Psychological interventions for alcohol use disorders in people living with HIV/AIDS: a systematic review.

BACKGROUND: Alcohol use disorders (AUDs) in people living with HIV/AIDS (PLWH) are a significant impediment to achieving virological control. HIV non-suppression in PLWH with AUDs is mainly attributable to sub-optimal antiretroviral therapy adherence. Sub-optimal adherence makes control of the epidemic elusive, considering that effective antiretroviral treatment and viral suppression are the two key pillars in reducing new infections. Psychological interventions have been proposed as effective treatments for the management of AUDs in PLWH. Evidence for their effectiveness has been inconsistent, with two reviews (2010 and 2013) concluding a lack of effectiveness. However, a 2017 review that examined multiple HIV prevention and treatment outcomes suggested that behavioural interventions were effective in reducing alcohol use. Since then, several studies have been published necessitating a re-examination of this evidence. This review provides an updated synthesis of the effectiveness of psychological interventions for AUDs in PLWH. METHODS: A search was conducted in the following databases: PubMed, Cochrane Central Register of Trials (CENTRAL), MEDLINE (Ovid), EMBASE, PsychInfo (Ovid) and Clinical trials.gov (clinicaltrials.gov) for eligible studies until August 2018 for psychotherapy and psychosocial interventions for PLWH with AUDs. Two reviewers independently screened titles, abstracts and full texts to select studies that met the inclusion criteria. Two reviewers independently performed data extraction with any differences resolved through discussion. Risk of bias was assessed by two independent reviewers using the Cochrane risk of bias tool, and the concordance between the first and second reviewers was 0.63 and between the first and third reviewers 0.71. Inclusion criteria were randomised controlled trials using psychological interventions in people aged 16 and above, with comparisons being usual care, enhanced usual care, other active treatments or waitlist controls. RESULTS: A total of 21 studies (6954 participants) were included in this review. Studies had diverse populations including men alone, men and women and men who had sex with men (MSM). Use of motivational interviewing alone or blended with cognitive behavioural therapy (CBT) and technology/computer-assisted platforms were common as individual-level interventions, while a few studies investigated group motivational interviewing or CBT. Alcohol use outcomes were all self-report and included assessment of the quantity and the frequency of alcohol use. Measured secondary outcomes included viral load, CD4 count or other self-reported outcomes. There was a lack of evidence for significant intervention effects in the included studies. Isolated effects of motivational interviewing, cognitive behavioural therapy and group therapy were noted. However for some of the studies that found significant effects, the effect sizes were small and not sustained over time. Owing to the variation in outcome measures employed across studies, no meta-analysis could be carried out. CONCLUSION: This systematic review did not reveal large or sustained intervention effects of psychological interventions for either primary alcohol use or secondary HIV-related outcomes. Due to the methodological heterogeneity, we were unable to undertake a meta-analysis. Effectiveness trials of psychological interventions for AUDs in PLWH that include disaggregation of data by level of alcohol consumption, gender and age are needed. There is a need to standardise alcohol use outcome measures across studies and include objective biomarkers that provide a more accurate measure of alcohol consumption and are relatively free from social desirability bias. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD  42017063856 .

The effects of alcohol hangover on future drinking behavior and the development of alcohol problems.

INTRODUCTION: Alcohol hangover experiences in young adulthood have been shown to predict more subsequent alcohol problems. Hangover susceptibility appears to be partially heritable and related to family history of alcohol use disorders. However, very little is known about the developmental course of these associations and whether they are accounted for by an individual's drinking history. The goal of this study is to investigate the prospective and unique relationships between family history of alcohol use disorders, severity of alcohol hangover experiences in adolescence, and later alcohol use and related problems measured over 13years. METHODS: Participants were first assessed on family history at age 12-14, prior to initiating drinking, and re-assessed annually on hangover severity, drinks per drinking day (DPDD), and alcohol-related problems throughout the 13-year follow-up period (n=205; 59% male). RESULTS: In mixed effects negative binomial regression models, greater family history density scores predicted more future DPDD (Incidence Rate Ratio [IRR]=1.19, p=0.04), alcohol problems (IRR=1.64, p=0.05), and future hangover severity (IRR=1.24; p=0.01). In turn, greater hangover severity predicted more future DPDD (IRR=1.03; p=0.002) and alcohol problems (IRR=1.12, p<0.001), and hangover severity mediated the relationship between family history and alcohol use/problems. All models controlled for participant age, sex, and past drinking behavior (where relevant). CONCLUSIONS: These results advance the alcohol hangover experience during late adolescence as a clinically relevant and uniquely informative marker of future alcohol use and problems, above and beyond that of prior personal or familial drinking history.

