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German Guidelines on Screening, Diagnosis and Treatment of Alcohol Use Disorders

Mann K.a · Batra A.b · Fauth-Bühler M.a · Hoch E.a, c · and the Guideline Group

Author affiliations

aDepartment of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, bDepartment of Psychiatry and Psychotherapy, University Hospital Tuebingen, Tuebingen, and cDepartment of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany

Corresponding Author

Prof. em. Karl Mann, MD

Central Institute of Mental Health

Senior Professor, Medical Faculty Mannheim/Heidelberg University

Square J5, DE-68159 Mannheim (Germany)

E-Mail karl.mann@zi-mannheim.de

Related Articles for ""

Eur Addict Res 2017;23:45-60

Abstract

Evidence-based strategies for screening, diagnosing and treating alcohol use disorders (AUD) are instrumental in the early and better management of individuals at risk for or suffering from AUD. However, existing guidelines vary and may be biased by conflicts of interests. Unbiased recommendations can be achieved only if sufficient detail is provided on the composition and representativeness of author groups, methodological rigor, handling of potential conflicts of interest and financing. This paper presents the first evidence-based guidelines for AUD from German-speaking countries. These guidelines are based on the work of delegates from a representative sample of 46 scientific societies (mostly medical) from Austria, Germany and Switzerland dealing with AUD. It also included patients and relatives. Recommendations were derived from a standardised hierarchical process involving quality controls drawn from existing guidelines, de novo literature searches and/or expert experience. Potential conflicts of interest were assessed yearly and led to exclusion from voting in specific areas. An overall cost of more than 400,000€ (for alcohol and tobacco guidelines) were exclusively covered by the participating societies and academic institutions. More than 100 recommendations on screening, diagnostics and treatment of AUD are outlined in this paper, and their scientific background is given in the online supplementary material. Tables of aggregated study synopses (in English) and the full version of guidelines (in German) are available (see “Links”).

© 2017 S. Karger AG, Basel


Introduction

According to the actual estimates, there are currently more than 2 million adults (1.8 million in the age range of 18-64 years) in Germany who fulfill the criteria for alcohol dependence [1]. Another 2 million suffer from harmful use of alcohol. Nearly 74,000 people die annually due to alcohol-related causes [2]. Alcohol is considered a major risk factor for various somatic diseases and can have severe psychosocial impacts [3,4]. In contrast to other mental disorders such as depression, the general public considers alcohol use disorders (AUD) much less of a problem that needs attention and treatment. Individuals with problematic alcohol intake tend to ignore, deny or trivialise their alcohol-related problems, a behaviour that is considered part of their disorder. Medical treatment often focuses on comorbidities and secondary diseases. Failure to recognise AUD as causal in these individuals hinders health care professionals to adequately treat these patients.

Estimation models suggest that in Germany 2,000 lives could be saved per year if the rates of patients in psycho- and/or pharmacological treatment increased from 10 to 40% [5]. To address the goal of involving more patients, we developed the current guideline for AUD to screen, diagnose and treat individuals suffering from AUD. The guideline conforms to the highest quality standards of the association of scientific medical societies (AWMF) [6] in Germany and constitutes the first such guideline in German-speaking countries. The recommendations summarised in the following are based on a systematic literature search. A formal consensus was used to adopt the recommendations.

The guideline is aimed at improving screening, diagnosis and treatment of individuals with at-risk consumption of alcohol, harmful alcohol use or alcohol dependence [7]. While the primary endpoint in many studies is the reduction of alcohol consumption, abstinence from alcohol remains an important goal especially for dependent individuals. Systematically developed, the guideline serves as a basis for healthcare professionals and individuals concerned and their relatives. The systematic search considers studies which were published until the end of 2012. Results from studies published until early 2014 could be considered, but in this case of an “unsystematic search” only Clinical Consent Point (CCP) recommendations were possible according to AWMF [6]. The guideline fosters the use of the most effective interventions and helps to point out procedures and treatments with no or minimal evidence. It is important to differentiate between a treatment method which receives low evidence grades due to the lack of studies or due to a failure to prove effectiveness (and hence should be recommended as inefficient or even harmful for the patient).

