When one hears “alcohol addiction”, one still has the image of a person out of socialization with many external symptoms …

Alcoholism affects 5 million French people and kills 45,000 a year. He also changed his face with excessive intermittent drinking, but a real addiction. Faced with this scourge, a drug would reduce its consumption on a piecemeal basis. Addictologue at Hôpital Beaujon (Clichy), Dr. Philippe Batel tells us more about this upheaval in the care that was hitherto focused solely on abstinence.

What is the treatment for alcohol-dependent patients?

Dr. Philippe Batel: The profile of alcohol dependence has changed. When I started my career, the majority of my patients had excessive daily intake. Today, these profiles represent only a third of my consultations.

The reduction of alcohol consumption can therefore be a stage of treatment?

Excessive consumption is now more intermittent, often limited to a few days in the week - mainly on weekends. I have many patients who notice: "On Friday night, I want to drink and I can not stop." This evolution implies today a change in the support.

Does this mean that abstinence is no longer the only objective?

Dr. Philippe Batel: The care is now based on a care program that is not standardized but rather adapted to the patient. Schematically, we can distinguish three steps

Can medicines help these patients reduce their consumption?

Can patients still participate in this clinical trial?

In the event of positive results, will this change the management of alcohol dependence? Make it more accessible to general practitioners?

What about the baclofen described by cardiologist Olivier Ameisen as a very interesting option against alcohol dependence?

Dr. Philippe Batel: Indeed, a reduction in consumption in the event of alcohol dependence directly corresponds to a reduction of the risk for the patient. If we can get a person who drinks two bottles of alcohol every day to drink only one, we are not in an ideal situation but we have actually reduced the risk of liver damage and other problems health. This reduction can be a step towards abstinence, but it is already a battle won against alcohol.

Dr. Philippe Batel: If one makes abstinence the only dogma of the care, one knows that one leaves on the way patients for whom this logic of the "all or nothing" is not good. This is especially true for those patients who do not drink alcohol for several days but who have excessive consumption over a limited period of time.

Today, however, this change in perspective is not unanimously shared by health professionals. A thesis led by Professor Henri-Jean Aubin of the Paul-Brousse Hospital (Villejuif) showed that half of the alcoologists are ready to join. They are aware that this step can help the patient regain confidence.

And in many cases, he himself will ask for the transition to total abstinence. For others (in a proportion estimated at 20 to 30%), adequate care will allow them to conserve alcohol consumption in the long term. This is mainly the case with a recent alcohol addiction and not installed.

Dr. Philippe Batel: Today, we can propose a medication that will help them reduce their consumption, in case of excessive consumption point 1. This drug to take half an hour before the period at risk is an opiate antagonist Named namefen. It is currently the subject of a European clinical trial. Fifteen centers are participating in it in the United States. Results are expected by December 2010, but it can already be noted that after 6 months of study, we have lost sight of any patient. This is rare for studies of alcohol dependence and at least shows good tolerance. The preliminary results showed a good efficiency: patients stopped after two to three drinks when they used to drink six.

Dr. Philippe Batel: Of course. This trial is totally free. Just call 0805 88 99 00. Four questions will be asked by phone to find out if you are eligible for this study. If this is the case, a technician will call you back for an interview of about 20 minutes before a final medical appointment, which will validate your participation in this trial.

Dr. Philippe Batel: That's the goal! The management of these excessive intakes could be greatly facilitated with an effective drug to take just half an hour before the period at risk. If one knows that one risks to drink a lot on Friday evening, this medicine allows to take the lead. Having no longer the sole option of total abstinence, the general practitioner can more easily open the dialogue.

Dr. Philippe Batel: Baclofen is currently undergoing a multi-center clinical trial, scheduled to begin in February 2010. Nevertheless, in my clinical practice I have rarely encountered such spectacular experiences as described in the book "The Last Glass "from Olivier Ameisen in patients who receive this medication. Most seem to tolerate it fairly poorly, nearly half of the patients stop it because of side effects or feeling ineffective. But while awaiting the results of the hospital clinical research program (PHRC), one can not really decide on the real interest of this promising product.

1 - Other drugs can reduce consumption in the event of alcohol dependence such as AOTAL ® but with a goal of abstinence. Other medicines, such as ESPERAL ®, cause nausea if alcohol is swallowed. 2 - This medication is developed by the Danish laboratories Lundbeck. It is the subject of a Phase III clinical trial in several European centers. Phase III is the last step before commercialization. This study is based on the double-blind principle: half of the patients enrolled receive a placebo and the other half the active drug, but neither the doctor nor the patient know which group they are in. After 6 months of follow-up, the results of the two groups were compared to evaluate the efficacy of the drug. Results are expected by December 2010.

To get rid of alcoholism, Dr Philippe Batel, Editions La découverte, 224 pages, Price: 16 euros

Define a goal to be achieved with the patient. Through a relational technique - "motivational interviewing" - trained caregivers work with the patient on his or her ability to change. Some are in an ambivalent situation, caught between the will to stop and the apprehension to engage in such an approach; Establish a program of care based on the capacities of the patient. If abstinence remains the ideal theoretical objective, in practice this is not always the case. Thus, it is possible to initially establish with the patient a goal of reducing consumption, which can be a step towards total abstinence but not only, since it is now estimated that 20 to 30% of them would have The ability to self-regulate in the long term; Maintain this objective both qualitatively and quantitatively. We must anticipate to avoid the reactivation of alcohol dependence. For some, the risk will be significant from the first drink, while others may be part of a controlled consumption process.