Current and future drug therapies for alcohol dependence

Managing the treatment of alcohol dependence is challenging due to the chronic, relapsing nature of the disease and the need for education about available pharmacotherapies. An increased understanding of the neurochemistry underlying alcohol dependence and improved clinical trial methodology has led to the development and use of medications in conjunction with psychosocial therapy for this disorder. Psychosocial interventions have been widely used as a method to support abstinence and reduce drinking behaviors; however, psychosocial support without pharmacological treatment has had limited success, with nearly half the patients relapsing within the first year. Currently, 3 US Food and Drug Administration-approved drugs are available for the treatment of alcohol dependence-disulfiram, naltrexone (oral and injectable), and acamprosate. Each drug is effective in reducing drinking via different biological mechanisms. Acamprosate and naltrexone demonstrate promise in the successful management of chronic alcohol use. Meta-analyses of clinical trials show that acamprosate may be best for achieving outcomes such as maintaining complete abstinence, whereas oral naltrexone is best for decreasing the number of heavy drinking days. A long-acting injectable form of naltrexone demonstrated a reduced event rate of heavy drinking, consistent with oral naltrexone data. Although inconsistent in clinical efficacy outcomes, selective serotonin reuptake inhibitors may be beneficial in certain subsets of alcoholics. Other drugs currently being investigated for the treatment of alcohol dependence are serotonin type 3 antagonists, anticonvulsants, and atypical antipsychotics.