Inpatient Alcohol Detoxification Research Articles

Ketogenic diet reduces a neurobiological craving signature in inpatients with alcohol use disorder.

Increasing evidence suggests that a ketogenic (high-fat, low-carbohydrate) diet (KD) intervention reduces alcohol withdrawal severity and alcohol craving in individuals with alcohol use disorder (AUD) by shifting brain energetics from glucose to ketones. We hypothesized that the KD would reduce a neurobiological craving signature when individuals undergoing alcohol detoxification treatment were exposed to alcohol cues. We performed a secondary analysis of functional magnetic resonance data of 33 adults with an AUD who were randomized to a KD (n = 19) or a standard American diet (SA; n = 14) and underwent 3 weeks of inpatient alcohol detoxification treatment. Once per week, participants performed an alcohol cue-reactivity paradigm with functional magnetic resonance imaging. We extracted brain responses to food and alcohol cues and quantified the degree to which each set of brain images shared a pattern of activation with a recently established 'Neurobiological Craving Signature' (NCS). We then performed a group-by-time repeated measures ANOVA to test for differences in craving signature expression between the dietary groups over the three-week treatment period. We also correlated these expression patterns with self-reported wanting ratings for alcohol cues. For alcohol relative to food cues, there was a main effect of group, such that the KD group showed lower NCS expression across all 3 weeks of treatment. The main effect of time and the group-by-time interaction were not significant. Self-reported wanting for alcohol cues reduced with KD compared to SA but did not correlate with the NCS score. A ketogenic diet reduces self-reported alcohol wanting, and induced lower NCS to alcohol cues during inpatient treatment for AUD. However, in the KD group alcohol wanting continued to decrease across the 3 weeks of abstinence while the NCS scores remained stable, suggesting that this cue-induced NCS may not fully capture ongoing, non-cue-induced alcohol desire.

Further Evidence of Relationship Between Thiamine Blood Level and Cognition in Chronic Alcohol-Dependent Adults: Prospective Pilot Study of an Inpatient Detoxification with Oral Supplementation Protocol.

The relationship between thiamine blood level (TBL) and cognition remains uncertain including amongst alcohol-dependent persons (ADP) AIM: To evaluate this relationship during protocol-driven inpatient alcohol detoxification treatment including thiamine supplementation (AD+Th) METHODS: Prospective 3-week study with 100 consecutively admitted detoxification-seeking ADP (47.7±11 years-old, 21% females) without superseding comorbidities requiring treatment. TBL and Montreal Cognitive Assessment (MoCA) were measured at admission (t1, pre-AD+Th) and discharge (t3, post-AD+Th). Frontal Assessment Battery (FAB) was performed at t1. AD+Th included abstinence, pharmacological alcohol withdrawal syndrome treatment and oral thiamine supplementation (200 mg/day for 14 days). Regression and mediation analyses assessed TBL-cognition relationships. We found no cases of Wernicke Encephalopathy (WE) and only one case of thiamine deficiency. Both MoCA and TBL significantly improved across AD+Th (with medium-to-large effect sizes). At t1, TBL significantly predicted MoCA and FAB sum scores (medium effect sizes; extreme and very strong evidence, respectively). The clear TBL-MoCA association disappeared at t3. In multivariate regression and mediation analyses exploring key influential factors of cognition (identified by LASSO regression), the TBL-MoCA interactions did not relevantly change at t1 and t3. Age, serum transaminases, vitamin D levels, drinking-years and depression score weakly modified the relationship. TBL was a robust predictor of pre-detoxification cognitive impairment, and both TBL and cognition improved significantly during AD+Th (including abstinence) in our ADP population, supporting routine thiamine supplementation for ADP, even those at low WE-risk. TBL-cognition relationship was minimally confounded by age, alcohol-toxicity proxies, mood, and vitamin D levels. https://osf.io/b54eh/.