The guideline should serve as a basis for decision making for the following groups of people:

• Adults with at-risk consumption of alcohol, harmful use or alcohol dependence, and specific patient groups with special needs (children, adolescents, pregnant women, and women, elderly people) and individuals concerned with somatic and psychiatric comorbidities and secondary diseases, and their relatives.

• Professionals (general practitioners, psychiatrists, psychotherapists, psychologists, social workers, social education workers, nurses, occupational therapists, staff in other institutions, legal advisors and others working in the social care system).

• Other persons and policy makers in the health and social system, who offer or organise support for people with psychological problems and psychiatric diseases.

It is of great importance to recognise and treat risky alcohol use, harmful alcohol use or alcohol dependence in a broad spectrum of settings and care areas. Screenings, motivation and early interventions can, for example, be applied in the primary healthcare setting (general practitioners, general hospitals and emergency facilities) and in work and training places. In addition, a variety of highly specialised healthcare areas exist for individuals with AUD. Examples are detoxifications and qualified withdrawal treatments (QWT).

Methods

Systematic Search, Selection and Evaluation of Scientific Evidences

The guideline “Screening, Diagnosis and Treatment of Alcohol Use Disorders” was developed between 2010 and 2015 following an iterative, hierarchical search process [6].

In a first step, the content and scope of the guideline was defined. Questions of high clinical relevance for the healthcare system were formulated and operationalised for subsequent literature search. In a second step, a systematic search was conducted on nationally and internationally available guidelines. Evidence-based suggestions in these guidelines were summarised and methodically assessed using the “German Handbook on Methodological Assessment of treatment guidelines” (http://www.leitlinien.de/leitlinien-grundlagen/leitlinienbewertung/delbi). In a third step, these recommendations were complemented by findings published in systematic reviews of the Cochrane Drugs and Alcohol Library. These reviews provide a comprehensive and systematic overview of the state of the art including quality evaluations. If clinical questions were not answered satisfactorily, a search for further systematic reviews, meta-analyses and single-case reports was added in a fourth step. A detailed methodological description including the instruments used for the quality checks can be found in the full guideline report (in German, please refer to http://www.awmf.org/leitlinien/detail/ll/076-001.html [6,8]). For a brief summary, see below. The full report also hosts more than 500 pages of tables (in English) where study synopses are aggregated (look for “Tabellenband” in http://www.awmf.org/fileadmin/user_upload/Leitlinien/076_D_Ges_fuer_Suchtforschung_und_Suchttherapie/076-001e_S3_Alkohol_2015-01.pdf).

Evaluation of Evidence

Systematic reviews, meta-analyses and single studies were methodologically evaluated using the checklists of the “Scottish Intercollegiate Guidelines Network [9].” Based on the type and methodological quality of the study, a level of evidence was given (Table 1) and the study details summarised for the guideline report (for link see above). The levels of evidence served as a basis for the grading of recommendations (Table 2;Fig. 1). Further considerations (ethical, clinical, …) could be considered for grading as well, and may have led to the up- or downgrading of a recommendation by one level.

Table 1

Level of evidence (LoE) [10]

http://www.karger.com/WebMaterial/ShowPic/536181

Table 2

Grades of recommendations (modified from [11])

http://www.karger.com/WebMaterial/ShowPic/536180

Fig. 1

From level of evidence to grade of recommendation (modified from [12]). * According to GRADE [13] and Oxford Centre of Evidence-based Medicine [10]. ** According to the German National Guidelines Program. For negative recommendations, the term “not” is added and the same symbols are used.

http://www.karger.com/WebMaterial/ShowPic/536167

Structured Way of Finding Consent

All key recommendations and grades of recommendations were drafted by members of 7 working groups which dealt with specific areas. Subsequently, they were carefully checked by the steering committee composed of seven elected members. In a next step, six consensus meetings (of 1-3 days duration) took place where all recommendations were presented and discussed, and the group of delegates voted on all recommendations. The principles of voting are defined by the German Association of Scientific Medical Associations (AWMF). Recommendations are not only based on evidence of effectiveness (and side effects), but also on other points such as ethical considerations, personal experiences of delegates including patients and relatives and alike (Fig. 1). Recommendations are accepted if only 75% of all delegates agree to wording and recommendation grades. In this case, the result is called a “consensus”. For a “strong consensus” 95% of participants had to agree. The voting was open.

