Alcohol Dependence — MRCPsych Paper B MCQ

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EasySubstance MisuseAlcohol DependenceMRCPsych Paper B

A 40-year-old man with moderate alcohol dependence has completed a medically assisted withdrawal and wishes to remain abstinent. According to NICE CG115, oral naltrexone may be offered alongside an alcohol-focused psychological intervention. Which other medication is recommended at the same point in the treatment pathway?

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Correct answer: D — Acamprosate

NICE CG115 recommends considering acamprosate or oral naltrexone after successful withdrawal in people with moderate or severe alcohol dependence. Either should be combined with an individual psychological intervention focused on alcohol misuse. Therefore, the alternative to oral naltrexone is acamprosate. Disulfiram is generally considered when acamprosate and naltrexone are unsuitable or when the patient prefers it and understands its risks. Nalmefene is used to reduce alcohol consumption in selected people who do not require immediate withdrawal, rather than as standard post-withdrawal abstinence treatment. Topiramate and baclofen are not recommended by CG115 as routine pharmacological options in this pathway.

Reference: National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis, assessment and management of harmful drinking (high-risk drinking) and alcohol dependence, CG115, recommendation 1.3.6.1, 2011 (updated 2014). https://www.nice.org.uk/guidance/cg115/resources/alcoholuse-disorders-diagnosis-assessment-and-management-of-harmful-drinking-and-alcohol-dependence-35109391116229