The cohesiveness of the proposed syndrome of alcohol dependence, and the
evolution of symptoms over time, was validated in a clinical sample. In healthy
individuals and in clinical samples, biological markers showed early signs of the
syndrome in healthy men. A comparison of Lothian general population data with
Edinburgh hospital admission data showed that heavier alcohol consumption predicted
admission to a general hospital bed. Analysis of national centrally collected data showed
that the burden on Scottish hospitals due to alcohol problems rose in the last 40 years.A randomized controlled trial showed the value of intervening at an early stage in
the career of a problem drinker.To treat more severe alcohol dependence, withdrawal symptoms must be
controlled. When randomly allocated to either a longer-acting or a shorter-acting
benzodiazepine, the former showed an advantage.To help prevent relapse, 'extended' treatment emerged as only very marginally
more effective than one session of firm advice to the patient to abstain. The medications
disulfiram and naltrexone, if compliance was enhanced, were found to reduce relapse.
Acamprosate appeared to be effective too, when results from many studies were pooled.
A selective serotonin re-uptake inhibitor (SSRI), fluvoxamine, was associated with
increased likelihood ofrelapse in early-onset alcohol dependence, a surprising finding,
which speculatively might be mediated through increased impulsivity in some patients.
Analysis of data on treatment of depression in the General Practice Research Database
confirmed other emerging concerns regarding the safety of the SSRI group of drugs in
young people.Abstinence was accompanied by improvement in brain magnetic resonance
parameters and cognitive testing.Analysis of outcomes in placebo-controlled treatment studies for alcohol
dependence, set alongside the costs to the Health Service of treating the complications of
alcohol dependence, showed that the costs of failure to help patients attain abstinence are
much greater than the costs of providing effective treatments
