Medication Assisted Treatment for Alcohol Dependence

1
Medication Assisted Treatment for Alcohol
Dependence

• Vinita Khanna, M.Ed., CRC
• Therapist
• Preferred Family Healthcare, Jefferson City, MO
• Email vkhanna_at_pfh.org

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What is Medication Assisted Treatment

• Uses medication and psychosocial therapy
• Therapy helps client to be medication compliant
• Medication helps individual by reducing craving
  and assist client maintain abstinence

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Medications

• Naltrexone (ReVia)
• Works by blocking the effect of narcotics or by
  decreasing the craving for alcohol
• It can reduce
• the percentage of days drinking
• The amount of alcohol consumed on a drinking
  occasion
• Relapse to excessive and destructive drinking

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Medications (cont.)

• Naltrexone (ReVia) Standard Dosage
• 50 mg per day or 350 mg per week
• Dosage may be increased depending on whether the
  person experiences difficulty or not
• Duration 12-24 weeks, can be extended to 12
  months based on clinical judgement

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Medications (cont.)

• Naltrexone (ReVia) Side Effects
• Nausea 10
• Headache 7
• Dizziness 4
• Nervousness 4
• Fatigue 4
• Insomnia 3
• Anxiety 2

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Medications (cont.)

• Naltrexone (ReVia) Side Effects
• Nausea was a major problem in the first week of
  taking medication
• Doctor should be informed if confusion,
  drowsiness, hallucinations, excessive vomiting,
  diarrhea, bone or joint pain, skin crawling,
  stomach pain, white bowel movement, skin rash or
  blood with stools occurs.

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Management of Common Adverse Effects

• Patient education
• Timing of doses
• Split dosage
• Dose reduction
• Management of nausea
• Withdrawal

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Medications (cont.)

• Naltrexone (ReVia) who should not take
• Patients who are taking opioid analgesics
• Are currently opioid dependent
• Are in acute opioid withdrawal
• Have abused opioids within the last 7-10 days
• Are allergic to naltrexone
• Suffer from acute hepatitis or liver failure

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Pretreatment Requirements

• Complete physical exam
• Liver function test (LFT)
• Urine toxicology screen
• Mental health or psychiatric screening
• Ascertain substance abuse history, especially
  opiate abuse
• Minimal alcohol withdrawal symptoms

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Naltrexone Related Questions

• Can other medications be taken alongside
• Can alcohol be consumed while on naltrexone
• What is the effect of stopping naltrexone
  suddenly
• What should be done if pain medication is needed
• What is the relationship of naltrexone to AA
• Will naltrexone sober me up if I drink

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Naltrexone Related Questions (cont)

• Use of naltrexone on dual-diagnosis patients
• In a study 82 of dual diagnosis patients had a
  75 reduction in drinking when treated with 50 mg
  dose of naltrexone
• Safe to use with antidepressants
• In a small study with depressed alcoholics, use
  of naltrexone produced significant reduction in
  craving and drinking and mild improvement in
  depressive symptoms

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Education in Medication Management Treatment

• Information on alcohol abuse and alcohol
  dependence
• - impact of alcohol on physical and mental
  health
• Introduction to MM treatment by using
  motivational interview
• -         information on medications naltrexone
  and acomprosate
• -         use of behavioral intervention

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Education in Medication Management Treatment
(cont)

• Provide rationale for medication compliance
• -         development of individualized
  medication compliance plan based on clients
  strengths and life style
•  Conduct a Process Group to identify
  interfering factors for medication compliance
  treatment

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Education in Medication Management Treatment
(cont)

• Group discussion on the role of family support
  and other support groups in medication management
  treatment

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Medication Assisted Therapy Screening Form
 
 
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Treatment Monitoring Form
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Naltrexone Treatment is Effective if

• Client has high motivation for abstinence
• Has willingness to enter into treatment
• Has willingness to take naltrexone as directed
• Has active family and/or social support

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Successful Termination of Medication Assisted
Treatment

• Compliance with the treatment plan
• Stable abstinence or decrease in frequency and
  amount of drinking
• Significant decrease in cravings
• Improvement in quality of life health, family,
  vocational status, legal status, mental status
• Abstinence from other substance abuse