Interventions to Improve Post-Detoxification Treatment Engagement and Alcohol Recovery: Systematic Review of Intervention Types and Effectiveness

Most inpatient alcohol detoxification patients do not seek treatment post-discharge, which increases the risk of relapse and re-hospitalization. To date, there have been no efforts to synthesize the evidence supporting the broad range of available interventions for this critical transition. The current study is a systematic review and evaluation of interventions designed to promote treatment engagement and recovery following alcohol detoxification. The initial literature search yielded 6419 articles, published since 1999, from PubMed, CINAHL, PsycINFO, Psychology & Behavioral Sciences Collection and PsycARTICLES databases, 49 of which were eligible for full review. Data extraction included in-depth evaluation of intervention types, study and research design features, reported outcomes and study quality/bias indicators. All articles were coded by independent raters and final results were obtained through consensus. Interventions included medical/medication, psychological/psychosocial, technological, mutual-help and combined approaches. On average, medical/medication interventions were less, and psychological/psychosocial and technological interventions were more likely to demonstrate efficacy with respect to treatment engagement and recovery. There was significant variability in study quality/bias but no significant differences across intervention types. Studies differed considerably across measured outcomes, internal and external validity, in/exclusion criteria and documentation of co-occurring psychiatric disorders. Over half of studies reviewed reported empirical support for the intervention(s) evaluated. Although findings slightly favor non-medical interventions, the variability in study design and quality/bias requires more rigorous follow-up research. Recommendations from this review may guide future implementation and intervention development, which are critically needed to improve post-detoxification care and outcomes for patients with alcohol use disorder.

Effect of a 1-year short message service in detoxified alcohol-dependent patients: a multi-center, open-label randomized controlled trial.

Existing evidence suggests that text message interventions can help people to reduce their alcohol consumption. However, studies with alcohol-dependent patients are lacking. In this study a 1-year automatic mobile phone-based short messaging service (SMS) intervention on alcohol consumption in patients after alcohol detoxification in hospital was compared with treatment as usual. Multi-center, randomized, controlled, two parallel-group, observer-blinded trial. Primary and secondary care: four hospitals and community (1million residents, 7600km2 area in Germany). A total of 462 patients with alcohol dependence (ICD-10) were included during inpatient detoxification treatment. Patients were randomly assigned (1:1) to an SMS intervention and treatment as usual (SMS+TAU; n=230; mean age: 45.4years; 22.6% women) or TAU alone (n=232 mean age: 44.5years; 22.8% women). Planned, automated messages were sent to patients over 1year to record assistance needs. A 'yes' or missing response triggered a telephone call from a hospital therapist. Outcome was assessed by an independent survey center. The primary end-point was a three-category alcohol consumption measure covering months 10-12 after discharge: abstinence, non-heavy drinking, heavy drinking [men >60g/day; women >40g/day equal to World Health Organization (WHO) criteria: high risk and very high risk, mean consumption]. Secondary end-points were number of abstinent days over 12months and frequency of abstinence. The arms differed primarily in the heavy drinking category (intervention group 22.2%, TAU-only group 32.3%) in months 9-12. This is reflected by an odds ratio (OR)=1.68, 95% confidence interval (CI)=1.11-2.54, P=0.015 for heavy drinking versus non-heavy drinking/abstinence. No difference between treatments was found with respect to any drinking versus abstinence (OR=1.13). These results were confirmed by models adjusting for randomization strata. In Germany, a 12-month mobile phone short messaging service-based intervention enhanced the reduction in heavy drinking for 1year in routine care among adults with alcohol dependence discharged from inpatient alcohol detoxification.

Elective alcohol detoxification – a resource and efficacy evaluation

An evaluation was performed to assess efficacy and resource utilisation of an elective inpatient alcohol detoxification service at a large inner-city teaching hospital. Abstinence rates at 3, 6 and 12 months post-detoxification were 68.1, 44.7 and 36.2%, respectively. Relapse was associated with referrals from acute hospital services, previous detoxifications, longer time between referral and admission for detoxification, presence of alcohol in the blood on the day of admission and requirement for benzodiazepines during withdrawal. The service operates within the national 18-week referral target and runs at a cost substantially lower than that of residential alcohol detoxification facilities but with similar sobriety rates. We demonstrate that elective detoxification with specialist follow-up provides an effective service both in terms of patient outcomes and resource use. Further investment in these services at both local and national level should be considered.

