Pharmacotherapy for Alcohol-Related Disorders: What Clinicians Should Know

Abstract

Alcohol-related disorders are a major public health problem in the United States. Alcohol interacts with several neurotransmitter systems causing both acute and chronic effects in the brain. While the mainstay of treatment of alcohol-related disorders, with the exception of alcohol withdrawal, has historically been psychosocial, pharmacotherapy is increasingly being investigated and incorporated into standard clinical practice. Patients with alcohol use disorders and comorbid psychiatric conditions, most commonly depressive and anxiety disorders, can benefit from symptom-targeted pharmacotherapy, even if the patient fails to achieve abstinence from alcohol. Although benzodiazepines remain the treatment of choice to treat alcohol withdrawal, a variety of other agents is being investigated, particularly in the outpatient setting. Further randomized clinical trials of alcohol-related disorder pharmacotherapy, particularly of comorbid subpopulations, are needed to better inform clinical decision making. The routine exclusion of alcohol-dependent patients from pharmacotherapy trials of psychiatric disorders presents a barrier to gathering more data. Recommendations for future research are discussed.

Treatment of substance abusing patients with comorbid psychiatric disorders

“…SSRI antidepressants have been found to be effective against mood disorders but contradictory evidence exists for the effect of SSRI antidepressants on drinking outcomes (Mariani and Levin, 2004; Torrens and colleagues, 2005). Improvement in drinking outcomes appear to be related to improvement in depression and the best outcomes have been found in studies combining antidepressants with psychotherapy.…”

“…Furthermore, research suggests that that the severity of its effects for those who drink on it, it should be used only in highly structured treatment programs, or with people who have high levels of support for remaining abstinent. In fact, disulfiram is most effective among older males who have high motivation to abstain from alcohol (Mariani and Levin, 2004). …”

Integrated Treatment of Substance Use and Psychiatric Disorders

“…Despite the positive findings on the use of SSRIs antidepressants in these studies, contradictory evidence exists for the direct effect of SSRI antidepressants on drinking outcomes (Mariani & Levin, 2004; Torrens, Fonseca, Mateu, & Farre, 2005). In fact, the preponderance of the evidence suggests that people with AUD and depression drink less when treated with antidepressants as a result of their depression improving.…”

Reduction in heavy drinking as a treatment outcome in alcohol dependence

“…This continuum effect seems to manifest differently depending on the nature of the disease and the recovery readiness of the individual with alcohol dependence. Individuals who are not yet ready or not yet able to commit to total abstinence may seek to reduce the amount they are drinking per occasion and work toward a goal of abstinence (Mariani & Levin, 2004). In the patient who is already abstinent, the objective may be prolongation of the abstinent state (and reduction in the rate of heavy drinking, if the patient happens to return to drinking).…”