Treatment for Alcoholism

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The immediate concern in the treatment of alcoholics is detoxification and management of the ethanol withdrawal syndrome. Once the patient is detoxified, long-term treatment requires complete abstinence, psychiatric treatment, family involvement, and frequently support from lay organizations such as Alcoholics Anonymous.

One pharmacological approach is aversion therapy using drugs such as disulfiram to associate drinking ethanol with unpleasant consequences. If ethanol is taken after disulfiram administration, blood acetalde-hyde concentrations increase 5 to 10 times, resulting in vasodilation, pulsating headache, nausea, vomiting, severe thirst, respiratory difficulties, chest pains, orthosta-tic hypotension, syncope, and blurred vision. In certain cases, marked respiratory depression, cardiac arrhythmias, cardiovascular collapse, myocardial infarction, acute congestive heart failure, unconsciousness, convulsions, and sudden death have been reported. Despite these potentially severe consequences, disulfiram is prescribed for some alcoholic patients.

Another pharmacological approach is the use of an-ticraving drugs, for example serotonin uptake inhibitors, dopaminergic agonists, and opioid antagonists. The only treatment that has shown considerable promise is one that uses the opioid antagonist naltrexone.

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