The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder

Reus, Victor I.; Fochtmann, Laura J.; Bukstein, Oscar; Eyler, A. Evan; Hilty, Donald M.; Horvitz-Lennon, Marcela; Mahoney, Jane; Pasic, Jagoda; Weaver, Michael F.; Wills, Cheryl D.; McIntyre, Jack; Kidd, Jeremy D.; Yager, Joel; Hong, Seung-Hee

doi:10.1176/appi.ajp.2017.1750101

Cited by 241 publications

(207 citation statements)

References 18 publications

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“…The recently published "Practice Guideline for the Pharmacological Treatment of Patients With AUD" [20] does not include recommendations on the use of thiamine. It explicitly reports that recommendations on the treatment of acute withdrawal are not included.…”

Section: American Psychiatric Associationmentioning

confidence: 99%

Thiamine Substitution in Alcohol Use Disorder: A Narrative Review of Medical Guidelines

et al. 2019

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Aims: Patients with alcohol use disorder (AUD) frequently suffer from cognitive deficits ranging from mild symptoms to most severe forms. Wernicke encephalopathy (WE), caused by thiamine deficiency, is a potentially fatal syndrome characterized by the clinical triad of ophthalmoplegia, ataxia, and confusion. WE frequently presents in patients with AUD and, if left untreated, can progress to Wernicke-Korsakoff syndrome, which constitutes severe anterograde amnesia, confabulation, and behavioral abnormalities. Due to oftentimes indistinct clinical presentation, WE remains undiagnosed in up to 80% of cases. We conducted a review of current treatment guidelines for AUD in order to identify recommendations for the use of thiamine. Methods: Three different keyword combinations (“alcohol treatment guideline,” “alcohol withdrawal guideline,” and “alcohol treatment recommendation”) were entered in PubMed and Scopus, additional guidelines were searched screening the online sites of the respective agencies or societies. In total, 14 guidelines were included. Results: Thiamine was mentioned in all but one of the reviewed publications. Specifications on application modalities and indications varied considerably. While the majority of reviewed guidelines recommended parenteral thiamine only for patients at high risk for WE, some gave no information regarding the application form or dosage. Conclusion: Substitution of parenteral thiamine in individuals with suspected WE is a well-established treatment regimen. However, suggestions according to guidelines vary widely. Furthermore, hardly any evidence-based recommendations exist on a more general use of thiamine as a preventative intervention in individuals with AUD. Further research is of utmost importance to raise awareness for this potentially undervalued problem.

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Section: American Psychiatric Associationmentioning

confidence: 99%

Thiamine Substitution in Alcohol Use Disorder: A Narrative Review of Medical Guidelines

et al. 2019

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“…Despite the demonstrated benefits and the endorsement by multiple professional bodies of treating AUD pharmacologically (9)(10)(11)(12), medications are not regularly prescribed for the disorder. Between 2002 and 2007, less than 9% of patients with AUD were prescribed an FDA-approved medication for the disorder (13), and from 2008 to 2009, only 3.4% of Veterans Health Administration patients diagnosed with AUD were prescribed one of these medications (14).…”

Section: Introductionmentioning

confidence: 99%

“…Meta-analyses of several other medications, including topiramate and baclofen, have shown them to be efficacious in treating AUD (8). Additional trials that evaluated existing medications provided further evidence of their safety and efficacy in treating AUD, and review articles and treatment guidelines called for increased prescribing of medications to treat the disorder (4,(7)(8)(9)(10)(11)(12). Despite these advances, however, medications with demonstrated efficacy in treating AUD are still prescribed infrequently (14,16).…”

