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CMAJ : Canadian Medical Association... Jun 2000Problem drinking is a serious health issue, but often patients whose alcohol consumption places them at risk are not diagnosed by physicians. Case finding is an... (Review)
Review
Problem drinking is a serious health issue, but often patients whose alcohol consumption places them at risk are not diagnosed by physicians. Case finding is an essential component of "best practice." In many cases if given the appropriate advice, counselling and behavioural interventions, problem drinkers can be helped to reduce their use of alcohol and improve functioning in other areas of their lives. Some patients may benefit from more comprehensive therapy including the prescription of disulfiram, calcium carbimide or naltrexone. For those with serious problems with alcohol, referral to specialized addiction treatment programs and other community resource centres may also be appropriate.
Topics: Alcohol Deterrents; Alcoholism; Behavior Therapy; Counseling; Humans; Referral and Consultation; Self-Help Groups
PubMed: 10870503
DOI: No ID Found -
International Journal of... 2003Alcohol abuse and alcoholism are responsible for a wide variety of medical problems. The pharmaco-therapeutic aspect of alcoholism includes the use of drugs, with... (Review)
Review
Alcohol abuse and alcoholism are responsible for a wide variety of medical problems. The pharmaco-therapeutic aspect of alcoholism includes the use of drugs, with different actions and objectives. Among them, metadoxine seems to be of interest. Metadoxine is able to accelerate the elimination of alcohol from the blood and tissues, to help restore the functional structure of the liver and to relieve neuro-psychological disorders associated with alcohol intoxication. Metadoxine also seems to be safe; in more than 15 years of post-marketing surveillance only minor aspecific and reversible events were monitored in patients exposed to the treatment. In this review the preclinical and clinical results obtained using metadoxine in acute and chronic alcohol intoxication are reported.
Topics: Acute Disease; Alcohol Deterrents; Alcoholism; Animals; Drug Combinations; Humans; Pyridoxine; Pyrrolidonecarboxylic Acid
PubMed: 14611722
DOI: 10.1177/039463200301600304 -
Progress in Neuro-psychopharmacology &... Feb 2016Polysubstance abuse of alcohol and nicotine has been overlooked in our understanding of the neurobiology of addiction and especially in the development of novel... (Review)
Review
Polysubstance abuse of alcohol and nicotine has been overlooked in our understanding of the neurobiology of addiction and especially in the development of novel therapeutics for its treatment. Estimates show that as many as 92% of people with alcohol use disorders also smoke tobacco. The health risks associated with both excessive alcohol consumption and tobacco smoking create an urgent biomedical need for the discovery of effective cessation treatments, as opposed to current approaches that attempt to independently treat each abused agent. The lack of treatment approaches for alcohol and nicotine abuse/dependence mirrors a similar lack of research in the neurobiology of polysubstance abuse. This review discusses three critical needs in medications development for alcohol and nicotine co-abuse: (1) the need for a better understanding of the clinical condition (i.e. alcohol and nicotine polysubstance abuse), (2) the need to better understand how these drugs interact in order to identify new targets for therapeutic development and (3) the need for animal models that better mimic this human condition. Current and emerging treatments available for the cessation of each drug and their mechanisms of action are discussed within this context followed by what is known about the pharmacological interactions of alcohol and nicotine. Much has been and will continue to be gained from studying comorbid alcohol and nicotine exposure.
Topics: Alcohol Deterrents; Alcohol-Related Disorders; Animals; Comorbidity; Drug Discovery; Drug Interactions; Humans; Tobacco Use Cessation Devices; Tobacco Use Disorder
PubMed: 26582145
DOI: 10.1016/j.pnpbp.2015.11.004 -
Annals of Medicine Dec 1989
Topics: Alcohol Deterrents; Animals; Humans; Research
PubMed: 2605033
DOI: 10.3109/07853898909149229 -
American Family Physician Nov 2005Medications for treating alcohol dependence primarily have been adjunctive interventions, and only three medications--disulfiram, naltrexone, and acamprosate--are... (Comparative Study)
Comparative Study Review
Medications for treating alcohol dependence primarily have been adjunctive interventions, and only three medications--disulfiram, naltrexone, and acamprosate--are approved for this indication by the U.S. Food and Drug Administration. Disulfiram, an aversive agent that has been used for more than 40 years, has significant adverse effects and compliance difficulties with no clear evidence that it increases abstinence rates, decreases relapse rates, or reduces cravings. In contrast, naltrexone, an anticraving agent, reduces relapse rates and cravings and increases abstinence rates. Acamprosate also reduces relapse rates and increases abstinence rates. Serotonergic and anticonvulsant agents promise to play more of a role in the treatment of alcohol dependence. Although not approved by the U.S. Food and Drug Administration for this indication, the anticonvulsant topiramate and several serotonergic agents (e.g., fluoxetine, ondansetron) have been shown in recent studies to increase abstinence rates and decrease drinking.