Short-term changes in global methylation and hydroxymethylation during alcohol detoxification

Alcohol dependence is a common public health problem and epigenetics may offer new aspects in understanding the biological and genetic underpinnings and improve treatment of this complex disease. Supposedly, methylation and hydroxymethylation are altered in brain tissues and in synapse-related genes due to chronic alcohol intake and during withdrawal. To assess potential epigenetic changes after cessation of chronic alcohol intake, we compared 23 alcohol-dependent individuals during inpatient alcohol detoxification with 13 carefully matched controls. Blood samples were taken on the day of admission, after one and after two weeks at the end of inpatient treatment. Genome-wide global methylation and global DNA hydroxymethylation were compared across groups. There were significant differences in global methylation across time from admission to one and two weeks of inpatient withdrawal (p < 0.001). These findings were paralleled to changes in global DNA hydroxymethylation across time when age was employed as a cofactor (p < 0.001). Several potentially influencing variables like severity of withdrawal, dose of withdrawal medication and alcohol intake before admission did not yield significant influence on epigenetic changes. The results confirm previous findings of significant alterations of epigenetic patterns during alcohol intoxication and present for the first time hydroxymethylation changes in these individuals.

Gender Differences in Anxiety and Depression before and after Alcohol Detoxification: Anxiety and Depression as Gender-Related Predictors of Relapse

Background/Aims: The aim of this prospective study was to estimate gender differences in anxiety, depression, and alcohol use severity among patients with alcohol use disorder (AUD) before and after detoxification program and within 12 months after discharge. Methods: AUD severity, state and trait anxiety, and depression were assessed in 187 patients entering an inpatient alcohol detoxification program. Follow-up assessments were performed at 6 and 12 months after discharge. A between- and within-subjects analyses explored gender differences. The predictive value of anxiety and depression for alcohol relapse was analyzed by logistic and linear regression in both genders. Results: Females had higher levels of anxiety and depression than males both at admission and after discharge. Trait anxiety and depression significantly increased 6 months after discharge in males and females respectively. Both state and trait anxiety levels at the 6-month follow-up predicted alcohol relapse at the 12-month follow-up in males. Conversely, in females, depression level at the 6-month follow-up was a predictor of relapse at the 12-month follow-up. Conclusions: In both genders, the psychopathological dimension that showed the most significant worsening at 6-month follow-up (i.e., anxiety in males and depression in females) was found to be a significant predictor of relapse at the 12-month follow-up.

Nutritional Status During Inpatient Alcohol Detoxification.

As low rates of thiamine are thought to be implicated in alcohol-related cognitive disorders, we wanted to assess patients with alcohol use disorders (AUD) during detoxification for their nutritional status and test if vitamins blood levels were associated with a surrogate of cognitive impairment. We performed a retrospective chart review of medical records of 94 consecutive patients hospitalized for alcohol detoxification in a specialized addiction medicine department. Nutritional status was assessed with Body Mass Index (BMI). Vitamins blood levels were available for 80 patients, but thiamine only for 52 patients. The Montreal Cognitive Assessment (MoCA) score was used to screen for cognitive impairment at Day 10 of entry and was available in 59 patients. A binary logistic regression was performed to identify factors associated with MoCA scores below the threshold (26 points). The mean BMI was 23.28 ± 3.78 kg/m2 and 8.79% of weighted patients qualified for malnutrition. The mean MoCA score was 22.75 ± 4.88 points, and 66% of tested patients were below the threshold of suspected cognitive impairment. No low blood thiamine level was found. In multivariate analysis, BMI, but not vitamins blood rates, was significantly associated with a pathological MoCA screening test. Clinical examination is more sensitive than biomarkers to determine malnourished AUD patients who are at-risk for cognitive impairment. Malnourished patients with AUD should receive a full neuropsychological testing. This retrospective chart review study screened for cognitive disorders during alcohol inpatient detoxification with the MoCA test. Body mass index, but not vitamins blood rates, was associated with a pathological MoCA. Clinical examination is more sensitive than biomarkers to determine malnourished AUD patients who are at-risk for cognitive impairment.

