Alcohol dependence: a general practitioner, a central role in the management

The GP is often the first caregiver to come into contact with an alcohol-dependent person, knowing that 20% of patients have a disorder related to their alcohol consumption.

It therefore appears not only as a crucial player in the screening but also to support the sustainable maintenance of abstinence, said Dr. Paul Kiritzé Topor (Beaupreau, Maine-et-Loire).

The results of a study called Combine, conducted among 1,383 volunteers reveal an significant efficacy of naltrexone, alone or in combination with cognitive behavioral therapy in the maintenance of abstinence and relapse prevention.

"Three successive and interrelated steps (before weaning, when the realization of this, and after) are key steps that the general should be able to manage if he decides to take charge of a alcohol-dependent person. Moreover, it often takes 15 years of alcohol dependence before a patient comes into care, "said Dr. Kiritzé Topor.

"Before the withdrawal, he says, one must know track: one adult in five has a problem with alcohol consumption (a third is alcohol-dependent, two-thirds having a harmful use or risk)."

To locate a heavy drinker, there is no better way, he said, the dialogue. "A discussion of the lifestyle must lead to the detection of consumer misuse, a goal that is achievable if the practitioner knows the necessary time to listen to his patient and provides several consultations can overflow a little. "

To quantify the importance of alcohol consumption, a number of questions can be asked in a simple progression that will lead gradually to approach the reality of the consumer: you happened to these alcoholic beverages last month? How many drinks per occasion? How many times a month?

"It should also try to establish the link between alcohol and the patient pathologies which he suffers. The clinic must also be able to locate an alcohol problem through taking the blood pressure, the dosage of blood triglycerides, or by looking for anxiety and depression. Moreover, it is essential to ask the addiction as an assumption, not a certainty and to suspend this type of consumption for 8 days. After this test is the patient arrives and says he eats and sleeps better, snore less and less often headache, in which case it will show more motivated, or he does not succeed and acceptance will be delicate, "explains the Kiritzé Topor.

Another requirement is to introduce the concept of time: "there is no rush to make a diagnosis of addiction, it may take 4-5 consultations," he considers.

For weaning, the general must then implement a support strategy by asking the question: where, when, how to make this withdrawal, by choosing the location of the patient (hospital or outpatient, the? hospitalization is primarily aimed at patients with a history of complicated withdrawal, as the occurrence of seizures or delirium tremens, or social disadvantage middle), timing and practicalities. The physical signs of dependence decreased from the third day of weaning and disappear in 7-10 days.

"It is important for the practitioner to ensure that the patient weaning safely and painlessly, negotiating a contract of care with him," insists the doctor.

After this phase, the monitoring is codified and has several objectives:

- Prevent réalcoolisations, knowing that "relapse is part of the course of alcoholics, it is necessary to address this issue in post-treatment," warns Dr. Topor Kiritzé while noting that attempts to reconsommer as everyone should be banned because of a brain memory dependence (80% of alcohol-dependent who take a drink of alcohol relapse, even after long months of abstinence);

- Maintain abstinence lasting (with the help of a medical treatment prescribed for 3 months, as is the case for naltrexone as one tablet per day, possibly associated with a cognitive-behavioral therapy). "The prescription of an order can further ensure a therapeutic relationship," he says.

Support is completely personalized and monitoring can be done in one of 230 outpatient centers cures of alcoholism, a French specificity. There are also spa resorts or post-treatments where patients can stay 1-3 months or up to a year if they wish. Nearly 100,000 patients are well monitored in consultation with alcoholism. "The former drinkers movements are also great allies, we must not neglect their impact," said the general.

To be successful these steps (one third of alcohol-dependent and heals with the help of a GP), the physician should be able to benefit from learning a support strategy, he judge.

DENIAL: A DEFENSE SYSTEM

In the opinion of Dr. Kiritzé Topor, denial is actually a defense system. "We must therefore reassure the patient who feels a sense of shame, saying that alcohol dependence is a disease and not being a bad person, prepare the idea of a long-term illness and the ability to care, to show that he is not alone in this (drawing, for example, medical records of all other records relating to patients followed in alcoholism).

"Denial is not patient-dependent, it is related to the interrelation and can be solved by a motivational technology from marketing to evacuate the resistance of the patient," informs Dr Philippe Batel, head of alcoholism Service at the Beaujon Hospital in Clichy (Hauts-de-Seine).

It is in this case to address the issue, not a closed question (if you do not want to finally get an answer) as: "You drink alcohol like everyone else, or?: do you drink? ", but open-ended questions:" What can you tell me about your drinking Is it you happen to consume alcoholic beverages such as beer, cider? wine? " This type of question should be integrated, according to him, more questions about the lifestyle.