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Consider pharmacological treatment.

The following pharmacotherapies for alcohol-dependent patients have well-established efficacy and moderate effectiveness, particularly as part of a comprehensive program of treatment (see Table 7 for implementation guidelines):

  • Naltrexone can attenuate some of the reinforcing effects of alcohol and lead to reduced drinking and resolution of alcohol-related problems. A long-acting injectable preparation may promote adherence, but published research is limited and FDA approval is pending.

  • Disulfiram can help deter subsequent "slips" by causing a highly aversive reaction after a patient has even a single drink.

  • Acamprosate may decrease alcohol craving in recently abstinent individuals.

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TABLE 7. Implementation of Pharmacotherapies for Alcohol-Dependent Patients

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Table Reference Number
TABLE 7. Implementation of Pharmacotherapies for Alcohol-Dependent Patients

Treat or prevent common neurological sequelae of chronic alcohol use by routinely giving thiamine if moderate to severe alcohol use is present.

  • Korsakoff'€™s syndrome (alcohol amnestic disorder) should be treated vigorously with B-complex vitamins (e.g., thiamine, 50–100 mg/day i.m. or i.v.), usually after adequate fluids and glucose levels are maintained.

Consider if pharmacotherapy is needed to treat comorbid psychiatric conditions.

  • For many patients, signs and symptoms of depression and anxiety may not require pharmacotherapy but instead are related to alcohol intoxication or withdrawal and remit in the first few weeks of abstinence. Treatment of nondepressed alcoholic patients with SSRIs appears to be ineffective.

  • For alcoholic hallucinosis during or after cessation of prolonged alcohol use, antipsychotic medication should be considered.

Consider providing psychosocial treatment.

Potentially helpful treatments include the following:

  • Cognitive-behavioral therapies aimed at improving self-control and social skills

  • Motivational enhancement therapy (MET)

  • 12-step facilitation therapy

  • Behavioral therapies

  • Marital and family therapy

  • Group therapies

  • Psychodynamic/interpersonal therapies

  • Brief interventions (i.e., abbreviated assessments of drinking severity and related problems and provision of motivational feedback and advice)

  • Aftercare, which may include partial hospitalization, outpatient care, or self-help group involvement and which may help maintain abstinence during the period following an intensive treatment intervention (e.g., hospital or residential care)

  • Self-help groups and 12-step–oriented groups, such as Alcoholics Anonymous

Table Reference Number
TABLE 7. Implementation of Pharmacotherapies for Alcohol-Dependent Patients

References

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