See Also
Brief Intervention Protocol for Problem Drinking
1. See Chemical Dependency Brief Counseling
Protocol for Alcohol Dependence
1. Initial Management
  1. Alcohol Detoxification
  2. Alcohol Withdrawal protocol
2. Long-Term Abstinence Programs
  1. Alcoholics Anonymous
  2. Sponsor
  3. Treatment Program
  4. Halfway House
3. Adjunctive Medications for abstinence
  1. General
    1. High relapse rate after 3 months
  2. First line (consider Naltrexone with Campral)
    1. Naltrexone
      1. Blocks Opioid receptors
      2. Decreases pleasure from Alcohol
      3. Dosing: 50 mg orally daily
      4. Effective in short-term, but not in long-term
    2. Campral (Acamprosate)
      1. Balances GABA and glutamate neurotransmitters
      2. Reduces anxiety from abstinence
      3. Dosing: 2 tabs PO tid
      4. Cost: $125/month
  3. Second line agents to consider
    1. Selective Serotonin Reuptake Inhibitors (SSRI)
      1. Consider especially if comorbid depression
      2. Prozac often used, but other SSRIs effective
      3. Naranjo (2001) J Clin Psychiatry 62:18
  4. Topiramate (Topamax)
    1. Decreases Alcohol use severity and binge drinking
    2. Improves well being, quality of life in Alcoholics
    3. Johnson (2004) Arch Gen Psychiatry 61:905
  5. Agents to avoid
    1. Antabuse
      1. Taken 250 to 500 mg orally daily
      2. Not recommended due to risk and uncertain benefit
Resources
1. See Chemical Dependency Resources
2. See Alcoholism for Alcohol specific resources
Precautions
1. Major Depression is common in recovering Alcoholics
  1. Treating Depression may lower risk of relapse
  2. Hasin (2002) Arch Gen Psychiatry 59:794
References
1. Sarmiento (Oct 2000) Federal Practitioner, p.45-50
2. Enoch (2002) Am Fam Physician 65(3):441
3. Fleming (1997) JAMA 277:1039

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.