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.