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      Patient Preference and Adherence (submit here)

      This international, peer-reviewed Open Access journal by Dove Medical Press focuses on the growing importance of patient preference and adherence throughout the therapeutic process. Sign up for email alerts here.

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      Patient preferences and perspectives regarding reducing alcohol consumption: role of nalmefene

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          Abstract

          Alcohol use disorder is a major public health issue. The absolute mortality burden of alcohol-attributable death has increased over the last 20 years. However, access to care remains very poor and many people with alcohol use disorder are untreated. The main limiting factor for access to care in alcohol use disorder appears to be the reluctance to engage in abstinence. Risk reduction is a developing approach in the treatment of alcohol use disorders, drawing its inspiration, with quite a delay, from the decades-long dominant approach in other substance use disorders. A paradigm shift has recently occurred that places more of an emphasis on reducing alcohol as a therapeutic strategy for patients with alcohol use disorder, to better meet the patients’ preferences and needs. The development and recent approval of nalmefene, in alcohol-dependent adults with a high drinking risk level, contributes to enlarging the therapeutic arsenal for alcohol dependence, strengthening the legitimacy of alcohol reduction strategies.

          Most cited references39

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          Alcohol use disorders and mortality: a systematic review and meta-analysis.

          To conduct a systematic review and meta-analysis on all-cause mortality in people with alcohol use disorders. Using the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines, studies were identified through MEDLINE, EMBASE, and Web of Science up to August, 2012. Prospective and historical cohort studies including a comparison of alcohol use disorder with a control group investigating all-cause mortality risk were included. This meta-analysis included 81 observational studies with 221 683 observed deaths among 853 722 people with alcohol use disorder. In men, the relative risk (RR) among clinical samples was 3.38 (95% confidence interval [CI]: 2.98-3.84); in women it was 4.57 (95% CI: 3.86-5.42). Alcohol use disorders identified in general population surveys showed a twofold higher risk compared with no alcohol use disorder in men; no data were available for women. RRs were markedly higher for those ≤40 years old (ninefold in men, 13-fold in women) while still being at least twofold among those aged 60 years or older. Mortality in people with alcohol use disorders is markedly higher than thought previously. Women have generally higher mortality risks than men. Among all people with alcohol use disorders, people in younger age groups and people in treatment show substantially higher mortality risk than others in that group. © 2013 Society for the Study of Addiction.
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            Motivation for treatment: a review with special emphasis on alcoholism.

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              Alcohol consumption, dependence, and treatment barriers: perceptions among nontreatment seekers with alcohol dependence.

              Alcohol use disorders are highly prevalent worldwide. However, only a minority with alcohol dependence seek and undergo treatment. From a public health perspective, it is important to understand why people do not seek treatment. This study aims to describe how people with alcohol dependence perceive and discuss treatment for alcohol use disorders and their reasons for seeking and not seeking treatment. 32 alcohol dependent adults from the general population participated in focus groups and individual interviews in Stockholm during 2011-2012. Data were analyzed with thematic content analysis. Suffering from alcohol dependence, as well as realizing the need for, and entering treatment, were associated with shame and stigma, and were strong barriers to treatment. Other barriers included the desire to deal with alcohol problems on one's own and the view that seeking treatment required total abstinence. Negative health-effects were mainly a nonissue. The participants' knowledge about treatment options was limited to lifelong abstinence, medication with Disulfiram and residential treatment. These were seen as unappealing and contrasted sharply with preferred treatment. CONCLUSIONS/IMPORTANCE: Public health literacy regarding alcohol use, dependence, and treatment ought to be improved in order to lower barriers to treatment. Treatment services need to better match the needs and wishes of potential service users, as well as taking stigmatization into account. In order to develop suitable treatments, and to reach the majority who do not seek treatment, the clinical understanding of alcohol dependence needs to be expanded to include mild to moderate dependence.
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                Author and article information

                Journal
                Patient Prefer Adherence
                Patient Prefer Adherence
                Patient Preference and Adherence
                Patient preference and adherence
                Dove Medical Press
                1177-889X
                2014
                29 September 2014
                : 8
                : 1347-1352
                Affiliations
                INSERM U669, Université Paris Sud, Hôpital Paul Brousse, Assistance Publique – Hôpitaux de Paris (AP-HP), Villejuif, France
                Author notes
                Correspondence: Amandine Luquiens, Addictologie, Hôpital Paul Brousse, 12 Avenue Paul Vaillant-Couturier, 94800 Villejuif, France, Tel +33 145 594 018, Email amandineluquiens@ 123456yahoo.fr
                Article
                ppa-8-1347
                10.2147/PPA.S57358
                4189699
                25302021
                ab4a4504-f72b-41ab-8370-9bd269502b98
                © 2014 Luquiens and Aubin. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                History
                Categories
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                Medicine
                harm reduction,alcohol use disorder,therapeutic goal,patients’ satisfaction
                Medicine
                harm reduction, alcohol use disorder, therapeutic goal, patients’ satisfaction

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