Patients whose drinking does not respond to this approach or who seek or would benefit from more intensive counseling can be referred to a behavioral specialist, while continuing the medication. A similar referral can be provided to patients who choose not to use a medication. If naltrexone is determined to be ineffective after a month of treatment, treatment with topiramate can be initiated at a dosage of 25 mg daily, with a gradual increase over 5–6 weeks to 100 mg twice daily.65
