Review article: pharmacotherapy for alcohol dependence – the why, the what and the wherefore

Goh, ET; Morgan, Marsha Y.

doi:10.1111/apt.13965

Cited by 61 publications

(50 citation statements)

References 120 publications

(164 reference statements)

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“…Patients with cirrhosis, particularly those with hepatic encephalopathy, are often too sick or debilitated to reliably participate in behavioral therapies. This challenge may necessitate new approaches to behavioral therapy and makes pharmacotherapy a potentially attractive, albeit understudied, option …”

Section: Discussionmentioning

confidence: 99%

“…Given this mechanism, there are theoretical concerns about encephalopathy related to acamprosate but few data to guide its use . For patients with cirrhosis, the safety profile of acamprosate is considered to be the most favorable among the three FDA‐approved agents . However, acamprosate is a glutamate receptor antagonist that could theoretically lead to encephalopathy .…”

Section: Discussionmentioning

confidence: 99%

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Impact of Alcohol Use Disorder Treatment on Clinical Outcomes Among Patients With Cirrhosis

et al. 2020

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BaCKgRoUND aND aIMS:Despite the significant medical and economic consequences of coexisting alcohol use disorder (AUD) in patients with cirrhosis, little is known about AUD treatment patterns and their impact on clinical outcomes in this population. We aimed to characterize the use of and outcomes associated with AUD treatment in patients with cirrhosis. appRoaCH aND ReSUltS: This retrospective cohort study included Veterans with cirrhosis who received Veterans Health Administration care and had an index diagnosis of AUD between 2011 and 2015. We assessed the baseline factors associated with AUD treatment (pharmacotherapy or behavioral therapy) and clinical outcomes for 180 days following the first AUD diagnosis code within the study time frame. Among 93,612 Veterans with cirrhosis, we identified 35,682 with AUD, after excluding 2,671 who had prior diagnoses of AUD and recent treatment. Over 180 days following the index diagnosis of AUD, 5,088 (14%) received AUD treatment, including 4,461 (12%) who received behavioral therapy alone, 159 (0.4%) who received pharmacotherapy alone, and 468 (1%) who received both behavioral therapy and pharmacotherapy. In adjusted analyses, behavioral and/or pharmacotherapy-based AUD treatment was associated with a significant reduction in incident hepatic decompensation (6.5% vs. 11.6%, adjusted odds ratio [AOR], 0.63; 95% confidence interval [CI], 0.52, 0.76), a nonsignificant decrease in short-term all-cause mortality (2.6% vs. 3.9%, AOR, 0.79; 95% CI, 0.57, 1.08), and a significant decrease in long-term all-cause mortality (51% vs. 58%, AOR, 0.87; 95% CI, 0.80, 0.96).CoNClUSIoNS: Most Veterans with cirrhosis and coexisting AUD did not receive behavioral therapy or pharmacotherapy treatment for AUD over a 6-month follow-up. The reductions in hepatic decompensation and mortality suggest that future studies should focus on delivering evidence-based AUD treatments to patients with coexisting AUD and cirrhosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of Alcohol Use Disorder Treatment on Clinical Outcomes Among Patients With Cirrhosis

et al. 2020

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“…Until recently the standard AUD care was based on completely stopping alcohol consumption, maintaining abstinence, preventing chronic complications related to excessive alcohol consumption, and managing withdrawal symptoms. The recent licensing of the two new pharmacotherapies nalmefene and baclofen in France, confirms this change [17].…”

Section: Introductionmentioning

confidence: 78%

Screening and care for alcohol use disorder in France: expectations, barriers and levers using a mixed-methods approach

