[Early detection, negotiation and treatment of alcohol use disorders in primary care]. / Alkoholerkrankung: Früherkennung, Gesprächsführung und Behandlung im primärärztlichen Bereich.

Subjects with alcohol dependence or alcohol-related health problems frequently use the primary care system without receiving the correct diagnosis or specific interventions. Stigma, lack of knowledge and know-how with regards to diagnosis and treatment of alcohol-related disorders on the site of the health care professionals may contribute to the treatment gap. General anamnesis, clinical evaluation, and laboratory parameters can serve as indicators, and validated screening tests can further corroborate the hypothesis. However, a diagnosis should only be made according to ICD-10 criteria. Adequate counselling techniques substantially contribute to successful physician-patient interaction. Motivational Interviewing combines a positive, appreciative attitude with communicative techniques to create a motivation to change. It includes general approaches as open questions, appreciation of the patient, active listening, summarizing results as well as specific approaches such as change and confidence talk and dealing with resistance. Within a positive relationship, the conversation can lead to change. Brief interventions cover four to five sessions with a duration between five and sixty minutes. Brief interventions based on an empathic attitude und reflection of findings, a brief advice leaving the responsibility on the patient's side and supporting self-efficacy can improve alcohol-related disorders. The transtheoretical model of change may help the health care provider to adapt intervention strategies to the patient's state. Primary health care provides an adequate framework for screening, diagnosis and intervention for alcohol-related disorders with the aim of reduction or abstinence. Further institutions in addiction treatment such as self-help and clinical institutions may complement the treatment system.

Wishes and expectations of alcoholic patients concerning their therapy.

AIM: To assess the wishes and expectations of alcoholic patients concerning their therapy. METHODS: 227 alcohol-dependent patients from three sites in two cities in Germany completed a questionnaire about their aspirations for the outcome (20 items) and their expectations about the elements (23 items) of treatment. RESULTS: Some components of treatment were equally important to men and women (a life without alcohol, individual sessions during therapy). Women attached more importance than men to 'strengthening of self-esteem' and 'an environment of tranquillity and security'. Most patients in this study were aware of their alcohol dependence, which limits the generalizability of these results to patients at earlier stages of recovery. CONCLUSION: Patients request individual, patient-oriented treatment. Some differences in expectations between men and women suggest that a gendered approach in treatment could mean an increase in patients' satisfaction, and thus a decrease in drop-outs.

The cannabinoid receptor gene (CNR1) is not affected in German i.v. drug users.

The aim of the study was to investigate a possible contribution of the cannabinoid receptor gene (CNR1) to the development of i.v. drug addiction. Allele and genotype frequencies of a previously associated flanking triplet repeat polymorphism were compared between patients and controls, and the whole coding region of the CNR1 gene of all patients were screened for presence of mutations. The study took place at the Addiction Treatment Unit of the Medical School Hannover, and two outpatients' departments in Hannover, Germany. Forty German unrelated opioid addicts (27 males and 13 females; mean age 37.9 years; range 16-53 years), took part, all of them satisfying ICD-10 and DSM-IV diagnostic criteria for opioid dependence and 81 age- and sex-matched controls (German blood donors). Measurements used were lengths of alleles, genotyping and single strand conformation polymorphism (SSCP) analysis. Neither the >/= 5 alleles of the extragenic triplet repeat (AAT) marker nor the alleles of an intragenic biallelic CNR1 polymorphism (1359G/A) were associated with i.v. drug use in our study group. In addition, we did not detect any sequence variation within the CNR1 gene which could confer susceptibility to i.v. drug abuse. In contrast to previous investigations, we found no evidence for an involvement of the CNR1 gene in i.v. drug addiction.

Comorbid anxiety and affective disorder in alcohol-dependent patients seeking treatment: the first Multicentre Study in Germany.

The goals of this study were to describe demographic variables, drinking history, and the 6-month prevalence of Axis I comorbidity among alcohol-dependent subjects in GERMANY: The variables: amount of alcohol consumption, age at onset of the first alcohol consumed, age at onset of daily alcohol consumption, age at onset of withdrawal symptoms and number of detoxifications were related to the different comorbid disorders and gender. In this study, 556 patients from 25 alcohol treatment centres were enrolled between 1 January 1999 and 30 April 1999. After a minimum of 10 days of sobriety patients who fulfilled ICD-10 and DSM-IV criteria of alcohol dependence were interviewed for data collection using the Mini-DIPS (German version of the Anxiety Disorders Interview Schedule) and a standardized psychosocial interview. The 6-month prevalence of comorbid Axis I disorders was 53.1%. Among the patients with comorbidity, affective and anxiety disorders were most frequent. Comorbid stress disorder was associated with an early start of drinking, an early beginning of withdrawal symptoms, highest number of detoxifications, and the highest amount of alcohol consumed. Female patients with anxiety disorder consumed more alcohol and started earlier than females without this comorbid disorder. The data do not answer the question of the pathogenesis of comorbid disorders and alcoholism, but indicate that stress disorders in alcoholic patients and anxiety disorders in female alcoholics influence the course and severity of alcoholism.