Showing papers by "John B. Saunders published in 1989"

The Efficacy of Treatment for Drinking Problems

Abstract: Examination of the alcohol treatment literature reveals conflicting opinions on the efficacy of various therapies. To a large extent this reflects the professional background of the reviewer and what is regarded as acceptable evidence. The results of randomised controlled trials are often difficult to interpret since the very acceptance of therapy is often a protracted process, treatment itself even more so and therefore ‘contamination’ by other interventions and life events almost invariable. In this review evidence from natural history studies as well as controlled trials will be taken into consideration. The efficacy of cognitive-behavioural strategies is well documented, at least in the short term, and cue-exposure, response-prevention offers promise. Psychoanalytically-based therapies seem unhelpful. The alcohol-sensitizing drug, disulfiram, appears to improve outcome over the first 3–6 months and is most beneficial when given under supervision. Serotonin uptake inhibitors reduce alcohol consumption ...

Treatment of alcoholic liver disease.

Abstract: With advances in our understanding of the pathophysiology of alcoholic liver disease, pharmacological treatments of some of the basic disease processes are now in sight. The most notable development has been the introduction of propylthiouracil for the treatment of alcoholic hepatitis. In a recent trial the mortality rate of patients treated with this drug was 62% lower than that of a control group. Its beneficial effects may stem not from its anti-thyroid properties but rather from other actions such as free radical scavenging. Corticosteroids now appear to have no place in the treatment of alcoholic liver disease. Anabolic steroids, however, show promise, though longer term trials are required before this can be confirmed. Colchicine, too, has been reported to improve survival in patients with established cirrhosis. More experience is required with this and other anti-inflammatory and anti-fibrogenic drugs. β Adrenergic blocking drugs, such as propranolol, reduce portal venous pressure. In a trial among patients with alcoholic cirrhosis who had oesophageal varices, 39% of those receiving propranolol had not experienced a haemorrhage by 2 years compared with 74% in the control group. The mortality rates at this time were 28% and 49% respectively. Results of treatment once the first haemorrhage has occurred are less impressive. Treatment of the alcohol withdrawal syndrome in patients with liver disease is often problematic. The dose of any sedative should be reduced to 25–50% of the usual dose and sedatives should be avoided in patients who are encephalopathic. Once the patient has recovered from the acute illness, abstinence from alcohol remains the single most important factor that determines long term survival.

Recent developments in drug and alcohol medical education in Australia

Abstract: Drug and alcohol training in Australian medical schools is about to undergo a transformation with the appointment of drug and alcohol co-ordinators to all medical schools. These federally-funded positions will ensure the development and implementation of integrated drug and alcohol medical curricula at the undergraduate level.