Summary Funded by the US government's alcohol institute, this review of drug-based treatment for alcohol dependence aimed to express the evidence base in such a way as to underpin the further expansion of these treatments beyond substance use services to primary care and clinics for other types of illness.
Full Answer
What research should be included in a systematic review of alcoholism?
Included studies need to include at least one of the following outcome measures: alcohol consumption, treatment engagement, uptake of pharmacological agents, and/or quality of life. Solely quantitative research will be included in this systematic review (e.g., randomized controlled trials (RCTs) and cluster RCTs).
How effective are medications for alcohol dependence?
Research findings on the efficacy of medical treatments for alcohol dependence are generally mixed. While overall treatment effects for these medications have been quite modest, it is clear that some alcohol dependent patients will benefit from pharmacotherapy.
Are pharmacologic treatments for alcohol dependence feasible in primary care settings?
Objective: To summarize published data on pharmacologic treatments for alcohol dependence alone and in combination with brief psychosocial therapies that may be feasible for primary care and specialty medical settings.
Are there evidence-based models of care for alcohol use disorder?
This systematic review and meta-analysis aims to guide improvement of design and implementation of evidence-based models of care for the treatment of alcohol use disorder in primary health care settings. The evidence will define which models are most promising and will guide further research. PROSPERO CRD42019120293.
What is the most effective treatment for alcohol dependence?
Naltrexone (Trexan) and acamprosate (Campral) are recommended as FDA-approved options for treatment of alcohol dependence in conjunction with behavior therapy.
What is alcohol use disorder Google Scholar?
Alcohol use disorder (AUD): Problematic pattern of alcohol use leading to clinically significant impairment or distress. AUD requires that ≥ 2 diagnostic criteria (Box 2) be met within a 12-month period. Mild AUD: 2–3 criteria; moderate AUD: 4–6 criteria; and severe AUD: 7–11 criteria.
What is the first line treatment for alcohol use disorder?
Evidence-Based Answer Acamprosate and naltrexone should be used as first-line agents for treatment of alcohol use disorder and are effective for reducing relapse rates.
What is the DSM 5 criteria for alcohol use disorder?
Alcohol Use Disorder Criteria, According to the DSM-5 Consumed more alcohol or spent more time drinking than intended. Wants to limit or halt alcohol use, but hasn't succeeded. Spends an inordinate duration drinking, being ill, and undergoing the aftereffects of alcohol use.
What are the differential diagnosis for alcohol use disorder?
Associated diagnoses include liver cirrhosis, depressive disorder, gastritis, gastrointestinal tract bleeding, difficult-to-control diabetes, erectile dysfunction, Wernicke-Korsakoff syndrome, Wernicke encephalopathy, cardiomyopathy, and acute pancreatitis.
What are alcohol related disorders?
DEFINITION. Alcohol use disorders are medical conditions that are diagnosed when a patient's drinking causes significant concern or harm, and decrease in functioning. They were formerly classified as either alcohol dependence (alcoholism) or alcohol abuse.
What are some treatment options for someone who is suffering from alcoholism?
Options for TreatmentBehavioral Treatments. Behavioral treatments are aimed at changing drinking behavior through counseling. ... Medications. ... Mutual-Support Groups. ... Current NIAAA Research—Leading to Future Breakthroughs. ... Mental Health Issues and Alcohol Use Disorder.
What is used for pharmacologic management of alcohol dependence?
Pharmacologic Therapy The ultimate goals for patients with alcohol dependence are to achieve abstinence and prevent relapse. Currently, the four pharmacologic agents that may aid in accomplishing these goals are disulfiram, oral naltrexone, injectable extended-release naltrexone, and acamprosate.
What is the best description of physiological dependence on alcohol?
Alcohol dependence is characterized by tolerance (the need to drink more to achieve the same "high") and withdrawal symptoms if drinking is suddenly stopped. Withdrawal symptoms may include nausea, sweating, restlessness, irritability, tremors, hallucinations and convulsions.
Is alcohol use disorder in the DSM V?
DSM–5 integrates the two DSM–IV disorders, alcohol abuse and alcohol dependence, into a single disorder called alcohol use disorder (AUD) with mild, moderate, and severe sub-classifications.
What are the criteria for substance dependence?
The substance is often taken in larger amounts or over a longer period than intended. There is a persistent desire or unsuccessful efforts to cut down or control substance use. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
What is the difference between alcohol use disorder and alcohol dependence?
What Is the Difference Between Alcoholism and Alcohol Use Disorder? Alcohol use disorder is a diagnosis used by medical professionals to describe someone with an alcohol problem to varying degrees. Alcoholism is a non-medical term used most often in everyday language and within the rooms of Alcoholics Anonymous.
What is alcohol use disorder discuss the signs and symptoms?
Signs and symptoms include sweating, rapid heartbeat, hand tremors, problems sleeping, nausea and vomiting, hallucinations, restlessness and agitation, anxiety, and occasionally seizures. Symptoms can be severe enough to impair your ability to function at work or in social situations.
