Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Alcoholism Medication

  • Author: Warren Thompson, MD, FACP; Chief Editor: Iqbal Ahmed, MBBS, FRCPsych(UK)  more...
 
Updated: Apr 07, 2016
 

Medication Summary

Treatment of alcohol withdrawal is best accomplished with benzodiazepines. Avoid fixed-dose therapy, and treat patients for symptoms. This results in use of lower doses of benzodiazepines, less patient sedation, and earlier patient discharge. Lorazepam and oxazepam are preferred for patients with significant liver disease because the half-lives of other benzodiazepines can be significantly prolonged. These shorter-acting benzodiazepines require more frequent patient monitoring. Use longer-acting drugs (eg, chlordiazepoxide) when monitoring is not reliable.

Other agents that have been used with some success in the treatment of withdrawal include beta-blockers, clonidine, phenothiazines, and anticonvulsants. All can be used with benzodiazepines, but none has been proven to be adequate as monotherapy. A number of medications have been tried in the treatment of alcoholism. Disulfiram (Antabuse) has been used as an adjunct to counseling and AA with motivated patients to reduce the risk of relapse. Patients are reminded of the risks of adverse effects when tempted to drink. Disulfiram causes nausea, vomiting, and dysphoria with coincident alcohol use. In a large trial, disulfiram did not increase abstinence. If a patient asks for disulfiram and thinks it will help, it might be worth considering.

Naltrexone blocks opiate receptors and works by decreasing the craving for alcohol, resulting in fewer relapses. A recent positron emission tomography study demonstrated that persons with alcoholism have increased opiate receptors in the nucleus accumbens of the brain and that the number of receptors correlates with craving.

Most, but not all, studies found that naltrexone decreases relapses but the effect is modest (12-20%). Combining naltrexone therapy with cognitive behavioral therapy enhanced benefit. One study showed benefit with an intensive primary care intervention. Studies suggest that virtually all placebo patients who sampled alcohol relapsed, while only half the naltrexone patients who sampled alcohol relapsed.

Most studies are of short duration, and more long-term trials are needed. In short-term studies when naltrexone was stopped, patients relapsed. Naltrexone has a greater effect on reducing relapse to heavy drinking than it does on maintaining abstinence. Extended-release intramuscular naltrexone resulted in reduced relapse to heavy drinking in a large, randomized trial. Its effects on complete abstinence were more modest. The main adverse effects are nausea and/or vomiting, abdominal pain, sleepiness, and nasal congestion.

In 2001, Sinclair reviewed 8 studies and suggested that naltrexone is safe to administer in patients who are still drinking and that it will gradually result in the patient consuming less alcohol (this is the case in laboratory animals).[46] Patients should take the naltrexone daily initially and then only when they have a strong urge to drink. Patients should carry naltrexone with them indefinitely. Patients should agree to always take the naltrexone prior to drinking alcohol. Daily naltrexone may be counterproductive in patients who remain abstinent. It is most helpful in those who sample alcohol after stopping (lower chance of a relapse). More data are needed before this approach can be adapted because it challenges the conventional wisdom that complete abstinence is always the goal of treatment.

Nalmefene is another opioid antagonist, and it blocks delta, kappa, and mu receptors; naltrexone acts primarily on mu receptors. One randomized trial with 100 patients using 10 mg PO bid has been completed, and nalmefene appears to have efficacy similar to naltrexone (reduces relapse to heavy drinking in patients who sample alcohol). At present, the drug is approved only for intravenous use for opiate addiction.

The 2010 Cochrane review on opioid antagonists for alcohol dependence included 50 studies with 7793 participants.[47] In most studies, treatment was provided over 3 months. The review showed that more patients who took naltrexone were able to reduce the amount and frequency of drinking compared with patients who took placebo. On average, 1 in 9 patients were helped by naltrexone. For injectable formulations of naltrexone, which can be advantageous for patients who have problems with taking their medication on schedule, and for the second opioid antagonist (nalmefene), the evidence was too limited to allow final conclusions. Nevertheless, available studies indicated that these drugs might have effects on drinking comparable to oral naltrexone.