Topics: Acamprosate; Adult; Aged; Alcohol Deterrents; Alcohol-Related Disorders; Alcoholism; Disulfiram; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Male; Middle Aged; Naltrexone; Patient Compliance; Randomized Controlled Trials as Topic; Serotonin Agents; Taurine; Treatment Outcome
PubMed: 16300039
DOI: No ID Found -
Acta Pharmacologica Sinica Mar 2014Neuronal nicotinic acetylcholine receptors are important targets for alcohol reward and dependence. Alcoholism is a serious public health problem and has been identified... (Review)
Review
Neuronal nicotinic acetylcholine receptors are important targets for alcohol reward and dependence. Alcoholism is a serious public health problem and has been identified as the third major cause of preventable mortality in the world. Worldwide, about 2 billion people consume alcohol, with 76.3 million having diagnosable alcohol use disorders. Alcohol is currently responsible for the death of 4% of adults worldwide (about 2.5 million deaths each year), and this number will be significantly increased by 2020 unless effective action is taken. Alcohol is the most commonly abused substance by humans. Ethanol (EtOH) is the intoxicating agent in alcoholic drinks that can lead to abuse and dependence. Although it has been extensively studied, the mechanisms of alcohol reward and dependence are still poorly understood. The major reason is that, unlike other addictive drugs (eg, morphine, cocaine or nicotine) that have specific molecular targets, EtOH affects much wider neuronal functions. These functions include phospholipid membranes, various ion channels and receptors, synaptic and network functions, and intracellular signaling molecules. The major targets in the brain that mediate EtOH's effects remain unclear. This knowledge gap results in a therapeutic barrier in the treatment of alcoholism. Interestingly, alcohol and nicotine are often co-abused, which suggests that neuronal nicotinic acetylcholine receptors (nAChRs), the molecular targets for nicotine, may also contribute to alcohol's abusive properties. Here, we briefly summarize recent lines of evidence showing how EtOH modulates nAChRs in the mesolimbic pathway, which provides a perspective that nAChRs are important targets mediating alcohol abuse.
Topics: Alcohol Deterrents; Alcoholism; Animals; Behavior, Addictive; Brain; Drug Design; Ethanol; Humans; Neurons; Receptors, Nicotinic; Reward; Signal Transduction
PubMed: 24464050
DOI: 10.1038/aps.2013.181 -
Alimentary Pharmacology & Therapeutics Apr 2017The development of alcohol dependence is associated with significant morbidity and mortality. For the majority of affected people the most appropriate goal, in terms of... (Review)
Review
BACKGROUND
The development of alcohol dependence is associated with significant morbidity and mortality. For the majority of affected people the most appropriate goal, in terms of drinking behaviour, is abstinence from alcohol. Psychosocial intervention is the mainstay of the treatment but adjuvant pharmacotherapy is also available and its use recommended.
AIM
To provide an updated analysis of current and potential pharmacotherapeutic options for the management of alcohol dependence. In addition, factors predictive of therapeutic outcome, including compliance and pharmacogenetics, and the current barriers to treatment, including doctors' unwillingness to prescribe these agents, will be explored.
METHODS
Relevant papers were selected for review following extensive, language- and date-unrestricted, electronic and manual searches of the literature.
RESULTS
Acamprosate and naltrexone have a substantial evidence base for overall efficacy, safety and cost-effectiveness while the risks associated with the use of disulfiram are well-known and can be minimised with appropriate patient selection and supervision. Acamprosate can be used safely in patients with liver disease and in those with comorbid mental health issues and co-occurring drug-related problems. A number of other agents are being investigated for potential use for this indication including: baclofen, topiramate and metadoxine.
CONCLUSION
Pharmacotherapy for alcohol dependence has been shown to be moderately efficacious with few safety concerns, but it is substantially underutilised. Concerted efforts must be made to remove the barriers to treatment in order to optimise the management of people with this condition.
