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    Alcohol Use Disorder (AUD)

    Cardinal Presentations / Presenting Problems, Pediatrics, Psychiatric and Behaviour, Toxicology

    Last Updated May 15, 2018
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    Context

    • Alcohol Use Disorder (AUD) effects 10% of BC’s population and has a huge impact on acute care services, yet fewer than 1% of people with AUD ever receive medications shown to improve outcomes.
    • AUD has a very high morbidity and mortality when untreated or under-treated.
    • More than 35% of fentanyl overdoses in BC and 1/3 of all suicides involve alcohol. Over 7% of all Alcoholics die by suicide.
    • The collateral damage to families and communities is huge.
    • AUD is a very heterogeneous condition and this is one of the reasons pharmacotherapies have been under-prescribed.
    • Initiating AUD pharmacotherapy whenever a patient presents with this disorder can dramatically improve their clinical course.
    • Possible AUD medication side-effects or the need to trial a 2nd med, should not deflect us from trying to improve outcomes for people with AUD.

    Recommended Treatment

    • The goal can be to reduce intake and gradually detox over weeks, rather than precipitously. Pharmacotherapies can help with this transition.
    • Please see AUD Medication Table (below) for dosing recommendations.
    • If a patient has a history of seizures, start patient on Gabapentin and Naltrexone.
    • If patient has evidence of liver disease start on Baclofen +/- Naltrexone with close follow up of liver function to GP and/or clinic.
    • If patient has history of significant cocaine or methamphetamine use, start patient on Topiramate.
    • If patient has history of Early Onset AUD use Ondansetron and Naltrexone.
    • If patient has been or will be sober for at least 7 days, start patient on Acamprosate.
    • Antabuse is not recommended due to there being much better medication options in terms of effectiveness and safety.

    AUD Medication Table (click to enlarge)

     

    Criteria For Hospital Admission

    • History of seizures recent or remote.
    • Poly-substance abuse without support for AUD medication compliance.
    • Acute alcohol withdrawal with high Clinical Institute Withdrawal Assessment (CIWA) high.
    • Need for high dose of benzodiazepines.

    Criteria For Close Observation And/or Consult

    • Suicidal ideation in spite of new hope given with new plan of care that includes pharmacotherapy options.

    Criteria For Safe Discharge Home

    • Patient and/or family understands the plan of care ie. Take new meds and reduce, but don’t stop drinking (see NBC video)
    • Follow-up with own MD or same walk-in clinic or see AUD Clinic if available.
    • One page patient handout with resources on med supported AUD care.
    • A referral service is available 24 hours a day to people across BC needing help with any kind of substance use issues. It provides information and referral to education, prevention, and treatment services and regulatory agencies.

    The Alcohol & Drug Information and Referral Service

    • Toll-Free: 1-800-663-1441
    • Lower Mainland: 604-660-9382

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