Alcoholism treatment in a medical setting.

The Medical Unit at the Royal Free Hospital, London, is a referral center for patients with liver disease. The increase in the number of patients referred with alcohol-related liver disease in recent years prompted the introduction of a clinical treatment program using modest resom'ces to curb alcohol misuse. The study described in the present report was undertaken to assess the efficacy of this treatment program, to provide preliminary data on variables predictive of success and to examine patterns of drinking during treatment. METHODS Patieats. Excluding patients living too far from the hospital to make outpatient visits, the first 36 alcoholics admitted to the medical unit in 1978 for treatment of liver disease were studied. All had drunk the equivalent of 80 g or more of absolute alcohol daily for 5 or more years. Relevant personal details, including ethnic origin, marital status, family history of alcoholism and socioeconomic circumstances, were recorded. Patients were also asked to complete a questionnaire comprising items about their perception of self, parents and spouse, with particular reference to strengths and weaknesses, introversion and extraversion and homosexuality. The physician and clinical psychologist independently took a history of each patient's drinking habits. When possible, their findings were verified by repeated history-taking and by confirmation from relatives or close friends. Age at onset of problem drinking, duration of problem drinking, preferred beverage and alnount consumed were recorded. Patients were regarded as physically dependent on alcohol if they reported lnorning retching, periods of amnesia and a histmy of tremor relieved hy alcohol. All patients had a complete physical examination and investigation including a liver biopsy.