A structured programme for out-patient alcohol detoxification

Article Abstract:

A London-based out-patient alcohol detoxification service with medical supervision and structured counseling sessions is described. The clinic is staffed by two nurses who interview all referrals and conduct the counseling sessions. Program exclusion criteria include the abuse of substances other than alcohol or severe withdrawal symptoms which require hospitalization. Once accepted into the program, patients take daily breath alcohol tests. If evidence of alcohol intake is assessed, treatment is terminated. A complete history is taken at the initial interview, followed by completion of a self-reported questionnaire to evaluate the patient's drinking habits over the past month. Each patient is then assigned either to a severely or moderately alcohol dependent group. All patients are given daily doses of diazepam (Valium) and thiamine (vitamin B1). Each patient attends five counselling sessions that address the following areas: general and alcohol-related history; health-related and other problems; coping skills and strategies; necessary long-term changes; and available long-term community support (e.g., groups such as Alcoholics Anonymous). The program emphasis is on a supportive approach, but stresses a belief that the responsibility for maintaining sobriety rests on the patient. Between August 1987 and July 1988, 76 patients were accepted for treatment in the program. Success was defined as attending all sessions while remaining sober. Sixty patients successfully completed the detoxification process. There were no significant medical complications in the successful group. These results suggest that out-patient detoxification is a safe and effective means for patients who would otherwise have to be hospitalized. (Consumer Summary produced by Reliance Medical Information, Inc.)

Alcoholics

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Care of chronic neurotic out-patients by community psychiatric nurses: a long-term follow-up study

Article Abstract:

Although they exhibit relatively low levels of symptoms or social handicap, chronic neurotic patients can impose heavy burdens on psychiatric services because of the longevity of their illness and the supports they require. A study was carried out between 1977 and 1982 which evaluated the effects of community psychiatric nursing (CPN) care versus traditional psychiatric outpatient (OP) care among discharged chronic neurotics who were primarily suffering from major depression. The study found that after 18 months of treatment CPN patients made more contact visits and had higher discharge rates from psychiatric care than the OP patients. After two years of treatment, more patients were discharged from psychiatric OP care, and care and discharge patterns for both groups were similar. In order to evaluate the stability of patient improvement over time, 76 patients from that study were followed-up and re-assessed approximately eight years after intake into the original study. Re-assessment included a psychological interview, an interview for depression, and a social adjustment scale. Results demonstrated that OP and CPN care groups had almost identical levels of depression, anxiety and distress to those found in their original intakes. While ongoing treatment - particularly CPN treatment - successfully reduced distress in early treatment stages, these effects did not endure. Since treatment results did persist for one to two years after intake, it is suggested that beneficial treatment effects probably work by improving patients' self-esteem and sense of personal efficacy. However, the necessity of providing long-term follow-up care is strongly indicated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Evaluation, Community psychiatric services, Community mental health services, Psychiatric nursing, Psychiatric hospital patients, Psychiatric hospitals, Neurotics

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Self-detoxification by opiate addicts: a preliminary study

Article Abstract:

Heroin addicts who seek treatment have usually been abusing drugs for a long time. When they first seek formal treatment, they have often already made other, informal, attempts at becoming drug-free. The circumstances around self-attempts at detoxification have not been well-reported, however. The present study is a preliminary, information-gathering, investigation into circumstances associated with attempts at self-detoxification, the strategies used, and the outcomes associated with self-detoxification attempts for 50 opiate (e.g., heroin, methadone) addicts. In all, 35 men and 15 women, with an average age of 29.4 years, were interviewed. They had been using opiates for an average of 10.2 years. Of the 50 subjects, 47 had made attempts at self-detoxification; 36 had tried at least twice, and 10 had tried at least 10 times. The success rate, as measured by achieving abstinence, was 24 percent for abstinence lasting a week, and only 14 percent for abstinence lasting up to a month. Most commonly, subjects chose to go 'cold turkey', ceasing drugs abruptly. Avoidance and distraction techniques were also used, and 44 subjects sometimes used other drugs. Given the relatively large number of opiate addicts who attempt self-detoxification at some point, it is recommended that self-help materials be provided. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Drug abuse treatment, Drug addicts, Drug abusers, Drug abuse, Narcotics

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