Tobacco Alcohol and Addiction Medicine: questions and answers

In detail

The service covers nicotine dependence, harmful alcohol use, and dependence on opioids, cannabis, sedatives, or other substances. Assessment follows standard diagnostic criteria such as DSM-5 for alcohol use disorder, which requires two or more of eleven symptoms within a year.

The team also screens for common comorbidities like depression, anxiety, and liver disease, which are frequently seen in people with substance use disorders. Evidence shows that a coordinated approach addressing both the substance use and any co-existing conditions improves the chance of sustained recovery.

In detail

Alcohol use disorder is diagnosed when at least two of eleven DSM-5 symptoms occur within a year.

These include drinking more or longer than intended, unsuccessful efforts to cut down, much time spent obtaining or recovering from alcohol, craving, failure to fulfil major obligations, continued use despite social or interpersonal problems, giving up important activities, use in hazardous situations, continued use despite physical or psychological problems, tolerance, and withdrawal.

For tobacco, daily use, strong urges, and withdrawal irritability or restlessness are key indicators. Early consultation allows the team to assess severity and start appropriate treatment before complications worsen.

In detail

Delirium tremens is a severe form of alcohol withdrawal that can cause seizures, hallucinations, and dangerous changes in heart rate and blood pressure. It requires immediate medical management, often with benzodiazepines, in a monitored setting.

Opioid overdose can lead to respiratory arrest and death without prompt naloxone and supportive care. Severe withdrawal from sedatives or multiple substances also needs inpatient detoxification. The hospital's 24-hour emergency department and intensive care unit are equipped to manage these crises. Inpatient detox programmes typically last 7 to 14 days with medical supervision.

In detail

The assessment follows standard diagnostic criteria. For alcohol, the doctor checks for DSM-5 symptoms to determine if the disorder is mild, moderate, or severe. For tobacco, the Fagerstrom test or similar tools may be used.

The doctor screens for common comorbidities such as depression, anxiety, and liver disease, which are prevalent in people with substance use disorders. Motivational interviewing techniques help explore your goals and ambivalence.

Based on this, the doctor outlines a plan that may include counselling, nicotine replacement therapy, medications like naltrexone or acamprosate for alcohol, or a referral for inpatient detox if withdrawal risk is high.

In detail

Evidence shows liver function tests are useful for diagnosing alcohol-related liver disease and monitoring recovery. For alcohol use, gamma-glutamyl transferase (GGT), AST, ALT, and bilirubin help assess liver damage. For opioid or injecting use, hepatitis B, C, and HIV screening are standard.

If seizures are a concern, electrolytes, magnesium, and calcium are checked. The CIWA-Ar scale guides monitoring during alcohol withdrawal. The doctor follows clinical guidelines to order only relevant tests, avoiding unnecessary investigations while ensuring safety before starting medications like naltrexone, which requires baseline liver function.

In detail

Evidence shows naltrexone has dose-related hepatotoxicity and is contraindicated in acute hepatitis or liver failure. Acamprosate is safer in liver disease but contraindicated in severe renal impairment. The CIWA-Ar score guides benzodiazepine dosing during alcohol withdrawal.

High scores or a history of delirium tremens or seizures favour inpatient detox. For opioid use, liver and kidney function guide agonist therapy dosing. Positive viral markers need referral for specific antiviral treatment.

The doctor integrates all results to balance efficacy and safety, adjusting the plan at each follow-up over the 6 to 12 month support period.

In detail

Evidence supports a combined approach. For tobacco, nicotine replacement patches, gum, or lozenges increase quit rates. For alcohol, naltrexone reduces heavy drinking days and craving; acamprosate supports abstinence; disulfiram creates an aversive reaction if alcohol is consumed. Motivational interviewing enhances readiness to change.

Cognitive-behavioural therapy teaches coping skills. Inpatient detox uses benzodiazepines for alcohol withdrawal under monitoring with CIWA-Ar scores. Opioid agonist therapy may be considered where indicated. The choice depends on liver and kidney function, past treatment response, and whether you are still using or already abstinent. Topiramate and ondansetron are options in specific situations. Family involvement and mutual-support groups complement formal treatment.

In detail

Screening and brief intervention in primary care significantly reduce drinking in people who are not yet dependent. For established dependence, medications are combined with psychosocial treatments. Cognitive-behavioural therapy teaches coping skills for cravings and high-risk situations.

Motivational enhancement builds commitment to change over about four sessions. Family counselling repairs relationships and improves support, which studies show helps maintain abstinence. Mutual-support groups provide peer accountability. Inpatient rehabilitation is considered for severe dependence, unstable home environments, or failed outpatient attempts. The team selects the right mix based on your assessment, not a fixed protocol.

In detail

Evidence shows that sudden cessation of heavy alcohol use can lead to delirium tremens, a severe withdrawal state with seizures and hallucinations requiring immediate medical care. Opioid withdrawal can also complicate with delirium and convulsions.

