DIAGNOSIS AND PHARMACOLOGICAL TREATMENT OF ALCOHOLIC PATIENTS

A clear understanding of the scope of alcohol (ethanol)-related proble ms is important for effective diagnosis and treatment of alcoholism. T he focus of medical treatment has long been on patients with severe al cohol dependence. These patients constitute only 5 to 6% of the adult population. However, approximately 20% of the adult population can be classified as 'problem drinkers', who are not alcohol dependent and ye t consume alcohol at levels that may result in hazardous medical and p sychosocial sequelae. Evaluation of alcohol-related problems should be viewed as an integral part of a medical assessment in all patients. T he ideal strategy should incorporate the findings of clinical intervie ws, physical examinations, questionnaires and laboratory tests. There has been important progress in the pharmacotherapy of alcoholism, part icularly for alcohol withdrawal and reduction of alcohol consumption. Benzodiazepines are currently the first-line therapy for the treatment of the alcohol withdrawal syndrome. Pharmacotherapy has been improved and simplified with the use of long-acting benzodiazepines via a load ing dose technique. Selective serotonin (5-hydroxytryptamine; 5-HT) re uptake inhibitors (SSRIs) and other agents modulating serotonergic fun ction are currently the most promising agents for the reduction of alc ohol consumption. In short term clinical trials, SSRIs, such as zimeld ine, viqualine, citalopram and fluoxetine, decreased alcohol consumpti on by averages of 14 to 20% from baseline. Reductions of up to 60% wer e observed in some patients. Citalopram and fluoxetine also decreased the desire for alcohol, and may be useful for prevention of relapse af ter detoxification.