[Alcohol dependence: diagnosis and treatment].
OBJECTIVE
Prevalence of alcohol dependence remains stable across time between 5-7% in men and 2-3% in women, corresponding to at least 1.5 million patients in France. A review about alcohol dependence is warranted, not only as prevalence of this disease is high, but also because of recent significant improvement in caring for these patients.


BACKGROUND
Management of alcohol withdrawal is well codified and chiefly entails the prescription of long half-life benzodiazepines, thiamin, and appropriate rehydratation. The objective is to prevent withdrawal syndrome, which can result in delirium tremens and seizures. Several drugs and therapies have proven efficacy to maintain abstinence. Cognitive behavioral therapies evaluate those factors triggering alcohol consumption, and involve behavioral techniques to promote a change. Motivational interviewing enhances individual effectiveness of treatment, and capacity to maintain abstinence. Three molecules used in France have proven efficacy through several mechanisms: acamprosate which interacts with GABAergic and glutamatergic central transmission; naltrexone, an antagonist of opiate receptors; disulfiram which has antabuse-like effect through inhibition of acetaldehyde dehydrogenase.


CONCLUSIONS
Main research strategies currently developed are: (i) investigating consumption of multiple psychoactive substances, and (ii) understanding the neurobiology of dependence, which may lead to new therapeutic discoveries.
Perney
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P
Service d'addictologie, CHU Carémeau, 30029 Nîmes cedex 9, France. pascal.perney@chu-nimes.fr
Rigole
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H
Blanc
F
F
D000077443:Acamprosate; D000427:Alcohol Deterrents / Q000627:therapeutic use; D000437:Alcoholism / Q000175:diagnosis* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D004221:Disulfiram / Q000627:therapeutic use; D006801:Humans; D009042:Motivation; D009271:Naltrexone / Q000627:therapeutic use; D009292:Narcotic Antagonists; D013375:Substance Withdrawal Syndrome / Q000628:therapy; D013654:Taurine / Q000031:analogs & derivatives / Q000627:therapeutic use
D000427:Alcohol Deterrents; D009292:Narcotic Antagonists; D013654:Taurine; D009271:Naltrexone; D000077443:Acamprosate; D004221:Disulfiram