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Symptoms of acute alcohol withdrawal like tremors, seizures and delirium are commonly treated with benzodiazepines and vitamins. When complaints are not reacting to this treatment, an alternative diagnosis must be considered. Although hypomagnesemia is present in at least 30 percent of the patients with alcohol dependence, it can provoke and maintain these complaints. We present a 43-year-old man with alcohol dependence, who shows neurological, muscular, and cardiac consequences of an undiagnosed hypomagnesemia. In daily clinical practice there is not enough attention for magnesium deficits, especially in patients with alcohol dependence. Serious complications can be prevented by recognizing and treating magnesium deficiency more adequately.

(1) Background: Current evidence-based treatments for alcohol use disorder (AUD) are moderately effective. Studies testing repetitive transcranial magnetic stimulation (rTMS) in AUD commonly apply a limited number of rTMS sessions with different rTMS settings, showing inconsistent effects on craving for alcohol. This study tested the efficacy of a robust rTMS protocol on craving and alcohol use. (2) Methods: In a single-blind randomized controlled trial in recently detoxified patients with AUD, ten days of high-frequency rTMS over the right dorsolateral prefrontal cortex on top of treatment as usual (n = 14) was compared with sham rTMS (n = 16). Outcome measures were alcohol craving and use over a follow-up period of one year. Analysis was performed by means of repeated measures multivariate analysis of variance. (3) Results: The results showed a main group-by-time interaction effect on craving (Wilks’ Λ = 0.348, F (12, 17) = 2.654, p = 0.032) and an effect of group on alcohol use (Wilk’s Λ = 0.44, F (6, 23) = 4.9, p = 0.002), with lower alcohol craving and use in the group with active rTMS compared to the control group. Differences in craving between groups were most prominent three months after treatment. At 12 months follow-up, there was no effect of rTMS on craving or abstinence. (4) Conclusions: This small-scale randomized controlled trial showed the efficacy of high-frequency rTMS over the right dlPFC diminished alcohol craving and use in recently detoxified patients with AUD during the first months after detoxification. These findings suggest that rTMS might be an effective add-on in treating patients with AUD and warrant replication in future large-scale studies.

This study examined the feasibility, safety, and efficacy of addiction-focused eye movement desensitization and reprocessing (AF-EMDR) treatment, as an add-on intervention to treatment as usual (TAU). Adult outpatients with alcohol use disorder (AUD) (N=109) who already received or had just started with TAU (Community Reinforcement Approach) were recruited at 6 outpatient addiction care facilities. They were randomly assigned to either TAU+7 weekly 90-minute sessions of AF-EMDR (N=55) or TAU-only (N=54). Assessments were made at baseline, after AF-EMDR therapy (+ 8weeks in the TAU-only group), and at 1- and 6-month follow-up. The primary outcomes were changes in drinking behavior as reported by the participant and biomarker indices. Data were analyzed as intent-to-treat with linear mixed models. Additionally, sensitivity analyses were performed. No group or interaction effects were found for any of the outcome variables. Only limited change over time was seen with regard to indices of personal and societal recovery and in some secondary indices of clinical recovery (craving, desire thinking, and rumination). Reliable Change Index calculations showed that more TAU-only participants showed clinical improvement with regard to alcohol consumption while a somewhat higher proportion of participants in the TAU+AF-EMDR group experienced less craving. The acceptability, safety, and feasibility of the treatments received in both groups were comparable. There was no add-on effect of AF-EMDR on TAU with regard to drinking behavior in outpatients with an AUD. Possible explanations are discussed. Future studies should first establish proof of principle regarding the potential of AF-EMDR therapy to disrupt operant learning and habits relevant in addiction.

Abstract. Desire thinking refers to verbal and imaginal elaboration of a desired target. It predicts escalations in craving intensity and subsequent alcohol use. This article aimed to determine the psychometric properties of the Dutch version of the Desire Thinking Questionnaire (DTQ-D). In Study 1, a confirmatory factor analysis provided support for the original two-factor solution, achieved with adequate internal consistency. The DTQ-D demonstrated partial invariance over time. In Study 2, convergent validity with measures of craving was demonstrated. Discriminant validity with measures of severity of alcohol use and perseverative thinking was satisfactory. Concurrent validity was established by comparing three distinctive groups of alcohol users with increasing levels of drinking: a normative and an out- and in-patient sample. The normative group scored significantly lower on the DTQ-D than the clinical groups. Within the normative sample a low and higher at-risk drinking group could be distinguished. Overall, the DTQ-D possesses reasonable psychometric properties for use with alcohol-drinking samples. However, additional psychometric evaluation in larger clinical samples as well as in other addictions is warranted.

