ETOH treatment

Q: 58 years old male is admitted to the ICU with severe alcohol ketoacidosis (AKA). Patient is now recovering in the ICU. The patient has previously failed many interventions to quit alcohol, and now desires only to reduce his dependence on ETOH, and feels he can't stop it completely. The pharmacologic treatment of ETOH disorder can be carved with the treatment goal to?

A) Complete abstinence 

B) Reduction of use

C) Either

Answer: C

It may be interesting that many patients with Alcohol/ETOH abuse may desire to reduce their dependence only!

Disulfiram is a known pharmacologic treatment when complete abstinence is desired.

In cases where the patient's treatment goal is only the reduction of use, naltrexone, acamprosate, and topiramate can be utilized.

Said all of the above, a trained clinician should take the initiative in treating such a disorder, as these patients frequently have many co-occurring morbidities, a preference for different modalities such as monthly injection versus daily medication, a rate of noncompliance, and a previous history of relapses.

#toxicology

References:

1. Mann K, Aubin HJ, Witkiewitz K. Reduced Drinking in Alcohol Dependence Treatment, What Is the Evidence? Eur Addict Res. 2017;23(5):219-230. doi: 10.1159/000481348. Epub 2017 Sep 22. PMID: 28934736.

2. Henssler J, Müller M, Carreira H, Bschor T, Heinz A, Baethge C. Controlled drinking-non-abstinent versus abstinent treatment goals in alcohol use disorder: a systematic review, meta-analysis and meta-regression. Addiction. 2021 Aug;116(8):1973-1987. doi: 10.1111/add.15329. Epub 2020 Dec 14. PMID: 33188563.

3. Fukuda T, Nakai M, Murakami M. [Reduction in alcohol consumption as a treatment goal of alcohol dependence: actual conditions in Okinawa]. Nihon Arukoru Yakubutsu Igakkai Zasshi. 2013 Feb;48(1):58-63. Japanese. PMID: 23659006.