward referral to other institutions for further treatment. Finally, the article reviews changes in the basis concept of therapy and in the style of communication and behaviour within the therapeutic team, besides commenting on unfavourable conditions.