Supporting Interventions for a Specific Aspect of Alcohol Dependence Health Care Practice - Essay Example

Report on the Evidence that you can use to Support Interventions for Specific Aspect of Alcohol dependence Health Care Practice Submitted by Prepared by Word count 2418 words (excluding content and reference pages) Report on the Evidence That you can use to Support Interventions for a Specific Aspect of Alcohol dependence Health Care Practice 1. Introduction Evidence is an important fact that decides the course of treatment. The result, relapse or development in the condition of the patient can be termed as evidence in continuing the therapy or to make a change in it. They can be termed as interventions. According to that the report on the evidence to support interventions is important for any health care practice, especially for alcohol dependence. The report on the evidence enables the practitioner to focus on pharmacotherapies used in the treatment of alcohol dependence. 1The report on the evidences will involve pharmaceutical agents that are used in the treatment in the past and present. It is important to identify that the role of pharmacotherapy in the treatment of alcohol dependence and evidence to support intervention is critical in that identification. There is chance of relapse in alcohol dependence after the treatment. The evidence regarding the relapse will help and support intervention in post treatment processes. The report of evidence is crucial in interventions after the course of treatment to avoid the relapse. The pharmaceutical agents and psycho social effects that influence the treatment and relapse can be identified using evidence report. The interventions that happen using the evidence are capable of increasing the efficacy of the treatment. By using the report of evidence the practitioner can know whether the medication reduced the alcohol intake or not The examination of potential harms associated with the treatment can be identified using evidence report. This hints at the change of the course of the treatment if there are any negative effects regarding it. The evidence must be dependent on five aspects. They are - 1. Craving, 2. Loss of control, 3. Abstinence, 4. Total drinking and 5. Non-drinking days. 2. Types of hierarchies of evidence While considering the views that favour randomised controlled trials the benefits and limitations of RCTs are considered. This is due to the fact that they intersect the contemporary issues in the field. The RCTs with lengthy follow up intervals contain important and relevant evidence base. This evidence is for establishing the treatment efficacy, continued centrality. If not the informing the substance abuse practice will be questioned. The evidence hierarchy can be in the following manner. The evidence about craving for substance, maintaining the abstinence, successful treatment, good outcomes, occurrence of relapse after treatment, the non happening of the relapse of alcohol dependence. 2 While studying the factors relating to remission from alcohol dependence the cross sectional general population sample aged 30 years or more can be taken into consideration. This is due to the fact that by that time the alcohol abuse will become alcohol dependence. The comorbid depressive and anxiety disorders were diagnosed in the actively alcohol dependent. The socio demographic clinical and child hood related factors that differentiate the evidential hierarchy can be considered. The comorbid social phobia and dysthymia differentiated active alcohol dependence from a remitted state. 3. The search process The search proces was based on the evidence based reports that dianose, study and treat the alcoholics. Care was taken in selecting and presenting the content that reflects the evidence based treatment. The evidences regarding the pre diagnosis period, treatment period, post treatment period were considered. The studies that details the efficacy of the treatment and decrease the relapse after treatment were considered and presented accordingly. The evidence reports and results regarding the drug treatment of alcohol abuse was explored and presented according to emphasise the evidence based treatment's importance. The prvention of relapse and attenuation of drinking was considered as another aspect that decides the prevalence of evidence based functioning of the treatment. The search has been done in that manner and the resultant literature was explored for the outcomes. The different diagnosis processes that determine the importance of evidence based treatment were discussed and the reports regarding those studies were searched from medscape. The diagnosis process also uses the evidence of the alcohol abuse before treatment and diagnosis. These aspects also wre considered while presenting the evidence based report. 