An Intervention for Treating Alcohol Dependence: Relating Elements of Medical Management to Patient Outcomes With Implications for Primary Care

Denise B. Ernst; Helen M. Pettinati; Roger D. Weiss; Dennis M. Donovan; Richard Longabaugh

doi:10.1370/afm.884

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We can do this!
Daniel C. Vinson

Published on: 17 September 2008
The Great Promise of Medical Management for Alcohol Dependence
Andrew J Saxon

Published on: 11 September 2008

Published on: (17 September 2008)
Page navigation anchor for We can do this!
We can do this!
Daniel C. Vinson, Columbia, MO
Although this was essentially a prospective cohort study (nested within a randomized clinical trial), the authors' findings provide yet more evidence that primary care clinicians can deliver effective interventions for patients with alcohol problems, even those with dependence.
Consider hypertension. We screen for it routinely (every visit). When it's unexpectedly elevated, we don't necessarily jump on it; we as...
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Although this was essentially a prospective cohort study (nested within a randomized clinical trial), the authors' findings provide yet more evidence that primary care clinicians can deliver effective interventions for patients with alcohol problems, even those with dependence.
Consider hypertension. We screen for it routinely (every visit). When it's unexpectedly elevated, we don't necessarily jump on it; we ask the patient to gather more data and return for more discussion and management. We use medications. We coach patients on lifestyle changes. Compliance is a major factor in success. Success isn't always complete, and we don't give up when the patient's blood pressure remains high. Alcohol dependence fits the same model of chronic-disease management. The COMBINE Study shows us one way of approaching it.
Alcohol problems are common, serious (64,000 deaths each year in the U.S.), and hidden, but treatable.
Now it's up to us to figure out how to make screening and intervention for alcohol fit in routine primary care.
Dan Vinson
Competing interests: None declared
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Competing Interests: None declared.
Published on: (11 September 2008)
Page navigation anchor for The Great Promise of Medical Management for Alcohol Dependence
The Great Promise of Medical Management for Alcohol Dependence
Andrew J Saxon, Seattle, WA
This important study highlights several points highly relevant to the delivery of treatment for alcohol dependence in primary care settings. The most critical finding is that many patients with alcohol dependence can derive great benefit from being prescribed naltrexone and receiving an average of only 3 total hours of in-person contact with a a health care provider who is addressing their alcohol problems. The second im...
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This important study highlights several points highly relevant to the delivery of treatment for alcohol dependence in primary care settings. The most critical finding is that many patients with alcohol dependence can derive great benefit from being prescribed naltrexone and receiving an average of only 3 total hours of in-person contact with a a health care provider who is addressing their alcohol problems. The second important point is that patients will attend this type of intervention and express satisfaction with it. Additionally, Health care providers can readily learn to deliver Medical Management and provide it according to the manual, though some flexibility seems beneficial. The next big challenge as noted by the authors is the need to push for widespread dissemination of this form of treatment into primary care practice.
Competing interests: Consultant to Schering-Plough. Honoraria received as a speaker from Schering-Plough Canada. Speakers Bureau Alkermes, Speakers Bureau Cephalon, Speakers Bureau Forest Pharmaceuticals. Research Support Ortho-McNeil-Janssen LLC, Research Support Titan Pharmaceuticals. I was a co-investigator on the COMBINE Study.
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Competing Interests: None declared.