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IntroductionRecent pharmacotherapy findings from new alcohol reduction programmes could change the paradigm of alcohol-dependence treatment. Material and MethodThis study reviews the neurobiological background and pharmacotherapy of alcohol-dependence disorder, focusing on opioid receptor antagonists, abstinence-oriented treatment and moderation-oriented treatment. Results 1.Alcohol-dependence treatment programs show only low to moderate efficacy. 2. Patients usually show low motivation to sustain abstinence but high motivation to reduce alcohol use. 3. A treatment program based on continued reduction of drinking and associated with intermittent treatment with naltrexone can be useful for low-severity alcohol-dependent patients. DiscussionAlthough high severity alcohol-dependent patients should stop drinking alcohol, low severity patients may have the option of reducing their alcohol consumption if they take an opioid antagonist medication every day that they decide to drink alcohol. In the short term, the continuing drinking-reduction programmes may reduce the number of drinks per drinking day and in the long term, they may progressively decrease the obsession for drinking, alcohol seeking behavior, and related medical, behavioral and social disorders. To change the paradigm in the treatment of alcohol-dependence disorder there is a need for further randomized controlled trials in order to assess their efficacy and tolerability.

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with 123 I-iodobenzamide ( 123 I-IBZM) can be useful tools for assessing relapse risk in early recovery from alcohol-dependency. The aim of this study was to assess possible relationships between MACS score, 123 I-IBZM binding and time to first heavy drinking day (TFHD) after detoxification treatment. Methods:Nineteen alcohol-dependent in-patients were evaluated by MACS scale and an 123 I-IBZM-SPECT, performed following alcohol detoxification treatment. At discharge, participants were advised to take naltrexone 50 mg/day for relapse prevention. TFHD was assessed over a 12-week follow up. Results:The MACS score at the beginning of the detoxification process and naltrexone treatment after detoxification were independent predictive factors for TFHD. Conclusions:The MACS scale is a better predictor of TFHD than IBZM binding. It is simple, non-invasive and inexpensive and appears to be a useful instrument both for clinical practice and for research. I-yodobenzamida (IBZM) pueden ser instrumentos válidos para evaluar el riesgo de recaída, durante la etapa inicial de la recuperación del trastorno por dependencia del alcohol. El objetivo de este estudio es evaluar las posibles relaciones entre la escala EMCA y la captación de IBZM y el tiempo hasta el primer consumo excesivo de alcohol (TPCEA) una vez finalizado el tratamiento de desintoxicación. Metodología: Diecinueve pacientes hospitalizados han sido evaluados mediante la escala EMCA y la SPECT con IBZM al finalizar el tratamiento de desintoxicación del alcohol. En el momento del alta se les aconsejó seguir un tratamiento con naltrexona 50 mg/día para la prevención de recaídas. El TPCEA ha sido evaluado durante 12 semanas de seguimiento. Resultados: La puntuación de la escala EMCA, al inicio del proceso de desintoxicación, y el seguimiento de un tratamiento con naltrexona, posteriormente a dicho proceso, fueron factores predictivos independientes del TPCEA. Conclusiones: La escala EMCA se ha mostrado como un buen predictor del TPCEA mientras que la captación de IBZM parece no serlo. La escala EMCA parece presentar una mayor utilidad, tanto clínica como para la investigación, frente a evaluaciones más complejas, invasivas y costosas.Palabras Clave: tomografía computarizada por emisión de fotón simple (SPECT) con yodobenzamida-I 123 , escala multidimensional de craving de alcohol (EMCA), tiempo hasta el primer consumo excesivo de alcohol, dependencia del alcohol.

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