ESBRA 2011

Time: 08:30 - 10:00

Organiser: Gerhard A. Wiesbeck, Sandra Mueller, Switzerland

Both tobacco and alcohol dependence are chronic and recurring diseases. Tobacco dependence has a high prevalence all over the world and is the most accepted substance use disorder (SUD) in society. This is true even though it is known that tobacco smoke is responsible for several health risks, health costs and for a high mortality. Among alcohol dependents 70-95% are estimated to be smokers. Comorbidity of tobacco and alcohol dependence boosts health risks, e.g., the risk of death due to a carcinoma, dramatically. Against this background it is astonishing that tobacco dependence is one of the most neglected topics in the treatment of substance use disorders in general. Smoking cessation should become a standard offer in every addiction treatment center.

The aim of this workshop is to discuss progress in tobacco cessation in the last years, the issue of treating the combination of alcohol and tobacco disorders and certain problems and obstacles in this issue.

WS 3
Acute therapy of alcohol addiction - Cut-down-drinking with Naltrexone

(supported by Chiesi Pharmaceuticals GmbH)

Time: 11:30 - 13:00

Organiser: Henriette Walter, Austria

Workshop: Acute therapy of alcohol addiction.

Abstract: Acute therapy of alcohol addiction – Cut-down-drinking with Naltrexone
H. Walter, P. Höfer, K. Skala, Medical University of Vienna, Department of Psychiatry and Psychotherapy

The so called “extinction method” conceived by David Sinclair from Finland is an alternative therapeutic method, which aims at reducing alcohol intake by the opiate antagonizing effects of naltrexone. Thus the learned process of addiction will gradually be deleted („Pharmaco-logic Extinction“) (Hernandez-Avila et al, 2006). The interconnection of the stimuli alcohol consumption and pleasure feeling will be gradually decoupled. The pleasurable feeling cannot set in as long as trhe opiate antagonist is present (pharmacologic de-conditioning). The additde persons should stay in their home conditions (where addiction has developed) and make the experience there, that alcohol has lost its familiar properties.

Over a time period of 3 months the connection “alcohol and lust” is supposed to gradually dissolve. A diary of the consumed drinks visualizes the success and regular counseling carries the reduction of drinking forward. In the US and in Europe the “Contral” clinics use this procedure. This method has been approbated in 1994. The international acceptance develops gradually as therapy goals tend to change in favor of the importance of quality of life and not only abstinence. In the project “combine” Anton et al (2006) could show that counseling did not ameliorate the results. In contrary Chick et al (2000) found that Naltrexone exerts its effects especially together with counseling. A disadvantage is, that the my-opiate receptors become up-regulated and that unfortunately not all patients are responsive to naltrexone.

References:
Anton RF et al (2006) JAMA. May 3;295(17):2003-17.
Hernandez-Avila CA et al (2006) Alcohol Clin Exp Res. 2006 May;30(5):860-5.
Chick J et al (2000)Alcohol Alcohol. 2000 Nov-Dec;35(6):587-93.

WS 4
Relapse prevention in alcohol dependence

Time: 16:30 - 18:00

Organisers: Bankole Johnson, United States, Otto Lesch, Austria

Relapses are common in alcohol dependent patients. Today we know that we have to define carefully the quality and background of relapses (with or without loss of control, caused by depressed or anxiety states, caused by triggers and so on).
We know that psychotherapeutic treatments have only in very few cases good results, but we know also that a combination with anticraving medications increase significantly sobriety rates and decreases significantly the amount and duration of alcohol intake.
In this workshop the position of acamprosate, naltrexone and disulfiram in relapse prevention will be presented and also newer compounds and their practical use will be discussed ( Baclofen, Topiramate, Sodium Oxybate, Ondansetrone, Nalmefene).
According to subgroups of alcohol dependence (family burden with alcohol dependence and or with affective diseases, onset of alcohol dependence, Typologies according to Babor, Cloninger and Lesch) the option of different medical treatments will be presented.
After summarizing these reports and discussions, it will be shown how easy and time saving the LAT instrument can be used. It combines diagnostic procedures with psychotherapeutic approaches and medical treatment

