Review: Pharmacotherapy for Alcohol-Use Disorders
Two large-scale research summaries on alcohol use disorder (AUD) have been released by the Agency for Healthcare Research and Quality (AHRQ). One is aimed at clinicians while the other is aimed for patient use. The researchers based their findings on an analysis of 135 studies between 1970 to 2013.
Most studies included in the review evaluated the use of medications in conjunction with psychosocial treatments. In fact, less than 10% of people being treated for AUD receive medication. The authors assert that the use of medications alone has not been studied enough to draw any firm conclusions. However, they did find moderate evidence that acamprosate (marketed as Campral) and oral naltrexone (marketed as Reviva, Vivitrol) improve outcomes for patients.
Head-to-head studies between the two treatments showed mixed results, and as such, researchers concluded that neither demonstrated a clear superiority to the either. For acamprosate and oral naltrexone (50mg per day), numbers needed to treat (NNTs) to prevent 1 person from returning to any drinking were 12 and 20, respectively. NNT to prevent 1 person from returning to heavy drinking for oral naltrexone (50mg per day) was 12.
Both acamprosate and naltrexone were associated with vomiting as an adverse effect, while acamprosate users also displayed a higher risk of anxiety and diarrhea compared to the placebo group.
No evidence was found to support efficacy of disulfiram (marketed as Antabuse) in randomized, placebo-controlled trials for clinical outcomes (eg, return to any drinking, number of drinks per drinking days, reducing the amount of alcohol consumed).
Although AUD affects more than 68 million Americans at some point in their lifetime, research into potential treatments is lacking. Alcohol use disorder is the third highest modifiable risk factor that leads to early death in the U.S., after tobacco use and being overweight; those with AUD are 3 times as likely to die early as those without AUD. The authors of the AHRQ research summaries hope their work will fill part of the research gap and that others will build upon it.
For more information visit ahrq.org.