Alcohol Use Disorder

Alcohol Use Disorder (AUD) – Treatment Options

Introduction
Alcohol Use Disorder (AUD) is a chronic, relapsing condition marked by impaired control over alcohol use, strong cravings, tolerance, and withdrawal symptoms. It negatively affects physical health (liver disease, cardiovascular issues, cancers), mental health (depression, anxiety, cognitive decline), and social well-being (work, family, legal consequences). Effective management requires a multimodal approach, integrating medical, psychological, and social strategies.

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1. Acute Withdrawal Management

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

• Benzodiazepines (first-line):

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

  • Prevent seizures and delirium tremens.

• Adjunctive therapies:

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

  • Folic acid and multivitamins.

  • Electrolyte correction (potassium, magnesium, phosphate).

• Alternatives for mild withdrawal: Carbamazepine or gabapentin.

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2. Pharmacological Relapse Prevention

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

  • Reduces cravings and reward from alcohol.

  • Contraindicated in acute hepatitis or liver failure.

• Acamprosate (666 mg TID):

  • Modulates glutamate neurotransmission, helps maintain abstinence.

  • Preferred in patients with liver disease; contraindicated in severe renal impairment.

• Disulfiram (250 mg daily):

  • Produces aversive reaction with alcohol ingestion (flushing, nausea, palpitations).

  • Works best with supervised administration.

• Other off-label agents:

  • Topiramate and gabapentin reduce cravings and heavy drinking days in some patients.

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3. Psychosocial and Behavioral Interventions

• Motivational interviewing: Helps patients resolve ambivalence about quitting.

• Cognitive Behavioral Therapy (CBT): Teaches coping and relapse-prevention strategies.

• 12-step programs (e.g., Alcoholics Anonymous): Provide peer support.

• Contingency management and community reinforcement approaches: Use structured reinforcement to promote abstinence.

• Family therapy and involvement: Improves adherence and social support.

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4. Long-Term Rehabilitation and Support

• Outpatient rehab programs: Counseling and medication-assisted treatment.

• Residential/inpatient programs: For severe dependence, repeated relapses, or unstable social environment.

• Aftercare planning: Regular follow-up, support groups, relapse monitoring.

• Social support services: Employment assistance, housing support, and reintegration programs.

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5. Management of Comorbidities

• Liver disease: Screening and management of alcoholic hepatitis, cirrhosis, and hepatocellular carcinoma.

• Mental health disorders: Treatment of depression, anxiety, and cognitive impairment.

• Other health risks: Hypertension, pancreatitis, malnutrition, and sleep disorders.