Pharmacological treatment of alcoholism

1. Pharmacological treatments are effective as part of a treatment plan that includes substantial education, psychological therapy and social support. This paper reviews recent literature on animal models of and treatment for alcohol abuse under seven categories: agents to block craving or reduce alcohol intake, agents to induce aversion to alcohol, agents to treat acute alcohol withdrawal, agents to treat protracted alcohol withdrawal, agents to diminish drinking by treating associated psychiatric pathology, agents to decrease drinking by treating associated drug abuse, and agents to induce sobriety in intoxicated individuals. 2. The benzodiazepines provide safe and effective treatment for detoxification, although current research focuses on finding drugs with a smaller likelihood of dependence. As yet, there are no drugs that effectively reverse the intoxicating effects of alcohol. 3. Currently, only two major groups of drugs that are relatively safe have shown any effect at reducing alcohol consumption: aversives such as disulfiram, and opioid antagonists such as naltrexone. 4. Finally, it is important to customize therapy for each patient rather than putting everyone through a standard treatment plan, especially in regards to the use of antidepressant or antipsychotic medications. Tailoring the program to the patient's needs dramatically improves the outcome of therapy and reduces the risk of adverse effects.     

Utilizing expectancies in alcoholism treatment.

35 veterans who participated in an assertion training program as part of their treatment for alcoholism completed the Alcohol Expectancy Questionnaire (AEQ; [S. A. Brown et al; see PA, Vol 65:1217]) and self-evaluations of social competence. The participants were rated on social interaction skills by an independent observer during their initial and final training sessions. Analyses indicated significant relations between the Social and Physical Pleasure scale of the AEQ and improvement in Ss' social competence. Findings provide modest support for the utility of incorporating alcohol expectancies in treatment allocation decisions and suggest that targeting certain expectancies may optimize treatment effect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Developments in the treatment of alcoholism

The treatment of alcoholism has changed during the past 2 decades. Notable developments have occurred in pharmacotherapy, psychotherapy, and health-care delivery. A better understanding of the biologic basis for addiction has led to clinical trials of medications that target neuroreceptors. One such medication is the opiate antagonist naltrexone, which decreases the craving for alcohol. Psychosocial interventions continue to be the mainstay of alcohol treatment programs. The efficacy of three different therapies was demonstrated in a study called Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity). This study, however, did not prove the patient-treatment "matching" hypothesis. In addition to therapies provided by addiction specialists, interest is growing in the use of brief motivational techniques in primary-care settings. As the field of addiction responds to an unfolding health-care delivery system, a broader range of treatment options in conjunction with a greater opportunity to individualize patient care is evolving.     

Cost effectiveness of alcoholism treatment in partial hospital versus inpatient settings after brief inpatient treatment: 12-month outcomes.

174 alcoholics (mean age 41.37 yrs) were randomly assigned to partial hospital treatment (PHT) or extended inpatient (EIP) rehabilitation after inpatient evaluation and/or detoxification. 12-mo follow-up results for the 115 Ss who consented to continue in the study show few differences in clinical outcomes between the PHT and EIP groups. Both reported more than 80% abstinent days during follow-up, and over 70% had a full-time occupational role, although almost a third experienced job losses during the year. Ss showed significant improvements in psychological well-being and social behavior. One-third were rehospitalized during the follow-up year. Costs for the PHT group were significantly lower than the EIP group, leading to an overall conclusion that PHT provides a cost-effective alternative to EIP treatment for many alcoholics. Implications for health care planning are addressed. (30 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The pathogenetic treatment of alcoholism

Overall ninety-seven male subjects suffering from stage-II alcoholism were studied for effects of verapamil on pathologic drawing toward alcohol. The above drug proved to be very effective in the treatment of alcoholism, which fact might be accounted for by certain confunction of membrane depolarization in the release of dopamine.     

