Alcohol Treatment Guidelines

The following information is copyright of Dr Bruce Trathen MBBS MRCPsych (2006). ISBN 0-9545164-0-0. The author grants permission for these guidelines to be downloaded, copied and distributed freely, but does not grant permission for their sale.

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Guidelines for the best practice treatment of SUBSTANCE MISUSE

• Basic Principles
  • Use, problem use and dependency
  • Prevalence of substance misuse
  • The approach with the client/patient
  • A needs-led approach which integrates psychosocial and pharmacotherapeutic interventions
• Identification of Substance Misuse
• Brief Interventions
  • What are brief interventions?
  • How do i deliver a 'Brief Intervention'?
  • What are brief interventions?
• Referral to Specialist Services
  • Referral to Specialist Services
  • Brief Interventions
• Initial Appraisal
  • Several decisions
  • Direct the immediate action plan
  • National drug treatment monitoring system reporting
  • Deliver harm-minimisation advice
  • Motivation through assessment
• Basic counselling interventions
• Principles of joint working in shared care
• Pharmacological approaches - basic principles
• The medical management of intoxication
  • General principles
  • Alcohol intoxication
  • Opiate intoxication
  • Sedative-hypnotic intoxication
  • Intoxication with solvents
  • Stimulant intoxication
  • Intoxication with other substances
  • The medical management of intoxication
• The management of withdrawal syndromes
  • General principles
  • Basic principles
  • The five key themes of successful progression to abstinence
  • Detoxification from alcohol
  • Detoxification from opiates
  • Detoxification from sedative-hypnotics
  • Detoxification from stimulant drugs
  • Detoxification from nicotine
• Community prescribing for opiate dependency
  • Community prescribing for opiate dependency
  • Induction onto methadone
  • On-going stabilisation with methadone
  • Slow methadone reduction regimes
  • Prescribing methadone
  • Other drugs for opiate substitution therapy
• Medication to prevent relapse
  • Naltrexone
  • Acamprosate
  • Disulfiram (Antabuse)
• Prescribing sedative-hypnotics
• Viral hepatitis and HIV
  • HIV
  • Viral hepatitis
  • Hepatitis A (HAV)
  • Hepatitis B (HBV)
  • Hepatitis C (HCV)
  • Hepatitis D (HDV)
  • Hepatitis E
  • Hepatitis G
• The management of 'dual diagnosis' 1
• The management of 'dual diagnosis' 2
  • The management of 'dual diagnosis' 2
  • Treatment principles
• In-patient detoxification methods
• Full needs assessment
• Risk assessment
• Care-planning & care-coordination
  • Care-planning & care-coordination
  • Care-planning
  • Care-coordination
• Social interventions
• Psychosocial interventions
  • Common tasks for psychosocial interventions
  • Specific intervention
  • Disease model approaches (traditional, minnesota model, 12-step-oriented)
  • Setting: residential and community psychosocial services
  • Therapists and counsellors
  • Conclusion
• Alternative therapies
  • Shiatsu
  • Homeopathy
  • Traditional chinese medicine (TCM)
  • Acupuncture
  • Conclusion
• Specialist pharmacological & biochemical interventions
  • Dispensing services
  • The opiate addiction test
  • Tolerance testing
  • Tolerance testing: specialist community services - Day 1, Day 2
  • Tolerance testing: specialist community services - Day 3, Day 7/14
  • Specialist in-patient detoxification
  • Specialist opiate detoxification techniques
  • Specialist community prescribing interventions - Prescribing injectable formulations
  • Specialist community prescribing interventions - Prescribing stimulants
  • Biochemical techniques for monitoring of substance misuse - Testing technology
  • Biochemical techniques for monitoring of substance misuse - Body matrix
  • Biochemical techniques for monitoring of substance misuse - Urine testing
  • Biochemical techniques for monitoring of substance misuse - Breath testing: alcohol detection
  • Biochemical techniques for monitoring of substance misuse - Saliva testing
  • Biochemical techniques for monitoring of substance misuse - Plasma tests
  • Biochemical techniques for monitoring of substance misuse - Hair testing
  • Biochemical techniques for monitoring of substance misuse - Testing protocols
• Pregnancy
  • Pregnancy
  • Objectives of care
  • Effects of drugs on the foetus
  • Methods used to detect substances in the neonate
  • Substance specific management during pregnancy
  • Management of labour
  • Treatment options for drug-exposed neonates
  • Breast-feeding
  • HIV and viral hepatitis in pregnancy
• Polydrug misuse
  • Polydrug misuse
  • Polydrug misuse: stabilisation phase
  • Polydrug misuse: detoxification phase
• Chaotic behaviour & poor concordance
  • Chaotic behaviour & poor concordance
  • Services which attract clients into treatment
  • Full engagement and retention in treatment
  • Delivering effective treatments - the one-stop shop
  • When to discharge poorly concordant clients from treatment
• The management of stimulant, solvent and steroid misuse
• References

