Garbutt JC. The state of pharmacotherapy for the treatment of alcohol dependence. J Subst Abuse Treat 36: S15-S23

University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Journal of substance abuse treatment (Impact Factor: 2.9). 02/2009; 36(1):S15-23; quiz S24-5.
Source: PubMed


Pharmacotherapy, in conjunction with psychosocial interventions, is emerging as a valuable tool for alcohol dependence treatment. Currently, four agents are approved by the Food and Drug Administration for this purpose: disulfiram, acamprosate, oral naltrexone, and the once-monthly injectable, extended-release naltrexone. All four agents have demonstrated some ability to reduce drinking and/or increase time spent abstinent, but results have not always been consistent. Except disulfiram, which has an aversive mechanism of action, effective pharmacotherapies for alcohol dependence are thought to work by blocking the rewards of alcohol or stabilizing systems dysregulated by chronic alcohol intake. Topiramate and baclofen have also demonstrated some efficacy in treating alcohol dependence. The efficacies of many of these regimens are modest and are limited by patient nonadherence to treatment and disease heterogeneity. Pharmacotherapeutic effectiveness could be enhanced through increased knowledge of the pathophysiology of alcohol dependence, through the identification of predictors of response to specific medications, and by modalities that improve medication adherence.

Download full-text


Available from: James C Garbutt, Jul 15, 2015
  • Source
    • "Alcoholism is a devastating illness with a profound impact on public health, for which the current pharmacotherapy appears of modest and limited efficacy as a result of patients' nonadherence to treatment (Garbutt, 2009). Notably, among the strategies aimed at the development of newer and more efficacious agents, an interesting one has been provided by the use of herbal remedies (Carai et al., 2000; Dhawan, 2003; Xu et al., 2005; Abenavoli et al., 2009), an approach that is based on the rationale that complementary and alternative medicine can make available agents that might be as efficacious as conventional drugs while having minimal side effects (NCCAM-NIH, Health info website: "

  • Source
    • "NTX, a complete opioid antagonist, is a medication that blocks endogenous opioids released through the brain's mesolimbic reward system (Pettinati & Rabinowitz, 2006), to reduce alcohol cravings in individuals with alcohol dependence (Olive, 2010; Richardson et al., 2008; Tambour & Quertemont, 2007). It is one of four evidence-based MAT used to treat alcohol dependence (Garbutt, 2009; Williams, 2005). NTX decreases days of heavy drinking (Anton et al., 2006) and alcohol relapse (Streeton & Whelan, 2001) and is superior to acamprosate and/or behavioral counseling (Anton et al., 2006). "
    [Show abstract] [Hide abstract]
    ABSTRACT: In Peru, the HIV epidemic is concentrated in men who have sex with men (MSM) and transgender women (TGW). Multiple studies correlate alcohol use disorders (AUDs) with risky sexual behaviors among Peruvian MSM. Qualitative research was used to inform a clinical trial on the acceptability of medication-assisted therapies to assist management of AUDs and improve antiretroviral therapy (ART) adherence among MSM/TGW in Peru. Three focus groups involving HIV-infected or HIV-uninfected MSM/TGW (n = 26) with AUDs (AUDIT ≥ 8) were transcribed, translated from Spanish into English, and analyzed using thematic content analysis. Despite having an AUD, participants considered themselves "social" drinkers, minimized their drinking behaviors, and differed about whether or not alcohol problems could be treated. Participants expressed skepticism about medication for treating AUDs. Three concepts emerged as necessary components of a treatment program for alcohol problems: cost, family support, and the potential to drink less alcohol without attaining total abstinence. This study reveals important areas of education to increase potential acceptability of a medication for treating AUDs among MSM/TGW. Given the social conditions and knowledge base of the participants, medication-assisted therapies using naltrexone may be a beneficial strategy for MSM with AUDs. © The Author(s) 2015.
    American journal of men's health 03/2015; DOI:10.1177/1557988315576775 · 1.15 Impact Factor
    • "OMMON APPROACHES FOR the treatment of alcohol dependence include individual or group psychotherapy (Martin and Rehm, 2012; Orchowski and Johnson, 2012), 1 of 4 FDA-approved medications (Garbutt, 2009), Alcoholics Anonymous (AA) or other mutual help organizations (Kelly and Yeterian, 2012), or some combination of these approaches. Despite major advances in research methodology and the development of effective psychotherapies and medications, many individuals who receive empirically supported treatment for alcohol dependence do not experience sustained reductions in drinking and associated problems (Litten et al., 2012). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Oral naltrexone is an efficacious medication for treatment of alcohol dependence, but small effect sizes and variability in outcomes suggest the presence of person-level moderators of naltrexone response. Identification of contextual or psychosocial moderators may assist in guiding clinical recommendations. Given the established importance of social networks in drinking outcomes, as well as the potential effects of naltrexone in reducing cue reactivity which may be especially important among those with more heavy drinkers and more alcohol cues in their networks, we examined pretreatment social network variables as potential moderators of naltrexone treatment effects in the COMBINE study.Methods The sample included all COMBINE study participants in medication conditions with full data on the Important People Inventory (IPI) and covariates at intake (N = 1,197). The intake IPI assessed whether participants had any frequent drinkers in their network and the average frequency of contact with these drinkers. The effects of treatment condition, pretreatment network variables, and their interactions on percent heavy drinking days were tested in hierarchical linear models, controlling for demographics and baseline clinical covariates.ResultsIn treatment conditions involving medical management and combined behavioral intervention (CBI), the effects of active naltrexone on heavy drinking were significantly greater for individuals with frequent drinkers in their network (z = −2.66, p < 0.01) and greater frequency of contact with those drinkers (z = −3.19, p < 0.01). These network variables did not moderate the effects of active naltrexone without CBI.Conclusions When delivered in conjunction with behavioral interventions, naltrexone can be more potent for alcohol-dependent adults who have greater contact with frequent drinkers prior to treatment, which may indicate patterns of environmental exposure to alcohol. Contextual, social risk factors are a potential avenue to guide personalized treatment of alcohol dependence.
    Alcoholism Clinical and Experimental Research 01/2015; 39(1). DOI:10.1111/acer.12605 · 3.21 Impact Factor
Show more