Challenge for doctors and policy makers

doi:10.1136/bmj.332.7536.277-a

BMJ 2006;332:277-278 (4 February), doi:10.1136/bmj.332.7536.277-a

Commentary

Challenge for doctors and policy makers

Paul Haber, head of department of drug and alcohol services¹

¹ Royal Prince Alfred Hospital, NSW 2050, Australia phaber@mail.usyd.edu.au

The first 150 words of the full text of this article appear below.

Mr Bond's management raises several issues.¹ In the rapid responseson bmj.com, Mark Willenbring succinctly summarises the mostpractical approach to the management of Mr Bond's alcohol dependence.²Regular follow-up with feedback on progress and continuing encouragementto reduce alcohol use can be surprisingly effective. It is alsoa straightforward management plan that can be offered by thepatient's current medical team. Cirrhotic patients can safelybe offered treatment to control their alcohol use with acamprosate,naltrexone, or disulfiram, singly or in combination.³ Thesedrugs are simpler to prescribe and monitor than many used inroutine clinical practice and do not have to be given by addictionspecialists. Colin Brewer correctly notes that the oldest ofthese, disulfiram, may be the most effective if administrationis supervised by a community nurse or family member.² However,unsupervised disulfiram is ineffective.