Dr Belda, Psychiatrist
Tel: 020 3793 6338
Email: contact@drbelda-psychiatrist-london.co.uk

ALCOHOL & SUBSTANCES MISUSE/DUAL DIAGNOSIS

When a problem is haunting us, it is easy to find comfort on substances like alcohol. However it is known that in the long run it worsens the initial problem and brings many additional ones. On many occasions alcohol detoxification is required, but many times although it is difficult to control the alcohol intake, detox is not necessary. This clinic provides the opportunity to bring the alcohol intake under control when there is not physical dependence as well as preventing it from developing. In turn, the problem which has been masked by alcohol, ie Depression, ADHD in Adults etc. can be identified and appropriately addressed.

There are times when after completing detoxification from alcohol or other substances, relapse prevention strategies, like anti-craving medications and psychological interventions can be life-saving. I have the expertise to identify and personalise the most appropriate strategy to each individual situation in a stigma-free environment.

The comorbidity between affective disorders and substance misuse is a recognised fact. Sometimes, the alcohol or other substances are disguising the main problem and worsening it. Studies suggest that the comorbidity between Alcohol Dependence and Bipolar type I is above 30%, between Alcohol Misuse and Bipolar type I is 14%, between Bipolar type II and alcohol dependence is 21% and between alcohol misuse and Bipolar type II is 18% (Soone et al 2002). For those patients, unless the alcohol intake is under control, it is difficult to establish a proper diagnosis; and unless the affective disorder is treated, it will be very difficult for them to control the alcohol intake. Something similar happens between alcohol and depression.

Looking at the ICD10 criteria for alcohol dependence, it does not always imply physical dependence and therefore medically assisted withdrawal will not be necessary on many cases. But those patients will require interventions aimed at targeting both, the excessive drinking and the underline psychiatric condition. This is something that can be done at this clinic.

There are cases where following alcohol detoxification, patients with or without a comorbid psychiatric condition need interventions aimed at preventing relapse; this might involve psychosocial interventions as well as anticraving medications. The anticraving medications should be tailored to the type of cravings that the person is experiencing as there are Relief type cravings and Reward type cravings. The different types of cravings are mediated by different systems; the Relief type by the Glutamaergic system and the Reward type by the Opiate system. In addition there are interventions which aim at preventing the development of alcohol dependence. I have the skill and expertise to provide the most appropriate clinical interventions based upon the latest research. Interventions like the prescribing of Nalmefene, Naltrexone or Acamprosate when appropriate are carried out at this clinic.

For people who, having undergone detoxification from Opiates, would benefit from interventions aimed at maintaining abstinence like Naltrexone prescription, this clinic will provide a stigma free environment away from addiction clinics where dependent and non-dependent patients attend together. In addition this clinic has the links to directly refer patients to experienced and highly trained therapists who will support the biological interventions with psychological therapies tailored to the individual's needs.

Many cases of Adult ADHD in Adults are masked by alcohol misuse. Studies suggest that up to 45% of adults with ADHD in Adults have a history of alcohol abuse. Up to 30% of adults with ADHD in Adults have a drug problem, mainly stimulants, as means of self-medication. It is not always easy to establish the differential diagnosis but a careful clinical history and the relevant collateral information can lead to the right diagnosis and hence to successful treatment options.

More information...
Dr Belda treats patients suffering from addiction
Contact Dr Belda on 020 3793 6338
or book an appointment online: