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Chapter 9. Clinical Management of Alcohol Abuse and Dependence

Hugh Myrick, M.D.; Tara Wright, M.D.
DOI: 10.1176/appi.books.9781585623440.346212

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Excerpt

Alcohol abuse and dependence are prevalent and costly problems in the United States today. Data from the Epidemiologic Catchment Area Study indicate that the lifetime prevalence of alcohol dependence is 14.7% (Regier et al. 1990). More strikingly, approximately 100,000 Americans die each year from alcohol-related disease or injury (McGinnis and Foege 1999). It has been estimated that alcohol-related problems account for at least 15% of health care expenditures and cost the U.S. economy an excess of $185 billion in medical costs, loss of life and property, and reduced productivity (Harwood 2000). Unfortunately, alcohol dependence is underdiagnosed and difficult to treat. In as few as 1–2 years following treatment, only about 20%–30% of treated patients have maintained abstinence, with most returning to heavy drinking. Clearly, there is a critical need for the development of more effective therapies for the treatment of alcoholism.

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Table Reference Number
TABLE 9–1. DSM-IV-TR criteria for alcohol intoxication
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TABLE 9–2. DSM-IV-TR criteria for substance abuse
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TABLE 9–3. DSM-IV-TR criteria for substance dependence
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TABLE 9–4. DSM-IV-TR criteria for alcohol withdrawal
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TABLE 9–5. Values of biological markers suggesting heavy drinking
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TABLE 9–6. Relative indications for outpatient alcohol detoxification
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Detection and referral rates of alcoholic patients are low.

The biomarker carbohydrate-deficient transferrin test alone, or in combination with -glutamyltransferase, may be used to identify heavy alcohol use and monitor drinking status during alcohol treatment.

Treatment of alcohol withdrawal has primarily become an outpatient procedure.

The Clinical Institute of Withdrawal Assessment for Alcohol Scale, Revised, appears to be a useful instrument for quantifying alcohol withdrawal and guiding the need for ancillary rescue medication dosing.

U.S. Food and Drug Administration–approved medications for the treatment of alcohol dependence include disulfiram, naltrexone, and acamprosate.

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Sample questions:
1.
Alcohol withdrawal is a common and often dangerous clinical problem in the general hospital, and it is often the beginning of a comprehensive treatment model for alcohol dependence. Which of the following is true?
2.
Disulfiram causes a toxic accumulation of acetaldehyde if the patient drinks alcohol. It thus serves as an aversive therapy. Which of the following symptoms is not a part of disulfiram-alcohol reaction?
3.
Which of the following characteristics best describes a subtype of alcoholics who are more likely to respond to naltrexone?
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