Alkol kullanım sorunları nasıl önlenir? Alkol kullanım bozukluklarının tanı ve tedavisinde kısa müdahale yaklaşımı

Aşırı alkol tüketimi ve alkolle ilişkili sorunlar tüm dünyada önemli bir halk sağlığı sorunudur. İçme sınırlarının ve aşırı alkol tüketimiyle ilişkili risklerin bilinmemesi alkolle ilişkili sorunların gelişmesinde en önemli etkendir. Günde dört standart içkiden fazla ve haftada 14 standart içkiden fazla içen erkekler, günde üç standart içkiden fazla ve haftada yedi standart içkiden fazla içen kadınların ve 65 yaş üstü erkeklerin alkolle ilişkili sorun yaşama riski artmıştır. Sağlık ocaklarına başvurular alkol sorunlarına erken dönemde müdahale etme olanağı yaratır. Birinci basamak sağlık hizmetlerine başvuran hastalarda alkol tüketiminin taranması ve erken kısa müdahale hastaları düşük-riskli tüketim düzeyleri ve aşırı alkol kullanımının riskleri konusunda eğitmek için fırsat sağlar. Alkol Kullanım Bozuklukları Tanıma Testi (AUDIT) riskli ve zararlı alkol kullanımını tanımlamak üzere geliştirilen tarama ölçeğidir. ‘Kısa müdahale’ hastanın davranışını değiştirmeye ve hastanın tedavi uyumunu artırmaya odaklanan, süresi sınırlı, hasta merkezli danışmanlık yöntemidir. Dört basamaktan oluşmaktadır: 1. Alkol kullanımını sormak, 2. Alkol kullanım bozukluklarını değerlendirmek, 3. Uygun davranışı önermek ve yardımcı olmak, 4. Hastanın gelişimini izlemek, desteği sürdürmek. Alkol kullanım bozukluklarında kısa müdahalenin ikincil koruma yöntemi olarak etkili olduğu çalışmalarda ve meta analizlerde gösterilmiştir. Önemli bir halk sağlığı sorunu olarak alkol kullanım sorunlarına birinci basamak sağlık hizmetlerinde ikincil koruma olarak müdahale edilmelidir. Erken tanı ve müdahale sorunun büyümesini önleyecektir.

How are alcohol related problems prevented? Brief intervention approach in the treatment of alcohol use disorders

Excessive alcohol consumption and alcohol related problems are significant public health problems worldwide. Many factors contribute to the development alcohol related problems. Lack of knowledge about low-risk consumption levels and risks of excessive alcohol use is the most important factor. Men who are drinking more than four standard drinks per day and 14 standard drinks per week, women and men older than age 65 who are drinking more than three drinks a day and seven standard drinks per week have an increased risk for alcohol related problems. Screening and early brief intervention for alcohol consumption among patients in primary health care provides an opportunity to educate them about low-risk consumption levels and risks of excessive alcohol use. Alcohol Use Disorders Identification Test (AUDIT) has been established as a screening scale to identify risky and harmful alcohol use. “Brief intervention” is a time-limited and patient centered counseling method focuses to change the patient’s behavior and increase the treatment compliance. It includes four stages; 1. Ask alcohol use, 2. Assess alcohol use disorders, 3. Advice and support, 4. Arrange follow-up. Brief intervention has been shown as an effective secondary prevention method in the studies and meta-analysis. Alcohol use problems as a major public health problem should be intervened in the primary health care as a secondary prevention. Early identification and intervention will prevent the growth of the problem.

