Pharmacological prevention of relapse

Interventions for moderate and severe alcohol dependence after successful withdrawal

After a successful withdrawal for people with moderate and severe alcohol dependence, consider offering acamprosate or oral naltrexone in combination with an individual psychological intervention (cognitive behavioural therapies, behavioural therapies or social network and environment-based therapies) focused specifically on alcohol misuse

After a successful withdrawal for people with moderate and severe alcohol dependence, consider offering acamprosate or oral naltrexone in combination with behavioural couples therapy to service users who have a regular partner and whose partner is willing to participate in treatment

After a successful withdrawal for people with moderate and severe alcohol dependence, consider offering disulfiram in combination with a psychological intervention to service users who:

• have a goal of abstinence but for whom acamprosate and oral naltrexone are not suitable, or
• prefer disulfiram and understand the relative risks of taking the drug

Notes:

• before starting treatment with acamprosate, oral naltrexone or disulfiram, conduct a comprehensive medical assessment (baseline urea and electrolytes and liver function tests including gamma glutamyl transferase [GGT]). In particular, consider any contraindications or cautions (see the SPC), and discuss these with the service user

Reference:

• 1) NICE (February 2011). Alcohol-use disorders - Diagnosis, assessment and management of harmful drinking and alcohol dependence