et al. 2020

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Background:The widespread under-screening and under-treatment of alcohol use disorder (AUD) contributes to its health and socioeconomic burden. We conducted a mixed-methods (qualitative and qualitative) study in people with alcohol use disorder (PWAUD) to explore their expectations, as well as barriers and levers to AUD care.Methods: Individuals with AUDIT > 15 (N = 179) were interviewed using computer-assisted interviews in several medical and non-medical sites (e.g., bars) (quantitative substudy). We also conducted semi-structured face-to-face interviews with 36 PWAUD (qualitative substudy). Using logistic regression, we explored factors associated with having previously received/sought care for AUD. Three major themes were identified in the qualitative textual analysis using a descending hierarchical classification. Results: Not socializing with heavy drinkers (AOR [95%CI]:3.84[1.66-8.85]), regular smoking (9.72[3.91-24.15]) and feeling discriminated against (2.35[1.10-5.05]) were independent levers to having sought/received care for AUD, while being aged < 50 and employment were independent barriers. The five predominant themes in PWAUD discourses emerging from the textual analysis were: drinking context, medical care, alcohol treatment, tobacco/ addiction and family. When triangulating results from the logistic regression and the textual analysis, two barriers (social drinking and difficulties with the medical care system), and two levers (family influence and tobacco addiction), emerged.Conclusion: These results underline the need for interventions targeting families and the social network to increase awareness about AUD and related care. Simplified and novel comprehensive care trajectories are urgently needed to reduce the clinical and public health burden of AUD.

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“…Disulfiram har vist seg å fremme avholdenhet, spesielt når medikamentet tas under tilsyn (13). Akamprosat har en uklar virkningsmekanisme, men blir omtalt som en funksjonell glutamatantagonist og virker sannsynligvis gjennom glutamaterg og/eller gammaaminobutansyre (GABA)nevrotransmisjon (14). Effekten er å dempe suget etter alkohol (15).…”

Section: Konklusjonunclassified

Bruk av medikamenter for alkoholbrukslidelser i Norge 2004–16

Heldal¹,

Lobmaier²,

Vederhus³

et al. 2018

Tidsskriftet

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Bruk av medikamenter for alkoholbrukslidelser i Norge 2004-16 | Tidsskrift for Den norske legeforening Bruk av medikamenter for alkoholbrukslidelser i Norge 2004-16 ORIGINALARTIKKEL ANNE TARALDSEN HELDAL E-post: anne.taraldsen.heldal@sshf.no ARA Avdeling for rus-og avhengighetsbehandling Sørlandet sykehus, Kristiansand Han har bidratt med utforming/design, datainnsamling, analyse og tolking av data, litteratursøk, utarbeiding/revisjon av selve manuset og godkjenning av innsendte manusversjon. Anne Taraldsen Heldal er ph.d. og lege i spesialisering i rus-og avhengighetsmedisin. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. SVETLANA SKURTVEIT Avdeling for psykiske lidelser Nasjonalt folkehelseinstitutt og Senter for rus-og avhengighetsforskning (SERAF) Universitetet i Oslo Hun har bidratt med utforming/design, analyse og tolking av data, utarbeiding/revisjon av selve manuset og godkjenning av innsendte manusversjon. Svetlana Skurtveit er seniorforsker og professor i rus-og avhengighetsmedisin. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. PHILIPP PAUL KOREN LOBMAIER Klinikk for psykisk helse og avhengighet Oslo universitetssykehus og Senter for rus og avhengighetsforskning (SERAF) Universitetet i Oslo Han har bidratt med tolking av data, utarbeiding og revisjon av selve manuset og godkjenning av innsendte manusversjon. Philipp Paul Koren Lobmaier er lege i spesialisering i psykiatri. Han har en ph.d.-grad på behandling av heroinavhengighet og er seniorforsker. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. JOHN-KÅRE VEDERHUSARA Avdeling for rus-og avhengighetsbehandling Sørlandet sykehus, Kristiansand Han har bidratt med analyse og tolking av data, litteratursøk, utarbeiding/revisjon av selve manuset og godkjenning av innsendte manusversjon. John-Kåre Vederhus er ph.d. og forsker. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. JØRGEN G. BRAMNESSNasjonal kompetansetjeneste for samtidig rusmisbruk og psykisk lidelse (N-ROP) Sykehuset

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Review article: pharmacotherapy for alcohol dependence – the why, the what and the wherefore

Cited by 61 publications

References 120 publications

Impact of Alcohol Use Disorder Treatment on Clinical Outcomes Among Patients With Cirrhosis

Impact of Alcohol Use Disorder Treatment on Clinical Outcomes Among Patients With Cirrhosis

Screening and care for alcohol use disorder in France: expectations, barriers and levers using a mixed-methods approach

Bruk av medikamenter for alkoholbrukslidelser i Norge 2004–16

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