# Chronic Alcohol Problem - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Alcohol Use Disorder: Screening, Evaluation, and Management (Nursing) - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK568739/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class PS12 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · DailyMed - NALTREXONE HYDROCHLORIDE tablet, film coated (oral tablets), Dosage and Administration, Treatment of Alcoholism - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care - Chronic Alcohol Problem - disease-level clinical article (chronic-alcohol-problem-clinical.txt) ## Treatment metadata - Referral & safety-netting (no drug therapy) - Naltrexone — 50 mg — oral.solid ## Complete treatment card ```text CHRONIC ALCOHOL PROBLEM Sources: Alcohol Use Disorder: Screening, Evaluation, and Management (Nursing) - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK568739/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class PS12 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · DailyMed - NALTREXONE HYDROCHLORIDE tablet, film coated (oral tablets), Dosage and Administration, Treatment of Alcoholism Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care, Chronic Alcohol Problem - disease-level clinical article (chronic- alcohol-problem-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Screening can use just one question, or a 3-item consumption questionnaire, in a primary-care visit - Diagnostic criteria weigh how drinking has affected relationships, health, activities like work, and the ability to cut down - The two core diagnostic features are withdrawal symptoms when not drinking, and needing more alcohol over time for the same effect - Meeting 2 or more diagnostic criteria means mild disease, 4 to 5 means moderate, and 6 or more means severe disease SIGNS - what you find (4) - Alcohol-related liver inflammation can show jaundice, fever, fluid in the belly, and a raised white-cell count [fever · jaundice] - Cirrhosis can bring the classic markers of spider-like blood vessels on the skin, red palms, and fluid in the belly [cirrhosis] - Nerve damage in a stocking-and-glove pattern, and gait trouble from large-fiber involvement, can follow thiamine deficiency - Memory loss for events before and after the injury marks Korsakoff syndrome from thiamine deficiency [memory loss] TESTS (7) - Blood alcohol level is the test used to confirm acute intoxication - Serum ethyl glucuronide picks up drinking within the last 5 days - Carbohydrate-deficient transferrin can flag drinking over roughly the past 2 weeks, though both it and ethyl glucuronide are prone to false positives - Phosphatidylethanol testing can detect drinking as far back as 3 weeks - Liver enzyme testing can show raised ALT, AST, and GGT reflecting alcohol's toxic effect on the liver - A blood count can show low white cells, low platelets, and anemia from alcohol's effect on the bone marrow - Enlarged red blood cells, with or without anemia, can reflect low B12 or folate IF NOT THIS - what else fits (1) - Screen for psychiatric conditions that can accompany unhealthy drinking, including PTSD, bipolar disorder, panic disorder, anxiety disorder, dysthymia, major depression, and insomnia Score CAGE questionnaire - Is this drinking a problem? Source StatPearls "Alcohol Use Disorder: Screening, Evaluation, and Management" - disease-level clinical article Status traced to the source above Rx: Main treatment | Anti-craving medication - cuts drinking days and relapse MAIN TREATMENT 1. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Harmful or dependent alcohol use causing health, psychological, or social damage; alcohol use is uncommon but not absent in Egypt, and the GP's role is screening, brief intervention, thiamine to prevent Wernicke's encephalopathy, and referral to addiction services for dependence, with diazepam used only for supervised withdrawal. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why Harmful or dependent alcohol use causing health, psychological, or social damage; alcohol use is uncommon but not absent in Egypt, and the GP's role is screening, brief intervention, thiamine to prevent Wernicke's encephalopathy, and referral to addiction services for dependence, with diazepam used only for supervised withdrawal. Caution Rare in Egyptian primary care. Referral is the pathway; the medicines listed alongside are what primary care can give before or while it happens. RED FLAG - Patients with alcohol-related cirrhosis require screening for complications such as hepatocellular carcinoma and esophageal varices. RED FLAG - Signs of withdrawal such as tremor, agitation, hallucinations or seizures need urgent medical supervision; confusion, unsteady gait or abnormal eye movements suggest Wernicke's encephalopathy, in which thiamine is given before glucose; evidence of liver disease or gastrointestinal bleeding also needs urgent assessment. ANTI-CRAVING MEDICATION - CUTS DRINKING DAYS AND RELAPSE 2. NALTREXONE [1st line] Adult 50 mg once daily x 12 weeks in the trials that showed benefit; review and continue on clinical grounds Peds No paediatric dose in the sources opened - this is an adult medicine. Source DailyMed - NALTREXONE HYDROCHLORIDE tablet, film coated (oral tablets), Dosage and Administration, Treatment of Alcoholism - verbatim: "A dose of 50 mg once daily is recommended for most patients." Why A licensed once-daily tablet exists that reduces relapse and drinking days, is prescribable in general practice and is stocked in Egypt. It works alongside counselling, not instead of it. Caution The patient must be off all opioids, tramadol included, for at least 7 to 10 days before the first dose, or you will precipitate a severe withdrawal. It blocks opioid pain relief, so plan analgesia in advance and make sure the patient carries something stating they take it. Liver injury and raised transaminases have been reported; check liver function before and during treatment, and take extra care in decompensated cirrhosis. Watch for new or worsening depression and suicidal thinking, and ask the family to report it. Egypt MORFBLOCK 50 MG 10 F.C.TABS. COPAD EGYPT 180.00 EGP (18.00/unit) MORFBLOCK 50 MG 20 F.C.TABS. COPAD EGYPT 360.00 EGP (18.00/unit) ANARCOL 50 MG 30 F.C.TABS. MULTI-APEX 777.00 EGP (25.90/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)