ATrain Education

 

Continuing Education for Health Professionals

Alcohol Use Disorders and Opioid Dependence Treated in Primary Care

Module 6

Relapse Prevention

Relapse to drug and/or alcohol use after detoxification is common without additional interventions, treatment, and support. Peer support groups, behavioral counseling, and pharmacotherapy combined offer the best course for relapse prevention [78]. For relapse prevention to alcohol use, naltrexone, acamprosate, and disulfiram have been utilized with varied results [36]. Disulfiram has been shown to be effective in the treatment of alcohol use disorders when administered as a supervised low-dose disulfiram integrated with behavioral counseling and support groups [37]. Oral naltrexone has been shown to be effective in reducing heavy drinking days as well as with highly motivated patients or patients who have medication support structures; extended-release naltrexone, in combination with counseling and peer support, reduced the level of drinking from four drinks per day at baseline to less than one drink per day within three months in a primary care setting [39]. Follow-up studies showed that extended-release naltrexone can promote lasting reductions in alcohol consumption as well as alcohol abstinence [40]. Acamprosate has been shown to be safe and efficacious in promoting abstinence in patients recently detoxified [45, 79]. Since detoxified patients frequently show signs of depression, these medications can be enhanced in their efficacy with the use of adjunct antidepressant medications [80].

For those individuals who are detoxified from opioids and prefer a nonopioid maintenance treatment, both oral and extended-release naltrexone can be used [41, 81]. For these patients, the absence of physical dependence to opioids is required prior to receiving naltrexone. Oral naltrexone has been shown to be effective in relapse prevention with highly motivated patients or patients who have medication support structures; for patients receiving extended-release naltrexone studies have shown total confirmed abstinence during the treatment period and a significantly greater reduction in opioid craving and a significantly longer retention in care and treatment. Thus, extended-release naltrexone has been shown to be a useful treatment option for the prevention of relapse to opioid dependence, following opioid detoxification.

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