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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.


Item Type:Evidence resource
Publication Type:Review
Drug Type:Alcohol
Intervention Type:AOD disorder drug therapy, AOD disorder treatment method
Source:Drug and Alcohol Findings
Date:21 June 2012
Publisher:Drug and Alcohol Findings
Volume:21 Jun
EndNote:View
Accession Number:HRB (Electronic Only)
Subjects:A Substance use, abuse, and dependence > Prevalence > Problem substance use
B Substances > Opioids (opiates) > Opioid product > Naltrexone
G Health and disease > Substance use disorder > Alcohol use > Alcohol dependence
HJ Treatment method > Substance disorder treatment method
HJ Treatment method > Substance disorder treatment method > Substance disorder drug therapy
HJ Treatment method > Substance disorder treatment method > Substance replacement method (substitution)
HJ Treatment method > Substance disorder treatment method > Substance replacement method (substitution) > Disulfiram therapy
HJ Treatment method > Treatment outcome
VA Geographic area > United States

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