PDF

___

1. World Health Organization. Global Status Report: Alcohol Policy. Geneva, World Health Organization, 2004.
2. Akvardar Y. Alkol ile ilişkili bozuklukların epidemiyolojisi. Türkiye Klinikleri Dahili Tıp Bilimleri Dergisi, Psikiyatri Alkol ve Madde Bağımlılığı Özel Sayısı, 2005; 5-9.
3. Ünüvar N, Mollahaliloğlu S, Yardım N. Türkiye hastalık yükü çalışması, 2004. Ankara, Türkiye, RSHMB Hıfzısıhha Mektebi Müdürlüğü, 2008.
4. Bendtsen P, Akerlind I. Changes in attitudes and practices in primary health care with regard to early intervention for problem drinkers. Alcohol Alcohol 1999; 34:795-800.
5. Babor TF, Higgins-Biddle JC. Alcohol screening and brief intervention: dissemination strategies for medical practice and public health. Addiction 2000; 95:677-686.
6. Babor TF, Higgins-Biddle JC. Brief intervention for hazardous and harmful drinking. Geneva, World Health Organization, 2001.
7. Fleming MF. Screeningfor at risk, problem, and dependent alcohol use. RK Hester, WR Miller (Eds.), Handbook of Alcoholism Treatment Approaches: Effective Alternatives, Boston, Pearson Education, 2003, p.64-77.
8. Amerikan Psikiyatri Birliği. Psikiyatride Hastalıkların Tanımlanması ve Sınıflandırılması Elkitabı. E Köroğlu (Çev.), dördüncü baskı (DSM-IV-TR), Ankara, Hekimler Yayın Birliği, 2001.
9. World Health Organization. The ICD-10 Clasification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Geneva, World Health Organization, 1993.
10. Anderson P, Kaner E, Wutzke S, Wensing M, Grol R, Heather N, et al. Attitudes and managing alcohol problems in general practice: Descriptive Analysis based on findings of a World Health Organization International Collaborative Survey. Alcohol Alcohol 2003; 38:597-601.
11. National Institude on Alcohol Abuse and Alcoholism. Helping patients who drink too much. A Clinician's Guide. NIH Publication No. 05-3769, National Institute of Health, 2005.
12. Hyman Z. Brief interventions for high-risk drinkers. J Clin Nurs 2006; 15:1383-1396.
13. Kahan M, Wilson L, Becker L. Effectiveness of physician-based interventions with problem drink- ers-a review. Can Med Assoc J 1995; 152:851-859.
14. Wilk AI, Jensen NM, Havighurst TC. Meta-analysis of randomized control trials addressing brief interventions in heavy alcohol drinkers. J Gen Intern Med 1997; 12:274-283.
15. Kaner EF, Beyer F, Dickinson HO, Pienaar E, Campbell F, Schlesinger C, et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2007; 18: CD004148. http://mrw.interscience.wiley.com/cochrane/clsysr ev/articles/CD004148/pdf_fs.html
16. Osilla KC, Zellimer SP, Larimer ME, Neighbors C, Marlatt GA. A brief intervention for at-risk drinking in an employee assistance program. J Stud Alcohol Drugs 2008; 69:14-20.
17. Fleming MF, Lund MR, Wilton G, Laundry M, Scheets D. The Healthy Moms Study: the efficacy of brief alcohol intervention in postpartum women. Alcohol Clin Exp Res 2008; 32:1600-1606.
18. Rose HL, Miller PM, Nemeth LS, Jenkins RG, Nietert PJ, Wessell AM, et al. Alcohol screening and brief counseling in a primary care hypertensive population: a quality improvement intervention. Addiction 2008; 103:1271-1280.
19. Simão MO, Kerr-Correa F, Smaira SI, Trinca HA, Floripes TM, Dalben I, et al. Prevention of "risky" drinking among students at a Brazilian university. Alcohol Alcohol 2008; 43:470-476.
20. Guth S, Lindberg SA, Badger GJ, Thomas CS, ROse GL, Helzer JE. Brief intervention in alcoholdependent versus nondependent individuals. J Stud Alcohol Drugs 2008; 69:243-250.
21. Madras BK, Compton WM, Avula D, Stegbauer T, Stein JB, Clark HW. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: comparison at intake and 6 months later. Drug Alcohol Depend 2009; 99:280-295.
22. Tsai YF, Tsai MC, Lin YP, Chen CY. Brief intervention for problem drinkers in a chinese populltion: a randomized controlled trial in a hospital setting. Alcohol Clin Exp Res 2009; 33:95-101.
23. Gül S, AkvardarY, Taş G, Tuncel P. The diagnostic validity of screening tests and laboratory markers in alcohol use disorders. Türk Psikiyatri Dergisi 2005; 16:3-12.
24. Modestolowe V, Boornazian A. Screening and brief intervention in the management of early problem drinkers: Integration into health care settings. Dis Manage Health Outcomes 2007; 8:129-142.
25. Babor TF, Higgins-Biddle JC, Saunders, Monterio MG. AUDIT The Alcohol Use Identification Test: Guidelines for Use in Primary Care. Second ed., Geneva, World Health Organization, 2001.
26. Fleming MF, Manwell LB. Brief interventions in primary care settings: A primary Treatment method for at risk, problem, and dependent drinkers. Alcohol Res Health 1999; 23:128-137.
27. Fleming MF, Barry KL, Manwell LB, Johnson K, London R. Brief physician advice for problem alcohol drinkers - A randomized controlled trial in community-based primary care practices. JAMA 1997; 277:1039-1045.
28. Kaner EF, Heather N, Mcavoy BR, Lock CA, Gilvarry E. Intervention for excessive alcohol consumption in primary health care: attitudes and practices of English general practitioners. Alcohol Alcohol 1999; 34:559-566.
29. Anderson P, Kaner E, Wutzke S, Funk M, Heather N, Wensing M, et al. Attitudes and managing alcohol problems in general practice: An interaction analysis based on findings from a WHO colla- borative study. Alcohol Alcohol 2004; 39:351-356.
30. Babor TF, Grant M. Project on identification and management of alcohol related problems. Report on Phase II: A randomized clinical trial of brief interventions in the primary health care setting. Geneva, World Health Organization, 1992.
31. Nick Heather. WHO Collaborativ e Project on Identification and Management of Alcohol-Related Problems in Primary Health Care. Report on Phase IV: Development of Country-Wide Strategies for Implementing Early Identification and Brief Intervention in Primary Health Care. Heather. Geneva, World Health Organization 2006.
32. Babor TF, Grant M, Acuda W, Burns FH, Campillo C, Delboca FK, et al. A Randomized Clinical-Trial of Brief Interventions in Primary Health-Care - Summary of A WHO Project. Addiction 1994; 89:657-660.
33. World Health Organization. Development of Country-wide Strategies for Implementing Early Identification and Brief Alcohol Intervention in Primary Health Care Phase III. 2006. www.whoalcohol-phaseiv.net/phase%203.htm. 22-12-2006.
34. Roche AM, Freeman T. Brief interventions: good in theory but weak in practice. Drug and Alcohol Review 2004; 23:11-18.
35. Akvardar Y. Pratisyen hekimlerin alkol kullanım sorunları olan hastalara yaklaşımlarının geliştirilmesi: Randomize kontrollü eğitim çalışması. Yayımlanmamış Doktora Tezi, İzmir, Dokuz Eylül Üniversitesi Sağlık Bilimleri Enstitüsü, 2007.