alcoholism

Alcohol Drinking / therapy

drinking

PMID (1):

37844924

MeSH

Alcoholism* / drug therapy

British Columbia

Humans

A Canadian guideline for management of alcohol use disorders. James W. Mold, MD, MPHG

Free full text

View

Background: In Canada, low awareness of evidence-based interventions for the clinical management of alcohol use disorder exists among health care providers and people who could benefit from care. To address this gap, the Canadian Research Initiative in Substance Misuse convened a national committee to develop a guideline for the clinical management of high-risk drinking and alcohol use disorder.

Methods: Development of this guideline followed the ADAPTE process, building upon the 2019 British Columbia provincial guideline for alcohol use disorder. A national guideline committee (consisting of 36 members with diverse expertise, including academics, clinicians, people with lived and living experiences of alcohol use, and people who self-identified as Indigenous or Métis) selected priority topics, reviewed evidence and reached consensus on the recommendations. We used the Appraisal of Guidelines for Research and Evaluation Instrument (AGREE II) and the Guidelines International Network’s Principles for Disclosure of Interests and Management of Conflicts to ensure the guideline met international standards for transparency, high quality and methodological rigour. We rated the final recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool; the recommendations underwent external review by 13 national and international experts and stakeholders.

Recommendations: The guideline includes 15 recommendations that cover screening, diagnosis, withdrawal management and ongoing treatment, including psychosocial treatment interventions, pharmacotherapies and community-based programs. The guideline committee identified a need to emphasize both underused interventions that may be beneficial and common prescribing and other practice patterns that are not evidence based and that may potentially worsen alcohol use outcomes.

Interpretation: The guideline is intended to be a resource for physicians, policymakers and other clinical and nonclinical personnel, as well as individuals, families and communities affected by alcohol use. The recommendations seek to provide a framework for addressing a large burden of unmet treatment and care needs for alcohol use disorder within Canada in an evidence-based manner.

Author/s:

Evan Wood, Jessica Bright, Katrina Hsu, Nirupa Goel, Josey W G Ross

Canadian guideline for the clinical management of high-risk drinking and alcohol use disorder

Alex Haga — Thu, 06 Feb 2025 19:07:47 +0000

Date Added:

February 6, 2025

Journal/Publication:

Canadian Medical Association Journal

Publication Date:

October 16, 2023

Issue:

Volume:

195

Pages:

E1364-E1379

URL:

Canadian guideline for the clinical management of high-risk drinking and alcohol use disorder

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.230715

Keywords

Alcohol Drinking / therapy

drinking

PMID (1):

37844924

MeSH

About Moderate Alcohol Use

Canadian guideline for management of patients with alcohol use disorders. James W. Mold, MD, MPH

Free full text

View

Methods: Development of this guideline followed the ADAPTE process, building upon the 2019 British Columbia provincial guideline for alcohol use disorder. A national guideline committee (consisting of 36 members with diverse expertise, including academics, clinicians, people with lived and living experiences of alcohol use, and people who self-identified as Indigenous or Métis) selected priority topics, reviewed evidence and reached consensus on the recommendations. We used the Appraisal of Guidelines for Research and Evaluation Instrument (AGREE II) and the Guidelines International Network's Principles for Disclosure of Interests and Management of Conflicts to ensure the guideline met international standards for transparency, high quality and methodological rigour. We rated the final recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool; the recommendations underwent external review by 13 national and international experts and stakeholders.

Author/s:

Evan Wood, Jessica Bright, Katrina Hsu, Nirupa Goel

About Moderate Alcohol Use

Alex Haga — Thu, 30 May 2024 22:17:25 +0000

Date Added:

May 30, 2024

Journal/Publication:

CDC

Publication Date:

May 15, 2024

URL:

Type:

Patient Education Materials

Format:

Article

Keywords

MeSH

Information for patients regarding moderate alcohol use and health. James W. Mold, MPH

Free full text

View

KEY POINTS
Drinking excessively increases your risk of getting sick, injured, or dying sooner.
You can choose not to drink alcohol, drink less, or drink in moderation to lower these risks, compared to drinking excessively.
However, even moderate drinking may increase your risk of death and other alcohol-related harms, compared to not drinking.

