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Consider These Medications to Help Patients Stay Sober

Naltrexone can help prevent relapse in recently detoxified patients with alcohol use disorder. The evidence for acamprosate is not quite as strong.

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References

PRACTICE CHANGER
Consider prescribing oral naltrexone (50 mg/d) for patients with alcohol use disorder who wish to maintain abstinence after a brief period of detoxification.1

STRENGTH OF RECOMMENDATION
A
: Based on a meta-analysis of 95 randomized controlled trials.1

ILLUSTRATIVE CASE
Your patient, a 42-year-old man with alcohol use disorder (AUD), detoxifies from alcohol during a recent hospitalization. He doesn’t want to resume drinking but reports frequent cravings. Are there any medications you can prescribe to help prevent relapse?

Excessive alcohol consumption is responsible for one of every 10 deaths among US adults ages 20 to 64.2 About 20% to 36% of patients seen in a primary care office have AUD.3 Up to 70% of people who quit with psychosocial support alone will relapse.3

The US Preventive Services Task Force gives a grade B recommendation to screening all adults for AUD, indicating that clinicians should provide this service.4 For patients with AUD who wish to abstain but struggle with cravings and relapse, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommends considering medication as an adjunct to brief behavioral counseling.5

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