A number of studies have focused on antidepressants. Early studies with the selective serotonin reuptake inhibitors (SSRIs) have been disappointing. Two fairly good studies used tricyclic antidepressants (ie, desipramine, imipramine), which showed some short-term benefit. More data are needed. SSRIs probably do not benefit patients who are not depressed but might benefit those who are depressed. Topiramate facilitates GABA function and antagonizes glutamate, which should decrease mesocorticolimbic dopamine after alcohol and reduce cravings. One double-blinded trial with 150 subjects for 12 weeks suggests this is the case (decreased drinking, decreased craving, and greater abstinence). Topiramate is not approved for this use by the US Food and Drug Administration.

The largest and longest studies on the treatment of alcohol abuse have been performed in Europe with acamprosate (Campral). At 1 year, the continuous abstinence rates were 18% in the acamprosate group and 7% in the placebo group. At 2 years, the continuous abstinence rates were 12% in the acamprosate group and 5% in the placebo group. Most patients returned to drinking while still using the drug. The drug was recently approved in the United States. It stimulates GABA transmission, inhibits glutamate, and decreases alcohol consumption in alcohol-dependent rats. The main adverse effect is diarrhea.

Two short-term trials have compared acamprosate and naltrexone. Both found naltrexone to be superior. One of these studies compared the combination with either drug alone and with placebo. The combination was statistically superior to placebo and acamprosate alone and superior (but not statistically) to naltrexone alone. Larger and longer trials of the combination therapy are needed.

Results from a 12-week, randomized, placebo-controlled trial of 150 adults with current alcohol dependence showed that patients treated with the anticonvulsant gabapentin were more likely to stop drinking or at least abstain from heavy drinking than those taking a placebo. In addition, gabapentin significantly reduced cravings, sleeplessness, and depression.[48, 49, 50]

A 2015 study funded by the National Institutes of Health (NIH) found that an antibiotic typically used to treat tuberculosis reduces alcohol cravings and may enhance cue-related extinction therapies in individuals with alcohol use disorders. Results showed that low doses of D-cycloserine (50 mg) significantly reduced alcohol cravings for up to 3 weeks, leading to significant reductions in alcohol consumption.[51, 52]

Next

Glutamate receptor blockers

Class Summary

Mechanism of action is unknown, but it enhances GABA transmission and inhibits glutamate transmission. Compared with placebo, reduces drinking frequency and effectively increases abstinence in patients with alcoholism.

Acamprosate (Campral)

 

Synthetic compound with a chemical structure similar to that of the endogenous amino acid homotaurine (structural analogue of GABA). Mechanism of action to maintain alcohol abstinence not completely understood. Hypothesized to interact with glutamate and GABA neurotransmitters centrally to restore neuronal excitation and inhibition balance. Not associated with tolerance or dependence development. Use does not eliminate or diminish alcohol withdrawal symptoms. Indicated to maintain alcohol abstinence as part of a comprehensive management program that includes psychosocial support. Available as a 333-mg tab.

Previous
Next

Aldehyde dehydrogenase inhibitors

Class Summary

Disulfiram inhibits aldehyde dehydrogenase, and, as a result, acetaldehyde accumulates. This leads to nausea, hypotension, and flushing if a person drinks alcohol while taking disulfiram.

Disulfiram (Antabuse)

 

Decreases number of drinking days but does not increase abstinence. Directly observed therapy might be more beneficial but has not been studied in a good randomized trial.

Previous
Next

Opiate antagonists

Class Summary

Alcohol has been shown to bind to opiate receptors in the brain. Studies show that blocking opiate receptors decreases cravings for alcohol.

Naltrexone (ReVia, Vivitrol)

 

Patients must be abstinent for 5-7 d before beginning therapy. Monitor liver function during treatment. Expensive, approximately $4.50/pill. Pure antagonist and is not addicting.

IM administration of Vivitrol reduces first-pass hepatic metabolism as compared with oral naltrexone. No significant increase from baseline in mean AST or ALT levels.