Pharmacotherapy for Adults With Alcohol Use Disorder in Outpatient Settings: Systematic Review

Rowan Hutchins — Mon, 20 Nov 2023 06:00:00 +0000

Date Added:

November 20, 2023

Journal/Publication:

Agency for Healthcare Research and Quality

Publisher:

RTI International–University of North Carolina at Chapel Hill Evidence-based Practice Center Research Triangle Park

Publication Date:

November 7, 2023

Issue:

Volume:

URL:

Pharmacotherapy for Adults With Alcohol Use Disorder in Outpatient Settings: Systematic Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Web Page

DOI (1):

10.23970/AHRQEPCCER262

Keywords

acamprosate

Acamprosate* / adverse effects

behavioral interventions

MeSH

Alcoholism* / drug therapy

Alcohol Deterrents* / therapeutic use

Alcohol Use Disorder and Alcohol-Associated Liver Disease

A review of medications available for helping patients with alcohol use disorders. James W. Mold, MD, MPH

Free full text

View

Pharmacotherapy for Adults With Alcohol Use Disorder in Outpatient Settings: Systematic Review
Background. Unhealthy alcohol use is the third leading preventable cause of death in the United States, accounting for more than 140,000 deaths annually. Only 0.9 percent of Americans who reported having alcohol use disorder (AUD) in the past year indicated they received medication-assisted AUD treatment.

Methods. We updated a 2014 Agency for Healthcare Research and Quality (AHRQ) report on pharmacotherapy for AUD treatment, following AHRQ Evidence-based Practice Center Guidance. We assessed efficacy and comparative effectiveness of specific medications for improving consumption outcomes (Key Question [KQ] 1) and health outcomes (KQ 2). We assessed harms (KQ 3) and sought to identify evidence for the use of pharmacotherapy to treat AUD in primary care (KQ 4) and among subgroups (KQ 5). When possible, we conducted quantitative analyses using random-effects models to estimate pooled effects. When quantitative analyses could not be conducted, we used qualitative approaches.

Results. We included 118 studies (156 articles) in our review, which included 81 studies (106 articles) from the 2014 review and 37 studies (50 articles) published since then. Studies generally included counseling co-interventions in all study groups, and the benefits observed reflect the added benefit of medications beyond those of counseling and placebo. Oral naltrexone at the 50 mg dosage had moderate strength of evidence (SOE) for reducing return to any drinking, return to heavy drinking, percent drinking days, and percent heavy drinking days. The addition of a new randomized controlled trial of injectable naltrexone conducted in a population experiencing homelessness resulted in positive outcomes for a reduction in drinking days and heavy drinking days with low SOE. Acamprosate had moderate SOE for a significant reduction in return to any drinking and reduction in drinking days. Topiramate had moderate SOE for several outcomes as well, but with greater side effects. Two other medications demonstrated low SOE for benefit in at least one consumption outcome—baclofen (reduced return to any drinking) and gabapentin (reduced return to drinking and to heavy drinking). With no new studies on disulfiram, there remains inadequate evidence for efficacy compared to placebo for preventing return to any drinking or for other alcohol consumption outcomes. No new eligible studies provided head-to-head comparisons.

Conclusions. Oral naltrexone at the 50 mg dose had moderate strength of evidence across multiple outcomes and relative ease of use as a once-daily oral medication. Acamprosate and topiramate also have moderate evidence of benefit with a less desirable side effect profile (topiramate) and a higher pill burden (acamprosate). Clinicians and patients may want to consider which treatment outcomes are most important when choosing among the medications. Current data are largely insufficient for understanding health outcomes. Finally, there is relatively little research to assess the use of medications for AUD among subgroups (9 studies) or in primary care settings (1 study).

Author/s:

Melissa McPheeters, Elizabeth A. O’Connor, Sean Riley, Sara M. Kennedy, Christiane Voisin, Kaitlin Kuznacic, Cory P. Coffey, Mark Edlund, Georgiy Bobashev, Daniel E. Jonas

Alcohol Use Disorder and Alcohol-Associated Liver Disease

Aubrey Delammermore — Thu, 01 Dec 2022 06:00:00 +0000

Date Added:

December 1, 2022

Journal/Publication:

Alcohol Research Current Reviews

Publisher:

National Institute on Alcohol Abuse and Alcoholism

Publication Date:

November 10, 2022

Issue:

Volume:

Pages:

1-9

URL:

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.35946/arcr.v42.1.13

Keywords

liver diseases

alcoholism complications

alcoholism diagnosis

alcohol misuse

PMID (1):

36420303

MeSH

Alcohol-Related Disorders*

National Institutes of Health (U.S.)

national institute on alcohol abuse and alcoholism (U.S.)

liver diseases, alcoholic*

A summary of current knowledge about alcohol use disorders and alcoholic liver disease. James W. Mold, MD, MPH.

