Understanding Alcohol Use Disorder and Its Treatment
Addiction Medicine • Psychiatry • Primary Care
Understanding Alcohol Use Disorder (AUD) and Its Treatment
Alcohol Use Disorder is a common, chronic condition characterised by impaired control over alcohol use, social impairment and risky use despite harms. Effective treatments exist — psychosocial interventions, pharmacotherapies and specialist services — and early intervention improves outcomes.
Diagnostic features
AUD is diagnosed by a pattern meeting DSM‑5 criteria (2+ of 11 criteria) over a 12‑month period: impaired control, social impairment, risky use, and pharmacologic criteria (tolerance/withdrawal). Severity: mild (2–3), moderate (4–5), severe (6+).
Assessment essentials
- Screening: AUDIT or AUDIT‑C in primary care.
- Detailed alcohol history: quantity (standard units), patterns, previous quit attempts, medical complications and family history.
- Comprehensive assessment: mental health comorbidity, social supports, legal/employment issues, and readiness to change.
- Baseline investigations: LFTs, FBC, electrolytes, GI evaluation, and screening for viral hepatitis and HIV where indicated.
Treatment framework
- Brief interventions: motivational interviewing and personalised feedback for hazardous drinkers.
- Psychosocial treatments: CBT, relapse prevention, 12‑step facilitation, community reinforcement and family interventions.
- Pharmacotherapy: first‑line options include naltrexone (oral or injectable) and acamprosate; disulfiram is an option for motivated patients; topiramate and baclofen have evidence but require specialist oversight.
- Detoxification: supervised withdrawal with benzodiazepines as needed; consider inpatient detox for complicated cases.
- Aftercare & relapse prevention: structured outpatient programmes, mutual‑help groups, medication continuation, and addressing social determinants.
Pharmacotherapy — quick guide
| Medication | Indication | Key points |
|---|---|---|
| Naltrexone (oral/IM) | Reduce heavy drinking, cravings | Check opioid use; avoid in acute hepatitis; monthly injectable improves adherence. |
| Acamprosate | Support abstinence | Start after detox; renal dose adjustments; well tolerated. |
| Disulfiram | Aversion therapy to deter drinking | Requires motivated patient and supervision; causes unpleasant reaction with alcohol. |
| Topiramate / Baclofen | Second‑line or specialist use | Off‑label in many settings; monitor side effects closely. |
Integrated care for comorbidity
- Treat coexisting depression, anxiety, PTSD, or psychosis in parallel — integrated models improve outcomes.
- Address medical comorbidity: liver disease, pancreatitis, cardiovascular risk and infections.
- Work with social services for housing, employment and legal issues essential for recovery.
Harm reduction and safer drinking
- Set realistic goals: reduction in heavy drinking days or abstinence depending on patient preference.
- Provide naloxone where opioid co‑use risk exists; brief safety planning for high‑risk periods.
- Medicines for overdose/relapse prevention and contingency management can be effective in community settings.
When to refer to specialist services
- Severe AUD, repeated detoxifications, complicated withdrawal or co‑occurring severe mental illness.
- Medical complications such as advanced liver disease, Wernicke–Korsakoff syndrome or pregnancy.
- Failure of community‑based treatments or need for structured residential rehabilitation.
Case vignette
Patient: L., 45, meets criteria for severe AUD with daily heavy drinking and two prior DTs. Management: inpatient detox with benzodiazepine protocol, initiate naltrexone post‑detox, enrol in outpatient CBT and family therapy, refer to hepatology and community rehabilitation. With integrated care, L. maintained reduced drinking and engaged with support groups at 6‑month follow‑up.
தமிழில் — சுருக்கம்
மது உபயோக குறைபாடு (AUD) ஒரு தொடர்ச்சியான நிலை. சிகிச்சை மனநல சிகிச்சை, மருந்துகள் மற்றும் ஆதரவு சேவைகள் மூலம் பயனுள்ளதாக இருக்கும். ஆரம்ப சிகிச்சை மற்றும் தொடர் ஆதரவு முக்கியம்.
Key takeaways
- Screening and early intervention (AUDIT, brief advice) reduce harms.
- Combine psychosocial treatments with pharmacotherapy when appropriate; tailor to patient goals.
- Ensure safe detoxification pathways and integrated care for comorbidities and social needs.