What is the pathophysiology of alcohol intoxication?
Alcohol is absorbed through the proximal GI tract. It is primarily metabolized in the liver by alcohol dehydrogenase to acetaldehyde. The primary site of action in acute toxicity is the central nervous system, where it increases central nervous system (CNS) inhibition and decreases excitation.
What is the pathophysiology of alcohol?
Pathophysiological consequences of alcohol use A progressive neurologic syndrome that affects gait and stance, often accompanied by nystagmus, can result from atrophy of the cerebellum due to alcohol toxicity.
What do you mean by alcoholic?
1 : continued excessive or compulsive use of alcoholic drinks. 2a : a chronic, a progressive, potentially fatal disorder marked by excessive and usually compulsive drinking of alcohol leading to psychological and physical dependence or addiction.
What is alcohol withdrawal syndrome?
Alcohol withdrawal syndrome is a clinical diagnosis. It may vary in severity. Complicated alcohol withdrawal presents with hallucinations, seizures or delirium tremens. Benzodiazepines have the best evidence base in the treatment of alcohol withdrawal, followed by anticonvulsants.
What is DT in alcohol withdrawal?
DT is a specific type of delirium occurring in patients who are in alcohol withdrawal states.
Does alcohol affect the CNS?
Alcohol facilitates GABA action, causing decreased CNS excitability [Figure 1b]. In the long-term, it causes a decrease in the number of GABA receptors (down regulation). This results in the requirement of increasingly larger doses of ethanol to achieve the same euphoric effect, a phenomenon known as tolerance.
Is alcohol a depressant?
Alcohol is a central nervous system (CNS) depressant, influencing the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). Ordinarily, the excitatory (glutamate) and inhibitory (GABA) neurotransmitters are in a state of homeostasis [Figure 1a].
Is alcohol withdrawal a general hospital?
Alcohol withdrawal is commonly encountered in general hospital settings. It forms a major part of referrals received by a consultation-liaison psychiatrist. This article aims to review the evidence base for appropriate clinical management of the alcohol withdrawal syndrome.
Does alcohol affect the excitatory tone?
Alcohol acts as an N-methyl-D-aspartate (NMDA) receptor antagonist, thereby reducing the CNS excitatory tone. Chronic use of alcohol leads to an increase in the number of NMDA receptors (up regulation) and production of more glutamate to maintain CNS homeostasis [Figure 1c]. Open in a separate window.
Access Options
You can be signed in via any or all of the methods shown below at the same time.
Objective
To summarize published data on pharmacologic treatments for alcohol dependence alone and in combination with brief psychosocial therapies that may be feasible for primary care and specialty medical settings.
Methods
We conducted electronic searches of published original research articles and reviews in MEDLINE, SCOPUS, CINAHL, Embase, and PsychINFO. In addition, hand searches of reference lists of review articles, supplemental searches of internet references and contacts with experts in the field were conducted.
Results
A total of 85 studies, representing 18,937 subjects, met our criteria for inclusion. The evidence base for oral naltrexone (6% more days abstinent than placebo in the largest study) and topiramate (prescribed off-label) (e.g., 26.2% more days abstinent than placebo in a recent study) is positive but modest.
Conclusions
Although treatment effects are modest, medications for alcohol dependence, in conjunction with either brief support or more extensive psychosocial therapy, can be effective in primary and specialty care medical settings.
What is the primary outcome measure of this proposed systematic review?
The primary outcome measure of this proposed systematic review is the consumption of alcohol at follow-up. Consumption of alcohol is often quantified in drinking quantity (e.g., number of drinks per week), drinking frequency (e.g., percentage of days abstinent), binge frequency (e.g., number of heavy drinking days), and drinking intensity (e.g., number of drinks per drinking day). Additionally, outcomes such as percentage/proportion included patients that are abstinent or considered heavy/risky drinkers at follow-up. We aim to report all these outcomes. The consumption of alcohol is often self-reported by patients. When studies report outcomes at multiple time points, we will consider the longest follow-up of individual studies as a primary outcome measure.
What is systematic review and meta-analysis?
This systematic review and meta-analysis aims to guide improvement of design and implementation of evidence-based models of care for the treatment of alcohol use disorder in primary health care settings. The evidence will define which models are most promising and will guide further research.
How much of the world's population died from alcohol in 2016?
It is well recognized that alcohol use disorders (AUD) have a damaging impact on the health of the population. According to the World Health Organization (WHO), 5.3% of all global deaths were attributable to alcohol consumption in 2016 [ 1 ]. The 2016 Global Burden of Disease Study reported that alcohol use led to 1.6% ...
Is masking included in randomized trials?
Both individualized and cluster randomized trials will be included. Masking of patients and/or physicians is not an inclusion criterion as it is often hard to accomplish in these types of studies.
Is referral to specialized care successful?
Furthermore, referral to specialized care is often not successful and patients that do seek treatment are likely to have developed more severe dependence. A more cost-efficient health care model is to treat less severe AUD in a primary care setting before the onset of greater dependence severity.