Free full text

View

This article is part of a Festschrift commemorating the 50th anniversary of the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Established in 1970, first as part of the National Institute of Mental Health and later as an independent institute of the National Institutes of Health, NIAAA today is the world’s largest funding agency for alcohol research. In addition to its own intramural research program, NIAAA supports the entire spectrum of innovative basic, translational, and clinical research to advance the diagnosis, prevention, and treatment of alcohol use disorder and alcohol-related problems. To celebrate the anniversary, NIAAA hosted a 2-day symposium, “Alcohol Across the Lifespan: 50 Years of Evidence-Based Diagnosis, Prevention, and Treatment Research,” devoted to key topics within the field of alcohol research. This article is based on Dr. Shah’s presentation at the event. NIAAA Director George F. Koob, Ph.D., serves as editor of the Festschrift.

Author/s:

Ramissoon, R., Shah, V. H.

Looking Back, Looking Forward: Current Medications and Innovative Potential Medications to Treat Alcohol Use Disorder

Aubrey Delammermore — Sun, 06 Nov 2022 05:00:00 +0000

Date Added:

November 6, 2022

Journal/Publication:

Alcohol Research Current Reviews

Publisher:

National Institutes of Health

Publication Date:

October 20, 2022

Issue:

Volume:

URL:

Looking Back, Looking Forward: Current Medications and Innovative Potential Medications to Treat Alcohol Use Disorder

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.35946/arcr.v42.1.11

Keywords

National Institute on Alcohol Abuse and Alcoholism (U.S.)

National Institutes of Health (U.S.)

Alcohol Deterrents* / therapeutic use

PMID (1):

36320345

MeSH

Naltrexone / therapeutic use

Alcohol-Related Disorders*

A review of current and potential new medications for treatment of patients with alcohol use disorders. James W. Mold, MD, MPH

Free full text

View

This article is part of a Festschrift commemorating the 50th anniversary of the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Established in 1970, first as part of the National Institute of Mental Health and later as an independent institute of the National Institutes of Health, NIAAA today is the world's largest funding agency for alcohol research. In addition to its own intramural research program, NIAAA supports the entire spectrum of innovative basic, translational, and clinical research to advance the diagnosis, prevention, and treatment of alcohol use disorder and alcohol-related problems. To celebrate the anniversary, NIAAA hosted a 2-day symposium, "Alcohol Across the Lifespan: 50 Years of Evidence-Based Diagnosis, Prevention, and Treatment Research," devoted to key topics within the field of alcohol research. This article is based on Dr. Mason's presentation at the event. NIAAA Director George F. Koob, Ph.D., serves as editor of the Festschrift.

Author/s:

Mason, B. J.

Naltrexone for the treatment of alcoholism: A meta-analysis of randomized controlled trials

Jeffrey Wilson — Wed, 02 Jan 2019 14:38:22 +0000

Date Added:

January 2, 2019

Journal/Publication:

International Journal of Neuropsychopharmacology

Publisher:

Oxford University Press

Publication Date:

June 1, 2005

Issue:

Volume:

Pages:

267-280

URL:

Naltrexone for the treatment of alcoholism: A meta-analysis of randomized controlled trials

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1017/S1461145704004997

Keywords

PMID (1):

15850502

MeSH

Brief physician advice for problem alcohol drinkers. A randomized controlled trial in community-based primary care practices

This Meta-analysis involving 2861 subjects in 24 RCTs found that, in short-term treatment, naltrexone significantly decreased relapses [relative risk (RR) 0.64, 95% confidence interval (CI) 0.51-0.82], but not return to drinking (RR 0.91, 95% CI 0.81-1.02). Short-term treatment of naltrexone significantly increased nausea, dizziness, and fatigue in comparison to placebo [RRs (95% CIs) 2.14 (1.61-2.83), 2.09 (1.28-3.39), and 1.35 (1.04-1.75)].

