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Monday, September 15, 2025

Alcoholism


Alcoholism (Alcohol Use Disorder) – Treatment Options

Introduction
Alcoholism, also known as alcohol use disorder (AUD), is a chronic relapsing condition characterized by compulsive alcohol use, loss of control over drinking, and withdrawal symptoms when not drinking. It leads to major health consequences including liver disease, cardiovascular illness, neurological damage, psychiatric comorbidities, and social/occupational impairment. Effective treatment is multidimensional, addressing withdrawal, relapse prevention, psychological support, and long-term rehabilitation.

1. Acute Management of Alcohol Withdrawal

  • Hospitalization for patients at risk of seizures, delirium tremens, or severe withdrawal.

  • Benzodiazepines (first-line):

    • Diazepam, chlordiazepoxide (long-acting); lorazepam (preferred in liver disease/elderly).

    • Dosing: symptom-triggered using CIWA-Ar scale or fixed taper if monitoring not possible.

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

  • Folic acid, multivitamins, and electrolyte correction (Mg, K, phosphate).

  • Adjuncts for mild withdrawal: Gabapentin, carbamazepine.

2. Pharmacological Relapse Prevention

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

    • Reduces craving and the rewarding effects of alcohol.

    • Contraindicated in acute hepatitis or severe liver failure.

  • Acamprosate (666 mg three times daily):

    • Restores glutamate balance and promotes abstinence.

    • Safe in liver disease; avoid in severe renal failure.

  • Disulfiram (250 mg daily):

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

    • Works best with motivated, supervised patients.

  • Off-label options: Topiramate and gabapentin may reduce cravings and heavy drinking days.

3. Psychosocial and Behavioral Interventions

  • Motivational interviewing: Helps patients engage and commit to change.

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

  • 12-step programs (Alcoholics Anonymous, SMART Recovery): Peer support.

  • Contingency management and community reinforcement programs: Structured incentives for abstinence.

  • Family therapy: Engages relatives in recovery and relapse prevention.

4. Rehabilitation and Long-Term Support

  • Outpatient programs: Counseling + medication-assisted treatment.

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

  • Aftercare planning: Continuous follow-up, peer support, relapse monitoring.

  • Social interventions: Employment support, housing programs, reintegration assistance.

5. Management of Complications and Comorbidities

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

  • Neuropsychiatric disorders: Depression, anxiety, alcoholic dementia, Wernicke–Korsakoff syndrome.

  • Other organ systems: Pancreatitis, cardiovascular disease, malnutrition.

  • Preventive care: Vaccinations (hepatitis A/B, influenza, pneumococcal).

Prognosis

  • Favorable with abstinence and sustained treatment, including pharmacological support and psychosocial therapy.

  • High relapse risk without structured intervention, requiring long-term multidisciplinary care.



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