alcohol

Substance Use Resources

Alex Haga — Tue, 16 Apr 2024 18:27:53 +0000

Date Added:

April 16, 2024

Journal/Publication:

Agency for Healthcare Research and Quality

Publisher:

Agency for Healthcare Research and Quality

URL:

Substance Use Resources

Type:

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

Format:

Web Page

MeSH

alcohol

alcohol abuse

Opioid use disorder

A set of resources from the Agency for Healthcare Research and Quality on how to help patients with unhealthy alcohol and substance use.
James W. Mold, MD, MPH

Free full text

View

Substance Use Resources
The AHRQ Academy has compiled and developed several resources for providers treating substance use disorders in primary care and ambulatory care practices.

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

alcohol

alcoholism

naltrexone

PMID (1):

15850502

MeSH

alcohol

alcoholism

naltrexone

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

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

alcohol

alcoholism

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:

Acamprosate for alcohol dependence

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1002/14651858.CD004332.pub2

Keywords

alcoholism

acamprosate

PMID (1):

20824837

MeSH

alcoholism

alcohol

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