Free full text

Many trials of naltrexone have been carried out in alcohol-dependent patients. This paper is aimed to systematically review its benefits, adverse effects, and discontinuation of treatment. We assessed and extracted the data of double-blind, randomized controlled trials (RCTs) comparing naltrexone with placebo or other treatment in people with alcoholism. Two primary outcomes were subjects who relapsed (including heavy drinking) and those who returned to drinking. Secondary outcomes were time to first drink, drinking days, number of standard drinks for a defined period, and craving. All outcomes were reported for the short, medium, and long term. Five common adverse effects and dropout rates in short-term treatment were also examined. A total of 2861 subjects in 24 RCTs presented in 32 papers were included. For short-term treatment, naltrexone significantly decreased relapses [relative risk (RR) 0.64, 95% confidence interval (CI) 0.51-0.82], but not return to drinking (RR 0.91, 95% CI 0.81-1.02). Short-term treatment of naltrexone significantly increased nausea, dizziness, and fatigue in comparison to placebo [RRs (95% CIs) 2.14 (1.61-2.83), 2.09 (1.28-3.39), and 1.35 (1.04-1.75)]. Naltrexone administration did not significantly diminish short-term discontinuation of treatment (RR 0.85, 95% CI 0.70-1.01). Naltrexone should be accepted as a short-term treatment for alcoholism. As yet, we do not know the appropriate duration of treatment continuation in an alcohol-dependent patient who responds to short-term naltrexone administration. To ensure that the real-world treatment is as effective as the research findings, a form of psychosocial therapy should be concomitantly given to all alcohol-dependent patients receiving naltrexone administration.

Author/s:

Srisurapanont, Manit, Jarusuraisin, Ngamwong

Brief physician advice for problem alcohol drinkers. A randomized controlled trial in community-based primary care practices

Jeffrey Wilson — Wed, 02 Jan 2019 14:31:45 +0000

Date Added:

January 2, 2019

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

April 1, 1997

Issue:

Volume:

277

Pages:

1039-1045

URL:

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jama.1997.03540370029032

Keywords

PMID (1):

9091691

MeSH

In this RCT conducted in primary care settings, two 10- to 15-minute counseling visits delivered by physicians using a scripted workbook that included advice, education, and contracting information was sufficient to reduce 7-day alcohol use from 19.1 to 11.5 at 12 months in the experimental group vs 18.9 at baseline to 15.5 at 12 months in controls (P<.001); episodes of binge drinking from 5.7 at baseline to 3.1 at 12 months in the experimental group vs 5.3 at baseline to 4.2 at 12 months in controls (P<.001), and percentage drinking excessively in previous 7 days from 47.5% at baseline to 17.8% at 12 months in the experimental group vs 48.1% at baseline to 32.5% at 12 months in controls (P<.001) at one year.

Commercial full text (fees may apply)

View

OBJECTIVE:

Project TrEAT (Trial for Early Alcohol Treatment) was designed to test the efficacy of brief physician advice in reducing alcohol use and health care utilization in problem drinkers.

DESIGN:

Randomized controlled clinical trial with 12-month follow-up.

SETTING:

A total of 17 community-based primary care practices (64 physicians) located in 10 Wisconsin counties.

PARTICIPANTS:

Of the 17695 patients screened for problem drinking, 482 men and 292 women met inclusion criteria and were randomized into a control (n=382) or an experimental (n=392) group. A total of 723 subjects (93%) participated in the 12-month follow-up procedures.

INTERVENTION:

The intervention consisted of two 10- to 15-minute counseling visits delivered by physicians using a scripted workbook that included advice, education, and contracting information.

MAIN OUTCOME MEASURES:

Alcohol use measures, emergency department visits, and hospital days.

