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[Drug and Alcohol Findings] (2012) Effectiveness Bank Bulletin. [Medical treatment of alcohol dependence]. Drug and Alcohol Findings. Drug and Alcohol Findings, 21 Jun

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Medical treatment of alcohol dependence: a systematic review.
Miller P.M., Book S.W., Stewart S.H.International Journal of Psychiatry in Medicine: 2011, 42(3), p. 227–266.

With from 2011 naltrexone licensed for this purpose, Britain now has the full suite of major medications authorised for the treatment of alcohol dependence. Largely from a primary care perspective, this US review examines a half century of evidence for whether these and other drugs aid recovery and which work best.

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 expansion of these treatments to medical settings including primary care and specialist clinics. It searched for research published in English from 1960 to 2010 which involved randomly allocating adult patients to medication versus either no treatment, a placebo, or some other treatment. The aim was to focus on studies which offered either no accompanying psychosocial therapy or only brief therapies of the kind which might be undertaken in general medicine as well as specialist clinics. Only drugs in at least two trials were included.

The reviewers found 85 eligible trials involving nearly 19,000 patients. Of these, 11 studies concerned disulfiram, a drug which blocks the breakdown of alcohol in the body, producing unpleasant reactions in response to even low levels of drinking and acting as an aversive deterrent. Other pharmacotherapies for alcohol dependence are generally thought to work by blocking the rewards experienced from drinking or by stabilising body systems disrupted by chronic alcohol intake. Among these, most researched was naltrexone, tested in 33 trials. By blocking the body's own opiate-type chemicals, the drug is thought to reduce the rewarding feelings patients gain from drinking. Next most extensively researched with 24 trials was the anti-craving medication acamprosate. SSRI antidepressants were investigated in seven trials, while the anticonvulsant topiramate was the subject of four. Various other medications were less extensively researched.


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