What are the options for alcohol cessation?

From the Guidelines

Alcohol cessation can be achieved through a combination of medical and non-medical approaches, with acamprosate being the most effective medication for maintaining abstinence, as supported by the most recent and highest quality study 1. Options for alcohol cessation include:

• Medical management: medications like naltrexone, acamprosate, and disulfiram can help reduce cravings and maintain abstinence
• Non-medical options: support groups like Alcoholics Anonymous (AA), cognitive behavioral therapy (CBT), motivational enhancement therapy, and residential rehabilitation programs
• Medically supervised detoxification for severe alcohol use disorder to safely manage potentially dangerous withdrawal symptoms
• A comprehensive approach combining medications with counseling and support groups typically yields the best outcomes The choice of treatment should be individualized based on the severity of alcohol dependence, presence of co-occurring conditions, previous treatment history, and personal preferences, as recommended by various studies 1. Some key points to consider:
• Benzodiazepines such as diazepam, lorazepam, or chlordiazepoxide are used for managing withdrawal symptoms during detoxification, typically over a 5-10 day tapering schedule
• Thiamine should be given to all patients with alcohol withdrawal syndrome (AWS) to prevent diminished cognitive function due to thiamine deficiency
• Brief interventions should be implemented to encourage abstinence or controlled drinking in hazardous drinkers and patients with alcohol use disorder
• Psychosocial support should be routinely offered to alcohol dependent patients, with more structured psychological interventions considered where providers have capacity.

From the FDA Drug Label

The efficacy of acamprosate calcium delayed-release tablets in the maintenance of abstinence was supported by three clinical studies involving a total of 998 patients who were administered at least one dose of acamprosate calcium delayed-release tablets or placebo as an adjunct to psychosocial therapy Naltrexone hydrochloride is a pure opioid antagonist. It markedly attenuates or completely blocks, reversibly, the subjective effects of intravenously administered opioids. The mechanism of action of naltrexone hydrochloride in alcoholism is not understood; however, involvement of the endogenous opioid system is suggested by preclinical data.

Alcohol Cessation Options:

• Acamprosate: used to maintain abstinence in alcohol-dependent patients
• Naltrexone: an opioid receptor antagonist that blocks the effects of opioids and is used as an aid to the treatment of alcoholism

2, 2, 3

From the Research

Alcohol Cessation Options

The following are options for alcohol cessation:

• Brief intervention, which is an effective form of treatment for excessive alcohol consumption prior to the development of dependency 4
• Motivational interviewing and cognitive therapy, which are likely to increase the effectiveness of treatment 4
• Twelve-Step Facilitation treatment programme, which is another effective method 4
• Supervised disulfiram medication, which significantly improves the results achieved with psychosocial therapies alone 4
• Naltrexone, which increases the number of non-drinking days and reduces relapses compared with a placebo, especially if the medication is combined with psychosocial treatment based on cognitive behaviour therapy 4, 5, 6
• Acamprosate, which improves the treatment results achieved with psychosocial therapies alone 4, 5, 6

Pharmacological Treatments

Pharmacological treatments for alcohol dependence include:

• Disulfiram, which has an equivocal evidence-base 5
• Naltrexone, which has a positive but modest evidence-base 5, 6
• Acamprosate, which shows modest efficacy with recently abstinent patients 5, 6
• Topiramate, which may be a promising candidate 7
• Baclofen, which may be a promising candidate 7

Individualised Treatment

Individualised treatment in alcohol-dependent patients may be based on biologically defined endophenotypes, such as:

• Naltrexone treatment, which seems more effective in carriers of a specific variant of the mu-opioid receptor gene 8
• Acamprosate treatment, which may be more effective in patients with a specific polymorphism 8
• Functional imaging, which may detect potential responders to naltrexone or acamprosate 8