Iniquidades Sociais e Saúde Mental no Meio Rural / Social Inequality and Mental Health in Rural Areas / Inequidades Sociales y Salud Mental en Contexto Rural

Esse artigo objetiva discutir casos de comorbidade de transtornos mentais comuns e uso abusivo de álcool e suas determinações entre moradores de assentamentos de reforma agrária. Trata-se de um estudo de delineamento combinado quantitativo-qualitativo, com amostra inicial de 2.012 moradores, resultando, após aplicação de questionário sociodemográfico e ferramentas de rastreamento (SRQ-20 e AUDIT) na identificação de 39 casos de comorbidade, aos quais foi aplicada entrevista semiestruturada. Para análise descritiva dos dados quantitativos utilizou-se o software SPSS for Windows, versão 20 e a construção de mapas dialógicos para os qualitativos. Aspectos envolvendo educação e trabalho, ambientes de interação/coesão social (redes e apoio social), mobilidade e transporte, acesso a equipamentos e serviços, falta de espaços de lazer, são fatores que interferem na saúde mental. Considera-se, dessa forma, a interdependência entre condições socioeconômicas, características dos territórios, padrões culturais, histórias de vida dos indivíduos e os agravos em saúde e morbidades psiquiátricas, em particular.(AU)

The vulnerable psychosocial conditions found within poverty are made worse when dealing with populations from rural areas. These groups suffer the most from a lack of basic infrastructure and the problems that arise from the lack of social development. These people are hit the hardest, but remain less visible and far out of reach of public policies, especially in the case of mental health. For this discussion, we analyze cases of comorbidity of common mental disorders and alcohol abuse and its determinations among residents of land reform settlements. It is a combined quantitative-qualitative delineated study, with na initial sample of 2,012 residents. After the administration of a sociodemographic questionnaire and screening tools (SRQ-20 e Audit), 39 cases of comorbidity were identified, to which semi-structured interviews were administered. For descriptive analysis of the quantitative data, we used SPSS for Windows version 20, and the construction of dialogic maps for qualitative data. We bserved the interdependence between socioeconomic conditions, the characteristics of territories, cultural patterns, individuallife stories and mental diseases in particular.(AU)

El objetivo de este artículo fue discutir casos de comorbilidad de trastornos mentales comunes y uso exagerado de alcohol y sus determinaciones entre vecinos de la reforma agraria.Se trata de un estudio de delineamiento combinado cuantitativo - cualitativo,con una muestra inicial de 2012 participantes, resultando después de aplicarse un cuestionario sociodemógrafico y herramientas de rastreamiento (SRQ-20 y AUDIT), la identificación de 39 casos de comorbilidad, a los cuales les fue aplicada una entrevista semiestructurada.Para el análisis descriptivo de los datos cuantitativos se utilizó el software for Windows, versión 20 y la construcción de mapas dialógicos para los datos cualitativos. Aspectos relativos a educación y trabajo, ambientes de interacción/cohesión social (redes y apoyo social) movilidad y transporte,acceso a equipamientos y servicios, falta de espacios de recreación, son factores que interfieren en la salud mental.Por lo tanto se considera la interdependencia entre condiciones socieconómicas, características de los territorios, padrones culturales, historia de vida de los individuos, y losagravios en salud y morbilidad psiquiátricas, en particular.(AU)

Anxiety, Anxiety Sensitivity, and Perceived Stress as Predictors of Recent Drinking, Alcohol Craving, and Social Stress Response in Heavy Drinkers.

