At a recent meeting, the American Psychiatric Association (APA) Board of Trustees approved the APA Practice Guideline for the Pharmacological Treatment of Patients with Alcohol Use Disorder (AUD). Some highlights include: assessment of comorbid psychiatric conditions at initial clinical evaluation, the use of physiological biomarkers to identify levels of alcohol initially and throughout treatment, and agreement between patient and clinician on the goals of treatment. With respect to pharmacotherapy, the APA recommends that naltrexone or acamprosoate be offered to patients with moderate to severe AUD who have not responded to nonpharmacological treatment alone. They recommend that gabapentin or topirimate be offered to patients who have not responded to naltrexone or acamprosoate, and disulfiram be offered to patients who are capable of understanding risks involved with this medication. The APA recommends against the use of specific medications, including antidepressants and benzodiazepines to treat AUD. They also make explicit the danger of using certain drugs if a patient has severe renal impairment or hepatic failure. The full text of the practice guidelines includes a detailed description of research evidence related to the effects of medication in individuals with AUD.
Reference
Reus VI, Fochtmann LJ, Bukstein O, et al. The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder. Am J Psychiatry. 2018;175(1):86-90. Abstract.
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