Консультация "Нарколог".

Раньше был англоязычный сайт, а теперь только на финском языке http://www.contral.com. А в английском варианте немного информации: Agosti, V. (1995). "The Efficacy of Treatment in Reducing Alcohol Consumption: A Meta-Analysis." International Journal of Addictions 30:1067-1077. Altshuler, H. L., Phillips, P.E., & Feinhandler, D.A. (1980). "Alteration of Ethanol Self-Administration by Naltrexone." Life Sciences 26:679-688. Bohn, M. J., Kranzler, H. R., Beazoglou, D., & Staehler, B. A. (1994). "Naltrexone and Brief Counseling to Reduce Heavy Drinking." The American Journal on Addictions 3:91-99. Garbutt, J.C., West, S.L., Carey, T.S., Lohr, K.N., & Crews, F.T. (1999). "Pharmacological Treatment of Alcohol Dependence: A Review of the Evidence." Journal of American Medical Association 281:1318-1325. Heinälä, P.; Alho, H., Kuoppasalmi, K, Lönnqvist, J, Sinclair, D.& Kiianmaa, K. (1999). "Naltrexone in Alcoholism Treatment: Patient Efficacy and Compliance." New Research. Program & Abstracts. American Psychiatric Association 1999 Annual Meeting. Washington, DC. May 15-20, 1999. Kranzler, H.R., Tennen, H., Penta, C., & Bohn, M.J. (1997). "Targeted Naltrexone Treatment of Early Problem Drinkers." Addictive Behaviors 22:431-436. Litten, R.Z., Croop, R.S., Chick, J., McCaul, M.E., Mason, B, & Sass, H.(1996). "International Update: New Findings on Promising Medications." Alcoholism: Clinical and Experimental Research20:216A-218A. Mason, B.J., Ritvo, E.C., Morgan, R.O., Salvato, F.R., Goldberg, G., Welch, B., & Mantero-Atienza, E. (1994). "A Double-Blind, Placebo-Controlled Pilot Study to Evaluate the Efficacy and Safety of Oral Nalmefene HCL for Alcohol Dependence." Alcoholism: Clinical and Experimental Research 18:1162-1167. Mason, B.J., Salvato, F.R., Williams, L.D., Ritvo, E.C., & Cutler, R.B. (1999). "A Double-Blind, Placebo-Controlled Study of Oral Nalmefene for Alcohol Dependence." Archives of General Psychiatry 56:719-724. Maxwell, S. & Shinderman, M.S. (2000). "Use of Naltrexone in the Treatment of Alcohol Use Disorders in Patients with Concomitant Major Mental Illness." Journal of Addictive Diseases 19(3). Abstract. O'Malley, S.S., Jaffe, A.J., Chang, G., Schottenfeld, R.S.,Meyer, R.E., & Rounsaville, B. (1992). "Naltrexone and Coping Skills Therapy for Alcohol Dependence." Archives of General Psychiatry 49:881-887. O'Malley, S.S., Jaffe, A.J., Chang, G., Rode, S., Schottenfeld, R.S., Meyer, R.E., & Rounsaville, B. (1996). "Six-month Follow-up of Naltrexone and Psychotherapy for Alcohol Dependence." Archives of General Psychiatry 53: 217-224. Renault, P.F. (1980). "Treatment of Heroin-Dependent Persons with Antagonists: Current Status." In Naltrexone: Research Monograph 28, ed. R.E. Willett & G. Barnett, 11-22. Washington, D.C.: National Institute on Drug Abuse. Sinclair, J.D., Kymäläinen, O., Hernesniemi, M., Shinderman, M.S. & Maxwell, S. (1998). "Treatment of Alcohol Dependence with Naltrexone Utilizing an Extinction Protocol." 38th Annual Meeting, National Institute of Mental Health (NIMH) -sponsored New Clinical Drug Evaluation Unit (NCDEU) Program, Boca Raton, Florida, June 10-13, 1998. Sinclair, J.D., Kymäläinen, O., & Jakobson, B. (1998). "Extinction of the Association between Stimuli and Drinking in the Clinical Treatment of Alcoholism with Naltrexone." Alcoholism: Clinical and Experimental Research 22: supplement: 144A. Sinclair, J.D., Vilamo, L., & Jakobson, B. (1994). "Selective Extinction of Alcohol Drinking in Rats with Decreasing Doses of Opioid Antagonists." Alcoholism: Clinical and Experimental Research 18:489. Volpicelli, J.R., Alterman, A.I., Hayashida, M.,& O'Brien, C.P. (1992). "Naltrexone in the Treatment of Alcohol Dependence." Archives of General Psychiatry 49:876-880. Frequently Asked Questions How does one get into the treatment? By making an appointment - there is usually no need for a doctor's referral, unless reimbursement policies require that. One's own motivation is sufficient. What is included in the treatment? It is a combination of therapy and medication aimed at extinguishing excessive alcohol drinking. The basic treatment programme consists of 8 visits to the clinic (each approximately 45-50 minutes long), of which four visits are with a doctor and four with a therapist. The visits initially are one week apart but the interval between visits lengthens as the treatment proceeds. All in all, the basic treatment lasts from 3 to 6 months. After the basic treatment, follow-up sessions are recommended. How much does the treatment cost? The total cost depends much on the amount of medication that is necessary. In Britain, the average total cost would be approximately two thousand pounds, possibly less. Health insurance reimbursements depend on the particular insurance policy. How successful is the treatment? In clinical trials, treatments resembling the ContrAl method have been shown to significantly reduce craving and drinking. In a survey of 147 clients from the first clinic, nearly four out of five clients (78%) reduced successfully their drinking below a level of increased risk for mortality and morbidity, or at least halved their alcohol consumption from what it was to begin with. A quarter of the clients reported having been abstinent during the last month. The treatment was unsuccessful in 12% of the clients, most often because of a failure to follow instructions. As to the long-term efficacy, the method is still young, and only time will show. Who benefits from the treatment? The treatment works for most excessive drinkers regardless of severity.It is not appropriate, however, for a recovering alcoholic who has been abstinent for a long time.It also is difficult to start the treatment in the middle of a severe binge that incapacitates the client and interferes with compliance. The treatment cannot be recommended for people with acute liver diseases, pregnant women, or individuals physically dependent upon opiates. A doctor evaluates the person's state of health in the screening visit. What effects does the medicine have? It prevents reinforcement from drinking alcohol by blocking the opiate receptors.As a result, the urge to drink gradually is weakened, and alcohol becomes an insignificant matter. It does not reduce intoxication but may instead slightly increase the detrimental effects of alcohol on driving and similar activities. The medicine is a passive substance with no stimulating or tranquilising effects. Unlike AntabuseR, it does not produce an aversive effect in combination with alcohol. Does the medicine have side effects? In general the medicine is well tolerated with no severe side effects, but approximately 10-15% of clients may in the beginning of the treatment experience passing nausea, headache, irritability, etc. What is the therapy needed for? The medicine alone is not sufficient because a total change of a way of life is involved. The therapy provides a channel to observe what things and feelings are related to drinking from various points of view and to plan a new life free of dependence upon alcohol. The visits are important for educating the client about how the extinction works and how to accentuate the benefits from it. It also is critical to assure clients in the early stages that the craving and drinking decrease slowly over many weeks and that they should not worry if they do not see immediate improvement. С уважением нарколог, канд. мед. наук Колесниченко Игорь Юревич, Медицинский центр "Здоровье" АнтиСТРЕСС