Meds for alcohol use disorders effective, but underutilized

Dr Jonas

Several medications can help people with alcohol use disorders to maintain abstinence or to reduce drinking, when added to psychosocial interventions. Two drugs, acamprosate and oral naltrexone, have the best evidence supporting their benefits, according to an analysis of more than 100 studies examining the use of medications to treat these conditions.

Lead author Daniel Jonas, MD, MPH, associate professor, Division of General Medicine, University of North Carolina--Chapel Hill, and his colleagues reviewed data from 122 randomized clinical trials and 1 cohort study involving a total of 22, 803 participants. The studies were, on average, 12 weeks long. They found that either oral naltrexone or acamprosate helped patients refrain from drinking. To prevent 1 person from resuming drinking, 12 patients would have to be treated with acamprosate (the number needed to treat) or 20 would have to be treated with oral naltrexone. Treatment with oral naltrexone also helped reduce the risk of a return to heavy drinking, with 1 patient benefiting for every 12 treated. Injectable naltrexone was associated with reduced drinking days, but not abstinence.

“Both drugs reduced return to drinking and improved other drinking outcomes,” according to Dr Jonas. “Among medications used off-label [ie, those not FDA approved for alcohol use disorders], moderate evidence showed improvement in some drinking outcomes for topiramate and nalmefene.”

Many studies of medications (those that are FDA approved and those used off-label) have been conducted, and it is a lot of information to digest, according to Dr Jonas.

“Thus, decision-makers often need a reliable research team that is free from bias to conduct a systematic review of a body of evidence,” he said. “Our paper provides a comprehensive review of medications for people with alcohol use disorders that can help decision-makers to determine which medications to provide for patients with alcohol use disorders.”

Medications can be a useful component of treatment for people with alcohol use disorders, Dr Jonas said. “The medications are currently used for less than 10% of people with alcohol use disorders. Increasing their use could improve outcomes for many people,” he said.

“The health implications of preventing return to drinking and reducing alcohol consumption are substantial,” he continued.”Modeling studies have shown that such improvements would result in significant reductions in alcohol-attributable mortality, costs from healthcare, arrests and motor vehicle accidents.

The last comprehensive review of these medications was published in 1999 in JAMA (Garbutt et al). Since 1999, there has been more than a 10-fold increase in the number of individuals studied in controlled clinical trials of naltrexone and acamprosate, and many trials of medications that are not FDA approved, according to Dr Jonas.