Alcohol use disorder - Revision history

Aidan: /* Acamprosate */ small changes

2020-07-10T19:59:18Z

Acamprosate: small changes

← Older revision		Revision as of 19:59, 10 July 2020
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	== Definition ==		==Definition==

	* [[Substance use disorder]] of alcohol		*[[Substance use disorder]] of alcohol

	== Management ==		==Management==

	* Based on stage of change		*Based on stage of change
	* Pre-contemplative		*Pre-contemplative
	** Screening, Brief Intervention, and Referral to Treatment (SBIRT)		**Screening, Brief Intervention, and Referral to Treatment (SBIRT)
	* Contemplative		*Contemplative
	** Motivational enhancement		**Motivational enhancement
	* Action		*Action
	** Residential treatment		**Residential treatment
	** Alcoholics Anonymous		**Alcoholics Anonymous
	** Medications (concurrent with psychosocial interventions)		**Medications (concurrent with psychosocial interventions)

	=== Medications ===		===Medications===

	==== Naltrexone ====		====Naltrexone====

	* First-line; anti-craving opioid antagonist		*First-line; anti-craving opioid antagonist
	* Can continue drinking but should commit to weekly counseling		*Can continue drinking but should commit to weekly counseling
	* Reduces the total amount of alcohol consumed		*Reduces the total amount of alcohol consumed, but may not help with abstinence
	** NNT 20 for any drinking		**NNT 20 for any drinking
	** NNT 12 for heavy drinking and cravings		**NNT 12 for heavy drinking and cravings
	* Contraindications: opioid use, liver disease		*Contraindications: opioid use, liver disease
	* Adverse effects: nausea, sleepiness		*Adverse effects: nausea, sleepiness
	* Start 25mg daily for 4 days then increase to 50mg daily		*Start 25mg daily for 4 days then increase to 50mg daily
	* Requires EAP approval, otherwise ~$300/mo		*Requires EAP approval, otherwise ~$300/mo

	==== Gabapentin ====		====Gabapentin====

	* Abstinent for 3 days, then start 300mg HS and increase by 300mg daily up to 300mg TID or 600mg TID		*Abstinent for 3 days, then start 300mg HS and increase by 300mg daily up to 300mg TID or 600mg TID
	* NNT 8 for abstinence		*NNT 8 for abstinence
	* NNT 5 for reducing heavy drinking		*NNT 5 for reducing heavy drinking
	* Adverse effects: insomnia, drowsiness		*Adverse effects: insomnia, drowsiness

	==== Acamprosate ====		====Acamprosate====

	* ~~Relapse~~ prevention		*Helps with abstinence and relapse prevention
	* 4 days of abstinence prior to start		*Requires 4 days of abstinence prior to start
	* On ODB after naltrexone		*On ODB after naltrexone
	* NNT 12 for maintaining abstinence, no effect on heavy drinking		*NNT 12 for maintaining abstinence, no effect on heavy drinking
	* Beware in renal disease, has GI side effects		*Beware in renal disease, has GI side effects

	==== Topiramate ====		====Topiramate====

	* Glutamate antagonist and GABA agonist		*Glutamate antagonist and GABA agonist
	* Start 25mg PO BID and titrate weekly by 25mg		*Start 25mg PO BID and titrate weekly by 25mg

	==== Baclofen ====		====Baclofen====

	* Has street value and can cause dependence		*Has street value and can cause dependence
	* Start 5mg TID and titrate up by 5mg		*Start 5mg TID and titrate up by 5mg
	* Beware in renal disease		*Beware in renal disease

	==== Ondansetron ====		====Ondansetron====

	* Limited but promising data		*Limited but promising data

	==== Disulfiram ====		====Disulfiram====

	=== Case management ===		===Case management===

	=== Day programs ===		===Day programs===

	== Maintenance ==		==Maintenance==

	* Relapse prevention		*Relapse prevention

	[[Category:Addiction medicine]]		[[Category:Addiction medicine]]

Aidan: /* Definition */

2020-07-05T20:48:11Z

Definition

← Older revision		Revision as of 20:48, 5 July 2020
Line 1:		Line 1:
	== Definition ==		== Definition ==

	* Substance use disorder of alcohol		* [[Substance use disorder]] of alcohol

	== Management ==		== Management ==

Maintenance script: Imported from text file

2020-07-04T01:17:22Z

Imported from text file

New page

== Definition ==

* Substance use disorder of alcohol

== Management ==

* Based on stage of change
* Pre-contemplative
** Screening, Brief Intervention, and Referral to Treatment (SBIRT)
* Contemplative
** Motivational enhancement
* Action
** Residential treatment
** Alcoholics Anonymous
** Medications (concurrent with psychosocial interventions)

=== Medications ===

==== Naltrexone ====

* First-line; anti-craving opioid antagonist
* Can continue drinking but should commit to weekly counseling
* Reduces the total amount of alcohol consumed
** NNT 20 for any drinking
** NNT 12 for heavy drinking and cravings
* Contraindications: opioid use, liver disease
* Adverse effects: nausea, sleepiness
* Start 25mg daily for 4 days then increase to 50mg daily
* Requires EAP approval, otherwise ~$300/mo

==== Gabapentin ====

* Abstinent for 3 days, then start 300mg HS and increase by 300mg daily up to 300mg TID or 600mg TID
* NNT 8 for abstinence
* NNT 5 for reducing heavy drinking
* Adverse effects: insomnia, drowsiness

==== Acamprosate ====

* Relapse prevention
* 4 days of abstinence prior to start
* On ODB after naltrexone
* NNT 12 for maintaining abstinence, no effect on heavy drinking
* Beware in renal disease, has GI side effects

==== Topiramate ====

* Glutamate antagonist and GABA agonist
* Start 25mg PO BID and titrate weekly by 25mg

==== Baclofen ====

* Has street value and can cause dependence
* Start 5mg TID and titrate up by 5mg
* Beware in renal disease

==== Ondansetron ====

* Limited but promising data

==== Disulfiram ====

=== Case management ===

=== Day programs ===

== Maintenance ==

* Relapse prevention

[[Category:Addiction medicine]]