The effectiveness of treatment for substance abuse. Reasons for optimism.

Reviews of treatment research have sometimes drawn gloomy conclusions which clash with the experience of clinicians. Yet the same literature provides reasons for optimism about the future of substance abuse treatment. There are treatment strategies with encouraging evidence of effectiveness that are only beginning to be applied in practice. Furthermore, research is clarifying the mechanisms and reasons for successful treatment, pointing to factors to be emphasized in therapy. Approaches that yield even short-term advantages can promote more rapid recovery, and may provide clues for how to prevent relapse. In difficult economic times, hope is also provided by evidence that even relatively brief treatment can be substantially more effective than none at all. Recent evidence also supports the importance of matching clients to alternative treatment strategies. To the extent that practitioners can keep abreast of such developments and adjust their clinical work accordingly, there is reason to believe that the effectiveness of substance abuse treatment can be greatly increased.     

Drug-induced hypokalaemia. A cause for concern.

Drug-induced hypokalaemia is a widespread problem in the elderly that can be caused by many therapeutically useful substances, the most common of which are diuretics. In certain classes of patients (e.g. those with acute myocardial infarction, with congestive heart failure receiving digitalis, or with cirrhosis), iatrogenic hypokalaemia is an established risk factor. In patients with hypertension who have no underlying heart disease or liver disease, the use of diuretics may lead to worsened glucose tolerance and cardiac arrhythmias. There is also evidence for an increased risk of sudden cardiac death.