What benefits a person from abstinence

A rocky road to abstinence

Recommendation: abstinence is the primary therapeutic goal in alcohol addiction syndrome. If this is currently not possible or if there is harmful or risky consumption, a reduction in consumption (amount, time, frequency) should be aimed for in order to minimize harm [A].

Patients with an alcohol-related disorder often have other mental disorders as well. You have a worse prognosis if both diseases are not treated according to guidelines as possible [B]. The comorbidity must be taken into account when selecting psychotherapeutic and / or medicinal measures. Treatment of the mental illness alone does not usually result in a lasting reduction in the amount of drink. This has been very well documented, for example, for antidepressants such as selective serotonin reuptake inhibitors [A for ineffectiveness]. It should be noted that accompanying affective symptoms in particular can be alcohol-induced. Whether and how these are to be treated can therefore only be meaningfully checked three to four weeks after withdrawal [A].

Acute treatment of alcohol addiction

Alcohol intoxication and / or withdrawal syndrome are common complications of the underlying disease alcohol dependence. A »physical detoxification« should ensure the vital functions, alleviate the vegetative withdrawal symptoms and avoid severe courses, for example epileptic seizures or delirium tremens. However, the recurrence rates are extremely high.

This results in the recommendation that physical detoxification alone is not a sufficient therapy for the addiction disease and that further addiction medical aids should be provided and conveyed [KKP]. In the so-called »qualified withdrawal treatment« (QE), physical detoxification is supplemented by psycho- and sociotherapeutic measures aimed at the underlying disease of addiction (5).

There is evidence that QE is more effective than a purely physical detox. Patients showed a higher abstinence rate, a higher rate of referrals to further therapy such as post-acute treatment (rehabilitation), a better success of rehab treatment, and a reduced rate of resumption of withdrawal treatment (6). Despite the longer duration of treatment, QE was cost effective.

Unfortunately, health insurances often limit their obligation to provide benefits to the acute treatment of complications, such as withdrawal. This leads to the unsatisfactory situation that neither adequate treatment of the often long-lasting psychological withdrawal symptoms such as addictive pressure, irritability, concentration disorders, inner restlessness (»nervousness«), dysphoria, emotional lability, anxiety and sleep disorders is permitted, nor co-treatment of the underlying disease alcohol dependence. This inevitably leads to a particularly high risk of relapse. Furthermore, the administrative hurdles and waiting times for further treatment and rehabilitation measures are sometimes considerable - fatal for patients who are often ambivalent in their motivation.

Recommendation: Qualified withdrawal treatment (QE) should be offered instead of pure physical detoxification, especially if the patient is ambivalent about further treatments. The QE usually lasts up to three weeks, with a complicated course and in individual cases it can last up to six weeks [KKP].

Pharmacotherapy in acute withdrawal