Vivitrol does not appear to be a hepatotoxin at recommended doses but patients should be warned of risk of hepatic injury. Preparation is considered nonaddicting.

Previous
 
 
Contributor Information and Disclosures
Author

Warren Thompson, MD, FACP Associate Professor, Department of Internal Medicine, Mayo Medical School

Warren Thompson, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Heart Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

R Gregory Lande, DO, FACN Clinical Consultant, Army Substance Abuse Program, Department of Psychiatry, Walter Reed Army Medical Center

R Gregory Lande, DO, FACN is a member of the following medical societies: American Osteopathic Academy of Addiction Medicine, American Osteopathic Association

Disclosure: Nothing to disclose.

Raj K Kalapatapu, MD Fellow, Addiction Psychiatry, Columbia University College of Physicians and Surgeons

Raj K Kalapatapu, MD is a member of the following medical societies: American Academy of Addiction Psychiatry, American Academy of Child and Adolescent Psychiatry, American Association for Geriatric Psychiatry, American Medical Association, American Psychiatric Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Iqbal Ahmed, MBBS, FRCPsych(UK) Faculty, Department of Psychiatry, Tripler Army Medical Center; Clinical Professor of Psychiatry, Uniformed Services University of the Health Sciences; Clinical Professor of Psychiatry, Clinical Professor of Geriatric Medicine, University of Hawaii, John A Burns School of Medicine

Iqbal Ahmed, MBBS, FRCPsych(UK) is a member of the following medical societies: Academy of Psychosomatic Medicine, American Neuropsychiatric Association, American Society of Clinical Psychopharmacology, Royal College of Psychiatrists, American Association for Geriatric Psychiatry, American Psychiatric Association

Disclosure: Nothing to disclose.

References
  1. CDC. Alcohol-Related Disease Impact (ARDI). Centers for Disease Control and Prevention. Available at http://nccd.cdc.gov/DPH_ARDI/default/default.aspx. Accessed: March 4, 2016.

  2. Stahre M, Roeber J, Kanny D, Brewer RD, Zhang X. Contribution of excessive alcohol consumption to deaths and years of potential life lost in the United States. Prev Chronic Dis. 2014 Jun 26. 11:E109. [Medline].

  3. Sacks JJ, Gonzales KR, Bouchery EE, Tomedi LE, Brewer RD. 2010 National and State Costs of Excessive Alcohol Consumption. Am J Prev Med. 2015 Nov. 49 (5):e73-9. [Medline].

  4. Substance Abuse and Mental Health Services Administration. Center for Substance Abuse Treatment. The Role of Biomarkers in the Treatment of Alcohol Use Disorders. US Department of Health and Human Services. September 2006. Available at http://kap.samhsa.gov/products/manuals/advisory/pdfs/0609_biomarkers.pdf.

  5. Das SK, Dhanya L, Vasudevan DM. Biomarkers of alcoholism: an updated review. Scand J Clin Lab Invest. 2008. 68(2):81-92. [Medline]. [Full Text].

  6. Niemelä O. Biomarkers in alcoholism. Clin Chim Acta. 2007 Feb. 377(1-2):39-49. [Medline].

  7. Peterson K. Biomarkers for alcohol use and abuse. Alcohol Research & Health. 2004/2005. 28:

  8. Vaillant GE. A long-term follow-up of male alcohol abuse. Arch Gen Psychiatry. 1996 Mar. 53(3):243-9. [Medline].

  9. Lopez-Quintero C, Cobos JP, Hasin DS, et al. Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: Results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drug Alcohol Depend. 2011 May 1. 115(1-2):120-30. [Medline]. [Full Text].

  10. CDC Press Release. Binge drinking is bigger problem than previously thought. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/media/releases/2012/p0110_binge_drinking.html. Accessed: January 10, 2012.

  11. World Health Organization. Global status report on alcohol and health. 2014. Available at http://www.who.int/substance_abuse/publications/global_alcohol_report/msb_gsr_2014_1.pdf?ua=1.

