Skip to main content
SpringerLink
Log in

Care of the Alcoholic Patient

Family Medicine

Abstract

Alcohol, as an intoxicant, has been a part of human civilization for millennia. Alcohol’s intoxicating effect appears to be due to the altering of cell membrane’s action potentials, specifically modulating the activity of gamma aminobutyric acid (GABA) and -methyl--aspartate (NMDA) channels. Enhancing GABA’s inhibitory effect leads to a global decrease of membrane potentials. NMDA , an excitatory neurotransmitter, is blocked in the presence of ethyl alcohol. Acutely, this results in an anxiolytic effect and lowers inhibitions. Higher blood alcohol concentrations (BAC) lead to slurred speech, confusion, and motor impairment. Levels above 300 mg/dL (0.3 g/dL) can cause stupor, coma, respiratory depression, and finally death.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Ducci F, Goldman D. Genetic approaches to addiction: genes and alcohol. Addiction. 2008;103:1414–28.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Schuckit MA. Alcohol-use disorders. Lancet. 2009;373:492–501.

    Article  PubMed  Google Scholar 

  3. Schuckit MA. Recognition and management of withdrawal delirium (delerium tremens). N Engl J Med. 2014;371:2109–13.

    Article  PubMed  Google Scholar 

  4. Adger Jr H, Saha S. Alcohol use disorders in adolescents. Pediatr Rev. 2013;34:103–13.

    Article  PubMed  Google Scholar 

  5. Ilomaki J, Paljarvi T, Korhonen MJ, et al. Prevalence of concomitant use of alcohol and sedative-hypnotic drugs in middle and older aged persons: a systematic review. Ann Pharmacother. 2013;47:257–68.

    Article  PubMed  Google Scholar 

  6. Moyer VA. Screening and behavioral counseling interventiions in primary care to reduce alcohol misues: U. S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013;159:210–8.

    Google Scholar 

  7. Schomerus G, Lucht M, Holzinger A, Matschinger H, Garta MG, Angermeyer MC. The stigma of alcohol dependence compared with other mental disorders: a review of population studies. Alcohol Alcohol. 2011;46:105–12.

    Article  CAS  PubMed  Google Scholar 

  8. O’Donnell A, Anderson P, Newbury-Birch D, et al. The impact of brief alcohol interventions in primary healthcare: a systematic review of reviews. Alcohol Alcohol. 2014;49:66–78.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Merrill JO, Duncan MH. Addiction disorders. Med Clin North Am. 2014;98:1097–122.

    Article  PubMed  Google Scholar 

  10. Muncie Jr HL, Yasinian Y, Oge L. Outpatient management of alcohol withdrawal syndrome. Am Fam Physician. 2013;88:589–95.

    PubMed  Google Scholar 

  11. Blondell RD. Ambulatory detoxification of patients with alcohol dependence. Am Fam Physician. 2005;71:495–502.

    PubMed  Google Scholar 

  12. Prater CD, Miller KE, Zylstra RG. Outpatient detoxification of the addicted or alcoholic patient. Am Fam Physician. 1999;60:1175–83.

    CAS  PubMed  Google Scholar 

  13. Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). Br J Addict. 1989;84:1353–7.

    Article  CAS  PubMed  Google Scholar 

  14. Elholm B, Larsen K, Hornnes N, Zierau F, Becker U. A psychometric validation of the Short Alcohol Withdrawal Scale (SAWS). Alcohol Alcohol. 2010;45:361–5.

    Article  PubMed  Google Scholar 

  15. Saitz R, Palfai TP, Cheng DM, et al. Brief intervention for medical inpatients with unhealthy alcohol use: a randomized, controlled trial. Ann Intern Med. 2007;146:167–76.

    Article  PubMed  Google Scholar 

  16. Orford J, Hodgson R, Copello A, Wilton S, Slegg G, UKATT Research Team. To what factors do clients attribute change? Content analysis of follow-up interviews with clients of the UK Alcohol Treatment Trial. J Subst Abuse Treat. 2009;36:49–58.

    Article  PubMed  Google Scholar 

  17. Mdege ND, Fayter D, Watson JM, Stirk L, Sowden A, Godfrey C. Interventions for reducing alcohol consumption among general hospital inpatient heavy alcohol users: a systematic review. Drug Alcohol Depend. 2013;131:1–22.

    Article  PubMed  Google Scholar 

  18. Bray JW, Cowell AJ, Hinde JM. A systematic review and meta-analysis of health care utilization outcomes in alcohol screening and brief intervention trials. Med Care. 2011;49:287–94.

    Article  PubMed  Google Scholar 

  19. Mayo-Smith MF. Pharmacological management of alcohol withdrawal. A meta-analysis and evidence-based practice guideline. American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal. JAMA. 1997;278:144–51.

