Pharmacotherapy in alcoholism

This review categorizes five main uses of pharmacologic agents in the treatment of alcoholism: reversing the active pharmacologic effects of alcohol; controlling withdrawal symptoms; blocking the desire for alcohol use; treating psychiatric symptoms induced by alcohol and other drugs; and treating independent, but concurrent, psychopathologic conditions. No medication, including stimulants such as caffeine, has been found to actually reverse the action of alcohol. Because of their cross-tolerance and dependence with alcohol, benzodiazepines--especially intermediate acting preparations such as chlordiazepoxide and diazepam--are the mainstay in treating alcohol withdrawal, including convulsions and delirium tremens. Studies suggest that serotonin uptake inhibitors such as zimelidine, citalopram, viqualine, and fluoxetine may reduce alcohol consumption and that is not an antidepressant effect. Naltrexone, an opioid antagonist, also may be effective in reducing the urge to drink. The major aversive agent to alcohol in clinical use is disulfiram. When an independent psychiatric disorder accompanies alcoholism or drug addiction, it may require treatment, including pharmacotherapy, as the addiction is also being treated with nonpharmacologic methods such as abstinence-based treatment programs.