Inpatient detoxification provides medically supervised withdrawal with monitoring of vital signs, medication for symptom control, and management of complications. The protocol uses medications such as benzodiazepines for alcohol withdrawal and supportive care for opioid withdrawal. A multidisciplinary team manages coexisting conditions like liver dysfunction, electrolyte imbalance, or psychiatric illness that increase risk during withdrawal.

In detail

Evidence indicates naltrexone reduces heavy drinking risk by 10% and any drinking by 5%. Acamprosate supports abstinence, though trial results are mixed. Topiramate shows medium effect size for increasing abstinent days. Counselling such as motivational interviewing enhances readiness to change. Recovery is an ongoing process with a persisting propensity to relapse.

In detail

Delirium tremens is a life-threatening alcohol withdrawal complication requiring immediate medical care. Seizures can occur in both alcohol and opioid withdrawal. Naltrexone can cause dose-related hepatotoxicity at higher doses, so liver function tests are checked monthly for three months then quarterly.

Acamprosate commonly causes transient diarrhoea. Topiramate may cause cognitive side effects needing slow titration. Disulfiram with alcohol causes severe reactions including tachycardia, nausea, and vomiting. If you relapse, return to treatment right away. Studies show relapse does not mean you cannot recover. The team can intensify outpatient support or readmit for inpatient care if needed.

In detail

Naltrexone may cause nausea, headache, dizziness, and sleep problems. Acamprosate commonly causes transient diarrhoea. Topiramate can cause dizziness, somnolence, impaired concentration, confusion, and speech difficulties, especially during dose escalation. Disulfiram requires absolute alcohol avoidance, including hidden alcohol in medicines, foods, and toiletries.

Nicotine replacement therapy has minimal impact on work or exercise. Counselling sessions like motivational interviewing and cognitive behavioural therapy teach coping skills for workplace stress. Studies show strong family support improves outcomes. The team provides medical certificates for leave if needed. Most people return to normal activities within weeks of stabilisation.

In detail

Evidence shows that strong family support through family therapy helps people stay away from drinking or substance use. Mutual‑support groups and continued motivational interviewing reduce relapse risk. The hospital provides guidance on home monitoring of cravings, medication adherence, and identifying high‑risk situations.

An attendant can help ensure medicines are taken correctly, accompany you to sessions, and recognise early warning signs of relapse. Home environment assessment may be suggested to remove triggers.

In detail

Alcohol use disorder symptoms include impaired control, social problems, risky use, and physical criteria like tolerance and withdrawal.

Heavy drinking is defined as 5 or more drinks in a day or 15 per week for men, 4 or more in a day or 8 per week for women. Tobacco dependence shows high prevalence; 55.8 percent of males in India use tobacco.

Screening tools like AUDIT identify hazardous drinking. In studies, 17 to 26 percent of alcohol users qualified for dependence. Comorbid depression, anxiety, and personality disorders are common. Liver function tests help assess alcohol-related damage. Self-report moderately agrees with laboratory testing for substance use.

• Tobacco dependence shows high prevalence; 55.8 percent of males in India use tobacco.

In detail

Alcohol withdrawal syndrome is monitored using CIWA-A scale. Benzodiazepines like lorazepam or chlordiazepoxide are used for safe detoxification. Inpatient detoxification over 7 to 14 days provides monitoring for seizures, electrolyte imbalance, and delirium.

For tobacco, nicotine replacement therapy (patches, gum, lozenges) reduces withdrawal severity and doubles quit rates. Medications for alcohol like naltrexone, acamprosate, or disulfiram are started after detox. Disulfiram is contraindicated if you have recently consumed alcohol, have psychosis, or cardiovascular disease. Naltrexone is contraindicated in liver failure or ongoing opioid use. Acamprosate is avoided in renal insufficiency or advanced cirrhosis.

In detail

Delirium tremens typically starts 48 to 72 hours after last drink. It causes severe autonomic instability, seizures, and hallucinations. Studies show it requires immediate medical care. Alcohol withdrawal seizures can occur within 6 to 48 hours. Opioid withdrawal can complicate with delirium and convulsions.

The CIWA-A scale monitors alcohol withdrawal severity. Inpatient detoxification provides continuous monitoring, IV fluids, benzodiazepines for seizure prevention, and correction of electrolyte abnormalities. Disulfiram-alcohol reaction causes tachycardia, flushing, nausea, vomiting, and headache needing emergency care. Naltrexone hepatotoxicity presents with jaundice, abdominal pain, or dark urine. Any suicidal thoughts or severe psychiatric symptoms also need urgent attention.

In detail

Outpatient care is typical for mild to moderate tobacco or alcohol use where withdrawal can be managed at home with regular reviews.

Inpatient detoxification (7 to 14 days) is usually recommended for severe alcohol dependence because sudden stopping can cause delirium tremens, seizures, or hallucinations that need immediate medical care. For opioid or sedative dependence, supervised admission allows safe medication titration and monitoring of vital signs.

The decision also considers comorbid medical conditions, pregnancy, lack of home support, or past complicated withdrawals. Evidence shows that matching the setting to clinical severity improves safety and retention in treatment.

