Treatment of pathological gambling - integrative systemic model.

Pathological gambling was classified under impulse control disorders within the International Classification of Diseases (ICD-10) (WHO 1992), but the most recent Diagnostic and Statistical Manual, 5th edition (DSM-V), (APA 2013), has recognized pathological gambling as a first disorder within a new diagnostic category of behavioral addictions - Gambling disorder. Pathological gambling is a disorder in progression, and we hope that our experience in the treatment of pathological gambling in the Daily Hospital for Addictions at The Institute of Mental Health, through the original "Integrative - systemic model" would be of use to colleagues, dealing with this pathology. This model of treatment of pathological gambling is based on multi-systemic approach and it primarily represents an integration of family and cognitive-behavioral therapy, with traces of psychodynamic, existential and pharmacotherapy. The model is based on the book "Pathological gambling - with self-help manual" by Dr Mladenovic and Dr Lazetic, and has been designed in the form of a program that lasts 10 weeks in the intensive phase, and then continues for two years in the form of "extended treatment" ("After care"). The intensive phase is divided into three segments: educational, insight with initial changes and analysis of the achieved changes with the definition of plans and areas that need to be addressed in the extended treatment. "Extended treatment" lasts for two years in the form of group therapy, during which there is a second order change of the identified patient, but also of other family members. Pathological gambling has been treated in the form of systemic-family therapy for more than 10 years at the Institute of Mental Health (IMH), in Belgrade. For second year in a row the treatment is carried out by the modern "Integrative-systemic model". If abstinence from gambling witihin the period of one year after completion of the intensive phase of treatment is taken as the main criterion of the effectiveness of our model, at this time it exceeds 90%. Given the relatively short period of application, it is necessary to continue to monitor and evaluate the model after 5 years.

Attitudes on alcohol and drinking patterns among youth in Serbia.

INTRODUCTION: Alcohol is most abused psychoactive substance among youth. Analyzing attitudes on alcohol, patterns and consequences we are getting inputs important for implementing evidence based preventive measures. OBJECTIVE: The aim of this study was to analyze drinking patterns and expectations and alcohol risk perception by gender and region and determine correlation between attitudes and one year prevalence of drinking. METHODS: The study used data from the European School Survey on Alcohol and Other Drugs, which was then conducted in 2008 in Serbia on a sample of 6,553 students aged 16 years. For data analysis descriptive and analytical statistic were used. RESULTS: The results show that nine out often students have had at least one alcoholic beverage during life and 5% have at least one alcohol beverage on more than 20 occasions during the last month. Students in Serbia have mainly positive expectations from alcohol, and the strongest potential drinking predictors in the previous year are expectation of having fun and the wish to feel relaxed. According to the participants, drinking 4-5 drinks on weekends (34.6%) is less risky than trying cannabis (52.0%). Boys have experienced problems caused by alcohol drinking more often than girls, while students from Vojvodina have performed badly in school in higher percentage than students from Belgrade and Central Serbia. CONCLUSION: In Serbia, girls drink less and perceive drinking as more risky in comparison to boys, while 16-year-old students from Vojvodina have more positive expectations but also more prominent problems caused by alcohol drinking. Additional education of the young on alcohol risk is recommended.

Continuous medical education (CME) of general practitioners (GP) in primary health care settings in the field of identification and diagnosis of alcoholism.

Institute of Public Health of Serbia (IPHS) is developing new function related to better monitoring of alcohol related diseases and injuries, actions focusing on alcohol as a lifestyle related factor using integrated strategic approaches for both population and individual risk reduction. In that regard the long term objective of the IPHS is to study, monitor, promote and safeguard public health--from the point of view of mental health and alcohol abuse--by means of research, development and the provision of expert services. Starting point in the aforementioned need for the capacity building in the area of mental health and alcohol abuse is the Program of education of general practitioners (GPs) in primary health care settings for identification and diagnosis of alcoholism. This is because GPs have the widest contact with the general population. Their education related to recognition of alcohol abuse and appropriate diagnostic tools application is first, but very important step in providing direction of the health service and other sectors for problem solving and would bring the largest benefit for the whole population. In the year 2010 National program against alcohol abuse and alcoholism will be developed. Program of education of GPs is very important complementary activity which outcome will have great impact on the National program implementation.

[Moral judgment of alcohol addicts].

INTRODUCTION: Alcoholism could represent an important factor of crime and different forms of abuse of family members (physical and emotional) exist in many alcohol-addict cases, as well as characteristics of immoral behaviour. OBJECTIVE: The objective of our study was to determine the predominating forms in moral judgment of alcohol addicts, and to examine whether there was any statistically significant difference in moral judgment between alcohol addicted persons and non-alcoholics from general population. METHODS: The sample consisted of 62 subjects, divided into a study (alcoholics) and a control group (non-alcoholics from general population). The following instruments were used: social-demographic data, AUDIT, MMPI-201, cybernetic battery of IQ tests (KOG-3) and the TMR moral reasoning test. RESULTS: Mature forms of moral judgment prevailed in both group of subjects, alcohol addicted persons and non-alcoholics. Regarding mature forms of moral judgment (driven by emotions and cognitive) non-alcoholics from the general population had higher scores, but the difference was not statistically significant. Regarding socially adapted and egocentric orientation alcohol addicted persons had higher scores. However, only regarding intuitive-irrational orientation there was a statistically significant difference in the level of moral judgment (p < 0.05) between alcoholics and non-alcoholics, in favour of the alcoholics. CONCLUSION: Moral judgment is not a category differing alcohol addicted persons from those who are not. Nevertheless, the potential destructivity of alcoholism is reflected in lower scores regarding mature orientations in moral judgment.