BACKGROUND: Stress and anxiety are widely considered to be causally related to alcohol craving and consumption, as well as development and maintenance of alcohol use disorder (AUD). However, numerous preclinical and human studies examining effects of stress or anxiety on alcohol use and alcohol-related problems have been equivocal. This study examined relationships between scores on self-report anxiety, anxiety sensitivity, and stress measures and frequency and intensity of recent drinking, alcohol craving during early withdrawal, as well as laboratory measures of alcohol craving and stress reactivity among heavy drinkers with AUD. METHODS: Media-recruited, heavy drinkers with AUD (N = 87) were assessed for recent alcohol consumption. Anxiety and stress levels were characterized using paper-and-pencil measures, including the Beck Anxiety Inventory (BAI), the Anxiety Sensitivity Index-3 (ASI-3), and the Perceived Stress Scale (PSS). Eligible subjects (N = 30) underwent alcohol abstinence on the Clinical Research Unit; twice daily measures of alcohol craving were collected. On day 4, subjects participated in the Trier Social Stress Test; measures of cortisol and alcohol craving were collected. RESULTS: In multivariate analyses, higher BAI scores were associated with lower drinking frequency and reduced drinks/drinking day; in contrast, higher ASI-3 scores were associated with higher drinking frequency. BAI anxiety symptom and ASI-3 scores also were positively related to Alcohol Use Disorders Identification Test total scores and AUD symptom and problem subscale measures. Higher BAI and ASI-3 scores but not PSS scores were related to greater self-reported alcohol craving during early alcohol abstinence. Finally, BAI scores were positively related to laboratory stress-induced cortisol and alcohol craving. In contrast, the PSS showed no relationship with most measures of alcohol craving or stress reactivity. CONCLUSIONS: Overall, clinically oriented measures of anxiety compared with perceived stress were more strongly associated with a variety of alcohol-related measures in current heavy drinkers with AUD.

Discussing alcohol and cancer with patients: Knowledge and practices of general practitioners in New South Wales and South Australia.

BACKGROUND: Alcohol is associated with several cancers; however, the Australian community has low awareness of the link between alcohol consumption and cancer. Little information exists regarding when and why general practitioners (GPs) discuss alcohol with patients. OBJECTIVE: The objective of this article is to explore GPs' attitudes and practices when discussing alcohol with patients. This includes awareness of alcohol recommendations and evidence of the alcohol-cancer link, and discussion around barriers and enablers to encouraging patients' alcohol behaviour change. RESULTS: GPs did not routinely ask patients about their alcohol consumption or advise on drinking recommendations. Many had a broad understanding of alcohol as a cancer risk factor, but knowledge of the causal mechanisms and current evidence was limited. DISCUSSION: GPs are trusted health advisers. Providing them with up-to-date evidence on the alcohol-cancer link and drinking recommendations may encourage routine patient screening of alcohol consumption and delivery of simple education on the harms of long-term drinking.

Environmental enrichment may protect against neural and behavioural damage caused by withdrawal from chronic alcohol intake.

Exposure to stress and prolonged exposure to alcohol leads to neuronal damages in several brain regions, being the medial prefrontal cortex (mPFC) one of the most affected. These changes presumably reduce the ability of the organism to cope with these stimuli and may underlie a series of maladaptive behaviours among which include drug addiction and withdrawal. Drug-addicted individuals show a pattern of behavior similar to patients with lesions of the mPFC. This impairment in the decision-making could be one of the mechanisms responsible for the transition from the casual to compulsive drug use. The environmental enrichment (EE) has a protective effect on the neural and cognitive impairments induced by psychoactive drugs, including ethyl alcohol. The present study aims to determine the influence of withdrawal from intermittent long-term alcohol exposure on alcohol preference, emotional reactivity and neural aspects of early isolated or grouped reared rats kept under standard or complex environments and the influence of social isolation on these measures, as well. Our results point out new insights on this matter showing that the EE can attenuate the adverse effects of withdrawal and social isolation on rat's behavior. This effect is probably due to its protective action on the mPFC integrity, including the cingulate area 1 (Cg1), and the prelimbic (PrL) and infralimbic cortex (IL), what could account for the absence of changes in the emotional reactivity in EE alcohol withdrawal rats. We argue that morphological changes at these cortical levels can afford the emotional, cognitive and behavioural dysregulations verified following withdrawal from chronic alcohol intake.

Epidemiological features of alcohol use in rural India: a population-based cross-sectional study.

