"You need to create a new life, whatever that life is gonna be" - Managing Alcohol Use Disorder (Part II)

In this episode, Dr. Barenboim and Dr. Holt discuss the important role that medications and mutual support groups play in helping James maintain sobriety from alcohol.

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=== Outline ===

Chapter 1: Managing Alcohol Withdrawal in the Outpatient Setting

Chapter 2: Medications for AUD

Chapter 3: Recovery Group/Social Support

=== Learning Points ===

1. Although our training has historically focused on the inpatient setting, managing alcohol withdrawal in the outpatient setting is also possible. A sample regimen for this may be 10mg diazepam every 6 hours on the first day, then every 8 hours on the second day, every 12 hours on the third day, and then once on day 4.
2. Medications approved by the FDA in the treatment of alcohol use disorder include: naltrexone, acamprosate, and disulfiram. Disulfiram is considered a first-line medication. 
3. Successful treatment of AUD often requires trying lots of combinations of interventions, which can include medications and non-pharmacologic interventions such as mutual support groups or therapy. The diversity of support groups is growing, making them more accessible to patients; but patients may need to trial many different groups before finding one that “works” for them.

=== Our Expert(s) ===

Dr. Stephen Holt attended Columbia University’s College of Physicians & Surgeons and subsequently completed his residency training and Chief Residency at Yale's Primary Care Internal Medicine Residency Program before joining the program as an Assistant Professor. He currently serves as the Associate Program Director for Ambulatory Education in the Primary Care Program. His areas of interest include addiction medicine, medical education, and the art and science of physical diagnosis. 

=== References ===

1. Tiglao SM, Meisenheimer ES, Oh RC. Alcohol Withdrawal Syndrome: Outpatient Management. Am Fam Physician. 2021 Sep 1;104(3):253-262. PMID: 34523874.
2. McPheeters M, O'Connor EA, Riley S, Kennedy SM, Voisin C, Kuznacic K, Coffey CP, Edlund MD, Bobashev G, Jonas DE. Pharmacotherapy for Alcohol Use Disorder: A Systematic Review and Meta-Analysis. JAMA. 2023 Nov 7;330(17):1653-1665. doi: 10.1001/jama.2023.19761. Erratum in: JAMA. 2024 Oct 2. doi: 10.1001/jama.2024.11331. PMID: 37934220; PMCID: PMC10630900.
3. Garbutt JC, Kranzler HR, O'Malley SS, et al. Efficacy and tolerability of long-acting injectable naltrexone for alcohol dependence: a randomized controlled trial. JAMA 2005; 293:1617.
4. Skinner MD, Lahmek P, Pham H, Aubin HJ. Disulfiram efficacy in the treatment of alcohol dependence: a meta-analysis. PLoS One 2014; 9:e87366.

=== About Us ===

The Primary Care Pearls (PCP) Podcast is created in collaboration with faculty, residents, and students from the Department of Internal Medicine at the Yale School of Medicine. The project aims to create accessible and informative podcasts about core primary care topics centered around real patient stories. 

Hosts: Dylan Balter

Producers: Helen Cai, Josh Onyango

Logo and Name: Eva Zimmerman

Theme music and Editing: Helen Cai, Josh Onyango

Other background music: Asher Fulero, Dan Bodan, Penguin Music, Nathan Moore, Chris Haugen

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