Αlcoholism in the environment of general hospital
MOUSSAS G.
Ass. Professor in Psychiatry. Medical School, University of Athens. "Attikon" General Hospital

Alcoholism is a widespread, often concealed, multifactorial public health issue. It is considered the third largest public health problem with a highly elevated cost and serious social complications.

The World Health Organization (WHO) estimates that 1,4% of the global burden of disease can be attributed to alcoholism. Alcohol increases the risk of mortality by 50% and the prevalence of alcohol dependance in the developed countries ranges between 1-5%. In Greece, during the last years, the customary pattern of alcohol consumption has changed and our country presents increased alcohol consumption, increased consumption by younger people and especially young men. The legalization, availability and easiness in the provision of alcohol seem to play an important role in the expansion of the phenomenon. However, its importance is overshadowed by the illegal use of substances which has received a lot of publicity mainly because of the sensitive population group that it regards.

A percentage of nearly 30% of the patients that are admitted in the General Hospital for whatever reason, present comorbidity with alcohol abuse and alcohol dependance. This comorbidity is usually not identified, not only in Greece but also internationally.

Often the conditions of hospitalization in patients with alcohol dependance present difficulties both because the medical and nursing staff do not fully comprehend the complessity of the problem and also because alcohol dependant patients present comorbidity with several psychiatric disorders such as depression, anxiety, personality disorders (i.e. antisocial and borderline personality disorder). Moreover, serious somatic health problems render the situation even more complex.

An alcoholic, who is admitted for any reason in the General Hospital, necessitates a full range assessment in all aspects - biological, psychological, psychiatric and social- in order to be helped to keep away from alcohol and to increase the probability of his admission in a specific alcohol addiction program.

This is a hard effort because the alcoholic patient with a high percentage of comorbidity of psychiatric disorders and a dependant behavior makes use or primitive defence mechanisms -denial, projection, splitting, projective identification, distortion - which make the therapeutic relation difficult and the motivation to quit drinking low.

For the aforementioned reasons, the Liaison Psychiatry team of the General Hospital, needs to have a very good knowledge and understanding of the subject, knowledge of the markers and signs of good prognosis and a specific assessment and follow-up protocol for this group of patients. Encephalos 2009, 46(2):64-71.

Key words: Alcohol, alcoholism., General Hospital, dependence.