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Alcohol Dependence — MRCPsych Paper B MCQ

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ModerateSubstance MisuseAlcohol DependenceMRCPsych Paper B

A 50-year-old man with a 25-year history of alcohol dependence drinks approximately 30 units of alcohol daily and requests help to stop drinking. Comprehensive assessment identifies no previous withdrawal seizures or delirium tremens, no significant physical or psychiatric comorbidity, and reliable support at home. The specialist service judges community-based medically assisted withdrawal to be appropriate. According to NICE CG115, which pharmacological approach should be used?

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Correct answer: D — Use a fixed-dose chlordiazepoxide regimen tapered over 7–10 days

For community-based assisted alcohol withdrawal, NICE recommends a fixed-dose benzodiazepine regimen, with the dose gradually reduced to zero over 7–10 days. Chlordiazepoxide and diazepam are the preferred benzodiazepines, so the fixed-dose chlordiazepoxide regimen in B is appropriate. Symptom-triggered treatment, as in E, is suitable only in inpatient or residential settings where trained staff can monitor withdrawal frequently and safely; it should not be self-managed at home. Acamprosate and oral naltrexone are relapse-prevention treatments considered after successful withdrawal alongside psychological treatment. Disulfiram is also an abstinence-maintenance option rather than treatment for the acute withdrawal syndrome.

Reference: National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. CG115, section 1.3.5, Drug regimens for assisted withdrawal. 2011, updated 2014. https://www.nice.org.uk/guidance/cg115/resources/alcoholuse-disorders-diagnosis-assessment-and-management-of-harmful-drinking-highrisk-drinking-and-alcohol-dependence-pdf-35109391116229