Erratum.

Alcohol: Clinical and Experimental ResearchVolume 41, Issue 8 p. 1526-1526 ErratumFree Access Erratum This article corrects the following: Cognitive Bias Modification Training During Inpatient Alcohol Detoxification Reduces Early Relapse: A Randomized Controlled Trial Victoria Manning, Petra K. Staiger, Kate Hall, Joshua B.B. Garfield, Gabriella Flaks, Daniel Leung, Laura K. Hughes, Jarrad A. G. Lum, Dan I. Lubman, Antonio Verdejo-Garcia, Volume 40Issue 9Alcoholism: Clinical and Experimental Research pages: 2011-2019 First Published online: August 4, 2016 First published: 29 June 2017 https://doi.org/10.1111/acer.13439AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat In the article by Manning et al., “Cognitive Bias Modification Training During Inpatient Alcohol Detoxification Reduces Early Relapse: A Randomized Controlled Trial,” 2016, 40: 2011–2019, the following error was published on page 2013 in the “Materials and Methods” section: “In total, there were 120 trials in each session and the training lasted for approximately 15 minutes.” This text was incorrect and should have read: “In total, there were 240 trials in each session and the training lasted for approximately 15 minutes.” We apologize for this error. Reference Manning V, Staiger PK, Hall K, Garfield JBB, Flaks G, Leung D, Hughes LK, Lum JAG, Lubman DI, Verdejo-Garcia A (2016) Cognitive bias modification training during inpatient alcohol detoxification reduces early relapse: a randomized controlled trial. Alcohol Clin Exp Res 40: 2011– 2019. https://doi.org/10.1111/acer.13163. Volume41, Issue8August 2017Pages 1526-1526 ReferencesRelatedInformation

An open label comparison of efficacy of low dose topiramate with naltrexone in preventing alcohol relapse

Introduction: Alcohol use disorder is a relapsing and remitting disorder. Preventing alcohol relapses has been a difficult task. The available drugs do not have adequate outcome in diverse needs. Topiramate, a GABAergic anticonvulsant, has been useful for the prevention of alcohol relapse as demonstrated in western studies. We compared the efficacy of Topiramate at 100mg with Naltrexone 50 mg in preventing relapse among Nepalese alcohol dependence patients.Methods: Following an inpatient alcohol detoxification, 37 patients taking Topiramate 100 mg and 41 patients taking Naltrexone 50 mg were followed up as outpatients at 1, 4, 8 and 12 weeks in order to monitor their abstinence period, craving for alcohol and alcohol use pattern.Results: At the end of 12 weeks follow up, Topiramate is as good as Naltrexone 50 mg in terms of maintaining abstinence (27% vs 31.7%, p=0.651) and reducing the daily alcohol intake. Topiramate is better than Naltrexone in decreasing craving at 12 wks (p=0.015).Conclusion: Topiramate 100 mg is equally efficacious to Naltrexone 50 mg in reducing alcohol craving and maintaining abstinence.

Cognitive Bias Modification Training During Inpatient Alcohol Detoxification Reduces Early Relapse: ARandomized Controlled Trial.

