Alcoholism treatment edmonton. Alcoholism Follow-up: Further Outpatient Care, Prognosis, Patient Education

Further Outpatient Care

Frequent follow-up is essential to support the patient in recovery. The most common mistake physicians make is assuming too soon that the patient is stable. Ask patients about attendance at AA meetings and about their relationships with their sponsors. Less than 20% of patients remain abstinent for a full year. Among patients who have been sober for 2 years, the relapse rate is 40%. Patients who have been sober for 5 years are likely to remain sober, but they are still at risk for relapse. Alcoholism prognosis.

Warning signs for physicians that a patient has relapsed include missing appointments or attending AA meetings less frequently. Warn patients to avoid testing themselves, particularly early in sobriety. Encouraging involvement in exercise and other leisure activities also is helpful.

The key step for the patient is to realize that treatment does not end with sobriety. Recovery means that patients can handle the stresses of everyday life without alcohol. Therefore, the patient must develop and rehearse strategies to cope with high-risk situations.

Successful recovery requires the patient to be able to do the following:

Patients should have a list of phone numbers of people they can call when they are having a difficult time coping. Importantly, patients should write out the list and put it in a convenient location because sometimes during high-stress periods they may become emotionally and mentally disorientated, necessitating written instructions.

Patients should spend time thinking about circumstances during which they feel at highest risk for relapse. They should anticipate these situations and make a written list. Most persons with alcoholism can quickly list the circumstances and/or emotions that led them to drink.

Patients need to identify specific responses (thoughts as well as behaviors) to each of these high-risk situations. Encourage patients to be very specific when considering their responses. For example, ask patients exactly what they are going to say and do when asked at parties what they want to drink. Once patients have made the list, they should practice responses to their high-risk situations.

When patients have the urge to drink, there are several techniques that can be used to deal with the situation, including (1) self-distraction (ie, getting involved with an alternate activity that they enjoy), (2) thought stopping (ie, patients should not dwell on thoughts of drinking but should stop these thoughts), (3) reprogramming (ie, patients should avoid activities that remind them of drinking), and (4) use of social support structure. The most common cause of relapse is failure to use coping strategies.

If the patient has a relapse, find out what happened (make a diagnosis) in order to formulate a new treatment plan. Below is an outline for dealing with relapses. Insist that the patient be actively involved in devising solutions, do not attempt to solve the problem for the patient.

Institute a treatment plan.

A 2010 study investigated a 10-year comparison of public endorsement of treatment and prejudice of the diagnoses of schizophrenia, depression, and alcohol dependence. Regarding alcohol dependence, high proportions of respondents in this study endorsed treatment, with general increases in the proportion endorsing treatment from doctors and specific increases in the proportions endorsing treatment from psychiatrists (from 61% in 1996 to 79% in 2006). This study found that more of the public embraces a neurobiological understanding of mental illness, which translates into support for services but not necessarily into a decrease in stigma.

Warren Thompson, MD, FACP Associate Professor, Department of Internal Medicine, Mayo Medical School

Disclosure: Nothing to disclose.

R Gregory Lande, DO, FACN Clinical Consultant, Army Substance Abuse Program, Department of Psychiatry, Walter Reed Army Medical Center

Disclosure: Nothing to disclose.

Raj K Kalapatapu, MD Fellow, Addiction Psychiatry, Columbia University College of Physicians and Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Iqbal Ahmed, MBBS, FRCPsych(UK) Faculty, Department of Psychiatry, Tripler Army Medical Center, Clinical Professor of Psychiatry, Uniformed Services University of the Health Sciences, Clinical Professor of Psychiatry, Clinical Professor of Geriatric Medicine, University of Hawaii, John A Burns School of Medicine

Disclosure: Nothing to disclose.

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