Long Term Pharmacotherapy for Alcohol Use Disorder

The psychopharmacology of alcohol dependence is today poised at interesting crossroads. Three major drugs Naltrexone, Disulfiram and Acamprosate have been tried and tested in various trials and have many meta-analyses each to support them. While Naltrexone may reduce craving, Acamprosate scores on cost effectiveness worldwide with Disulfiram being an alcohol deterrent drug. Studies support, refute and criticize the use of each of these drugs. Combining one or more of them is also a trend seen. The most important factor in efficacy has been the combination of psychosocial treatment with medication. In this article, we are going to discuss about long term pharmacological management of chronic alcoholism.

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Extrastriatal Dopamine D2/3 Receptor Availability in Alcohol Use Disorder and Individuals at High Risk

Neuropsychobiology ◽

10.1159/000521103 ◽

2022 ◽

pp. 1-10

Author(s):

Gianna Spitta ◽

Tobias Gleich ◽

Kristin Zacharias ◽

Oisin Butler ◽

Ralph Buchert ◽

...

Keyword(s):

High Risk ◽

Alcohol Use ◽

Alcohol Use Disorder ◽

Protective Factor ◽

Region Of Interest ◽

Anterior Cingulate ◽

Dopamine D2 ◽

Positron Emission ◽

Significant Difference ◽

Meta Analyses

Introduction: Reduced striatal dopamine D2/3 receptor availability in alcohol use disorder (AUD) has been demonstrated in recent clinical studies and meta-analyses. However, only a limited number of studies investigated extrastriatal D2/3 availability in AUD or in at-risk populations. In line with a dimensional understanding of addiction, extrastriatal dopaminergic neuroadaptations have been suggested to be relevant from a pathobiological perspective. Methods: We investigated D2/3 receptor availability via 18F-fallypride positron emission tomography applying a region of interest (ROI) approach. We selected ROIs for the prefrontal cortex (PFC) and the anterior cingulate cortex (ACC). Our sample included 19 healthy controls (low risk [LR]), 19 individuals at high risk (HR) to develop addiction, and 20 recently detoxified AUD patients. Results: We found significantly higher D2/3 receptor availability of HR compared to AUD in the left and right rostral ACC (rACC), as well as in the left ventrolateral PFC (vlPFC). We did not observe a significant difference between AUD and LR. After corrections for multiple comparisons none of the ROIs reached significance throughout the group comparison. The D2/3 receptor availability in the left rACC was inversely correlated with symptom severity assessed with the Alcohol Dependency Scale. Discussion: To our knowledge, the present work is the first study investigating extrastriatal D2/3 receptor availabilities in individuals at HR and patients with AUD. The observation that D2/3 receptor availabilities are highest in HR might suggest that their pathobiology differs from subjects with AUD. Future studies are necessary to clarify the intraindividual course of this biomarker over different disease stages and its possible role as a risk or protective factor.

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Residual alcohol use disorder symptoms after treatment predict long‐term drinking outcomes in seniors with DSM‐5 alcohol use disorder

Alcoholism Clinical and Experimental Research ◽

10.1111/acer.14722 ◽

2021 ◽

Author(s):

Silke Behrendt ◽

Alexis Kuerbis ◽

Barbara Braun‐Michl ◽

Randi Bilberg ◽

Gerhard Bühringer ◽

...

Keyword(s):

Alcohol Use ◽

Alcohol Use Disorder ◽

Dsm 5 ◽

Drinking Outcomes

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Stability of Drinking Reductions and Long-term Functioning Among Patients with Alcohol Use Disorder

Journal of General Internal Medicine ◽

10.1007/s11606-020-06331-x ◽

2020 ◽

Author(s):

Katie Witkiewitz ◽

Henry R. Kranzler ◽

Kevin A. Hallgren ◽

Deborah S. Hasin ◽

Arnie P. Aldridge ◽

...

Keyword(s):

Quality Of Life ◽

Alcohol Use ◽

Alcohol Use Disorder ◽

Well Being ◽

Total Sample ◽

World Health ◽

End Of Treatment

Abstract Background The World Health Organization (WHO) categorizes alcohol consumption according to grams consumed into low-, medium-, high-, and very-high-risk drinking levels (RDLs). Although abstinence has been considered the ideal outcome of alcohol treatment, reductions in WHO RDLs have been proposed as primary outcomes for alcohol use disorder (AUD) trials. Objective The current study examines the stability of WHO RDL reductions and the association between RDL reductions and long-term functioning for up to 3 years following treatment. Design and Participants Secondary data analysis of patients with AUD enrolled in the COMBINE Study and Project MATCH, two multi-site, randomized AUD clinical trials, who were followed for up to 3 years post-treatment (COMBINE: n = 694; MATCH: n = 806). Measures Alcohol use was measured via calendar-based methods. We estimated all models in the total sample and among participants who did not achieve abstinence during treatment. Key Results One-level RDL reductions were achieved by 84% of patients at the end of treatment, with 84.9% of those individuals maintaining that reduction at a 3-year follow-up. Two-level RDL reductions were achieved by 68% of patients at the end of treatment, with 77.7% of those individuals maintaining that reduction at a 3-year follow-up. One- and two-level RDL reductions at the end of treatment were associated with significantly better mental health, quality of life (including physical quality of life), and fewer drinking consequences 3 years after treatment (p < 0.05), as compared to no change or increased drinking. Conclusion AUD patients can maintain WHO RDL reductions for up to 3 years after treatment. Patients who had WHO RDL reductions functioned significantly better than those who did not reduce their drinking. These findings are consistent with prior reports suggesting that drinking reductions, short of abstinence, yield meaningful improvements in patient health, well-being, and functioning.