Lesch OM, Walter H, Wetschka CH, Hesselbrock M, Hesselbrock V (2011) Alcohol and Tobacco, Medical and Sociological Aspects of Use, Abuse and Addiction, Springer Wien - NewYork
Johnson B.(2011) Addiction Medicine: Science and Praxis, (Ed) Springer Wien - NewYork

WS 5
"Struktur" - A therapeutic strategy for Type IV alcohol addicts - what we learn from homeless shelters

Time: 18:00 - 19:30

Organiser: Christian Wetschka, Austria, Iannis Mouza, Greece

Is the social attachment one of the psychological and neurobiological links between homelessness and alcohol-addiction?
Fact is that Lesch Type IV alcohol addicts are also determined by social dysfunction. Experiences made in the last two decades in different settings (Homeless Shelter, Commune) in Vienna have led to the evidence that social integration (f. g. living in communities) is one of the most efficient strategies in the sociotherapy of Type IV-addicts. In our two Viennese communes we have an longtime-outcome of 86 - 99 % abstinence duration, values that are very high in comparison to common catamnese-data.
The intention of the workshop is to present and discuss the main principles in organization and sociotherapy of these special and challenging subgroup of alcohol addicts.

Tuesday, September 6

WS 6
Acamprosate: Clinical benefit of Glutamate modulation (supported by Merck-Serono)

Time: 09:00 - 10:30

Chair: Mauro Ceccanti, Italy

Effect of acamprosate on neuronal hyperexcitability
Philippe De Witte, Belgium
Acamprosate may modulate glutamatergic transmission through blockade of metabotropic glutamate receptors, resulting in modulation of the actions of excitatory and inhibitory amino acids. Importantly, these effects were only observed in the setting of alcohol dependence, with no effect in non-dependent animals. The mechanisms involved are complex and likely involve of changes in the activity of excitatory glutamate receptors and also modulation of feedback systems. The net result is that acamprosate prevents the harmful increase in glutamate release during withdrawal from alcohol.

Sleep disturbances in abstinent patients
Pascal Perney, France
There is a high prevalence of sleep disturbance among alcohol-dependent patients, and anxiety or depression were major risk factors for sleep disturbance. Moreover, sleep disturbance before withdrawal was an important predictor of sleep disturbance after withdrawal, and in turn, is likely to increase the risk of alcohol relapse.
Sleep disturbance before alcohol withdrawal should be assessed in alcohol-dependent patients The SSI index appears to be a sensitive and clinically useful score for diagnosis and follow-up of sleep disturbance for this population. In our study, acamprosate was effective both for maintaining abstinence and for decreasing sleep disturbance in these patients.

Alteration of balance glutamate-GABA after alcohol withdrawal in patients seen in emergency
Georges Brousse, France

WS 7
Ethyl Glucuronide –
What can this Biomarker tell us about Ethanol Intake? (supported by Thermofischer Scientific)

Time: 12:30 - 14:00

Introduction
Walda Klomp
International Marketing Manager, Thermo Fisher Scientific

Direct Ethanol Metabolites – Basic Aspects and Clinical Applications
Friedrich M. Wurst
Universitätsklinik für Psychiatrie & Psychotherapie II, Christian Doppler Klinik,
Universitätsklinik Salzburg, Austria

Experiences with EtG Testing from a Laboratory Perspective
Michael Böttcher
Abteilung Drogen- und Medikamentenanalytik, MVZ Labor Dessau GmbH
Dessau, Germany

Monitoring Alcohol Abstention in Patients Awaiting Liver Transplantation
PD Dr. Yesim Erim
Klinik für Psychosomatische Medizin und Psychotherapie
Kliniken / Institut der Universität Duisburg-Essen

