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Background: In the general hospital setting, alcohol-use disorders very commonly remain undetected., Objective: The authors hypothesized that including a consultation-liaison (C-L) psychiatrist in primary-care rounds would improve detection rates of alcohol-use-disorders., Method: Patients (N=165) on two medical wards were screened by means of the Alcohol Use Disorders Identification Test. Diagnoses were confirmed with the International Diagnostic Checklists and compared with physicians' detection rates. C-L intervention included demonstrations of standardized diagnostic procedures in order to change primary-care physicians' behavior., Results: Primary-care-physicians' detection rates of alcohol-use disorders increased significantly after implementation of the C-L service, whereas no significant differences were observed on the control ward., Conclusion: Tentative data thus underscore the efficacy of C-L psychiatry for detection and intervention in alcohol-use disorders.

Objective: Based on the Obsessive Compulsive Drinking Scale (OCDS) we developed and validated the Mannheimer Craving Scale (MaCS) for quantitative measurements of craving across different substances and suitable for multiple substance abuse., Methods: The MaCS questionnaire measures obsessive-compulsive symptoms in the context of substance abuse and dependence similar to the OCDS. The MaCS consists of 12 items and 4 additional items. Validation of the instrument was performed by means of 3 assessments of each subject within a project for the evaluation of a detox treatment on n = 292 alcohol and drug-dependent patients with multiple substance abuse., Results: The MaCS showed a very high measurement reliability (0.87 < alpha < 0.93). The MaCS total score correlated highly significant with the mean intensity of craving (0.47 < r (tc ) < 0.64, p < 0.0001), with the maximum of craving (0.52 < r (tc) < 0.69, p < 0.0001), and with the frequency of craving (0.43 < r (tc) < 0.65, p < 0.0001) measured by means of analogue scales., Conclusions: The MaCS for overall measurements of craving across multiple substances showed very good reliability and validity. In combination with a simple and universal feasibility of the MaCS these results indicate the applicability in everyday clinical settings as well as scientific settings.

Onset and course of alcohol dependence show gender related differences (telescoping effect) suggesting that women are more vulnerable to chronic alcohol consumption. This raises the question whether the differences are associated with a different treatment outcome as well. We hypothesized, that alcohol dependent women with a telescoping course show a less favourable treatment outcome compared to men. We investigated 212 alcohol dependent patients; matching 106 consecutively admitted women with 106 men drawn from a total sample of 343 male patients. The treatment program consisted of a 6 week inpatient treatment and 12 months of outpatient aftercare. We assessed milestone variables in development and course of alcoholism and carried out standardized diagnostic tests, physical and blood examinations to evaluate the course of the disease and treatment outcome. Overall, we confirm the telescoping effect, a faster progression in the course of alcoholism (developmental events and adverse consequences) in women compared to men ("telescoping effect"). However, despite the telescoping effect treatment outcome was similar in women and men. During the inpatient treatment program no alcohol relapse occurred. Throughout the 12 months outpatient treatment we found no significant differences in the survival analysis between women (283.29+/-11.26 days) and men (284.72+/-12.16 days). At the end of the 12 months both groups had an abstinence rate of approximately 50% and a drop-out rate of 33%.