• Service Standards
  • Key characteristics of effective services (Scoda, 1997)
  • Quality standards for structured day programmes (Scoda, 1997)
  • Rights & responsibilities of service users
• The Stages of Change Model
• Intoxication and Withdrawal Syndromes
  • Sedative-type drugs
  • Stimulant-type drugs
• Physical complications of injecting substance misuse/anabolic steroids
  • Physical complications of injecting drug misuse
  • Anabolic steroids
• Interpretation of laboratory results of drugs of abuse screening
• Interpretation of screening tests for hepatitis B, hepatitis C and HIV
• Dosage equivalents of various controlled medications
  • Table A
  • Table B
• Illicit drug/prescribed drug interactions
  • Interactions between medication and alcohol/Illicit drugs
    • Table A
    • Table B
  • Interactions between medication prescribed for substance misuse disorder and other medications/illicit drugs
    • Table A
    • Table B
• Products and foodstuffs to avoid when using antabuse
• Detoxification protocols and withdrawal scales
  • A. Example protocol for community alcohol detoxification with chlordiazepoxide
    1. Clinical condition to which the protocol applies
    2. Characteristics of staff authorised to take responsibility for the supply or administration of medicines under the protocol
    3. Description of treatment available under the protocol
    4. Paper work requirements
    5. Clinical monitoring requirements
    6. Adjunctive medication
    7. Chlordiazepoxide regimes
    8. Managing adverse outcomes
       • Managing confusion and disorientation (delirium)
       • Managing withdrawal convulsions
       • Managing alcohol use during detoxification
       • Management of anaphylaxis induced by administration of Pabrinex.
  • B. Example protocol for in-patient alcohol detoxification x10 with chlordiazepoxide
    1. Clinical condition to which the protocol applies
    2. Characteristics of staff authorised to take responsibility
    3. Description of treatment available under the protocol
    4. Paper work requirements
    5. Clinical monitoring requirements
    6. Adjunctive medication
    7. Chlordiazepoxide regimes
    8. Managing adverse outcomes
       • Managing acute confusion and disorientation (delirium).
       • Managing withdrawal convulsions.
       • Managing alcohol use during detoxification.
       • Management of anaphylaxis induced by administration of Pabrinex.
  • C. Example protocol for community opiate x10 detoxification with lofexidine
    • Exclusion criteria
    • Description of treatment available under the protocol
    • Regime tables
      1. Regime one: Detoxification from moderate dosages of methadone (20 - 70mg methadone daily)
      2. Regime two: For patients detoxifying from moderate dosages of street heroin 1/4g - 3/4g daily
      3. Regime three: For patients detoxifying from dosages of methadone >70mg daily
      4. Regime four: Detoxification from large dosages of street heroin (> 3/4g street heroin daily)
      5. Regime five: For patients detoxifying from small dosages of methadone <20mg daily
      6. Regime six: For patients detoxifying from dosages of street heroin <1/4g daily
      7. Adjunctive medication
    • Other requirements
    • Managing adverse outcomes
  • D. Example protocol for in-patient opiate detoxification with lofexidine
    • Clinical condition to which the protocol applies
    • Characteristics of staff authorised to take reponsibility
    • Description of treatment available under the protocol
    • Prescribing regimes
    • Regime tables
      1. Regime one: Detoxification from moderate dosages of methadone (20 - 70mg methadone daily)
      2. Regime two: For patients detoxifying from moderate dosages of street heroin 1/4g - 3/4g daily
      3. Regime three: For patients detoxifying from dosages of methadone >70mg daily
      4. Regime four: Detoxification from large dosages of street heroin (> 3/4g street heroin daily)
      5. Regime five: For patients detoxifying from small dosages of methadone <20mg daily
      6. Regime six: For patients detoxifying from dosages of street heroin <1/4g daily
      7. Adjunctive medication
    • Clinical monitoring requirements
    • Managing adverse outcomes
  • Scales for use in detoxification
    • Glasgow coma scale
    • Short opiate withdrawal scale
    • Severity of opiate dependence questionnaire (SODQ)
    • Severity of alcohol dependence questionnaire (SADQ)
  • Ciwa-ar (alcohol withdrawal scale)
• Example protocol for administration of the 'narcan challenge'
  • Clinical condition to which the protocol applies
  • Characteristics of staff authorised to take reponsibility for the supply or administration of medicines under the protocol
  • Description of treatment available under the protocol
  • Prescribing regimes
    • Stage A: Naloxone challenge
    • Stage B: Naltrexone administration
  • Managing adverse outcomes
  • Increasing lofexidine dosage due to precipitation of opiate withdrawal symptoms
  • Managing abnormal liver function
• Contact details of AA and other ‘12 step’ meetings

 

The above information is copyright of Dr Bruce Trathen MBBS MRCPsych (2006). ISBN 0-9545164-0-0. The author grants permission for these guidelines to be downloaded, copied and distributed freely, but does not grant permission for their sale.