Alcohol Dependence (Alcohol Use Disorder)

Alcohol Dependence (Alcohol Use Disorder) – Treatment Options

Introduction
Alcohol dependence, also known as alcohol use disorder (AUD), is a chronic, relapsing condition marked by impaired control over alcohol consumption, strong cravings, tolerance, and withdrawal symptoms when intake is reduced. It contributes to significant medical, psychological, and social complications, including liver disease, cardiovascular illness, psychiatric comorbidities, and impaired quality of life. Management requires a multimodal approach involving medical, psychological, and social interventions tailored to each patient’s needs.

---

1. Acute Management: Alcohol Withdrawal

• Hospitalization may be required in severe withdrawal, history of seizures, delirium tremens, or comorbidities.

• Benzodiazepines (first-line):

  • Diazepam, chlordiazepoxide, or lorazepam – tapered over several days.

  • Prevent seizures and delirium tremens.

• Adjunctive therapy:

  • Thiamine (100 mg IV/IM before glucose) to prevent Wernicke’s encephalopathy.

  • Multivitamins, folic acid supplementation.

  • IV fluids and electrolyte correction (potassium, magnesium, phosphate).

• Adjunctive agents for withdrawal symptoms: Carbamazepine or gabapentin (alternative in mild withdrawal).

---

2. Pharmacological Relapse Prevention

• Naltrexone (oral 50 mg daily or monthly injection):

  • Reduces cravings and reward effects of alcohol.

  • Contraindicated in acute hepatitis or liver failure.

• Acamprosate (666 mg three times daily):

  • Modulates glutamate neurotransmission, helps maintain abstinence.

  • Safe in liver disease, but contraindicated in severe renal impairment.

• Disulfiram (250 mg daily):

  • Causes unpleasant reaction when alcohol is consumed (flushing, nausea, palpitations).

  • Effective in motivated patients with supervised administration.

• Other off-label agents:

  • Topiramate, gabapentin – may help reduce cravings and heavy drinking days.

---

3. Psychosocial and Behavioral Interventions

• Motivational interviewing: Helps patients resolve ambivalence and engage in treatment.

• Cognitive behavioral therapy (CBT): Develops coping strategies and relapse prevention skills.

• 12-step programs (Alcoholics Anonymous) or mutual-help groups: Provide peer support.

• Contingency management and community reinforcement approaches: Structured programs with rewards for abstinence.

• Family therapy: Involving relatives to improve adherence and support.

---

4. Long-Term Support and Rehabilitation

• Outpatient rehabilitation programs: Counseling, pharmacotherapy, relapse prevention.

• Inpatient/residential rehabilitation: For severe dependence, unstable social environments, or repeated relapses.

• Aftercare planning: Ongoing follow-up with addiction specialists, primary care, and support groups.

• Social interventions: Vocational training, housing support, and reintegration programs.

---

5. Management of Comorbidities

• Screening and treatment of liver disease, hypertension, depression, anxiety, and cognitive decline.

• Integrated care addressing both psychiatric and medical conditions improves outcomes.