[Medical management of alcohol use disorders]

Medical management of alcohol use disorders. Psychosocial support remains the key element of treatment of patients with an alcohol use disorder in order to either decrease or cease their alcohol consumption. However two drugs can now be used to reduce alcohol consumption: nalmefene and baclofen. Currently available studies have shown weak to moderate effect sizes in this indication. Four molecules are available to help patients maintain abstinence: acamprosate, naltrexone, disulfiram and baclofen (off-label use). Effect sizes calculated by various metaanalyses are also low to moderate. Disulfiram appears to be more effective when the patient has understood its mechanism of action and when it is used under supervision. However, the use of disulfiram is limited by the risk of rare, but potentially serious adverse effects. Identification of patient subgroups obtaining better responses to certain drugs constitutes a major research challenge, but only a few criteria have been defined to date. However, regardless of the drug considered, heavy drinking and difficulty to maintain abstinence significantly improve the efficacy of the drugs. After an initially promising period, identification of genetic markers has not yet resulted in any clinical applications. Promising molecules currently under evaluation include sodium oxybate and topiramate.