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Biomedical subjects

R J Frances

Publications and source records attributed to R J Frances.

At least 19 recordsLinked to original sources
PubMed1993

The treatment of anxiety in patients with alcoholism.

The high incidence and the high comorbidity of alcohol and anxiety problems make the relationship between these two disorders one of the most important issues clinicians have to address. However, many general psychiatrists have had minimal training in treating patients with addictions, and many experts on alcoholism have not fully mastered the armamentarium of approaches to treating anxiety. In general, special problems exist in treating anxiety in patients with alcoholism, particularly in those patients with anxiety disorders. The clinician must analyze and treat the complicated interaction between these disorders and target the right combination and sequences of treatment fitting the specific needs of the case. The effects of intoxication, withdrawal, and chronic use on anxiety and need to be taken into account and the primary vs. secondary nature of the disorders needs to be determined. Parameters for choosing setting, modality, pharmacologic approaches, and issues in treating special populations will be discussed. Decisions about treatment should be based on sound knowledge of the epidemiology, diagnostic issues, genetics, pathophysiology, biological aspects, clinical course, complications, and treatment-outcome studies of anxiety and alcohol disorders. The wise clinician also needs to show flexibility in approaching treatment-resistant cases.

Alcoholism↗
PubMed1991

Substance abuse.

Explore the source record for details and available documents.

Humans↗
PubMed1988

Update on alcohol and drug disorder treatment.

The numbers of patients in all forms of psychoactive substance abuse disorder treatments have dramatically risen in the past decade, and it is estimated that $1.8 billion are spent on alcohol and drug inpatient and outpatient treatment. Recent developments in therapeutic modalities and the differential therapeutics of alcohol and psychoactive drug abuse treatment are presented. Choice of treatment setting, combination of treatment modalities, and the special needs of subpopulations are discussed in terms of both review of the literature and practical decisions made by clinicians. Problems in diagnosis and treatment and the dual-diagnosis patient, patients with multiple substance abuse, women, minorities, and the homeless are touched upon. The heterogeneous nature of patients with psychoactive substance abuse problems requires flexibility and sophistication in treatment design, with attention to biopsychosocial variables. The treatment implications of recent developments in diagnosis such as DSM-III-R, research on AIDS in relation to substance abuse, and studies of familial alcoholism and fetal alcoholism are highlighted. A concise update of detoxification, pharmacotherapy, behavioral treatment, psychodynamically informed approaches, family therapy, and group therapy focuses on clinical decisions. Although demonstrating overall efficacy of alcohol treatment, few studies demonstrate differential responses for subpopulations or specific treatment modalities.

Alcoholism↗
PubMed1987

The impact of cost containment on alcohol and drug treatment.

Hospitals offering alcohol and drug treatment programs that meet certain criteria are currently exempt from Medicare's prospective payment system, which was introduced in October 1983 as a means of containing medical costs. Substance abuse experts have successfully lobbied for changes in the alcohol and drug diagnosis-related groups (DRGs) on which reimbursement is based so that they now more accurately reflect patterns of inpatient detoxification and rehabilitation. However, major adjustments are still necessary to protect the quality of care and financial diversity of substance abuse treatment programs. Differences in types of treatment facilities must be considered in order to prevent a major redistribution of funds away from facilities offering specialized care. Incentives to reduce costs must be balanced with a determination to maintain high-quality care.

Centers for Medicare and Medicaid Services, U.S.↗