Alcohol Pharmacotherapies

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Addressing Unhealthy Alcohol Use in Primary Care
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Abstract

Increasingly, some cases of alcohol use disorders can be conceptualized as chronic diseases that can be controlled and managed with the help of effective medications. These can be used in concert with comprehensive psychosocial therapies and other specialized addiction treatments, but also within more simplified, medical management models in primary care settings. While few individuals with alcohol dependence, and fewer still with alcohol abuse or hazardous drinking access alcohol pharmacotherapies, there is robust evidence that these medications should be in much wider use. National screening and brief intervention guidelines for primary care settings now emphasize these pharmacotherapy options.

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References

  1. National Institute on Alcohol Abuse and Alcoholism. Alcohol use and alcohol use disorders in the United States: main findings from the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions NESARC. US Alcohol Epidemiologic Data Reference Manual 8(1). Bethesda: National Institutes of Health; 2006. NIH Publication no. 05-5737.

    Google Scholar 

  2. National Institute on Alcohol Abuse and Alcoholism. Hel** patients who drink too much: A clinician's guide, Updated 2005 Edition. 2007; NIH Publication No. 07–3769.http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/guide.pdf.Accessed 4 Aug 2011.

  3. Rosenthal R. Alcohol abstinence management. In: Ruiz P, Strain E, Wolters, editors. Lowinson and Ruiz's Substance Abuse: a Comprehensive Textbook 5th ed..; 2011.

    Google Scholar 

  4. Kranzler H, Ciraulo D, Jaffe J. Medications for use in alcohol rehabilitation. In: Ries R, Fiellin D, Miller S, Saitz R. Wolters, editors. Principles of Addiction Medicine. Philadelphia, PA 4th ed., 2009.

    Google Scholar 

  5. Garbutt JC. The state of pharmacotherapy for the treatment of alcohol dependence. J Subs Abuse Treatment. 2009;36(S1):S15–S23.

    Google Scholar 

  6. McBride WJ, Le AD, Noronha A. Central nervous system in alcohol relapse. Alcohol Clinical Exp Res. 2002;26:280–286.

    Article  CAS  Google Scholar 

  7. Arias A, Feinn R, Kranzler HR. Association of an Asn40Asp (A118G) polymorphism in the mu-opioid receptor gene with substance dependence: a meta-analysis. Drug Alcohol Depend. 2006;83(3):262–268.

    Article  PubMed  CAS  Google Scholar 

  8. Myrick H, Anton RF, Li X, Henderson S, Randall PK, Voronin K. Effect of naltrexone and ondansetron on alcohol cue-induced activation of the ventral striatum in alcohol-dependent people. Arch Gen Psychiatry. 2008;65(4):466–475.

    Article  PubMed  CAS  Google Scholar 

  9. McCaul ME, Wand GS, Stauffer R, Lee SM, Rohde CA. Naltrexone dampens ethanol-induced cardiovascular and hypothalamic-pituitary-adrenal axis activation. Neuropsychopharmacol. 2001;25(4):537–547.

    Article  CAS  Google Scholar 

  10. Davidson D, Palfai T, Bird C, Swift R. Effects of naltrexone on alcohol self-administration in heavy drinkers. Alcohol Clin Exp Res. 1999;23(2):195–203.

    Article  PubMed  CAS  Google Scholar 

  11. Oslin DW, Berrettini W, Kranzler HR, Pettinati H, Gelernter J, Volpicelli JR, O’Brien CP. A functional polymorphism of the mu-opioid receptor gene is associated with naltrexone response in alcohol-dependent patients. Neuropsychopharmacology. 2003;28(8):1546–1552.

    Article  PubMed  CAS  Google Scholar 

  12. Anton RF, Oroszi G, O’Malley SS, Couper D, Swift R, Pettinati H, Goldman D. An evaluation of mu-opioid receptor (OPRM1) as a predictor of naltrexone response in the treatment of alcohol dependence: results from the Combined pharmacotherapies and behavioral interventions for Alcohol Dependence (COMBINE) study. Arch Gen Psychiatry. 2008;65(2):135–144.

    Article  PubMed  CAS  Google Scholar 

  13. Gelernter J, Kranzler H, Cubells J. Genetics of two mu opioid receptor gene (OPRM1) exon I polymorphisms: population studies, and allele frequencies in alcohol- and drug-dependent subjects. Mol Psychiatry. 1999;4(5):476–83.

    Article  PubMed  CAS  Google Scholar 

  14. Anton RF, O’Malley SS, Ciraulo DA, Cisler RA, Couper D, Donovan DM, et al. Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE controlled study: a randomized trial. JAMA. 2006;295(17):2003–2017.

    Article  PubMed  CAS  Google Scholar 

  15. Rösner S, Hackl-Herrwerth A, Leucht S, Vecchi S, Srisurapanont M, Soyka M. Opioid antagonists for alcohol dependence. Cochrane Database Syst Rev. 2010;(12):CD001867.

