Alcohol Dependance

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Features

-  Pts generally present later for medical help

-  EtOH Hx

-  CAGE questions

-  Meets DSM IV criteria for dependance

-  Drug Hx

 

Associated S/S

-  Thiamine deficiency

-  Wernickes-Korsakov syndrome

-  Beri-beri

-  Chronic liver disease

-  Gout

 

Mx

-  Brief intervention

-  Mainly for at risk drinkers

-  Less effective for dependant drinkers

-  Relapse prevention

-  Start after withdrawal

-  12/12 Rx

-  Combination therapy

-  Acamprosate (Campral)

-  Decreases NMDA

-  Decrease cravings & withdrawal S/S

-  Naltrexone

-  U opiate antagonist

-  Decreases cravings & reward

-  Disulfiram (Antabuse)

-  ALDH inhibitor

-  Severe aversive reaction to EtOH

-  Flushing, hypotension, vomiting, headache, palpitations

-  Carefully selected & informed pts only

-  Not on PBS, > $50 per month

-  Harm reduction

-  Thiamine 200mg IM/IV Stat then 100mg PO daily

-  Driving

-  Child care

-  Psychotherapy

-  Group CBT (SMART Recovery)

-  Alcoholics Anonymous (AA)