Alcoholism Risk Reduction in France: A Modernised Approach Related to Alcohol Misuse Disorders
Abstract
:1. Introduction
2. Difficulties in the Implementation of Risk Reduction for Alcohol Related Disorders
3. Alcohol risk Reduction for the General Population
4. Risk Reductions in Patients with Alcohol Use Disorders
4.1. Categorical Approach versus Dimensional Approach
4.2. The Benefits of Abstinence
1 | Consumption reduction has not been proven as a successful strategy on a long-term basis, in particular in the scientific literature; |
2 | Addictive processes entail long-lasting changes in the reward circuitry (allostasis) which, even after a period of abstinence, cannot regain its previous stability; |
3 | This newly modified state presents a cumulating vulnerability to relapse through hypersensitisation to the smallest quantity of alcohol; |
4 | Sustained abstinence is the most effective strategy to stop neuronal degeneration induced by long-term alcohol consumption; |
5 | Abstinence remains the method of choice for the treatment of psychiatric comorbidities. |
4.3. The Benefits of Reduction
1 | The benefit obtained by the reduction of consumption corresponds to an improvement goal in terms of public health; |
2 | Expansion of the spectrum of available therapies is necessary to meet the demands of a larger number of patients; |
3 | Several Guidelines include the reduction of alcohol consumption as an “intermediate therapeutic target”; |
4 | Changes in the DSM-5 using a dimensional approach lead to consumption reduction as a realistic strategy in some programmes; |
5 | “Come back when you are motivated” is no longer an acceptable therapeutic response; |
6 | A goal of reducing consumption can be a first step in helping those patients who have hit a block with total abstinence to achieve success with the disease; |
7 | The prognosis for therapeutic success is improved if the patient chooses the goal; |
8 | Psychiatric comorbidities are decreased with reduction in alcohol consumption; |
9 | Quality of life is improved by a reduction in alcohol consumption; |
10 | The therapeutic approach to reducing alcohol consumption can be seen as a treatment paradigm shift. |
4.4. In Practice
Indications | Contraindications |
---|---|
Patients who have lost control and do not wish to stop drinking | Patient refusal |
Suggest an early response to alcohol problems | Medical contraindications to alcohol consumption |
Women, young, workers, married | CI treatments with alcohol |
Mild history | Previous failure of reduction |
First attempt, no involvement with AA, severe somatic or psychiatric comorbidities | Severe somatic or psychiatric comorbidities |
No family history of addiction | History of severe alcohol withdrawal syndrome |
Continuous consumption | |
Important sense of self-efficacy | |
Solid social and family stability |
5. Conclusions
Author Contributions
Conflicts of Interest
References
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Brousse, G.; Bendimerad, P.; De Chazeron, I.; Llorca, P.M.; Perney, P.; Dematteis, M. Alcoholism Risk Reduction in France: A Modernised Approach Related to Alcohol Misuse Disorders. Int. J. Environ. Res. Public Health 2014, 11, 11664-11675. https://doi.org/10.3390/ijerph111111664
Brousse G, Bendimerad P, De Chazeron I, Llorca PM, Perney P, Dematteis M. Alcoholism Risk Reduction in France: A Modernised Approach Related to Alcohol Misuse Disorders. International Journal of Environmental Research and Public Health. 2014; 11(11):11664-11675. https://doi.org/10.3390/ijerph111111664
Chicago/Turabian StyleBrousse, Georges, Patrick Bendimerad, Ingrid De Chazeron, Pierre Michel Llorca, Pascal Perney, and Maurice Dematteis. 2014. "Alcoholism Risk Reduction in France: A Modernised Approach Related to Alcohol Misuse Disorders" International Journal of Environmental Research and Public Health 11, no. 11: 11664-11675. https://doi.org/10.3390/ijerph111111664