Total abstinence or harm reduction - different strategies of alcohol treatment in research studies and international guidelines
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Psychiatr Pol 2012;46(3):373–386
Alcohol use is considered to be one of the major factors contributing to global health burden as well as social and economic harm. Only about 16% of alcohol dependent individuals enter addiction treatment programs in Poland, with only a few more in Western Europe. The aim of the paper was to present two main treatment strategies of alcohol dependence: total abstinence and harm reduction. The advantages and disadvantages of both treatment goals are presented, pointing to a possibility of treating them as complementary strategies. A need to choose a proper, personalised patient-oriented aim of a treatment program is emphasised, with an option to revise the objective during long-term therapy.. The paper describes implications from investigating the problem of alcohol dependence from a population health perspective. The surprisingly high amount of individuals remitting spontaneously from alcohol dependence without treatment is also discussed, and a possible bias resulting from analysing data on alcoholic subjects coming only from addiction centres, not from general population is taken into consideration. In the second part of the paper, American as well as British alcohol treatment guidelines are presented.