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    Alcohol Use Disorder (AUD)

    Cardinal Presentations / Presenting Problems, Psychiatric and Behaviour, Substance Use, Toxicology

    Last Updated May 15, 2018
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    • Alcohol Use Disorder (AUD) effects 10% of BC’s population and has a huge impact on acute care services, yet fewer than 1% of people with AUD ever receive medications shown to improve outcomes.
    • AUD has a very high morbidity and mortality when untreated or under-treated.
    • More than 35% of fentanyl overdoses in BC and 1/3 of all suicides involve alcohol. Over 7% of all Alcoholics die by suicide.
    • The collateral damage to families and communities is huge.
    • AUD is a very heterogeneous condition and this is one of the reasons pharmacotherapies have been under-prescribed.
    • Initiating AUD pharmacotherapy whenever a patient presents with this disorder can dramatically improve their clinical course.
    • Possible AUD medication side-effects or the need to trial a 2nd med, should not deflect us from trying to improve outcomes for people with AUD.

    Recommended Treatment

    • The goal can be to reduce intake and gradually detox over weeks, rather than precipitously. Pharmacotherapies can help with this transition.
    • Please see AUD Medication Table (below) for dosing recommendations.
    • If a patient has a history of seizures, start patient on Gabapentin and Naltrexone.
    • If patient has evidence of liver disease start on Baclofen +/- Naltrexone with close follow up of liver function to GP and/or clinic.
    • If patient has history of significant cocaine or methamphetamine use, start patient on Topiramate.
    • If patient has history of Early Onset AUD use Ondansetron and Naltrexone.
    • If patient has been or will be sober for at least 7 days, start patient on Acamprosate.
    • Antabuse is not recommended due to there being much better medication options in terms of effectiveness and safety.

    AUD Medication Table (click to enlarge)

    Criteria For Hospital Admission

    • History of seizures recent or remote.
    • Poly-substance abuse without support for AUD medication compliance.
    • Acute alcohol withdrawal with high Clinical Institute Withdrawal Assessment (CIWA) high.
    • Need for high dose of benzodiazepines.

    Criteria For Close Observation And/or Consult

    • Suicidal ideation in spite of new hope given with new plan of care that includes pharmacotherapy options.

    Criteria For Safe Discharge Home

    • Patient and/or family understands the plan of care ie. Take new meds and reduce, but don’t stop drinking (see NBC video)
    • Follow-up with own MD or same walk-in clinic or see AUD Clinic if available.
    • One page patient handout with resources on med supported AUD care.
    • A referral service is available 24 hours a day to people across BC needing help with any kind of substance use issues. It provides information and referral to education, prevention, and treatment services and regulatory agencies.

    The Alcohol & Drug Information and Referral Service

    • Toll-Free: 1-800-663-1441
    • Lower Mainland: 604-660-9382

    Quality Of Evidence?


    Related Information



    Dr. Harries passed away Nov 2021 from complications from ALS. His tremendous passion for medicine and support for patients was profound and lives on through all his contributions in the field, including through his legacy with the Canadian Alcohol Use Disorder Society.

    For more on Dr. Harries: https://www.pentictonherald.ca/news/article_8f51a0d0-440d-11ec-b9ec-cbddef76d947.html

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