Recommended drug treatment strategies for the alcoholic patient

Significant progress has been made in the pharmacotherapy of alcoholism, specifically in the areas of withdrawal reaction, decreasing consumption, relapse prevention, and comorbid psychiatric illnesses. Psychosocial interventions are an important component of treatment strategies, and studies into the efficacy of medications often include psychotherapy or other nonpharmacological modalities. Increasingly, however, the evidence reveals the effectiveness of drug treatments for various components of the illness. Many different pharmacological agents and dosage regimens have been investigated for the treatment of the alcohol withdrawal syndrome. The effectiveness and simplicity of giving long-acting benzodiazepines, using a loading-dose technique, make this regimen first-line therapy. Both naltrexone (an opioid antagonist) and acamprosate (calcium acetylhomotaurinate) increase rates of abstinence and decrease relapse rates in alcohol-dependent individuals who are in abstinence-orientated programmes. If patients enter a comprehensive treatment programme, either naltrexone or acamprosate should be considered as an option in the treatment plan. The choice of medication is most likely to be determined by the availability of each, which differs considerably throughout the world. Selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs) seem to have short term effects, and are more effective in depressed alcoholics-dependent and in men. For all medications there is wide variability in treatment response (i.e. effect size) and compliance seems to be essential for successful treatment. Preliminary evidence suggests the usefulness of pharmacotherapy in treating alcohol dependence in the presence of other comorbid psychiatric illnesses. Antidepressants have shown efficacy in the treatment of alcoholism with comorbid depression, as has buspirone for the treatment of comorbid chronic anxiety symptoms. Further understanding of the neurobiological mechanisms of dependence in animals and humans as well as improved knowledge of predictors of treatment response will lead to improvements in the pharmacotherapy of alcohol dependence.