GP · addiction-medicine
Alcohol use disorder: screening, brief intervention, withdrawal
Also known as Alcohol dependence · Alcohol withdrawal · Problem drinking
GP-fellowship guide to alcohol use disorder: AUDIT-C screening, brief intervention (FRAMES), naltrexone and acamprosate pharmacotherapy with JAMA meta-analysis NNT data (naltrexone NNT 11 for preventing return to heavy drinking), alcohol withdrawal management with benzodiazepines, Wernicke encephalopathy prevention with thiamine, and when to refer to specialist AOD services.
On this page
Study tools
Your progress
Saved on this device.
Practise this topic
Target exams
Red flags
- Never give glucose before thiamine in suspected Wernicke encephalopathy — glucose precipitates encephalopathy in thiamine-deficient patients
- Never leave severe alcohol withdrawal untreated — untreated delirium tremens carries significant mortality
- Naltrexone is contraindicated in patients taking opioids — it precipitates acute opioid withdrawal
- Check liver function and renal function before prescribing acamprosate — it is contraindicated in severe renal impairment
Overview
Alcohol use disorder affects more than 28.3 million people in the United States alone and is associated with increased rates of morbidity and mortality.[1] Most patients with AUD are seen in general practice, not in specialist AOD services. The GP screens, delivers brief intervention, manages withdrawal, prescribes pharmacotherapy, and provides long-term follow-up.
References5ShowHide
- [1]Plosker GL Acamprosate: A Review of Its Use in Alcohol Dependence. Drugs, 2015.PMID 26084940
- [2]Palpacuer C, Duprez R, Huneau A, Locher C, Boussageon R, et al. Pharmacologically controlled drinking in the treatment of alcohol dependence or alcohol use disorders: a systematic review with direct and network meta-analyses on nalmefene, naltrexone, acamprosate, baclofen and topiramate. Addiction, 2018.PMID 28940866
- [3]McPheeters M, O'Connor EA, Riley S, Kennedy SM, Voisin C, et al. Pharmacotherapy for Alcohol Use Disorder: A Systematic Review and Meta-Analysis. JAMA, 2023.PMID 37934220
- [4]Morley KC, Kranzler HR, Luquin N, Jamshidi N, Adams C, et al. Topiramate Versus Naltrexone for Alcohol Use Disorder: A Genotype-Stratified Double-Blind Randomized Controlled Trial. Am J Psychiatry, 2024.PMID 38706338
- [5]Greene MC, Loongo H, Metz K, Shawa M, Mtongo N, et al. Screening, brief intervention, and referral to treatment compared with treatment as usual for alcohol use in an integrated refugee settlement in Zambia: a hybrid, type 1, randomised controlled trial. Lancet Glob Health, 2026.PMID 42492563