RESULTS:

There were no significant differences between groups at baseline on alcohol use, age, socioeconomic status, smoking status, rates of depression or anxiety, frequency of conduct disorders, lifetime drug use, or health care utilization. At the time of the 12-month follow-up, there were significant reductions in 7-day alcohol use (mean number of drinks in previous 7 days decreased from 19.1 at baseline to 11.5 at 12 months for the experimental group vs 18.9 at baseline to 15.5 at 12 months for controls; t=4.33; P<.001), episodes of binge drinking (mean number of binge drinking episodes during previous 30 days decreased from 5.7 at baseline to 3.1 at 12 months for the experimental group vs 5.3 at baseline to 4.2 at 12 months for controls; t=2.81; P<.001), and frequency of excessive drinking (percentage drinking excessively in previous 7 days decreased from 47.5% at baseline to 17.8% at 12 months for the experimental group vs 48.1% at baseline to 32.5% at 12 months for controls; t=4.53; P<.001). The chi2 test of independence revealed a significant relationship between group status and length of hospitalization over the study period for men (P<.01).

CONCLUSIONS:

This study provides the first direct evidence that physician intervention with problem drinkers decreases alcohol use and health resource utilization in the US health care system.

Author/s:

Fleming, Michael F., Barry, Kristen L., Manwell, Linda B., Johnson, Kristen, London, Richard

Brief physician and nurse practitioner-delivered counseling for high-risk drinking. Results at 12-month follow-up

Jeffrey Wilson — Wed, 02 Jan 2019 14:26:10 +0000

Date Added:

January 2, 2019

Journal/Publication:

Journal of General Internal Medicine

Publisher:

Society of General Internal Medicine

Publication Date:

January 1, 2005

Issue:

Volume:

Pages:

7-13

URL:

Brief physician and nurse practitioner-delivered counseling for high-risk drinking. Results at 12-month follow-up

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1111/j.1525-1497.2005.21240.x

Keywords

Adapting Screening, Brief Intervention, and Referral to Treatment for Alcohol and Drugs to Culturally Diverse Clinical Populations

PMID (1):

15693921

MeSH

In this RCT conducted in academic primary care practices, brief (5–10 minute) patient-centered counseling plus an office system that cued providers to intervene and provided patient educational materials was sufficient to reduce weekly alcohol intake in patients with unhealthy alcohol intake one year post-intervention.

Free full text

BACKGROUND:

The objective of this study was to determine the effects of a brief primary care provider-delivered counseling intervention on the reduction of alcohol consumption by high-risk drinkers. The intervention was implemented as part of routine primary care medical practice.

METHODS:

We performed a controlled clinical trial with 6- and 12-month follow-up. Three primary care practices affiliated with an academic medical center were randomly assigned to special intervention (SI) or usual care (UC). A total of 9,772 primary care patients were screened for high-risk drinking. A fourth site was added later. From the group that was screened, 530 high-risk drinkers entered into the study, with 447 providing follow-up at 12 months. The intervention consisted of brief (5-10 minute) patient-centered counseling plus an office system that cued providers to intervene and provided patient educational materials.

RESULTS:

At 12-month follow-up, after controlling for baseline differences in alcohol consumption, SI participants had significantly larger changes (P=.03) in weekly alcohol intake compared to UC (SI=-5.7 drinks per week; UC=-3.1 drinks per week), and of those who changed to safe drinking at 6 months more SI participants maintained that change at 12 months than UC.

CONCLUSIONS:

Project Health provides evidence that screening and very brief (5-10 minute) advice and counseling delivered by a patient's personal physician or nurse practitioner as a routine part of a primary care visit can reduce alcohol consumption by high-risk drinkers.

Author/s:

Reiff-Hekking, Sarah, Ockene, Judith K., Hurley, Thomas G.

Adapting Screening, Brief Intervention, and Referral to Treatment for Alcohol and Drugs to Culturally Diverse Clinical Populations

Jeffrey Wilson — Wed, 02 Jan 2019 14:20:26 +0000

Date Added:

January 2, 2019

Journal/Publication:

Journal of Addiction Medicine

Publisher:

American Society of Addiction Medicine

Publication Date:

September 1, 2015

Issue:

Volume:

Pages:

343-351

URL:

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1097/ADM.0000000000000150

Keywords

community health services

SBIRT

PMID (1):

26428359

MeSH

substance-related disorders

motivational interviewing

This is a systematic review that provides guidance regarding use of the SBIRT process in culturally diverse patient populations.

Free full text

OBJECTIVES:

To review the literature on the screening, brief intervention, and referral to treatment (SBIRT) approach to alcohol and drug use with racial and ethnic subgroups in the United States and to develop recommendations for culturally competent SBIRT practice.