BackgroundThe automatic tendency to attend to and focus on substance-related cues in the environment (attentional bias), has been found to contribute to the persistence of addiction. Attentional bias modification (ABM) interventions might, therefore, contribute to treatment outcome and the reduction of relapse rates. Based on some promising research findings, we designed a study to test the clinical relevance of ABM as an add-on component of regular intervention for alcohol and cannabis patients.Design/MethodsThe current protocol describes a study which will investigate the effectiveness and cost-effectiveness of a newly developed home-delivered, multi-session, internet-based ABM (iABM) intervention as an add-on to treatment as usual (TAU). TAU consists of cognitive behavioural therapy-based treatment according to the Dutch guidelines for the treatment of addiction. Participants (N = 213) will be outpatients from specialized addiction care institutions diagnosed with alcohol or cannabis dependency who will be randomly assigned to one of three conditions: TAU + iABM; TAU + placebo condition; TAU-only. Primary outcome measures are substance use, craving, and rates of relapse. Changes in attentional bias will be measured to investigate whether changes in primary outcome measures can be attributed to the modification of attentional bias. Indices of cost-effectiveness and secondary physical and psychological complaints (depression, anxiety, and stress) are assessed as secondary outcome measures.DiscussionThis randomized control trial will be the first to investigate whether a home-delivered, multi-session iABM intervention is (cost-) effective in reducing relapse rates in alcohol and cannabis dependency as an add-on to TAU, compared with an active and a waiting list control group. If proven effective, this ABM intervention could be easily implemented as a home-delivered component of current TAU.Trial registrationNetherlands Trial Register, NTR5497, registered on 18th September 2015.

ABSTRACTObjective: In recent years, treatment of substance use disorder has rekindled emphasis on recovery which, being a gradual process, starts with remoralization. In this study, we examine the level of demoralization throughout the treatment process for patients with comorbid substance dependence and psychiatric disorders. Methods: 217 patients with co-occurring disorders and 179 community-based individuals participated in this study. Demoralization was measured twice over one month as inpatient treatment happened. Results: In contrast with the community sample, we found high levels of demoralization in the clinical cohort, with 86% of patients having demoralization scores above threshold. During the first month there was a statistically significant reduction in demoralization scores. However, clinically relevant change appeared limited, with only 3% of patients moving from dysfunctional to functional status in this naturalistic setting without targeted intervention aimed at remoralization. Conclusions: Although the level of demoralization is significantly improved during the first month of treatment, patients still remain strongly demoralized. Clinically relevant improvement is limited. It could be worthwhile to set up targeted interventions aimed at remoralization. Furthermore, we advocate for the assessment of demoralization in the clinical setting to monitor patients' treatment outcomes.

The misuse of γ-hydroxybutyrate (GHB) for recreational purposes has resulted in an increase in GHB-related problems such as intoxications, dependence and withdrawal in several countries in Europe, Australia and the US over the last decade. However, prevalence rates of misuse of GHB and its precursor, γ-butyrolactone (GBL), are still relatively low. In this qualitative review paper, after a short introduction on the pharmacology of GHB/GBL, followed by a summary of the epidemiology of GHB abuse, an overview of GHB dependence syndrome and GHB/GBL withdrawal syndrome is provided. Finally, the existing literature on management of GHB detoxification, both planned and unplanned, as well as the available management of GHB withdrawal syndrome, is summarized. Although no systematic studies on detoxification and management of withdrawal have been performed to date, general recommendations are given on pharmacological treatment and preferred treatment setting.

Introduction: Elderly alcohol dependent patients can be discriminated based on the age of onset of alcohol use. This is relevant for their clinical problem presentation and for the course of treatment.Materials and methods: In this paper, problems of elderly patients are presented at intake in an addiction treatment center, based on the most recent, almost nationwide applied intake instrument in The Netherlands: the MATE. Prevalences are analyzed for substance use, psychiatric and somatic co-morbidity, level and severity of dependence, limitations in daily functioning, craving, and perceived levels of depression, anxiety and stress. Among a total of 1942 alcohol dependent patients, four subpopulations were compared in the analyses: adults (24–55 years), elderly patients (≥ 55 years) with early (early-onset alcohol dependence (EOAD), < 25 years), middle (medium-onset alcohol dependence (MOAD), 25–45 years) and late (late-onset alcohol dependence (LOAD), > 45 years) onset alcohol dependence.Results: Results show that LOAD has less problem severity in almost all assessment areas than adults. They do however use 3.5 times more often medication for physical illnesses, and suffer more often from confusion and somatic diseases. LOAD is not different from EOAD and MOAD.Conclusion: The results show that LOAD in a relatively short time period developed an alcohol dependence and alcohol related problems that are similar to that of their peers who used alcohol for a much longer time.