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Management of Alcohol Dependence in Patients with Liver Disease

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Abstract

Alcohol dependence represents a chronic and relapsing disease affecting nearly 10 % of the general population both in the USA and in Europe, with a widespread burden of morbidity and mortality. Alcohol dependence represents the most common cause of liver damage in the Western world. Although alcoholic liver disease is associated primarily with heavy drinking, continued alcohol consumption, even in low doses after the onset of liver disease, increases the risk of severe consequences, including mortality. Consequently, the ideal treatment of patients affected by alcohol dependence and alcoholic liver disease should aim at achieving long-term total alcohol abstinence and preventing relapse. The aim of the present review is to provide an update on the management of alcohol dependence in patients with alcoholic liver disease. Increasing evidence suggests the usefulness of psychosocial interventions and medications combined in order to reduce alcohol intake, promote abstinence and prevent relapse in alcohol-dependent patients. Disulfiram, naltrexone and acamprosate have been approved for this indication; gamma-hydroxybutyric acid (GHB) is approved in Italy and Austria. However, these drugs have not been tested in patients with advanced liver disease. Amongst other emerging pharmacotherapies for alcoholism, topiramate, ondansetron, and baclofen seem the most promising ones. Both topiramate and ondansetron have a safe profile in alcoholic patients; however, none of them has been tested in alcoholic patients with advanced liver disease. To date, baclofen represents the only anti-craving medication formally tested in a randomized clinical trial in alcoholic patients affected by liver cirrhosis, although additional confirmatory studies are warranted.

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Acknowledgements

The preparation of this review was partially supported by the Italian Ministry for University, Scientific and Technological Research (MURST). However, the authors have the full responsibility for the contents written in this paper.

Giovanni Addolorato served as a consultant for D&A Pharma, and was paid for his consulting services. He has received lecture fees from D&A Pharma.

All authors declare no conflicts of interest.

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Authors and Affiliations

  1. Department of Internal Medicine, Institute of Internal Medicine, Catholic University of Rome, Gemelli Hospital, Largo Gemelli 8, 00168, Rome, Italy

    Giovanni Addolorato, Antonio Mirijello, Lorenzo Leggio, Anna Ferrulli & Raffaele Landolfi

  2. Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA

    Lorenzo Leggio

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  1. Giovanni Addolorato
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  2. Antonio Mirijello
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  3. Lorenzo Leggio
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  4. Anna Ferrulli
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  5. Raffaele Landolfi
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Correspondence to Giovanni Addolorato.

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Dr. Leggio’s current affiliations are Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health (NIH), Bethesda, MD; and Intramural Research Program, National Institute on Drug Abuse, NIH, Baltimore, MD, USA.

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Addolorato, G., Mirijello, A., Leggio, L. et al. Management of Alcohol Dependence in Patients with Liver Disease. CNS Drugs 27, 287–299 (2013). https://doi.org/10.1007/s40263-013-0043-4

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