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Evaluation of childhood traumatic experience as a risk factor for alcohol use disorder in adulthood

BMC Psychiatry ◽

10.1186/s12888-020-2428-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Lan Wang ◽

Cui-Xia An ◽

Mei Song ◽

Na Li ◽

Yuan-Yuan Gao ◽

...

Keyword(s):

Risk Factors ◽

Alcohol Use ◽

Alcohol Abuse ◽

Alcohol Dependence ◽

Physical Abuse ◽

Emotional Abuse ◽

Alcohol Use Disorder ◽

Alcohol Use Disorders ◽

Traumatic Experience ◽

Frequent Drinking

Abstract Background We aimed to investigate the effect of early-age (prenatal, infant, and childhood) trauma on adulthood alcohol use disorder. Methods A total number of 1534 subjects who were born and live in the city of Tangshan were selected. The subjects were divided into three age groups. General demographic data, conditions of the mothers during pregnancy, and condition of the babies at birth, were collected. The diagnosis of alcohol use disorder was based on Structured Clinical Interviews for DSM-IV Axis Disorders (patient version) (SCID). The childhood trauma questionnaire short form (CTQ-SF) [1] and the Lifetime of Experience Questionnaire (LTE-Q) [2] were used to evaluate stress in childhood and adulthood, respectively. Results Only male subjects were diagnosed with lifelong alcohol abuse and alcohol dependence. There was no statistically significant difference in the prevalence of lifetime alcohol use disorder (X2 = 4.480, P = 0.345), current alcohol abuse, and current alcohol dependence among the three groups (X2abuse = 2.177, X2depedence = 2.198, P > 0.05). However, higher prevalence of lifetime alcohol use disorders was found in group with higher scores of CTQ (X2 = 9.315, P = 0.009), emotional abuse (X2 = 8.025, P = 0.018), physical abuse (X2 = 20.4080, P < 0.001), but not in the group with higher scores of emotional neglect (X2 = 1.226, P = 0.542), sexual abuse (X2 = 2.779, P = 0.249), physical neglect (X2 = 3.978, P = 0.137), LTE-Q (X2 = 5.415, P = 0.067), and PSQI (X2 = 5.238, P = 0.073). Protective factor for alcohol abuse for men was identified to be heavy drinking (OR = 0.085, 95%CI: 0.011–0.661), and the risk factors for alcohol abuse were identified to be frequent drinking (OR = 2.736, 95%CI: 1.500, 4.988), and consumption of low liquor (OR = 2.563, 95%CI: 1.387, 4.734). Risk factors for alcohol dependence in males were identified to be consumption of low liquor (OR = 5.501, 95%CI: 2.004, 15.103), frequent drinking (OR = 2.680, 95%CI: 1.164, 6.170), and childhood physical abuse (OR = 2.310, 95% CI: 1.026, 5.201). Conclusion Traumatic experience during infant and prenatal periods does not have a strong statistical correlation with alcohol use disorders for male adults. However, subjects with high CTQ scores, experience of emotional abuse and physical abuse show a statistically higher prevalence of lifetime alcohol use disorders. Several risk factors including consumption of low liquor, frequent drinking, and childhood physical abuse contribute to alcohol dependence in male adults.

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Universal family-focused interventions in alcohol-use disorder prevention: cost-effectiveness and cost-benefit analyses of two interventions.

Journal of Studies on Alcohol ◽

10.15288/jsa.2002.63.219 ◽

2002 ◽

Vol 63 (2) ◽

pp. 219-228 ◽

Cited By ~ 91

Author(s):

Richard L Spoth ◽

Max Guyll ◽

Susan X Day

Keyword(s):

Cost Effectiveness ◽

Alcohol Use ◽

Alcohol Use Disorder ◽

Cost Benefit ◽

Universal Family ◽

Disorder Prevention

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Group Versus Standard Behavioral Couples’ Therapy for Alcohol Use Disorder Patients: Cost-Effectiveness

Journal of Studies on Alcohol and Drugs ◽

10.15288/jsad.2020.81.152 ◽

2020 ◽

Vol 81 (2) ◽

pp. 152-163

Author(s):

Laura J. Dunlap ◽

Timothy J. O’Farrell ◽

Jeremiah A. Schumm ◽

Stephen S. Orme ◽

Marie Murphy ◽

...

