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Drug Therapy for Alcohol Dependence
Abstract
Alcohol dependence is a chronic disorder that results from a variety of genetic, psychosocial, and environmental factors.1 As defined by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders, it is characterized by increased tolerance of the effects of alcohol, impaired control over drinking, and continued drinking despite adverse consequences (Table 1).2 Alcohol dependence affects nearly 10 percent of the population and results in social problems, considerable morbidity and mortality, and high health care costs.3,4 Alcohol dependence is treated by medical, psychological, and social interventions that reduce or eliminate the desire to drink and the . . .
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“Disulfiram blocks the enzyme aldehyde dehydrogenase (ALDH).”
From Disulfiram Efficacy in the Treatment of Alcohol Dependence: A Meta-Analysis (2014) · cites this paper as [8]
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“This figure, which coincides with that of previous publications [52,57,64], is clearly a cause for concern as adherence to treatment had shown itself to be a fundamental factor in the remission of alcohol dependence [4,51].”
BackgroundResultAddolorato, G. (2002) · Alcohol and Alcoholism · doi:10.1093/alcalc/37.5.504 · Cited by 479
“However, to date, drugs with proven efficacy are very few (see Garbutt et al., 1999; Swift, 1999; Kranzler, 2000) and the discovery of new medications capable of positively affecting the components of alcohol dependence syndrome, such as craving and loss of control on drinking or protracted…”
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Skinner, M. D., Lahmek, P., Pham, H., & Aubin, H.-J. (2014) · PLoS ONE · doi:10.1371/journal.pone.0087366 · Cited by 347
“If alcohol is present, acetaldehyde accumulates [8,9] usually resulting in an unpleasant reaction, the disulfiram-ethanol reaction (DER), consisting primarily of tachycardia, flushing, nausea, and vomiting [8].”
BackgroundFilley, C. M., & Kleinschmidt‐DeMasters, B. K. (2001) · New England Journal of Medicine · doi:10.1056/nejm200108093450606 · Cited by 340
Why Physicians Are Unprepared to Treat Patients Who Have Alcohol- and Drug-related Disorders
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“Physicians may be more likely to detect addiction and intervene in the management of addicted patients if they understand the physical effects of and medical approaches to addictive disorders in addition to being aware of other effective interventions.(7,8) For instance, the view of addiction as a ‘‘brain disease’’ ha…”
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“therapy, the clinical outcome is poor, with up to 70% of patients resuming drinking within one year [3,4].”
BackgroundAcamprosate Efficacy in Alcohol‐Dependent Patients: Summary of Results from Three Pivotal Trials
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Parks, C. L., Wallack, S. S., Lee, S., McCarty, D. W., & Swift, R. M. (2003) · Journal of Substance Abuse Treatment · doi:10.1016/s0740-5472(02)00319-7 · Cited by 183
“Review articles published in prominent medical journals endorsed the use of naltrexone among other medications as an effective adjunct in alcoholism treatment (Garbutt, West, & Carey, 1999; Swift, 1999).”
BackgroundSelf-citationThe relationship between cocaine craving, psychosocial treatment, and subsequent cocaine use
Weiss, R. D., Griffin, M. L., Mazurick, C., Berkman, B., Gastfriend, D. R., Frank, A., Barber, J. P., Blaine, J., Salloum, I., & Moras, K. (2003) · American Journal of Psychiatry · doi:10.1176/appi.ajp.160.7.1320 · Cited by 171
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Medication treatment of different types of alcoholism
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“Without a pharmacological adjunct to psychosocial therapy, the clinical outcome is poor, with up to 70% of patients resuming drinking within 1 year (3, 4).”
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“[46] Because of this problem, pharmacological adjuncts that aid in relapse prevention have long been of interest to clinicians and researchers.”
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Self-citationEffectiveness and Safety of Baclofen in the Treatment of Alcohol Dependent Patients
Leggio, L., Garbutt, J. C., & Addolorato, G. (2010) · CNS & Neurological Disorders - Drug Targets · doi:10.2174/187152710790966614 · Cited by 116
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“Type of administration (direct observation), psychological deterrent factors, and physician and patient choice account for the continued positive use of disulfiram [25].”