METHODS:

Articles reporting on the use of SBIRT components (screening, brief intervention, referral to treatment) for alcohol and drug use were identified through a comprehensive literature search of PubMed from 1995 to 2015.

RESULTS:

A synthesis of the published literature on racial and ethnic considerations regarding SBIRT components (including motivational interviewing techniques) was created using evidence-based findings. Recommendations on culturally competent use of SBIRT with specific ethnic groups are also described.

CONCLUSIONS:

On the basis of the literature reviewed, SBIRT offers a useful set of tools to help reduce risky or problematic substance use. Special attention to validated screeners, appropriate use of language/literacy, trust building, and incorporation of patient and community health care preferences may enhance SBIRT acceptability and effectiveness.

PRACTICE IMPLICATIONS:

Providers should consider the implications of previous research when adapting SBIRT for diverse populations, and use validated screening and brief intervention methods. The accompanying case illustration provides additional information relevant to clinical practice.

Author/s:

Manuel, Jennifer K., Satre, Derek D., Tsoh, Janice, Moreno-John, Gina, Ramos, Jacqueline S., McCance-Katz, Elinore F., Satterfield, Jason M.

Planning and Implementing Screening and Brief Intervention for Risky Alcohol Use

Jeffrey Wilson — Thu, 27 Dec 2018 16:53:24 +0000

Date Added:

December 27, 2018

Publisher:

National Center on Birth Defects and Developmental Disabilities

Publication Date:

January 1, 2014

Type:

Meta-analyses, Reviews, and Guidelines, Practice Management Research Results

Format:

Slides

Keywords

MeSH

referral and consultation

This is a comprehensive set of recommendations from the CDC on how to establish a system for screening for and management of patients with unhealthy alcohol use.

Free full text

Like hypertension or tobacco screening, alcohol screening and brief intervention (alcohol SBI) is a clinical preventative service. It identifies and helps patients who may be drinking too much. It involves:

A validated set of screening questions to identify patients' drinking patterns,
A short conversation who are drinking to omuch, and for patients with severe risk, a referral to specialized treatment as warranted.

The entire service takes only a few minutes, is inexpensive, and may be reimbursable. Thirty years of resesarch has shown that alcohol SBI is effective at reducing the amount of alcohol consumed by those who are drinking too much. Based on this evidence the U.S. Preventative Services Task Force and many other organizations have recommended that alcohol SBI be implemented for all adults in primary health care settings.

Author/s:

Higgins-Biddle, John C., Hungerford, Daniel W., Baker, Susan D., Reynolds, Megan R., Cheal, Nancy E., Weber, Mary Kate, Dang, Elizabeth P.

Diagnosis and Pharmacotherapy of Alcohol Use Disorder: A Review

Jeffrey Wilson — Thu, 27 Dec 2018 16:24:11 +0000

Date Added:

December 27, 2018

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

August 28, 2018

Issue:

Volume:

320

Pages:

815-824

URL:

Diagnosis and Pharmacotherapy of Alcohol Use Disorder: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2018.11406

Keywords

Acamprosate for alcohol dependence

pharmacogenetics

PMID (1):

30167705

MeSH

This is a 5-part series of reviews pertaining to the treatment of patients with alcohol use disorders.

View

IMPORTANCE:

Alcohol consumption is associated with 88 000 US deaths annually. Although routine screening for heavy alcohol use can identify patients with alcohol use disorder (AUD) and has been recommended, only 1 in 6 US adults report ever having been asked by a health professional about their drinking behavior. Alcohol use disorder, a problematic pattern of alcohol use accompanied by clinically significant impairment or distress, is present in up to 14% of US adults during a 1-year period, although only about 8% of affected individuals are treated in an alcohol treatment facility.

OBSERVATIONS:

Four medications are approved by the US Food and Drug Administration to treat AUD: disulfiram, naltrexone (oral and long-acting injectable formulations), and acamprosate. However, patients with AUD most commonly receive counseling. Medications are prescribed to less than 9% of patients who are likely to benefit from them, given evidence that they exert clinically meaningful effects and their inclusion in clinical practice guidelines as first-line treatments for moderate to severe AUD. Naltrexone, which can be given once daily, reduces the likelihood of a return to any drinking by 5% and binge-drinking risk by 10%. Randomized clinical trials also show that some medications approved for other indications, including seizure disorder (eg, topiramate), are efficacious in treating AUD. Currently, there is not sufficient evidence to support the use of pharmacogenetics to personalize AUD treatments.

