Review article: pharmacotherapy for alcohol dependence - the why, the what and the wherefore

BACKGROUND: The development of alcohol dependence is associated with significant morbidity and mortality. For the majority of affected people the most appropriate goal, in terms of drinking behaviour, is abstinence from alcohol. Psychosocial intervention is the mainstay of the treatment but adjuvant pharmacotherapy is also available and its use recommended. AIM: To provide an updated analysis of current and potential pharmacotherapeutic options for the management of alcohol dependence. In addition, factors predictive of therapeutic outcome, including compliance and pharmacogenetics, and the current barriers to treatment, including doctors' unwillingness to prescribe these agents, will be explored. METHODS: Relevant papers were selected for review following extensive, language- and date-unrestricted, electronic and manual searches of the literature. RESULTS: Acamprosate and naltrexone have a substantial evidence base for overall efficacy, safety and cost-effectiveness while the risks associated with the use of disulfiram are well-known and can be minimised with appropriate patient selection and supervision. Acamprosate can be used safely in patients with liver disease and in those with comorbid mental health issues and co-occurring drug-related problems. A number of other agents are being investigated for potential use for this indication including: baclofen, topiramate and metadoxine. CONCLUSION: Pharmacotherapy for alcohol dependence has been shown to be moderately efficacious with few safety concerns, but it is substantially underutilised. Concerted efforts must be made to remove the barriers to treatment in order to optimise the management of people with this condition

Self-Help Groups for Alcohol Dependency: A Scoping Review

The aim of this literature review was to scope and present evidence on self-help groups that aim to facilitate recovery from alcohol addiction. A threefold search strategy was deployed. Within the 25 identified quantitative studies, three themes were identified: attendance, involvement and location, each of which impacted on recovery. Nine qualitative studies were also identified, five of these focusing on Alcoholics Anonymous. This international review of self-help groups in recovery from alcohol dependency demonstrates them to be an important and effective component of recovery. However, this review demonstrates that more research is needed into ‘non-AA, non-12-step’ affiliated self-help groups