zelko.mustac@gmail.com

Music Royalty free www.benesound.com

DR Zelko Mustac

Psychiatrist

Your URL or Logo (on every slide)

For detailed information on these slides

What are we going to

learn? (and why it’s

important to learn now).The best case is that you replace these words with pictures. But to brainstorm, bullet points

aren’t a bad place to start. Also you can experiment with using presentation notes (but those

keep you at the podium.)

What are we going to learn?

Why you should listen to me.

The specific takeaways you’ll get.

Baclofen authorised up to 300mg/day

To Psychologise or Not, that is the

question?

Only 50?

The problem

For Patient who have repeatedly tried but failed to achieve sobriety.

Legislators have foreseen this situation and provided for it (for

France [13]). Off-label prescribing is permitted under the

following conditions:

- Scientific data justify this therapeutic use. - It is required as

a treatment due to the failure of properly conducted

conventional therapies. - The patient has been given

comprehensive information concerning the potential benefits

and risks of the treatment. - Informed consent of the patient

and his written acceptance to take this treatment with full

knowledge of the risks involved. - Appropriate medical

monitoring. -

The solution.

The before and after

Ameisen.

• Disulfiram (Antabuse) since 1970’s

• Acomprosate (Campral) - limited

• Naltrexone (? 30%)

• Nalmefene (not in Oz)

• Topirimate (2nd line)

• SSRI’s/Ondansetron

• Psychosocial

“The End Of My Addiction “Olivier

Ameisen

• “In the depths of a desperate struggle with

alcoholism, I found a medicine, baclofen,

that both freed me of all craving for alcohol

and resolved the underlying disorder,

overwhelming anxiety, that made me

vulnerable to addiction.”

• RPHx Emergency Physican

Before solution 1.

• 35 yr old White Australian woman

• Caring successful parents

• Failing 2nd Marriage

• All treatments have been tried and failed

• Unhappy re: “controlling spouse”

After solution 1 .

• She stopped drinking entirely

• Now working in Aged Care “loving it”

• Marital Problems no longer an issue

• No further treatment in 4 years

Before solution 2.• Retired (64yr old) successful executive.

• Falling through glass windows,

• Wife attempting to “dole out EtOH”

• Repeated serious falls and injuries

After solution .• Previously 2 admissions without sobriety

• Now drinks 1-2 Standard drinks/day

• Wife wants him in Antabuse

Before solution 3.• Pretty 32 yr old UK immigrant

• Binge drinker from age of 18

• Hb FIFO, binges when he leaves

• Marriage about to end.

• No Health Insurance to detoxify

After solution (story or

case study) #3.

• Became nominated driver at Hen’s nights

• No hospital admission required

• Moved to N.W. for Hb’s work

• No psychological treatment.

Stages of Change

• Precontemplation

• Contemplation

• Preparation

• Action

• Maintenance

• Termination

Rational Emotive Therapy (CBT)

• Cognitive Restructuring- Anger, Self-Blame, Self-Pity, Other-

Pity, Demandiness

• Defects• Rigidity

• USA

• UOA

• Specific Stimuli leads to Urges (Thoughts create

Feelings)

• Observer Status (Instead of Victim Status)

Skills Training

• Self- Soothing, Mindfulness (Headspace), Self acceptance, Other

Acceptance

• Habit Model – Takes 3 months to change a habit, Prefrontal Cortex

Automated functioning, Addictions are a habit

• Environmental Cues – To change a habit, Pictures, Audio

recordings, House Clean, Friend, phone Clean

• New Habits, Family, Friends, Work, Finances

• Ongoing Support, Failure is when you stop trying

• Cognitive Function Assessment

Assessment

• Has drinking resulted in employment, legal,

family, friendship problems ?

• Do you have memory, mood or irritability

problems related to your drinking

• EtOh impairs recollection, under-reporting is

common

• Drink to get going? (10% lifetime preval.)

• Understate the patient’s concerns

Depression and Alcohol Use

• Over 70% Depressed in 1st week of sobriety

• Less than 10% by 3rd week

• Suicidality, Depression preceding EtOh Use,

Pessimism, Family History

• Prognosis is better if EtOh Use driven by

Depression and Depression is treated with

SSRI

• SSRI ineffective in non- depressed EtOh

Psychiatric Comorbidity

• Bipolar Disorder 5X

• PTSD, Depression 2X

• Early Childhood Trauma – lack of effective

Reward Pathways, lack of self-soothing

• Remember “HALT” and Craving

Motivational Interviewing

• Ask Leading Questions

• Establish what the patient (customer) wants

from seeing you

• Request permission to offer interventions

now or in the future

• Don’t get ahead of where the patient

(customer) is.

• Time is rarely a factor (time poor treatment)

Psychological Treatments

• Project Match – 3 treatments

• Motivational Interviewing

• Contingency Management, Cognitively Impaired

• 12 Step Programme ( AA, Smart Recovery)• Social Support key to Group Therapy

The mistakes people

make.• No chemical solution?

• I want patient to change !

• Change can be totally unexpected !

• Baclofen won’t work every time, have a

backup plan !

What you can do to take

action now.• Check for Hypertension/Diabetes.

EtOh

• Develop Motivational Interviewing

• Try Baclofen (Anxiety not required)

• Increase the dosage to side-effect

level

• Then 2nd Tier Craving reduction agent

YourURL.com/Conference

Your Twitter or Email

Your Q and A Slide