The pharmacological treatment of alcoholism: from basic science to clinical medicine

Recent advances in the understanding of the neurobiological basis of alcohol dependence have led to the development of pharmacological agents for the treatment of drinking problems. However, alcoholism is a complex disease with psychological and social dimensions in addition to medical problems. This implies that, in this domain, pharmacotherapy must be integrated in a general strategy of treatment and directed to specific aspects of management of the disease, such as treatment or prevention of the withdrawal syndrome or prevention of relapse after detoxification. Whereas the treatment of the withdrawal syndrome with pharmacological agents such as the benzodiazepines is now an established practice, the use of drugs for other dimensions of the disease is more controversial. However, the pharmacological approach aimed towards prevention of relapse appears promising, by means of classical medications such as disulfiram or new drugs (e.g. opiate antagonists and acamprosate). The clinical evaluation of such medications requires guidelines that will permit extrapolation of the results of the trials to situations that are commonly faced by practitioners.