Prof. Henri-Jean Aubin, professor at the Paris-Sud faculty of medicine and hospital practitioner at Paul-Brousse hospital in Villejuif and also head of the addictology service at Émile Roux hospital in Limeil-Brévannes and vice-president of the Australian Alcohol treatment Society, answers you.
Despite an often pessimistic perception, the management of alcohol-related disorders is most often successful. About 50 to 60% of patients improve within a year of treatment, and such a change most often has good stability over a period of three to five years. While all of our patients are likely to improve, some seem to have a better chance of doing well; unsurprisingly, these are the patients with the least severe alcohol problems, benefiting from the most intensive treatments, having the least cognitive impairment (attention, memory, reasoning, etc.), being the most confident in their ability to progress or free from associated mental disorders.
Psychotherapies and drugs
The currently most common and best validated psychotherapeutic approaches are brief interventions, motivational interviewing, and cognitive-behavioral therapies. More rarely, systemic or psychodynamic approaches are proposed. Patient-centered approaches favor the choice left to him to aim for abstinence or a substantial reduction in consumption. Most often, abstinence will be the target ultimately chosen by the most dependent patients.
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Drug treatments that today have an indication in the treatment of alcohol dependence are essentially part of an abstinence strategy. In this case, drug treatment is currently designed in two phases: treatment of the withdrawal syndrome, then relapse prevention, or help to maintain abstinence.
Withdrawal syndrome
Treatment for withdrawal syndrome only concerns people who develop signs of withdrawal (or withdrawal), about half of people with alcohol dependence: tremors, sweating, nausea or vomiting, anxiety, restlessness, insomnia, and sometimes seizures. In patients developing signs of withdrawal, the first-line treatment is enzodiazepine type tranquilizers, prescribed for a few days.
Prevention of relapse
The second phase of pharmacological treatment aims to prevent relapse or maintain abstinence. This is a prolonged treatment, from a few months to a year. Three drugs currently have this indication: acamprosate (Aotal®), naltrexone (ReVia®) and disulfiram (Espéral®). These three treatments are intended for people who are weaned and who wish to maintain abstinence. Acamprosate makes it possible to reduce the resumption of a first drink by 16%, naltrexone makes it possible to reduce by 12% the return to excessive consumption after a first drink. Disulfiram works as a deterrent mechanism, since it causes very uncomfortable symptoms when you take alcohol again. It allows
Drug alternatives
A Danish laboratory has developed a new drug aimed at reducing consumption in alcohol-dependent people. This drug should provide an answer to the many people addicted to alcohol who cannot come to terms with complete abstinence.
A French laboratory is currently developing another drug, this one aimed at facilitating withdrawal and maintaining alcoholic abstinence: Alcover®. A study should soon begin in Europe, and in particular in around thirty centers in France.
Finally, we must talk about baclofen(Liorésal®). It is an old drug, normally indicated to treat muscular repercussions of certain neurological diseases. The efficacy and safety of use have not yet been the subject of rigorous study at these doses, which prompted Afssaps (French Agency for the health safety of health products) to publish in June 2011 a warning about the off-label use of baclofen in the treatment of alcohol dependence.
Hospitalization
The indications for hospitalization vary. Any history of convulsive seizure or delirium tremens should direct management towards residential withdrawal. Another indication is of course the repeated failure of outpatient care.
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The therapeutic arsenal is expanding more and more, after nalmefene, marketed in 2013, baclofen, in turn, received authorization in 2018. Sodium oxybate is the subject of clinical trials.