OBJECTIVES: We sought to estimate the proportion of adults in Sehore District, India, who consumed alcohol, and the proportion who had behaviours consistent with alcohol use disorders (AUDs), using the Alcohol Use Disorders Identification Test (AUDIT). Among men who drank, we identified individual-level, household-level and community-level factors associated with AUDIT scores. Men with AUDs (AUDIT score ≥ 8) reported on whether and where they had sought treatment, and about alcohol-related internal stigma. DESIGN: Population-based cross-sectional study. SETTING: Rural villages and urban wards in Sehore District, Madhya Pradesh, India. PARTICIPANTS: n=3220 adult (≥ 18 years of age) residents of Sehore District. PRIMARY OUTCOME MEASURE: Score on the AUDIT. RESULTS: Nearly one in four men (23.8%) had consumed alcohol in the past 12 months, while few (0.6%) women were consumers. Among drinkers, 33.2% (95% CI 28.6% to 38.1%) had AUDIT scores consistent with hazardous drinking, 3.3% (95% CI 2.1% to 5.1%) with harmful drinking and 5.5% (95% CI 3.8% to 8.0%) with dependent drinking. We observed that AUDIT scores varied widely by village (intraclass correlation=0.052). Among men who had recently consumed alcohol, AUDIT scores were positively associated with depression, having at least one child, high-quality housing, urban residence, tobacco use and disability. AUDIT scores were negatively associated with land ownership, out-of-pocket healthcare expenditure and participation in the national employment programme. While 49.2% of men with AUDs felt embarrassed by their problems with alcohol, only 2.8% had sought treatment in the past 12 months. CONCLUSIONS: A need exists for effectively identifying and treating adults with AUDs. Health promotion services, informed by commonly-expressed stigmatised beliefs held among those affected by AUDs and which are targeted at the most affected communities, may be an effective step in closing the treatment gap.

Steep Decrease of Gender Difference in DSM-IV Alcohol Use Disorder: A Comparison of Two Nation-wide Surveys Conducted 10 Years Apart in Korea.

While decreasing trend in gender differences in alcohol use disorders was reported in Western countries, the change in Asian countries is unknown. This study aims to explore the shifts in gender difference in alcohol abuse (AA) and dependence (AD) in Korea. We compared the data from two nation-wide community surveys to evaluate gender differences in lifetime AA and AD by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Face-to-face interviews using the Composite International Diagnostic Interview (CIDI) were applied to all subjects in 2001 (n=6,220) and 2011 (n=6,022). Male-to-female ratio of odds was decreased from 6.41 (95% CI, 4.81-8.54) to 4.37 (95% CI, 3.35-5.71) for AA and from 3.75 (95% CI, 2.96-4.75) to 2.40 (95% CI, 1.80-3.19) for AD. Among those aged 18-29, gender gap even became statistically insignificant for AA (OR, 1.59; 95% CI, 0.97-2.63) and AD (OR, 1.18; 95% CI, 0.80-2.41) in 2011. Men generally showed decreased odds for AD (0.55; 95% CI, 0.45-0.67) and women aged 30-39 showed increased odds for AA (2.13; 95% CI 1.18-3.84) in 2011 compared to 2001. Decreased AD in men and increased AA in women seem to contribute to the decrease of gender gap. Increased risk for AA in young women suggests needs for interventions.

Prevalence and correlates of anger in the community: results from a national survey.

INTRODUCTION: Little is known about the prevalence and correlates of anger in the community. METHODS: We used data derived from a large national sample of the U.S. population, which included more than 34,000 adults ages 18 years and older. We defined inappropriate, intense, or poorly controlled anger by means of self-report of the following: (1) anger that was triggered by small things or that was difficult to control, (2) frequent temper outbursts or anger that lead to loss of control, or (3) hitting people or throwing objects in anger. RESULTS: The overall prevalence of inappropriate, intense, or poorly controlled anger in the U.S. population was 7.8%. Anger was especially common among men and younger adults, and was associated with decreased psychosocial functioning. Significant and positive associations were evident between anger and parental factors, childhood, and adulthood adverse events. There were strong associations between anger and bipolar disorder, drug dependence, psychotic disorder, borderline, and schizotypal personality disorders. There was a dose-response relationship between anger and a broad range of psychopathology. CONCLUSIONS: A rationale exists for developing screening tools and early intervention strategies, especially for young adults, to identify and help reduce anger.

Effects of alcohol hangover on simulated highway driving performance.

