Alcohol use disorders (AUD) continue to be a concerning health issue
April 30, 2017
Alcohol use disorders (AUD) continue to be a concerning health issue worldwide. current literature on pharmacologic (both approved and non-approved) treatment options for AUD offered in the United States and elsewhere are reviewed. The Ki16425 aim is to inform clinicians regarding the options for alcohol abuse treatment keeping in mind that not all treatments are completely successful in reducing craving or heavy drinking or increasing abstinence. (DSM-IV-TR) definition of alcohol use disorders ([AUD] Ki16425 abuse or dependence) to define study participants. The DSM-IV definition of alcohol dependence requires significantly harmful impact caused by at least three out of seven target conditions within a single 12 months. These dependence symptoms include tolerance; withdrawal; increased amounts of alcohol consumed over time; ineffective efforts to reduce use; interference with personal or professional life; significant amount of time spent obtaining using and recovering from alcohol; or continued use of alcohol despite harmful sequelae.2 Alcohol abuse is defined broadly and requires the presence of at least one of the four abuse criteria for diagnosis. The DSM-5 which was released in May 2013 has combined criteria for alcohol dependence and abuse into a single term (AUD). Craving was added as a diagnostic criteria and at least two target conditions are now required for diagnosis of AUD.3 New International Statistical Classification of Diseases and Related Health Problems (ICD) 10 codes that correspond to DSM-5 will be used beginning in October 2014. The Ki16425 majority of clinical trials in this review include subjects with DSM-IV alcohol dependence diagnosis. Although approved pharmacologic treatment options for patients with AUD are limited in number recent trials describe a host of alternative approaches to reducing alcohol consumption. These include the use of antipsychotics antidepressants anticonvulsants as well as others under the rationale that these drugs target the neurotransmitter systems that have been shown to undergo changes with chronic exposure Ki16425 to alcohol. This review explains current evidence for the clinical use of a broader range of pharmacotherapies in AUD along with available information on patient characteristics (eg genetic demographic behavioral) that may predict positive outcomes of treatment. Methods Clinical trials associated with alcohol abuse or dependence were identified using PubMed Ovid Cochrane Library and MEDLINE. Search terms included “alcohol abuse ” “alcoholism ” “antipsychotics ” “antidepressants ” “anticonvulsants ” and “treatments for alcohol use disorders” through October 2013. Articles that focus on alcohol detoxification and managing alcohol withdrawal syndrome were excluded as this topic is outside the scope of this review. Medications within and outside the United States are included in this review. Only articles available in English are included. Studies using dual diagnosis articles older than 10 years uncontrolled trials and review articles were excluded except where noted. Neurobiology and pathophysiology of AUD The acute and chronic effects of alcohol on brain physiology have been well studied and help to rationalize the investigation of psychotropic drugs in the treatment of AUD. In Ki16425 particular neurotransmitter pathways involved in learning and reward have proven to be effective targets based on the mechanisms of action of two currently approved AUD drugs acamprosate and naltrexone. Other compounds under Hoxa2 current investigation similarly produce effects by targeting monoamine (eg serotonin [5-HT] norepinephrine dopamine) or amino acid (eg glutamate γ-aminobutyric acid [GABA]) neurotransmitters. Alcohol neuroadaptation and reward Alcohol like other addictive drugs stimulates release of the neurotransmitter dopamine from cells originating in a region of the brain called the ventral tegmental area (VTA).4 The VTA is a component of a neuronal circuit called the mesolimbic dopamine system that has been associated with behavioral motivation and reward. Following exposure to alcohol dopamine released into the nucleus accumbens (NAc) and prefrontal cortex has been postulated to reinforce drinking behaviors or make the experience of drinking more salient. Recent Ki16425 reviews of the neurobiological literature have described evidence that neuronal plasticity and metaplasticity in the mesolimbic system can promote reward-based learning.