Questions & Answers
Closing Remarks
Walda Klomp
International Marketing Manager, Thermo Fisher Scientific

WS 8
Epigenetics and alcohol dependence

Time: 15:00 - 16:30

Organiser: Helge Frieling, Germany

Epigenetic mechanisms have gained profound research interest during the last ten years in the neurosciences. Recent research suggests epigenetic disturbances involving DNA methylation and histone modification to be involved not only in the vulnerability towards psychiatric disorders but also to play a major role for initiating and maintaining active disorders. Especially alcohol dependence seems to have a large “epigenetic background” with the substance excerting large effects on the methylation cycle. In the workshop, the fundamental concepts and mechanisms of epigenetics will be explained and findings in alcohol dependence will be presented. We then want to discuss an “epigenetic model” of addictive disorders with its potential clinical applications.

WS 9
The danger of habit formation in pain therapy (supported by Gerot Lannach)

Time: 15:00 - 16:30

Therapists of Pain and Addiction, how they should cooperate
Wilfried Ilias, Dept. Of Anaesthesiology, Intensive Care Medicine and Pain Therapy, at the Academic Teaching Hospital St. John of God Vienna

The use of morphine and opioids respectively for the treatment of non cancer pain has been discussed since decades. In the same time, it has been neglected, that chronification of pain due to degenerative diseases of the musculo-skeletal apparatus, specifically the lumbar spine became a socio-economic problem. This because of disease related early retirement as well as dependence on public nursing. Social statistics of Austria show, that 30% of early „handicap“ retirements are related to chronic low back pain (1). Although it had been proven repeatedly, that development of addiction, because of therapeutic use of of opioids in chronic none cancer pain patients is a very rare event, it was not before 2003 that an international group of pain experts published a general recommendation for the use of opioids in the treatment of non cancer pain (2). The basic content of this paper is that prescription of opioids for pain treatment should be under control of one responsible physician, escalations of opioid doses and recurrent “losses” of drugs or prescriptions respectively should be observed and followed up with specific alertness, besides, patients should be informed about the potential risk of opioid addiction before starting with he treatment. As to own experiences in pain treatment of opioid addicted patients, cooperation of pain experts with specialist of addiction medicine showed up to be not only helpful but essential to warrant adequate pain control an to avoid escalation of addictive behaviour as well. Besides it could be shown, that nicotine and alcohol abuse are very predictive in estimating the relative risk of opioid addiction in pain patients.

References:
Ilias, W. 2004. Epidemiologie chronischer Schmerzen. In Aktuelle Schmerztherapie, Standards und Entwicklungen. H.G. Kress, editor. Landsberg Lech: Ecomed Medizin. ^1-14.
Kalso, E., Allan, L., Dellemijn, P.L., Faura, C.C., Ilias, W.K., Jensen, T.S., Perrot, S., Plaghki, L.H., and Zenz, M. 2003. Recommendations for using opioids in chronic non-cancer pain. Eur J Pain 7:381-386

Wednesday, September 7

WS 10
Treatment of alcohol dependent patients in a specialized praxis

Time: 08:30 - 10:00

Organiser: Albrecht Ulmer, Germany

The established standard for the treatment of alcohol dependence is very low, compared to other severe chronic diseases. Patients remain insufficiently treated too often. Our documentation shows that a huge number of them are never healed. Abstinence as a goal seems to be insufficient or wrong for them. They have to find a good way of living with the disease. Medicine and all therapeutic disciplines have widely failed to develop this necessary perspective for the patients, together with them. But it is possible!
One sign of the deficient structure is the lack of specialized physicians in private practices, as for nearly all other severe chronic diseases. For almost all of these other diseases, the development of basic medication has clearly improved the situation. We have convincing data that this is also the case for alcohol dependence, and it could turn out much better, if practice and researching units build a new cooperation.
What kind of medication can serve as basic medication and which treatment setting is required?
There is a lot to discuss! Very new and very encouraging perspectives.

last update: Aug. 18, 2011

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