What are the strategies for preventing alcohol use disorder (AUD)?

From the Guidelines

Preventing alcohol use disorder (AUD) requires a comprehensive approach that includes limiting alcohol consumption, early intervention, and lifestyle modifications, with the most effective strategy being total alcohol abstinence, especially for those with risk factors such as family history of alcoholism, as recommended by the most recent and highest quality study 1. To prevent AUD, individuals should limit their alcohol consumption to moderate levels, defined as up to 1 drink daily for women and up to 2 drinks daily for men, or abstain completely if they have risk factors. Some key strategies for preventing AUD include:

• Developing healthy coping mechanisms for stress, such as exercise, meditation, or counseling, instead of using alcohol
• Seeking early intervention through screening tools like the AUDIT (Alcohol Use Disorders Identification Test) if concerning drinking patterns are noticed
• Building strong social connections and avoiding high-risk drinking environments
• Addressing underlying mental health issues, such as depression or anxiety, which can contribute to AUD Medications like naltrexone, acamprosate, and disulfiram may be used to help those already struggling with alcohol dependence, but they are not typically used for prevention. The AUDIT is considered the "gold standard" screening test for alcohol abuse and dependence, and brief motivational interventions should be routinely used in the medical management of alcohol use disorders, as recommended by 1. Total alcohol abstinence is the most effective recommendation for individuals with persistent alcohol intake and ALD, and medications like baclofen may be safe and effective in preventing alcohol relapse in patients with advanced ALD, as suggested by 1. Overall, preventing AUD requires a multi-faceted approach that prioritizes education, early intervention, and lifestyle modifications, with a focus on total alcohol abstinence for those with risk factors or existing ALD, as supported by the highest quality evidence 1.

From the FDA Drug Label

Although usually taken in the morning, disulfiram may be taken on retiring by patients who experience a sedative effect Alternatively, to minimize, or eliminate, the sedative effect, dosage may be adjusted downward. The daily, uninterrupted administration of disulfiram must be continued until the patient is fully recovered socially and a basis for permanent self-control is established Depending on the individual patient, maintenance therapy may be required for months or even years.

The strategies for preventing alcohol use disorder (AUD) include:

• Medication adherence: taking disulfiram as directed, without interruption, until the patient is fully recovered socially and has established a basis for permanent self-control 2
• Dose adjustment: adjusting the dosage of disulfiram downward to minimize or eliminate sedative effects 2
• Long-term maintenance therapy: continuing disulfiram therapy for months or even years, depending on the individual patient's needs 2

Acamprosate calcium delayed-release tablets proved superior to placebo in maintaining abstinence, as indicated by a greater percentage of subjects being assessed as continuously abstinent throughout treatment 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

Additional strategies for preventing AUD include:

• Acamprosate therapy: using acamprosate calcium delayed-release tablets as an adjunct to psychosocial therapy to maintain abstinence 3
• Psychosocial therapy: providing patients with psychosocial therapy in conjunction with acamprosate therapy to support maintenance of abstinence 3

Patients treated for alcohol dependence with naltrexone hydrochloride should also be assessed for underlying opioid dependence and for any recent use of opioids prior to initiation of treatment with naltrexone hydrochloride Precipitated opioid withdrawal has been observed in alcohol-dependent patients in circumstances where the prescriber had been unaware of the additional use of opioids or co-dependence on opioids

Further strategies for preventing AUD include:

• Assessment for opioid dependence: assessing patients for underlying opioid dependence and recent opioid use before initiating naltrexone therapy 4
• Opioid-free interval: ensuring an opioid-free interval of at least 7-10 days before starting naltrexone hydrochloride treatment in patients previously dependent on short-acting opioids 4

From the Research

Strategies for Preventing Alcohol Use Disorder (AUD)

The following strategies can be employed to prevent AUD:

• Primary prevention, which focuses on protecting healthy individuals from alcohol abuse and dependence, can be provided on a universal, selective, or indicated level 5
• Secondary prevention aims to prevent deterioration regarding alcoholic dependence and relapse in individuals already diagnosed with the condition, and can include counseling and structured help with the delivery of programs in schools and in high-risk groups for alcohol dependence 5
• Tertiary prevention focuses on minimizing deterioration of functioning in chronically suffering individuals from alcoholic dependence, and can include interventions such as motivational interviewing and alternative forms of treatment like acupuncture and meditation 5
• Pharmacotherapy, in conjunction with psychosocial interventions, can be a valuable tool for AUD treatment, with approved agents including disulfiram, acamprosate, oral naltrexone, and extended-release naltrexone 6
• Brief behavioral counseling can be provided to persons engaged in risky or hazardous drinking behaviors to reduce alcohol misuse 7

Medications for AUD Treatment

The following medications have been shown to be effective in treating AUD:

• Naltrexone, which reduces relapse rates and cravings, and increases abstinence rates 7, 8, 9, 6
• Acamprosate, which reduces relapse rates and increases abstinence rates 7, 8, 9, 6
• Disulfiram, which has been used for years but has inconsistent evidence supporting its effectiveness 7, 8, 9, 6
• Topiramate, which has demonstrated some efficacy in treating AUD 9, 6
• Baclofen, which has also demonstrated some efficacy in treating AUD 6
• Serotonergic agents, such as fluoxetine and ondansetron, which have been shown to increase abstinence rates and decrease drinking 9