What are the treatment options for Alcohol Use Disorder (AUD)?

From the Guidelines

Treatment for Alcohol Use Disorder (AUD) should prioritize baclofen (30-60 mg/d) as a first-line medication, especially in patients with advanced Alcoholic Liver Disease (ALD), due to its safety and efficacy in preventing alcohol relapse, as demonstrated in a randomized trial 1.

Medications for AUD

• Baclofen: 30-60 mg/d, a GABA-B receptor agonist, has shown benefit in patients with ALD, with improved rates of total alcohol abstinence and decreased relapse compared to control 1.
• Acamprosate: 666 mg tid, an NMDA receptor antagonist, may be safe in patients with ALD, but its efficacy in this population is not well-studied 1.
• Naltrexone: 50 mg/d orally or 380 mg monthly sq, an opioid receptor antagonist, is not recommended in patients with ALD due to hepatotoxicity concerns 1.

Therapy and Support

• Cognitive Behavioral Therapy (CBT): 12-16 weekly sessions to identify and change drinking triggers and behaviors.
• Motivational Enhancement Therapy (MET): 4-6 sessions to build motivation for change.
• Contingency Management: provides tangible rewards for sobriety.
• Support groups: such as Alcoholics Anonymous or SMART Recovery offer ongoing community support.

Treatment Approach

• Treatment should be individualized based on severity, comorbidities, and patient preferences.
• Regular follow-up appointments are essential to monitor progress, adjust treatment as needed, and address any medication side effects or challenges to recovery.
• Integrating AUD treatment with medical care remains the best option for management of advanced ALD and AUD, although it may not be practical in all resource settings 1.

From the FDA Drug Label

To achieve the best possible treatment outcome, appropriate compliance-enhancing techniques should be implemented for all components of the treatment program, especially medication compliance. Treatment of Alcoholism A dose of 50 mg once daily is recommended for most patients The placebo-controlled studies that demonstrated the efficacy of naltrexone hydrochloride as an adjunctive treatment of alcoholism used a dose regimen of naltrexone hydrochloride 50 mg once daily for up to 12 weeks.

Treatment for AUD: Naltrexone hydrochloride is recommended as an adjunctive treatment for alcoholism, with a dose of 50 mg once daily for up to 12 weeks.

• The treatment should be part of a comprehensive plan that includes measures to ensure patient compliance.
• Factors associated with a good outcome include the type, intensity, and duration of treatment, management of comorbid conditions, use of community-based support groups, and good medication compliance 2.
• Naltrexone hydrochloride has been shown to support abstinence, prevent relapse, and decrease alcohol consumption in clinical studies 2.

From the Research

Treatment Options for Alcohol Use Disorder (AUD)

• There are several medications approved by the US Food and Drug Administration (FDA) to treat AUD, including disulfiram, naltrexone, and acamprosate 3, 4, 5, 6.
• In addition to these approved medications, researchers have identified new therapeutic targets and are evaluating alternative medications, such as nalmefene, varenicline, gabapentin, topiramate, and baclofen, for the treatment of AUD 3, 4, 5.
• These medications have shown mixed efficacy, with some demonstrating good efficacy and mild to moderate side effects, while others have mixed or promising results but require further study 3, 4.
• Pharmacogenetic approaches, which use a patient's genetic makeup to inform medication selection, have garnered interest but have yet to yield robust results for incorporation into routine clinical care 5.

Challenges and Solutions in AUD Treatment

• Despite the availability of effective treatments, AUD remains under-treated, with a significant treatment gap 7, 6.
• Challenges facing the alcohol field include increasing access to treatment, de-stigmatizing AUD, and improving education for healthcare professionals and the public about alcohol misuse 7.
• Solutions include broadening endpoints for medication approval, increasing screening and brief intervention, and implementing a heuristic definition of recovery 7.
• Engaging early treatment and educating healthcare professionals and the public about AUD are also crucial for addressing the treatment gap 7, 6.

Medications for AUD

• Opioid antagonists, such as naltrexone and nalmefene, have consistent evidence supporting their use in reducing drinking frequency and heavy drinking 5.
• Topiramate has also demonstrated consistent small to moderate effects in reducing drinking frequency and heavy drinking 5, 6.
• Other medications, such as gabapentin, baclofen, and acamprosate, may be effective in reducing alcohol consumption, but require further study to determine their optimal dosage and length of treatment 5, 6.