The detection and treatment of alcohol dependence

The cohesiveness of the proposed syndrome of alcohol dependence, and the evolution of symptoms over time, was validated in a clinical sample. In healthy individuals and in clinical samples, biological markers showed early signs of the syndrome in healthy men. A comparison of Lothian general population data with Edinburgh hospital admission data showed that heavier alcohol consumption predicted admission to a general hospital bed. Analysis of national centrally collected data showed that the burden on Scottish hospitals due to alcohol problems rose in the last 40 years.A randomized controlled trial showed the value of intervening at an early stage in the career of a problem drinker.To treat more severe alcohol dependence, withdrawal symptoms must be controlled. When randomly allocated to either a longer-acting or a shorter-acting benzodiazepine, the former showed an advantage.To help prevent relapse, 'extended' treatment emerged as only very marginally more effective than one session of firm advice to the patient to abstain. The medications disulfiram and naltrexone, if compliance was enhanced, were found to reduce relapse. Acamprosate appeared to be effective too, when results from many studies were pooled. A selective serotonin re-uptake inhibitor (SSRI), fluvoxamine, was associated with increased likelihood ofrelapse in early-onset alcohol dependence, a surprising finding, which speculatively might be mediated through increased impulsivity in some patients. Analysis of data on treatment of depression in the General Practice Research Database confirmed other emerging concerns regarding the safety of the SSRI group of drugs in young people.Abstinence was accompanied by improvement in brain magnetic resonance parameters and cognitive testing.Analysis of outcomes in placebo-controlled treatment studies for alcohol dependence, set alongside the costs to the Health Service of treating the complications of alcohol dependence, showed that the costs of failure to help patients attain abstinence are much greater than the costs of providing effective treatments