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1
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4
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   ??????? ???????????? ??????? (?????? ??????
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   ?????????????????? 6 ??? 12 ???, ??????? ?
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5
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6
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7
??????????? ???????????? ???????????? ????????
(EMA)

• Full abstinence

• Intermediate harm reduction
• Reduction total alcohol consumption
• AND
• Reduction heavy drinking days

European Medicines Agency. February 2010
8
???? ??????? ???????????? ?????????
UK survey of patients withalcohol problems
(n742)1
Canadian study of patients with chronic
alcoholism (n106)2
50
Approximately half of patients would choose
reduction rather than abstinence as a treatment
goal
8
1. Heather et al. Alcohol Alcohol
201045(2)128135 2. Hodgins et al. Addict
Behav 199722(2)247255
9
???????? ??????????? ????????
Drinks per day
10
NALMEFEN
11
????????

• ????? ????????? ??????????
• ??????????? ??????????? ???????? ?? ?????? ?
  ??????????? ?? ????
• ?o????? ?????????????? ??? ???????????
  ????????????
• ????? ??????????????? ????????????????? ????????
• ??????? ????????? ? ???????? ??????????
• Targeted use

12
???????????? ????????? (3-? ????)
Adapted from www.clinicaltrials.gov
13
Reduction approach Nalmefene
14
?????????? ???????????? ?????????
????? ??????????? ????????
??? ???????? ????????
19 HDDs
100 g/day
7 HDDs
33 g/day
R
R
Van den Brink et al 2014
15
??????????? ?????????? ???? ???????? ????????
??????? ?????????? ???????? ? ???? (?/????)
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Patient-Centered Care (PCC)

• Providing care that is respectful of and
  responsive to individual patient preferences,
  needs, and values, and ensuring that patient
  values guide all clinical decisions.
• Institute of Medicine, 2001

No decision about me, without me.
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Be careful!
32

??????!!!
33

• ??????? ?? ????????