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.focus.17205

Cited by 40 publications

(90 citation statements)

References 18 publications

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“…Overall, AUD is undertreated in all populations, and pharmacotherapy is particularly underutilized. The American Psychiatric Association reported that less than 10% of all patients receive any treatment after an AUD diagnosis . Even fewer receive evidence‐based AUD treatments.…”

Section: Discussionmentioning

confidence: 99%

“…Acamprosate blocks withdrawal symptoms and has efficacy in maintaining alcohol abstinence . Given this mechanism, there are theoretical concerns about encephalopathy related to acamprosate but few data to guide its use .…”

Section: Discussionmentioning

confidence: 99%

“…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 . Despite this theoretical concern, one study of 12 patients with cirrhosis found that a low dose of acamprosate was associated with no increase in subclinical encephalopathy, although there was a small decrease in diastolic, but not systolic, blood pressure .…”

Section: Discussionmentioning

confidence: 99%

“…Naltrexone is an opioid receptor antagonist that works by reducing the craving for alcohol and has been shown to be equivalent to acamprosate in efficacy. However, the American Psychiatric Association recommends caution when using naltrexone in patients with liver failure . This is because naltrexone has been associated with hepatotoxicity, particularly in patients with decompensated disease.…”

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%

Section: Discussionmentioning

confidence: 99%

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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“…The American Psychiatric Association recommends that biomarkers should be used to assist diagnosis and support recovery, representing a foundation for discussing alcohol relapse and abstinence rather than as instruments to “catch” or punish patients. Every effort should be made to make patients aware of this concept, so that they can perceive biomarker assessment as part of treatment rather than a punitive tool, and useful to improve the therapeutic alliance between patients and physicians …”

Section: Diagnosis Of Aud In End‐stage Aldmentioning

confidence: 99%

Diagnosis and Treatment of Alcohol Use Disorder in Patients With End‐Stage Alcoholic Liver Disease

2019

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Between 14%‐30% of the world’s population is affected by alcohol use disorder (AUD), and excessive alcohol consumption represents the most common cause of liver disease in the western world. The clinical picture of alcoholic end‐stage liver disease is rendered extremely complex, as manifestations such as alcohol withdrawal syndrome, craving and physical dependence, as well as extrahepatic alcohol‐related diseases merge with the complications of advanced cirrhosis. This makes AUD recognition and assessment difficult and its management arduous as many drugs commonly used to treat complications such as alcohol withdrawal syndrome are often contraindicated by the presence of hepatic encephalopathy or hepatorenal syndrome. Reaching and maintaining abstinence represents the mainstay of managing patients with AUD and end‐stage liver disease. Psychosocial interventions are an essential component of treatment to reach these goals. However, these interventions alone often prove insufficient in AUD patients and even more frequently in those with end‐stage liver disease because of inadequate adherence due to poor functional and physical status. Pharmacological treatments need to be associated, but the available options are greatly limited in end‐stage liver disease because many GABA‐Ergic drugs can favor the development of hepatic encephalopathy, whereas drugs undergoing extensive liver metabolism should be avoided or used with the greatest caution. Because of these limitations, the management of end‐stage AUD is extremely challenging and requires an integrated multidisciplinary approach.

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Defining the psychiatric and financial burden of mental and substance use disorders in cancer patients

et al. 2022

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Purpose To identify the proportion of Emergency Department (ED) visits in cancer patients associated with a mental and substance use disorder (MSUD) and the subsequent healthcare costs. Methods Nationally representative data on ED visits from 2009 to 2018 was obtained from the Nationwide Emergency Department Sample (NEDS). We identified cancer‐related visits with or without a MSUD using the Clinical Classifications Software diagnoses documented during the ED visit. Survey‐adjusted frequencies and proportions of ED visits among adult cancer patients with or without a MSUD was evaluated. Survey‐adjusted multivariable logistic regression models were used to examine demographic and clinical predictors of the presence of an MSUD and the likelihood of hospital admission for patients with a primary MSUD. Results Among 54,004,462 ED visits with a cancer diagnosis between 2009 and 2018, 11,803,966 (22%) were associated with a MSUD. Compared to a primary diagnosis of cancer, patients who presented to the ED with a chief complaint of MSUD were more likely to be female (54% vs. 49%), younger (median: 58 vs. 66), more likely to have Medicaid insurance, and more likely to be discharged home. The three most common MSUD diagnoses among cancer patients were alcohol‐related disorders, anxiety disorders, and depressive disorders. The total costs associated with a primary MSUD from 2009 to 2018 was $3,133,432,103, of which alcohol‐related disorders claimed the largest majority. Younger age (OR per 10‐year increase: 0.86, 95% CI: 0.85, 0.86) and female sex (OR: 1.34, 95% CI: 1.33–1.35) were associated with higher odds of having an MSUD. Conclusions Our findings demonstrate a high burden of psychiatric and substance use illness in the cancer population and provide the rationale for early psychosocial intervention to support these patients.

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

Cited by 40 publications

References 18 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

Diagnosis and Treatment of Alcohol Use Disorder in Patients With End‐Stage Alcoholic Liver Disease

Defining the psychiatric and financial burden of mental and substance use disorders in cancer patients

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