Pharmacological approaches to the treatment of excessive drinking and alcohol dependence

Excessive drinking is common in Western societies and leads to a wide range of physical, psychological and social problems. These problems are costly to society. The 1-year prevalence of dependence is 4-5% and lifetime prevalence 13-16%. A wide range of pharmacological approaches to attenuate drinking or promote abstinence has been studied. Clinical research in this area has been affected by poor methodological quality, with some important exceptions and there is a need for agreed standards of research conduct. Nevertheless, several pharmacological agents have emerged as having potential. Acamprosate (a synthetic GABA analog) and naltrexone (an opioid anatagonist) have some evidence of efficacy in excessive drinking and alcohol dependence. However, precise mechanisms of effect and identification of drinkers most likely to benefit have still to be established.