Delegates for the consensus group had been nominated by 46 specialist societies from Austria, Switzerland and Germany. To avoid systematic bias, an external moderator from the AWMF steered the consensus meetings. To further assure agreement on the guideline recommendations, all documents were sent for final approval to the boards of the participating scientific societies. As the literature continues to expand, the guidelines will be updated every 5 years.

Potential Conflicts of Interest

Delegates were asked to declare any interests that could constitute an apparent or potential conflict of interest with respect to his or her involvement in the project. This was repeated on an annual basis (time frame: last 3 years). Experts had to indicate (a) direct financial interests (e.g., reimbursements from companies and organisations working in the healthcare industry, pharmaceutical companies, counselling and non-profit treatment institutions, pensions or healthcare insurances); (b) indirect relations to companies with financial interests in this area (e.g., activities for a lobby group of treatment facilities); (c) immaterial interests regarding academic, subject-specific, political and personal opinions, norms or personal relationships with other participants, which could potentially bias their decision. A member of the steering committee was responsible for double-checking whether the disclosure questions had been assessed. The declaration of interests and decisions on how to proceed with them, were discussed and decided in the consensus meeting. As a result, delegates were allowed to vote only in matters where no conflict of interest existed. This process was double-checked by the moderator of AWMF and the steering committee.

Financing the Guideline

The guideline “Screening, Diagnosis and Treatment of Alcohol Use Disorders” was developed together with the guideline “Screening, Diagnosis and Treatment of Tobacco-related Disorders” (see Batra et al. [14] for English version). Both guidelines were prepared under the auspices of the German Society for Psychiatry, Psychotherapy and Psychosomatics (Deutsche Gesellschaft für Psychiatrie, Psychotherapie, Psychosomatik und Nervenheilkunde) and the German Society for Addiction Research and Addiction Therapy (Deutsche Gesellschaft für Suchtforschung und Suchttherapie). Fifteen scientific specialist societies, professional associations and organisations were involved in financing the guidelines. The costs for both guidelines together amounted to approximately 400,000€ (excluding expenses of the societies for sending delegates; please refer to the German version for details [6]).

Results

The essential results of the process are given in this paper. However, recommendations on the impact of psychiatric comorbidities on screening, diagnostics and treatment of AUD patients were published in a separate paper (Preuss et al. [15], English version under review).

Screening and Diagnostics of Intoxication, Harmful Alcohol Consumption and Alcohol Dependence

AUD are frequent but often remain undiagnosed. State-dependent markers can be used alone or in combination with questionnaires for early screening, precise diagnostics, estimation of disease severity, documentation of disease course and therapy. A state-dependent marker is defined as a characteristic of the clinical status, appropriate for monitoring the disease course and outcome.

From a public health perspective, screenings are recommended in patients aged 14-70 years starting with the initial contact. Screenings should be repeated every 1-2 years.

In this paper, the term “acute” is used when alcohol intake was within the last hours or days. The term “chronic” is used when alcohol was consumed within the last weeks or months (Tables 3, 4; references in online suppl. material; for all online suppl. material, see www.karger.com/doi/10.1159/000455841).

Table 3

Screening and diagnostics of intoxication, harmful alcohol consumption and alcohol dependence (references marked with S can be found in the suppl. material)

http://www.karger.com/WebMaterial/ShowPic/536179

Table 4

Somatic complications of alcohol use disorders and comorbidities (references marked with S can be found in the suppl. material)

http://www.karger.com/WebMaterial/ShowPic/536178

Comorbid Psychiatric Diseases

Alcohol consumption can lead to various mental comorbidities. Inter-individual differences exist regarding the disease type and severity. In addition to the diagnostics of AUD, the precise diagnostics of comorbid mental disorders is important (Table 5; references in online suppl.). This chapter was published in German in a separate paper [15], English version under review.

