Relapse Prevention

Psychosocial intervention

• CBT
• Motivational enhancement therapy
• 12-step facilitaion therapy (AA method)
• Behavioural self-control training
• Family/couple therapy

All have been shown (almost) equally effective, depending on the patient.

Pharmacological intervention

NB NO role for BDZs after detoxification

• Disulfiram (antabuse)- inhibits aceylaldehyde dehydrogenase leading to accumulation of acetylaldehyde if alcohol is ingested i.e. extremely bad hangover.  Leads to flushed skin, tachycardia, nausea and vomiting, arrhythmias and hypotension depending on the volume consumed.  Therefore, compliance can be an issue and informed consent is crucial.
• Acamprosate– acts centrally on glutamate and GABA systems to reduce cravings;  should start immediately after detox and continue through remission and relapse in conjunction with psychosocial intervention.  Side effects include headache, nausea and diarrhoea.
• Naltrexone is not actually licensed yet but is an opioid antagonist that works because alcoholics have an increased number of opioid receptors in the nucleus accumbens (addiction centre).