The Lesch alcoholism typology - psychiatric and psychosocial treatment approaches.
Bottom Line: Pharmacological treatments are not always the most effective way of preventing relapses in alcohol dependent patients.Many times, a combination with psychosocial as well as psychotherapeutic approaches is necessary and essential for helping patients to stay sober.Depending on the patient's Lesch Type, certain therapeutic approaches are more appropriate and subsequently lead to better results and higher chances of lasting abstinence.
In the past three decades, researchers have been attempting to replace the obsolete concept of homogeneity of alcohol dependence, by classifying these patients into specific heterogeneous subtypes. Based on 30 years of experience and research, the Lesch Typology has proved to be very useful in clinical daily routine. The aim of the Lesch Typology is to provide targeted subtype-specific treatments to patients, thereby increasing their probability of long-term abstinence and hence improving their prognosis. The Lesch Typology is based on data from a longitudinal prospective study (with follow ups even 19 years later) on alcohol dependent patients (n=436). By observing the long term development of these patients, four distinct courses could be identified. In the meantime, a computerized version of the Lesch Typology had been created and translated into many languages, and is currently being employed in numerous psychiatric institutions while assisting clinicians in quickly determining a patient's subtype (www.lat-online.at). Based on the patients' drinking patterns and origin of substance craving, hence according to the Lesch Typology, four subtypes of alcohol dependent patients can be distinguished: 1. the "allergy model" (craving caused by alcohol); 2. the "conflict resolution and anxiety model" (craving caused by stress); 3. the "depressive model" (craving caused by mood); and 4. the "conditioning model" (craving caused by compulsion). Pharmacological treatments are not always the most effective way of preventing relapses in alcohol dependent patients. Many times, a combination with psychosocial as well as psychotherapeutic approaches is necessary and essential for helping patients to stay sober. Depending on the patient's Lesch Type, certain therapeutic approaches are more appropriate and subsequently lead to better results and higher chances of lasting abstinence.
No MeSH data available.
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Mentions: The multidimensional diagnostic process involved in determining the Lesch subtype is demonstrated in Figure 1. If a symptom specific to Type IV can be assessed, then the patient instantly falls into the category of Type IV. If there are no symptoms of Type IV, but the patient has an affective disorder or presents suicidal behavior unrelated to alcohol consumption, Type III is diagnosed. If neither symptoms of Type IV or Type III are present, but severe withdrawal symptoms or seizures have occurred, then Type I is diagnosed. Type II patients, consuming alcohol to cope with states of anxiety, do not show any symptoms of Type IV, III or I. In Table 3, the different craving symptoms and fundamental neurobiological models associated with each Lesch subtype are summarized.
No MeSH data available.