Which of the following is an anti-craving drug?

Appeared in: IGNOU Post B. SC. Nursing entrance-2019

Explanation

Acamprosate is approved for maintaining abstinence from alcohol in patients who have already undergone detoxification.
Its mechanism is thought to involve restoring the balance between GABA (inhibitory) and Glutamate (excitatory) neurotransmission, which is disrupted by chronic alcohol use.
By stabilizing this chemical imbalance, it reduces the protracted withdrawal symptoms like unease, anxiety, and insomnia, which are major drivers of craving and relapse.

Option A: Disulfiram is not an anti-craving drug; it is an aversive or deterrent agent.
Option C: Chlordiazepoxide is a benzodiazepine used for managing acute alcohol withdrawal, not for long-term craving.
Option D: Diazepam, like chlordiazepoxide, is a benzodiazepine used for managing acute alcohol withdrawal symptoms.

Clinical Relevance

Nursing practice connection: Knowing Pharmacological management of alcohol use disorder helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
A key nursing responsibility is patient education. For a patient on Disulfiram, the nurse must emphasize the critical importance of avoiding all forms of alcohol, including in foods, cough syrups, and even some topical products like aftershave, to prevent a severe reaction.
When administering benzodiazepines like Diazepam or Chlordiazepoxide for withdrawal, the nurse must monitor for signs of over-sedation, respiratory depression, and hypotension. These drugs are typically tapered off as the withdrawal period subsides.
For patients starting Acamprosate, nurses should reinforce that the medication helps reduce cravings but is most effective when combined with psychosocial support and counseling.

How to Approach the Question

First, identify the key term in the question: 'anti-craving drug'. This points to a medication used for long-term maintenance to prevent relapse.
Next, analyze the options by classifying each drug based on its primary function in treating alcohol dependence.
Differentiate between drugs for acute withdrawal (managing immediate symptoms), aversive therapy (creating a negative consequence), and anti-craving (reducing the desire to use).
Recall or deduce that benzodiazepines (Chlordiazepoxide, Diazepam) are for acute withdrawal.
Recall or deduce that Disulfiram causes a negative reaction to alcohol, making it an aversive agent.
This leaves Acamprosate, which by elimination and knowledge, is the drug specifically designed to reduce cravings and support long-term abstinence.

Concept Tested & Keywords

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E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) pp. 914-916, 912-914, 2182-2184

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