Treatment Of Alcohol Use

Disorders
Ruling out any physical disorder.
Ruling out any psychiatric disorder and/or co-morbid substance use
disorder.
Assessment of motivation for treatment.
Assessment of social support system.
Assessment of personality characteristics of the patient.
Assessment of current and past social, interpersonal and occupational
functioning.
Detoxification
The aim of detoxification is symptomatic management of emergent
withdrawal symptoms.
The usual duration of uncomplicated withdrawal syndrome is 7-14 days.
The drugs of choice for detoxification are Benzodiazepines.
Chlordiazepoxide (80-200 mg/day in divided doses)
Diazepam (40-80 mg/day in divided doses)
These drugs are used in a standardised protocol, with the dosage steadily
decreasing everyday before being stopped, usually on the tenth day.
Vitamin B containing 100 mg of thiamine should be administered
parenterally, twice everyday for 3-5 days.

This should be followed by oral administration of vitamin B1 for at least 6

months.
Hospital Adimission Is needed when-
Signs of impending delirium tremens (tremor, autonomic hyperactivity,
disorientation, or perceptual abnormalities)

Psychiatric symptoms (psychotic disorder, mood disorder, suicidal

ideation or attempts, alcohol induced neuro-psychiatric disorders)

Physical illness (caused by chronic alcohol use or incidentally present)

Inability to stop alcohol in the home setting.

Treatment Of Alcohol Dependence

Behavior Therapy
Psychotherapy
Group Therapy
Deterrent Agents
Anti-craving Agents
Psychosocial Rehabilitation
 Behavior Therapy
Aversion therapy - Most commonly used in past, now obsolete
Using either a sub-threshold electric shock or an emetic such as apomorphine.

Covert sensitisation, relaxation techniques, assertiveness training, self-control

skills, and positive reinforcement have been used alone or in combination
with aversion therapy.
Psychotherapy
Both group and individual psychotherapy have been used.

The patient should be educated about the risks of continuing alcohol use,
asked to resume personal responsibility for change and be given a choice of
options for change.
Group Therapy
The voluntary self-help group known as AA ( Alcoholics Anonymous)
has branches all over the world and a membership in hundreds of
thousands.

Many patients derive benefits from the group meetings which are non-
professional in nature.
Deterrent Agents
Disulfiram
When alcohol is ingested by a person who is on disulfiram, alcohol-
derived acetaldehyde cannot be oxidised to acetate and this leads to an
accumulation of acetaldehyde in blood.

Disulfiram-Ethanol Reaction is characterised by flushing, tachycardia,

hypotension, tachypnoea, palpitations, headache, sweating, nausea,
vomiting, giddiness and a sense of impending doom associated with
severe anxiety.
In sensitive patients or in those who have ingested a large amount of
alcohol, DER can be very severe and life threatening due to- shock,
myocardial infarction, convulsions, hypoxia, confusion and coma.
The usual dose of disulfiram is 250-500 mg/day in the first week
250 mg/day for the maintenance treatment.
The effect begins within 12 hours of first dose and remains for 7-10 days
after the last dose.
Contraindiations-
First trimester of pregnancy
Coronary artery disease
Liver failure
Chronic renal failure
Peripheral neuropathy
Muscle disease
Psychotic symptoms
Other deterrent agents
Citrated Calcium Carbimide
Metronidazole
Animal charcoal (Coprinus atramentarius)
Sulfonylureas
Anti-craving Agents
Acamprosate interacts with NMDA receptor-mediated glutamatergic
neurotransmission in the various brain regions and reduces Ca++ fluxes
through voltage-operated channels.

 Naltrexone interferes with alcohol-induced reinforcement by blocking

opioid receptors.

 Fluoxetine (and other SSRIs) have been occasionally used as anti-craving

agents in their usual antidepressant doses.
Psychosocial Rehabilitation
Rehabilitation is an integral part of the multi-modal treatment of alcohol
dependence.
Thank You