Pharmacotherapy of alcoholism: Gaps in knowledge and opportunities for research

Kranzler, HR

Hr. Kranzler, Pharmacotherapy of alcoholism: Gaps in knowledge and opportunities for research, ALC ALCOHOL, 35(6), 2000, pp. 537-547

83

INGLESE

Article

Clinical Psycology & Psychiatry","Neurosciences & Behavoir

ALCOHOL AND ALCOHOLISM

0735-0414 → ACNP

35

6

2000

537 - 547

ISI

0735-0414(200011/12)35:6<537:POAGIK>2.0.ZU;2-R

During the past decade, renewed interest in medications to prevent relapse in alcoholics has yielded a number of promising candidates. Although two of these medications, naltrexone and acamprosate, are currently in clinical u se in a number of countries, overall, their effectiveness appears to be lim ited. Disulfiram, the deterrent medication that was approved 50 years ago f or the treatment of alcoholism, has not consistently been shown to be effic acious. However, since inadequate dosing and other modifiable factors may l imit its deterrent effects, the identification of a more potent metabolite of disulfiram appears to warrant further evaluation. Studies of serotonergi c agonists for treatment of alcoholism have also yielded inconsistent resul ts. There is evidence, however, that subgroups of alcoholics may respond we ll to such medications, suggesting that treatment matching may enhance thei r efficacy. In addition, nalmefene, a compound with effects similar to nalt rexone, as well as a sustained release formulation of naltrexone, may enhan ce the beneficial effects of opioid antagonist therapy. Despite these devel opments, much remains to be learned about the pharmacotherapy of alcoholism . The ongoing development and evaluation of novel medications should be giv en a high priority. However, such basic issues as; the optimal dosing strat egy and duration of treatment for existing therapies are not known. Similar ly, combination therapy, involving either multiple medications or the combi nation of medication with specific psychotherapies, has not been well studi ed. The utility of specific pharmacotherapies in women, different ethnic/ra cial groups, adolescent and geriatric patients, and individuals with co-mor bid alcohol and drug use disorders (including nicotine dependence) is also largely unknown, as is the appropriateness of medication therapy for treatm ent of early problem drinkers. The ultimate aim of these efforts is the dev elopment of algorithms for the pharmacological treatment of heavy drinking, which incorporate the characteristics of the patient and of pharmacologica l and psychosocial treatments with demonstrated efficacy. Although a genera l framework for such an effort currently exists, much detail is needed befo re it will be of widespread clinical value.