skip to main content

Alcohol use disorder relapse prevention with liver disease — USMLE Step 3 MCQ

Instant feedback + full explanation. One question, done properly.

HardPsychiatryAlcohol use disorder relapse prevention with liver diseaseUSMLE Step 3

A patient with alcohol use disorder is abstinent after withdrawal treatment and wants medication to reduce relapse. They use prescribed oxycodone for severe chronic pain and have AST 148 U/L, ALT 132 U/L and bilirubin 2.3 mg/dL. Renal function is normal. Which medication is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Start acamprosate with adherence support and monitoring

The best answer is “Start acamprosate with adherence support and monitoring”. Acamprosate is an appropriate relapse-prevention option when naltrexone is contraindicated by ongoing opioid analgesia and concerning liver injury; normal renal function supports use. Methadone is not alcohol-relapse treatment. Naltrexone can precipitate opioid withdrawal, while disulfiram requires carefully selected, supervised use and is not the preferred option here.

Reference: SAMHSA, Treatment Improvement Protocol for Alcohol Use Disorder: https://store.samhsa.gov/product/tip-49-incorporating-alcohol-pharmacotherapies-medical-practice/sma13-4380