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Pharmacotherapy of Alcohol Use Disorders

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NeuroPsychopharmacotherapy

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Abstract

To date few medications are approved for treatment of alcohol use disorders. Medications for treatment of alcoholism should either increase abstinence rates resp reduce relapse rates or reduce alcohol intake (number of drinks per day) in affected individuals. Disulfiram has been used for decades. The drug blocks the enzyme alcohol dehydrogenase and causes unpleasant or toxic effects after alcohol intake but failed to find widespread use. The level of evidence for efficacy is limited, and disulfiram may be most useful in a supervised treatment setting. The putative glutamate modulator acamprosate has been studied extensively and has modest but significant effects on abstinence rates in alcoholics, while the opioid antagonist naltrexone antagonizes rewarding effects of alcohol and reduces alcohol intake or the risk of relapse to heavy drinking. Another opioid antagonist nalmefene has been approved in recent years and was reported to reduce alcohol intake in moderate drinkers while its effect on abstinence rates is unclear. Nalmefene was used as an as-needed medication and its use is still somehow controversial. No magic bullet for treatment of alcoholism is at the horizon. To date some medications targeting multiple neurotransmitters and used for other medical indications are studied for use in alcoholism including topiramate, varenicline, ondansteron, gabapentin, and others.

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Michael Soyka declares no conflict of interest related to the content of this review.

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  1. Psychiatric Hospital, University of Munich, Munich, Germany

    Michael Soyka

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  1. Clinic and Policlinic for Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Wuerzburg, Germany

    Peter Riederer

  2. Institute of Psychological Medicine (IPM), Soyen, Germany

    Gerd Laux

  3. Centre for Research Promotion and Support, Fujita Health University, Toyoake, Aichi, Japan

    Toshiharu Nagatsu

  4. Center Translational Res Neurol Diseases, Dalian Med Uni Shanghai Inst Health Sc Center Translational Res Neurol Diseases, Dalian, China

    Weidong Le

  5. Würzburg, Germany

    Christian Riederer

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  1. The International College of Neuropsychopharmacology, East Kilbride, Scotland, UK

    Toshikazu Saito

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Soyka, M. (2022). Pharmacotherapy of Alcohol Use Disorders. In: Riederer, P., Laux, G., Nagatsu, T., Le, W., Riederer, C. (eds) NeuroPsychopharmacotherapy. Springer, Cham. https://doi.org/10.1007/978-3-030-62059-2_384

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