Keyword(s):

Cost Effectiveness ◽

Alcohol Use ◽

Couples Therapy ◽

Alcohol Use Disorder ◽

Group Versus ◽

Behavioral Couples Therapy

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Alcohol craving and the dimensionality of alcohol disorders

Psychological Medicine ◽

10.1017/s003329171000053x ◽

2010 ◽

Vol 41 (3) ◽

pp. 629-640 ◽

Cited By ~ 61

Author(s):

K. M. Keyes ◽

R. F. Krueger ◽

B. F. Grant ◽

D. S. Hasin

Keyword(s):

Alcohol Use ◽

Alcohol Dependence ◽

Latent Variable ◽

Alcohol Use Disorder ◽

Alcohol Problems ◽

Continuous Measure ◽

Alcohol Disorders ◽

Alcohol Craving ◽

Epidemiologic Survey ◽

Dsm Iv

BackgroundICD-10 includes a craving criterion for alcohol dependence while DSM-IV does not. Little is known about whether craving fits with or improves the DSM-IV criteria set for alcohol-use disorders.MethodData were derived from current drinkers (n=18 352) in the 1991–1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES), a nationally representative survey of US adults >17 years of age. The Alcohol Use Disorder and Associated Disabilities Interview Schedule was used to assess the eleven DSM-IV dependence and abuse criteria, and alcohol craving. Exploratory factor, item response theory, and regression analyses were used to evaluate the psychometric properties and concurrent validity of DSM-based alcohol disorder criteria with the addition of alcohol craving.ResultsThe past 12-month prevalence of craving was 1.3%. Craving formed part of a unidimensional latent variable that included existing DSM-IV criteria. Craving demonstrated high severity on the alcohol-use disorder continuum, resulting in an improved dimensional model with greater discriminatory ability compared with current DSM-IV criteria. Correlates of the diagnosis did not change with the addition of craving, and past 12-month craving was associated with prior alcohol dependence, depression, and earlier age of alcohol disorder onset among those with current DSM-IV alcohol dependence.ConclusionsThe addition of craving to the existing DSM-IV criteria yields a continuous measure that better differentiates individuals with and without alcohol problems along the alcohol-use disorder continuum. Few individuals are newly diagnosed with alcohol dependence given the addition of craving, indicating construct validity but redundancy with existing criteria.

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Connections between personality and the symptomatology of alcohol use disorder

European Psychiatry ◽

10.1016/s0924-9338(11)71782-5 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 71-71

Author(s):

E. Kurgyis ◽

B. Andó ◽

S. Rózsa ◽

A. Szkaliczki ◽

I. Demeter ◽

...

Keyword(s):

Alcohol Use ◽

Alcohol Dependence ◽

Symptom Severity ◽

Impulse Control ◽

Alcohol Use Disorder ◽

Specific Impulse ◽

Personality Factors ◽

Clinical Aspects ◽

Novelty Seeking ◽

Dsm Iv

IntroductionTemperament and character factors and specific impulse control-related personality traits are connected to the developmental and clinical aspects of alcohol use disorder (AUD).Objectives/aimsTo reveal the underlying personality structure of individual differences in the symptom severity of AUD. Therefore temperament and character, impulsivity and aggression were assessed in relation to alcohol addiction severity.MethodsSixty-three patients with AUD were involved. Temperament and Character Inventory-Revised was used to quantify temperament and character dimensions. Impulsivity was assessed by the Barratt Impulsivity Scale-11 (BIS) and aggression by the Buss-Perry Aggression Questionnaire (BPAQ). To determine symptom severity of AUD the Severity of Alcohol Dependence Questionnaire (SADQ), the Alcohol Use Disorders Identification Test (AUDIT), the MacAndrew Alcoholism Scale-Revised (MAC-R) and the number of DSM-IV alcohol dependence symptoms were registered. To analyze the connections between symptom severity indicators and personality factors Pearson and Spearman correlation analysis were applied, p < 0.05 were considered significant.ResultsSADQ (r = 0.290), AUDIT (r = 0.345), MAC-R (r = 0.504) and the DSM-IV alcohol dependence symptoms (Spearman rho = 0.271) correlated positively with novelty-seeking temperament factor. SADQ (r = 0.262) and AUDIT (r = 0.293) scores correlated positively with BIS. Furthermore SADQ (r = 0.382), AUDIT (r = 0.318), MAC-R (r = 0.416) correlated positively with BPAQ.ConclusionsNovelty-seeking, impulsivity and aggression as indicators of impulse control have different theoretical backgrounds but a common root. This study has revealed that the adverse consequences of lower impulse control can lead to more severe symptoms of AUD. These connections between impulse control and the symptomatology could contribute to a better understanding of the clinical complexity of AUD.

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