Relapse is common in alcohol-dependent individuals and can be triggered by alcohol-related cues in the environment. It has been suggested that these individuals develop cognitive biases, in which cues automatically capture attention and elicit an approach action tendency that promotes alcohol seeking. The study aim was to examine whether cognitive bias modification (CBM) training targeting approach bias could be delivered during residential alcohol detoxification and improve treatment outcomes. Using a 2-group parallel-block (ratio 1:1) randomized controlled trial with allocation concealed to the outcome assessor, 83 alcohol-dependent inpatients received either 4 sessions of CBM training where participants were implicitly trained to make avoidance movements in response to pictures of alcoholic beverages and approach movements in response to pictures of nonalcoholic beverages, or 4 sessions of sham training (controls) delivered over 4 consecutive days during the 7-day detoxification program. The primary outcome measure was continuous abstinence at 2weeks postdischarge. Secondary outcomes included time to relapse, frequency and quantity of alcohol consumption, and craving. Outcomes were assessed in a telephonic follow-up interview. Seventy-one (85%) participants were successfully followed up, of whom 61 completed all 4 training sessions. With an intention-to-treat approach, there was a trend for higher abstinence rates in the CBM group relative to controls (69 vs. 47%, p=0.07); however, a per-protocol analysis revealed significantly higher abstinence rates among participants completing 4 sessions of CBM relative to controls (75 vs. 45%, p=0.02). Craving score, time to relapse, mean drinking days, and mean standard drinks per drinking day did not differ significantly between the groups. This is the first trial demonstrating the feasibility of CBM delivered during alcohol detoxification and supports earlier research suggesting it may be a useful, low-cost adjunctive treatment to improve treatment outcomes for alcohol-dependent patients.

Gender differences among Alaska Native people seeking alcohol withdrawal treatment

ABSTRACTBackground: Few studies focus on gender differences among patients who utilize detoxification services; even fewer focus on detoxification for Alaska Native people. This analysis focused on gender differences at admission among a sample of Alaska Native patients seeking alcohol withdrawal treatment. Methods: The sample included 383 adult Alaska Native patients admitted to an inpatient alcohol detoxification unit during 2006 and 2007. Logistic regression was used to estimate unadjusted and adjusted associations with gender. Results: Women were 88% more likely to have stable housing than men (odds ratio [OR] = 1.88, 95% confidence interval [CI] = 1.15, 3.05, P = .01). Women were 87% less likely to be seasonal workers (OR = 0.13, 95% CI = 0.03, 0.48, P = .003) and 50% less likely than men to be seeking employment (OR = 0.50, 95% CI = 0.29, 0.84, P = .01) at admission. Women had more than 5 times the odds of having children in the home at admission (OR = 5.64, 95% CI = 3.03, 10.56, P < .001) and almost 3 times the odds of experiencing physical abuse than men (OR = 2.96, 95% CI = 1.31, 6.66, P = .01). Additionally, women were 50% less likely to accept a referral to substance abuse treatment following detoxification (OR = 0.50, 95% CI = 0.30, 0.83, P = .01). Conclusions: The study found significant differences based upon gender. For instance, women are in need of services that accommodate women with children and services that address histories of physical abuse. Conversely, men are in need of housing and employment opportunities. Post detoxification follow-up, case management, and transition to care should include gender as a factor in treatment planning.

Gender Differences in the Life Concerns of Persons Seeking Alcohol Detoxification

BackgroundThis study explored the life concerns of persons seeking alcohol detoxification, a group with multiple life and psychosocial challenges. Gender may be an important contributor to the particular life concerns of persons with alcohol use disorders. MethodsUsing a 32-item, previously-validated life concerns survey that captures ten conceptual domains, we interviewed persons entering inpatient alcohol detoxification asking them to rate their level of concern about health and welfare items. ResultsParticipants (n=189) were 27% female, with a mean age of 43.5years. Overall, concern about alcohol problems was perceived as the most serious, followed by mental health, cigarette smoking, financial, and relationship problems. Men were significantly more concerned than women about six of the ten domains including money, drug use, transmissible diseases, and physical illness. ConclusionsRecognition of the daily worries of persons seeking inpatient alcohol detoxification persons could allow providers to better tailor their services to the context of their patients' lives. Focusing on pressing life concerns such as mental health, financial, relationship problems, and other drug use may influence detoxification services and aftercare treatment choices.

