Links To And Excerpts From “5 Pearls on Treatment of Alcohol Use Disorder” From CoreIM

In this post I link to and excerpt from 5 Pearls on Treatment of Alcohol Use Disorder
Posted: November 7, 2018. By: Dr. Katharine Lawrence, Dr. Martin Fried, Dr. Irene Swanenberg and Dr. Shreya P. Trivedi of CoreIM.

Here are excerpts from the above:

The Above Graphic: Dr. Caroline Srisarajivakul-Klein for CoreIM

Pearl 1 (Throwback)

  • Unhealthy alcohol use is a catch-all term meant to describe a spectrum of drinking ranging from risky use to alcohol use disorder. Alcohol use disorder (AUD) is a problematic pattern of alcohol use leading to clinically significant impairment or distress.
  • Risky drinking is thought of as daily and weekly alcohol limits:
    • For  men less than 65 years:  more than 4 drinks/day or 14 drinks/week for
    • For women and men over 65 years: more than 3 drinks/day or 7 drinks/week
  • The AUDIT-C tool* is the recommended screening tool for unhealthy alcohol use.
  • single-item screening question has also been validated: how many times in the last year, have you had more than three drinks (four drinks for men) in a day?

*Link is to the AUDIT-C tool on MDCalc.

Pearl 2

  • First-line non-pharmacotherapies for AUD are captured in the mnemonic S-BIRT: screening, brief intervention, referral to treatment. It is a comprehensive approach identify and intervene in patient with unhealthy alcohol use. Basic tenets of BI include:
    • raising the subject
    • giving feedback about the level of risk
    • encouraging the patient’s motivation to change, and
    • setting goals or making a plan to implement that change.
  • BI alone has not been shown to be effective in patients with alcohol use disorder

Pearl 3

  • Patients who meet criteria for AUD should be offered medications in addition to non-pharmacologic therapies for treatment
  • First-line pharmacotherapies for moderate to severe AUD include naltrexone and acamprosate
  • Common side effects for naltrexone are largely gastrointestinal, and include abdominal pain, nausea, and diarrhea; naltrexone is contraindicated in patients with cirrhosis or who are actively using or at high risk for using opiates
  • Acamprosate requires three-times-a-day dosing, and is not for use in patients with ESRD or CrCl<30; neuro-pysch side effects in including suicidality may also limit its use

Pearl 4

  • Second-line pharmacotherapies include topiramate and gabapentin
  • Their well-known side effect profiles (including memory impairment and somnolence, respectively) at the doses required to achieve efficacy may hinder their broader use in the outpatient setting

Pearl 5

  • Novel therapeutic options currently under investigation for AUD include neuromodulationnalmafene, and psychaedelics
  • Neuromodulation, such as deep brain stimulation, is thought to work on the nucleus accumbens to target centers of reward behavior and reduce cravings
  • Nalmafene is a long-acting k-opioid antagonist which is used in Europe
  • Psychedelics like psilocybin and LSD are experiencing a resurgence in the study of a variety of diseases, including AUD, PTSD, and depression

See the Transcript that follows the 5 Pearls list in the show notes for additional details on the 5 Pearls.



This entry was posted in Alcohol Use Disorder, CoreIM, Toxicology. Bookmark the permalink.