4. Critical Appraisal of the Studies Efficacy and effects of the treatment The studies detail about the efficacy and the effect of the treatment. They help in estimating and collecting the evidence regarding the result of the treatment. When naltrexone for alcohol dependence was considered, it yielded variable findings. They may be due in part to variation in compliance with oral intake of naltrexone. The efforts of making the naltrexone to in take in the form of injection were observed and found feasible in the future. When the trial conducted on 315 subjects that are assigned randomly. They received intramuscular injection of a formulation of naltrexone of 3 months. After that the patents received five sessioins of motivational enhancement therapy that was guided manually by a practitioner and researcher. The evidence regarding the above trials suggest that alcohol use depend upon the y-glutamyl transpeptidase level. It was observed that the subjects who discontinued the treatment or intake of medicines are heavy drinkers or on the heavy drinking days the subjects did not comply to the treatment conditions. The toleration to medication was observed and three fourths of the subjects received all the injections. The evidence in the study detailed the heavy drinking days, the percentage of the subjects who avoided the heavy drinking and the level of y glutamyl transpeptidase that favoured naltrexone injection. The main problem in this type of study is that the effects did not reach statistical significance. The advantage for naltrexone injection on the time to the first drinking day was not taken into consideration. The greater abstinence that was shown by the patients was also not taken into consideration resulting lack of authenticity in the evidence report for reasonable intervention. 3 By using a conservative intention for treatment analysis an advantage was observed for active medication. The study did not observe the evidence for the treatment in the absence or lack of intention from the side of patient. Prevention of relapse and attenuation of drinking To prevent relapse or attenuate drinking in people with alcohol problems novel drug treatments are suggested. These suggestions are based on the studies conducted after the observing the evidence while and post treatment periods. The evidence was collected from the randomised controlled trials for the efficacy. The candidates selected on random from the number of patients. The drugs such as acamprosate, naltrexone, bromocriptine, selective serotonin reuptake inhibitors and buspirone were examined and evidence of their effect on the patient was recorded. The problems regarding methodology that introduced bias were also recorded and were taken into consideration while estimating the result and the effect. The failure to test the integrity of the double blind can be a such instance of introduced bias. The excluding or estimating outcome in early withdrawals also was considered for the introduced bias in the treatment and the effect of the drugs. 4 The above defects and the lack of accuracy in methodology may lead to the limited procedures that can be followed using the studies. The sample selection also was taken on random basis ignoring the case wise selection. This may effect the course of the research or study when unforeseen circumstances arise from the patients of different kinds. The study will be more effective and up to the point if the selection of the candidates or the patients can be done on a particular method rather then random. In the view of the potential adverse effects of the drug treatment Apart from the above mentioned studies the alcohol use disorders can be considered as a subset of substance related disorders. These are characterised by recurrent and excessive drinking. When this drinking impairs the function and leads to negative physical, legal or social abuse and leads to physiologic dependence it can be termed as a disorder. The associated tolerance and withdrawal and continued use in spite of knowledge of the consequences can be termed as a disorder named alcohol dependence. Individuals with alcohol related medical illnesses have more frequent hospitalisations and longer hospital stays when compared with other with no alcoholism. The financial impact of the health care on society and family of the patient is substantial.5 The one day training programme focussed on building awareness of evidence based addiction treatment can be considered as the best way in addiction treatment. The main problem for the practitioners is the difficulty they face in implementing research findings. The study and the research must be in such a manner that the participants will learn about treatment models and evidence based practices supported by the substance abuse and mental health services. 