  12. Nutt DJ, King LA, Phillips LD. Drug harms in the UK: a multicriteria decision analysis. Lancet. 2010 Nov 6. 376(9752):1558-65. [Medline].

  13. Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to alcohol consumption: a prospective study among male British doctors. Int J Epidemiol. 2005 Feb. 34(1):199-204. [Medline].

  14. Knoops KT, de Groot LC, Kromhout D, Perrin AE, Moreiras-Varela O, Menotti A. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA. 2004 Sep 22. 292(12):1433-9. [Medline].

  15. Thun MJ, Peto R, Lopez AD, et al. Alcohol consumption and mortality among middle-aged and elderly U.S. adults. N Engl J Med. 1997 Dec 11. 337(24):1705-14. [Medline].

  16. Pletcher MJ, Varosy P, Kiefe CI, Lewis CE, Sidney S, Hulley SB. Alcohol consumption, binge drinking, and early coronary calcification: findings from the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Epidemiol. 2005 Mar 1. 161(5):423-33. [Medline].

  17. Ruidavets JB, Ducimetiere P, Evans A, Montaye M, Haas B, Bingham A. Patterns of alcohol consumption and ischaemic heart disease in culturally divergent countries: the Prospective Epidemiological Study of Myocardial Infarction (PRIME). BMJ. 2010. 341:c6077. [Medline].

  18. Sood B, Delaney-Black V, Covington C, et al. Prenatal alcohol exposure and childhood behavior at age 6 to 7 years: I. dose-response effect. Pediatrics. 2001 Aug. 108(2):E34. [Medline].

  19. Baer JS, Sampson PD, Barr HM, et al. A 21-year longitudinal analysis of the effects of prenatal alcohol exposure on young adult drinking. Arch Gen Psychiatry. 2003 Apr. 60(4):377-85. [Medline].

  20. Ault, A. Proven Screening Tool for Alcohol Abuse Underutilized. Medscape Medical News. Available at http://www.medscape.com/viewarticle/861116. March 29, 2016; Accessed: April 7, 2016.

  21. Grant BF, Goldstein RB, Saha TD, Chou SP, Jung J, Zhang H, et al. Epidemiology of DSM-5 Alcohol Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry. 2015 Aug. 72 (8):757-66. [Medline].

  22. Arria AM, Caldeira KM, Kasperski SJ, Vincent KB, Griffiths RR, O'Grady KE. Energy Drink Consumption and Increased Risk for Alcohol Dependence. Alcohol Clin Exp Res. 2010 Nov 12. [Medline].

  23. Brauser D. New Guidelines for Alcohol Misuse in Adults Released. Medscape Medical News. Available at http://at http://www.medscape.com/viewarticle/804212.

  24. Moyer VA; U.S. Preventive Services Task Force. Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2013 May 14. doi:10.7326/0003-4819-159-3-201308060-00652. [Epub ahead of print].

  25. Enoch MA, Goldman D. Problem drinking and alcoholism: diagnosis and treatment. Am Fam Physician. 2002 Feb 1. 65(3):441-8. [Medline].

  26. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. 1999 Nov 10. 282(18):1737-44. [Medline].

  27. Boutin-Foster C, Ferrando SJ, Charlson ME. The Cornell Psychiatric Screen: a brief psychiatric scale for hospitalized medical patients. Psychosomatics. 2003 Sep-Oct. 44(5):382-7. [Medline].

  28. Nery FG, Stanley JA, Chen HH, Hatch JP, Nicoletti MA, Serap Monkul E, et al. Bipolar disorder comorbid with alcoholism: A (1)H magnetic resonance spectroscopy study. J Psychiatr Res. 2009 Oct 7. [Medline]. [Full Text].

  29. Hicks BM, Krueger RF, Iacono WG, McGue M, Patrick CJ. Family transmission and heritability of externalizing disorders: a twin-family study. Arch Gen Psychiatry. 2004 Sep. 61(9):922-8. [Medline].

