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Current Care Guidelines for drinking problems

Published 17.12.2015

The key contents of the Current Care Guidelines are based on scientific impact studies. In recent years, the Finnish Medical Society Duodecim, together with medical specialist associations, has compiled over 50 treatment recommendations for common diseases. The objective is to improve the quality of care.

These recommendations are not simple authority regulations, but are instead used as one guideline when a client, together with the worker treating them, considers which operational modes would perhaps benefit the treatment and have as good results as possible.

The first version of Current Care Guidelines for people with a drinking problem was completed in spring 2005, with the assistance of the Finnish Society of Addiction Medicine. After this, the Care Guidelines have been updated twice and the latest version was published in autumn 2015. The Current Care Guidelines for people with a drinking problems comment on the treatment of alcohol addiction and alcohol consumption that exceeds the risk levels, occupational ability assessment of people with a drinking problem and the quality of substance abuse treatment locations. Additionally, the guidelines take into account the treatment of special groups, such as people suffering from simultaneous mental health problems, young people, aging people and pregnant people. The guidelines are mainly intended for the staff of basic healthcare, occupational healthcare and specialised medical care, but they are also suitable for special services of substance abuse and social care.

The most extensive section of the guidelines are the evidence rate reviews, which are based on research data, especially randomised, controlled experimental designs. The reliability of data is described with evidence rates A, B, C and D, in which A represents the strongest research evidence and level D is based on practical experiences. Rate D is especially useful in situations where more scientific assessments of a certain treatment method are currently lacking.

The guidelines highlight that healthcare has a key role in the prevention, discovery and treatment of a drinking problem. The prevalence of drinking problems should be kept in mind in all healthcare treatment locations and the problems should actively be sought out among the different patient groups. Short-term counselling (mini-intervention) is an efficient way to affect alcohol consumption and prevent the detrimental effects caused by alcohol.

In the Current Care Guidelines, the high risk level has been determined to be 23–24 portions a week for men and 12–16 portions per week for women. This can be seen as an alarming level, when alcohol consumption should be intervened in, at the latest. The moderate risk level has been determined to be 14 portions a week for men and 7 portions per week for women. Additionally, heavy drinking every week (5–6 portions for women and 6–7 portions for men at a time) or repeated binge drinking with the aim of becoming intoxicated are also classified as risk consumption due to the increased risk of accidents. The most important diagnostic method for discovering a drinking problem is discussion with the patient but various surveys and laboratory indicators can also be used as supporting methods.

Psychosocial treatment in its different forms is more efficient that not treating the patient. A good treatment relationship is linked to successful treatment results. The social skills of the treatment personnel apparently have an effect on the treatment results, and the results of psychosocial treatment vary depending on the treating staff. A motivating interview improves the success of the treatment and its continuity. In milder cases, the use of self-treatment materials leads to similar level of results as going to therapy. The patient’s entire life situation revolves around their drinking problem, which means that the treatment must also be holistic.

Psychosocial treatments are the basis for alcohol addiction, but the treatment results can be improved with the help of medication. Benzodiazepines are effective medications for short-term treatment of alcohol withdrawal symptoms, but their regular use is not recommended. For medication treatment of alcohol addiction, disulfiram is the primary choice, if complete abstinence is the objective of the treatment. If the treatment objective is to cut down alcohol consumption or its gradual quitting, opioid antagonists (naltrexone or nalmefene) are recommended.

More information is available here.

Solja Niemelä
Professor of Psychiatry (temp.), special competence in substance abuse medicine
University of Oulu and Lapland Hospital District

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