    PubMed  Google Scholar 

  16. Srisurapanont M, Jarusuraisin N. Naltrexone for the treatment of alcoholism: a meta-analysis of randomized controlled trials. Int J Neuropsychopharmacol. 2005;8(2):267–280.

    Article  PubMed  CAS  Google Scholar 

  17. Krystal JH, Cramer JA, Krol WF, Kirk GF, Rosenheck RA. Naltrexone in the treatment of alcohol dependence. NEJM. 2001;345(24):1734–1739.

    Article  PubMed  CAS  Google Scholar 

  18. Kranzler HR, Stephenson JJ, Montejano L, Wang S, Gastfriend DR. Persistence with oral naltrexone for alcohol treatment: implications for health-care utilization. Addiction. 2008;103(11):1801–1808.

    Article  PubMed  Google Scholar 

  19. Harris KM, DeVries A, Dimidjian K. Datapoints: trends in naltrexone use among members of a large private health plan. Psychiatr Serv. 2004;55(3):221.

    Article  PubMed  Google Scholar 

  20. Hermos JA, Young MM, Gagnon DR, Fiore LD. Patterns of dispensed disulfiram and naltrexone for alcoholism treatment in a veteran patient population. Alcohol Clin Exp Res. 2004;28:1229–1235.

    Article  PubMed  CAS  Google Scholar 

  21. National Institute on Drug Abuse. Narcotic antagonists: naltrexone pharmacochemistry and sustained-release preparations. In: Willette R, Barnett G, editors. DHS, NIDA research monograph, Vol. 28;1981.

    Google Scholar 

  22. Garbutt JC, Kranzler HR, O’Malley SS, Gastfriend DR, Pettinati HM, Silverman BL, et al. Efficacy and tolerability of long-acting injectable naltrexone for alcohol dependence: a randomized controlled trial. JAMA. 2005;293(13):1617–1625.

    Article  PubMed  CAS  Google Scholar 

  23. Lee JD, Grossman E, DiRocco D, Truncali A, Hanley K, Stevens D, Rotrosen J, Gourevitch MN. Extended-release Naltrexone for treatment of alcohol dependence in primary care. J Subst Abuse Treat. 2010;39(1):14–21.

    Article  PubMed  CAS  Google Scholar 

  24. Food and Drug Administration. Naltrexone Injection Site Reactions [naltrexone for extended-release injectable suspension (marketed as Vivitrol)]–Healthcare Professional Sheet. FDA Alert. http://ww.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm126446.htm. Accessed 8 Dec 2008.

  25. Mann K, Lehert P, Morgan MY. The efficacy of acamprosate in the maintenance of abstinence in alcohol-dependent individuals: results of a meta-analysis. Alcohol Clin Exp Res. 2004;28:51–63.

    Article  PubMed  Google Scholar 

  26. Mason BJ, Goodman AM, Chabac S, Lehert P. Effect of oral acamprosate on abstinence in patients with alcohol dependence in a double-blind, placebo-controlled trial: the role of patient motivation. J Psychiatric Res. 2006;40:383–393.

    Article  Google Scholar 

  27. Fuller Rk, Branchey L, Brightwell DR, et al. Disulfiram treatment of alcoholism: a veterans administratinon cooperative study. J Am Med Assoc. 1986;256:1449–1455.

    Article  CAS  Google Scholar 

  28. Chick J, Gough K, Falkowski W, Kershaw P, Hore B, Mehta B, Ritson B, Ropner R, Torley D. Disulfiram treatment of alcoholism. Br J Psychiatry. 1992;161:84–89.

    Article  PubMed  CAS  Google Scholar 

  29. Besson J, Aeby F, Kasas A, Lehert P, Potgieter A. Combined efficacy of acamprosate and disulfiram in the treatment of alcoholism: a controlled study. Alcohol Clin Exp Res. 1998;22(3):573–579.

    Article  PubMed  CAS  Google Scholar 

  30. Krampe H, Ehrenreich H. Supervised disulfiram as adjunct to psychotherapy in alcoholism treatment. Curr Pharm Des. 2010;16(19):2076–2090.

    Article  PubMed  CAS  Google Scholar 

  31. Johnson BA, Rosenthal N, Capece JA, Wiegand F, Mao L, Beyers K, McKay A, Ait-Daoud N, Anton RF, Ciraulo DA, Kranzler HR, Mann K, O'Malley SS, Swift RM. Topiramate for Alcoholism Advisory Board; Topiramate for Alcoholism Study Group. Topiramate for treating alcohol dependence: a randomized controlled trial. JAMA. 2007;298(14):1641–1651.

    Article  PubMed  CAS  Google Scholar 

  32. Anton RF, Myrick H, Wright TM, Latham PK, Baros AM, Waid LR, Randall PK. Gabapentin combined with naltrexone for the treatment of alcohol dependence. Am J Psychiatry. 2011;168(7):709–717.

    Article  PubMed  Google Scholar 

  33. Addolorato G, Leggio L, Ferrulli A, Cardone S, Bedogni G, Caputo F, Gasbarrini G, Landolfi R. Baclofen Study Group, dose-response effect of baclofen in reducing daily alcohol intake in alcohol dependence: secondary analysis of a randomized, double-blind, placebo-controlled trial  Alcohol Alcohol. 2011;46(3):312–317.

