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Special Issue "Treating Alcoholism between Harm Reduction and Immediate Abstinence"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (31 January 2016).

Special Issue Editor

Guest Editor
Prof. Dr. Icro Maremmani

Vincent P. Dole Dual Disorder Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Via Roma, 67 56126 Pisa, Italy
Website | E-Mail
Interests: substance use disorders and their treatment; opioid dependence; alcoholism and to agonist treatments; dual diagnosis patients; temperamental traits of normal subjects; psychiatric patients; substance abuser patients; heroin addiction; dual disorders; psychopharmacology

Special Issue Information

Dear Colleagues,

Alcohol is one of the most important risk factors for health and is a major cause of death and morbidity; notwithstanding, only about one-tenth of individuals with alcohol abuse disorders receive therapeutic intervention and specific rehabilitation.
Among the various dichotomies that limit an effective approach to the problem of alcohol use disorder treatment, one of the most prominent is “integrated treatment versus reduction of damage”.
What can represent a partial result for the operator (e.g., reduction of alcohol consumption rather than abstinence) is the only objective, which is, for the patient, at this moment, possible.
For years, these two strategies have been considered as opposite poles of different philosophies of intervention, one bound to the search for methods that lead the subject to complete abstinence, while the other prioritises a decrease in the use, with maximum reduction in the damage correlated with its use.
Reducing alcohol consumption has an immediate positive impact on the health of the at-risk-drinker.
Reduction of alcohol intake does not require any particular setting, but does require the collaboration between the general practitioner, specialized services for addiction, alcohology services, and psychiatry.
In patients who reach this target, significant savings in terms of health and social costs can be achieved. Reduction of harm is a desirable target, even from an economic point of view.
At the present state of neuroscientific knowledge, it is possible to go one step further in the logic that led to the integration of psychosocial and pharmacological approaches, to remove the shadows of social judgment and to aim for a course of treatment towards absolute abstention. In fact, when abstention is not considered the ideal therapeutic target for a given patient because he/she is unwilling to accept it, which therefore represents a de facto barrier to treatment, new therapeutic modalities should be identified and integrated approaches that motivate patients towards a path of individualized treatment should be considered.

This Special Issue is open to any subject area of public health, economics and policy related to the alcohol treatment focusing on the importance of a “harm reduction” strategy. The listed keywords suggest just a few of the many possibilities.

Prof. Dr. Icro Maremmani
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Alcohol dependence
  • Alcoholism
  • Anti-craving medications
  • Compliance to treatment
  • Comprehensive treatment
  • Detoxification
  • Economic costs
  • Harm reduction Strategy
  • Opioid receptors
  • Public health
  • Reduction in alcohol consumption
  • Stigma

Published Papers (5 papers)

