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Main topics of the Progress in Mind: Focus on Alcohol Use Disorders Resource Centre

The Resource Centre will examine various topics related to alcohol use disorders. Over the course of 1 year, one particular theme will be highlighted monthly, with the goal of increasing awareness from a general practice, psychiatric, and public health point of view. Visit the Resource Centre on a regular basis to find new topics and updated content and subscribe to the E-Alert to stay tuned for the latest developments on the platform. The next topic will be New treatments in alcohol use disorders.

Click here to go to the individual Topics.
The “must-be-known” neurobiology of alcohol use disorders
Burden of disease
New treatments in alcohol use disorders
Primary care and alcohol use disorders
Alcohol as a risk factor for hypertension

Alcohol use disorders and sleep disruption

Poor sleep can affect multiple aspects of quality of life, and is associated with conditions like heart disease, hypertension, diabetes and depression. This month we are addressing the bidirectional relationship that exists between sleep disruption and alcohol. Among patients with alcohol use disorder, sleep disturbances are common during phases of active drinking, withdrawal, and abstinence, with more than of half of alcohol-dependent patients suffering from symptomatic insomnia. Co-occurrence of alcohol dependence and insomnia is associated with greater psychosocial problem severity, impacting personal and professional relationships.

As Professor Timothy Roehrs explains in his video presentations, alcohol can disrupt circadian rhythms and circadian disruption can promote alcohol intake. The causal mechanisms of how they interact as risk factors for one another remain unclear. This reciprocal interaction can result in a vicious circle of alcohol intake causing poor sleep and self-administration of alcohol for sleep problems. Disruptions in circadian rhythms can persist during abstinence for several weeks to months and increase the risk for relapse. Physicians should address alcohol with patients who present in general practice with sleep problems. In our article section you will find practical information for assessment of sleep problems and an overview of treatments.

Early recognition and treatment of alcohol use disorders

We are focusing in our new topic on the early recognition and treatment of alcohol related problems. In primary care identifying the symptoms which can be related to alcohol use can help us to recognize drinking problems at an early stage – examples covered so far on our Resource Centre are the hypertension and depression topics. Another setting for early recognition and intervention is the Emergency Department, if patients present to the department with acute intoxication or alcohol related injuries.

As reported in our selection of articles, brief interventions and motivational interviewing are effective and low cost approaches for preventing or delaying the initiation of alcohol use, or intervening with heavier users before they progress to more problematic levels. Although originally, motivational interviewing was designed to be delivered by highly trained specialist counselors more recently there has been interest in training general medical practitioners – physicians and nurses – to use this intervention in routine practice. Motivational interviewing – 'change talk' – emphasizes developing a discrepancy between current behavior and future goals, increasing problem recognition, motivation, and self-efficacy. Learn more on how to talk change in the video Lectures presented by Dr Antoni Gual and in our interview with Professor Gerard Schippers.

Alcohol use disorders and depression

This month in our Resource Centre we are focusing on alcohol use disorders and depression, which are among the most common psychiatric disorders in Western societies. An accurate understanding of their comorbidity is crucial to both prevention and treatment. While there is ample evidence of important relationships between the disorders, as yet nosingle nor specific etiological risk factor has been identified.

As Professor Henri-Jean Aubin of the Paris-Sud University demonstrates in his presentations, the diagnosis of current mood or anxiety disorders among active alcohol abusers is complicated by the fact that many symptoms of alcohol intoxication and withdrawal resemble those of mood and anxiety disorders. Alcohol itself can produce negative mood swings (not necessarily independent major depressive episodes), especially when consumed in high doses. Conversely depressed individuals might use alcohol as a self-medication to reduce tension and stress, which can result in secondary alcohol dependence − a finding significantly more frequent in women than in men. Sustained alcohol reduction or abstinence can lead to a significant improvement in depressive symptoms, as well as to a better response to antidepressants. In patients with an alcohol use disorder and comorbid depressive or anxiety disorder, NICE treatment guidelines recommend treating alcohol misuse first.

Find out more on the relationship between alcohol misuse and mood disorders in the articles and video presentations on our Resource Centre.

Alcohol as a risk factor for hypertension

L'alcoolisme, cause d'hypertension artérielle is the first publication which reports on the subject we are focusing on this month in our Resource Centre. Many studies on the association of alcohol consumption and hypertension have appeared since Camille Lian's publication in the Bulletin de l'Académie de Médecine, now 100 years ago. His study subjects were French soldiers who drank more than 2 liters of wine per day − the impact of far less alcohol consumption on blood pressure has been the subject of many more studies that followed since. We have included a sample of these in our Resource Centre.

