[Diagnostic and treatment of alcohol-related disorders. Results of a representative survey in counseling centers].
BACKGROUND
Due to the high prevalence of alcohol related disorders (dependent, harmful and at risk drinking) the improvement of the outpatient treatment situation in this area is of major importance. The aim of this study was to examine the treatment structure and modalities of patients with alcohol related disorders in counseling centers for substance abusers based on the questioning of the counselors.


METHODS
A 3-page questionnaire to characterize the institution and six standardized 10-page questionnaires (for the counselors) were sent to all counseling centers (n = 123) in Baden-Württemberg. The counselors were asked about diagnostic and therapeutic procedures they had employed in the last patient seen. Further questions regarded patient related and structural problems.


RESULTS
The results are related to a representative sample of 262 counselors of 73 counseling centers (59.5 %). Further 28 counseling centers (22.6 %) were not able to take part in the survey because they do not care for people with alcohol related disorders. The sample complies with respect of relevant dimensions (sponsoring institution, profession of the counselors, age distribution of patients, accomplished interventions) with the population of counseling centers in Baden-Württemberg. The reported patients were predominantly male (80.5 %) and nearly all patients were addicted to alcohol (95.8 %). They had a mean age of 41,9 +/- 10 years, high acceptance of diagnosis (79.2 %) and treatment (80.3 %) and only 6.4 % used multiple substances. The results with respect of the diagnostic procedure refer to a structured, broad and professional procedure. 63.4 % of the counsellors are geared to formal diagnostic criteria when making a diagnosis. All relevant history elements are observed. But the study pointed towards some deficits in recognising suicidal tendencies. The own responsibility related to the supply of people with alcohol problems is predominantly seen in educational advertising and counselling, but also in numerous other areas the own responsibility is judged very high. Further training is particularly seen regarding relapse prevention and suicidality. The co-operation with several institutions, e. g. general practitioners, is judged to be relatively low.


CONCLUSIONS
The majority of patients described by the counselors were dependent drinkers. This indicates that harmful and at risk drinkers are hardly reached by counseling centers. So there is clear space for optimizing the care for people with alcohol-related disorders.
Berner
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Universitätsklinikum Freiburg, Abteilung für Psychiatrie und Psychotherapie (Arztlicher Direktor: Prof. Dr. M. Berger). Michael_Berner@psyallg.ukl.uni-freiburg.de
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Härter
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D000328:Adult; D019973:Alcohol-Related Disorders / Q000175:diagnosis* / Q000628:therapy*; D003376:Counseling; D003627:Data Interpretation, Statistical; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000628:therapy; D008875:Middle Aged; D010361:Patients; D011569:Psychiatric Status Rating Scales; D011795:Surveys and Questionnaires