3rd Croatian Conference On Alcoholism and Other Addictions: 7th Alpe-Adria Conference On Alcoholism/3. Hrvatska Konferencija O Alkoholizmu I Drugim Ovisnostima: 7. Alpe-Jadran Konferencija O Alkoholizmu

Extract

---

3rd Croatian Conference On Alcoholism and Other Addictions: 7th Alpe-Adria Conference On Alcoholism/3. Hrvatska Konferencija O Alkoholizmu I Drugim Ovisnostima: 7. Alpe-Jadran Konferencija O Alkoholizmu

ALCOHOL RELATED DISORDERS - ONE OF THE LARGEST PUBLIC HEALTH PROBLEMS TODAY, AND TOMORROW?!

Srdan Marusic, Vlatko Thaller

Department of Psychiatry, University Hospital Sestre milordnice, Zagreb, Croatia

Drinking of alcoholic beverages is a part of general human behavior. Widespredness and encouragement of a positive view towards alcohol consumption, as well as availability and low price leads to a development of an »alcohol culture« that finally leads to widespread alcohol related disorders. About 2 billion people worldwide consuming alcohol beverages and 76.3 million with diagnosed alcohol use disorders. Globally, alcohol consumption causes 3.2% of deaths (1.8 million) and 4% of Disability Adjusted Life Years (WHO 2004.)

In Croatia more than 2/3 of population consume alcohol and about 2 500 000 have directly or indirectly consequences because alcohol consumption. Between smoking cigarettes, drinking alcohol or experimenting with psychoactive substances, young people in Croatia prefer alcohol. About 92% of pupils of first classes Middle schools in Croatia consume alcohol.

About 70% of pupils and 48% female pupils at least one time in their life have been drunk.

This stimulating and overspread positive attitude to alcohol use will be result in late middle years with in creased possibilities of alcohol caused problems. In small quantities alcohol is a stimulant for CNS , and in higher doses it is a depressor, but we also can not ignore it's toxicity that leads to a series of damages to both physical and mental health. The relationship between drinking and health is a very complex and multidimensional problem; alcohol is causally connected with over 60 different medical conditions, and it also affects social functioning and the individual who drinks but also his environment, primarily his family. Precisely because of that it is necessary to develop clear and widespread preventive programs that might lead to some crucial breakthroughs in the way of decreasing drinking among children and adolescents, improvement of psychosocial surroundings inside the social community and stopping further development of permanent consequences of alcoholism. We should try to, out of a society with a strong alcoholic culture, to create a society that promotes healthy living, and to strengthen general anti- alcohol politics.

A NEW APPROACH OF CONDUCTING RAPID TRANSFER TO BUPRENORPHINE AMONG ADDICTS WHO DID NOT FUNCTION EVEN ON EXTREMELY HIGH METHADONE DOSES

Slavko Sakoman

Department of Psychiatry, KB »Sestre milosrdnice«, Zagreb, Croatia

Since the initiation of methadone treatment of heroin addicts (1991), the number of heavy and complex cases of drug addicts that could not be stabilized using different approaches, including the usage of high daily doses of methadone, has significantly increased. Even in addicts with whom good cooperation and persistence in therapeutic process has been established, their psychophysical state could not be stabilized and the disturbances which caused them to persistently seek treatment with tranquilization medications (BDZ) and high daily methadone doses, often higher than those that could be attributed to development of tolerance, could not be removed.

Research on the possible causes of these problems has revealed that some addicts show a side effect of dysphoria, which is caused by agonistic effect of methadone on kappa opoid receptors. This category, which includes 10-15% of all the treated opiate addicts, poses enormous load on the treatment system. Since the initiation of buprenorphine treatment 4 years ago, the possibility of transferring at least some of these cases from high methadone doses to this partial opiate agonist was explored, under the assumption that they might better react to this drug. In order to begin treatment with this drug considering its antagonizing effect on methadone, the addict first needed to be tapered on a 30 mg daily dose of methadone to avoid provoked withdrawal effect. Nevertheless, even the attempt of dose reduction resulted in destabilization of general state, negative changes in behavior and in purchasing additional doses of methadone or heroine and BZD on the black market. In searching for a way to accomplish the therapeutic goal in spite of this, we developed a method of fast transfer within hospital treatment, which consists of termination of methadone treatment on the day of admission, while the withdrawal crisis is prevented by temporary giving minimal daily doses of MST continus (morphine sulfate) which are necessary until the methadone is naturally eliminated from the addict's body, which takes 7-10 days. The application of morphine sulfate is then interrupted and, after the withdrawal symptoms begin, the induction of buprenorphine starts, until the stabilization on the necessary daily dose. After the transfer, we still needed to cancel buprenophrine in some addicts, because due to different experience of drug effects (feeling of clarity in the head an...

See the full content of this document

---