New drugs in the treatment of alcoholism

Pharmacotherapy of alcoholism is improving rapidly with the introduction of new agents. New knowledge about the neurobiology of alcoholism is necessary for the clinician, who has to establish the diagnosis. Useful pharmacological agents for the treatment of alcohol dependence can be classified into four groups: (1) agents for the treatment of the withdrawal syndrome, (2) aversive agents, (3) therapeutic agents for comorbidity, (4) new agents to reduce craving for alcohol or prevent relapse. These new agents derive from research in four directions, based on neurobiological hypotheses: (a) the glutamatergic hypothesis with acamprosate, (b) the opioid hypothesis with naltrexone, (c) the serotonergic hypothesis with the new antidepressants, and (d) other hypotheses, including dopaminergic, peptidic etc. Of these new agents, acamprosate has undergone most study in controlled clinical trials around Europe. Its efficacy has been demonstrated statistically, it is well tolerated and does not interact with alcohol. Acamprosate can be associated with disulfiram therapy. Future perspectives for treatment and research are discussed, in particular with regard to therapeutic associations.     

An aversion-desensitization treatment for alcoholism.

Gave to 21 30-58 yr. old male alcoholic patient volunteers in a state hospital a mean of 11 hr. in 1 of 3 treatments: (a) interpersonal aversion (in which S watched his own audiovideo-recorded drinking "confessions" while being systematically derogated by 2 therapists), followed immediately by systematic desensitization to drinking-related anxieties; (b) interpersonal aversion, followed by a control procedure consisting of friendly interaction; or (c) group discussion. Ss were given the Alcadd Test and MacAndrews' Alcoholism scale (derived from the MMPI) before, after, and 6-9 mo. following treatment. Follow-up interview data show that 5 of the 7 traceable Ss given the interpersonal aversion-systematic desensitization treatment reported abstinence, compared with only 1 of 7 treated by the interpersonal aversion-control procedure. This significant difference was supported by changes on the Alcadd Test but not on the Alcoholism scale. Difficulties in contacting Ss for follow-up precluded complete comparisons with the group-discussion Ss. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Matching treatment to alcoholism subtypes.

In the field of alcoholism treatment, as in mental health treatment more generally, no one treatment model is equally effective for all patients and problem types. Literature in both alcohol treatment and in psychotherapy research suggests some relationships in common between treatment efficacy and patient coping style, drinking patterns, and family dynamics. This literature suggests that "internalizing" alcoholics, whose drinking tends to be steady and to be functionally interwoven with family dynamics, will benefit more from family systems oriented treatments than from symptom- or individually focused treatments. Conversely, "externalizing" alcoholics may derive more benefit from symptom-focused cognitive and behavioral treatments than from family systems treatment. An ongoing research project designed to test these hypotheses and the development of treatment manuals that may increase differential treatment efficacy is described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Imipramine treatment of alcoholism with comorbid depression

Of 60 depressed alcoholics who completed an open trial of imipramine, 27 (45%) responded with improvement in both mood and drinking behavior, and eight (13%) responded after further dosage increases or treatment with disulfiram. In a subsequent 6-month, randomized discontinuation trial, four of 13 subjects (31%) relapsed during imipramine treatment and seven of 10 (70%) relapsed while taking placebo. This suggests a potential treatment approach for a high-risk subgroup of alcoholics.     

The social climate of alcoholism treatment programs

The social climate of four residential alcoholism treatment programs was assessed with the Community-Oriented Programs Environment Scale (COPES). The programs differed in terms of their treatment orientations (aversion-conditioning, milieu therapy) and the sociodemographic characteristics of the patients admitted. Results showed that (1) COPES profiles distinguished between the four alcoholism programs in ways that were consistent with their respective treatment orientations; (2) the type of patient admitted to these programs did not systematically affect their treatment environment; and (3) changes occurring within an alcoholism program resulted in corresponding changes in relevant dimensions of the treatment environment. We also discuss the practical utility of the COPES for assessing alcoholism programs.     

Inpatient alcoholism treatment: Who benefits?

