Treatment with naltrexone:
Presentation of the program of the short term unit for alcohol addiction treatment of the Psychiatric Hospital of Attiki
ΝΤΑΝΤOUTI G.

Alcoholism is a widely spread problem in our country as it is globally. During their lifetime, it is estimated that a 10-13% of people develops some alcohol addiction problem.

It is a complex phenomenon with biological, psychological and social parameters which need to be taken into consideration by the therapist upon trying to deal with it.

The program of the short term unit for alcohol treatment proposes a therapeutic model of meeting with the problem of alcohol addiction taking notice of all these parameters.

The 1st phase includes the patients' introductory valuation that come to the Advisory Centre of our unit which is performed by psychiatrists. In this introductory valuation all the needed information concerning to alcohol use, in possible prior treatments and background, as far as family history, are collected, and a thorough pathologic and psychiatric evaluation is performed. Lastly, the aim of the therapy is determined and the best therapeutic framework is chosen.

The aims of the therapy are:

• Abstinence of alcohol and commitment to therapy
• Improvement of psychosocial functioning
• Prevention of relapse

The therapeutic frameworks are:

• Outpatient treatment: it is advised to patients that have the ability of self-care, strong motive, great potentiality of treatment commitment and a quite supportive family and social environment.
• Inpatient treatment: it is advised for patients that have a special need for strict structure, support, security and control in order for the abstinence to be kept and whose environment, family or social, can be either supportive or in some cases rejective or high risky. It is about a framework of intensive care.

During the 1st phase within the Advisory Centre besides what has already been mentioned, the psychiatrist provides pharmaceutic regimen for the discontinuation of alcohol use and for the privative syndrome connecting with it to be affronted.

1. Inpatient treatment program

It is about a 6-month program that is divided in 3 phases.

- Preparatory phase

It lasts for 2 months and it is done in the Advisory Centre by participating in a preparatory group for admission in the inpatient treatment phase (considering that the admissions are performed in groups and not individually) once a week and at the same time they attend weekly meetings with psychiatrists of the Unit. The aim of this phase is on one hand the detoxification and on the other hand the development and cultivation of the motive for the continuation of the therapy as well as the establishment and conservation of positive therapeutic alliance. This is achieved by means of technical interviews that are meant to elicit from the part of the patient the reasons for change and to support him in his shift within the different stages of change of their own addictive behavior.

The approach is done in a way that is empathetic, open, non - critical, supportive, flexible and not rigid, sincere, with respect towards the patient, discreet and warm.

- Inpatient treatment phase

The residence takes place in the Short Term Alcohol Treatment Unit and it lasts for 2 months. A group of patients that have attended consistently the preparatory phase and remain in abstinence from alcohol are admitted.

During the residence in the Unit, in therapeutic community terms, efforts are made, by means of individual and group therapeutic meetings, to clarify the reasons that led them to alcohol addiction and to develop coping skills of the situations that usually lead to alcohol use. Efforts are also made for more structural changes in the way they relate with themselves and with other people.

The theoretic models of approach both for the individual and the group meetings are mixed, with cognitive-behavioral elements as well as psychodynamic and interpersonal ones.

During their residence in the Unit the patients have no form of communication with their family environment. Their relatives, however, or the most important people in their lives have the potential to participate in Relative Groups taking place in the Advisory Centre for as long as the patients remain in the inpatient treatment program.

- Rehabilitation phase

It also lasts for 2 months, it takes place in the Advisory Centre and it constitutes the normal continuation of the inpatient treatment phase. The aim of this phase is to keep the abstinence, the consolidation of the understanding that has come up to the surface and above all the prevention of relapses. The therapeutic tools in this phase remain the same including meetings with the personal therapist and participation in psychotherapeutic and drama-therapy groups.

2. Οutpatient treatment program

The outpatient treatment program is addressed to patients that have the ability of self-care, supportive family and social environment and great potentiality of treatment commitment. It includes psychotherapy, primarily individually and later on by participating in psychotherapeutic groups along with pharmaceutical regimen, if needed, and at the same time intervention in the families of the alcoholics.

NALTREXONE

All patients, irrespective of the program they attend, since their livery function allows it and irrespective of any other regimen, they take naltrexone for 9-12 months with constant monitoring of their hepatic enzymes every 2-3 months due to possible liver toxicity.

Naltrexone is an opioid antagonist. It acts by specifically blocking opioid receptors and it reduces the 'kick' or euphoria experienced with alcohol and blunts the craving for it. The usual side effects of naltrexone is the appearance of nausea and headache. Encephalos 2009, 46(2):92-99.

Key words: Alcoholism, naltrexone, alcohol addiction, treatment, relapse prevention.