II. 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

III. Protocol: Alcohol Use Disorder

  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, generics for both are available)
      1. Naltrexone
        1. Blocks Opioid receptors
        2. Decreases pleasure from Alcohol
        3. Effective in reducing Alcohol use in non-abstaining patients
        4. Dosing: 50 mg orally daily
        5. Effective in short-term, but not in long-term
      2. Campral (Acamprosate)
        1. Balances GABA and glutamate neurotransmitters
        2. Reduces anxiety from abstinence (with better efficacy in abstinence than Naltrexone)
        3. Dosing: 2 tabs orally three times daily
    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 [PubMed]
      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 [PubMed]
    4. Other medications that may be effective
      1. Gabapentin (Neurontin) or Pregabalin (Lyrica)
      2. Ondanestron
    5. Agents to avoid
      1. Baclofen (insufficient evidence)
      2. Disulfiram (Antabuse)
        1. Taken 250 to 500 mg orally daily
        2. Not recommended due to risk and uncertain benefit

IV. Resources

  1. See Chemical Dependency Resources
  2. See Alcoholism for Alcohol specific resources

V. Precautions

  1. Vitamin Deficiency is common (Vitamins A, C, B1, B3, B6, B9, B12)
    1. See Alcohol Dependence
  2. Major Depression is common in recovering Alcoholics
    1. Treating Depression may lower risk of relapse
    2. Hasin (2002) Arch Gen Psychiatry 59:794-800 [PubMed]

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