Prehabilitation in alcohol dependence as a treatment model for sustainable outcomes. A narrative review of literature on the risks associated with detoxification, from animal models to human translational research
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Published version
Author(s)
Kouimtsidis, Christos
Duka, Theodora
Palmer, Emily
Lingford-Hughes, Anne
Type
Journal Article
Abstract
In this review paper, we discuss how the overarching concept of prehabilitation is applicable to alcohol dependence. Central to prehabilitation are the concepts of expected harm, risks, and proactive planning to eliminate the harm or cope with the risks. We review the evidence from animal models, psychological experimental studies, as well as pharmacological studies, on the potential risks and harms associated with medically assisted alcohol detoxification and the current treatment paradigm for alcohol dependence. Animal models provide an approximation mostly of the physical aspect of alcohol withdrawal and detoxification process and make predictions about the development of the phenomena in humans. Despite their limitations, these models provide good evidence that withdrawal from chronic ethanol use induces cognitive impairment, which is worsened by repeated bouts of withdrawal and that these impairments are dependent on the duration of alcohol withdrawal. Initial clinical observations with alcohol-dependent patients confirmed increased incidence of seizures. In recent years, accumulating evidence suggests that patients who have had repeated episodes of withdrawal also show changes in their affect, increased craving, as well as significant deterioration of cognitive abilities, when compared to patients with fewer withdrawals. Alcohol dependence is associated with tolerance and withdrawal, with neuroadaptations in γ-Aminobutyric Acid-A Receptor (GABA-A) and glutamatergic N-methyl-D-aspartate (NMDA) receptors playing key roles. It is suggested that dysregulation of the NMDA receptor system underpins alcohol-related memory impairments. Finally, we discuss the Structured Preparation for Alcohol Detoxification (SPADe) as an example of how prehabilitation has been applied in clinical practice. We discuss the importance of partial control over drinking as an interim step toward abstinence and early introduction of lifestyle changes for both the patient and the immediate environment prior to detoxification and while the patient is still drinking.
Date Issued
2019-05-16
Date Acceptance
2019-04-30
Citation
Frontiers in Psychiatry, 2019, 10
ISSN
1664-0640
Publisher
Frontiers Media
Journal / Book Title
Frontiers in Psychiatry
Volume
10
Copyright Statement
© 2019 Kouimtsidis, Duka, Palmer and Lingford-Hughes. This is an openaccess article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000468150800001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Subjects
Science & Technology
Life Sciences & Biomedicine
Psychiatry
alcohol dependence
prehabilitation
withdrawal
detoxification
animal models
human research
EMOTIONAL FACIAL EXPRESSION
CHRONIC ETHANOL-CONSUMPTION
OLD-WORLD MONKEY
PREFRONTAL CORTEX
DECISION-MAKING
BINGE DRINKING
MULTIPLE DETOXIFICATIONS
ORBITOFRONTAL CORTEX
INTERMITTENT ALCOHOL
WITHDRAWAL SEIZURES
Publication Status
Published
Article Number
339
Date Publish Online
2019-05-16