Citation

Ritvo JI, Park C. Curr. Treat. Options Neurol. 2007; 9(5): 381-392.

Copyright

(Copyright © 2007, Current Science)

DOI

10.1007/bf02938545

PMID

unavailable

Abstract

Alcohol dependence is a chronic, relapsing biobehavioral disease mediated by various parts of the brain, including reward systems, memory circuits, and the prefrontal cortex. It is characterized by loss of the ability to drink alcohol in moderation and continued drinking despite negative consequences. The alcohol withdrawal syndrome is a common but not universal diagnostic feature of alcohol dependence. Benzodiazepine detoxification of the alcohol withdrawal syndrome prevents the development of withdrawal seizures and delirium tremens, and makes patients more comfortable, which promotes engagement in treatment. Symptom-triggered dosing, based on a withdrawal rating scale such as the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised, is optimal for minimizing the total benzodiazepine dosage. Use of a long-acting benzodiazepine (eg, chlordiazepoxide) is preferred in uncomplicated patients. Thiamine should be administered routinely beforethe administration of intravenous fluids to prevent the development of Wernicke's encephalopathy and Wernicke-Korsakoff syndrome. In combination with psychosocial treatment, disulfiram, naltrexone, and acamprosate can reduce the frequency of relapse. Naltrexone may be more effective for reduction of loss of control with the first drink and cue-related craving, and acamprosate may be more effective for stabilizing the physiology of post-acute withdrawal. Disulfiram, an aversive deterrent, can be useful if administration can be monitored and tied to meaningful contingencies or when used prophylactically for situations anticipated to carry high risk of relapse. Psychiatric comorbidity, especially depression, is common and is best addressed concurrently, although definitive diagnosis may have to await a period of prolonged sobriety. Prescription of addictive substances, including benzodiazepines beyond the period of acute detoxification, should be avoided, and if necessary should be closely monitored (eg, by frequent visits with small prescriptions, clinic-administered disulfiram, and/or urine or breath alcohol screenings). Abstinence from alcohol is recommended for persons with alcohol dependence. Psychosocial treatment and participation in Alcoholics Anonymous can help patients achieve and maintain abstinence. Copyright © 2007 by Current Medicine Group LLC.

Language: en

Keywords

memory; human; suicide; alcoholism; insomnia; abdominal pain; depression; saliva; anxiety; prefrontal cortex; psychosis; clinical trial; comorbidity; review; fatigue; anorexia; vomiting; prescription; neuroleptic agent; behavior disorder; citalopram; clinical feature; fluoxetine; sedation; tachycardia; xerostomia; somnolence; cognitive therapy; drowsiness; libido; constipation; gastrointestinal symptom; diazepam; haloperidol; placebo; drug blood level; drug potentiation; seizure; psychosocial care; drug cost; extrapyramidal symptom; risperidone; tardive dyskinesia; diarrhea; nausea; tremor; drug withdrawal; benzodiazepine; impotence; sweating; akathisia; lorazepam; urinalysis; detoxification; delirium; naltrexone; unindexed drug; screening test; mania; high risk patient; relapse; side effect; symptom; disulfiram; withdrawal syndrome; agitation; asthenia; dystonia; hepatitis; phenytoin; arthralgia; myalgia; pruritus; liver toxicity; clonazepam; drug half life; glucose; hypnotic sedative agent; drug contraindication; warfarin; flatulence; reward; ejaculation; long acting drug; opiate agonist; acamprosate; urine incontinence; dream; dermatitis; psychological rating scale; nervousness; infusion fluid; thiamine; dyspepsia; malaise; hyperglycemia; chlordiazepoxide; drug fever; dizziness; drug eruption; rhinitis; urticaria; benzatropine; neuropathy; metronidazole; central depressant agent; drug induced headache; drug dose increase; short acting drug; jaundice; upper respiratory tract infection; taste disorder; sinusitis; ejaculation disorder; dysmenorrhea; paraldehyde; liver function; alcohol abstinence; oxazepam; sensory dysfunction; yawning; breath analysis; clorazepate; Wernicke encephalopathy; Wernicke Korsakoff syndrome