Explaining anti-craving medicines after detox — CASC communication station

MRCPsych/FRANZCP-style communication station: explain naltrexone, acamprosate, and disulfiram in plain language with doses and safety gates; address opioids, liver concerns, disulfiram alcohol education, COMBINE-level honesty about expectations, and psychosocial aftercare.

Prompt

A 42-year-old woman completed medical alcohol detox two days ago. She is oriented and anxious. Her partner is present. They have heard of 'Antabuse', 'the monthly injection', and 'three tablets a day' from online forums. She still has oxycodone at home from dental pain last month (last tablet five days ago). She wants something that 'cures craving forever' and fears liver damage because a relative had cirrhosis. She asks whether she can drink 'a little champagne at a wedding next month if she skips the tablet that day'.

Station brief

Format. Communication station, approximately 7–10 minutes after reading time. You are the psychiatry registrar in the post-detox clinic. [5]

Candidate instructions. Explain that medicines reduce risk of relapse but are not a permanent cure; outline naltrexone, acamprosate, and disulfiram in plain language with key doses and safety points; address leftover opioids before naltrexone; address liver monitoring without catastrophising mild risk; correct the 'skip tablet then drink' plan for disulfiram; emphasise counselling/psychosocial care; shared decision and follow-up. [1][2][3]

Psychiatry Fellowship Pro

You have read the opening of this CASC / OSCE. The complete unit — every section and its primary-source references — is part of the Psychiatry Fellowship fellowship atlas.

References5Show ledger

[1]Reus VI, Fochtmann LJ, Bukstein O, et al. The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder Am J Psychiatry, 2018.PMID 29301420
[2]Jonas DE, Amick HR, Feltner C, et al. Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis JAMA, 2014.PMID 24825644
[3]Fuller RK, Gordis E Does disulfiram have a role in alcoholism treatment today? Addiction, 2004.PMID 14678055
[4]Anton RF, O'Malley SS, Ciraulo DA, et al. Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial JAMA, 2006.PMID 16670409
[5]Connor JP, Haber PS, Hall WD Alcohol use disorders Lancet, 2016.PMID 26343838