Recent advances in the treatment of alcoholism

Alcoholism is a major public health problem, and a devastating disorder for affected individuals, their families, and society. We have made great gains in the past 25 years in understanding and treating alcoholism. A recent and important treatment advance is the use of pharmacotherapies that improve treatment response for many patients beyond what they obtain from counseling. We have gained a better understanding of the neurobiology associated with alcoholism, pharmacological treatments can be targeted to numerous pathways affected by chronic and excessive alcohol drinking. Consequently, an increased number of investigational studies of new compounds that are meant to reduce alcohol craving and drinking have emerged in the literature. There are three medications that have been approved in the United States (US) by the Food and Drug Administration (FDA) for the treatment of alcohol dependence: disulfiram, naltrexone, and acamprosate. Many more are being used in Canada, Europe, Australia and other parts of the world for treating alcohol dependence. Studies have also examined best practices in prescribing medications. For example, it has been empirically demonstrated that patient non-adherence to treatment diminishes the treatment's value. In turn, we can improve treatment response if we proactively provide patients with strategies to help them take their medications and attend their counseling visits. Other important advances related to pharmacotherapy are that alcoholic subgroups differentially respond to specific pharmacotherapies, and combining two pharmacotherapies that address different neurobiological systems simultaneously to treat alcohol dependence may prove more beneficial than a single medication in some patient groups.