Affective Disorders with or Without Comorbid Alcohol Dependence: a Longitudinal Neuropsychological and Neuroimaging Investigation in Young Adults

Introduction Limited research has examined the early neuropsychological and neurobiological changes associated with comorbid affective disorders and alcohol dependence. Objectives & Aims To investigate the cognitive and volumetric changes in individuals diagnosed with affective disorders with or without comorbid alcohol dependence. Methods Young adults (n = 21) who were undergoing medically-managed inpatient alcohol detoxification with comorbid affective disorders were neuropsychologically assessed 4-weeks following hospital discharge, and additionally underwent MRI brain scans during admission and 4-weeks following discharge. An affective disorders-only group (n = 21) with an equal distribution of anxiety and mood disorders was recruited through a youth mental health clinic. Results Compared to affective disorders only (M = 31.8 ± 4.4 years old), individuals with affective disorders and alcohol dependence (M = 33.9 ± 6.3 years old; M = 21.1 ± 9.2 standard drinks/day) exhibited worse sustained attention and visual memory functioning. There was a highly significant association between drinking levels since detoxification and total brain volume change, such that resumption of heavy drinking attenuated brain volume gains associated with short-term abstinence (r = -0.87, p Conclusions In young adults with affective disorders, comorbid alcohol dependence is associated with more pronounced cognitive dysfunction, suggesting that these deficits are most relevant for cognitive remediation interventions. Crucially, abstinence or reduced drinking was associated with brain volume gains, whereas resumption of heavy drinking was associated with brain volume reductions, suggesting that medically-managed alcohol detoxification may, at least, partially reverse the neurobiological changes associated with prolonged alcohol dependence in young adults.

Quality of life, alcohol detoxification and relapse: is quality of life a predictor of relapse or only a secondary outcome measure?

To estimate variations in Overall Quality Of Life (OQOL) within 12 months following alcohol detoxification and to evaluate the predictive value of OQOL for relapse and alcohol use severity. Alcohol use disorders and four OQOL domains (physical health, psychological health, social relationships and environment) were assessed in 199 patients entering in-patient alcohol detoxification. Follow-up assessments were performed at 6 and 12 months after discharge. Cross-sectional and longitudinal analyses explored the relationship between OQOL and alcohol use severity, examining differences between abstinent and relapsed patients. The predictive value of OQOL was analyzed by logistic and linear regression. Correlation between OQOL and Alcohol Use Disorders Identification Test scores was confirmed at all stages of observation. Abstinent patients showed a significant improvement in all OQOL domains at 6 months after discharge, whereas OQOL domains did not undergo any significant change in relapsed patients. Baseline OQOL did not prove to be predictive of either relapse or alcohol use severity. Overall quality of life changed in parallel with alcohol use severity throughout the duration of the study, confirming it to be a useful and sensitive measure of secondary outcome for alcohol detoxification. Conversely, none of the OQOL baseline scores functioned as predictors of relapse within 12 months following discharge or alcohol use severity in relapsed patients.

Impact of adaptive functioning on readmission to alcohol detoxification among Alaska Native People

BackgroundThis study examined predictors associated with readmission to detoxification in a sample of adult Alaska Native patients admitted to inpatient alcohol detoxification. Even though Alaska Native people diagnosed with alcoholism have been identified as frequent utilizers of the health care system and at elevated risk of death, little is known about factors associated with readmission to detoxification for this group. MethodsWe sought to predict readmission using a retrospective cohort study. The sample included 383 adult Alaska Native patients admitted to an inpatient detoxification unit and diagnosed with alcohol withdrawal during 2006 and 2007. Cox proportional hazard modeling was used to estimate unadjusted and adjusted associations with time to readmission within one year. ResultsForty-two percent of the patients were readmitted within one year. Global Assessment Functioning (GAF; Axis V in the multi-axial diagnostic system of the Diagnostic and Statistical Manual of Mental Disorders [DSM IV]) score measured at the time of intake was associated with readmission. A one point increase in the GAF score (HR=.96, 95% CL=.94, .99, P=.002) was associated with a four percent decrease in readmission. The results also indicated that the GAF mediated the relationship between readmission and: employment and housing status. ConclusionsThe GAF measures both illness severity and adaptive functioning, is part of standard behavioral health assessments, and is easy to score. Readmission rates potentially could be decreased by creating clinical protocols that account for differences in adaptive functioning and illness severity during detoxification treatment and aftercare.

