New Guideline to Treat Alcohol Use Disorder Focuses on Evidence-Based Pharmacological Treatments

A new guideline focused on the use of evidence-based pharmacological treatments to treat alcohol use disorder has been released by the American Psychiatric Association (APA). Although effective, evidence-based interventions are already available, alcohol use disorder remains undertreated, according to the APA.

Approximately 29% of the population is estimated to, at some point in their lifetime, experience alcohol use disorder.

“This new guideline is an important step in bringing effective, evidence-based treatments for alcohol use disorder to many more people and in helping address the public health burden of alcohol use,” APA President Anita Everett, MD, said in a statement.

Alcohol use disorder and related conditions stemming from it cost the United States $223.5 billion annually, according to a 2006 CDC-sponsored study. However, research has found that fewer than 1 in 10 individuals in the United States with a 12-month diagnosis of alcohol use disorder receive any treatment. Furthermore, of the 11 million people in the United States with the disorder, only 674,000 (6%) receive psycho-pharmacological treatment.

The guideline recommends using naltrexone and acamprosate to treat patients with moderate to severe alcohol use disorder in specific circumstances, such as when nonpharmacological approaches have not been effective or when patients prefer to use the medications. After trying naltrexone and acamprosate, the guidelines suggest topiramate and gabapentin in patients with moderate to severe alcohol use disorder.

Since disulfiram produces physical reactions if alcohol is taken within 12 to 24 hours of the medication’s use, the guideline does not recommend using it as a first-line treatment.

In addition to medication recommendations, the guideline also includes statements related to assessment and treatment planning, and evidence-based psychotherapeutic treatments that can play a major role in treatment, such as cognitive-behavioral therapy, 12-step facilitation, and motivational enhancement therapy.

While the APA noted the benefits of community-based peer support groups, such as Alcoholics Anonymous, the guideline does not touch upon these types of treatments.

The APA Board of Trustees approved the guideline, which was developed using a systematic process by the 11-member Guideline Writing Group, in July 2017.