Dahl G, Thakker K D
Leksands vårdcentral, Huddinge.
Lakartidningen. 1998 Oct 21;95(43):4726-30.
A review of findings in randomised trials with at least one-year follow-up suggests that primary care physicians can intervene briefly and successfully for patients manifesting symptoms of excessive drinking but no serious dependence. The risk level can be assessed by summing the preceding week's intake of spirits, wine and beer in standard measures and then convert it into grams of pure alcohol. Denial is minimised by using a non-judgmental lifestyle approach, and defining problems in terms of lifestyle habits and its consequences. Nervous problems, hypertension and dyspepsia are the most common diagnoses in the target group. Measurement of biochemical markers can be used, the serum gamma-glutamyl transpeptidase (GGT) level being still the most useful. Questionnaires are of limited value as they are associated with high false-positive rates. To motivate patients to reduce alcohol consumption, an intervention strategy with feedback is proposed, mainly based on the monitoring of symptoms and clinical findings including biochemical markers, and a self-help pamphlet is recommended. It is emphasised that the goal should be realistic to the patient, and that controlled drinking is an acceptable goal even in cases of mild dependence.
一项对至少随访一年的随机试验结果的综述表明，初级保健医生可以对表现出过度饮酒症状但无严重依赖的患者进行简短且成功的干预。风险水平可通过将前一周烈酒、葡萄酒和啤酒的摄入量按标准度量相加，然后将其换算为纯酒精克数来评估。通过采用无评判的生活方式方法，并从生活习惯及其后果的角度定义问题，可将否认心理降至最低。神经问题、高血压和消化不良是目标群体中最常见的诊断结果。可以使用生化标志物测量，血清γ-谷氨酰转肽酶（GGT）水平仍然是最有用的。问卷的价值有限，因为它们的假阳性率很高。为了激励患者减少酒精消费，建议采用一种带有反馈的干预策略，主要基于对症状和临床检查结果（包括生化标志物）的监测，并推荐一本自助手册。需要强调的是，目标应对患者来说切实可行，即使在轻度依赖的情况下，控制饮酒也是一个可接受的目标。
