Medications for Treatment of Alcohol Use Disorder

Summary

Alcohol use disorder is a prevalent and potentially fatal condition in the U.S., with only 8.9% receiving treatment. Medications like naltrexone, acamprosate, and disulfiram can help but are underutilized due to misconceptions and treatment program limitations. Despite modest efficacy, these medications should be offered to patients experiencing cravings, heavy drinking, or at risk of relapse.

Takeaways

• 📈 Alcohol use disorder (AUD) is prevalent in the U.S., with a 50% increase in the last decade.
• 🚑 Most people with AUD do not receive treatment, and of those who do, few receive pharmacotherapy.
• 💊 There are effective medications for AUD, yet they are underutilized.
• 👨‍⚕️ A patient's testimony highlights the desire for medication despite potential complications.
• 🔄 AUD is chronic and potentially fatal, being the third leading cause of preventable death in the U.S.
• 🏥 Only a small percentage of those needing treatment for AUD receive it at specialty facilities.
• 💊 There are reasons for underprescription, including lack of program capacity, belief issues, and misconceptions.
• 🤔 The myth that medication for AUD replaces one addiction with another may deter people from treatment.
• 📊 Only 10% of diagnosed individuals receive medication, usually just one prescription per year.
• 💊 FDA-approved medications for AUD include naltrexone, acamprosate, and disulfiram.
• 📈 Non-FDA approved but effective medications include topiramate and gabapentin.

Q & A

What is the prevalence of alcohol use disorder in the U.S.?

The prevalence of alcohol use disorder in the U.S. has increased by about 50% in the last 10 years.

What percentage of people with alcohol use disorder receive treatment?

Only 8.9 percent of those classified as needing treatment for their alcohol use disorder received treatment at a specialty addiction facility in 2018.

Why do some people with alcohol use disorder not receive pharmacotherapy?

Some people and clinicians do not believe medication for alcohol use is helpful, and there is a myth that taking medication is just treating one addiction for another.

What is considered the third leading cause of preventable death in the United States?

Alcohol use disorder is the third leading cause of preventable death in the United States.

What are the three FDA-approved medications for the treatment of alcohol use disorder?

The three FDA-approved medications for the treatment of alcohol use disorder are naltrexone, acamprosate, and disulfiram.

How does naltrexone work in the treatment of alcohol use disorder?

Naltrexone is an opioid antagonist that blocks the increase of endogenous opioids in the brain's reward pathway caused by alcohol consumption.

What are the side effects of naltrexone?

The main side effects of naltrexone are nausea and dizziness.

How does acamprosate differ from naltrexone in its treatment of alcohol use disorder?

Acamprosate affects different neurotransmitter systems, including glutamate and GABA, and seems to have an effect on protracted withdrawal symptoms.

What is the mechanism of action of disulfiram?

Disulfiram causes a negative reaction when combined with alcohol, leading to symptoms like flushing, sweating, and nausea, which discourages drinking.

What are the potential side effects of disulfiram?

The side effects of disulfiram include drowsiness, metallic taste, and many medication interactions, and it can be harmful to the liver.

Are there any additional medications that have shown some efficacy in treating alcohol use disorder, even though they are not FDA-approved?

Yes, topiramate and gabapentin are two medications that have shown some efficacy in treating alcohol use disorder, but they are not FDA-approved for this purpose.