BACKGROUND: The purpose of this study was to examine the effects of alcohol hangover on simulated highway driving performance. METHODS: Driving performance of forty-two social drinkers was tested the morning following an evening of consuming on average 10.2 (SD = 4.2) alcoholic drinks (alcohol hangover) and on a control day (no alcohol consumed). Subjects performed a standardized 100-km highway driving test in the STISIM driving simulator. In addition to the standard deviation of lateral position (SDLP; i.e., the weaving of the car), lapses of attention were examined. Self-reported driving quality and driving style were scored, as well as mental effort to perform the test, sleepiness before and after driving, and hangover severity. RESULTS: Driving performance was significantly impaired during alcohol hangover as expressed by an SDLP increase of +1.9 cm (t (1,41) = 2.851, p = 0.007), increased number of lapses relative to the control day (7.7 versus 5.3 lapses, t (1,41) = 2.125, p = 0.019), and an increased total lapse time (182.7 versus 127.3 s, p = 0.040). During alcohol hangover, subjects reported their driving quality to be significantly poorer (t (1,41) = 4.840, p = 0.001) and less safe (t (1,41) = 5.078, p = 0.001), wise (t (1,41) = 4.061, p = 0.001), predictable (t (1,41) = 3.475, p = 0.001), and responsible (t (1,41) = 4.122, p = 0.001). Subjects further reported being significantly more tense while driving (t (1,41) = 3.280, p = 0.002), and more effort was needed to perform the driving test (t (1,41) = 2.941, p = 0.001). There was a significant interaction with total sleep time and hangover effects on SDLP and the number of lapses. CONCLUSIONS: In conclusion, driving is significantly impaired during alcohol hangover, as expressed in an elevated SDLP and increased number of lapses. Total sleep time has a significant impact on the magnitude of driving impairment.

Treating the "unhealthy alcohol user" on medical wards: beyond withdrawal.

BACKGROUND: Alcohol use disorders (AUDs) are common among patients admitted to general hospitals. Unfortunately, AUDs often go undetected and untreated. Psychiatrists are frequently called upon to assist in the management of cases involving alcohol withdrawal. However, there is a dearth of knowledge regarding potential therapeutic approaches to AUDs beyond the acute withdrawal stage. OBJECTIVE: This article presents an overview of the epidemiology, clinical characteristics, and treatment of AUDs on medical wards, with a specific focus on the post alcohol-withdrawal phase. METHOD: This article is based on a survey of the published literature on AUDs and their treatment in the medical ward using the PubMed database. RESULTS: Various screening tools are available to facilitate the detection of AUDs. Among non-medically ill patients, brief psychological interventions have proven to be effective in primary care and emergency room settings, while pharmacotherapy has been shown to reduce the risk of relapse. Existing data on the implementation of these interventions in the general hospital setting remain scarce. CONCLUSION: Current evidence suggests the need for additional research in this area with a view toward clarifying AUD treatment guidelines for medically ill inpatients. The hospital stay could provide a valuable opportunity to initiate interventions for AUDs with medically ill patients, leading to significant changes in alcohol use behaviors and better health-related outcomes.

Substance-induced psychoses converting into schizophrenia: a register-based study of 18,478 Finnish inpatient cases.

BACKGROUND: Despite the clinical importance of substance-induced psychosis (SIP), few studies have examined the course of this condition after its acute manifestation. OBJECTIVE: To investigate the rate of SIP conversion to a schizophrenia spectrum disorder and the length of follow-up needed to catch the majority of these patients whose diagnoses change. In addition to the conversion rate and pattern, we wanted to look for possible related factors. METHOD: Using the nationwide Finnish Hospital Discharge Register, we followed all patients (N = 18,478) since their first inpatient hospital admission with a diagnosis of SIP (codes 2921 and 2928 in DSM-III-R and codes F10-F19 in ICD-10 with a third digit of 4, 5, or 7) between January 1987 and December 2003 in Finland. Patients (mean age = 43.7 years, standard deviation = 13.5 years) were followed until first occurrence of schizophrenia spectrum disorder, death, or the end of December 2003, whichever took place first. Conversions of discharge diagnoses into schizophrenia spectrum disorders (codes 2951-2959 and 2971 in DSM-III-R and codes F20, F22, and F23 in ICD-10) were recorded at follow-up. RESULTS: Eight-year cumulative risk to receive a schizophrenia spectrum diagnosis was 46% (95% CI, 35%-57%) for persons with a diagnosis of cannabis-induced psychosis and 30% (95% CI, 14%-46%) for those with an amphetamine-induced psychosis. Although alcohol-induced psychosis was the most common type of SIP, 8-year cumulative risk for subsequent schizophrenia spectrum diagnosis was only 5.0% (95% CI, 4.6%-5.5%). No differences were detected with regard to gender, except for amphetamine-induced psychosis, which converted into a schizophrenia spectrum disorder significantly more often in men (P = .04). The majority of conversions to a schizophrenia spectrum diagnosis occurred during the first 3 years following the index treatment period, especially for cannabis-induced psychosis. CONCLUSION: Substance-induced psychotic disorders predict schizophrenia spectrum disorders to a greater extent than previously thought. The intensity of clinical attention focused on substance-induced psychotic disorders should be increased.

