Alcohol use disorder is a medical term that healthcare professionals use to describe alcohol addiction. Here we’ll discuss the diagnosis and treatment of alcohol use disorder. Alcohol use disorder, problem drinking and high-risk groups are discussed in a previous article.
Diagnosis
A healthcare specialist will ask you some questions about your habits, past medical history, and family history. The questions include the amount and frequency of alcohol consumption, the impact of drinking on your life and the presence or absence of withdrawal symptoms. Based on these questions your disorder will be specified as mild, moderate or severe. During a thorough physical exam, a healthcare professional also will look for signs of alcohol consequences on your physical health.
There are no lab tests or imaging tests for the diagnosis of alcohol use disorder. But some of them are essential for the diagnosis of complications and for the evaluation of different organs (e.g., liver, heart, etc.). Sometimes, you may be referred to another specialist, including a mental health professional, for a comprehensive psychological evaluation.
Treatment
Usually, before the start of treatment, the care team establishes a goal. Ideally, the goal of treatment is to fully exclude alcohol from your life, but sometimes, lowering the amount of consumption also could be acceptable. The complete stop of alcohol consumption is called abstinence.
Identification and treatment of alcohol withdrawal is another key aspect of treating alcohol use disorder. If left untreated, alcohol withdrawal symptoms (see previous article) can cause fear and avoidance from treatment.
Treatment plans for alcohol use disorder vary depending on the disorder’s severity. Some people may need to stay in a specialised centre (inpatient treatment) for rehabilitation (rehab). The presence of complications (see previous article) also should be taken into account before the initiation of treatment.
Treatment options for mild disorders are behavioural treatments and support groups. But treatment of severe alcohol use disorder should include medications. Medications help to stop or lower the consumption of alcohol or prevent resuming drinking. Several agents are effective for treatment: naltrexone, acamprosate, disulfiram and topiramate. All these medications are available in oral dosage forms, and only naltrexone is available as a solution for intramuscular injection (brand name Vivitrol).
What is Vivitrol?
Vivitrol is prescription injectable medicine. It is an opioid antagonist, which means that it blocks opioid receptors. These receptors are responsible for the feeling of euphoria and “high” that is caused by alcohol and opioids.
How does it work?
Vivitrol reduces alcohol cravings and the amount of alcohol that you use. Vivitrol is not an opioid, which means that it can’t cause addiction or withdrawal symptoms. When starting Vivitrol, you should not be physically dependent on alcohol or other substances. Vivitrol is usually used after the detox process.
How is it administered?
In comparison to oral naltrexone, which is taken daily, Vivitrol is injected once monthly by a specialist. It is injected into the muscle of your buttocks by a healthcare provider. You can’t inject yourself, because serious reactions might happen.
Are there any safety precautions for Vivitrol use?
Before starting treatment with Vivitrol, you should tell your healthcare provider if you:
- have ongoing liver and kidney problems, bleeding disorders or other health issues
- are pregnant, breastfeeding or plan to become pregnant
- use other illegal drugs
- Take medications, prescription strength or over-the-counter, especially tell about opioid-containing medicines, like for coughs, colds, pain or diarrhoea.
- now are treated for alcohol use disorder or opioid use disorder
- are allergic to naltrexone or other components of Vivitrol
What are the side effects of Vivitrol?
- The most serious and life-threatening side effect of Vivitrol is the risk of opioid overdose. It happens when a patient tries to overcome the opioid-blocking effects of Vivitrol with large amounts of opioids (e.g., heroin) or opioid-containing drugs. When you take Vivitrol, its effect gradually decreases and goes away over time. If you use street drugs in amounts that you used to take before treatment with Vivitrol, it can lead to overdose or death.
You or someone around you should call 9-1-1 if overdose symptoms are present:
- trouble breathing or slow, shallow breathing
- drowsiness
- feeling of dizziness, confusion or unusual symptoms
- Severe reactions at the site of injection, including tissue death. Call your healthcare provider if you notice the following at the sites of injection:
- intense pain
- swelling or hardening
- lumps or blisters
- an open wound
- a dark scab
- sudden opioid withdrawal
- liver damage or hepatitis
- depressed mood
- pneumonia
- allergic reactions
- other (nausea and vomiting, sleepiness, dizziness, headache, muscle and joint pain, toothache, cold symptoms, sleeping problems)
Call your healthcare specialist if any of these side effects bother you and do not go away.
Prognosis
For most people, treatment of alcohol use disorder is effective. Fighting alcohol dependence is an ongoing process. You may relapse (return to alcohol consumption), especially to cope with stress. Though, you should keep trying to quit and return to treatment right away.
Sources:
Cleveland Clinic
Medline Plus
UpToDate
Vivitrol.com
Substance Abuse and Mental Health Administration
