This paper reviews the state of alcohol treatment services in Russia. There have been some recent improvements, for example the introduction of confidentiality in treatment, the closure of correctional centres, and the payment of state benefits to in-patients. However, there remains a considerable stigma attached to a diagnosis of alcoholism. Although new approaches to treatment have been promulgated, in practice Russian treatment methods remain idiosyncratic with little in the way of psychotherapy. Many techniques utilise placebos and persuasion, with the patient as a passive recipient. Services are generally of a poor quality, and underfunded and medical specialists are poorly trained. To improve matters it is suggested that there will need to be: (1) changes in knowledge and attitude among the general population and within the specialist services; and (2) a continuing exchange of ideas and specialists between Russia and the West.
An epidemic of scabies affecting elderly patients on one ward of a nursing home is described. The outbreak was characterized by a high degree of contagion and treatment resistance among patients suffering from malignant diseases and receiving immunosuppressive therapy. The clinical picture was unusual, with papules surmounted by scabies burrows and a high percentage of persistent nodular lesions. The origin of the outbreak was probably a patient with an exfoliative psoriasis, treated with an aromatic retinoid and potent topical corticosteroids. In view of the high recurrence rate, follow-up may be advisable especially in elderly patients.
Women with alcohol problems constitute an increasing number of patients in medical service. Do they need special care? How should the treatment program be designed? The specialized female Karolinska Project for Early Treatment of Women with Alcohol Addiction (EWA) unit at the Karolinska Hospital in Stockholm, Sweden, was opened in 1981. The aim of the project is to reach women in an early stage of alcohol dependence behavior and to develop treatment programs specific to the needs of females alone. In order to investigate the value of such a specialized female unit a controlled 2-year follow-up study was carried out including 200 women. The probands were treated in the female only EWA-unit, whereas the controls were placed in the care of traditional mixed-sex alcoholism treatment centers. The 2-year follow-up study showed a more successful rehabilitation regarding alcohol consumption and social adjustment for the women treated in the specialized female unit (EWA). Improvement was noted also for the controls but to a lesser extent. Probably one of the most important achievements of a specialized female unit, such as EWA, is to attract women to come for help earlier.
It was shown that the prevalence of alcoholism among pulmonary tuberculosis patients was high and the outcomes of both the diseases proceeding in the presence of lowered immunity were often unfavourable, including the results of long-term follow-ups. The use of a specially constructed instrument for investigating the neurodynamic characteristics of the cerebral cortex and determination of gamma-glutamyl transpeptidase in the serum promoted diagnosis of prenosological entities of alcoholism. Higher efficacy of alcoholism treatment in the patients with tuberculosis was achieved with narcotic psychotherapy using the mixture of nitrous oxide and oxygen, esperal implantation and application of rifusal, a new preparation, as well as application of extracorporeal hemosorption and enterosorption for eliminating the intoxication. Higher efficacy of tuberculosis treatment in the alcoholic patients was achieved with intravenous drop-wise infusion of antituberculous drugs along with other routes of administration. For increasing the cellular immunity, the patients were treated with chlorophylliptum or T-activin. Continuation of the complex antialcoholic and antituberculous treatment of outpatients along with simultaneous observation by phthisiologists and narcologists provided higher results.
In a 2-year outpatient treatment programme for alcoholics, 90% of the patients used aversive drugs during some part of the treatment period. Long-term use was significantly related to a favourable drinking outcome during 2 years subsequent to treatment compared with short-term use. Long-term and short-term users did not differ in background data. Continued use of aversive drugs after the first 6 months might have been critical for favourable outcome.
The purpose of this study was to examine the clinical features of alcohol-dependent suicide attempters and the treatment they received before and after the index attempt. A total of 47 subjects with current DSM-III-R alcohol dependence were identified from a systematic sample of 114 suicide attempters in Helsinki. All of them were comprehensively interviewed after the attempt, and the treatment they had received was established from psychiatric and other health-care records and follow-up interviews. Most had a history of psychiatric (83%) or substance abuse (83%) treatment. During the final month before the attempt, half of the subjects (51%) had been treated by health care services; 11% had received disulfiram-treatment and 6% had received psychotherapy. Subjects complied with recommended aftercare more often when they had been actively referred. After 1 month, 64% were being treated by health care services. However, only 14% were receiving disulfiram-treatment and 9% were receiving psychotherapy. These findings suggest that the quality and activity of treatment offered to suicide attempters with alcohol dependence should be improved.
Experimental studies have indicated that disulfiram (Antabuse) has antineoplastic effects against melanoma, breast, and prostate cancer. To explore this hypothesis, we examined the association between disulfiram use and these cancers in a nationwide register-based case-control study nested within ever-users (=one prescription) of disulfiram. Cases were all Danish individuals with a histologically verified first-time diagnosis of malignant melanoma, breast, or prostate cancer during 2000-2009. For each case, we selected four cancer-free controls matched for age, sex, and year of first disulfiram prescription using risk set sampling. Similarly, for secondary analyses, we selected case-control populations for selected tobacco-related and alcohol-related cancer types, that is, cancers of the buccal cavity, liver, lung, and colorectal cancer. Disulfiram use 1 year before cancer diagnosis and the corresponding date for controls were disregarded. We estimated crude and adjusted odds ratios and 95% confidence intervals (CI) for cancer associated with long-term (=500 daily defined doses) versus one-time (one prescription) use of disulfiram. Among 53 856 disulfiram users, we identified 166, 644, and 464 cases, respectively, of melanoma, breast, or prostate cancer. Adjusted odds ratios for melanoma, breast, or prostate cancer associated with long-term disulfiram use were 1.04 (95% CI: 0.60-1.78), 0.92 (95% CI: 0.70-1.22), and 0.77 (95% CI: 0.56-1.06), respectively. For prostate cancer, dose-response analyses showed a further risk reduction with the highest cumulative dose level of disulfiram; however, the test for trend did not reach statistical significance. Our study provides some epidemiological support for a protective effect of disulfiram against prostate and breast cancer.