Self-focused attention reduces self-injurious behavior in alcohol-intoxicated men.

Both chronic alcohol use and acute intoxication are risk factors for self-aggression (i.e., intentional self-injury) across the spectrum of lethality. Studies designed to identify a cause-and-effect relation between alcohol intoxication and self-aggression, or the factors that facilitate or mitigate this effect, are rare due to the inherent difficulty of studying self-injurious behavior experimentally. In this study, we experimentally demonstrate that alcohol intoxication leads to heightened self-injurious behavior, and that enhanced self-focused attention (self-awareness) attenuates this effect. Specifically, 40 men consumed either alcohol (mean Blood Alcohol Concentration [BAC] = .10) or a veridical control drink, and then completed a laboratory task designed to assess self-injurious behavior. Self-focused attention was experimentally enhanced in half the participants in each drink condition. Results support the notion that prevention and intervention programs designed to reduce intentional self-injurious behaviors should include components that address alcohol misuse and self-awareness.

Subjective responses to alcohol prime event-specific alcohol consumption and predict blackouts and hangover.

OBJECTIVE: Individual differences in subjective response to alcohol and the occurrence of blackouts and hangover are associated with the development of alcohol-use disorders. As such, subjective responses to alcohol, blackouts, and hangover may share a biological vulnerability to excessive alcohol consumption. The purpose of the current study was to examine subjective responses to alcohol as predictors of estimated blood alcohol concentration (BAC), blackouts, and hangover for a single heavy drinking event. METHOD: Data were collected on 150 (50% female) college students at a large, public university who reported consuming alcohol during their 21st birthday celebration. Using semi-structured interviews and self-report measures, subjective responses to alcohol (at midpoint of a 21 st birthday celebration) were examined as predictors of final estimated BAC, blackouts, and hangover. RESULTS: Stimulant effects reported for the midpoint of the drinking event predicted final estimated BAC. Both stimulant and sedative alcohol effects directly predicted blackouts during the drinking event and the occurrence of a hangover. Neither stimulant nor sedative effects were mediated by final estimated BAC. CONCLUSIONS: Retrospective reports of subjective responses to alcohol were associated with the level of intoxication, blackouts, and hangover during a heavy drinking event. Findings therefore suggest the utility of incorporating subjective responses to alcohol into event-specific interventions that are designed to reduce or prevent heavy episodic drinking.

Empathy ability is impaired in alcohol-dependent patients.

Empathy is a complex form of psychological inference in which observation, memory, knowledge and reasoning are combined to yield insights into the thoughts and feelings of others. The aim of this study was to evaluate the level of empathy in a sample of alcohol-dependent patients in comparison to a control sample. One hundred and fifty alcohol-dependent subjects were consecutively recruited. All of the subjects successfully detoxified have been evaluated with the Empathy Quotient (EQ) and then compared with 107 control subjects. The level of empathy was significantly lower in the group of alcohol-dependent subjects than in the control sample (p <.001). Differences with respect to gender and psychiatric comorbidity have also been observed. A low level of empathy could be a psychological trait typically observed in pre-morbid alcoholic personalities. Further, the lack of empathy could lead latent abusers to find in the alcohol misuse something enabling them to compensate for their intrinsic weakness.

Association of psoriasis and alcoholism: psychodermatological issue.

Psoriasis is a chronic, hereditary disease generally characterized by eruption of erythematous, silvery-scaled plaques, predominantly on the elbows, knees, scalp and trunk, affecting between 1-2% of the population worldwide. Psoriasis is a multifactorial disease of unknown etiology. It has been shown that in some patients alcohol abuse has been associated with psoriasis. Chronic alcohol abuse results in the impairment of health-related, social and occupational functioning. Therefore the association of psoriasis and alcoholism represents one of the major psychodermatological issues where a multidisciplinary approach (including dermatologist, psychiatrist, psychologist and others) is crucial for optimal outcome.

[Alcohol-related disorders in the preclinical medicine]. / Psychosozialer Notfall--Substanzinduzierte Störungen durch Alkohol.

Alcohol is the most frequently abused drug in Germany. Approximately 50.000 individuals die annually due to alcohol-related disorders. Emergency situations due to alcohol intoxications, abuse or dependence are frequent reasons for calls for emergency physicians and paramedics. Agitation, suicidal intent, trauma and a multitude of degenerative and other somatic disorders may further complicate diagnosis and treatment on scene. The motivation of patients to participate in withdrawal programs should be built and strengthened already in emergency medicine.