Section: Introductionmentioning

confidence: 99%

Survey of Addiction Specialists’ Use of Medications to Treat Alcohol Use Disorder

et al. 2020

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Objectives: Several medications have been shown to be safe and effective for treating alcohol use disorder (AUD); however, these medications are prescribed infrequently. We conducted a survey of the demographics, practice characteristics, and self-perceived knowledge, experience, and opinions of addiction specialists on the use of AUD medications and how to increase their use. Methods:We sent a 19-question survey to members of the American Society of Addiction Medicine (ASAM) and the American Academy of Addiction Psychiatry (AAAP). Results:We received a total of 395 responses from ASAM members and 194 responses from AAAP members. One hundred of the respondents were members of both organizations. The large majority of respondents (92.6%) were prescribers, and 81.6% were non-trainee physicians. The two most frequently used medications for treating AUD were oral naltrexone (27%) and long-acting naltrexone (18%). Respondents were significantly more confident in the strength of the research findings and evidence for the efficacy and safety of naltrexone than other AUD medications (p < 0.001 ). Respondents identified additional education to current providers about existing medications as the most important potential intervention to increase the use of AUD medications. Conclusions:Compared with a survey published in 2001, in 2018 the proportion of respondents who reported using naltrexone more than doubled and addiction specialists were more confident in their use of AUD medications, rating their efficacy and safety more highly. Consistent with findings from other recent studies, providing more education to practitioners about existing AUD medications may be the most effective way to increase their use.

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“…Despite such differences, the mega-modules presented in Table 1 shared certain structural similarities. Most of the IAPSAD- and ALSPAC-nominal genes in these modules shared edges with hub genes (Fig 3–5). These hub genes included: CUL3 and ELAVL1 from PFC Aliceblue; ESR1 from PFC Cadetblue; ELAVL1rom NAc Cadetblue2; TRIM25 and HECW2 from VTA Bisque.…”

Section: Discussionmentioning

confidence: 99%

“…These hub genes included: CUL3 and ELAVL1 from PFC Aliceblue; ESR1 from PFC Cadetblue; ELAVL1rom NAc Cadetblue2; TRIM25 and HECW2 from VTA Bisque. Further, GWAS nominally significant genes (IASPAD or ALSPAC) generally were not hub genes in the derived networks (see Fig 3–5; Table S2). This may be consistent with the general tenet that genetic variation in complex traits does not produce major alterations in cellular function, but rather modulation of cellular mechanisms for maintaining homeostasis.…”

Section: Discussionmentioning

confidence: 99%

Cross-species alcohol dependence-associated gene networks: Co-analysis of mouse brain gene expression and human genome-wide association data

Mignogna

Bacanu

Riley

et al. 2018

Preprint

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22Genome-wide association studies on alcohol dependence, by themselves, have yet to account for 23 the estimated heritability of the disorder and provide incomplete mechanistic understanding of 24 this complex trait. Integrating brain ethanol-responsive gene expression networks from model 25 organisms with human genetic data on alcohol dependence could aid in identifying dependence-26 associated genes and functional networks in which they are involved. This study used a 27 modification of the Edge-Weighted Dense Module Searching for genome-wide association 28 studies (EW-dmGWAS) approach to co-analyze whole-genome gene expression data from 29 ethanol-exposed mouse brain tissue, human protein-protein interaction databases and alcohol 30 dependence-related genome-wide association studies. Results revealed novel ethanol-regulated 31 and alcohol dependence-associated gene networks in prefrontal cortex, nucleus accumbens, and 32 ventral tegmental area. Three of these networks were overrepresented with genome-wide 33 association signals from an independent dataset. These networks were significantly 34 overrepresented for gene ontology categories involving several mechanisms, including actin 35 filament-based activity, transcript regulation, Wnt and Syndecan-mediated signaling, and 36 ubiquitination. Together, these studies provide novel insight for brain mechanisms contributing

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The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder

Cited by 241 publications

References 18 publications

Thiamine Substitution in Alcohol Use Disorder: A Narrative Review of Medical Guidelines

Thiamine Substitution in Alcohol Use Disorder: A Narrative Review of Medical Guidelines

Survey of Addiction Specialists’ Use of Medications to Treat Alcohol Use Disorder

Cross-species alcohol dependence-associated gene networks: Co-analysis of mouse brain gene expression and human genome-wide association data

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