A review of the pharmacologic options for the treatment of alcohol dependence

The chronic and excessive use of alcohol adversely affects the healthcare system, work productivity, and familial and social relationships. Alcohol misuse accounts for 85,000 deaths per year in the United States, and the overall financial costs related to alcohol dependence are more than $100 billion annually. The reduction of alcohol misuse can be measured as an increase in the frequency of abstinence or a reduction in the frequency of relapses. The recommendation for alcohol dependence treatment is a combination of psychosocial support therapy and pharmacologic treatment. Currently, there are only 3 FDA-approved agents for the treatment of alcohol dependence: naltrexone, acamprosate, and disulfiram, The literature suggests that there may be varying expectations for the potential beneficial outcomes associated with each of these medications. Treatment with naltrexone has consistently demonstrated a decrease in overall alcohol consumption and fewer relapses when compared with placebo. Acamprosate has been associated with an improvement in maintaining abstinence and more total days of continuous abstinence compared with placebo. Disulfiram treatment has yielded inconsistent results in reducing alcohol consumption when compared with placebo, and observed administration may be the only way to ensure compliance. In general, since disulfiram treatment has not demonstrated long-term efficacy and because of its risk for causing hepatotoxicity, it is not considered a first-line medication option. Other pharmacologic options with differing effects on neurotransmitters also are being studied. Each agent, with its unique mechanism of action, seems to play a role in treating alcohol dependence, either as monotherapy or as part of polypharmacy. Future research is necessary to help specify which patient characteristics will predict the most effective pharmacologic treatment plan for the management of alcohol dependence.