Table 5

Concomitant tobacco use (references marked with S can be found in the suppl. material)

http://www.karger.com/WebMaterial/ShowPic/536177

Age- and Gender-Specific Populations

For the treatment of AUD in age- and gender-specific populations, different treatment recommendations may apply. For example, with respect to children and adolescents, developmental perspectives and family situations should be taken into consideration (Table 6; references in online suppl.). As in other parts of the guidelines, some of the points made in this context are based on clinical experience rather than on scientifically derived evidence. In elderly people, metabolic changes and increased rates of somatic comorbidities and cognitive disabilities need to be taken into consideration (Table 8). For women, and in particular pregnant women, interventions and treatment settings should be tailored to their specific needs (Table 7; references in online suppl.).

Table 6

Children and adolescents (references marked with S can be found in the suppl. material)

http://www.karger.com/WebMaterial/ShowPic/536176

Table 7

Pregnant women (references marked with S can be found in the suppl. material)

http://www.karger.com/WebMaterial/ShowPic/536175

Table 8

Elderly people (references marked with S can be found in the suppl. material)

http://www.karger.com/WebMaterial/ShowPic/536174

Acute Treatment of Harmful Alcohol Use and Alcohol Dependence

Brief Interventions

Brief interventions can be applied to motivate individuals with problematic alcohol consumption in non-specialised settings to reduce their alcohol intake or to achieve abstinence. Brief interventions are defined as interventions with a maximum of 5 sessions, each lasting not more than 60 minutes. The interventions are targeted to reduce alcohol consumption and alcohol-associated problems. Therefore, an integrated approach is used combining: (a) personalised feedback, (b) individual definition of goals, and (c) concrete advice. Brief interventions can be provided in an electronic format. In addition, they can be supplemented by information material in written form or provided in a computer-assisted format.

Brief interventions have been studied particularly in primary healthcare. The best evidence exists for primary outpatient care in patients with harmful alcohol use. The evidence for patients in general hospitals is still insufficient. Compared to general hospitals, brief interventions in work places are rarely studied (Table 9; references in online suppl.).

Table 9

Brief interventions (references marked with S can be found in the suppl. material)

http://www.karger.com/WebMaterial/ShowPic/536173

Detoxification and “Qualified Withdrawal Treatment”

In German language, different terminologies exist for alcohol withdrawal treatment. While ‘detoxification' is limited to the treatment of somatic consequences resulting from withdrawal of alcohol consumption irrespective of the underlying diagnosis or severity, a “qualified withdrawal treatment” (definition below) focuses on alcohol dependence. The term “withdrawal treatment” is used to describe both alcohol detoxification and qualified withdrawal.

Physical detoxification includes treatment of alcohol intoxication with neuro-psychiatric deficits and/or alcohol-related withdrawal symptoms. The main goal is to maintain vital functions and to avoid complications (e.g., epileptic seizures or delirium tremens) and reduction/relief of withdrawal effects.

QWT is an acute treatment beyond physical detoxification. Treatment of intoxication and withdrawal symptoms and diagnostics and treatment of mental and somatic comorbidities and secondary diseases are done simultaneously. Essential for a QWT are psycho- and socio-therapeutic elements that support the willingness to change, the competence to change and the stabilisation of abstinence. The motivation to seek further support should be increased and corresponding contacts into the regional help system established (e.g., self-help groups, psychotherapy, social work) within the scope of QWT. When indicated, options for further treatment are arranged, for example, social or medical rehabilitation (Table 10; references in online suppl.).

