Alcoholism Management

Aka: Alcoholism Management, Problem Drinking Management, Alcohol Dependence Management, Alcohol Abuse Management

1. See Also
   1. Alcohol Dependence
   2. Alcohol Toxicity
   3. Alcohol Withdrawal
   4. Alcohol Detoxification in Ambulatory Setting
   5. Alcoholism Management
   6. Chemical Dependency
   7. Drug Withdrawal
   8. Substance Abuse Evaluation
   9. Substance Addiction Aftercare
2. Protocol: Brief Intervention for Problem Drinking
   1. See Chemical Dependency Brief Counseling
   2. Track patient progress
      1. Metrics for the last month
         1. Number of Alcohol free days
         2. Number of heavy drinking days
         3. Maximum number of drinks in one day
      2. Lab markers
         1. Serum Gamma glutamyl transferase or
         2. Carbohydrate deficient Transferrin
3. Protocol: 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 62:18-25
         2. 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 61:905-12
      4. Agents to avoid
         1. Antabuse
            1. Taken 250 to 500 mg orally daily
            2. Not recommended due to risk and uncertain benefit
4. Resources
   1. See Chemical Dependency Resources
   2. See Alcoholism for Alcohol specific resources
5. Precautions
   1. Major Depression is common in recovering Alcoholics
      1. Treating Depression may lower risk of relapse
      2. Hasin (2002) Arch Gen Psychiatry 59:794-800
6. References
   1. Sarmiento (Oct 2000) Federal Practitioner, p.45-50
   2. Enoch (2002) Am Fam Physician 65(3):441-50
   3. Fleming (1997) JAMA 277:1039-45
   4. Willenbring (2009) Am Fam Physician 80(1): 44-50