A Pharmacokinetic and Pharmacodynamic Drug Interaction Study of Acamprosate and Naltrexone
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“Acamprosate and naltrexone have each demonstrated efficacy and safety in randomized, double-blind, placebo-controlled trials in alcohol-dependent outpatient volunteers (Garbutt et al. 1999; Litten and Allen 1998; Mason 2001; Mason and Ownby 2000; Swift 1999).”
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“Since relapse rates peak during the first months after cessation of drinking (Lesch et al., 1989; Feuerlein and Kuefner, 1989; Swift, 1999), a search has begun for pharmacological means to prevent relapse especially during this difficult period (Garbutt et al., 1999).”
BackgroundManagement of Alcohol Dependence in Patients with Liver Disease
Addolorato, G., Mirijello, A., Leggio, L., Ferrulli, A., & Landolfi, R. (2013) · CNS Drugs · doi:10.1007/s40263-013-0043-4 · Cited by 113
“These pathways include several neurotransmitters, such as gamma-aminobutyric acid (GABA), glutamate, opioids, dopamine (DA), serotonin, adenosine, neuropeptide Y, norepinephrine, acetylcholine and cannabinoids.[14] Furthermore, different subtypes of patients could have different and/or several mechanisms craving is ba…”
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“Liskow and Goodwin (1987) and Swift (1997, 1999) reviewed and identified agents used to treat alcoholism as belonging to one of six categories: (1) agents to treat withdrawal, (2) anticraving agents, (3) aversive agents, (4) agents to treat concomitant psychiatric problems, (5) agents to treat…”
BackgroundThe Role of Craving in Alcohol Use, Dependence, and Treatment
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“Our results corroborate the outcomes of the previous reviews on NTX and alcohol dependence (Bouza et al., 2004; Fiellin et al., 2000; Garbutt et al., 1999; Kranzler and Van Kirk, 2001; Miller and Wilbourne, 2002; Sinclair, 2001; Srisurapanont and Jarusuraisin, 2004; Streeton and Whelan, 2001; Swift, 1999).”
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Pharmacotherapy for Alcohol Use Disorder
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“Fortunately, the personal and societal impact of AUD can be reduced through treatment, which consists of psychological, social, and pharmaceutical interventions to reduce alcohol consumption and its consequences.(5) While a number of successful, evidence-based treatments for AUD currently exist, treatment is not succe…”
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“These pathways include several neurotransmitters, such as gamma-aminobutyric acid (GABA), glutamate, opioids, dopamine, serotonin, adenosine, neuropeptide Y, norepinephrine, acetylcholine and cannabinoids [7].”
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“Although psychosocial and behavioral therapies help many alcoholdependent persons to reduce alcohol consumption and maintain abstinence, 40–70% of patients who achieve abstinence from alcohol after detoxification or psychosocial or behavioral treatment resume drinking within 1 year of such treatment (Swift, 1999).”
BackgroundThe European Acamprosate Trials: Conclusions for Research and Therapy
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“The international literature agrees on the assumption that drug therapy should be considered for all alcoholdependent patients [ 40 ].”
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“Relapse rates remain high under treatment (Anton, 2001 ; Garbutt et al., 1999 ; Kranzler and Van Kirk, 2001 ; Swift, 1999) largely due to the polymodal nature of the disease.”
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“Investments in the development of pharmacotherapies for the treatment of alcohol and drug dependence have begun to yield medications that enhance treatment effectiveness (Garbutt, West, Carey, Lohr, & Crews, 1999; Litten & Allen, 1999; O’Brien, 1997; Steenrod et al., 2001; Swift, 1999; Swift et al., 1998).”
BackgroundChemical toxicology: reactive intermediates and their role in pharmacology and toxicology
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“Alcohol aversion therapy depends on inhibition of aldehyde dehydrogenase (ALDH), which is responsible for the conversion of acetaldehyde to acetic acid [95].”
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“Acamprosate®, a glutamate antagonist has been found promising in the treatment of alcoholics [3,4] but present limitations.”
