Pharmacotherapy for Alcohol Use Disorders in Outpatient Settings
The review and meta-analysis by Jonas and colleagues examines the benefits and potential harms of approved medication for adults with alcohol use disorders.
The medications that were examined are often combined with other behavioral outpatient treatment. In particular, the researchers examined acamprosate, disulfiram, and naltrexone (both oral and injection).
The authors included randomized controlled trials comparing one of the medications with a placebo, and prospective cohort studies that compared two medications. This study included 151 articles about 123 studies that included sample sizes from 21-1383 participants. Most studies enrolled participants after detoxification or a brief period of sobriety. There were 22 placebo controlled trials of acamprosate, 4 of disulfiram and 44 of naltrexone. The authors also included the drug nalmefene in their review.
Acamprosate and naltrexone were both associated with improvements in consumption outcomes.
The authors found that:
- the number needed to treat (NNT) to prevent one person from returning to any drinking was 12 for acamprosate and 20 for naltrexone
- the number needed to treat (NNT) to prevent one person from returning to heavy drinking was 20 for oral naltrexone, whereas, acamprosate was not associated with improvement in preventing a person from returning to heavy drinking
- depot naltrexone (a once per month injection) did not make any difference in whether or not someone drank any alcohol, but it did make a difference in how often someone drank if they did return to alcohol use
- Disulfiram was not found to make a difference in whether someone drank any alcohol or the amount drank if they did return to alcohol use
- compared with a placebo, patients who were treated with naltrexone or nalmefene had an increased risk of withdrawal.
When combined with behavioral interventions, the addition of several medications resulted in better alcohol consumption outcomes.
Jonas, D. E., Amick, H. R., Feltner, C., Bobashev, G., Thomas, K., Wines, R., … & Garbutt, J. C. (2014). Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. Jama, 311(18), 1889-1900.