Policymaker Summary – Aug. 9, 2016
Pharmacotherapy for Adults With Alcohol Use Disorder in Outpatient Settings
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Table of Contents
- Key Issue
- Background
- Summary of Evidence From the Systematic Review
- Considerations for Programs and Policies*
- References
- Additional Resources
- Source
Key Issue
Medications can be effective in treating alcohol use disorder (AUD) when used in combination with psychosocial interventions. Evidence from epidemiological studies suggests that improving alcohol consumption outcomes (such as reduction in return to drinking or in percentage of drinking days) would likely result in improved health outcomes. However, medications are underutilized in treating AUD, thus providing opportunities for expanding treatment optimization. This is a summary of a systematic review evaluating the efficacy, comparative effectiveness, and adverse effects of medications in adults with AUD. The systematic review included 167 articles published from January 1, 1970, to October 11, 2013.
Background
Alcohol use disorder (AUD) includes harmful use of alcohol, alcohol abuse, and alcohol dependence. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), alcohol abuse and alcohol dependence are no longer distinguished and are identified together as AUD. The prevalences of 12-month and lifetime AUD among adults in the United States in 2012 and 2013 were 13.9 percent (32.6 million individuals) and 29.1 percent (64.5 million individuals), respectively.1 Between 2006 and 2010, there were, on average, nearly 85,000 deaths per year related to alcohol consumption in the United States.
Current guidelines by the Veterans Administration, the National Institute on Alcohol Abuse and Alcoholism, and the Substance Abuse and Mental Health Services Administration all recommend that pharmacotherapy be offered as an adjunct to psychosocial therapies (e.g., cognitive behavioral therapy, 12-step programs). However, estimates indicate that fewer than 1 in 3 patients with AUD receives treatment, and fewer than 1 in 10 patients receives pharmacotherapy as part of their treatment. Medications approved by the U.S. Food and Drug Administration for AUD include acamprosate (Campral®, thrice daily), disulfiram (Antabuse®, once daily), oral naltrexone (ReVia®, once daily), and extended-release injectable naltrexone (Vivitrol®, once monthly). In addition, medications such as topiramate have not been approved to treat AUD but have been used or studied as treatment for AUD.
Health care utilization studies* report reduced medical costs among patients treated with AUD medication when compared with patients treated without it.2 A meta-analysis of three health care utilization studies on alcohol dependence reported that total medical costs were $3,649 less among patients on AUD medication than those not on the medication.3
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