  30. Schuckit MA, Smith TL. An 8-year follow-up of 450 sons of alcoholic and control subjects. Arch Gen Psychiatry. 1996 Mar. 53(3):202-10. [Medline].

  31. Chengappa KN, Levine J, Gershon S, Kupfer DJ. Lifetime prevalence of substance or alcohol abuse and dependence among subjects with bipolar I and II disorders in a voluntary registry. Bipolar Disord. 2000 Sep. 2(3 Pt 1):191-5. [Medline].

  32. Jacobsen LK, Southwick SM, Kosten TR. Substance use disorders in patients with posttraumatic stress disorder: a review of the literature. Am J Psychiatry. 2001 Aug. 158(8):1184-90. [Medline].

  33. Vlahov D, Galea S, Ahern J, Resnick H, Boscarino JA, Gold J. Consumption of cigarettes, alcohol, and marijuana among New York City residents six months after the September 11 terrorist attacks. Am J Drug Alcohol Abuse. 2004 May. 30(2):385-407. [Medline].

  34. Marshall RD, Galea S. Science for the community: assessing mental health after 9/11. J Clin Psychiatry. 2004. 65 Suppl 1:37-43. [Medline].

  35. Shipherd JC, Stafford J, Tanner LR. Predicting alcohol and drug abuse in Persian Gulf War veterans: what role do PTSD symptoms play?. Addict Behav. 2005 Mar. 30(3):595-9. [Medline].

  36. Green B. Post-traumatic stress disorder: symptom profiles in men and women. Curr Med Res Opin. 2003. 19(3):200-4. [Medline].

  37. Dobie DJ, Kivlahan DR, Maynard C, Bush KR, Davis TM, Bradley KA. Posttraumatic stress disorder in female veterans: association with self-reported health problems and functional impairment. Arch Intern Med. 2004 Feb 23. 164(4):394-400. [Medline].

  38. de Beaurepaire R, Lukasiewicz M, Beauverie P, Castéra S, Dagorne O, Espaze R, et al. Comparison of self-reports and biological measures for alcohol, tobacco, and illicit drugs consumption in psychiatric inpatients. Journal of European Psychiatry. November 2007. 22 (8):540-548. [Medline].

  39. Hannuksela ML, Liisanantti MK, Nissinen AE, Savolainen MJ. Biochemical markers of alcoholism. Clin Chem Lab Med. 2007. 45(8):953-61. [Medline]. [Full Text].

  40. Sommers MS, Savage C, Wray J, Dyehouse JM. Laboratory measures of alcohol (ethanol) consumption: strategies to assess drinking patterns with biochemical measures. Biol Res Nurs. 2003 Jan. 4(3):203-17. [Medline].

  41. Bergström JP, Helander A. Clinical Characteristics of Carbohydrate-Deficient Transferrin (%Disialotransferrin) Measured by HPLC: Sensitivity, Specificity, Gender Effects, and Relationship with other Alcohol Biomarkers. Alcohol Alcohol. 2008 Apr 24. [Medline].

  42. Neumann T, Spies C. Use of biomarkers for alcohol use disorders in clinical practice. Addiction. 2003 Dec. 98 Suppl 2:81-91. [Medline].

  43. Bean P. State of the art contemporary biomarkers of alcohol consumption. MLO Med Lab Obs. 2005 Nov. 37(11):10-2, 14, 16-7; quiz 18-9. [Medline].

  44. Hietala J, Koivisto H, Anttila P, Niemelä O. Comparison of the combined marker GGT-CDT and the conventional laboratory markers of alcohol abuse in heavy drinkers, moderate drinkers and abstainers. Alcohol Alcohol. 2006 Sep-Oct. 41(5):528-33. [Medline].

  45. Johnson BA. Medication treatment of different types of alcoholism. Am J Psychiatry. 2010 Jun. 167(6):630-9. [Medline].

  46. Sinclair JD. Evidence about the use of naltrexone and for different ways of using it in the treatment of alcoholism. Alcohol Alcohol. 2001 Jan-Feb. 36(1):2-10. [Medline].