    CAS  Google Scholar 

  34. Knudsen HK, Abraham AJ, Roman PM. Adoption and implementation of medications in addiction treatment programs. J Addict Med. 2011;5(1):21–27.

    Article  PubMed  Google Scholar 

  35. Fitzgerald JP, McCarty D. Understanding attitudes towards use of medication in substance abuse treatment: a multilevel approach. Psychol Serv. 2009;6(1):74–84.

    Article  PubMed  Google Scholar 

  36. Abraham AJ, Rieckmann T, McNulty T, Kovas AE, Roman PM. Counselor attitudes toward the use of naltrexone in substance abuse treatment: a multi-level modeling approach. Addict Behav. 2011;36(6):576–583.

    Article  PubMed  Google Scholar 

  37. Knudsen HK, Studts CR, Studts JL. The implementation of smoking cessation counseling in substance abuse treatment. J Behav Health Serv Res. 2011, E pub ahead of print.

    Google Scholar 

  38. Weiss RD. Adherence to pharmacotherapy in patients with alcohol and opiod dependence. Addiction. 2004;99:1382–1392.

    Article  PubMed  Google Scholar 

  39. Peterson AM. Improving adherence in patients with alcohol dependence: a new role for pharmacists. Am J Health Syst Pharm. 2007;64(5 Suppl 3):S23–29.

    Article  PubMed  Google Scholar 

  40. Project MATCH research group. Matching alcoholism treatments to client heterogeneity: Project MATCH three-year drinking outcomes. Alcohol Clinical Exp Res. 1998;22:1300–1311.

    Article  Google Scholar 

  41. Kranzler HR, Armeli S, Tennen H, Blomqvist O, Oncken C, Petry N, Feinn R. Targeted naltrexone for early problem drinkers. J Clin Psychopharmacol. 2003;23(3):294–304.

    PubMed  CAS  Google Scholar 

  42. Kranzler HR, Tennen H, Penta C, Bohn MJ. Targeted naltrexone treatment of early problem drinkers. Addict Behav. 1997;22(3):431–436.

    Article  PubMed  CAS  Google Scholar 

  43. Tidey JW, Monti PM, Rohsenow DJ, Gwaltney CJ, Miranda R Jr, McGeary JE, MacKillop J, Swift RM, Abrams DB, Shiffman S, Paty JA. Moderators of naltrexeone’s effects on drinking, urge, and alcohol effects in non-treatment-seeking heavy drinkers in the natural environment. Alcohol Clin Exp Res. 2008;32(1):58–66.

    Article  PubMed  CAS  Google Scholar 

  44. O’Malley SS, Krinhnan-Sarin S, McKee SA, et al. Dose-dependent reduction of hazardous alcohol in a placebo-controlled trial of naltrexone for smoking cessation. Int J Neuropsychoparmacol. 2009;12(5):489–497.

    Google Scholar 

  45. Heinälä P, Alho H, Kiianmaa K, Lönnqvist J, Kuoppasalmi K, Sinclair JD. Targeted use of naltrexone without prior detoxification in the treatment of alcohol dependence: a factorial double-blind, placebo-controlled trial. J Clin Psychopharmacol. 2001;21(3):287–292.

    Article  PubMed  Google Scholar 

  46. Falk D, Wang XQ, Liu L, Fertig J, Mattson M, Ryan M, Johnson B, Stout R, Litten RZ. Percentage of subjects with no heavy drinking days: evaluation as an efficacy endpoint for alcohol clinical trials. Alcohol Clin Exp Res. 2010;34(12):2022–2034.

    Article  PubMed  Google Scholar 

  47. Donovan D, Mattson ME, Cisler RA, Longabaugh R, Zweben A. Quality of life as an outcome measure in alcoholism treatment research. J Stud Alcohol Suppl. 2005;15:119–139.

    PubMed  Google Scholar 

  48. Zarkin GA, et al. The effect of alcohol treatment on social costs of alcohol dependence. Medical Care. 2010; 48(5):396-401.

    Google Scholar 

  49. Mark TL, et al. Comparison of healthcare utilization among patients treated with alcohol medications. Am J Managed Care. 2010; 16(12): 879-68.

    Google Scholar 

  50. Baser O, Chalk M, Rawson R, Gastfriend DR. Alcohol dependence treatments: comprehensive healthcare costs, utilization outcomes, and pharmacotherapy persistence. Am J Manag Care. 2011;17(8 Suppl):S222–S234.

    PubMed  Google Scholar 

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Correspondence to Joshua D. Lee MSc .

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Brock, D., Tofighi, B., Lee, J., Fastenberg, J. (2013). Alcohol Pharmacotherapies. In: Saitz, R. (eds) Addressing Unhealthy Alcohol Use in Primary Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4779-5_5

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  • DOI: https://doi.org/10.1007/978-1-4614-4779-5_5

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