Topics: Acamprosate; Alcohol Deterrents; Alcoholism; Baclofen; Disulfiram; Drug Combinations; Fructose; Humans; Naltrexone; Polymorphism, Single Nucleotide; Pyridoxine; Pyrrolidonecarboxylic Acid; Taurine; Topiramate; Treatment Outcome
PubMed: 28220511
DOI: 10.1111/apt.13965 -
Journal of Studies on Alcohol and... 2014Modern pharmacotherapy for alcohol dependence has its roots in the failure of National Prohibition in the United States and the rise of the disease model of alcoholism... (Review)
Review
Modern pharmacotherapy for alcohol dependence has its roots in the failure of National Prohibition in the United States and the rise of the disease model of alcoholism (embodied in Alcoholics Anonymous). In 1948, disulfiram was the first medication approved by the U.S. Food and Drug Administration (FDA) to treat alcohol dependence, but its efficacy has not been supported by randomized controlled trials. In the 1960s, benzodiazepines replaced older treatments for alcohol withdrawal, but sedative and dependence-producing effects limit their utility in the postwithdrawal period. In the 1980s, the focus shifted to the treatment of co-occurring psychiatric disorders and medications that modify negative mood states, which contribute to relapse to heavy drinking. In the 1990s, developments in neurobiology implicated specific neurotransmitter systems underlying alcohol's effects, culminating in the 1994 approval by the FDA of the opioid antagonist naltrexone to treat alcohol dependence. In 2006, the FDA approved a long-acting formulation of naltrexone. Recently, nalmefene, another opioid receptor antagonist, was approved in Europe for as-needed use to reduce heavy drinking. Acamprosate, an amino acid derivative, first approved in France in 1989, received FDA approval in 2004. However, the beneficial effects of the approved medications are only modestly greater than those of placebo, and their use is limited. Topiramate, currently under investigation for alcohol dependence, has greater efficacy but a variety of adverse effects. In addition to the identification of novel compounds, the future of alcohol dependence pharmacotherapy will depend on developments in pharmacogenetics, in which genetic variation that moderates treatment efficacy and adverse effects is used to personalize treatment.
Topics: Acamprosate; Alcohol Deterrents; Alcohol-Related Disorders; Disulfiram; Fructose; Humans; Hypnotics and Sedatives; Narcotic Antagonists; Pharmacogenetics; Taurine; Topiramate
PubMed: 24565314
DOI: No ID Found -
The American Journal of Drug and... 2019Alcohol use disorder (AUD) and its associated consequences remain significant public health concerns. Given that AUD represents a spectrum of severity, treatment options... (Review)
Review
BACKGROUND
Alcohol use disorder (AUD) and its associated consequences remain significant public health concerns. Given that AUD represents a spectrum of severity, treatment options represent a continuum of care, ranging from single-session brief interventions to more intensive, prolonged, and specialized treatment modalities.
OBJECTIVE
This qualitative literature review seeks to describe the best practices for AUD by placing a particular emphasis on identifying those practices which have received the most empirical support.
METHOD
This review summarizes psychological and pharmacological intervention options for AUD treatment, with a focus on the relapse prevention phase of recovery. Psychological and pharmacological treatments are summarized in terms of the empirical evidence favoring each approach and the level of AUD severity for which they are most indicated.
SCIENTIFIC SIGNIFICANCE
One of the broad assertions from this review is that while AUD is highly prevalent, seeking treatment for AUD is not. There are a myriad of behavioral and pharmacological treatments that have shown compelling evidence of efficacy for the treatment of AUD. In the behavioral treatment literature, cognitive behavioral therapy has received the most consistent support. Opioid antagonism (via naltrexone) has been the most widely studied pharmacotherapy and has produced moderate effect sizes. While none of the treatments reviewed herein represents a so-called silver bullet for AUD, they each have the potential to significantly improve the odds of recovery. Precision medicine, or the identification of best treatment matches for individual patients, looms as an important overarching goal for the field, although specific matches are not yet sufficiently reliable in their empirical evidence to warrant clinical dissemination.
Topics: Alcohol Deterrents; Alcohol-Related Disorders; Cognitive Behavioral Therapy; Combined Modality Therapy; Decision Trees; Humans; Naltrexone
PubMed: 30373394
DOI: 10.1080/00952990.2018.1528265 -
The American Journal of Medicine Feb 2000Primary care physicians are frequently involved in the longitudinal care of patients with alcohol problems and in helping patients to decrease their alcohol consumption.... (Review)
Review
Primary care physicians are frequently involved in the longitudinal care of patients with alcohol problems and in helping patients to decrease their alcohol consumption. Recent clinical trials provide evidence in support of new treatment strategies for these patients. Brief interventions have been used successfully to reduce alcohol consumption in patients with hazardous and harmful drinking. Twelve-step facilitation, cognitive behavioral, and motivational enhancement therapies have produced sustained drinking reductions in patients with alcohol dependence. Pharmacologic therapies, such as naltrexone and acamprosate, have been effective in decreasing alcohol consumption when provided along with psychosocial counseling in patients with alcohol dependence. The current review highlights the application of these new therapies to primary care physicians' efforts on behalf of their patients with alcohol problems.
Topics: Acamprosate; Alcohol Deterrents; Alcohol Drinking; Alcohol-Related Disorders; Clinical Trials as Topic; Humans; Naltrexone; Narcotic Antagonists; Primary Health Care; Psychotherapy; Research Design; Taurine; United States
PubMed: 10723977
DOI: 10.1016/s0002-9343(99)00448-9