  47. Rosner S, Hackl-Herrwerth A, Leucht S, Vecchi S, Srisurapanont M, Soyka M. Opioid antagonists for alcohol dependence. Cochrane Database Syst Rev. 2010 Dec 8. 12:CD001867. [Medline].

  48. Cassels C. Anticonvulsant Promising for Alcohol Dependence. Medscape Medical News. Available at http://www.medscape.com/viewarticle/813817. Accessed: November 13, 2013.

  49. Mason BJ, Quello S, Goodell V, Shadan F, Kyle M, Begovic A. Gabapentin Treatment for Alcohol Dependence: A Randomized Clinical Trial. JAMA Intern Med. 2013 Nov 4. [Medline].

  50. Nunes EV. Gabapentin: A New Addition to the Armamentarium for Alcohol Dependence?. JAMA Intern Med. 2013 Nov 4. [Medline].

  51. Davenport, L. Antibiotic Cuts Alcohol Cravings, May Enhance Psychotherapy. Medscape Medical News. Available at http://www.medscape.com/viewarticle/845066. Accessed: May 22, 2015.

  52. MacKillop J, Few LR, Stojek MK, Murphy CM, Malutinok SF, Johnson FT, et al. D-cycloserine to enhance extinction of cue-elicited craving for alcohol: a translational approach. Transl Psychiatry. 2015 Apr 7. 5:e544. [Medline].

  53. Pescosolido BA, Martin JK, Long JS, Medina TR, Phelan JC, Link BG. "A disease like any other"? A decade of change in public reactions to schizophrenia, depression, and alcohol dependence. Am J Psychiatry. 2010 Nov. 167(11):1321-30. [Medline].

  54. Saitz R. Clinical practice. Unhealthy alcohol use. N Engl J Med. 2005 Feb 10. 352(6):596-607. [Medline].

  55. American Medical Association. Alcoholism in the elderly. Council on Scientific Affairs, American Medical Association. JAMA. 1996 Mar 13. 275(10):797-801. [Medline].

  56. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Washington, DC: American Psychiatric Association; 2000.

  57. Anton RF, Moak DH, Waid LR, et al. Naltrexone and cognitive behavioral therapy for the treatment of outpatient alcoholics: results of a placebo-controlled trial. Am J Psychiatry. 1999 Nov. 156(11):1758-64. [Medline].

  58. Bigby JA. Substance Abuse Education and General Internal Medicine: A Manual for Faculty. Washington, DC: Society of General Internal Medicine; 1993.

  59. Brauser D. CDC Urges Physicians to Ask About Alcohol. Medscape Medical News. Available at http://www.medscape.com/viewarticle/818793. Accessed: January 16, 214.

  60. Brauser D. Inflammatory Markers May Predict Alcohol Dependence. Medscape Medical News. Available at http://www.medscape.com/viewarticle/836307. Accessed: December 12, 2014.

  61. Brooks M. Alcohol remains a leading cause of premature death. Medscape Medical News. June 27, 2014. [Full Text].

  62. Brooks M. Binge Drinking Boosts Mortality Risk in Older Adults. Medscape Medical News. Mar 3 2014. [Full Text].

  63. CDC. Alcohol Screening and Counseling: An effective but underused health service. Available. Medscape Medical News. Available at http://www.cdc.gov/vitalsigns/alcohol-screening-counseling/index.html.. Accessed: January 16, 214.

  64. Fleming MF, Barry KL, Manwell LB, et al. Brief physician advice for problem alcohol drinkers: A randomized controlled trial in community-based primary care practices. JAMA. 1997. 277:1039-1045. [Medline].

  65. Garbutt JC, Kranzler HR, O'Malley SS. Efficacy and tolerability of long-acting injectable naltrexone for alcohol dependence: a randomized controlled trial. JAMA. 2005 Apr 6. 293(13):1617-25. [Medline].

