Treatment of Alcohol Abuse

 four areas of intervention/treatment:

1. preventive interventions against hazardous alcohol consumption
a. outcome measures:
i. changes in alcohol consumption & alcohol-related problems (most
important)
ii. others were changes in laboratory values (GGT, ALT, AST), number
of sick days, inpatient days at a hospital, and physical or mental
illness
b. different interventions:
i. brief intervention 
a. varied from short information (5min) up to 60 min of
intervention. The studies used cognitive behavioral
therapy which for the most part, it consisted of a
motivational discussion about the risks of heavy
consumption with advice to reduce the alcohol
consumption
b. in 18 of 25 studies, brief intervention had a significant
positive effect (eg., decreased alcohol consumption,
reduction in the GGT level, fewer alcohol-related
problems, reduction of psychosocial problems)
c. the NNT ranged from 3 to 6 & from 7 to 17
d. in 7 of 8 studies, they found no difference in effect
between brief counseling given by a physician compared
with a more intense form of intervention such as cognitive
intervention [the other study showed cognitive
intervention to be more effective than brief counseling]

2. Treatment of alcohol withdrawal

a. most important goal: to prevent seizures, delirium tremens & death
b. drug of choice: benzodiazepines
c. outcome measures:
i. reduction of withdrawal symptoms measured by the Clinical
Institute Withdrawal Assessment (CIWA) scale
ii. number of deaths
iii. number of seizures & deliriums
d. benzodiazepines:
i. BDZ reduced symptoms of autonomous hyperactivity
(perspiration, tremor, papillations…)
ii. effective for preventing delirium & seizures
iii. one study indicated that adding hydantoin to patients being
treated with BDZ could reduce the risks of developing seizures
 e. some case studies have been published in which ethanol was given to
intoxicated patients who had undergone acute surgical procedures in
association with accidents to prevent withdrawal during surgery
f. Treatment of delirium tremens:
i. chlormethiazole & clonidine has been showed to be effective in
decreasing the mortality from delirium tremens

3. Pharmacological Treatment of Alcohol Dependence

a. naltrexone
i. was effective in short-term treatment (measurement: rate of
return to heavy drinking)
b. acamprosate
i. helps with cravings
ii. marked improvement in staying abstinence
c. Antabuse (disulfiram)
i. blocks acetaldehyde dehydrogenase
ii. effective (if delivered under supervision)
MAT for Opioid addiction

 withdrawal sx: lacrimation, rhinorrhea, yawning, sneezing, coughing, piloerection,

restless & tremor
 methadone  full u-opioid agonist
o oral with a t1/2 of 22 hours  once daily use prevents opioid withdrawal
symptoms
o better treatment retention, but reduced illicit opioid use early in treatment
 buprenorphine  partial u agonist & k-opioid antagonist
o safer profile
 ceiling effect  further doses do not increase the effects & risks of
respiratory depression are low
o sublingual  gradual onset & long t1/2
o FDA considering a subdermal implant that has a six-month duration
 suboxone (buprenorphine/naloxone)
o intended to prevent misuse
o naloxone  u-opioid antagonist that has minimal sublingual bioavailability
 since it has good parenteral bioavailability, crushing & injecting the
suboxone results in simultaneous administration of a partial agonist &
antagonist (it may even precipitate opioid withdrawal effects