Alcohol abstinence maintenance

The mechanism of action of acamprosate in the maintenance of alcohol abstinence is not completely understood. Chronic alcohol exposure is hypothesized to alter the normal balance between neuronal excitation and inhibition. Studies suggest acamprosate may interact with glutamate and gamma-aminobutyric acid (GABA) neurotransmitter systems centrally, and have led to the hypothesis that acamprosate restores this balance. 

Maintenance of alcohol abstinence in alcohol-dependent patients who are abstinent at initiation of treatment PO Two tablets 3 times a day. 

In this chapter Case studies levels 1-3 explore the management of a patient with alcoholic liver disease. The patient has alcoholic liver cirrhosis and first presents with alcohol withdrawal (Case study level 1), then the patient s risk of bleeding and treatment for the maintenance of alcohol abstinence are considered (Case study level 2). The patient then goes on to develop encephalopathy (Case study level 3). Case studies levels Ma and Mb consider two patients one presents with TB and the other liver failure. 

Case study level 2 - Alcoholic cirrhosis management of bleeding risk and treatment for the maintenance of alcohol abstinence... 

In various studies/clinical cases, thiamine 100 mg has been given intravenously for several days to two weeks, followed by maintenance doses of 50-100 mg orally per day until the patient is able to eat a well-balanced diet regularly (Lacasse and Lum, 2004 Chiossi et al, 2006). Long-term treatment and prevention should include continued oral thiamine supplementation, alcohol abstinence and a balanced diet (Ogershok et al, 2002), but this program is based on logic and overall good medical care, not data. 

Mann K, Lehert P, Morgan MY The efficacy of acamprosate in the maintenance of abstinence in alcohol-dependent individuals results of a meta-analysis. Alcohol... 

In research and clinical treatment of substance use disorders, pharmacotherapy and psychotherapy are frequently combined. Medication is often used as a maintenance drug, to reduce cravings or intoxication, or to produce aversion to a substance, while the focus of psychotherapy may be to encourage abstinence, teach the patient new coping skills, or improve motivation to address drug or alcohol problems. 

Naltrexone (ReVia). Naltrexone is a very potent antagonist of the actions of opiates. It has been used to reduce the rewarding effects of not only opiates but alcohol as well. Like buprenorphine, naltrexone appears to reduce craving for opiates by blocking their pleasurable effects. Naltrexone is not useful for detoxification and in fact worsens withdrawal. Naltrexone can be useful for maintenance treatment in those patients motivated to achieve total abstinence. It is taken at a constant dose of 50mg/day. A sustained-release depot formulation currently under development will likely help to overcome adherence issues that often undermine treatment for substance use disorders. 

For maintenance of abstinence from alcohol in patients with alcohol dependence who are abstinent at treatment initiation. Treatment with acamprosate should be part of a comprehensive management program that includes psychosocial support. 

It is also clear that anxiety symptoms are common among primary alcoholic patients [although abstinence leads to a reduction in symptoms even without any specific pharmacological or psychosocial treatments [S. A. Brown et al. 1991]]. Repeated alcohol withdrawals may result in kindling of the limbic system, producing chronic elevation in sympathetic tone [D. T. George et al. 1988]. This in turn can result in further anxiety symptoms and hence maintenance of drinking behavior. 

Acamprosate is indicated for the maintenance of abstinence in alcohol-dependent adults. It appears to decrease brain hyperexcitability during alcohol withdrawal, which may reduce alcohol consumption. Treatment should be initiated as soon as possible after the alcohol-withdrawal period is complete. The recommended period of treatment with acamprosate is one year and treatment should be combined with counselling. The GGT level can be monitored as a marker of abstinence from alcohol. 

Medications can play an important role in the treatment of alcohol-related disorders. Figure 12-C lists medications that can be used in the treatment of alcohol-related disorders. Most of those medications are covered in part three of this book. The exception is disulfiram (Antabuse), a medication used to assist in the maintenance of abstinence. Disulfiram causes an accumulation of acetaldehyde if a person drirrks alcohol while taking it, which leads to an unpleasant and potentially dangerous reaction involving flushing, throbbing headache, nausea, and vomiting. Only certain people are appropriate for disulfiram treatment. Some are able to remain abstinent without it some will drirrk in spite of it. In between are those who will... 

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