If the patient is not acutely intoxicated or at risk for alcohol withdrawal, they should be referred to a social worker or their PCP for resources to quit drinking and can usually be discharged safely.
Disulfiram can be prescribed as alcohol avoidance therapy. This can be prescribed in the emergency department or referred to PCP/psychiatrist treating the patient's addiction.
A Cochrane review assessed the efficacy of naltrexone in randomized control trials.
Naltrexone helps to reduce the number of participants who relapse or return to heavy drinking in a short time frame following treatment (12 weeks).
Naltrexone reduces the time in days to first drink when compared to placebo or disulfiram.
Naltrexone reduces reported cravings and the total amount of alcohol consumed.
Naltrexone should be offered to patients with<unk>  who are interested in reducing alcohol intake.
A Cochrane review assessed the efficacy of naltrexone in randomized control trials.
Naltrexone helps to reduce the number of participants who relapse or return to heavy drinking in a short time frame following treatment (12 weeks).
Naltrexone reduces the time in days to first drink when compared to placebo or disulfiram.
Naltrexone reduces reported cravings and the total amount of alcohol consumed.
Naltrexone should be offered to patients with<unk>  who are interested in reducing alcohol intake.
Naltrexone 380 mg IM or Naltrexone 50 mg PO qday #30 tabs, no refills
Naltrexone 380 mg IM or Naltrexone 50 mg PO qday #30 tabs, no refills
Contraindications for<unk>  in<unk> :
Any opioid<unk>  (including Buprenorphine):
Must be off short-acting opioids for 1 week and methadone for 2 weeks
Planned surgery/anesthesia in next 30 days (okay to<unk>  tablets, stop 1 day prior to surgery)
Acute liver injury with AST or ALT >/= 250 or decompensated cirrhosis (Childs Pugh Class 3)
Pregnancy
Allergy
Any opioid<unk>  (including Buprenorphine):
Must be off short-acting opioids for 1 week and methadone for 2 weeks
Planned surgery/anesthesia in next 30 days (okay to<unk>  tablets, stop 1 day prior to surgery)
Acute liver injury with AST or ALT >/= 250 or decompensated cirrhosis (Childs Pugh Class 3)
Pregnancy
Allergy
Must be off short-acting opioids for 1 week and methadone for 2 weeks
A metanalysis of several randomized control trials demonstrates that<unk>  of gabapentin for<unk>  reduces the number of total heavy drinking days. 
Furthermore, the addition of gabapentin to naltrexone further helped to reduce cravings in the first 6 weeks of<unk> . 
A metanalysis of several randomized control trials demonstrates that<unk>  of gabapentin for<unk>  reduces the number of total heavy drinking days. 
Furthermore, the addition of gabapentin to naltrexone further helped to reduce cravings in the first 6 weeks of<unk> . 
Gabapentin 600 mg PO TID #90 tabs, no refills
counsel to decrease to 300 mg PO TID if dizzy, can increase after 1 week
renally dosed if CrCl<60
ACOG approves of<unk>  in pregnancy
Gabapentin 600 mg PO TID #90 tabs, no refills
counsel to decrease to 300 mg PO TID if dizzy, can increase after 1 week
renally dosed if CrCl<60
ACOG approves of<unk>  in pregnancy
counsel to decrease to 300 mg PO TID if dizzy, can increase after 1 week
renally dosed if CrCl<60
ACOG approves of<unk>  in pregnancy

At risk for thiamine deficiency, but no symptoms: thiamine 100mg PO q day
Give multivitamin PO; patient at risk for other vitamin deficiencies
The majority of chronic alcoholics do NOT require a banana bag
Thiamine 100mg IV
Folate 1mg IV (cheaper PO)
Multivitamin 1 tab IV (cheaper PO)
Magnesium sulfate 2mg IV
Normal saline as needed for hydration
Alcohol use disorder
Ethanol toxicity
Depression
Bipolar disorder
Alcohol withdrawal
Alcohol withdrawal seizures
Drugs of abuse
Delerium tremens