STAGE 5. Defining the action plan
What steps should be completed?
Step 1: Specify intervention actions
EVIDENCE ON PHARMACOLOGICAL TREATMENT PROGRAMMES
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ALCOHOL
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Alcohol detoxification. Success has been demonstrated by prescription of the following:
- Benzodiazepines (first choice drugs).1
- Clomethiazole (also effective but not safe in outpatient detoxification).1
- Clonidine, beta-blockers or haloperidol (as adjuvants for benzodiazepines, but ineffective in monotherapy).2
- Carbamazepine (for mild or moderate alcoholic abstinence, being a "safe" therapeutic option for outpatient use).1
- Valproic acid (for the treatment of severe alcohol withdrawal syndrome).1
- Tiapride (has demonstrated efficacy for treatment of alcohol withdrawal in controlled studies).1
- Beta-blockers (propranolol, atenolol, etc.; used in polytherapy to treat certain symptoms of alcohol withdrawal syndrome).1
Alcohol cessation. Prescription of the following has proven successful:
- Naltrexone (associated with psychosocial intervention, for relapse prevention).2,3
- Acamprosate (improves abstinence rates; apparently more effective for severe dependence).2,3
- Topiramate (has been shown to reduce alcohol consumption and increase days of abstinence). 2,3
- Disulfiram (alcohol interdictor: effective in highly motivated patients, as part of a broad therapeutic programme, although its general effectiveness is limited because patient compliance is often poor).1,3
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References:
1 Pereiro C (ed.) et al. (2010). Addiction Handbook for Physicians Specialists in Training. Barcelona: Socidrogalcohol.
2 Guard J (Coordinator) et al. (2010). Alcoholism (2nd edition). Socidrogalcohol clinical guides based on scientific evidence. Valencia: Socidrogalcohol.
3 Nida. (2010). Principles of drug treatment: a research-based guide. Washington: National Institute on Drug Abuse (NIDA).