    Article  CAS  PubMed  Google Scholar 

  20. Ntais C, Pakos E, Kyzas P, Ioannidis JP. Benzodiazepines for alcohol withdrawal. Cochrane Database Syst Rev. 2005;20(3):005063.

    Google Scholar 

  21. Kosten TR, O’Connor PG. Management of drug and alcohol withdrawal. N Engl J Med. 2003;348:1786–95.

    Article  CAS  PubMed  Google Scholar 

  22. Polycarpou A, Papanikolaou P, Ioannidis JP, Contopoulos-Ioannidis DG. Anticonvulsants for alcohol withdrawal. Cochrane Database Syst Rev. 2005;20(3):005064.

    Google Scholar 

  23. Lum E, Gorman SK, Slavik RS. Valproic acid management of acute alcohol withdrawal. Ann Pharmacother. 2006;40:441–8.

    Article  CAS  PubMed  Google Scholar 

  24. Schik G, Wedegaertner FR, Liersch J, Hoy L, Emrich HM, Schneider U. Oxcarbazepine versus carbamazepine in the treatment of alcohol withdrawal. Addict Biol. 2005;10:283–8.

    Article  CAS  PubMed  Google Scholar 

  25. Koethe D, Juelicher A, Nolden BM, et al. Oxcarbazepine–efficacy and tolerability during treatment of alcohol withdrawal: a double-blind, randomized, placebo-controlled multicenter pilot study. Alcohol Clin Exp Res. 2007;31:1188–94.

    Article  CAS  PubMed  Google Scholar 

  26. Myrick H, Malcolm R, Randall PK, et al. A double-blind trial of gabapentin versus lorazepam in the treatment of alcohol withdrawal. Alcohol Clin Exp Res. 2009;33:1582–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  27. Addolorato G, Leggio L, Abenavoli L, et al. Baclofen in the treatment of alcohol withdrawal syndrome: a comparative study vs diazepam. Am J Med. 2006;119:276.e13–18.

    Article  Google Scholar 

  28. Daeppen JB, Gache P, Landry U, et al. Symptom-triggered vs fixed-schedule doses of benzodiazepine for alcohol withdrawal: a randomized treatment trial. Arch Intern Med. 2002;162:1117–21.

    Article  CAS  PubMed  Google Scholar 

  29. Elholm B, Larsen K, Hornnes N, Zierau F, Becker B. Alcohol withdrawal syndrome: symptom-triggered versus fixed-schedule treatment in an outpatient setting. Alcohol Alcohol. 2011;46:318–22.

    Article  PubMed  Google Scholar 

  30. Muzyk AJ, Leung JG, Nelson S, Embury ER, Jones SR. The role of diazepam loading for the treatment of alcohol withdrawal syndrome in hospitalized patients. Am J Addict. 2013;22:113–8.

    Article  PubMed  Google Scholar 

  31. Mayo-Smith MF, Beecher LH, Fischer TL, Gorelick DA, Guillaume JL, Hill A, Jara G, Kasser C, Melbourne J, Working Group on the Management of Alcohol Withdrawal Delirium, Practice Guidelines Committee, American Society of Addiction Medicine. Management of alcohol withdrawal delirium. An evidence-based practice guideline. Arch Intern Med. 2004;164:1405–12.

    Article  CAS  PubMed  Google Scholar 

  32. Rayner SG, Weinert CR, Peng H, Jepsen S, Broccard AF, Study Institution. Dexmedetomidine as adjunct treatment for severe alcohol withdrawal in the ICU. Ann Intensive Care. 2012;2:12. doi:10.1186/2110-5820-2-12.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Lenaerts E, Mathei C, Matthys F, et al. Continuing care for patients with alcohol use disorders: a systematic review. Drug Alcohol Depend. 2014;135:9–21.

    Article  PubMed  Google Scholar 

  34. Gastfriend DR, Mee-Lee D. The ASAM patient placement criteria: context, concepts and continuing development. J Addict Dis. 2003;22:1–8.

    Article  PubMed  Google Scholar 

  35. Huebner RB, Kantor LW. Advances in alcoholism treatment. Alcohol Res Health. 2011;33:295–9.

    PubMed Central  PubMed  Google Scholar 

  36. McKay JR, Hiller-Sturmhofel S. Treating alcoholism as a chronic disease: approaches to long-term continuing care. Alcohol Res Health. 2011;33:356–70.

