This chapter reviews the epidemiology and pathophysiology of alcohol use
disorders. No two patients with alcohol use disorders are the same and recognition of
these patients in our practice is the first priority. Diagnostic indicators and the CAGE
questions that can be used to assist in the identification of patients with alcohol use
disorders are presented. Non-drug therapies are integral and include lifestyle changes,
group therapies (alcoholics anonymous), and individual therapies (i.e., cognitive
behavioral therapy). These and other non-drug treatment options are discussed in this
chapter. Medication options for the management of outpatient alcohol withdrawal are
discussed and include benzodiazepines and anticonvulsant agents (off-label use).
Medications to assist in maintaining sobriety and reduce craving should be offered to
all patients. Medications discussed in this chapter include acamprosate, naltrexone and
disulfiram. The information presented includes discussion of patient specific
characteristics such as renal and hepatic function and underlying psychiatric issues
such as anxiety, depression and insomnia that may affect medication selection and
outcome. This chapter includes key learning points and a patient vignette to assist the
learner. A patient education sheet on alcohol use disorders and additional patient
resources accompanies the chapter.
Keywords: Acamprosate, Alcohol withdrawal, CAGE, Craving, Disulfiram,
Naltrexone.
