Pharmacology of Alcohol Use Disorder

2020 ◽  
pp. 203-220
Author(s):  
Megan Lemay
Keyword(s):  
Alcohol Use ◽  
Alcohol Withdrawal ◽  
Alcohol Use Disorder ◽  
Behavioral Treatment ◽  
Treatment Plan ◽  
Medication Management ◽  
Outpatient Setting ◽  
Inpatient Setting ◽  
Standard Medication ◽  
Long Acting

Alcohol use disorder (AUD) is a common and costly disease. Alcohol withdrawal is a common complication of AUD. Alcohol withdrawal has primarily been managed in the inpatient setting, though evidence supports treatment in the outpatient setting for selected low-risk patients. Benzodiazepines are the gold standard medication class to prevent complications of alcohol withdrawal and may be given in symptom-triggered, fixed-schedule, and loading dose regimens. Medications for the treatment of AUD are effective and underutilized. There are three medications approved by the US Food and Drug Administration for AUD: naltrexone (available in short-acting oral and long-acting injectable formulations), acamprosate, and disulfiram. Naltrexone and acamprosate are preferred in most settings due to their efficacy and tolerability. Patients with moderate to severe AUD should be offered medication as part of their treatment plan along with a comprehensive history and physical, behavioral treatment, and mutual goal-setting. It is recommended that medications for AUD are continued for at least 6–12 months or until their risks outweigh their benefits. This chapter reviews the medication management of alcohol withdrawal and AUD in detail.

scholarly journals Sugar intake and craving during alcohol withdrawal in alcohol use disorder inpatients

2020 ◽  
Author(s):  
Régis Alarcon ◽  
Margaux Tiberghien ◽  
Raphael Trouillet ◽  
Stéphanie Pelletier ◽  
Amandine Luquiens ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Alcohol Withdrawal ◽  
Alcohol Use Disorder ◽  
Sugar Intake

scholarly journals The following abstracts were presented as posters at the 2018 NEI Congress

CNS Spectrums ◽  
2019 ◽  
Vol 24 (1) ◽  
pp. 175-175 ◽  
Keyword(s):  
Alcohol Use ◽  
Alcohol Use Disorder ◽  
Treatment Approaches ◽  
Adolescent Population ◽  
Scientific Poster ◽  
Long Acting

The 2018 NEI Congress would like to congratulate the following scientific poster winners:1stPlace:20 - The Need for Speed: Adjunctive Triple Chronotherapy. An Accelerated Intervention in the Treatment of Acute Depression in the Adolescent PopulationDiane Hurd, PMHNP; Mariela Herrera, MD; Nicholas Coombs, MS; Jeannine M. Brant, PhD, APRN, AOCN, FAAN; Eric Arzubi, MD2ndPlace:93 - Practical Outpatient Pharmacotherapy for Alcohol Use DisorderYoungjung Kim, MD, PhD; Laura Hack, MD, PhD; Elizabeth Ahn, MD; Jungjin Kim, MD3rdPlace:95 - Differential Aspects Between Schizophrenia Treatment Approaches: Oral Antipsychotics vs. Aripiprazole Long-Acting InjectableS Arques Egea; E Ros Cucurull; C Iranzo Tatay; C Parro-Torres; RF Palma-Álvarez; E Castrillo; MA Cantillo; P Aznar

scholarly journals Efficacy of long-acting, injectable versus oral naltrexone for preventing admissions for alcohol use disorder

2017 ◽  
Vol 7 (3) ◽  
pp. 106-110 ◽  
Author(s):  
Allison Beatty ◽  
Christopher Stock
Keyword(s):  
Health Care ◽  
Alcohol Use ◽  
Health Care Utilization ◽  
Alcohol Use Disorder ◽  
Randomized Trials ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Oral Naltrexone ◽  
Lower Health ◽  
Long Acting

Abstract Introduction: Approximately 17 million Americans and 300 000 veterans have an alcohol use disorder (AUD). Both oral naltrexone (NTX) and long-acting, injectable naltrexone (LAI NTX) are FDA-approved to treat AUD. LAI NTX is often reserved for patients with adherence concerns due to considerable differences in drug cost and administration requirements. To date, there are no randomized trials comparing efficacy of LAI NTX to oral NTX. This retrospective cohort study compared clinical outcomes in veterans treated with LAI NTX or oral NTX. Methods: Health care utilization in veterans at 1 Veterans Affairs facility treated for AUD with oral NTX and LAI NTX was compared. The primary outcome was 90-day alcohol-related hospital admissions per patient (ARA90). Secondary outcomes included 90-day outpatient clinic and emergency department visits and 30-day alcohol-related admissions (ARA30). Inclusion criteria included first-time prescription of NTX for AUD from January 1, 2015, through December 1, 2015. Veterans receiving concurrent acamprosate or disulfiram were excluded. Results: Seventy-nine patients were included with 65 in the oral NTX group and 14 in the LAI NTX group. The ARA90 was 0.17 for the oral NTX group and 0.64 for the LAI NTX group (P = .06). The oral NTX group had significantly fewer ARA30 than the LAI NTX group (P < .01). Oral NTX also had significantly lower health care utilization for all other parameters. Discussion: Oral NTX was associated with lower health care utilization compared to LAI NTX in this veteran population. This indicates that LAI NTX may not provide additional benefit justifying the cost. This study had several limitations. Randomized trials comparing efficacy between oral NTX and LAI NTX are needed.