Table 10

Detoxification and “qualified withdrawal treatment (QWT)” (references marked with S can be found in the suppl. material)

http://www.karger.com/WebMaterial/ShowPic/536172

Pharmacotherapy for Alcohol Detoxification

If alcohol-dependent individuals stop drinking, clinically relevant and often dangerous withdrawal symptoms can be observed. The type and degree of withdrawal symptoms can vary from person to person. Pharmacological treatment can lead to suppression of withdrawal symptoms, prevent acute complications that may be life-threatening and reduce or prevent long-term complications (Table 11; references in online suppl.).

Table 11

Pharmacotherapy for alcohol detoxification (references marked with S can be found in the suppl. material)

http://www.karger.com/WebMaterial/ShowPic/536171

Post-Acute Treatment for Dependent Individuals after Detoxification

Post-acute treatment can be offered as an outpatient, full-day outpatient or in-patient weaning (rehabilitation) treatment and pharmacological relapse prevention or other forms.

These comprise institutions for chronically impaired patients, in particular socio-therapeutic institutions for chronic alcohol-dependent individuals with multi-morbid conditions and low-threshold approaches, counselling services and interventions that enhance the possibilities to get a job.

Post-acute treatment is often part of medical rehabilitation to abstain from alcohol. The aim is to maintain, improve or reinstate the performance and functions of the alcohol-dependent individual and to support participation in work-life and society. In Germany, medical rehabilitation for most alcohol-dependent individuals is conducted on behalf of statutory pension insurance with the aims outlined above. The rehabilitation institutions require that the addicted individual stays abstinent or is at least able to minimise relapse regarding frequency, duration and severity (Table 12; references in online suppl.).

Table 12

Post-acute treatment after in-patient and outpatient detoxification (references marked with S can be found in the suppl. material)

http://www.karger.com/WebMaterial/ShowPic/536170

Psychosocial Interventions of AUD

Psychosocial interventions are important and effective in almost every stage of the addiction process. This holds true, for example, for interventions to improve motivation in general medicine, in QWT or as part of a more complex withdrawal treatment and as a stand-alone outpatient intervention in the post-acute phase. The most compelling evidence exists for Motivational Enhancement Therapy [16].

Below we refer primarily to psychosocial and psychotherapeutic interventions which are generally used in German-speaking countries (Table 13; references in online suppl.). A more detailed description of evidence-based psychotherapeutic approaches and treatment recommendations can be found in the long version of the guideline. Proofs of efficacy exist for common psychotherapeutic approaches. However, none of the studies systematically reported any side effects. Therefore, we recommend conducting further studies in which side effects are listed systematically, similar to pharmacotherapy studies.

Table 13

Psychotherapy of alcohol use disorders (references marked with S can be found in the suppl. material)

http://www.karger.com/WebMaterial/ShowPic/536169

Pharmacotherapy in Post-Acute Treatment

In the NICE guidelines (2011) [17,] the effectiveness of different medications used for the treatment of alcohol-dependent patients was systematically analysed. For the following chapter, we evaluated and adopted the NICE recommendations where appropriate. Nalmefene studies leading to approval by the European Medicines Agency were published from 2013 onwards, which was after our own systematic search was closed (end of 2012). Following the AWMF rules, recommendations for nalmefene treatment were not part of the systematic review and had to be graded as CCP. Disulfiram which has shown efficacy in several studies was not analysed because the manufacturer removed it from the German market.

Overall, some of the recommendations here (and elsewhere) may not be completely in line with meta-analyses and other sources of gathered information. In these cases and after weighing all arguments, a majority of members of the consensus felt that a divergent recommendation was justified (Table 14; references in online suppl.).