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Research

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Open AccessArticle
Improvements in Empathy and Cognitive Flexibility after Court-Mandated Intervention Program in Intimate Partner Violence Perpetrators: The Role of Alcohol Abuse
Int. J. Environ. Res. Public Health 2016, 13(4), 394; https://doi.org/10.3390/ijerph13040394
Received: 6 January 2016 / Revised: 24 March 2016 / Accepted: 24 March 2016 / Published: 31 March 2016
Cited by 13 | PDF Full-text (306 KB) | HTML Full-text | XML Full-text
Abstract
Research assessing the effectiveness of intervention programs for intimate partner violence (IPV) perpetrators has increased considerably in recent years. However, most of it has been focused on the analysis of psychological domains, neglecting neuropsychological variables and the effects of alcohol consumption on these [...] Read more.
Research assessing the effectiveness of intervention programs for intimate partner violence (IPV) perpetrators has increased considerably in recent years. However, most of it has been focused on the analysis of psychological domains, neglecting neuropsychological variables and the effects of alcohol consumption on these variables. This study evaluated potential neuropsychological changes (emotional decoding, perspective taking, emotional empathy and cognitive flexibility) and their relationship with alcohol consumption in a mandatory intervention program for IPV perpetrators, as well as how these variables affect the risk of IPV recidivism. The sample was composed of 116 individuals with high alcohol (n = 55; HA) and low alcohol (n = 61; LA) consumption according to self-report screening measures who received treatment in a IPV perpetrator intervention program developed in Valencia (Spain). IPV perpetrators with HA consumption were less accurate in decoding emotional facial signals and adopting others’ perspective, and less cognitively flexible than those with LA consumption before the IPV intervention. Further, the effectiveness of the intervention program was demonstrated, with increases being observed in cognitive empathy (emotional decoding and perspective taking) and in cognitive flexibility. Nevertheless, the HA group showed a smaller improvement in these skills and higher risk of IPV recidivism than the LA group. Moreover, improvement in these skills was related to a lower risk of IPV recidivism. The study provides guidance on the targeting of cognitive domains, which are key factors for reducing IPV recidivism. Full article
(This article belongs to the Special Issue Treating Alcoholism between Harm Reduction and Immediate Abstinence)
Open AccessArticle
Indicated Prevention of Fetal Alcohol Spectrum Disorders in South Africa: Effectiveness of Case Management
Int. J. Environ. Res. Public Health 2016, 13(1), 76; https://doi.org/10.3390/ijerph13010076
Received: 5 November 2015 / Revised: 11 December 2015 / Accepted: 21 December 2015 / Published: 23 December 2015
Cited by 7 | PDF Full-text (1077 KB) | HTML Full-text | XML Full-text
Abstract
In the Western Cape Province of South Africa (ZA) a subculture of binge drinking produces the highest global documented prevalence of fetal alcohol spectrum disorders (FASD). FASD prevention research activities in ZA use the Comprehensive Prevention approach from the United States Institute of [...] Read more.
In the Western Cape Province of South Africa (ZA) a subculture of binge drinking produces the highest global documented prevalence of fetal alcohol spectrum disorders (FASD). FASD prevention research activities in ZA use the Comprehensive Prevention approach from the United States Institute of Medicine. Case management (CM) was delivered as a method of indicated prevention to empower heavy drinking pregnant women to achieve cessation or a reduction in drinking. CM activities incorporated life management, Motivational Interviewing (MI) techniques and the Community Reinforcement Approach (CRA). Data were collected at baseline, 6, 12 and 18 months. Mean drinking decreases 6 months into CM; but overall alcohol consumption rose significantly over time to levels higher than baseline at 12 and 18 months. Alcohol consumption drops significantly from before pregnancy to the second and third trimesters. AUDIT scores indicate that problematic drinking decreases significantly even after the vulnerable fetus/baby was born. CM significantly increases client happiness, which correlates with reduced weekend drinking. CM was successful for women with high-risk drinking behaviour, and was effective in helping women stop drinking, or drink less, while pregnant, reducing the risk of FASD. Full article
(This article belongs to the Special Issue Treating Alcoholism between Harm Reduction and Immediate Abstinence)
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Review

