What is the treatment approach for alcohol deaddiction?

Comprehensive Treatment Approach for Alcohol Deaddiction

The treatment of alcohol deaddiction requires a structured approach including supported withdrawal management with benzodiazepines, pharmacotherapy with medications like acamprosate, naltrexone, or disulfiram for relapse prevention, and psychosocial interventions including mutual help groups like Alcoholics Anonymous.

Screening and Initial Assessment

• Screening for alcohol dependence should be conducted using validated instruments like AUDIT-3, AUDIT-C, or ASSIST to identify patients requiring intervention 1
• Brief interventions should be provided for hazardous and harmful alcohol use, while patients with dependence require comprehensive treatment 1

Management of Alcohol Withdrawal

• Supported withdrawal is essential for patients with alcohol dependence 1
• Benzodiazepines are the first-line medication for managing alcohol withdrawal symptoms, preventing seizures and delirium 1, 2
  • Long-acting benzodiazepines (chlordiazepoxide, diazepam) are preferred for most patients 2, 3
  • Lorazepam is recommended for patients with liver disease, advanced age, or serious medical comorbidities 2
• Antipsychotics should not be used as standalone medications for withdrawal management but may be used as adjuncts to benzodiazepines for severe withdrawal delirium 1, 4
• All patients should receive thiamine supplementation (100-300 mg/day) to prevent Wernicke's encephalopathy 1, 2
• Patients with severe withdrawal, concurrent serious physical or psychiatric disorders, or inadequate support should be managed in an inpatient setting 1, 2

Pharmacotherapy for Relapse Prevention

• Acamprosate, disulfiram, or naltrexone should be offered to reduce relapse in alcohol-dependent patients 1
• Acamprosate:
  • Reduces withdrawal effects and alcohol craving 1
  • Recommended dose is two 333 mg tablets (666 mg) three times daily 5
  • Should be initiated as soon as possible after withdrawal when abstinence is achieved 5
  • Treatment period typically lasts 3-6 months 1
• Naltrexone:
  • Decreases dopamine concentration in the brain, reducing excessive drinking and relapse rates 1
  • Typical dosage is 25 mg for the first 1-3 days, then 50 mg daily 1
  • Treatment duration is 3-6 months, but can extend up to 12 months 1
  • Not recommended for patients with alcoholic liver disease due to risk of hepatotoxicity 1
• Disulfiram:
  • Inhibits aldehyde dehydrogenase, causing unpleasant symptoms when alcohol is consumed 1
  • Currently not commonly used due to side effects and compliance issues 1

Psychosocial Interventions

• Psychosocial support should be routinely offered to all alcohol-dependent patients 1
• Individual psychotherapy helps establish a therapeutic plan through psychiatric evaluation and appropriate treatment modalities 1
• Treatment principles include:
  • Helping patients accept their lack of control over alcohol 1
  • Providing education about alcohol dependence 1
  • Developing self-control strategies to maintain abstinence 1
• Structured psychological interventions like motivational techniques should be considered when providers have capacity 1
• Other effective psychosocial treatments include cognitive behavioral therapy, social skills training, and coping skills training 1

Role of Mutual Help Groups

• Healthcare providers should familiarize themselves with local mutual help groups like Alcoholics Anonymous (AA) 1
• Patients with alcohol dependence should be encouraged to engage with such groups 1
• AA meetings provide peer support that helps reduce alcohol craving and maintain abstinence 1
• Family members should also be encouraged to participate in appropriate mutual help groups 1

Family Involvement

• Family members should be involved in the treatment process when appropriate 1
• Family education and therapy can benefit both the patient and family members 1
• Support, counseling, and/or cognitive behavioral interventions should be offered to address psychological strain in family members 1

Common Pitfalls and Considerations

• Pharmacotherapy for relapse prevention should be selected based on patient preferences, motivation, and availability 1
• Psychosocial treatment should not end with inpatient treatment but continue after discharge to prevent relapse 1
• Brief interventions should follow the FRAMES model (Feedback, Responsibility, Advice, Menu, Empathy, Self-efficacy) 1
• Benzodiazepine treatment for withdrawal should not exceed 10-14 days to avoid dependence 2
• Anticonvulsants should not be used following alcohol withdrawal seizures for prevention of further seizures 1