6 While conducting a research and a study the evidence base for alcohol policy must be considered to evaluate the extent of impact on public health on the whole. The epidemiological surveys of the prevalence of alcohol problems in UK can be considered. After that the prevention strategies and interventions based on evidence for effectiveness must be taken into consideration. The research support, cost implement and feasibility issues can be considered while making a study or a research. The evidence collected will help a researcher in the above mentioned aspects. The implications of the evidence can be discussed next in relation to alcohol policy initiatives in UK. The goals of the research and studies should be the prevention of deterioration of current drinking patterns and to reduce the overall volume of the drinking. 7 Definitive diagnosis Additional evaluation is needed to make a definitive diagnosis of alcohol abuse or dependence. The diagnosis must be based on the criteria in the diagnostic and statistical manual of mental disorders. The criteria should establish the presence or absence of alcohol abuse or dependence. The hazardous situations faced by the patient, the legal problems due to alcohols, continued use in spite of knowledge of interpersonal or social problems must be evaluated and must be taken in the evidence based report for enabling further interventions. This must include 3 month of the following 12 month period of time to test the tolerance to alcohol effects. The withdrawal symptoms, lack of control, extended drinking time negligence of activities, psychological and physical problems can be considered as evidence regarding the result of the treatment. 8 The best way to differentiate alcohol induced transient symptoms from psychiatric illness is by observing the candidate during the period of abstinence. When this observation is not present the evidence obtained cannot be considered as complete. The duration regarding abstinence is necessary for accuracy in diagnosis is controversial but most of the successful practitioners practice this. 9 The screening for alcoholism should not be in occasional manner, instead it must be a part of routing examination. This can result good outcomes in case of individuals who induced the alcohol related health problems. The health problems may be regarding physical and mental illness. The problems like depression, liver disease and chronic problems like hypertension and gastrointestinal disorders. The consideration of the above mentioned topics can be important because they do not respond to standard therapy. 10 The information obtained from epidemiologic catchment area suggest that the lifetime prevalence of alcohol dependence is 13.5 percent. According to survey of National institute on Alcohol abuse and Alcoholism 18 million adults in the united states abuse or dependent on alcohol. Out of these in 1991-92 13.8 million adults meet the critirea of the alcohol abuse. Out of them 2.4 million only received treatment, which suggests that the treatment and diagnosis of the alcohol dependence is not complete. 5. Factors influencing evidence based practice The performance of the people can be considered as key to the effectiveness of the organisation. The alcohol dependence prevailing in the staff will effect their performance. There must be a preliminary frame work to integrate management and psychological approaches. The aim should be assisting future explanation, prediction and organisational change. There is a need to take health care as the focus of the study. The organisational culture, inter group relations, resources along with staffing can be considered as factors that influence the evidence based study alcohol dependence. This makes the study of evidence based report on alcohol dependence different for each organisation or at least different for organisations which differ in organisational culture and policy. The psycholocigal consequences of the employees also must be taken into consideration in the evidence based studies that are based on the organisation. 11 The evidence from the practice involves the practitioners to evaluate interventions in order to inform their own practice. They can guide local service development and can act as a factor that influences the evidence based support. The support given to the publication of the local evaluations in peer reviewed journals to add to our collective understanding of mental health should be considered. As there are mental disorders regarding the alcohol dependence, the mental disorders observed can be another factor that influence the evidence in the treatment of alcohol abuse or treatment. While considering the mental health impacts the aspects of the work of the candidate must be taken into consideration and it can be considered as a factor that influences the treatment. The nature of the work and the working conditions also will affect the evidence based treatment of alcohol dependence. 