Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, QLD, Australia; Discipline of Psychiatry, The University of Queensland, Brisbane, QLD, Australia.
Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Drug Health Services, Sydney Local Health District, Sydney, NSW, Australia.
Lancet. 2016 Mar 5;387(10022):988-998. doi: 10.1016/S0140-6736(15)00122-1. Epub 2015 Sep 3.
Alcohol use disorders are common in developed countries, where alcohol is cheap, readily available, and heavily promoted. Common, mild disorders often remit in young adulthood, but more severe disorders can become chronic and need long-term medical and psychological management. Doctors are uniquely placed to opportunistically assess and manage alcohol use disorders, but in practice diagnosis and treatment are often delayed. Brief behavioural intervention is effective in primary care for hazardous drinkers and individuals with mild disorders. Brief interventions could also encourage early entry to treatment for people with more-severe illness who are underdiagnosed and undertreated. Sustained abstinence is the optimum outcome for severe disorder. The stigma that discourages treatment seeking needs to be reduced, and pragmatic approaches adopted for patients who initially reject abstinence as a goal. To engage people in one or more psychological and pharmacological treatments of equivalent effectiveness is more important than to advocate a specific treatment. A key research priority is to improve the diagnosis and treatment of most affected people who have comorbid mental and other drug use disorders.
在发达国家,酒精使用障碍很常见,因为那里的酒精价格低廉、易于获得且大量促销。常见的轻度障碍通常在年轻成年期缓解,但更严重的障碍可能会变成慢性的,需要长期的医疗和心理管理。医生具有独特的机会评估和管理酒精使用障碍,但实际上,诊断和治疗往往会被延迟。在初级保健中,针对有危险饮酒行为和轻度障碍的个体,简短的行为干预是有效的。简短的干预措施还可以鼓励那些被漏诊和治疗不足的更严重疾病患者尽早接受治疗。对于严重障碍患者,持续戒酒是最佳结果。需要减少阻碍治疗寻求的污名化,对于最初拒绝戒酒作为目标的患者,应采取务实的方法。让人们参与到具有同等效果的一种或多种心理和药物治疗中比提倡一种特定的治疗更为重要。一个关键的研究重点是改善那些同时患有精神障碍和其他药物使用障碍的最受影响人群的诊断和治疗。