BackgroundCurrent Pharmacotherapies of Alcoholism: A U.S. Perspective
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Self-citationDOES PSYCHOSOCIAL TREATMENT ENHANCE THE EFFICACY OF ACAMPROSATE IN PATIENTS WITH ALCOHOL PROBLEMS?
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“In a systematic review of the scientific literature on the efficacy of different agents for the treatment of alcohol dependence, both acamprosate and naltrexone were judged to be quite promising (Garbutt et al., 1999; Swift, 1999).”
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Overview of harm reduction treatments for alcohol problems
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“…that depresses MDA receptor activation, has been evaluated in 17 pubished, placebo-controlled studies with the majority of studies emonstrating the efficacy of acamprosate, as compared to lacebo, in maintaining abstinence (Garbutt, West, Carey, ohr, & Crews, 1999; Mann, 2004; Swift, 1999).”
BackgroundMethodInfluence of alcohol consumption on IBS and dyspepsia
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“Upon removal of alcohol, this excitatory state remains unopposed, resulting in hyperactivity and dysfunction that is characteristic of alcohol withdrawal [9].”
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“As a result, acetaldehyde accumulation caused unpleasant symptoms such as tachycardia, hypotension, diaphoresis, flushing, dyspnea, nausea, and vomiting, acting as a deterrent to alcohol ingestion [15].”
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“Upon removal of alcohol, this excitatory state remains unopposed, resulting in hyperactivity and dysfunction that is characteristic of both acute and protracted alcohol withdrawal [15].”
BackgroundAnti‐dipsotropic isoflavones: The potential therapeutic agents for alcohol dependence
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Emerging approaches to managing alcohol dependence
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Is Baclofen a Revolutionary Medication in Alcohol Addiction Management? Review and Recent Updates
Gorsane, M.-A., Kébir, O., Hache, G., Blecha, L., Aubin, H., Reynaud, M., & Benyamina, A. (2012) · Substance Abuse · doi:10.1080/08897077.2012.663326 · Cited by 38
“Other neurotransmitters such as serotonin, adenosine, neuropeptide Y, norepinephrine, acetylcholine, and cannabinoids are also implicated in the longterm modifications within the corticomesolimbic system (22).”
BackgroundEthanol Reinforcement in Nondeprived Mice: Effects of Abstinence and Naltrexone
Middaugh, L. D., Lee, A. M., & Bandy, A. E. (2000) · Alcoholism Clinical and Experimental Research · doi:10.1097/00000374-200008000-00006 · Cited by 39
Suicide attempts and externalizing psychopathology in a nationally representative sample
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Design of naltrexone-loaded hydrolyzable crosslinked nanoparticles
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“The effectiveness of acamprosate in the treatment of alcoholics has been reported by many workers (Paille, et al., 1995; Swift, 1999).”
BackgroundSHORT-TERM METHADONE ADMINISTRATION REDUCES ALCOHOL CONSUMPTION IN NON-ALCOHOLIC HEROIN ADDICTS
Caputo, F. (2002) · Alcohol and Alcoholism · doi:10.1093/alcalc/37.2.164 · Cited by 39
“…from alcohol and reducing the relapse rate in alcoholic patients (O'Malley et al., 1992; Volpicelli et al., 1992), it is no more beneficial than placebo in drinking-related outcomes when administered to patients affected by both alcohol dependence and cocaine and opiate abuse (Swift, 1999).”
BackgroundLeggio, L., Kenna, G. A., Ferrulli, A., Zywiak, W. H., Caputo, F., Swift, R. M., & Addolorato, G. (2011) · Human Psychopharmacology Clinical and Experimental · doi:10.1002/hup.1244 · Cited by 37
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Acupuncture for alcohol dependence: a systematic review.
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Substance abuse in adolescents: a complex conundrum for the clinician.
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“Various other products are used but not approved for alcohol dependence in adults; these include tricyclic antidepressants, selective serotonin reuptake inhibitors, buspirone, bromocriptine, carbamazepine, nalmefene, and ondansetron [148,149].”