CONCLUSIONS AND RELEVANCE:

Alcohol consumption is associated with a high rate of morbidity and mortality, and heavy alcohol use is the major risk factor for AUD. Simple, valid screening methods can be used to identify patients with heavy alcohol use, who can then be evaluated for the presence of an AUD. Patients receiving a diagnosis of the disorder should be given brief counseling and prescribed a first-line medication (eg, naltrexone) or referred for a more intensive psychosocial intervention.

Author/s:

Kranzler, Henry R., Soyka, Michael

Acamprosate for alcohol dependence

Jeffrey Wilson — Mon, 17 Dec 2018 15:20:21 +0000

Date Added:

December 17, 2018

Journal/Publication:

Cochrane Database of Systematic Reviews

Publisher:

Cochrane Library

Publication Date:

September 7, 2010

Issue:

Volume:

URL:

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1002/14651858.CD004332.pub2

Keywords

acamprosate

PMID (1):

20824837

MeSH

Antidepressants for the treatment of people with co-occurring depression and alcohol dependence.

acamprosate

Acamprosate appears to be an effective and safe treatment strategy for supporting continuous abstinence after detoxification in alcohol dependent patients.

Commercial full text (fees may apply)

View

BACKGROUND:

Alcohol dependence is among the main leading health risk factors in most developed and developing countries. Therapeutic success of psychosocial programs for relapse prevention is moderate, but could potentially be increased by an adjuvant treatment with the glutamate antagonist acamprosate.

OBJECTIVES:

To determine the effectiveness and tolerability of acamprosate in comparison to placebo and other pharmacological agents.

SEARCH STRATEGY:

We searched the Cochrane Drugs and Alcohol Group (CDAG) Specialized Register, PubMed, EMBASE and CINAHL in January 2009 and inquired manufacturers and researchers for unpublished trials.

SELECTION CRITERIA:

All double-blind randomised controlled trials (RCTs) which compare the effects of acamprosate with placebo or active control on drinking-related outcomes.

DATA COLLECTION AND ANALYSIS:

Two authors independently extracted data. Trial quality was assessed by one author and cross-checked by a second author. Individual patient data (IPD) meta-analyses were used to verify the primary effectiveness outcomes.

MAIN RESULTS:

24 RCTs with 6915 participants fulfilled the criteria of inclusion and were included in the review. Compared to placebo, acamprosate was shown to significantly reduce the risk of any drinking RR 0.86 (95% CI 0.81 to 0.91); NNT 9.09 (95% CI 6.66 to 14.28) and to significantly increase the cumulative abstinence duration MD 10.94 (95% CI 5.08 to 16.81), while secondary outcomes (gamma-glutamyltransferase, heavy drinking) did not reach statistical significance. Diarrhea was the only side effect that was more frequently reported under acamprosate than placebo RD 0.11 (95% 0.09 to 0.13); NNTB 9.09 (95% CI 7.69 to 11.11). Effects of industry-sponsored trials RR 0.88 (95% 0.80 to 0.97) did not significantly differ from those of non-profit funded trials RR 0.88 (95% CI 0.81 to 0.96). In addition, the linear regression test did not indicate a significant risk of publication bias (p = 0.861).

AUTHORS' CONCLUSIONS:

Acamprosate appears to be an effective and safe treatment strategy for supporting continuous abstinence after detoxification in alcohol dependent patients. Even though the sizes of treatment effects appear to be rather moderate in their magnitude, they should be valued against the background of the relapsing nature of alcoholism and the limited therapeutic options currently available for its treatment.

Author/s:

Rösner, Susanne, Hack-Herrwerth, Andrea, Leucht, Stefan, Lehert, Philippe, Vecchi, Simona, Soyka, Michael

Antidepressant treatment of co-occurring depression and alcohol dependence

Jeffrey Wilson — Mon, 17 Dec 2018 15:08:54 +0000

Date Added:

December 17, 2018

Journal/Publication:

Cochrane Database of Systematic Reviews

Publisher:

Cochrane Library

Publication Date:

April 24, 2018

URL:

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1002/14651858.CD008581.pub2

Keywords

depression

antidepressive agents

PMID (1):

29688573

MeSH

depression

antidepressive agents