Table 14

Pharmacotherapy in post-acute treatment (references marked with S can be found in the suppl. material)

http://www.karger.com/WebMaterial/ShowPic/536168

Members of “the Guideline Group”

Klaus Amann, Julia Arens, Anil Batra*, Martin Beutel, Oliver Bilke-Hentsch, Gallus Bischof, Udo Bonnet, Gerhard Bühringer*, Ralf Demmel, Heribert Fleischmann, Jennis Freyer-Adam, Wilma Funke, Dieter Geyer, Euphrosyne Gouzoulis-Mayfrank, Arthur Günthner, Ursula Havemann-Reinecke, Derik Hermann, Eva Hoch*, Bettina Jäpel, Michael Klein*, Andreas Koch, Joachim Köhler, Georg Kremer, Gerhard Längle, Nikolaus Lange, Bodo Lieb, Johannes Lindenmeyer, Karl Mann*, Peter Missel, Tim Neumann, Kay-Uwe Petersen*, Ulrich W. Preuß, Jens Reimer*, Olaf Reis, Gerhard Reymann*, Monika Ridinger, Hans-Jürgen Rumpf, Peter-Michael Sack, Ingo Schäfer, Martin Schäfer, Norbert Scherbaum, Welf Schröder, Manfred Singer, Michael Soyka, Claudia Spies, Julian Stappenbeck, Rainer Thomasius, Natascha Thon, Clemens Veltrup, Irmgard Vogt, Tillmann Weber, Georg Weil, Volker Weissinger, Bernd Wessel, Arnold Wieczorek, Klaudia Winkler, Nadja Wirth, Norbert Wodarz, Dirk Wolter, Friedrich M. Wurst.

* Member of the steering committee

Links

http://www.awmf.org/leitlinien/detail/ll/076-001.html.

http://www.awmf.org/uploads/tx_szleitlinien/076-001m_S3-Leitlinie_Alkohol_2015-02_02.pdf.

http://www.awmf.org/fileadmin/user_upload/Leitlinien/076_D_Ges_fuer_Suchtforschung_und_Suchttherapie/076-001e_S3_Alkohol_2015-01.pdf.

Acknowledgement

We would like to thank the guideline consensus group for sharing their expertise and knowledge. The authors are grateful to Ingrid Weber who kept the whole process afloat for over more than 5 years and who provided the baseline translation for this paper. We further thank Angelika Heimann for helping with manuscripts.

Disclosure Statement

K.M. received fees for consulting from Abbvie, D&A Pharma, Lundbeck and Novartis. M.F.-B., E.H., and A.B. have no conflicts of interest.


References

  1. Pabst A, Kraus L, Gomes de Matos E, Piontek D: Substanzkonsum und substanzbezogene Störungen in Deutschland im Jahr 2012. Sucht 2013;59:321-331.
    External Resources
  2. Gärtner B, et al: Alkohol - Zahlen und Fakten zum Konsum. Jahrbuch Sucht 2013:36-66.
  3. Salize HJ, Jacke C, Kief S, Franz M, Mann K: Treating alcoholism reduces financial burden on care-givers and increases quality-adjusted life years. Addiction 2013;108:62-70.
  4. Singer MV, Batra A, Mann K (Hrsg): Alkohol und Tabak. Grundlagen und Folgeerkrankungen. Stuttgart und New York, Thieme Verlag, 2011, pp 57-62.
  5. Rehm J, Rehm M, Shield KD, Gmel G, Frick U, Mann K: Reduzierung alkoholbedingter Mortalität durch Behandlung der Alkoholabhängigkeit [Decrease in alcohol-attributable mortality by treatment of alcohol dependents]. Sucht Zeitschrift für Wissenschaft und Praxis 2014;60:93-105.
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  6. Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) - Ständige Kommission Leitlinien. AWMF-Regelwert “Leitlinien”. 1. Auflage 2012. Verfügbar. http://www.awmf.org/leitlinien/awmf-regelwert.html (August 5, 2016).
  7. Hoch E, Batra A, Mann K: Das S3-Leitlinienprogramm für substanzbezogener Störungen. Sucht 2012;2:14-25.
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  14. Batra A, Petersen KU, Hoch E, Andreas S, Bartsch G, Gohlke H, Jähne A, Kröger C, Lindinger P, Mühlig S, Neumann T, Pötschke-Langer M, Ratje U, Rüther T, Schweizer C, Thürauf N, Ulbricht S, Mann K: S3 Guideline “Screening, diagnostics, and treatment of harmful and addictive tobacco use”. Sucht 2016;62:139-152.
    External Resources
  15. Preuss UW, Gouzoulis-Mayfrank E, Havemann-Reinecke U, Schäfer I, Beutel M, Mann KF, Hoch E: Psychische Komorbiditäten bei alkoholbedingten Störungen. Nervenarzt 2016;87:26-34.
    External Resources
  16. Sellman JD, Sullivan PF, Dore GM, Adamson SJ, MacEwan I: A randomized controlled trial of motivational enhancement therapy (MET) for mild to moderate alcohol dependence. J Stud Alcohol 2001;62:389-396.
  17. National Institute for Health and Care Excellence: Alcohol-Use Disorders: Diagnosis, Assessment and Management of Harmful Drinking and Alcohol Dependence (CG 115). National Institute for Health and Clinical Excellence, 2011.
    External Resources

