THE CHALLENGE OF COMORBID ALCOHOL AND OPIOID USE DISORDER: CLINICAL CASE REPORT AND LITERATURE REVIEW

Substance Use Disorders (SUDs), including alcohol use disorder (AUD) and opioid use disorder (OUD), repre­sent significant global health challenges. Co-occurring AUD and OUD are often under-recognized, complicating diagnosis and treatment and leading to poorer outco­mes. This article explores the complexities of managing individuals with both disorders through a clinical case study of a 49-year-old male who was admitted for alco­hol withdrawal while receiving methadone treatment for OUD. The case underscores the challenges in diagnosing and managing withdrawals in cases of comorbid AUD and OUD and the difficulties in providing integrated care. The neurobiological mechanisms of AUD and OUD, par­ticularly their effects on the mesolimbic dopamine pat­hway, are also discussed. Moreover, recommendations for the initial management of withdrawal Treatment stra­tegies for AUD include pharmacological options such as acamprosate, disulfiram, baclofen, topiramate, and gabapentin, which help reduce alcohol consumption and cravings. Opioid antagonists like naltrexone can also be useful for both AUD and OUD treatment, particularly in reducing the amount of alcohol used through blunting its euphoric effects. For OUD, opioid maintenance therapies (OMT) such as methadone and buprenorphine are widely used, providing effective management by reducing opioid use, withdrawal symptoms, and cravings. However, these treatments can be dangerous in individuals with active AUD, especially when alcohol is consumed concurrently, as they may exacerbate respiratory depression and other complications. There is no standardized treatment pro­tocol for managing comorbid AUD and OUD, highligh­ting the need for more research to develop integrated treatment strategies to improve patient outcomes.