Therapeutical strategies and aid for chronical alcoholics

Chronical alcoholics are a challenge in therapy, especially if they have an adverse course of illness and treatment as well as multiple resulting soma tical and neurological diseases. In German treatment of alcoholics the term 'chronisch mehrfach geschadigte Alkoholkranke' (chronically multiple affec ted alcoholics) has been established, describing patients with severe somat ical and psychological disorders as well as social, professional, financial or legal problems. Permanent or even temporary abstinence is hard to achie ve for these patients. They are usually found in psychiatric hospitals rath er than in addiction wards, but also in social services or even prisons. Re habilitation is possible in mental state hospitals that accept patients wit h dual diagnosis, sometimes even in special wards. Psychiatric co-morbidity in alcoholics is often underestimated. This is most important for psychoti c illness, as well as other psychic diseases. A special problem is posed by delinquent patients that often have to be treated while in a penal institu tion. Some of the follow-up studies done on that have shown relatively good results in patients in penal institutions, but further studies are needed. As of yet, recent treatment options in pharmacotherapy to prevent alcoholic relapse are not sufficiently used. Anti-dipsotropics or so-called anti-cra ving-agents like acamprosate and naltrexone are primarily given to increase the rate of abstinence but could successfully be used in a harm reduction strategy (less drinking, shorter relapses).