Author Contacts

Prof. em. Karl Mann, MD

Central Institute of Mental Health

Senior Professor, Medical Faculty Mannheim/Heidelberg University

Square J5, DE-68159 Mannheim (Germany)

E-Mail karl.mann@zi-mannheim.de


Article / Publication Details

First-Page Preview
Abstract of Review

Received: August 12, 2016
Accepted: January 09, 2017
Published online: February 09, 2017
Issue release date: February 2017

Number of Print Pages: 16
Number of Figures: 1
Number of Tables: 14

ISSN: 1022-6877 (Print)
eISSN: 1421-9891 (Online)

For additional information: https://www.karger.com/EAR


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References

  1. Pabst A, Kraus L, Gomes de Matos E, Piontek D: Substanzkonsum und substanzbezogene Störungen in Deutschland im Jahr 2012. Sucht 2013;59:321-331.
    External Resources
  2. Gärtner B, et al: Alkohol - Zahlen und Fakten zum Konsum. Jahrbuch Sucht 2013:36-66.
  3. Salize HJ, Jacke C, Kief S, Franz M, Mann K: Treating alcoholism reduces financial burden on care-givers and increases quality-adjusted life years. Addiction 2013;108:62-70.
  4. Singer MV, Batra A, Mann K (Hrsg): Alkohol und Tabak. Grundlagen und Folgeerkrankungen. Stuttgart und New York, Thieme Verlag, 2011, pp 57-62.
  5. Rehm J, Rehm M, Shield KD, Gmel G, Frick U, Mann K: Reduzierung alkoholbedingter Mortalität durch Behandlung der Alkoholabhängigkeit [Decrease in alcohol-attributable mortality by treatment of alcohol dependents]. Sucht Zeitschrift für Wissenschaft und Praxis 2014;60:93-105.
    External Resources
  6. Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) - Ständige Kommission Leitlinien. AWMF-Regelwert “Leitlinien”. 1. Auflage 2012. Verfügbar. http://www.awmf.org/leitlinien/awmf-regelwert.html (August 5, 2016).
  7. Hoch E, Batra A, Mann K: Das S3-Leitlinienprogramm für substanzbezogener Störungen. Sucht 2012;2:14-25.
  8. Mann K, Hoch E, Batra A, Bonnet U, Günthner A, Reymann G, Soyka M, Wodarz N, Schäfer M: Leitlinienorientierte Behandlung alkoholbezogener Störungen [Guideline-oriented treatment of alcohol-related disorders]. Nervenarzt 2016;87:13-25.
  9. Scottish Intercollegiate Guidelines Network (SIGN): The management of harmful drinking and alcohol dependence in primary care. http://www.sign.ac.uk/guidelines (August 5, 2015).
  10. OCEBM Levels of Evidence Working Group: The Oxford Levels of Evidence 2. Oxford Centre for Evidence-Based Medicine. http://www.cebm.net/index.aspx?o=5653 (August 10, 2015).
  11. Bundesärztekammer (BÄK), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Kassenärztliche Bundesvereinigung (KBV): Nationales Programm für Versorgungs-Leitlinien. Methoden-Report, 2014.
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