Dr Paco Pascual holistic approach to dependencies

He believes it is important to detect alcohol-dependency and alcohol-related problems so that the illness can be treated as soon as possible. When making a diagnosis, he asks the patient to estimate their consumption of alcohol, administers the Munich Alcoholism Test (MALT) and the Alcohol Use Disorders Identification Test (AUDIT) and measures blood Gamma-GT and carbo deficient transferrin. DSM-V criteria are also followed. To complete the diagnosis, a family interview takes place for verification of the patient’s history as often patient’s estimates and accounts can be unreliable.

In order to diagnose depression correctly in patients with alcohol dependency, Dr Pascual feels it is important to reduce the patient’s alcohol intake because much of the depressive symptomatology is often guilt-associated. During this initial phase of treatment, pharmacological agents can help and after 1 month, and only once alcohol consumption levels are low, would Dr Pascual prescribe an antidepressant due to his having concerns about drug-alcohol interactions.

Motivational interventions – short, frequent interventions made by the whole mental health team - are excellent promotors of adherence as they continually reinforce the patient’s positive advances.

Motivational interventions – short, frequent interventions made by the whole mental health team - are excellent promotors of adherence as they continually reinforce the patient’s positive advances. Family intervention and mutual help groups are also very valuable in this respect. Having a family member as the ‘pill controller’, for example, can aid not only in adherence to a therapeutic programme but also in the avoidance of dependency on some of the therapeutic agents being given. Having the patient become involved in mutual help and other cultural activities also aid their recovery by simply making them feel better. After all, as Dr Pascual commented, “Patients need to feel they belong to society too.”