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  • Prescribing Options for Alcohol Use Disorder
    Patients working to overcome alcohol use disorder may benefit from being prescribed a medication to help modify their behavior. When used either alone or in conjunction with counseling, pharmacotherapy can be an effective tool for individuals to overcome addiction. Unfortunately, research has indicated that medications to treat alcohol use disorder have not been widely accessible or used, which means millions of individuals who could be receiving help are not.

    Alcohol use disorder is considered a brain disorder, as there are lasting neurological changes that occur. The condition can be classified as mild, moderate, or severe. In order to record how extensive substance use and abuse is in the US, the Substance Abuse and Mental Health Services Administration established by Congress conducts the National Survey on Drug Use and Health. The most recent survey data indicated that nearly 1 in 9, or 15 million, people aged 12 and older have alcohol use disorder. According to the American Psychological Association, nearly 1 in 4 adults have reported turning to alcohol in order to cope with stress throughout the current pandemic, indicating that overall substance abuse statistics may rise greatly. Patients who wish to stop or reduce their drinking do have options, but some debates cite cultural stigma surrounding alcoholism as something that hinders treatment. Improved access to and increased prescribing of medications for those with alcohol use disorder can be beneficial in combatting the adverse social, occupational, and health consequences that accompany the condition.

    At present, there are three FDA-approved medications for alcohol use disorder, and each is uniquely effective for helping patients stop or reduce problematic alcohol consumption and avoid a relapse into its misuse. The first of these is naltrexone, an opioid receptor antagonist that may aid in relapse prevention. Blocking the opioid receptors involved in the perceived reward effects of drinking and the craving for alcohol can reduce problematic drinking in some patients. It is available as a once-a-day pill and as a monthly injection. Another treatment option is disulfiram, which is used as a deterrent to ethanol consumption. It is to be used only in highly motivated individuals who are also receiving psychotherapy for their alcohol use disorder. Its purpose is to aid patients in maintaining abstinence. The oral medication interferes with the hepatic oxidation of acetaldehyde. If a patient consumes alcohol within 12–24 hours of their disulfiram dose, the accumulation of acetaldehyde in their system produces a physical response such as throbbing headache, dyspnea, throbbing in the neck, nausea, copious vomiting, diaphoresis, thirst, chest pain, palpitation, tachycardia, hypotension, blurred vision, vertigo, weakness, anxiety, syncope, or confusion. Individuals develop an anticipatory fear of these responses, which can ultimately deter alcohol use. The third approved drug is acamprosate. It is taken three times per day to assist patients with the symptoms of ethanol withdrawal. Acamprosate heightens the patient’s ability to remain abstinent during withdrawal by reducing the postsynaptic efficacy of excitatory receptors.

    In addition to the three FDA-approved treatments, several drugs do have off-label uses for treating alcohol use disorder and are included within the guidelines issued by the American Psychiatric Association (APA) for treatment of alcohol dependence:
    • Topiramate: Trials have shown improvements in measures of alcohol use, such as the length of time to relapse or reduction in daily intake.
    • Gabapentin: Used for treating symptoms of alcohol dependence, such as improving the rates of abstinence and no heavy drinking, reducing the number of heavy drinking days, and reducing the number of drinks per day.
    The APA also discusses additional medications currently being investigated as options for treating alcohol use disorder, such as zonisamide and ondansetron. In all cases, the prescribing information and guidelines emphasize the importance of applying clinical judgment to assess any contraindications and determine a lack of response to nonpharmacological treatments alone. A comprehensive management program consisting of tailored psychosocial support and treatment is always needed in order to help maintain a patient’s motivation for recovery. Improving access to all forms of treatment will bring about the best results for addressing alcohol use disorder.

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