Pharmacotherapy for alcohol-related disorders: what clinicians should know.
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.
Mariani
John J
JJ
Department of Psychiatry, Division on Substance Abuse, Columbia University, College of Physicians and Surgeons, USA. Mariani@pi.cpmc.columbia.edu
Levin
Frances R
FR
D000430:Alcohol Withdrawal Delirium / Q000517:prevention & control; D020270:Alcohol Withdrawal Seizures / Q000517:prevention & control; D000437:Alcoholism / Q000453:epidemiology / Q000534:rehabilitation*; D015897:Comorbidity; D004358:Drug Therapy / Q000379:methods*; D006801:Humans; D019964:Mood Disorders / Q000188:drug therapy / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000534:rehabilitation