Admission for alcohol-related illness is often the moment a patient is most willing to address their drinking, and the window closes quickly after discharge. Medications for alcohol use disorder, such as naltrexone and acamprosate, are underused and can be started in hospital once withdrawal is managed.
Check liver function before naltrexone and avoid it in patients taking or likely to need opioids. Acamprosate needs dose adjustment in kidney impairment. Pair the prescription with a named follow-up appointment.
- Ask every patient admitted with an alcohol-related problem whether they want help to cut down or stop
- Consider naltrexone or acamprosate before discharge once withdrawal is controlled
- Avoid naltrexone in patients on opioids; adjust acamprosate for kidney function
- Give thiamine to patients at risk of Wernicke encephalopathy
Why it matters
The admission is often the best chance to start treatment, and it is usually missed.
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