STAGE 4. Selecting the theoretical approach

What steps should be completed?

Step 1: Select the theoretical approach or approaches on which the intervention will be based

PHARMACOLOGICAL TREATMENTS FOR ALCOHOL DEPENDENCE

What is detoxification based on?

In patients with an alcohol dependence disorder, alcoholic beverages must be withdrawn in a programmed manner and with the help of certain medicines. Detoxification of these patients aims to achieve abstinence by preventing alcohol withdrawal syndrome (AWS) and is usually the first step towards a cessation treatment.

AWS can occur when a person with alcohol dependence stops consuming it for a few hours. It is characterised by vegetative hyperactivity (tremors, sweating, tachycardia, arterial hypertension, nausea, vomiting), anxiety, irritability, restlessness, insomnia and an imperative desire to ingest alcohol ("craving"). When abstinence is severe, the patient may present generalised seizures and perceptual disturbances (delusions, hallucinations) in the context of a state of confusion (delirium), which progresses with psychomotor agitation and which, if not treated correctly, can even lead to death (especially in patients with concomitant organic disorders).

Hypnosedatives (benzodiazepines or chlormethiazole), anticonvulsants, sympatholytics, antidopaminergics and vitamin therapy (especially thiamine) are used in the pharmacological treatment of AWS.

What is the basis of cessation?

Cessation treatment aims to maintain abstinence and prevent relapse. Together with various psychological and social interventions, this treatment includes a specific pharmacotherapy that may be based on interdictor or anti-craving medication, along with medication to treat the medical and psychiatric comorbidity associated with alcoholism. The most commonly used medicines in alcohol cessation are:

• Alcohol interdictors; these cause a toxic reaction to the accumulation of reactive metabolites in the blood if alcohol is consumed. This is intended to deter consumption and prevent impulsive consumption (a frequent cause of relapse). Disulfiram and calcium cyanamide are among the most commonly used interdictors.
• Anti-craving drugs: naltrexone, acamprosate, disulfiram and topiramate.
• Drugs to prevent relapses: naltrexone and acamprosate.
• Other drugs: antiepileptics, antidepressants, antidopaminergics, etc.