If you've heard of the medication gabapentin before, you'll recall that it is most often used in the treatment of seizures as well as neuropathic pain.

However, addiction medicine specialists have been beginning to use the medication in the management of patients with alcohol use disorder, due to growing evidence that gabapentin, when used at moderate-high doses and compared to placebo, increases abstinence rate and days free of heavy drinking. In addition, studies also demonstrate that gabapentin can reduce withdrawal symptoms and aid in long-term recovery by reducing anxiety, insomnia, and cravings. 

The most common side effect of the medication is sedation and drowsiness. Doses tend to commonly range from 900-1800mg per day in TID divided dosing, but can be as high as 3600mg a day.
​
To find out more, check out one of the RCTs that examined the utility of gabapentin for alcohol use disorder:
http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/1764009

Alcohol withdrawal is not an uncommon presentation in our healthcare system. From patients making ER visits to get help for withdrawal symptoms to patients with a history of heavy or chronic alcohol use being admitted to medical and surgical units where they experience abrupt cessation of their alcohol consumption, it is important that physicians of all specialties be able to determine an individual's drinking history and risk of alcohol withdrawal, as well as be able to manage the withdrawal syndrome accordingly.

While the CIWA protocol is the tool we are most familiar with in terms of assessing a patient's withdrawal symptoms and guiding treatment with medications, in the last few years a new assessment tool has been developed as a way to help providers distinguish between those who are at risk of developing more "complicated" forms of withdrawal that require more intensive monitoring and management, and which are more highly associated with morbidity, mortality, and healthcare resources.

The tool is known as PAWSS "Prediction of Alcohol Withdrawal Severity Scale", and provides physicians with guidelines of both clinical investigations to order and questions to ask patients, to determine one's risk of experiencing severe withdrawal including seizures and delirium tremens. Based on current literature, it is thought that the scale is both highly sensitive and specific, when a score threshold of 4 is used.
​
To read more about the PAWSS tool, click here: 
http://alcalc.oxfordjournals.org/content/50/5/509.long

While most suggest abstinence as the form of treatment for ‪alcoholism‬, in Ottawa, Ontario at the Managed Alcohol Program they focus more on a harm reduction approach that aims to change individuals' drinking behaviours and foster better physical and mental health.

MAP first began in 2001, and is a partnership program between Shepherds of Good Hope and Ottawa Inner City Health. Originally the program consisted of a 12-bed homeless hostel downtown Ottawa, but in 2010 they also opened a larger facility called the Oaks. At these residences residents receive a glass of wine every hour from 7:30am to 9:30pm.

Most of the residents who are engaged in the MAP program have resorted to drinking hand sanitizer, mouth wash, and even hairspray in the past, often putting themselves at great risk. Many more used to be frequent visitors of the local emergency rooms, and others struggled in the cold during harsh winters simply to feed their addiction. The MAP program however, has helped to reduce 911 calls and hospital emergency visits, as well as help stabilize the residents and turn their lives around.

""The thought was that if we could stabilise the craziness of their lives, the day that begins with the search for alcohol and all the complications that occur with that, then maybe we could make inroads with their mental health, addiction to alcohol and their physical illnesses," says Dr Jeff Turnbull, one of those early innovators, and the chief of staff at Ottawa Hospital."

For the full story, click here:
http://www.bbc.com/news/magazine-36717557

Catch up with all the news related to mental health and psychiatry from last week!

Catch up on all the news related to mental health and psychiatry from last week!

Merry Christmas from all of us at Beyond The Body! We wish you all a safe and happy holiday season!

Tis the season to be jolly, but remember to drink responsibly! Check out the handy low-risk drinking guidelines below from the Canadian Centre on Substance Abuse.   

And don't forget to read up on the CAMH's tips for reducing stress during the holidays to avoid becoming a Scrooge!
http://camhblog.com/2014/12/22/nyac-holiday-survival-tips/