Broadening the Base of Treatment for Alcohol Problems (1990) / Chapter Skim
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C: International Review of Treatment and Rehabilitation Services for Alcoholism and Alcohol Abuse
C: International Review of Treatment and Rehabilitation Services for Alcoholism and Alcohol Abuse
Pages 550-578
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From page 550... ...
Machona, Harare, Zimbabwe; S Montero, San Jose, Costa Rica; J
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From page 551... ...
These generalists, whether social workers, primary health care workers, casualty staff, or law enforcement officers, were often reluctant to become involved in this work either because they did not see it as part of their job or more often because they felt that they lacked skills in working with "problem drinkers" and regarded this as a task for "specialists." Thus, primary-level workers are encountering clients with alcohol problems often at an early stage in their drinking careers. Such workers seem to be ideally situated to intervene in a simple and nonstigmatizing way, and yet in many countries there is an obvious reluctance to take on this task.
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From page 552... ...
A recent investigation into the drinking history of factory workers in Nairobi who had retired prematurely on medical grounds showed that chronic alcohol abuse seemed to be the commonest cause of retirement. A systematic study of such employees initiated by the Ministry of Labour is now in progress.
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From page 553... ...
With relative frequency, the medical services cover problems of the acute type. Eleven percent of all the cases that were seen in the emergency services in five hospitals in Mexico City were identified as being intoxicated with alcohol, and 22 percent of the cases in similar services had positive alcohol levels.
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From page 554... ...
Between 10 and 30 percent of patients admitted to general or psychiatric hospitals have an alcohol-related problem. In general, Australia
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From page 555... ...
They may be consequences of intoxication or injudicious drinking, which result, for instance, in accidents, assaults, criminal damage, or overdose, or they may be those that are the end stage of many years of habitual drinking such as alcoholic cirrhosis, delirium tremens, or "alcoholism." Treatment Responses Most of the countries had some form of specialist treatment for alcohol problems, although in some cases it was almost exclusively embedded within the general wards of a psychiatric hospital. For example, in Kenya, recognition of the extent of the problem has been coupled with the realization that, apart from a few overburdened psychiatrists, no other profession is "offering treatment seriously" and that Treatment is currently being carried out mainly either in psychiatric hospitals or general medical hospitals on either an inpatient or outpatient basis depending on the mode and severity of presentation.
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From page 556... ...
Inpatient treatment is currently less favored. Many outpatient drug and alcohol services are now located in general hospitals, a development which has taken place over the past 5-7 years.
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From page 557... ...
Local councils are accountable to an executive committee that usually includes representatives from Health, Social Services, and Probation. Recently, a number of councils established formal links with community alcohol teams.
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Alcohol treatment units (ATUs) are the major National Health Services treatment institutions for people with drinking problems.
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One of the intents of the new system is for each state to share the responsibility of arranging policies and administrating funds. Alcohol treatment in Mexico has benefited from the above-mentioned changes.
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From page 560... ...
The following extract outlines the current organizational structure of alcohol treatment services in the USSR: In the USSR there are different organizational forms of treatment of alcoholics: outpatient, inpatient, one-halfway settings. Treatment may be voluntary and involuntary.
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From page 561... ...
The role of each sector is described as follows: The Ministry of Health provides preventive measures through the Department of Health Education. At the moment these comprise publication and distribution of posters on health dangers of alcohol and drug abuse.
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From page 562... ...
The social workers in the Department of Social Welfare of the Ministry of Labour, Manpower Planning and Social Welfare provide counselling and support to clients with alcohol related and drug abuse problems. The department liaises with health workers, medical consultants and other agencies involved in problems of alcohol and drug abuse.
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During this time, patients receive group, occupational, and behavioral therapy, as well as social and family rehabilitation. Costa Rica also has a network of outpatient clinics, which have links with the innovative pronwtore development.
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The development of community alcohol teams in England and Wales is evidence of a similar trend. The rationale for these developments was ably summarized in the Australian National Health Policy on Alcohol: There is recognition that resources for specialist services will never be adequate to meet the needs as has been emphasized by the WHO Expert Committee reporting in 1980.
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From page 565... ...
. Level Types of Intervention Examples 1 2 Informal Communibr Response Formal Community Response Generalist Health and Social Seances Specialist Sentences Dnnker Family Fnends Workplace Traditional healers Police Social welfare agencies Pharmacists Primary health care Casually Social work Outpatient clinic Rehabilitation hostel Detoxification Center Day Program Outpatient clinic Work program Inpatient unit Self-help group concluded that, ~in each area, the family was the battle ground on which most alcoholrelated problems were fought out." The high level of concern, for instance, among Mexican women about their husband's drinking is a reminder that alcohol-related problems are not confined to the drinker but affect many of those nearby.
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From page 566... ...
Primary health care (PHC) is usually accessible and widespread within most countries, patients feel less stigma within the PHC network than is commonly felt in seeking specialist services.
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From page 567... ...
In most cases there has been an evident trend toward a greater investment in outpatient services and a reduction in lengths of stay among existing inpatient programs. However, there is also the possibility of a contrary trend among some private health treatment programs in England and Wales, Australia, and Costa Rica.
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From page 568... ...
The reply from Costa Rica illustrates the way in which criteria are deduced from physical state, degree of dependence, and social need as well as more subjective concerns such as motivation: In the case of the Unit of Detoxification which LAFA offers, the main condition is that they are not chronic nor deteriorated patients-mental patients [who] are hospitalized for the first time there and who are under intoxication levels and are not [capable]
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From page 569... ...
The special treatment programmes for women within some of the Norwegian treatment centres are efforts at meeting their particular needs. Some centers stress their growing concern about alcohol problems among adolescents and the way in which such problems are often linked to other forms of drug abuse.
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From page 570... ...
There is considerable emphasis on presentation of alcohol intoxication among adolescents in national media campaigns and community drug education campaigns. In their reports, Costa Rica and Australia both describe several facilities designed specifically for women.
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Few reports of systematic monitoring were received, however. Costa Rica quoted a follow-up of 3,000 men treated in a rehabilitation center: the researcher found that relapse was particularly common among younger patients (Miguez, 1983~.
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From page 572... ...
Usually their health insurance policies cover all medical treatment including alcohol dependence, but the diagnosis of "alcoholism" is hardly ever entered in the case notes or on the sick sheet. Even in these settings the cost of treatment for alcohol problems remain unknown.
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From page 573... ...
The Future of Alcohol Treatment Services Almost all of the countries had or were about to formulate plans for the future of their treatment services. As already described, some countries (e.g., Mexico, the USSR)
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From page 574... ...
The curriculum for the training of primary health care workers is being finalized and it has a strong section on alcohol problems. Costa Rica envisages a greater emphasis on community workers (promotores)
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From page 575... ...
A survey carried out in 1985 showed that only 18 percent of District Health Authorities had specific planning teams on alcohol and/or drug abuse. Social services: Most social services departments give very low priority to alcohol-related problems in spite of the evidence that many of their clients experience such problems.
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From page 576... ...
The balance between specialist and nonspecialist services needs careful consideration as do the needs of both during a time of transition toward more community-based services. Some countries are examining the potential role of new kinds of change agents, such as promotores, pharmacists, or even the drinker's own family.
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From page 577... ...
1983. El paciente aloholico en Costa Rica: Caracteristicas y resultados.
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From page 578... ...
1987. The Respective Roles of Primary Health Care and Specialized Services: The Development and Implementation of Programs for Problem Drinkers.
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