Authors' objectives:

This report focuses on the pharmacotherapies used for the treatment of alcohol dependence. The report is organized around a series of major clinical questions on the pharmacotherapy for alcohol dependence. They involve pharmaceutical agents that have been historically or are presently used in the treatment of alcoholism: disulfiram, the opiate antagonists naltrexone and nalmefene, serotonergic agents such as ondansetron, buspirone, and the selective serotonin reuptake inhibitors (SSRIs, such as citalopram, fluoxetine, paroxetine, sertraline, etc.), and lithium.

Authors' recommendations: Disulfiram - A substantial literature has been generated on the use of disulfiram in alcoholism, but the number of controlled clinical trials is limited. - Controlled clinical trials of disulfiram reveal mixed findings. There is little evidence that disulfiram enhances abstinence, but there is evidence that disulfiram reduces drinking days. - When measured, compliance is a strong predictor of outcome. - Studies of disulfiram implants are methodologically weak and generally without good evidence of bioavailability. - Studies of supervised disulfiram administration are provocative but limited. Naltrexone - Trials of naltrexone in the treatment of alcoholism are recent and of generally good quality. - There is good evidence that naltrexone reduces relapse and number of drinking days in alcohol-dependent subjects. - There is some evidence that naltrexone reduces craving and enhances abstinence in alcohol-dependent subjects. - There is good evidence that naltrexone has a favorable harms profile. Acamprosate - Trials of acamprosate in alcohol dependence are large but limited to European populations. - There is good evidence that acamprosate enhances abstinence and reduces drinking days in alcohol-dependent subjects. - There is minimal evidence on the effects of acamprosate on craving or rates of severe relapse in alcohol-dependent subjects. - There is good evidence that acamprosate is reasonably well tolerated and without serious harm. Serotonergic Agents - There are several controlled clinical trials of serotonergic agents in primary alcoholics without comorbid mood or anxiety disorders. - There is minimal evidence on the efficacy of serotonergic agents for treatment of the core symptoms of alcohol dependence. - There is some evidence on the efficacy of serotonergic agents for the treatment of alcohol-dependent symptoms in patients with comorbid mood or anxiety disorders, although the data are limited. Lithium - There are limited studies on the effects of lithium in primary alcoholics without comorbid mood disorders. - There is evidence that lithium is not efficacious in the treatment of the core symptoms of alcohol dependence. - There is minimal evidence for efficacy of lithium for the treatment of alcohol-dependent symptoms in patients with comorbid depression.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/

Year Published: 1999

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)