Biochemical Predictors of Delirium Tremens in Patients in Alcohol Withdrawal

Aims: To study whether routine blood parameters in patients with alcohol syndrome predict the risk of developing delirium tremens. Methods: Biochemical parameters were collected and analysed in 212 patients attending a psychiatry department for inpatient alcohol detoxification treatment. Results: Differences between those who did, and did not, develop delirium were observed in baseline platelet count (131 ± 53 versus 270 ± 83 × 109/l, t = −10.013, P 75 U/l, and total WBC count <7 × 109/l, although not significant as independent risk factors, showed high specificity and predictive value in conjunction with low platelet count and/or previous history of delirium tremens. A normal baseline platelet count nearly rules out development of delirium tremens in patients with alcohol withdrawal in this population.

Diagnosis and treatment of Wernicke's encephalopathy in an in-patient alcohol detoxification unit: a completed audit cycle

Aims and methodA baseline audit of trainees' ability to recognise Wernicke's encephalopathy and initiate appropriate thiamine regimes in an in-patient alcohol detoxification unit was carried out. Based on the findings, gaps were addressed using targeted education and training, and their impact on improving standards of managing Wernicke's encephalopathy was re-audited.ResultsThe initial audit revealed that trainees' ability to recognise Wernicke's encephalopathy and initiate thiamine was inadequate. Significant improvement in appropriate use of treatment regime (P &lt; 0.05) of thiamine and the monitoring of clinical response was observed after addressing the initial gaps through education.Clinical implicationsTreatment of Wernicke's encephalopathy can be inadequate, given a lack of awareness of clinical presentation and appropriate management. This can be addressed through education and training.

O7 * FREE ORAL COMMUNICATIONS 7: COMORBIDITY AND DETOXIFICATION

O7 * FREE ORAL COMMUNICATIONS 7: COMORBIDITY AND DETOXIFICATION

Alcohol dependent patients have weak negative rather than strong positive implicit alcohol associations

RationaleAlcohol dependence is characterised by motivational conflict (or ambivalence) in controlled cognitive processes, but it is unclear if ambivalence also exists within automatic cognitive processes, and if ambivalence operates between controlled and automatic processes.ObjectiveTo investigate ambivalence operating within and between controlled and automatic processes in alcohol dependence.MethodAlcohol-dependent patients who had recently completed inpatient alcohol detoxification (N = 47) and social drinking controls (N = 40) completed unipolar implicit association tests and self-report measures of alcohol approach and avoidance motivation and alcohol outcome expectancies.ResultsAs predicted, both positive and negative alcohol outcome expectancies were stronger in alcohol-dependent patients compared to controls, indicative of ambivalence. Groups did not differ on implicit alcohol-positive associations, but alcohol-dependent participants had significantly weaker alcohol-negative associations than controls. Regression analyses revealed that implicit negative associations accounted for unique variance in group membership after controlling for alcohol outcome expectancies.ConclusionsOur findings demonstrate that alcohol dependent patients possess weak automatic alcohol-negative associations but not strong automatic alcohol-positive associations, and they suggest the presence of conflict between controlled and automatic processes with regard to negative alcohol cognitions.Electronic supplementary materialThe online version of this article (doi:10.1007/s00213-013-3066-0) contains supplementary material, which is available to authorized users.