In detail

For alcohol, naltrexone blocks opioid receptors that mediate the rewarding effects of drinking and has been shown to reduce heavy drinking days and craving. Acamprosate helps restore glutamate balance, easing post-acute withdrawal symptoms that drive relapse. Both are recommended alongside psychosocial support.

For tobacco, nicotine replacement patches, gum, or lozenges reduce withdrawal cravings and double quit rates compared to placebo. Counselling using motivational interviewing enhances readiness to change, and cognitive-behavioural therapy teaches skills to manage triggers and stress.

Studies show combined medication and counselling yields better outcomes than either alone. The team selects medicines based on your health profile, liver function, and preferences.

In detail

Smokeless tobacco delivers high nicotine doses, causing strong dependence. Nicotine replacement therapy (patches, gum, lozenges) reduces withdrawal cravings and is the first-line pharmacotherapy. Behavioural counselling helps identify triggers such as stress, social situations, or oral fixation.

Studies show combined NRT and counselling roughly doubles abstinence rates compared to unaided attempts. Oral examination during consultation can detect pre-cancerous lesions like leukoplakia or submucous fibrosis, which need monitoring or referral. The Fagerstrom test for nicotine dependence helps gauge severity. If you have comorbid conditions like hypertension or diabetes, medical supervision ensures safe NRT use.

In detail

Alcohol use disorder is diagnosed when drinking causes clinically significant impairment with two or more criteria such as loss of control, tolerance, withdrawal, or continued use despite harm. Severity ranges from mild (two to three criteria) to severe (six or more).

Early intervention improves outcomes; studies show most people with alcohol use disorder can reduce drinking or stop entirely with treatment. First-line medicines include naltrexone to reduce heavy-drinking days, acamprosate to support abstinence, and disulfiram as a deterrent.

Combined with motivational interviewing and cognitive-behavioural strategies, these reduce relapse rates. Liver function tests and a thorough history guide medicine choice.

In detail

Alcohol withdrawal syndrome typically starts 6 to 24 hours after the last drink. Mild cases involve tremor, anxiety, and autonomic hyperactivity. Severe cases can develop seizures (12-48 hours) or delirium tremens (48-72 hours) with confusion, fever, and cardiovascular instability.

The CIWA-A scale guides severity assessment and medication dosing. Inpatient detoxification (7 to 14 days) with benzodiazepines like lorazepam or chlordiazepoxide is standard for moderate to severe withdrawal to prevent complications. Outpatient management may suit mild withdrawal with good home support and daily review. Thiamine supplementation prevents Wernicke's encephalopathy. Medical conditions like liver disease, epilepsy, or electrolyte imbalance increase risk.

In detail

Evidence shows high lifetime comorbidity (around 60%) between substance use disorders and other psychiatric illnesses. Alcohol use can cause or worsen liver dysfunction, gastritis, neuropathy, and cardiomyopathy. Opioids and sedatives interact dangerously with other central nervous system depressants.

Some medicines (e.g., certain antidepressants, antipsychotics, or anticonvulsants) may affect craving, withdrawal severity, or liver enzymes that metabolise addiction medications. Disulfiram is contraindicated in cardiovascular disease and psychosis. Acamprosate requires dose adjustment in renal impairment. Naltrexone is contraindicated in acute hepatitis or liver failure. A comprehensive review avoids adverse interactions and ensures each condition is treated appropriately.

• Evidence shows high lifetime comorbidity (around 60%) between substance use disorders and other psychiatric illnesses.

In detail

Addiction medicines have specific contraindications: naltrexone is avoided in acute hepatitis or liver failure; acamprosate needs dose adjustment in renal impairment; disulfiram is contraindicated in cardiovascular disease and psychosis. Benzodiazepines used for alcohol withdrawal require caution in respiratory disease.

Opioid agonist therapy needs coordination with pain management if you have chronic pain. Psychiatric comorbidity (depression, anxiety, bipolar disorder, schizophrenia) is present in a majority of patients with substance use disorders and often requires parallel pharmacotherapy and psychotherapy.

Pregnancy mandates obstetric involvement for safe prescribing and monitoring. The hospital's multispecialty setup allows timely internal referrals to gastroenterology, psychiatry, cardiology, neurology, and obstetrics.

In detail

Outpatient treatment involves 30 to 60 minute sessions of counselling, motivational interviewing, and pharmacotherapy review over 6 to 12 months. Medicines such as nicotine replacement patches, naltrexone, acamprosate, or disulfiram are prescribed as indicated and purchased separately from the in-house chemist.

Inpatient detoxification includes 24-hour nursing monitoring, withdrawal medication, investigations like liver function tests and electrolytes, and meals. The final amount varies with length of stay, medicine doses, and any comorbid condition management.

The hospital accepts RGHS, MAA Yojana, CGHS, and private insurance panels; coverage details can be checked with the insurance desk.

In detail

The estimate covers the core clinical components defined in our protocol. Separate charges usually apply for specialised blood tests, imaging, or medications not part of the standard detox regimen.

If you have co-existing medical conditions requiring additional specialist consultations or specific drugs, those are billed separately. The final bill also reflects the actual length of stay, which may vary from the typical 7 to 14 days depending on your withdrawal severity and clinical stability.