  66. Heinz A, Reimold M, Wrase J, et al. Correlation of stable elevations in striatal {micro}-opioid receptor availability in detoxified alcoholic patients with alcohol craving: a positron emission tomography study using carbon 11-labeled carfentanil. Arch Gen Psychiatry. 2005 Jan. 62(1):57-64. [Medline].

  67. Holahan CJ, Schutte KK, Brennan PL, et al. Episodic Heavy Drinking and 20-Year Total Mortality Among Late-Life Moderate Drinkers. Alcohol Clin Exp Res. 2014 Mar 3. [Medline].

  68. Kiefer F, Jahn H, Tarnaske T, et al. Comparing and combining naltrexone and acamprosate in relapse prevention of alcoholism: a double-blind, placebo-controlled study. Arch Gen Psychiatry. 2003 Jan. 60(1):92-9. [Medline].

  69. Malone SM, Iacono WG, McGue M. Drinks of the father: father's maximum number of drinks consumed predicts externalizing disorders, substance use, and substance use disorders in preadolescent and adolescent offspring. Alcohol Clin Exp Res. 2002 Dec. 26(12):1823-32. [Medline].

  70. Mayo-Smith MF, American Society of Addiction Medicine Working Group on Pharmacology. Pharmacological management of alcohol withdrawal: A meta-analysis and evidence-based practice guideline. JAMA. 1997. 278:144-151. [Medline].

  71. Melville N. Confirmed: Gabapentin Improves Alcohol Dependence Outcomes. Medscape [serial online]. Available at http://www.medscape.com/viewarticle/817472. Accessed: December 16, 2013.

  72. Mendelson JH, Mello NK. Medical Diagnosis and Treatment of Alcoholism. New York, NY: McGraw-Hill; 1992.

  73. National Institute on Alcohol Abuse and Alcoholism. Etiology and Natural History of Alcoholism. [Full Text].

  74. NIAAA. Alcohol Involvement in Accidental Death, Homicide, and Suicide. [Full Text].

  75. O'Connor PG, Schottenfeld RS. Patients with alcohol problems. N Engl J Med. 1998 Feb 26. 338(9):592-602. [Medline].

  76. O'Malley SS, Jaffe AJ, Chang G, et al. Six-month follow-up of naltrexone and psychotherapy for alcohol dependence. Arch Gen Psychiatry. 1996 Mar. 53(3):217-24. [Medline].

  77. O'Malley SS, Rounsaville BJ, Farren C, et al. Initial and maintenance naltrexone treatment for alcohol dependence using primary care vs specialty care: a nested sequence of 3 randomized trials. Arch Intern Med. Apr 6 2005. 163(14):1695-704. [Medline].

  78. Piccinelli M, Tessari E, Bortolomasi M, et al. Efficacy of the alcohol use disorders identification test as a screening tool for hazardous alcohol intake and related disorders in primary care: a validity study. BMJ. 1997 Feb 8. 314(7078):420-4. [Medline].

  79. Pletcher MJ, Varosy P, Kiefe CI, et al. Alcohol consumption, binge drinking, and early coronary calcification: findings from the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Epidemiol. 2005 Mar 1. 161(5):423-33. [Medline].

  80. Room R, Babor T, Rehm J. Alcohol and public health. Lancet. 2005 Feb 5. 365(9458):519-30. [Medline].

  81. Saitz R. Clinical practice. Unhealthy alcohol use. N Engl J Med. 2005 Feb 10. 352(6):596-607. [Medline].

  82. Saitz R, O'Malley SS. Pharmacotherapies for alcohol abuse. Withdrawal and treatment. Med Clin North Am. 1997 Jul. 81(4):881-907. [Medline].

  83. Samet JH, Rollnick S, Barnes H. Beyond CAGE. A brief clinical approach after detection of substance abuse. Arch Intern Med. 1996 Nov 11. 156(20):2287-93. [Medline].

  84. Sigvardsson S, Bohman M, Cloninger CR. Replication of the Stockholm Adoption Study of alcoholism. Confirmatory cross-fostering analysis. Arch Gen Psychiatry. 1996 Aug. 53(8):681-7. [Medline].

