What is the treatment for alcohol-induced blackouts?

From the Guidelines

The primary treatment for alcohol-induced blackouts is immediate cessation of alcohol consumption and supportive care while the person becomes sober. There is no specific medication that can reverse a blackout once it has occurred, as blackouts represent a failure to form new memories due to alcohol's effect on the hippocampus. For someone experiencing a blackout, ensuring their safety is paramount—this includes monitoring vital signs, maintaining hydration, preventing aspiration if vomiting occurs, and keeping them in a safe environment until the alcohol is metabolized. In the longer term, prevention is essential through reducing alcohol consumption or abstinence. For those with alcohol use disorder, treatments may include medications like naltrexone (50mg daily), acamprosate (666mg three times daily), or disulfiram (250-500mg daily), combined with counseling approaches such as cognitive behavioral therapy or motivational enhancement therapy, as recommended by guidelines such as those outlined in 1.

Key Considerations

• Ensuring the person's safety during a blackout is crucial, including monitoring vital signs and preventing aspiration.
• Medications such as naltrexone, acamprosate, and disulfiram can be used to reduce cravings and support abstinence in individuals with alcohol use disorder, as discussed in 1.
• Counseling approaches, including cognitive behavioral therapy and motivational enhancement therapy, are also essential components of treatment, as highlighted in 1.
• Brief interventions, such as motivational interviewing and counseling, can be effective in reducing risky drinking behavior and promoting abstinence, as noted in 1.

Treatment Approach

The treatment approach should be individualized, taking into account the person's preferences, motivation, and availability of resources. Acamprosate, disulfiram, or naltrexone should be offered as part of treatment to reduce relapse in alcohol-dependent patients, as recommended in 1. The decision to use these medications should be made in consideration of patient preferences, motivation, and availability. Additionally, psychosocial treatment, including individual psychotherapy, group therapy, and family therapy, can help the patient understand and obtain insight into their pathological pattern of drinking, as discussed in 1.

Medication Options

• Naltrexone: 50mg daily, as discussed in 1.
• Acamprosate: 666mg three times daily, as noted in 1.
• Disulfiram: 250-500mg daily, as mentioned in 1. However, disulfiram is not commonly used due to its aversive effects.

Counseling Approaches

• Cognitive behavioral therapy: helps individuals identify and change negative thought patterns and behaviors associated with alcohol use.
• Motivational enhancement therapy: helps individuals resolve ambivalence and increase motivation to change their drinking behavior.
• Brief interventions: effective in reducing risky drinking behavior and promoting abstinence, as noted in 1.

From the FDA Drug Label

To reduce the risk of precipitated withdrawal in patients dependent on opioids, or exacerbation of a preexisting subclinical withdrawal syndrome, opioid-dependent patients, including those being treated for alcohol dependence, should be opioid-free (including tramadol) before starting naltrexone hydrochloride treatment A dose of 50 mg once daily is recommended for most patients The placebo-controlled studies that demonstrated the efficacy of naltrexone hydrochloride as an adjunctive treatment of alcoholism used a dose regimen of naltrexone hydrochloride 50 mg once daily for up to 12 weeks.

The treatment for alcohol-induced blackouts is naltrexone hydrochloride 50 mg once daily. This medication should be used as part of a comprehensive plan of management that includes some measure to ensure the patient takes the medication. Patients should be opioid-free before starting naltrexone hydrochloride treatment. 2

From the Research

Treatment for Alcohol-Induced Blackouts

The treatment for alcohol-induced blackouts, a symptom of alcohol use disorder, typically involves a combination of pharmacological and psychosocial interventions.

• Pharmacological Treatment: Several medications have been approved for the treatment of alcohol dependence, including disulfiram, naltrexone, and acamprosate 3, 4, 5, 6.
• Acamprosate: This medication has been shown to be effective in maintaining abstinence and reducing alcohol consumption 7, 5. It is thought to work by affecting glutamatergic and GABAergic receptors in the brain 5.
• Naltrexone: This opioid receptor antagonist has been found to reduce the risk of relapse to heavy drinking and the frequency of drinking compared to placebo 6.
• Disulfiram: While its effects are less clear, disulfiram may reduce drinking frequency, although it does not substantially enhance abstinence 6.
• Other Medications: Other medications, such as baclofen, gabapentin, and topiramate, have been investigated for their potential in treating alcohol use disorder, but their efficacy and safety profiles vary 7.

Considerations for Treatment

When selecting a treatment, it is essential to consider the individual patient's preferences, comorbid conditions, and the unique risk-benefit profile of each medication 4.

• Safety Considerations: The safety of pharmacological treatments for alcohol dependence can be affected by concurrent alcohol consumption, physical comorbidities, and concomitant medications 4.
• Combination Therapy: Combining medications, such as acamprosate and naltrexone, may be more effective than using a single medication, especially when combined with psychosocial interventions 5.

Patient-Tailored Treatment

Effective treatment will require a greater understanding of the individual patient's needs and the development of new, safe, and effective pharmacological agents 3, 7.