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14 - Pharmacotherapy of alcohol misuse, dependence and withdrawal

from Part III - Specific treatments

Published online by Cambridge University Press:  12 May 2010

By
George A. Kenna ,
Kostas Agath  and
Robert Swift
Edited by
Peter Tyrer  and
Kenneth R. Silk
George A. Kenna
Affiliation:
Center for Alcohol and Addiction Studies Brown University Providence, RI USA
Kostas Agath
Affiliation:
Westminster Substance Misuse Services London UK
Robert Swift
Affiliation:
Center for Alcohol and Addiction Studies Brown University Medical School Providence, RI USA
Peter Tyrer
Affiliation:
Imperial College of Science, Technology and Medicine, London
Kenneth R. Silk
Affiliation:
University of Michigan, Ann Arbor
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Summary

Editor's note

While there is a large volume of research on alcohol misuse, dependence and withdrawal, the pharmacologic solutions are not as directly evident as this amount may suggest. There are widespread cultural determinants as to what constitutes alcohol misuse though the definitions for dependence are much clearer. Yet we do not have good solid pharmacologic treatments to prevent or decrease alcohol usage in the alcohol-dependent individual, though results from the recent COMBINE study suggest a more prominent and effective role for naltrexone in conjunction with medical management. Acamprosate did not fare as well in this trial even though it has been approved for alcohol dependence, and questions of heterogeneity among patient populations might explain conflicting findings. The effectiveness of disulfiram appears to rely heavily upon the patient's determination to remain abstinent. Anticonvulsants may have a role here, but more data is needed. Benzodiazepines remain the gold standard for treatment of symptoms of alcohol withdrawal, while a number of studies also support the use of some anticonvulsant drugs in assisting with withdrawal, especially in cases of mild-to-moderate severity.

Introduction

There is a large volume of research on the pharmacological treatments for alcohol misuse, dependence and withdrawal. Part of that research is marred by methodological difficulties (Moncrieff & Drummond 1997), necessitating increasingly sophisticated means of grading the available evidence to allow generalizability of findings (Mayo-Smith, 1997, Garbutt et al., 1999, Scottish Intercollegiate Guidelines Network –SIGN, 2003, Lingford-Hughes et al., 2004).

Type
Chapter
Information
Cambridge Textbook of Effective Treatments in Psychiatry , pp. 289 - 313
Publisher: Cambridge University Press
Print publication year: 2008

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