BackgroundRole of dopamine D3 receptors in the addictive properties of ethanol
Heidbreder, C. A., Andreoli, M., Marcon, C., Thanos, P. K., Ashby, C. R., & Gardner, E. L. (2004) · Drugs of today · doi:10.1358/dot.2004.40.4.820081 · Cited by 36
The History and Practice of College Health
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Pharmacotherapies and Personalized Medicine for Alcohol Use Disorder: A Review
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“Naltrexone modification of drinking effects in a subacute treatment and bar-lab paradigm: influence of OPRM1 and dopamine transporter (SLC6A3) genes. Alcohol. Clin. Exp. Res. 36(11), 2000–2007 (2012). 55 Oslin DW, Leong SH, Lynch KG et al. Naltrexone vs placebo for the treatment of alcohol dependence: a randomized cli…”
BackgroundMethodInfluentialOrganizational Predictors of Pharmacological Innovation Adoption: The Case of Disulfiram
Knudsen, H. K., Roman, P. M., Ducharme, L. J., & Johnson, J. A. (2005) · Journal of Drug Issues · doi:10.1177/002204260503500308 · Cited by 33
Deep brain stimulation in addiction due to psychoactive substance use
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A Pilot Study of Oxcarbazepine Versus Acamprosate in Alcohol‐Dependent Patients
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The Pharmacotherapy of Alcohol Dependence: A State of the Art Review
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“…understanding of the basic neurobiological components of alcohol dependence, we have pharmacological agents targeted at improving drinking behavior, enhancing abstinence and preventing relapse as well as reducing the amount of alcohol people drink when they relapse (Swift, 1999; Rosenthal, 2006).”
BackgroundAltered Motor Cortex Excitability to Magnetic Stimulation in Alcohol Withdrawal Syndrome
Nardone, R., Bergmann, J., Kronbichler, M., Caleri, F., Lochner, P., Tezzon, F., Ladurner, G., & Golaszewski, S. M. (2010) · Alcoholism Clinical and Experimental Research · doi:10.1111/j.1530-0277.2009.01131.x · Cited by 30
An approach to the patient with substance use and abuse.
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Alcoholism treatment outcome studies, 1970–1998
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An open randomized trial comparing disulfiram and naltrexone in adolescents with alcohol dependence
Sousa, A. D., & Sousa, A. D. (2008) · Journal of Substance Use · doi:10.1080/14659890802305861 · Cited by 29
“The resulting increase in the acetaldehyde levels in the body leads to the characteristic DSF ethanol reaction that includes a sense of uneasiness, flushing, nausea and vomiting (Savas, & Gullu, 1997; Swift, 1999).”
BackgroundTHE ROLE OF ANXIETY IN PREDICTING DRINKING BEHAVIOUR
Sloan, T. (2003) · Alcohol and Alcoholism · doi:10.1093/alcalc/agg090 · Cited by 29
Acamprosate: Safety and Tolerability in the Treatment of Alcohol Dependence
Rosenthal, R. N., Gage, A. T., Perhach, J. L., & Goodman, A. M. (2008) · Journal of Addiction Medicine · doi:10.1097/adm.0b013e31816319fd · Cited by 27
“Lost to follow-up 194 (16) 213 (16) 125 (17) 136 (15)”
Metadata
- Authors
- Swift, R. M.
- Affiliations
- Brown University (US)
- Corresponding author
- Swift, Robert M.
- ORCID
- Swift, Robert M.
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1999-05-13
- Volume
- 340
- Issue
- 19
- Pages
- 1482-1490
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W1984819772
- Cited by
- 255
- References
- 97
- Citations by year
- 2025: 3 · 2024: 7 · 2022: 7 · 2021: 2 · 2020: 5 · 2019: 4 · 2018: 11 · 2016: 5 · 2015: 9 · 2014: 7 · 2013: 10 · 2012: 5
- FWCI
- 3.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Clinical Neurology › Alcoholism and Thiamine Deficiency
- Keywords
- alcoholism, pharmacotherapy, alcohol tolerance, impaired control, DSM-IV diagnostic criteria, health care costs
- MeSH terms
- Alcohol Deterrents, Ethanol, Alcoholism, Antidepressive Agents, Mental Disorders, Humans, Narcotic Antagonists, Receptors, Neurotransmitter, Dopamine Antagonists
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