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Cees Goos writes:
Two years ago a European working group on the
treatment of alcohol dependence was established. It aims to
improve international communication and co-operation between
treatment centres. Progress made over the last 15 years on
the promotion of public health oriented alcohol policies has
outstripped co-operation on the development of effective treatments.
Much can however, be gained by sharing knowledge of the wide
variety of treatment regimes across Europe and the investment
that has been put into them.
The group is loosely structured, with the majority
of members being clinicians and managers of major treatment
facilities, though there are also some researchers. Membership
is free: the only real obligation is active participation,
and a commitment to the group's aims. Meetings have been cosponsored
by the Regional Office for WHO Europe. Recent support has
come from the Society for the Study of Addiction. To maintain
its independence the group refrains from seeking sponsorship
by pharmaceutical companies.
The launch meeting in Vienna reviewed the state
of the art on psychological and pharmacological treatments.
Another theme was the need and the opportunities for co-operation
between specialised treatment centres and the primary health
care system. The pros and contras of a European standard as
one of the long-term perspectives of the group were also debated.
The report on the meeting plus the papers presented were published
in a special issue of Wiener Zeitschrift für Suchtforschung
(Springer et al. 2004).
The group met for a second time from 17 to 18
June 2005 at the Jellinek Centre in Amsterdam. The three themes
for debate were the impact on public health of treatment efforts,
rationalizing treatment procedures, and psychiatric co-morbidity.
Picture: European Working Group for
the Treatment of Alcohol Dependence, second meeting
in Amsterdam, June 2005 |
The debate about the public health impact of
treatment efforts reiterated the tension between the clinical
and the public health perspectives. Public health interests
(such as availability and equal access to treatment, offering
treatment to all in need, securing follow-up care and last
but not least reducing costs) tend to be neglected in clinical
settings. and despite substantial efforts and investment as
well as technical progress, it is hard to prove that alcohol
treatment has significant impact on rates of alcohol-related
morbidity and mortality.
The Jellinek Centre was the ideal place in which
to debate the rationalization of treatment procedures. More
than any other treatment facility in Europe it has invested
in the design and re-structuring of evidence-based interventions.
Thirty-six treatment modules have been developed and are being
implemented by staff throughout the institution. The modules
cover the whole array of possible interventions from assessment,
through various lifestyle-training interventions, basic social
skills training, up to web-based treatment. Systematic evaluation
of the effectiveness of the modules takes place continuously.
Reports were presented on recent efforts in
Norway, Sweden and the UK to make treatment a more rational
and logical enterprise and to implement national strategies.
In Norway a national registration program (including standardised
registration forms, detailed manuals and training programs)
was introduced in 1997 and has provided insights into parameters
such as substances being used by clients, gender distribution,
and the share of young people visiting treatment centres.
After publication of a systematic review on treatment for
alcohol and drug problems by the Swedish Council on Technology
Assessment in Health Care in 2001, the Swedish Board for Health
and Welfare is about to issue national guidelines for treatment
of alcohol and drug problems.
The UK Alcohol Treatment Trial is the largest
multi-site trial to date in the UK; funded by the Medical
Research Council during the latter half of the 1990s. It compares
the effectiveness of Motivational Enhancement Therapy with
a novel though evidence-based social treatment: Social Behaviour
and Network Therapy. Training and supervision of therapists
proved critical in maintaining consistent standards of practice
across geographically dispersed sites, different agency types
and professional groups.
On the issue of alcohol dependence and psychiatric
co-morbidity, Christian Krappel, the Jellinek Centre's new
medical director, described the co-operation between the Centre
as a specialised addiction facility and the city mental health
services. Work done in Vienna over the last decade suggests
that the specific missing link on the issue of psychiatric
co-morbidity might be anxiety. A cybernetic model has been
developed at the Anton Proksch Institut which provides an
explanation for the complex connections between depression,
anxiety and alcohol dependence.
In a final excellent presentation Wim van den
Brink summarized current knowledge on the enhanced effects
of combined psychosocial and pharmacological interventions,
the effectiveness of combining various pharmacological agents,
the possibilities of aftercare and the potential of patient-treatment
matching using either clinical characteristics or genotypes.
The group's future work program will be collaborative
research on physical co-morbidity and alcohol dependence.
Fifteen clinical centres throughout Europe have committed
themselves to participate in the study, to be led by Professor
Michael Gossop. First results will be presented at the next
meeting of the group, to be held this autumn in Warsaw.
The group secretariat is at the Anton Proksch
Institut in Vienna. For more information on the group and
its activities please refer to http://www.api.or.at/ewgtad.
Reference
Springer, A., Mader, R. (eds), Goos, C. (guest
editor) (2004) Wiener Zeitschrift für Suchtforschung,
27, 1.
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