Therapy and supportive care of alcoholics: guidelines for practitioners

Alcohol dependence is one of the most pervasive diseases of the Western world. However, less than 5% of all patients receive proper treatment. Each year, about 30% of all alcohol-dependent patients are admitted to general hospitals, usually to treat alcohol-related physical diseases. The alcohol dependence itself, however, is often not diagnosed or is ignored. This chapter describes current neurobiological findings, which help in the diagnosis and understanding of the development of alcohol tolerance, withdrawal and craving. It also discusses evidence-based treatment options that include brief interventions, outpatient programmes, self-help groups and medication to reduce the relapse risk. The state-of-the-art would be to develop a therapeutical network that offers a menu of treatment options for alcohol-dependent patients. If adequate treatment is available, relapse rates were as low as 50% in those follow-up studies that examined treatment periods of up to 2 years, so that there is no justification for therapeutic nihilism.