The development of alcohol dependence is associated with significant morbidity and mortality.
For the majority of affected people the most appropriate goal, in terms of drinking behavior, is abstinence from alcohol.
Psychosocial intervention is the mainstay of the treatment but adjuvant pharmacotherapy is also available and its use recommended.
Drs Goh and Morgan from the United Kingdom provided an updated analysis of current and potential pharmacotherapeutic options for the management of alcohol dependence.
In addition, the team explored factors predictive of therapeutic outcome, including compliance and pharmacogenetics, and the current barriers to treatment, including doctors’ unwillingness to prescribe these agents.
|A number of other agents are being investigated for potential use for this indication including baclofen|
|Alimentary Pharmacology & Therapeutics|
Relevant papers were selected for review following extensive, language- and date-unrestricted, electronic and manual searches of the literature.
Acamprosate and naltrexone have a substantial evidence base for overall efficacy, safety and cost-effectiveness while the risks associated with the use of disulfiram are well-known, and can be minimized with appropriate patient selection and supervision.
The team report that acamprosate can be used safely in patients with liver disease, and in those with comorbid mental health issues and co-occurring drug-related problems.
The researchers found that a number of other agents are being investigated for potential use for this indication including, baclofen, topiramate and metadoxine.
Dr Morgan and colleague conclude, "Pharmacotherapy for alcohol dependence has been shown to be moderately efficacious with few safety concerns, but it is substantially underutilized."
"Concerted efforts must be made to remove the barriers to treatment in order to optimize the management of people with this condition."