12 6. Reflection of Learning Alcohol abuse can be seen many forms. It is frequently hidden and denied by the candidates who depend on it. Excessive use of alcohol cause accidents along with physical and mental ailments. The social problems and crime increase with the increase of alcohol dependence. Excessive consumption of alcohol will go unnoticed until it was removed. The withdrawal syndrome cannot be identified and it is compulsory to be aware in the differences with various diagnosis. The recommended maximum intake of men and women is 21 units and 14 units respectively for a week. The is more than reflection of a weak body mass and women are more prone to the adverse effects that alcohol causes in the blood. One of the serious concerns is the increase of drinking habits in the youth. 13 When chemically dependent teenagers with LD are compared to without LD are twice likely to reuse the alcohol. LD teenagers are more likely to attend alcoholics. The LD teenagers who have undergone complete treatment also felt a decrease in current depression. This when compared to LD teenagers who did not have treatment, is a better result as one of the mental disorder depression has been decreased. References The references are given in the following format Author, year, title, publisher, edition, type of media, date retrieved, website address If any information in the above format is not available, a gap is left or that thing is mentioned. 1. Rockville, MD , 1999, Pharmacotherapy for Alcohol Dependence. Summary, Evidence Report/Technology Assessment, Agency for Health Care Policy and Research, number 3 January, 1-01-07, http://www.ahrq.gov/clinic/epcsums/alcosumm.htm 2. Kranzler H R, Wesson D R, Billot L, 2004, Naltrexone depot for treatment of alcohol dependence: a multicenter, randomized, placebo-controlled clinical trial, Reckitt Benckiser, ,electronic, 1-02-07, http://www.coretext.org/show_detail.asprecno=6789 3. JOANNA MONCRIEFF, 1997, New drug treatments for alcohol problems: a critical appraisal, Blackwell synergy, ,electronic, 1-02-07, http://www.blackwell-synergy.com/doi/abs/10.1111/j.1360-0443.1997.tb02966.xjournalCode=add 4. Hugh Myrick, MD, 2006, Diagnosis of Alcohol Dependence, medscape, ,electronic, 1-02-07, http://www.medscape.com/viewarticle/543758 5. ATTC, 2003, in Addiction Treatment:A Workshop Facilitator's Guide , ATTC, ,electronic, 1-02-07, http://www.nattc.org/resPubs/bpat/docs/bpatmanual.pdf 6. Caetano R, Babor TF. 2005, Evidence-based alcohol policy in the Americas: strengths, weaknesses, and future challenges. Rev Panam Salud Publica. 18(4-5):327-337, electronic, 1-02-07, http://journal.paho.org/a_ID=164 7. WILLIAM R. FLYNN, M.D, 2003, Treating Alcohol and Drug Abuse: An Evidence Based Review, American Journal of Psychiatry, ,electronic, 1-02-07, http://ajp.psychiatryonline.org/cgi/content/full/162/8/1557-a 8. Hugh Myrick, MD. 2006, Making the Diagnosis of Alcoholism, Medscape, ,electronic, 1-02-07, http://doctor.medscape.com/viewarticle/543758_4 9. Hugh Myrick, 2006, Alcoholism and Psychiatric Illness, Medscape, ,electronic, 1-02-07, http://doctor.medscape.com/viewarticle/543758_5 10. Hugh Myrick, 2006, diagnosis for alcohol dependence, medscape, ,electronic, 1-02-07, http://doctor.medscape.com/viewarticle/543758_6 11. Hugh Myrick, 2006, Epidemiology, medscape, ,electronic, 1-02-07, http://doctor.medscape.com/viewarticle/543758_2 12. Susan Michie, Michael A. West (2004), Managing people and performance: an evidence based framework applied to health service organizations International Journal of Management Reviews 5-6 (2), 91-111. http://www.blackwell-synergy.com/links/doi/10.1111/j.1460-8545.2004.00098.x/abs/ 13. Susan Michie, Michael A. West, (2004), Managing people and performance: an evidence based framework applied to health service organizations, International Journal of Management Reviews 5-6 (2), 91-111., http://www.blackwell-synergy.com/doi/abs/10.1111/j.1460-8545.2004.00098.xjournalCode=ijmr 14. Health Scotland, 2005, Mental Health Improvement, evidence and practice, NHS, ,electronic, 1-02-07, www.wellscotland.info/uploads/file.phpserve=1133628478-Guide2Measuringsuccess.pdf&action=download 15. patient plus, 2007, Alcoholism - diagnosis and management in primary care, patient plus, ,electronic, 1-02-07, http://www.patient.co.uk/showdoc/40001944/ 16. JenniferW.Yu1, StephenL.Buka, GarrettM.Fitzmaurice and MarieC.McCormick, 2006, Treatment Outcomes for Substance Abuse among Adolescents with Learning Disorders, Springer Link, ,electronic, 1-02-07, http://www.springerlink.com/content/d451428867241368/ 17. Jalie A. Tucker, David L. Roth (2006) Extending the evidence hierarchy to enhance evidence-based practice for substance use disorders, , electronic, 1-02-07, http://www.blackwell-synergy.com/doi/abs/10.1111/j.1360-0443.2006.01396.xjournalCode=add 18. SAMI P. PIRKOLA 1 *, KARI POIKOLAINEN 2, and JOUKO K. LNNQVIST, 2005, Currently active and remitted alcohol dependence in a nationwide adult general population-results from the finnish health 2000 study, Oxford Journals, ,electronic, 1-02-07, http://alcalc.oxfordjournals.org/cgi/content/abstract/agh240v1 Read More