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Open AccessReview
A Brief Up-Date of the Use of Sodium Oxybate for the Treatment of Alcohol Use Disorder
Int. J. Environ. Res. Public Health 2016, 13(3), 290; https://doi.org/10.3390/ijerph13030290
Received: 22 December 2015 / Revised: 8 February 2016 / Accepted: 23 February 2016 / Published: 5 March 2016
Cited by 14 | PDF Full-text (259 KB) | HTML Full-text | XML Full-text
Abstract
The treatment of alcohol use disorder (AUD) with sodium oxybate (SMO) or gamma-hydroxybutyric acid (GHB) was introduced in Italy and Austria more than 20 years and 15 years ago, respectively, and it is now widely employed to treat alcohol withdrawal syndrome (AWS) and [...] Read more.
The treatment of alcohol use disorder (AUD) with sodium oxybate (SMO) or gamma-hydroxybutyric acid (GHB) was introduced in Italy and Austria more than 20 years and 15 years ago, respectively, and it is now widely employed to treat alcohol withdrawal syndrome (AWS) and to maintain alcohol abstinence. These indications derive from its similar structure to the inhibitory neurotransmitter γ-amino-butyric acid (GABA), exerting an ethanol-mimicking effect, because it binds to GABAB receptors. Craving for, and abuse of, SMO remain a controversial issue; even though these unfavorable effects are evident in poly-drug addicted patients and in those with psychiatric diagnosis of borderline personality disorder. In addition, despite cases of severe intoxication and deaths being widely documented when GHB is used as “street drug”; its clinical use remains safe. Thus, the aim of the present review is to examine the role of SMO in the treatment of AUD, its possible implications in reducing alcohol consumption, and cases of abuse, and severe intoxication due to SMO during its clinical use in the treatment of AUD. Full article
(This article belongs to the Special Issue Treating Alcoholism between Harm Reduction and Immediate Abstinence)
Open AccessReview
Biomarker-Based Approaches for Assessing Alcohol Use Disorders
Int. J. Environ. Res. Public Health 2016, 13(2), 166; https://doi.org/10.3390/ijerph13020166
Received: 10 November 2015 / Revised: 14 January 2016 / Accepted: 20 January 2016 / Published: 27 January 2016
Cited by 26 | PDF Full-text (528 KB) | HTML Full-text | XML Full-text
Abstract
Although alcohol use disorders rank among the leading public health problems worldwide, hazardous drinking practices and associated morbidity continue to remain underdiagnosed. It is postulated here that a more systematic use of biomarkers improves the detection of the specific role of alcohol abuse [...] Read more.
Although alcohol use disorders rank among the leading public health problems worldwide, hazardous drinking practices and associated morbidity continue to remain underdiagnosed. It is postulated here that a more systematic use of biomarkers improves the detection of the specific role of alcohol abuse behind poor health. Interventions should be initiated by obtaining information on the actual amounts of recent alcohol consumption through questionnaires and measurements of ethanol and its specific metabolites, such as ethyl glucuronide. Carbohydrate-deficient transferrin is a valuable tool for assessing chronic heavy drinking. Activities of common liver enzymes can be used for screening ethanol-induced liver dysfunction and to provide information on the risk of co-morbidities including insulin resistance, metabolic syndrome and vascular diseases. Conventional biomarkers supplemented with indices of immune activation and fibrogenesis can help to assess the severity and prognosis of ethanol-induced tissue damage. Many ethanol-sensitive biomarkers respond to the status of oxidative stress, and their levels are modulated by factors of life style, including weight gain, physical exercise or coffee consumption in an age- and gender-dependent manner. Therefore, further attention should be paid to defining safe limits of ethanol intake in various demographic categories and establishing common reference intervals for biomarkers of alcohol use disorders. Full article
(This article belongs to the Special Issue Treating Alcoholism between Harm Reduction and Immediate Abstinence)
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Other

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Open AccessConcept Paper
Harm Reduction as “Continuum Care” in Alcohol Abuse Disorder
Int. J. Environ. Res. Public Health 2015, 12(11), 14828-14841; https://doi.org/10.3390/ijerph121114828
Received: 16 September 2015 / Revised: 8 November 2015 / Accepted: 17 November 2015 / Published: 19 November 2015
Cited by 8 | PDF Full-text (794 KB) | HTML Full-text | XML Full-text
Abstract
Alcohol abuse is one of the most important risk factors for health and is a major cause of death and morbidity. Despite this, only about one-tenth of individuals with alcohol abuse disorders receive therapeutic intervention and specific rehabilitation. Among the various dichotomies that [...] Read more.
Alcohol abuse is one of the most important risk factors for health and is a major cause of death and morbidity. Despite this, only about one-tenth of individuals with alcohol abuse disorders receive therapeutic intervention and specific rehabilitation. Among the various dichotomies that limit an effective approach to the problem of alcohol use disorder treatment, one of the most prominent is integrated treatment versus harm reduction. For years, these two divergent strategies have been considered to be opposite poles of different philosophies of intervention. One is bound to the search for methods that aim to lead the subject to complete abstinence; the other prioritizes a progressive decline in substance use, with maximum reduction in the damage that is correlated with curtailing that use. Reduction of alcohol intake does not require any particular setting, but does require close collaboration between the general practitioner, specialized services for addiction, alcohology services and psychiatry. In patients who reach that target, significant savings in terms of health and social costs can be achieved. Harm reduction is a desirable target, even from an economic point of view. At the present state of neuroscientific knowledge, it is possible to go one step further in the logic that led to the integration of psychosocial and pharmacological approaches, by attempting to remove the shadows of social judgment that, at present, are aiming for a course of treatment that is directed towards absolute abstention. Full article
(This article belongs to the Special Issue Treating Alcoholism between Harm Reduction and Immediate Abstinence)
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Int. J. Environ. Res. Public Health EISSN 1660-4601 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert
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