Before-discharge intervention method in the treatment of alcohol dependence.

BACKGROUND: Alcoholics have the fundamental problem of denying dependence on alcohol and minimizing their alcohol-related problems. Therapeutic interventions often fail to help alcoholics become aware of their drinking problem and remain in long-range treatment programs, which is a prerequisite for recovery from alcohol dependence. METHODS: Inpatients were assigned to either group 1 or 2 depending on which day of the week they were admitted to the hospital. A newly developed structured intervention method (Before-Discharge Intervention Method, or BDIM) was employed with select (nonrandomized) hospitalized alcoholics in group 1 and their family members before the patients were discharged from the hospital. None of the patients in group 2 received the BDIM. With this intervention method, the alcoholic's family members delivered to him or her verbal messages that conveyed concern about the alcoholic's problem drinking, their observations of the alcoholic's past episodes of drinking problems, and wishes and support for abstinence. Unless patients died during hospitalization or would not be able to attend the hospital follow-up clinic and local self-help groups (Danshukai) after discharge, outcome evaluations were carried out on all patients in groups 1 and 2 during two calendar months, 3 months after the last BDIM patient left the hospital. Outcome measures included patient's and family members' attendance at hospital outpatient follow-up sessions and self-help group meetings, and patient's abstinence. RESULTS: Family members' attendance at hospital follow-up sessions and/or self-help group meetings was significantly higher in group 1 than in group 2. Among the three subgroups of discharged patients in either group 1 or 2-that is, those who lived with their spouse, those who lived with someone other than their spouse, and those who lived alone-only those in group 1 who lived with their spouse did significantly better than their counterparts in group 2 in three treatment outcome measures. However, patients' maintenance of abstinence was significantly better only when they and their family members both attended hospital outpatient follow-up sessions and/or self-help group meetings. We noted no other statistically significant difference between groups 1 and 2 in any of the other two subgroups of discharged or patients in any of the three treatment outcome variables. Irrespective of the BDIM, patients who lived alone did significantly more poorly than either those who lived with their spouse or those who lived with someone other than their spouse in terms of attendance at hospital follow-up sessions and local self-help group meetings and abstinence. CONCLUSIONS: This intervention method can help the alcoholic face the reality of his or her drinking problems and alcohol dependence and thus remain longer in long-range rehabilitation programs, which is a prerequisite for successful recovery from alcohol dependence.

Direct activation of human CD8+ cytotoxic T lymphocytes by interleukin-18.

Direct activation of human cytotoxic T lymphocytes (CTL) by interleukin (IL)-18 was observed in a system in which CTL effective against autologous tumor cells were generated. Peripheral blood mononuclear cells (PBMC) from tumor-bearing patients, after removal of natural killer (NK) cells, were cultured in a medium containing IL-1, -2, -4, and -6, with or without IL-18, and stimulated with autologous tumor cells. IL-18 increased the activity of the CTL and the proportion of autologous CD8+ T cells present after 28 days in the induction culture. When purified CD8+ T cells were cultured in the presence of IL-18 and IL-2 for 7 days, the CTL showed enhanced cytotoxic activity against autologous tumor cells. Moreover, a purified CD8+ T cell population, which did not exhibit any apparent cytotoxic activity against autologous tumor cells, displayed cytotoxic activity after 7-day incubation with IL-18. These results suggest that IL-18 may be useful to generate autologous CTL in humans and may thereby contribute to adoptive immunotherapy for tumors.