Alcohol Use Disorder – Evidence Based Recommendations for Diagnosis and Pharmacotherapy
Alcohol use remains one of the top 10 global risk factors for illness and disease. It affects males more than females and is responsible for around 5.9% of deaths worldwide (7.6% of men, 4.0% of women). Other health conditions associated with alcohol-related deaths include cardiovascular disease and diabetes (33.4%), injuries (17.1%), gastrointestinal illnesses (16.2%) and cancers (12.5%). [Rehm and Imtiaz 2016], [WHO 2018]
Alcohol use disorder is the most common cause of death in men under 50, with heavy drinking and alcohol dependence causing the most significant burdens of harm. [Nutt, 2019]
In 2018, Kranzler and Soyka did a multi-year literature search to determine which pharmacological therapies were most used and which were most effective at treating alcohol use disorder. Meta-analyses were prioritised, and randomised controlled trials (RCTs) were selected where data on medication effects were poor or absent. A total of 81 relevant articles were reviewed. This article summarises the evidence along with current recommendations on pharmacotherapy in AUD. [Kranzler and Soyka, 2018]
We have previously covered the neurobiology of AUD.
Pettinati, H. M., Oslin, D. W., Kampman, K. M., Dundon, W. D., Xie, H., Gallis, T. L., Dackis, C. A., & O’Brien, C. P. (2010). A double-blind, placebo-controlled trial combining sertraline and naltrexone for treating co-occurring depression and alcohol dependence. The American journal of psychiatry, 167(6), 668–675.
Palpacuer C, Laviolle B, Boussageon R, Reymann JM, Bellissant E, Naudet F. (2015). Risks and benefits of nalmefene in the treatment of adult alcohol dependence: A systematic literature review and meta-analysis of published and unpublished double-blind randomized controlled trials. PLoS Med, 12(12):e100192
Palpacuer C, Duprez R, Huneau A, Locher C, Boussageon R, Laviolle B, Naudet F. Pharmacologically controlled drinking in the treatment of alcohol dependence or alcohol use disorders: a systematic review with direct and network meta-analyses on nalmefene, naltrexone, acamprosate, baclofen and topiramate. Addiction. 2018 Feb;113(2):220-237.
Johnson, B. A., Rosenthal, N., Capece, J. A., Wiegand, F., Mao, L., Beyers, K., McKay, A., Ait-Daoud, N., Anton, R. F., Ciraulo, D. A., Kranzler, H. R., Mann, K., O’Malley, S. S., Swift, R. M., Topiramate for Alcoholism Advisory Board, & Topiramate for Alcoholism Study Group. (2007). Topiramate for treating alcohol dependence: a randomized controlled trial. JAMA, 298(14), 1641–1651.
Wood, A. M., Kaptoge, S., Butterworth, A. S., Willeit, P., Warnakula, S., Bolton, T., Paige, E., Paul, D. S., Sweeting, M., Burgess, S., Bell, S., Astle, W., Stevens, D., Koulman, A., Selmer, R. M., Verschuren, W., Sato, S., Njølstad, I., Woodward, M., Salomaa, V., … Emerging Risk Factors Collaboration/EPIC-CVD/UK Biobank Alcohol Study Group. (2018). Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. Lancet (London, England), 391(10129), 1513–1523.
Reus, V. I., Fochtmann, L. J., Bukstein, O., Eyler, A. E., Hilty, D. M., Horvitz-Lennon, M., Mahoney, J., Pasic, J., Weaver, M., Wills, C. D., McIntyre, J., Kidd, J., Yager, J., & Hong, S. H. (2018). The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder. The American journal of psychiatry, 175(1), 86–90.