Cardiologist Daniel Duprez from the University of Minnesota explores in his presentation the impact alcohol consumption has on the cardiopulmonary and cardiovascular system in general and on blood pressure in particular. He exposes hypertension as a silent killer and demonstrates the dose-dependent relationship between alcohol intake and hypertension. Alcohol-induced hypertension can be reversed, and both abstinence and the reduction of alcohol consumption have a significant clinical benefit on hypertension and the need for blood pressure lowering medication. Find out more on the relationship between alcohol and hypertension and the impact on the cardiovascular system in this topic on the Resource Centre.

Primary care and alcohol use disorders

The topic of the Resource Centre this month is the role and specificities of primary care in the detection and treatment of alcohol use disorders. The vast majority of adults visit a physician at least once a year, and patients have an ongoing, trusting relationship with their physicians and expect to receive lifestyle advice from them. Primary care thus provides a unique opportunity for the provision of both alcohol screening and intervention. On many occasions in a primary care setting patients will not only accept but will expect to be asked about smoking and alcohol, especially if it is part of chronic disease management.

However, as Steve Brinksman comments in his video presentation, physicians don't always dig around enough when patients present with conditions which could be related to alcohol, and a correct diagnosis might be missed – a theme echoed in the discussion of Anne Lingford-Hughes and Devi Mathur on the patient's perspective on alcohol dependence. After screening other key roles of primary care in alcohol use disorders are delivering brief interventions and advice, and initiating treatment or referral. Primary care physicians can conduct most treatments for less severe cases of alcohol dependence. Carsten Grimm, in his video presentations, recommends evidence-based guidelines about alcohol dependence and how to treat alcohol use disorders, and discusses how to assess severity of alcohol dependence. Our selection of articles is a reflection of the key position primary care has in reducing alcohol-attributable harm.

New treatments in alcohol use disorders

Patients with alcohol dependence can differ in many traits with different genetic vulnerabilities and biological risk factors, and different environmental backgrounds. The “ideal” and effective drug for all types of alcoholic patients does not exist and it is essential to identify a personalized approach for individual patients. Progress in pharmacology and better understanding of the neurobiology of addiction have resulted in a broad spectrum of pharmacological treatments with drugs indicated for alcohol withdrawal and relapse prevention on one side of the spectrum, and reduction of alcohol consumption in patients with alcohol dependence on the other. In his video presentations, Wim van den Brink discusses the neurobiology of addiction and gives an overview of the current pharmacological treatments available for alcohol dependence, with a special focus on the new drug nalmefene.
Psychosocial support is an essential component in the treatment of alcohol use disorders. With the rapid rise of social media and new technology, there are new options for technology-based interventions like supportive text messaging, apps, psychoeducational websites, and computerized cognitive behavioural therapy to help patients to achieve and maintain treatment goals. Join Conor Farren’s presentations for an outlook on the future horizons of patient care using social media and new technology.

The “must-be-known” neurobiology of alcohol use disorders

The new topic of the month on our Resource Centre is neurobiology of alcohol use disorders. Continuous progress in technology has resulted in imaging techniques which enable us to visualize brain structure and function, measure neurotransmitters and their receptors, and electrical activity and changes in blood flow in the brain. Techniques like CT, MRI, DTI, PET, SPECT and MEG are yielding unprecedented images and show us what happens to and in the brain for instance when it is activated by emotional stimuli or when exposed to drugs of abuse or pharmacological agents. Advances in neurobiology paralleled by those made in genetics give us a better understanding of alcohol use disorders and the underlying mechanisms, increasing the body of evidence from which to design new drugs, optimize existing treatment options and identify which patients will respond best to which treatment. To learn more, see the video presentations by David Nutt on visualizing the alcohol dependent brain, and by Philip Gorwood on the genetics of alcohol dependence, and find a selection of articles on the topic on our articles page.

Burden of disease

The first topic featuring the Progress in Mind: Focus on Alcohol Use Disorders Resource Centre is the ‘burden of disease’. We have selected content from journal articles and video presentations with associated transcripts and slides to focus on the burden of disease from different perspectives. Alcohol is the most common single risk factor worldwide for men dying before the age of 60, and is the most harmful drug overall. As the speakers explain in their presentations, there are multiple instruments to prevent or reduce the burden of alcohol-related harm. If we want to tackle this massive problem with effective strategies, we need to make use of the complete armamentarium available. Preventive measures, like alcohol prevention and awareness campaigns and pricing and taxation policies should be complementary to treatment interventions. We need to improve early diagnosis and optimize treatment of alcohol use disorders and make better use of the available treatment options. Full awareness of the size of this huge burden is a prerequisite to tackle the problems and to reduce harm to users and others.

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