Alcoholism Management

See Also
Page Contents

Page Contents...
Protocol: Brief Intervention for Problem Drinking
Protocol: Alcohol Use Disorder
Resources
Precautions
References
Extra: Related Bing Images
Extra: Related Studies
Extra: Navigation Tree

II. Protocol: Brief Intervention for Problem Drinking

See Chemical Dependency Brief Counseling
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. Biomarkers of Alcohol Use
    1. Urine Ethyl Glucuronide (C1987551)
    2. Urine Ethyl Sulfate
    3. Phospatidylethanol
  2. Other markers
    1. Serum Gamma glutamyl transferase (GGT)
    2. Carbohydrate deficient Transferrin

III. Protocol: Alcohol Use Disorder

Initial Management
1. Alcohol Detoxification
2. Alcohol Withdrawal protocol
Long-Term Abstinence Programs (12 step programs appear most effective)
1. Alcoholics Anonymous
2. Sponsor
3. Treatment Program
4. Halfway House
Adjunctive Medications for abstinence
1. General
  1. High relapse rate after 3 months
  2. Best evidence is for Naltrexone and Topiramate
  3. Consider Naltrexone with either Campral or Topiramate (generics for all are available)
2. First line
  1. Naltrexone (Vivitrol, Revia)
    1. Blocks Opioid receptors
    2. Decreases pleasure from Alcohol
    3. Effective in reducing Alcohol use in non-abstaining patients
    4. Prevents relapse in one in 20 patients with 3 months of use
    5. Dosing
      1. Oral: 50 mg orally daily ($50/month in 2019)
      2. IM: Vivitrol once monthly IM ($1500/month in 2019)
    6. 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. May prevent relapse in one in 12 patients with 3-6 months of use
    4. Dosing: 2 tabs orally three times daily ($200/month in 2019)
      1. Risk of lower complicance due to a very large tablet taken 3 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 heavy, binge drinking
    2. Improves abstinence, well being, quality of life in Alcoholics
    3. Requires dose titration
    4. Johnson (2004) Arch Gen Psychiatry 61:905-12 [PubMed]
4. Other medications that may be effective
  1. Gabapentin (Neurontin) or Pregabalin (Lyrica)
    1. Risk of misuse, especially with Opioids
  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

See Chemical Dependency Resources
See Alcoholism for Alcohol specific resources

V. Precautions

Vitamin Deficiency is common (Vitamins A, C, B1, B3, B6, B9, B12)
1. See Alcohol Dependence
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]

VI. References

(2019) Presc Lett 26(2): 11
Sarmiento (Oct 2000) Federal Practitioner, p.45-50
Enoch (2002) Am Fam Physician 65(3):441-50 [PubMed]
Fleming (1997) JAMA 277:1039-45 [PubMed]
Willenbring (2009) Am Fam Physician 80(1): 44-50 [PubMed]
Winslow (2016) Am Fam Physician 93(6): 457-65 [PubMed]

Images: Related links to external sites (from Bing)

These images are a random sampling from a Bing search on the term "Alcoholism Management." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images