Seattle University Collaborative Projects - International Academy of ...

Specific Alcohol Dependence Treatment according to the Lesch Typology: AProspective 2 Year Outcome StudyOtto M. Lesch, Psychiatric Medical University Vienna (otto.lesch@meduniwien.ac.at)Introduction: In guidelines from the European Medicine Agency (EMEA, 18. 02. 2010) andfrom the FDA it is clearly stressed that we need more homogenous phenotypes for clinical trialsin alcohol dependent patients defined by ICD-10 and DSM IV. They should be definedmultidimensionally and it is accepted internationally that four different subgroups are the bestsolution (e.g. typologies by Windle and Scheit, Del Boca and Hesselbrock, or Lesch). The Leschtypology has been investigated in many international basic and clinical trials and nowadays isused in daily practice in different countries (Portugal, Bulgaria, Poland, Germany, Switzerland,and so on).Objectives: Using specific treatment approaches we hypothesize that we can significantly reducerelapse rates and durations. The aim of the present study was to assess the outcome of 2 years ofLesch-typology based treatment of alcohol dependent patients.Methods: 321 alcohol dependent patients treated and classified during in- or outpatient treatmentin our department were contacted two years later by a structured telephone interview. 101(31.46%) persons could be reached and were included in the study. A profile of daily alcoholconsumption was assessed with the “Timeline Follow back” method and categorized asabstinent, slips, episodic or steady. Furthermore the CCAD and a prognosis for each Lesch Typewere calculated.Results: 37% of patients had an abstinent course of alcohol consumption, 31% had slips, 12%had an episodic and 20% a steady course. The rate of abstinence in patients treated according tothe Lesch typology was significantly higher than in patients who received treatment as usual.Using this intent to treatment method it is obvious that the results have serious limitationsbecause we could only reach one third of our patients. These methodological problems should bediscussed.How to use Lesch-Typology in Forensic Questions?Werner E. Platz, Vivantes Forensic Psychiatry, Berlin, Germany (werner.platz@vivantes.de)Following a decision of the Federal Constitutional Court, prior to hospitalization of an addictedoffender in a detention center withdrawal unit, the prospects for success of withdrawal treatmentare to be tested. In the Guidelines of the Federal Constitutional Court (BVerfG), a successfulprognosis for "cure" or at least abstinence for "a certain period of time" is required by thetherapy. So far, only limited meaningful forecasting tools have been available, so therapy andprognosis based on Lesch-Typology in forensic psychiatric evaluations and follow-ups havebeen used in detention centers. It has been determined that dependent patients according to318