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Thai) 2:
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Given
the safety profiles of naltrexone and acamprosate,
either agent is recommended, though disulfiram
can be considered if the patient has an
abstinence goal, someone to supervise dosing,
and no contraindications.
Although the patient in the vignette is considered
to be in “full, sustained remission”4 (i.e., he
has had no adverse consequences for >12 months)
and should be lauded for cutting down on his
use of alcohol, he should understand that he
continues to be at risk for relapse. He should be
counseled that abstinence remains his safest
option,45 because only about 1 in 10 men with
alcohol dependence can maintain controlled
drinking over the long term.13 The clinician
should inquire at regular follow-up visits about
his alcohol consumption; its consequences and
related health problems; attendance at specialty
aftercare and mutual support groups; progress
toward functional goals; craving, triggers, and
coping strategies; and readiness to consider further
reductions in drinking.
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