Disease Description (Causes and Symptoms)
- Summary of definition: A condition in which behavioral and physical dependence (tolerance and withdrawal), loss of control over drinking, and persistent impairment of social and occupational functioning occur due to long-term alcohol use.
- Causes and pathophysiology: Interaction between genetic predisposition (approximately 60% heritable contribution) and environmental and psychosocial factors. Changes in neurotransmitter systems, including dopamine, opioids, and GABA, alter the reward and inhibitory circuits, leading to the development of dependence.
- Main symptoms: Tolerance (needing to drink more to achieve the same effect), withdrawal (anxiety, insomnia, cold sweats, tremor, and, in severe cases, seizures and delirium), loss of control over drinking (drinking more or for longer), reduced social and occupational functioning due to drinking, continued drinking despite alcohol-related problems, spending a great deal of time drinking, and strong craving.
- Diagnostic criteria (reference): According to the traditional criterion, dependence (addiction) is considered when three or more of the listed clinical features persist for at least one year (clinical evaluation is necessary).
- Comorbidities and major complications: Alcohol-related liver disease (hepatitis and cirrhosis), nutritional deficiencies (including Korsakoff syndrome due to vitamin B1 deficiency), alcohol-related dementia, psychiatric comorbidities (antisocial personality disorder, depression, anxiety, bipolar disorder, psychosis, etc.), and fetal alcohol syndrome (when drinking during pregnancy).
Treatment Methods
- Acute treatment (detoxification and withdrawal)
- Assess whether bed observation is necessary for safe detoxification (hospitalization is required in cases of seizures, severe autonomic instability, or risk of delirium).
- Relief of withdrawal symptoms: benzodiazepines (symptom-triggered treatment; dosage and schedule should follow clinical guidelines), intravenous fluids and electrolyte correction, and vitamin supplementation including high-dose thiamine (vitamin B1).
- Management of severe complications (seizures, delirium, severe dehydration, etc.).
- Maintenance treatment (relapse prevention)
- Pharmacotherapy: naltrexone (reduces craving and reward), acamprosate (helps maintain abstinence), and disulfiram (conditional use) — selection should consider the patient’s condition, liver function, pregnancy status, and other factors.
- Psychosocial interventions: motivational enhancement therapy (MET), cognitive behavioral therapy (CBT), group therapy, family therapy, 12-step self-help groups (AA), etc.
- Rehabilitation programs: occupational and social skills training, long-term rehabilitation and follow-up.
- Lifestyle management and precautions
- During the acute phase, do not drive or operate heavy machinery; monitor liver function and neurological status.
- Concurrent treatment of comorbidities (liver disease, depression, liver failure, etc.) is necessary.
- When selecting medication, check liver function (especially for naltrexone), kidney function (for acamprosate), and drug interactions.
- Risk of complications
- If untreated: seizures and delirium (potentially fatal), cirrhosis and liver failure, malnutrition and gastrointestinal lesions, cognitive impairment (alcohol-related dementia), loss of family and social functioning, and fetal harm.
Checklist Before an Outpatient Visit (Items to Bring and Matters to Review)
- Items and information to prepare
- List of medications currently being taken (prescription and nonprescription drugs, herbal medicines, and supplements)
- Past medical and psychiatric history (including a history of seizures and whether delirium has occurred)
- History of previous hospitalization, detoxification, and rehabilitation treatment
- Recent test results, if available, such as liver function tests (LFT), CBC, electrolytes, blood glucose, and vitamin B1; bring them if possible
- Drinking diary (recent amount and frequency of drinking, time spent drinking, and time of last drink)
- Social support and family situation, and whether there are occupational or legal issues
- Possibility of pregnancy (for women of childbearing potential) and whether breastfeeding
- Information to report in advance at the outpatient visit
- Whether there have recently been withdrawal symptoms (insomnia, tremor, seizures, etc.)
- Thoughts of self-harm or suicide, or current risk
- Drug allergies and any previous experience of medication side effects
Examples of General Questions to Ask the Doctor
- What are the expected effects and possible side effects of this medication (or treatment)?
- What treatment options do you recommend for me, and why do you recommend that approach?
- What tests or monitoring schedule should be followed during treatment (liver function, blood levels, etc.)?
- What should I do immediately, and how should I respond, if I relapse to drinking?
- What precautions should I take in daily life regarding work, driving, pregnancy plans, and other matters?
Examples of Questions Tailored to the Condition
- Considering my liver function (or other comorbidities), which of naltrexone, acamprosate, and disulfiram is appropriate? What are the risks and benefits of each?
- I previously experienced seizures or severe withdrawal (delirium). How do you determine whether outpatient detoxification is safe this time or whether inpatient detoxification is necessary?