Academic journal article Alcohol Research

Medications for Unhealthy Alcohol Use: Across the Spectrum

Academic journal article Alcohol Research

Medications for Unhealthy Alcohol Use: Across the Spectrum

Article excerpt

The prevalence of unidentified or untreated unhealthy alcohol use remains high. With the advent of pharmacotherapy and models of counseling appropriate for use in primary care settings as well as in specialty care, clinicians have new tools to manage the range of alcohol problems across the spectrum of health care settings. By extending treatment to primary care, many people who do not currently receive specialty care may have increased access to treatment. In addition, primary care providers, by virtue of their ongoing relationship with patients, may be able to provide continuing treatment over time. Extending the spectrum of care to hazardous drinkers who may not be alcohol dependent could result in earlier intervention and reduce the consequences of excessive drinking. KEY WORDS: Alcohol use, abuse and dependence; harmful drinking; hazardous drinking; treatment; primary care; pharmacotherapy; medication therapy; screening; counseling; brief intervention; continuum of care

Unhealthy alcohol use, which includes the spectrum of drinking behaviors and consequences ranging from risky use to problem drinking, along with alcohol abuse and alcohol dependence (Saitz 2005), has been linked to a multitude of health and social problems. Unhealthy alcohol use accounts for an estimated 85,000 deaths at an economic cost of $185 billion annually in the United States (Harwood 2000). Beyond this, numerous medical problems, such as liver disease, neurologic problems, and malignancies, as well as behavioral dysfunction resulting in employment and legal problems are directly attributable to alcohol.

Research has demonstrated that a variety of treatment approaches can help individuals with unhealthy alcohol use decrease their alcohol intake and thus avoid the many consequences described above. Counseling interventions have been designed to address the full spectrum of unhealthy alcohol use from brief interventions for risky use to more complex and rigorous counseling strategies for individuals with alcohol dependence. In addition, beginning with disulfiram in the late 1940s and more recently with naltrexone and acamprosate along with newer medications "in the pipeline," pharmacotherapy has been demonstrated to be a useful adjunct to behavioral therapies for many people with unhealthy alcohol use, particularly those with alcohol dependence.

The spectrum of unhealthy alcohol use can be addressed in a variety of health care settings, including primary care, specialty practice, and alcohol treatment programs. Although complex behavioral strategies have been developed primarily for specialty settings and treatment programs where they can be effectively delivered, screening and brief intervention counseling has been developed for use in primary care settings, with a focus on treatment referral when necessary. Medication use in these nonspecialized settings and in a spectrum of patients including nondependent individuals is a recent phenomenon.

Research is needed to address the optimal use of medication therapy for the treatment of alcohol use disorders and for treating the broader spectrum of unhealthy alcohol use, from nondependent risky drinking to alcohol dependence. This is especially true given the major scientific advances in pharmacotherapy that have been made over the past 60 years. To improve access to effective medication therapy, research also should explore the use of these medications in a range of health care settings. To optimize medication treatment outcomes, practitioners need to assess both the appropriate level of counseling (from minimal to more intensive) and the appropriate methods to enhance medication adherence for individual patients. The development of medications to address the spectrum of unhealthy alcohol use across the broad range of health care settings has the potential to maximize benefits for future patients.

After reviewing the medications currently approved for alcohol dependence and new medications being investigated, this article will outline ways to optimize treatment outcomes through patient-treatment matching and increased treatment adherence and review potential uses of medications for nondependent hazardous drinkers, including the use of medications in primary care settings. …

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