Alcohol use disorder: Difference between revisions
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| − | == |
+ | ==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, but may not help with abstinence |
| − | ** |
+ | **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==== |
| − | * |
+ | *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 |
| − | * |
+ | *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]] |
[[Category:Addiction medicine]] |
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Latest revision as of 15:59, 10 July 2020
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, but may not help with abstinence
- 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
- Helps with abstinence and relapse prevention
- Requires 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
