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New Treatment Recommendations from the APA on Alcohol Use Disorder

Alcohol use disorder is a widespread disorder that is affecting millions of individuals each year. Some individuals try to quit drinking “cold turkey”, some seek medications from their doctor, some go to Alcoholics Anonymous and others check into a rehabilitation facility. New practice guidelines have just been released indicating the 1st line treatment recommendations for alcohol use disorder.

“The American Psychiatric Association (APA), at its annual meeting in New York City, announced new practice guidelines for the pharmacological treatment of alcohol use disorder (AUD) with the goal of improving outcomes and quality of care for the condition”

An estimated 16 million people in the United States have AUD with only 10% of this population receiving treatment for this disorder. According to statistics, only 674,000 prescriptions were written for FDA approved therapies for these individuals. AUD, commonly known as alcohol abuse or alcoholism, is a chronic relapsing brain disease characterized by compulsive alcohol use, loss of control over alcohol intake, and a negative emotional state when not using.

“The APA recommended or suggested the following for specific medication use: [Recommendation] Naltrexone or acamprosate should be offered to those patients with moderate to severe AUD that have a goal of reducing consumption or achieving abstinence, prefer pharmacotherapy or have not responded to nonpharmacologic therapies, and have no contraindications.
[Suggestion] Disulfiram should be offered to patients with moderate to severe AUD that seek to achieve abstinence, prefer the therapy or have not responded (or are intolerant) to naltrexone or acamprosate, and have no contraindications. Additionally, patients must understand the risks associated with consuming alcohol while on disulfiram.
[Suggestion] Topiramate or gabapentin should be offered to patients with moderate to severe AUD when they have a goal of reducing or achieving abstinence, prefer the 2 to other medications or have not responded to naltrexone or acamprosate, and have no contraindications.”

The APA recommended that benzodiazepines should only be used for patients with AUD when they require treatment for acute alcohol withdrawal or unless they have a disorder for which a benzodiazepine is indicated. Benzodiazepines are extremely addictive and therefore should be used with extreme caution. Similarly, with regard to antidepressants such as SSRIs and TCAs, the APA suggested that patients with AUD should only receive them if they have another indication such as depression or anxiety, which are co-occurring disorder that often exist in the presence of alcohol use disorder. Recommended non-pharmacological treatments include motivational enhancement therapy, cognitive behavioral therapy, and medical management. Community-based peer support groups such as Alcoholics Anonymous and other 12-step programs are helpful in achieving long-term remission but not for replacing formal medical treatment.

Signs that you may have an alcohol abuse disorder

Alcohol, like any other addictive substance, can re-wire your brain to create strong physiological and psychological cravings. Often times, you may be the last person to recognize that you have a substance abuse addiction with alcohol because you may change your lifestyle to conform around your addiction. Alcohol abuse can ruin relationships, create financial burdens associated with job loss, lead to illegal activity such as drinking while under the influence and even lead to violent outbursts. At the end of the day, it is up to you to seek treatment for you disorder. Fortunately there are many resources in your community that can provide you with help however you must first be willing to admit that you in fact, do have an alcohol addiction.

The following are common questions to ask yourself if you think you have an alcohol addiction:

  • Have you ever tried to stop drinking for a week or longer but only lasted a couple of days?
  • Has your drinking ever caused you trouble at home?
  • Has your drinking ever caused you trouble with your job?
  • Have you ever felt the need to have a drink in the morning to curb shakiness?
  • Do you have “blackouts”? A blackout occurs when you have been drinking for a period of time and you cannot recall any events.
  • Do you drink when you are stressed out, disappointed or are in a fight with someone?
  • Have you ever had withdrawal symptoms from alcohol? These can include a racing heart, nausea, vomiting, tremors, or seizures.
  • Have you ever operated a motor vehicle while under the influence?
  • Have you ever tried to hide your drinking habits from your friends or family?
  • Has anyone close to you expressed concern about your drinking?
  • Do you often find yourself in a hurry to have your first drink of the day?
  • Do you ever feel disappointed or uncomfortable if alcohol is not available in a social setting?
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