Jr. Volpicelli et al., MEDICAL-MANAGEMENT OF ALCOHOL DEPENDENCE - CLINICAL USE AND LIMITATIONS OF NALTREXONE TREATMENT, Alcohol and alcoholism, 30(6), 1995, pp. 789-798
Historically, pharmacological and psychosocial treatments for alcohol
dependence have demonstrated only modest effectiveness in reducing alc
ohol drinking. However, the recent US Food and Drug Administration app
roval of naltrexone for the treatment of alcohol dependence offers a n
ew, safe and effective medication to reduce relapse following alcohol
detoxification. This paper reviews the various psychosocial and pharma
cological treatments currently available and the effectiveness of thes
e treatments. This paper also reviews preclinical research which demon
strates the involvement of the opioid system in the reinforcing effect
s of alcohol. This research led to clinical trials on the use of the o
pioid antagonist, naltrexone, to reduce alcohol's pleasurable effects
and enhance the effectiveness of psychosocial therapy. In two randomiz
ed clinical trials, naltrexone treatment reduced rates of alcohol rela
pse, number of drinking days and alcohol craving. The clinical efficac
y of all pharmacological treatments for substance abuse are limited by
compliance with taking the medication. Also, pharmacological treatmen
t does not address the psychosocial complications which often result f
rom chronic alcohol dependence. Therefore, the integration of medicati
ons such as naltrexone and psychosocial therapies may offer the best t
reatment. The further development and investigation of new pharmacolog
ical agents will enable matching of patient populations with specific
treatments, offering more successful treatment outcomes.