    PubMed Central  PubMed  Google Scholar 

  37. Pagano ME, White WL, Kelly JF, Stout RL, Tonigan JS. The 10-year course of Alcoholics Anonymous participation and long-term outcomes: a follow-up study of outpatient subjects in Project MATCH. Subst Abus. 2013;34:51–9.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Moos RH, Moos BS. Participation in treatment and Alcoholics Anonymous: a 16-year follow-up of initially untreated individuals. J Clin Psychol. 2006;62:735–50.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Ferri M, Amato L, Davoli M. Alcoholics Anonymous and other 12-step programmes for alcohol dependence. Cochrane Database Syst Rev. 2006;19(3):005032.

    Google Scholar 

  40. Magill M, Ray LA. Cognitive-behavioral treatment with adult alcohol and illicit drug users: a meta-analysis of randomized controlled trials. J Stud Alcohol. 2009;70:516–27.

    Article  Google Scholar 

  41. Irvin JE, Bowers CA, Dunn ME, Wang MC. Efficacy of relapse prevention: a meta-analytic review. J Consult Clin Psychol. 1999;67:563–70.

    Article  CAS  PubMed  Google Scholar 

  42. O’Farrell TJ, Fals-Stewart W. Behavioral couples therapy for alcoholism and drug abuse. J Subst Abuse Treat. 2000;18:51–4.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Jonas DE, Amick HR, Feltner C, et al. Pharmacotherapy for adults with alcohol use disorders inoutpatient settings. A systematic review and meta-analysis. JAMA. 2014;311:1889–900.

    Article  PubMed  Google Scholar 

  44. Tabakoff B, Hoffman PL. The neurobiology of alcohol consumption and alcoholism: an integrative history. Pharmacol Biochem Behav. 2013;113:20–37.

    Article  CAS  PubMed  Google Scholar 

  45. Laaksonen E, Koski-Jannes A, Salaspuro M, Ahtinen H, Alho H. A randomized, multicentre, open-label, comparative trial of disulfiram, naltrexone and acamprosate in the treatment of alcohol dependence. Alcohol Alcohol. 2008;43:53–61.

    Article  CAS  PubMed  Google Scholar 

  46. Mason BJ, Quello S, Goodell V, Shadan F, Kyle M, Begovic A. Gabapentin treatment for alcohol dependence a randomized clinical trial. JAMA Intern Med. 2014;174:70–7.

    Google Scholar 

  47. Muzyk AJ, Rivelli SK, Gagliardi JP. Defining the role of baclofen for the treatment of alcohol dependence: a systematic review of the evidence. CNS Drugs. 2012;26:69–78.

    Article  CAS  PubMed  Google Scholar 

  48. Torrens M, Fonseca F, Mateu G, Farre M. Efficacy of antidepressants in substance use disorders with and without comorbid depression. A systematic review and meta-analysis. Drug Alcohol Depend. 2005;78:1–22.

    Article  CAS  PubMed  Google Scholar 

  49. Trumpler F, Oez S, Stahli P, Brenner HD, Juni P. Acupuncture for alcohol withdrawal: a randomized controlled trial. Alcohol Alcohol. 2003;38:369–75.

    Article  PubMed  Google Scholar 

  50. Potter G. Intensive therapy: utilizing hypnosis in the treatment of substance abuse disorders. Am J Clin Hypn. 2004;47:21–8.

    Article  PubMed  Google Scholar 

  51. Cunningham JA, Kypri K, McCambridge J. The use of emerging technologies in alcohol treatment. Alcohol Res Health. 2011;33:320–6.

    PubMed Central  PubMed  Google Scholar 

  52. American Psychiatric Association. Dianostic and statistical manual of mental disorders, Alcohol use disorder, vol. 5. 5th ed. Washington, DC: American Psychiatric Association; 2013.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Family Medicine, Louisiana State University School of Medicine, 1542 Tulane Ave, Box T1-8, 70112, New Orleans, LA, USA

    Herbert L. Muncie

Authors
  1. Herbert L. Muncie
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Herbert L. Muncie .

Editor information

Editors and Affiliations

  1. Department of Family Medicine, University of Nebraska, Omaha, Nebraska, USA

    Paul Paulman

  2. Virginia Beach, Virginia, USA

    Robert Taylor

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this entry

Cite this entry

Muncie, H.L. (2015). Care of the Alcoholic Patient. In: Paulman, P., Taylor, R. (eds) Family Medicine. Springer, Cham. https://doi.org/10.1007/978-1-4939-0779-3_66-1

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-0779-3_66-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Online ISBN: 978-1-4939-0779-3

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Chapter history

  1. Latest

    Care of the Alcoholic Patient
    Published:
    20 November 2020

    DOI: https://doi.org/10.1007/978-1-4939-0779-3_66-2

  2. Original

    Care of the Alcoholic Patient
    Published:
    23 June 2015

    DOI: https://doi.org/10.1007/978-1-4939-0779-3_66-1

Search

Navigation