  85. Stahre M, Roeber J, Kanny D, Brewer RD, Zhang X. Contribution of excessive alcohol consumption to deaths and years of potential life lost in the United States. Prev Chronic Dis. 2014 Jun 26. 11:E109. [Medline]. [Full Text].

  86. Steinbauer JR, Cantor SB, Holzer CE 3rd, Volk RJ. Ethnic and sex bias in primary care screening tests for alcohol use disorders. Ann Intern Med. 1998 Sep 1. 129(5):353-62. [Medline].

  87. Thun MJ, Peto R, Lopez AD, Monaco JH, Henley SJ, Heath CW Jr. Alcohol consumption and mortality among middle-aged and elderly U.S. adults. N Engl J Med. 1997 Dec 11. 337(24):1705-14. [Medline].

  88. Volpicelli JR, Alterman AI, Hayashida M, O'Brien CP. Naltrexone in the treatment of alcohol dependence. Arch Gen Psychiatry. 1992 Nov. 49(11):876-80. [Medline].

  89. Walden B, McGue M, Lacono WG, et al. Identifying shared environmental contributions to early substance use: the respective roles of peers and parents. J Abnorm Psychol. 2004 Aug. 113(3):440-50. [Medline].

  90. Walsh DC, Hingson RW, Merrigan DM, Levenson SM, Coffman GA, Heeren T, et al. The impact of a physician's warning on recovery after alcoholism treatment. JAMA. 1992 Feb 5. 267(5):663-7. [Medline].

  91. Wilk AI, Jensen NM, Havighurst TC. Meta-analysis of randomized control trials addressing brief interventions in heavy alcohol drinkers. J Gen Intern Med. 1997 May. 12(5):274-83. [Medline].

 
Previous
Next
 
Deaths while intoxicated. Data from the National Institute on Alcohol Abuse and Alcoholism (NIAAA).
Table 1. AUDIT Questions and Scoring System
Questions 0 Points 1 Point 2 Points 3 Points 4 Points
1. How often do you have a drink containing alcohol? Never Monthly or less 2-4 times a month 2-3 times a week 4 or more times a week
2. How many drinks containing alcohol do you have on a typical day when you are drinking? 1 or 2 3 or 4 5 or 6 7-9 10 or more
3. How often do you have 6 or more drinks on 1 occasion? Never Less than monthly Monthly Weekly Daily or almost daily
4. How often during the past year have you found that you were not able to stop drinking once you had started? Never Less than monthly Monthly Weekly Daily or almost daily
5. How often during the past year have you failed to do what was normally expected of you because of drinking? Never Less than monthly Monthly Weekly Daily or almost daily
6. How often during the past year have you needed a first drink in the morning to get yourself going after a heavy drinking session? Never Less than monthly Monthly Weekly Daily or almost daily
7. How often during the past year have you had a feeling of guilt or remorse after drinking? Never Less than monthly Monthly Weekly Daily or almost daily
8. How often during the past year have you been unable to remember what happened the night before because you had been drinking? Never Less than monthly Monthly Weekly Daily or almost daily
9. Have you or has someone else been injured as a result of your drinking? No   Yes, but not in the past year   Yes, during the past year
10. Has a relative, friend, or a doctor or other health care worker been concerned about your drinking or suggested you cut down? No   Yes, but not in the past year   Yes, during the past



year



Table 2. Sensitivity and Specificity of Alcohol Biomarkers*
Biomarker Sensitivity (%) Specificity (%)
AST 15-69 47-68
ALT 18-58 50-57
GGT 34-85 11-95
MCV 34-89 26-95
CDT 39-94 82-100
CDT + GGT 90 † 98
Alcohol 0-100 0-100
EtG 76-91 77-92
*Values vary considerably according to gender, age, drinking pattern, prevalence of alcohol abuse/dependence, and prevalence of comorbidity, among other factors.[39, 6, 40, 42, 43]



† The sensitivity comes from one study in Finland, which uses a special formula. This study needs to be replicated.[44]



Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.