Reviews findings from 26 controlled studies, which have consistently shown no overall advantage for residential over nonresidential settings, for longer over shorter inpatient programs, or for more intensive over less intensive interventions in treating alcohol abuse. Predictor data suggest that intensive treatment may be differentially beneficial for more severely deteriorated and less socially stable individuals. The outcome of alcoholism treatment is more likely to be influenced by the content of interventions than by the settings in which they are offered. It is recommended that 3rd-party reimbursement policy should (1) discourage the use of intensive residential models for addressing alcohol abuse when more cost-effective alternatives are available and (2) reinforce the use of research-supported treatment methods regardless of setting. It is noted that such policy priorities run directly counter to the current practices and financial interests of many for-profit providers. (76 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive–behavioral treatment for depression in alcoholism.

Alcoholics with depressive symptoms score ≥ 10 on the Beck Depression Inventory (A. T. Beck, C. H. Ward, M. Mendelson, J. Mock, & J. Erbaugh, 1961) received 8 individual sessions of cognitive-behavioral treatment for depression (CBT-D, n?=?19) or a relaxation training control (RTC; n?=?16) plus standard alcohol treatment. CBT-D patients had greater reductions in somatic depressive symptoms and depressed and anxious mood than RTC patients during treatment. Patients receiving CBT-D had a greater percentage of days abstinent but not greater overall abstinence or fewer drinks per day during the first 3-month follow-up. However, between the 3- and 6-month follow-ups, CBT-D patients had significantly better alcohol use outcomes on total abstinence (47% vs. 13%), percent days abstinent (90.5% vs. 68.3%), and drinks per day (0.46 vs. 5.71). Theoretical and clinical implications of using CBT-D in alcohol treatment are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of professional journals in internship alcoholism treatment training.

Examined 137 psychology internship supervisors' ratings of the clinical utility of 24 professional journals in alcoholism treatment training (ATT). The highest rated journal was Journal of Studies on Alcohol and Addictive Behaviors. Ss also listed texts and readings used in their ATT program. Ss seemed to draw their materials relevant to ATT from a diverse group of journal and text outlets. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acceptance of moderate drinking by alcoholism treatment services in Canada

OBJECTIVE: The present study was conducted to provide a nationwide survey of acceptance of nonabstinence goals and related alcoholism treatment practices by Canadian alcoholism treatment services. METHOD: A random sample of 335 Canadian alcoholism treatment service agencies were mailed a 4-page questionnaire designed to assess acceptance of moderate drinking as a drinking goal and related alcoholism treatment practices. RESULTS: Acceptance varied by type of service, with considerably more acceptance by outpatient programs (62%) and mixed inpatient/outpatient programs (43%) than inpatient/detoxification/ correctional facilities (27%) and halfway houses (16%). Two-thirds of the respondents who reported moderate drinking as unacceptable in their own agencies categorically rejected moderation for all alcoholism clients. CONCLUSIONS: Individuals seeking services in Canadian alcoholism treatment agencies are more likely to have a choice of drinking goals if they present to an outpatient program than a residential institution, and Canadian agencies appear more accepting of moderation goals than American programs, but less accepting than British and Norwegian service agencies.     

The hospital treatment of alcoholism and drug addiction

Inpatient treatment of alcoholism is an option indicated by certain clinical criteria. The American Society of Addiction Medicine suggests four levels of care, and six assessment dimensions determine which level of care is indicated. An addiction medicine physician can consult with the primary care physician to recommend appropriate placement in difficult cases. Abstinence is a primary goal of treatment; for without abstinence, no other recovery will be possible. The remaining goals of recovery are detoxification, medical evaluation, stabilization of life-threatening emotional issues, education, identification of barriers to recovery, readjustment of behavior toward recovery, and orientation and membership in a self-help group. Successful family contributions can make the difference between success or failure of treatment goals; the role the family plays in recovery is discussed. Treatment for family members is important; the physical, emotional, and spiritual effects on family members can be just as profound on them as they are on the alcoholic. Continuing care maintains the link between the patient and the professional recovery community after discharge and is appropriate for all patients. Extended care allows for structured support of sobriety and often further progress through psychosocial issues identified during the initial treatment phase (i.e., abuse, molestation, unresolved grief). Extended care is indicated for patients requiring further structured assistance in early recovery. A large variety of treatment options are available once the decision has been made to hospitalize the patient.