Psychopharmacology for Substance Use Disorders

2021 ◽  
Author(s):  
Olapeju Simoyan ◽  
Krista Ulisse
Keyword(s):  
Substance Use ◽  
Alcohol Use ◽  
Alcohol Withdrawal ◽  
Alcohol Use Disorder ◽  
Maintenance Treatment ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Duration Of Symptoms ◽  
Stimulant Use

The illicit use of opioids is the fastest growing substance use problem in the United States. There are three FDA- approved medications for maintenance treatment for opioid use disorder: methadone, buprenorphine and naltrexone. Stimulants include cocaine and methamphetamines. 3,4-methylenedioxymethamphetamine (MDMA or “ecstasy”) is an amphetamine derivative that also has hallucinogenic properties. Treatment of stimulant withdrawal is primarily supportive. Psychosocial interventions for stimulant use disorder may improve adherence, but they have not been shown to improve abstinence at the end of treatment. Benzodiazepines have been shown to reduce the severity and duration of symptoms related to alcohol withdrawal, in addition to reducing the risk of seizures. The Food and Drug Administration has approved disulfiram, acamprosate and naltrexone for the treatment of alcohol use disorder. This review contains 3 tables, and 31 references. Keywords: Opioid use disorder, maintenance treatment for opioid use disorder, stimulant use disorder, stimulant withdrawal, benzodiazepine overdose, benzodiazepine withdrawal, alcohol use disorder, alcohol withdrawal

Alcohol withdrawal symptoms predict corticostriatal dysfunction that is reversed by prazosin treatment in alcohol use disorder

2021 ◽  
Author(s):  
Rajita Sinha ◽  
Nia Fogelman ◽  
Stephanie Wemm ◽  
Gustavo Angarita ◽  
Dongju Seo ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Alcohol Withdrawal ◽  
Alcohol Use Disorder ◽  
Withdrawal Symptoms

scholarly journals Naltrexone efficacy in treating alcohol-use disorder in individuals with comorbid psychosis: a systematic review

2017 ◽  
Vol 7 (8-9) ◽  
pp. 211-224 ◽  
Author(s):  
Martyna Sawicka ◽  
Derek K Tracy
Keyword(s):  
Alcohol Use ◽  
Alcohol Use Disorder ◽  
Evidence Base ◽  
Opioid Antagonist ◽  
Drinking Behaviour ◽  
Pharmaceutical Agent ◽  
Key Issues ◽  
Randomized Control ◽  
Long Acting ◽  
Study Designs

Background: Psychotic illnesses, such as schizophrenia, are typically enduring and disabling conditions, impacting individual, family, and societal outcomes. Individuals with these face greater vulnerabilities in developing alcohol-use disorder (AUD). Furthermore, the nature of psychoses, often manifesting with paranoia, cognitive impairment, a lack of insight, sub-optimal treatment adherence, and stigma from others, means that they can pose unique treatment challenges when these two conditions comorbidly occur. These challenges mean that the standard literature on the effectiveness of the opioid antagonist naltrexone in AUD does not necessarily translate to this vulnerable population. Methods: Following PRISMA guidelines, we herein systematically reviewed the evidence for naltrexone in individuals with both psychosis and AUD. Overall, there is a paucity of research in this important area, with only nine reports meeting search criteria, only four of which were randomized control trials. Studies compared naltrexone with: placebo, another pharmaceutical agent, or upon changes to baseline drinking behaviour. One study evaluated the long-acting injectable formulation of this drug. Results: Most studies, including the methodologically more robust ones, supported naltrexone’s effectiveness over placebo in terms of reduction in drinking days and numbers of drinks consumed on such days in this cohort. Work comparing naltrexone to other pharmaceutical interventions showed approximate equivalence with disulfiram, and modest superiority over acamprosate. Conclusions: On this limited evidence base, this review endorses the use of naltrexone as both safe and effective in those with both psychotic illnesses and AUD. Several key issues remain to be elucidated. Critically, study designs meant that they were limited to individuals with good engagement with services, and levels of adherence were attained that are unlikely to be replicated in this cohort in real-world settings. Finally, effects of specific psychosis symptomatology, not least paranoia and insight, upon naltrexone use, and the reverse directional potential of ‘double dysphoria’ from an opioid antagonist remain largely unexplored.

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