Reimer J, Cimander K F, Reimer C
Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg.
Kompetenzzentrum für Suchtmedizin und Infektiologie, Hannover.
Dtsch Med Wochenschr. 2014 May;139(18):943-52; quiz 953-6. doi: 10.1055/s-0034-1369832. Epub 2014 Apr 23.
Subjects with alcohol dependence or alcohol-related health problems frequently use the primary care system without receiving the correct diagnosis or specific interventions. Stigma, lack of knowledge and know-how with regards to diagnosis and treatment of alcohol-related disorders on the site of the health care professionals may contribute to the treatment gap. General anamnesis, clinical evaluation, and laboratory parameters can serve as indicators, and validated screening tests can further corroborate the hypothesis. However, a diagnosis should only be made according to ICD-10 criteria. Adequate counselling techniques substantially contribute to successful physician-patient interaction. Motivational Interviewing combines a positive, appreciative attitude with communicative techniques to create a motivation to change. It includes general approaches as open questions, appreciation of the patient, active listening, summarizing results as well as specific approaches such as change and confidence talk and dealing with resistance. Within a positive relationship, the conversation can lead to change. Brief interventions cover four to five sessions with a duration between five and sixty minutes. Brief interventions based on an empathic attitude und reflection of findings, a brief advice leaving the responsibility on the patient's side and supporting self-efficacy can improve alcohol-related disorders. The transtheoretical model of change may help the health care provider to adapt intervention strategies to the patient's state. Primary health care provides an adequate framework for screening, diagnosis and intervention for alcohol-related disorders with the aim of reduction or abstinence. Further institutions in addiction treatment such as self-help and clinical institutions may complement the treatment system.
患有酒精依赖或与酒精相关健康问题的患者经常使用初级保健系统，但未得到正确诊断或特定干预。医疗保健专业人员在酒精相关疾病的诊断和治疗方面存在耻辱感、知识和技能不足，这可能导致治疗差距。一般问诊、临床评估和实验室参数可作为指标，经过验证的筛查测试可进一步证实诊断假设。然而，诊断应仅根据国际疾病分类第十版（ICD - 10）标准进行。适当的咨询技巧对成功的医患互动有很大帮助。动机性访谈将积极、赞赏的态度与沟通技巧相结合，以激发改变的动力。它包括一般方法，如开放式问题、对患者的赞赏、积极倾听、总结结果，以及特定方法如改变和信心谈话以及应对抵触情绪。在积极的关系中，对话可促成改变。简短干预包括四到五次疗程，每次时长五到六十分钟。基于共情态度和对结果的反思、将责任留给患者并支持自我效能感的简短建议的简短干预，可改善与酒精相关的疾病。跨理论模型可能有助于医疗保健提供者根据患者状态调整干预策略。初级卫生保健为酒精相关疾病的筛查、诊断和干预提供了适当框架，目标是减少饮酒或戒酒。成瘾治疗的其他机构，如自助机构和临床机构，可补充治疗体系。
