Supplementation for Individuals with Alcohol Use Disorder

Introduction to Essential Nutrients

All individuals with alcohol use disorder require thiamine supplementation to prevent Wernicke's encephalopathy, along with comprehensive multivitamin and mineral replacement including B-complex vitamins, vitamin D, zinc, and folic acid (after B12 correction) 1, 2, 3

Vitamin B12 deficiency must be identified and treated before folic acid supplementation to prevent masking B12 deficiency and precipitating irreversible neurological damage 2
The treatment protocol for Vitamin B12 deficiency includes hydroxocobalamin 1 mg (1000 μg) intramuscularly three times weekly for 2 weeks without neurological involvement 2
The American College of Gastroenterology recommends long-term supplementation of Vitamin B12 is required for life, as discontinuation leads to recurrence 2

The National Institutes of Health recommends never treating folate deficiency before correcting B12 deficiency to prevent masking B12 deficiency and precipitating irreversible neurological damage 1, 2
Folic acid dosing is 5 mg daily for a minimum of 4 months 2

Measure serum 25-hydroxyvitamin D levels in all patients, as deficiency occurs in 64-92% of those with chronic liver disease 3
The Endocrine Society recommends supplementing until serum levels exceed 30 ng/ml 3

Empiric supplementation with multivitamins and minerals is more cost-effective than measuring individual deficiencies before replacement, according to the Academy of Nutrition and Dietetics 1
Zinc is frequently deficient and affects immune function, and the National Institutes of Health recommends supplementation 1

Protein-calorie malnutrition is common and associated with increased complications and mortality, and the American Gastroenterological Association recommends standard patients receive 35-40 kcal/kg/day with protein 1.2-1.5 g/kg/day 2, 3, 4
Severely ill patients require 40 kcal/kg/day with protein 1.5 g/kg/day, according to the Society of Critical Care Medicine 2, 3

Never give glucose before thiamine, as this can precipitate acute Wernicke's encephalopathy, and never treat folate before B12, as this masks B12 deficiency and worsens neurological complications 1, 2
Do not discontinue B12 after normalization, as lifelong maintenance is required, according to the American College of Gastroenterology 2

Complete alcohol abstinence is the fundamental first step, as continued drinking perpetuates all nutritional deficiencies, and the American Medical Association recommends monitoring for alcohol withdrawal symptoms requiring specific management 2